Antoniou Stavros A, Mavridis Dimitrios, Hajibandeh Shahab, Hajibandeh Shahin, Antoniou George A, Gorter Ramon, Tenhagen Mark, Koutras Christos, Pointner Rudolph, Chalkiadakis George E, Granderath Frank-Alexander, Fragiadakis George F, Philalithis Anastas E, Bonjer Hendrik Jaap
Center for Minimally Invasive Surgery, Neuwerk Hospital, Mönchengladbach, Germany; Department of General Surgery, University Hospital of Heraklion, Heraklion, Crete, Greece.
Department of Hygiene and Epidemiology, School of Medicine, University of Ioannina, Ioannina, Greece; Department of Primary Education, School of Education, University of Ioannina, Ioannina, Greece.
Surgery. 2017 Nov;162(5):994-1005. doi: 10.1016/j.surg.2017.07.013. Epub 2017 Aug 30.
Laparoscopic appendectomy is the predominant method of treatment of acute appendicitis. There is insufficient evidence on the most effective management of the appendix stump. The aim of this study was to investigate the relative effectiveness and provide a treatment ranking of different options for securing the appendix stump.
Electronic databases were searched to identify randomized controlled trials comparing ligation methods of the appendix. The primary outcomes were organ/space infection and superficial operative site infection. We performed a network meta-analysis and estimated the pairwise relative treatment effects of the competing interventions using the odds ratio and its 95% confidence interval. We obtained a hierarchy of the competing interventions using rankograms and the surface under the cumulative ranking curve.
Forty-three randomized controlled trials were eligible and provided data for >5,000 patients. Suture ligation seemed to be the most effective treatment strategy, in terms of both organ/space infection and superficial operative site infection. Statistical significance was reached for the comparisons of clip versus endoloop (odds ratio 0.56, 95% confidence interval, 0.32-0.96) for organ/space infection; and suture versus clip (odds ratio 0.20, 95% confidence interval 0.08-0.55) and clip versus endoloop (odds ratio 2.22, 95% confidence interval 1.56-3.13) for superficial operative site infection. The network was informed primarily by indirect treatment comparisons.
The use of suture ligation of the appendix in laparoscopic appendectomy seems to be superior to other methods for the composite parameters of organ/space and superficial operative site infection.
腹腔镜阑尾切除术是治疗急性阑尾炎的主要方法。关于阑尾残端最有效的处理方法，证据不足。本研究的目的是调查不同阑尾残端处理方法的相对有效性，并给出治疗排序。
检索电子数据库，以识别比较阑尾结扎方法的随机对照试验。主要结局为器官/腔隙感染和手术切口浅部感染。我们进行了网状Meta分析，并使用比值比及其95%置信区间估计了各竞争干预措施的成对相对治疗效果。我们使用排序图和累积排序曲线下的面积获得了各竞争干预措施的等级排序。
43项随机对照试验符合纳入标准，纳入患者超过5000例。就器官/腔隙感染和手术切口浅部感染而言，缝扎似乎是最有效的治疗策略。在器官/腔隙感染方面，钛夹与套扎圈比较（比值比0.56，95%置信区间0.32 - 0.96）达到统计学显著性；在手术切口浅部感染方面，缝扎与钛夹比较（比值比0.20，95%置信区间0.08 - 0.55）以及钛夹与套扎圈比较（比值比2.22，95%置信区间1.56 - 3.13）达到统计学显著性。该网状分析主要基于间接治疗比较。
在腹腔镜阑尾切除术中，阑尾缝扎术在器官/腔隙和手术切口浅部感染的综合参数方面似乎优于其他方法。
