腹腔镜与开腹脾切除贲门周围血管离断术治疗门脉高压症的Meta分析

目的：系统评价腹腔镜与开腹行脾切除贲门周围血管离断术治疗门静脉高压症的疗效及安全性。方法：计算机检索国内外文献数据库，收集腹腔镜与开腹行脾切除贲门周围血管离断术比较研究的相关论文，根据纳入、排除标准筛选文献、提取资料并评价质量后，采用RevMan5.2软件进行Meta分析。结果：未获得随机临床对照试验，最终仅纳入11个临床对照试验，共494例患者，腹腔镜组227例，开腹组267例。Meta分析结果显示，腹腔镜组手术时间长于开腹组，腹腔镜组术中出血量、手术并发症发生率少于开腹组，腹腔镜组术后住院时间短于开腹组，腹腔镜组住院费用高于开腹组；差异均有统计学意义（均P<0.05）。结论：腹腔镜脾切除贲门周围血管离断术与开腹手术比较，具有术中出血量少、并发症发生率低等优点，但手术时间长，住院总费用高。因受纳入研究的数量和质量的影响，结果尚需谨慎对待。

Laparoscopic versus open splenectomy and esophagogastric devascularization for portal hypertension: a Meta-analysis

Objective: To evaluate the efficacy and safety of laparoscopic and open splenectomy and esophagogastric devascularization for portal hypertension by means of systematic review. Methods: The literature of studies related to laparoscopic versus open splenectomy and esophagogastric devascularization was collected by searching the national and international online databases. The articles were screened according to the inclusion and exclusion criteria. After data extraction and quality assessment, Meta-analysis was performed by using RevMan 5.2 software. Results: No randomized controlled trial was found in the literature, and 11 non-randomized controlled clinical trials were finally included, with a total of 494 patients, of whom, 227 cases underwent laparoscopic surgery (laparoscopic group) and 267 cases were subjected to open surgery (laparotomy group). Compared with laparotomy group, the results of Meta–analysis showed that in laparotomy group, the operative time was prolonged, and the intraoperative blood loss, surgical complications and length of postoperative hospital stay was reduced, but the hospitalization costs were increased. All the differences reached statistical significance (all P<0.05). Conclusion: Compared with open surgery, laparoscopic splenectomy and esophagogastric devascularization has the advantages of reduced intraoperative blood loss, postoperative hospital stay and complications, but it has increased hospitalization costs and operative time. However, this conclusion should be considered cautiously, due to limitations in the quality and quantity of the included studies.