目的:本研究旨在比较腹腔镜和开腹缝合治疗消化性溃疡穿孔(PPU)的临床结果。
方法:PubMed,EMBASE,从开始到2023年3月31日,搜索了Cochrane图书馆数据库中符合条件的研究。还计算了赔率比(OR)和95%置信区间(Cl)。采用纽卡斯尔-渥太华量表(NOS)评价纳入研究的质量。本研究使用Stata(V.16.0)软件进行。
结果:本研究共纳入29项研究,涉及17,228例患者。就术后结果而言,腹腔镜组术后住院时间较短(MD=-0.29,95CI=-0.44~-0.13,P=0.00),失血减少(MD=-0.45,95CI=-0.82至-0.08,P=0.02),伤口感染较少(OR=0.20,95CI=0.17至0.24,P=0.00),减少肺炎(OR=0.59,95CI=0.41至0.87,P=0.01),呼吸系统并发症少(OR=0.26,95CI=0.13~0.55,P=0.00),术后并发症少(OR=0.51,95CI=0.33~0.78,P=0.00)。腹腔镜组死亡率低于开腹组(OR=0.36,95CI=0.27~0.49,P=0.00)。我们还发现腹腔镜组的总体并发症发生率高于开放组(OR=0.45,95CI=0.34至0.60,P=0.00)。
结论:在PPU患者中,腹腔镜修复与开放修复相比具有更低的死亡风险。腹腔镜修复可能是PPU患者的更好选择。
OBJECTIVE: This study aimed to compare the clinical outcomes of the clinical outcomes of laparoscopic and open sutures for peptic ulcer perforation (PPU).
METHODS: PubMed, EMBASE, and Cochrane Library databases were searched for eligible studies from inception to March 31, 2023. Odds ratios (OR) and 95% confidence intervals (Cl) were also calculated. The Newcastle-Ottawa Scale (NOS) was used to evaluate the quality of the included studies. This study was performed using the Stata (V.16.0) software.
RESULTS: A total of 29 studies involving 17,228 patients were included in this study. In terms of postoperative outcomes, the laparoscopic group had a shorter postoperative hospital stay (MD = -0.29, 95%CI = -0.44 to -0.13, P = 0.00), less blood loss (MD = -0.45, 95%CI = -0.82 to -0.08, P = 0.02), fewer wound infection (OR = 0.20, 95%CI = 0.17 to 0.24, P = 0.00), fewer pneumonia (OR = 0.59, 95%CI = 0.41 to 0.87, P = 0.01), fewer respiratory complications (OR = 0.26, 95%CI = 0.13 to 0.55, P = 0.00) and lower postoperative morbidity (OR = 0.51, 95%CI = 0.33 to 0.78, P = 0.00). The laparoscopic group had a lower mortality rate (OR = 0.36, 95%CI = 0.27 to 0.49, P = 0.00) than the open group. We also found that the laparoscopic group had a higher overall complication rate than the open group (OR = 0.45, 95%CI = 0.34 to 0.60, P = 0.00).
CONCLUSIONS: Laparoscopic repair was associated with a lower risk of mortality than open repair in patients with PPU. Laparoscopic repair may be a better option in patients with PPU.