手助腹腔镜与开腹脾切除术对巨脾患者 临床疗效差异的Meta 分析

Meta-analysis of clinical efficacy of hand-assisted laparoscopic splenectomy and open splenectomy for splenomegaly

摘要:

目的 探讨手助腹腔镜脾切除术（HALS）与开腹脾切除术（OS）对巨脾患者临床疗效的差异。方法 检索中国知网（CNKI）、中国生物医学数据库（CBM）、万方数据库、维普科技期刊（VIP）、PUBMED、 COCHRANE LIBRARY 等数据库，查找关于HALS 和OS 对巨脾患者临床疗效的临床随机对照实验或非随 机对照实验文献，再用Rev Man 5.3 系统评价软件进行统计学分析并阐述统计学结果。结果 检索出有关文献 258 篇，最终纳入分析文献8 篇，Meta 分析结果显示HAL 与OS 比较，术中出血量[ 加权均数差（WMD）= -135.437（95%CI ：-251.405，-19.469），P <0.05]、手术时间[WMD=41.097（95%CI ：18.036，64.159），P < 0.05]、术后肠道排气时间[WMD=0.927（95%CI ：-1.401，-0.452），P <0.05]、术后住院时间[WMD=-2.557 （95%CI ：-3.200，-1.914），P <0.05] 差异有统计学意义，而术后并发症发生率[Ol ^ R=0.555（95%CI ：0.289， 1.064），P >0.05] 差异无统计学意义。结论 在巨脾患者的治疗中，HALS 相较于OS 而言，其具有术中出血量少、 术后肠道排气时间早及术后住院时间短的优势，是一种合理有效的手术方式。

Abstract:

Objective To investigate the difference of clinical efficacy between hand-assisted laparoscopic splenectomy (HALS) and open splenectomy (OS) for the patients with splenomegaly. Methods Relevant literature was retrieved from databases including CNKI, CBM, Wanfang database, VIP, PubMed and Cochrane Library. All the relevant trials were collected for comparison of the clinical efficacy of HALS and OS on splenomegaly in the patients with randomized controlled trials (RCT) or non-RCT documents, the eligible literature and data in the literature were extracted according to a proposed standard. Then, Rev Man 5.3 software was used for statistical analysis and the statistical results were expounded. Results A total of 258 relevant papers were retrieved and 8 articles were included in the analysis. Meta-analysis results showed that the intraoperative blood loss [WMD = -135.437 (95% CI: -251.405, -19.469), P < 0.05], the surgery time [WMD = 41.097 (95% CI: 18.036, 64.159), P < 0.05], the postoperative intestinal exhaust time [WMD = 0.927 (95% CI: -1.401, -0.452), P < 0.05], and the postoperative hospitalization time [WMD = -2.557 (95% CI: -3.200, -1.914), P < 0.05] were significantly different between the HALS group and the OS group, but there was no statistically significant difference in the incidence of postoperative complications between the two groups [O^R = 0.555 (95% CI: 0.289, 1.064), P > 0.05]. Conclusions In the treatment of patients with splenomegaly, compared with OS, HALS has the advantages of less intraoperative blood loss, shorter postoperative intestinal exhaust time and shorter postoperative hospitalization time, so it is a reasonable and effective surgical method.