腹腔镜阑尾切除与开腹阑尾切除术的对比研究及Meta分析

目的比较腹腔镜与开腹阑尾切除术对急性阑尾炎的疗效和手术安全性。方法收集2006年10月至2007年10月问120例急性阑尾炎患者进行前瞻性研究，随机分为两组，分别采用腹腔镜阑尾切除（LA）术式和开腹阑尾切除（OA）术式，对手术时间、术中出血量、术后胃肠功能恢复时间、止痛药物应用时间、开始进食时间、住院天数和术后并发症等指标进行比较分析。并对1996年1月至2008年12月期间的该类前瞻性随机对照研究（RCT）文献进行Meta分析，比较两种术式手术时间、住院天数和并发症等指标。结果本组资料表明，两组手术时间、出血量无明显差异，而LA组肠功能恢复时间、止痛药物应用时间、住院天数明显短于OA组，LA组手术并发症也少于OA组；Meta分析有6组资料纳入，LA住院天数和手术并发症少于OA组，而两组的手术时间无明显差异。结论腹腔镜阑尾切除术具有恢复时间短、术后疼痛轻、住院时间短和并发症发生率低等优点，值得推荐。

Laparoscopic vs open appendectomy in acute appendicitis: a randomized prospective study and meta-analysis

Objective To compare the efficacy and safety of laparoscopic appendectomy and open appendectomy in treating acute appendicitis. Methods One hundred and twenty patients admitted with acute appendicitis from October 2006 to October 2007 were given laparoscopic appendectomy（LA） or open appendectomy （OA） randomly. Operating time, blood loss volume, time of gastrointestinal function recovery, applying time of analgesia, fasting time postoperative, hospitalized time and complications were collected and analyzed. With recta-analysis on literatures of randomized controlled trials （RCTs） from January 1996 to December 2008, operating time, hospitalized time and complications of these two surgery methods were evaluated. Results There was no significant difference in operating time and blood loss volume between LA and OA group according to our data, while LA group had advantages in faster gastrointestinal function recovery, less demand of analgesia, shorter hospitalized time and fewer complications compared to OA group. Data of 6 RCTs analyzed by meta-analysis also showed that LA group had shorter hospitalized time and fewer complications than OA group, while no difference in operating time between the two groups was observed. Conclusions Laparoscopic appendectomy has advantages in faster gastrointestinal function recovery, less postoperative pain, shorter hospitalized time and fewer complications. Therefore, LA is worth recommending as an effective and safe procedure for acute appendicitis.