Feng Jian, Cui Naiqiang, Wang Zhenyu, Duan Jutao
Department of Emergency, Tianjin Nankai Hospital, Tianjin 300100, P.R. China.
Department of Hepatopancreatobiliary Surgery, Tianjin Nankai Hospital, Tianjin 300100, P.R. China.
Exp Ther Med. 2017 Dec;14(6):5908-5916. doi: 10.3892/etm.2017.5343. Epub 2017 Oct 18.
The present study aimed to systematically evaluate the effectiveness of single-incision laparoscopic surgery (SILS), conventional laparoscopic appendectomy (CLA) and open appendectomy (OA) for the treatment of acute appendicitis. PubMed and Embase databases were systematically searched to identify relevant studies comparing the effectiveness of different appendectomy methods for treating acute appendicitis published prior to April 2016. ADDIS 1.16.5 software was used for data analysis. Heterogeneity was assessed using I statistic. Odds ratios or standardized mean differences and 95% confidence intervals were calculated and pooled accordingly. Consistency was assessed using node-splitting analysis and inconsistency standard deviation. Convergence was assessed with the Brooks-Gelman-Rubin method using Potential Scale Reduction Factor (PSRF). Surgical procedure duration, duration of hospital stay, wound infection and incidence of abscesses were compared. A total of 24 eligible studies were included in this meta-analysis. A consistency model was used to pool data regarding the four outcomes. The PSRFs in each item were all <1.03. Pooled results showed that, compared with OA, SILS and CLA were associated with significantly shorter durations of hospital stay (all P<0.01) and lower risk of wound infection (SILS vs. OA P=0.02 and CLA vs. OA P<0.01, respectively), but no significant differences were identified between SILS and CLA. However, compared with OA, SILS exhibited a significantly longer surgical procedure duration (P=0.01) and lower incidence of abscesses (P=0.04), while no significant difference was observed between OA and CLA. This comprehensive network meta-analysis indicated that laparoscopic appendectomy, including SILS and CLA, may have more advantages for acute appendicitis compared with OA. Furthermore, SILS procedures require improvement and simplification to reduce the surgical procedure duration.
本研究旨在系统评价单孔腹腔镜手术（SILS）、传统腹腔镜阑尾切除术（CLA）及开腹阑尾切除术（OA）治疗急性阑尾炎的有效性。系统检索PubMed和Embase数据库，以识别2016年4月之前发表的比较不同阑尾切除方法治疗急性阑尾炎有效性的相关研究。使用ADDIS 1.16.5软件进行数据分析。采用I统计量评估异质性。计算并合并比值比或标准化均数差及95%置信区间。采用节点拆分分析和不一致标准差评估一致性。使用潜在缩尺因子（PSRF）的布鲁克斯-格尔曼-鲁宾方法评估收敛性。比较手术时间、住院时间、伤口感染及脓肿发生率。本荟萃分析共纳入24项符合条件的研究。采用一致性模型汇总四项结局的数据。各项目的PSRF均<1.03。汇总结果显示，与OA相比，SILS和CLA的住院时间显著缩短（均P<0.01），伤口感染风险较低（SILS与OA相比，P=0.02；CLA与OA相比，P<0.01），但SILS与CLA之间未发现显著差异。然而，与OA相比，SILS的手术时间显著延长（P=0.01），脓肿发生率较低（P=0.04），而OA与CLA之间未观察到显著差异。这项全面的网状荟萃分析表明，包括SILS和CLA在内的腹腔镜阑尾切除术治疗急性阑尾炎可能比OA更具优势。此外，SILS手术需要改进和简化以缩短手术时间。
