背景:传统的三通道腹腔镜阑尾切除术(CLA)是目前的金标准治疗方法,然而,已提出单孔腹腔镜阑尾切除术(SILA)作为替代方案。本系统评价/荟萃分析的目的是评估SILA与常规方法的安全性和有效性。
方法:根据PRISMA指南,我们系统回顾了比较CLA和SILA治疗急性阑尾炎的随机对照试验(RCT).采用随机Mantel-Haenszel方法进行Meta分析。使用ReviewManager软件进行统计数据分析,并使用Cochrane“偏差风险”评估工具评估偏差风险。
结果:选择了21项研究(RCT)(2646例患者)。SILA组手术时间明显延长(MD=7,32),在两个儿科(MD=9,80),(Q=1,47)和成人亚组(MD=5,92),(Q=55,85)。接受SILA的患者术后总发病率较高,但结果无统计学意义。在SILA组中,评估住院时间较短,更少的伤口感染和更高的转化率,但结果无统计学意义。由于每个研究使用不同的量表,因此未对皮肤疤痕和术后疼痛的化妆品进行荟萃分析。
结论:这项分析表明,SILA,尽管术后伤口感染较少,手术时间明显更长。此外,术后一般并发症的风险仍然存在.需要进一步的研究来分析与术后疼痛和手术疤痕的化妆品相关的结果。
BACKGROUND: Conventional three-access laparoscopic appendectomy (CLA) is currently the gold standard treatment, however, Single-Port Laparoscopic Appendectomy (SILA) has been proposed as an alternative. The aim of this systematic review/meta-analysis was to evaluate safety and efficacy of SILA compared with conventional approach.
METHODS: Per PRISMA guidelines, we systematically reviewed randomised controlled trials (RCTs) comparing CLA vs SILA for acute appendicitis. The randomised Mantel-Haenszel method was used for the meta-analysis. Statistical data analysis was performed with the Review Manager software and the risk of bias was assessed with the Cochrane \"Risk of Bias\" assessment tool.
RESULTS: Twenty-one studies (RCTs) were selected (2646 patients). The operative time was significantly longer in the SILA group (MD = 7,32), confirmed in both paediatric (MD = 9,80), (Q = 1,47) and adult subgroups (MD = 5,92), (Q = 55,85). Overall postoperative morbidity was higher in patients who underwent SILA, but the result was not statistically significant. In SILA group were assessed shorter hospital stays, fewer wound infections and higher conversion rate, but the results were not statistically significant. Meta-analysis was not performed about cosmetics of skin scars and postoperative pain because different scales were used in each study.
CONCLUSIONS: This analysis show that SILA, although associated with fewer postoperative wound infection, has a significantly longer operative time. Furthermore, the risk of postoperative general complications is still present. Further studies will be required to analyse outcomes related to postoperative pain and the cosmetics of the surgical scar.