单切口与传统三切口腹腔镜阑尾切除术：随机对照试验的荟萃分析。
Single-incision versus conventional three-incision laparoscopic appendectomy: A meta-analysis of randomized controlled trials.
作者信息
Deng Lihui, Xiong Junjie, Xia Qing
机构信息
Department of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
Department of Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
出版信息
J Evid Based Med. 2017 Aug;10(3):196-206. doi: 10.1111/jebm.12238.
BACKGROUND
Conventional three-incision laparoscopic appendectomy (CTLA) is considered the new golden standard for the treatment of acute appendicitis. However, single-incision laparoscopic appendectomy (SILA) can further reduce the number of abdominal incisions and visible scars.
METHODS
Major databases were researched for randomized clinical trials (RCTs) comparing SILA and CTLA for acute appendicitis from January 1983 and to March 2015. The technical feasibility, effectiveness, and safety between SILA and CTLA were compared. Pooled odds ratios (ORs) and weighted mean differences (WMDs) with 95% confidence intervals (CIs) were calculated using fixed- or random-effects models.
RESULTS
In total, 11 RCTs with 1489 patients were analyzed. The patients in the SILA group had a significantly shorter hospital duration (WMD: -0.63; 95% CI: -1.04, -0.21; P = 0.003) and return to activity (WMD: -2.91; 95% CI: -5.45, -0.37; P = 0.02) but experienced a longer operating time (WMD: 6.56; 95% CI: 3.55, 9.58; P < 0.0001) and higher rate of conversion (OR: 6.82; 95% CI: 3.14, 14.79; P < 0.00001). There were no differences between the two groups in visual analog pain scores, doses of analgesics, overall complication rates, wound infection, or cosmesis (all P > 0.05).
CONCLUSIONS
SILA is a safer and more effective than CTLA in both pediatric and adult patients.
背景
传统三切口腹腔镜阑尾切除术（CTLA）被认为是治疗急性阑尾炎的新金标准。然而，单切口腹腔镜阑尾切除术（SILA）可进一步减少腹部切口数量及可见疤痕。
方法
检索主要数据库，查找1983年1月至2015年3月间比较SILA与CTLA治疗急性阑尾炎的随机临床试验（RCT）。比较SILA与CTLA之间的技术可行性、有效性和安全性。采用固定效应或随机效应模型计算合并比值比（OR）和加权平均差（WMD）及其95%置信区间（CI）。
结果
共分析了11项RCT，涉及1489例患者。SILA组患者住院时间显著缩短（WMD：-0.63；95%CI：-1.04，-0.21；P = 0.003），恢复活动时间也显著缩短（WMD：-2.91；95%CI：-5.45，-0.37；P = 0.02），但手术时间较长（WMD：6.56；95%CI：3.55，9.58；P < 0.0001），中转率较高（OR：6.82；95%CI：3.14，14.79；P < 0.00001）。两组在视觉模拟疼痛评分、镇痛药用量及总体并发症发生率、伤口感染或美观度方面均无差异（所有P > 0.05）。
结论
在儿童和成人患者中，SILA比CTLA更安全、更有效。
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