PDF(Pubmed)
Abstract：
UNASSIGNED: We aimed to assess the efficacy and safety of low-pressure pneumoperitoneum (LPP) in minimally invasive colorectal surgery.
UNASSIGNED: A PRISMA-compliant systematic review/meta-analysis was conducted, searching PubMed, Scopus, Google Scholar, and clinicaltrials.gov for randomized-controlled trials assessing outcomes of LPP vs standard-pressure pneumoperitoneum (SPP) in colorectal surgery. Efficacy outcomes [pain score in post-anesthesia care unit (PACU), pain score postoperative day 1 (POD1), operative time, and hospital stay] and safety outcomes (blood loss and postoperative complications) were analyzed. Risk of bias2 tool assessed bias risk. The certainty of evidence was graded using GRADE.
UNASSIGNED: Four studies included 537 patients (male 59.8%). LPP was undertaken in 280 (52.1%) patients and associated with lower pain scores in PACU [weighted mean difference: -1.06, 95% confidence interval (CI): -1.65 to -0.47, P = 0.004, I 2 = 0%] and POD1 (weighted mean difference: -0.49, 95% CI: -0.91 to -0.07, P = 0.024, I 2 = 0%). Meta-regression showed that age [standard error (SE): 0.036, P < 0.001], male sex (SE: 0.006, P < 0.001), and operative time (SE: 0.002, P = 0.027) were significantly associated with increased complications with LPP. In addition, 5.9%-14.5% of surgeons using LLP requested pressure increases to equal the SPP group. The grade of evidence was high for pain score in PACU and on POD1 postoperative complications and major complications, and blood loss, moderate for operative time, low for intraoperative complications, and very low for length of stay.
UNASSIGNED: LPP was associated with lower pain scores in PACU and on POD1 with similar operative times, length of stay, and safety profile compared with SPP in colorectal surgery. Although LPP was not associated with increased complications, older patients, males, patients undergoing laparoscopic surgery, and those with longer operative times may be at risk of increased complications.
UNASSIGNED: A PRISMA-compliant systematic review/meta-analysis was conducted, searching PubMed, Scopus, Google Scholar, and clinicaltrials.gov for randomized-controlled trials assessing outcomes of LPP vs standard-pressure pneumoperitoneum (SPP) in colorectal surgery. Efficacy outcomes [pain score in post-anesthesia care unit (PACU), pain score postoperative day 1 (POD1), operative time, and hospital stay] and safety outcomes (blood loss and postoperative complications) were analyzed. Risk of bias2 tool assessed bias risk. The certainty of evidence was graded using GRADE.
UNASSIGNED: Four studies included 537 patients (male 59.8%). LPP was undertaken in 280 (52.1%) patients and associated with lower pain scores in PACU [weighted mean difference: -1.06, 95% confidence interval (CI): -1.65 to -0.47, P = 0.004, I 2 = 0%] and POD1 (weighted mean difference: -0.49, 95% CI: -0.91 to -0.07, P = 0.024, I 2 = 0%). Meta-regression showed that age [standard error (SE): 0.036, P < 0.001], male sex (SE: 0.006, P < 0.001), and operative time (SE: 0.002, P = 0.027) were significantly associated with increased complications with LPP. In addition, 5.9%-14.5% of surgeons using LLP requested pressure increases to equal the SPP group. The grade of evidence was high for pain score in PACU and on POD1 postoperative complications and major complications, and blood loss, moderate for operative time, low for intraoperative complications, and very low for length of stay.
UNASSIGNED: LPP was associated with lower pain scores in PACU and on POD1 with similar operative times, length of stay, and safety profile compared with SPP in colorectal surgery. Although LPP was not associated with increased complications, older patients, males, patients undergoing laparoscopic surgery, and those with longer operative times may be at risk of increased complications.
摘要：
■我们旨在评估低压气腹（LPP）在微创结直肠手术中的疗效和安全性。
■进行了符合PRISMA的系统评价/荟萃分析，搜索PubMed,Scopus,谷歌学者，和clinicaltrials.gov用于评估LPP与标准压力气腹（SPP）在结直肠手术中的结局的随机对照试验。疗效结果[麻醉后监护病房（PACU）疼痛评分，术后第1天疼痛评分（POD1），手术时间,和住院时间]和安全性结果（失血量和术后并发症）进行分析。偏差风险2工具评估偏差风险。使用GRADE对证据的确定性进行分级。
■四项研究包括537例患者（男性59.8%）。在280名（52.1％）患者中进行了LPP，并与PACU的较低疼痛评分相关[加权平均差：-1.06，95％置信区间（CI）：-1.65至-0.47，P=0.004，I2=0％]和POD1（加权平均差：-0.49，95％CI：-0.91至-0.07，P=0.024，I2=0％）。Meta回归显示年龄[标准误差（SE）：0.036，P<0.001]，男性（SE：0.006，P<0.001），和手术时间（SE：0.002，P=0.027）与LPP并发症的增加显着相关。此外,5.9％-14.5％的使用LLP的外科医生要求压力增加到等于SPP组。PACU疼痛评分和POD1术后并发症和主要并发症的证据等级较高，失血,手术时间适中，术中并发症低，和非常低的停留时间。
■LPP与PACU和POD1的较低疼痛评分相关，手术时间相似，逗留时间,与SPP在结直肠手术中的安全性比较。尽管LPP与并发症的增加无关，老年患者,男性,接受腹腔镜手术的患者，那些手术时间较长的人可能有增加并发症的风险。
■进行了符合PRISMA的系统评价/荟萃分析，搜索PubMed,Scopus,谷歌学者，和clinicaltrials.gov用于评估LPP与标准压力气腹（SPP）在结直肠手术中的结局的随机对照试验。疗效结果[麻醉后监护病房（PACU）疼痛评分，术后第1天疼痛评分（POD1），手术时间,和住院时间]和安全性结果（失血量和术后并发症）进行分析。偏差风险2工具评估偏差风险。使用GRADE对证据的确定性进行分级。
■四项研究包括537例患者（男性59.8%）。在280名（52.1％）患者中进行了LPP，并与PACU的较低疼痛评分相关[加权平均差：-1.06，95％置信区间（CI）：-1.65至-0.47，P=0.004，I2=0％]和POD1（加权平均差：-0.49，95％CI：-0.91至-0.07，P=0.024，I2=0％）。Meta回归显示年龄[标准误差（SE）：0.036，P<0.001]，男性（SE：0.006，P<0.001），和手术时间（SE：0.002，P=0.027）与LPP并发症的增加显着相关。此外,5.9％-14.5％的使用LLP的外科医生要求压力增加到等于SPP组。PACU疼痛评分和POD1术后并发症和主要并发症的证据等级较高，失血,手术时间适中，术中并发症低，和非常低的停留时间。
■LPP与PACU和POD1的较低疼痛评分相关，手术时间相似，逗留时间,与SPP在结直肠手术中的安全性比较。尽管LPP与并发症的增加无关，老年患者,男性,接受腹腔镜手术的患者，那些手术时间较长的人可能有增加并发症的风险。
