Doshi Neel, Bandyopadhyay Soham, Green Madeline, Richardson Edward, Komber Ahmad, Chen Si Emma, Shah Rahul, Lakhoo Kokila
University of Oxford and Oxford University Hospitals, Headley Way, Headington, Oxford, OX3 9DU, United Kingdom.
University of Oxford and Oxford University Hospitals, Headley Way, Headington, Oxford, OX3 9DU, United Kingdom.
J Pediatr Surg. 2024 Aug;59(8):1477-1485. doi: 10.1016/j.jpedsurg.2024.03.021. Epub 2024 Mar 14.
Complicated appendicitis is associated with a higher risk of postoperative complications, including adhesive bowel obstruction. The aim of this meta-analysis is to investigate the difference in rates of postoperative bowel obstruction in paediatric patients with complicated versus simple appendicitis and whether this is influenced by the surgical approach.
A systematic literature search following PRISMA guidelines was conducted using MEDLINE, Embase and Cochrane Library for studies that analysed incidence of adhesive bowel obstruction in paediatric patients after appendicectomy. Studies from 1998 to 2022 were included in analysis. The study protocol was registered on PROSPERO (ID CRD42022309769).
Pooled analysis of 6 studies with low risk of bias and adequate follow up periods, considering 58,962 cases of appendicectomy, revealed complex appendicitis was associated with a near two-fold increase in incidence of SBO (pooled odds ratio 2.02 (95% CI 1.35-2.69)). Interestingly, a similar pooled analysis of 10 studies, considering 62,433 cases of appendicectomy, revealed no significant difference between open and laparoscopic management of complex appendicitis (pooled odds ratio 0.93 (95% CI 0.24 to 1.62)).
Complex appendicitis is associated with a two-fold increase in the rates of adhesive bowel obstruction. Whilst there are cosmetic advantages of a laparoscopic approach, surgical expertise should be favoured in decision making relating to surgical approach (laparoscopic versus open) as the evidence for a laparoscopic approach reducing risks of adhesive bowel obstruction is not convincing.
Level II.
复杂性阑尾炎与术后并发症风险较高相关，包括粘连性肠梗阻。本荟萃分析的目的是研究复杂性阑尾炎与单纯性阑尾炎患儿术后肠梗阻发生率的差异，以及这是否受手术方式的影响。
按照PRISMA指南，使用MEDLINE、Embase和Cochrane图书馆进行系统文献检索，以分析小儿阑尾切除术后粘连性肠梗阻发生率的研究。纳入1998年至2022年的研究进行分析。研究方案已在PROSPERO上注册（ID CRD42022309769）。
对6项偏倚风险低且随访期足够的研究进行汇总分析，纳入58,962例阑尾切除术病例，结果显示复杂性阑尾炎与粘连性小肠梗阻发生率增加近两倍相关（汇总比值比2.02（95%CI 1.35 - 2.69））。有趣的是，对10项研究进行类似的汇总分析，纳入62,433例阑尾切除术病例，结果显示复杂性阑尾炎的开放手术和腹腔镜手术治疗之间无显著差异（汇总比值比0.93（95%CI 0.24至1.62））。
复杂性阑尾炎与粘连性肠梗阻发生率增加两倍相关。虽然腹腔镜手术有美容优势，但在决定手术方式（腹腔镜与开放）时，应优先考虑手术专业知识，因为腹腔镜手术降低粘连性肠梗阻风险的证据并不令人信服。
二级。
