腹腔镜阑尾切除术残端夹闭与缝合包埋疗效的Meta分析

目的系统评价腹腔镜阑尾切除术残端直接夹闭与缝合包埋的疗效与安全性。 方法计算机检索Pubmed、Embase、Web of Science、Clinical Trail、Cochrane Library、中国生物医学文献数据库、万方数据库、中国知网、维普期刊数据库，收集腹腔镜阑尾切除术残端夹闭与缝合包埋相关的随机对照试验（RCT），检索时限为建库起至2020年1月，对符合纳入标准的研究进行资料提取及质量评价后行荟萃分析。 结果共纳入14项RCT 1 739例患者，两种方法的术后胃肠功能恢复时间无明显统计学差异（MD=-0.61，95% CI：-1.93~0.70，P=0.36），但应用直接夹闭法处理阑尾残端较缝合包埋法有手术时间短（MD=-14.81，95% CI：-17.20~-12.43，P<0.001）、术中出血量少（MD=-3.54，95% CI：-4.79~-2.29，P<0.001）、总住院时间短（MD=-0.38，95% CI：-0.68~-0.09，P=0.01）及术后住院时间短（MD=-0.20，95% CI：-0.38~-0.03，P=0.02）、术后并发症少（RR=0.70，95% CI：0.50~0.98，P<0.05）的优势；而缝合包埋法有住院费用低的优点（MD=2.84，95% CI：1.56~4.12，P<0.001）。 结论腹腔镜阑尾切除术残端采用直接夹闭法与缝合包埋法各有优势，对于阑尾残端条件好的患者，直接夹闭法可做首选。应综合考虑内外在因素，个性化进行方案选择和处理。

Direct clamping vs suture embedding of the appendiceal stump in laparoscopic appendectomy: A systematic review and Meta-analysis

ObjectiveTo systematically evaluate the effects of direct clamping and suture embedding in laparoscopic appendectomy, and to provide evidence-based reference for clinical treatment. MethodsPubmed, Embase, Web of Science, Clinical Trail, Cochrane Library, CBM, WanFang, CNKI and VIP databases were searched, the retrieval period was from the establishment of the database to January 2020. Relevant randomized controlled trials (RCT) of laparoscopic appendectomy using stump clipping and suture embedding were collected, and Meta-analysis was conducted after data extraction and quality evaluation of the studies meeting the inclusion criteria. ResultsA total of 1 739 patients in 14 RCTs were included. There was no significant difference in the recovery time of gastrointestinal function between the two methods (MD=-0.61, 95% CI: -1.93 to 0.70, P=0.36). However, compared with the suture embedding method, the direct clamping method had the advantages of shorter operation time (MD=-14.81, 95% CI:-17.20 to -12.43, P<0.001), less intraoperative bleeding (MD=-3.54, 95% CI: -4.79 to -2.29, P<0.001), shorter total hospital stay (MD=-0.38, 95% CI: -0.68 to -0.09, P=0.01) and postoperative hospital stay (MD=-0.20, 95% CI: -0.38 to -0.03, P=0.02), and less postoperative complications (RR=0.70, 95% CI: 0.50 to 0.98, P<0.05). Suture embedding method had the advantages of reducing hospital costs (MD=2.84, 95% CI: 1.56 to 4.12, P<0.001). ConclusionsThere are respective advantages in clipping the appendix stump and suturing the embedded stump during laparoscopic appendectomy. For patients with good condition of appendix stump, direct clipping can be the first choice. The choice of treatment plan and final decision should be based on the comprehensive consideration of the internal and external factors.