国内腹腔镜与开腹修补术在良性胃穿孔患者中应用的Meta分析

2016-09-12何劲松李利发张井潇黄静魏寿江

川北医学院学报 2016年4期

关键词：腹腔镜分析手术

何劲松，李利发，张井潇，黄静，魏寿江

(川北医学院附属医院胃肠外科，四川南充　637000)

国内腹腔镜与开腹修补术在良性胃穿孔患者中应用的Meta分析

何劲松，李利发，张井潇，黄静，魏寿江

(川北医学院附属医院胃肠外科，四川南充637000)

目的：探讨腹腔镜修补术治疗良性胃穿孔的可行性和安全性。方法：对国内已公开发表的有关腹腔镜与开腹修补术在良性胃穿孔中应用的文献进行Meta分析,数据采用标准化均数差(SMD)、优势比(OR)和95 %置信区间(95%CI)表达。结果：纳入文献17篇，共1 457例患者，其中腹腔镜修补术组(观察组)730例，开腹修补术组(对照组)727例。分析表明：相比开腹修补术，腹腔镜修补术不仅可减少手术时间和术中出血量(P<0.05)，缩短术后肠鸣音恢复时间、肛门首次排气时间和住院时间(P<0.05)，降低术后切口感染、肠梗阻、盆腹腔感染等并发症的发生率(P<0.05)；且术后血清胃泌素的分泌水平更高(P<0.05)。结论：相比开腹修补术，腹腔镜胃穿孔修补术具有减少手术时间、住院时间、术中出血量和术后并发症，缩短术后肠鸣音恢复时间、肛门首次排气时间，术后血清胃泌素分泌水平更高等优势，因而安全可行。

腹腔镜；胃穿孔；Meta分析

【Abstract】Objective：To investigate the feasibility and security of laparoscopic repair in the treatment of benign gastric perforation.Methods：The primary literature about laparoscopic and open repair in the treatment of benign gastric perforation were retrieved and filtered，and then a meta-analysis was carried out based on the data．Data were assessed by standardized mean difference(SMD)，odds ratio(OR)and 95% confidence interval(95%CI)．Results：Seventeen articles involving 1 459 patients with benign gastric perforation,including laparoscopic repair group(observation group)of 730 cases,727 cases in the open repair(control group),were incorporated.From the pooled analyses,compared to open repair,laparoscopic repair can not only reduce operative time and blood loss (P<0.05),shorten recovery time after bowel sounds,first anal exhaust time and length of hospital stay (P<0.05),reduce postoperative incision infection，intestinal obstruction,abdominal infections and so on (P<0.05);but also improve the level of postoperative serum gastrin secretion (P<0.05).Conclusion：Compared with open repair，laparoscopic gastric perforation repair can reduce operative time,hospital stay,blood loss and postoperative complications,shorten recovery time after bowel sounds and first anal exhaust time,improve serum advantages of gastrin secretion;therefore it is safe and feasible.

胃穿孔是腹部外科常见急腹症之一，传统的手术方式为开腹行胃穿孔修补或胃大部切除[1]。但伴随着大多数外科医生对腹腔镜手术技术的掌握，经腹腔镜行胃穿孔修补术也得到了广泛的应用。与开腹手术相比，腹腔镜手术具有创伤小、痛苦少、术后并发症少等优点，治疗效果与传统手术同样安全有效，其在胃穿孔修补中的应用符合经典手术的要求[2]。目前，国内外已发表的文献中尚未见与腹腔镜和开腹行胃穿孔修补术相关的Meta分析，因此本次研究对国内已公开发表的相关文献进行Meta分析，进而阐明上述两种手术方式在胃穿孔患者中应用的优缺点，为腹腔镜胃穿孔修补术的推广应用提供理论依据。