Department of Gastrointestinal Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China.
Surg Endosc. 2011 Apr;25(4):1199-208. doi: 10.1007/s00464-010-1344-z. Epub 2010 Sep 17.
Currently, laparoscopic appendectomy (LA) provides a safe and effective alternative to open appendectomy (OA), but its use remains controversial. This study aimed to evaluate the efficiency and safety of LA through a metaanalysis.
Randomized controlled trials (RCTs) comparing LA and OA published between January 1992 and February 2010 were included in this study. Strict literature appraisal and data extraction were carried out independently by two reviewers. A metaanalysis then was performed to evaluate operative time, hospital cost, postoperative complications, length of analgesia, bowel function recovery, day liquid diet began, hospital stay, and return to work and normal activity.
The metaanalysis comprised 25 RCTs involving 4,694 patients (2,220 LA and 2,474 OA cases). No significant differences were found between the LA and OA groups in terms of age, gender, body mass index (BMI), or type of appendiceal inflammation. Compared with OA, LA showed advantages of fewer postoperative complications (odds ratio [OR], 0.74; 95% confidence interval [CI], 0.55-0.98; p = 0.04), less pain (length of analgesia: weighted mean difference [WMD], -0.53; 95% CI, -0.91 to -0.15; p = 0.007), earlier start of liquid diet (WMD, -0.51; 95% CI, -0.75 to -0.28; p < 0.0001), shorter hospital stay (WMD, -0.68; 95% CI, -1.02 to -0.35; p < 0.0001), and earlier return to work (WMD, -3.09; 95% CI, -5.22 to -0.97; p = 0.004) and normal activity (WMD, -4.73; 95% CI, -6.54 to -2.92; p < 0.00001), but a comparable hospital cost (WMD of LA/OA ratio, 0.11; 95% CI, -0.18 to 0.40; p = 0.47) and a longer operative time (WMD, 10.71; 95% CI, 6.76-14.66; p < 0.00001).
Despite the longer operative time, LA results in less postoperative pain, faster postoperative rehabilitation, a shorter hospital stay, and fewer postoperative complications than OA. Therefore, LA is worth recommending as an effective and safe procedure for acute appendicitis.
目前，腹腔镜阑尾切除术（LA）为开腹阑尾切除术（OA）提供了一种安全有效的替代方法，但它的使用仍然存在争议。本研究旨在通过荟萃分析评估 LA 的有效性和安全性。
纳入了 1992 年 1 月至 2010 年 2 月间发表的比较 LA 和 OA 的随机对照试验（RCT）。由两名评审员独立进行严格的文献评估和数据提取。然后进行荟萃分析，以评估手术时间、住院费用、术后并发症、镇痛时间、肠道功能恢复时间、开始液体饮食的时间、住院时间以及恢复工作和正常活动的时间。
荟萃分析纳入了 25 项 RCT，共涉及 4694 例患者（LA 组 2220 例，OA 组 2474 例）。LA 组和 OA 组在年龄、性别、体重指数（BMI）或阑尾炎症类型方面无显著差异。与 OA 相比，LA 具有以下优势：术后并发症更少（比值比 [OR]，0.74；95%置信区间 [CI]，0.55-0.98；p = 0.04），疼痛较轻（镇痛时间：加权均数差 [WMD]，-0.53；95%CI，-0.91 至 -0.15；p = 0.007），更早开始液体饮食（WMD，-0.51；95%CI，-0.75 至 -0.28；p < 0.0001），住院时间更短（WMD，-0.68；95%CI，-1.02 至 -0.35；p < 0.0001），以及更早恢复工作（WMD，-3.09；95%CI，-5.22 至 -0.97；p = 0.004）和正常活动（WMD，-4.73；95%CI，-6.54 至 -2.92；p < 0.00001），但住院费用相当（LA/OA 比值的 WMD，0.11；95%CI，-0.18 至 0.40；p = 0.47），手术时间较长（WMD，10.71；95%CI，6.76-14.66；p < 0.00001）。
尽管手术时间较长，但 LA 术后疼痛较轻、康复较快、住院时间较短、术后并发症较少，优于 OA。因此，LA 作为治疗急性阑尾炎的一种有效且安全的方法值得推荐。
