保守治疗与早期阑尾切除术对阑尾周围脓肿疗效比较的Meta分析

目的:通过 Meta分析评价保守治疗与早期阑尾切除术对阑尾周围脓肿的临床疗效及安全性。方法:根据PRISMA，检索SinoMed、PubMed、Web of Science、MEDLine、Wiley Online、EMBASE和Cochrane 图书馆中2000-2019年收录的保守治疗与早期阑尾切除术治疗阑尾周围脓肿的相关文献，评价两组并发症发生率、总住院时间等13个指标。采用RevMan 5.3 软件进行Meta分析。结果:最终共纳入15篇相关文献，其中保守治疗（CT）组645例，早期阑尾切除术（EA）组471例。Meta分析结果显示，两组的年龄、体重、白细胞、C反应蛋白、脓肿最大直径、再入院率和总住院时间相比，差异无统计学意义（均P＞0.05）；支持保守治疗的结局指标是禁食时间（WMD=-1.21，95%CI:-1.85～-0.57，P=0.000 2）、并发症发生率（OR=0.08，95%CI:0.03～0.23，P＜0.000 01）、脓肿复发率（OR=0.16，95%CI:0.07～0.35)，P＜0.000 01）。支持早期阑尾切除的结局指标是病程（WMD=-1.61，95%CI:0.66~2.56，P=0.000 9）和阑尾炎复发率（OR=23.47，95%CI:5.72～96.32，P＜0.000 1）。另外，择期手术比早期手术时间短（WMD=-19.06，95%CI:-33.61～-4.52，P=0.01），术后并发症发生率低（OR=0.26，95%CI:0.07~0.94，P=0.04），两者的住院时间没有差异（WMD=0.91，95%CI:-5.85～7.68，P=0.79）。结论:保守治疗阑尾周围脓肿能明显减少并发症和脓肿复发的发生率，并且能明显缩短择期手术的手术时间和术后禁食时间，加速患者康复，具有一定的安全性和有效性。

Conservative treatment versus early appendectomy for patients with periappendiceal abscess: a Meta-analysis

Objective: To evaluate the efficacy and safety of conservative treatment (CT) versus early appendectomy (EA) for patients with periappendiceal abscess(PA) through meta-analysis. Methods:Adhered to the PRISMA guidelines, SinoMed, PubMed, Web of Science, MEDLine, Wiley Online Library, EMBASE and the Cochrane Library databases were searched from 2000 to 2019 comparing CT with EA for PA. Thirteen indicators, such as complication rate and total hospital stay were evaluated. Meta analyses were performed using RevMan 5.3. Results: Fifteen studies were selected for meta-analysis, including 645 cases in the conservative treatment (CT) group and 471 cases in the early appendectomy(EA) group. No significant difference was found in age, weight, WBC, CRP, maximum size of abscess, readmission and total hospital stay between the two groups(all P＞0.05). Outcomes favoring CT group were oral feeding time（WMD=-1.21, 95%CI:-1.85--0.57, P=0.000 2）,complication rate（OR =0.08, 95%CI:0.03-0.23, P<0.000 01）and abscess recurrence（OR=0.16, 95%CI: 0.07-0.35, P<0.000 01）. Outcomes favoring EA group were duration of symptoms（WMD=-1.61, 95%CI:0.66-2.56, P=0.000 9）and appendicitis recurrence（OR =23.47, 95%CI:5.72-96.32, P＜0.000 1）. Besides, the time of interval appendectomy is shorter than early appendectomy（WMD=-19.06, 95%CI:-33.61--4.52, P=0.01）， postoperative complications of interval appendectomy was lower（OR=0.26, 95%CI:0.07-0.94, P=0.04）, there was no difference in total hospital stay （WMD=0.91, 95%CI:-5.85-7.68, P=0.79）. Conclusion:Conservative treatment of periappendicular abscess can significantly reduce the incidence of complications and abscess recurrence, and can significantly shorten the operation time and postoperative feeding time of interval surgery, accelerate the recovery of patients, with a certain safety and effectiveness.