摘要目的 系统评价经脐单孔和传统三孔腹腔镜阑尾切除术的安全性和疗效.方法 按Cochrane系统评价方法,计算机检索1996年1月至2013年1 1月的PubMed、EMBASE、the Cochrane Controlled Trials Register、中国期刊全文数据库、生物医学文献数据库及维普数据库.纳入文献为随机对照试验,经2名研究员独立提取信息并进行交叉比对,比较单孔腹腔镜阑尾切除术与传统三孔腹腔镜阑尾切除术,并观察两组手术时间、术后疼痛评分、术后住院时间、术后并发症、平均住院时间以及医疗费用等临床指标.采用RevMan 4.2软件进行Meta分析.采用I2检验对异质性进行定量分析.二分类变量采用优势比(OR)及95％可信区间(95％CI)表示,连续性变量采用加权均数差(WMD)及95％ CI表示.结果 共有8项试验、1444例患者纳入研究,成人和儿童分别为760例和684例.施行单孔腹腔镜阑尾切除术721例(单孔腹腔镜手术组),施行传统三孔腹腔镜阑尾切除术723例(传统三孔腹腔镜手术组).Meta分析结果显示:与传统三孔腹腔镜阑尾切除术比较,单孔腹腔镜阑尾切除术成人组和儿童组的手术时间均有所延长,且差异有统计学意义(WMD=4.40,7.39,95％CI:2.14～6.66,2.16 ～12.61,P＜0.05);而术后疼痛评分、术后并发症和住院时间等指标比较,差异无统计学意义(WMD=-0.34,95％ CI:-1.02 ～0.33;OR=0.97,95％CI:0.64～1.47;WMD=-0.19,95％ CI:-1.14～0.76,P＞0.05).单孔腹腔镜阑尾切除术儿童组医疗费用比传统三孔腹腔镜阑尾切除术高,差异有统计学意义(WMD =0.87,95％ CI:0.26～1.48,P＜0.05).结论 单孔腹腔镜阑尾切除术中及术后各项临床指标与传统三孔腹腔镜阑尾切除术比较无明显优势.因此,单孔腹腔镜阑尾切除术只是为阑尾炎患者提供了另一选择,而非首选术式.

abstractsObjective To compare the efficacy and safety of single-incision and conventional three-port laparoscopic appendectomy.Methods According to the Cochrane systematic review methods,literatures on the comparison of the effects of single-incision laparoscopic appendectomy (SILA) and conventional three-port laparoscopic appendectomy (CTLA) were searched for in the PubMed,EMBASE,the Cochrane Controlled Trials Register,CNKI,CBM and VIP database.Data including the operation time,pain visual analogue scales scores,duration of postoperative hospital stay,incidence of postoperative complications,mean time of hospital stay and cost between the SILA and CTLA were compared by 2 reviewers.RevMan 4.2 software was used for Meta analysis,and the heterogeneity of the study was analyzed using the 12 test.Categorical variables were presented by odds ratio and 95％ confidence interval (95％ CI),and continuous variables were presented by weighted mean difference (WMD) and 95％C1.Results Eight randomized controlled trials including 1 444 patients were selected.All the patients were subdivided into the adults group (760 patients) and the children group (684 patients).A total of 721 patients received SILA (SILA group) and 723 received CTLA (CTLA group).The operation time of patients who received SILA in the adults group and the children group were significantly longer than those who received CTLA (WMD =4.40,7.39,95％ CI:2.14-6.66,2.16-12.61,P ＜0.05).There were no significant difference in the pain visual analogue scales scores,incidence of postoperative complications and duration of hospital stay between patients who received SILA and CTLA in the adults group and the children group (WMD =-0.34,95 ％ CI:-1.02-0.33,OR=0.97,95％CI:0.64-1.47; WMD=-0.19,95％CI:-1.14-0.76,P＞0.05).The cost of patients who received SILA was significantly higher than those who received CTLA in the children group (WMD =0.87,95 ％ CI:0.26-1.48,P ＜ 0.05).Conclusions There is no obvious advantages of SILA in perioperative and postoperative outcomes when compared with CTLA.Therefore,SILA is only a possible alternative to CTLA other than the preferred method.