Sauerland S, Lefering R, Holthausen U, Neugebauer E A
2nd Department of Surgery, University of Cologne, Germany.
Langenbecks Arch Surg. 1998 Aug;383(3-4):289-95. doi: 10.1007/s004230050135.
To compare the effectiveness and safety of laparoscopic and conventional "open" appendectomy in the treatment of acute appendicitis.
Meta-analysis of randomised controlled trials available by May 1998 that compared both techniques. Within each trial and for each outcome an effect size was calculated; the effect sizes were then pooled by a random-effects model.
We summarised outcome data of 2877 patients included in 28 trials. Operating time was +16 min (95% confidence interval +12-20 min) longer for laparoscopic appendectomy. Overall complication rates were comparable, but wound infections were definitely reduced after laparoscopy [rate difference -4.2%, (-2.3% to -6.1%)]. Intra-abdominal abscesses, however, occurred slightly more frequently [+0.9%, (-0.4% to +2.3%)]. Hospital stay after laparoscopic appendectomy was 15 h (8-23 h) shorter, and patients returned to full fitness or work 7 days (5-9 days) earlier. Pain intensity on day 1 was slightly less. Heterogeneity was present for some outcome measures due to methodological differences among the primary studies.
Laparoscopic appendectomy reduces wound infections and eases postoperative recovery. Nevertheless, the various differences among the primary studies and their partly flawed methodology make it difficult to generalise from these findings.
比较腹腔镜阑尾切除术与传统“开放”阑尾切除术治疗急性阑尾炎的有效性和安全性。
对1998年5月前可得的比较这两种技术的随机对照试验进行荟萃分析。在每个试验中，针对每个结果计算效应量；然后通过随机效应模型汇总效应量。
我们总结了28项试验中纳入的2877例患者的结果数据。腹腔镜阑尾切除术的手术时间长16分钟（95%置信区间为长12 - 20分钟）。总体并发症发生率相当，但腹腔镜检查后伤口感染明显减少[率差 - 4.2%，（- 2.3%至 - 6.1%）]。然而，腹腔内脓肿的发生频率略高[+ 0.9%，（- 0.4%至 + 2.3%）]。腹腔镜阑尾切除术后的住院时间短15小时（8 - 23小时），患者恢复完全健康或恢复工作的时间提前7天（5 - 9天）。术后第1天的疼痛强度略低。由于主要研究之间的方法学差异，一些结果测量存在异质性。
腹腔镜阑尾切除术可减少伤口感染并促进术后恢复。然而，主要研究之间的各种差异及其部分存在缺陷的方法学使得难以从这些发现中进行推广。
