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目的评价腹腔镜下和开腹阑尾切除术治疗国内老年急性阑尾炎的疗效及安全性。方法计算机检索CBM(1978～2011年)和CNKI(1979～2011年)及手工检索发表的资料和会议论文并追索纳入文献的参考文献,查找比较腹腔镜下和开腹阑尾切除术治疗国内老年急性阑尾炎的相关病例-对照试验。对纳入研究进行方法学质量评价之后,采用RevMan 5.1软件进行Meta分析。结果共纳入7个国内相关病例-对照研究,合计527例患者。Meta分析结果表明:腹腔镜下与开腹阑尾切除术治疗老年急性阑尾炎相比,术后第1次下床时间、术后第1次排气时间、术后出现切口感染、术后住院天数、住院花费等比较差异有统计学意义,而在手术时间方面比较差异无统计学意义。结论腹腔镜下行阑尾切除术治疗国内老年急性阑尾炎的疗效及安全性优于开腹阑尾切除术。由于纳入研究数量少,加之质量普遍较低,上述结论尚需开展更多设计合理、执行严格的多中心大样本且随访时间足够的随机对照试验加以验证。
Objective To evaluate the efficacy and safety of laparoscopic and open appendectomy in the treatment of acute appendicitis in the elderly in China. Methods CBM (1978-2011) and CNKI (1979-2011) were searched by computer. The published papers and conference papers were searched by hand and the references included in the literature were retrieved. The comparative analysis of laparoscopic and open appendectomy for the elderly Related cases of acute appendicitis - controlled trials. Meta-analysis was performed using RevMan 5.1 software after evaluating the methodological quality of the included studies. Results A total of 7 domestic related case-control studies were included, totaling 527 patients. Meta analysis showed that laparoscopic appendectomy compared with open appendectomy in elderly patients with acute appendicitis, the first bed time after surgery, the first postoperative exhaust time, postoperative incision infection, postoperative hospital stay, Hospitalization costs and other differences were statistically significant, but no significant difference in the operation time. Conclusion The efficacy and safety of laparoscopic appendectomy for the treatment of acute appendicitis in the elderly in our country is better than that of appendectomy. Due to the small number of studies included, together with the generally lower quality, the above conclusion still needs to be verified by more well-designed and well-executed multi-center large sample and follow-up randomized controlled trials.