腹腔镜阑尾切除术治疗复杂性阑尾炎：冲洗与吸引的荟萃分析。

Irrigation Versus Suction in Laparoscopic Appendectomy for Complicated Appendicitis: A Meta-analysis.

机构信息

Department of Surgery, Johns Hopkins University, Baltimore, Maryland; Laboratory of Experimental Surgery and Surgical Research N.S. Christeas, Medical School, National and Kapodistrian University of Athens, Athens, Greece.

Laboratory of Experimental Surgery and Surgical Research N.S. Christeas, Medical School, National and Kapodistrian University of Athens, Athens, Greece; Department of General Surgery, Watford General Hospital NHS Trust, Watford, UK.

出版信息

J Surg Res. 2019 Mar;235:237-243. doi: 10.1016/j.jss.2018.10.005. Epub 2018 Nov 1.

DOI:10.1016/j.jss.2018.10.005

PMID:30691801

Abstract

BACKGROUND

Acute appendicitis is currently one of the most common surgical emergencies. Intra-abdominal abscesses (IAA) are a fearsome complication, which may occur. Irrigation during the appendectomy is one of the factors suggested to affect the rates of IAA. We sought to investigate the evidence regarding the use of irrigation versus suction alone and the development of IAA after laparoscopic appendectomy for complicated appendicitis.

METHODS

We searched PubMed, Scopus, Embase, Cochrane, and the Web of Science through November 10, 2017, according to Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. We extracted information of interest, including rates of postoperative (IAA), and performed meta-analysis using random-effects model using the RevMan software.

RESULTS

We identified five eligible studies with 2511 patients in total. Use of irrigation overall did not demonstrate significant increase in IAA (odds ratio [OR] = 2.39, 95% confidence interval [CI; 0.49, 11.74], P = 0.28). For the adult subpopulation, the use of irrigation was associated with nonsignificant lower odds of IAAs (OR = 0.42, 95% CI [0.15, 1.16]), whereas in pediatric with nonsignificant higher risk (OR = 2.98, 95% CI [0.25, 35.34]). Performance of irrigation led to the addition of, on average, 7 min to the duration of the operation (mean difference = 7.16, 95% CI [3.23, 11.09], P < 0.001). Irrigation did not affect postoperative length of stay (mean difference = -0.80, 95% CI [-2.30, 0.69], P = 0.29).

CONCLUSIONS

Performance of irrigation during laparoscopic appendectomy does not seem to prevent the development of IAA in neither adults nor pediatric patients.

摘要

背景

急性阑尾炎是目前最常见的外科急症之一。腹腔脓肿（IAA）是一种可怕的并发症，可能会发生。在阑尾切除术中冲洗是影响 IAA 发生率的因素之一。我们旨在调查在复杂性阑尾炎的腹腔镜阑尾切除术中冲洗与单纯抽吸相比对 IAA 发展的影响的证据。

方法

我们根据系统评价和荟萃分析的首选报告项目，于 2017 年 11 月 10 日之前在 PubMed、Scopus、Embase、Cochrane 和 Web of Science 上进行了搜索。我们提取了感兴趣的信息，包括术后（IAA）的发生率，并使用 RevMan 软件采用随机效应模型进行荟萃分析。

结果

我们确定了五项符合条件的研究，共纳入 2511 例患者。总体而言，冲洗的使用并未显示出 IAA 显著增加（优势比[OR] = 2.39，95%置信区间[CI; 0.49, 11.74]，P = 0.28）。对于成人亚组，冲洗的使用与 IAA 的发生风险降低无关（OR = 0.42，95% CI [0.15, 1.16]），而在儿科患者中冲洗的使用与风险增加无关（OR = 2.98，95% CI [0.25, 35.34]）。冲洗操作平均使手术时间延长 7 分钟（均数差= 7.16，95% CI [3.23, 11.09]，P < 0.001）。冲洗不会影响术后住院时间（均数差= -0.80，95% CI [-2.30, 0.69]，P = 0.29）。