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目的分析急性胆囊炎患者腹腔镜手术时机选择与临床效果的关系。方法采用计算机文献检索和手动搜索方法,收集近年来国内外发表的有关急性胆囊炎患者行腹腔镜手术时机选择方案的文献,采用随机效应模型对其行Meta分析。对文献质量进行评价,然后采用Rev Man 5.0.21软件统计计算有关手术时机选择和手术时间、术中出血量及术后并发症发生情况的RR值和95%CI。结果共纳入13篇文献进行Meta分析,中文8篇,英文5篇,共包含病例2535例,其中早期手术组1401例,延迟手术组1134例,有10篇为低偏倚风险,有3篇为中偏倚风险。随机效应模型Meta分析显示早期手术组手术时间较延迟手术组明显缩短(P=0.00,RR=-20.25,95%CI=-24.97~15.33),术中出血量也明显减少(P=0.00,RR=-12.58,95%CI=-29.36~5.78),术后并发症也显著减少(P=0.00,RR=0.63,95%CI=0.47~0.84)。结论急性胆囊炎患者于发病72小时内采用腹腔镜手术治疗不仅可以缩短手术时间,减少术中出血量,对减少术后并发症也有显著作用。
Objective To analyze the relationship between the timing of laparoscopic surgery and clinical outcome in patients with acute cholecystitis. Methods The computer literature search and manual search methods were used to collect the literature about the timing options of laparoscopic surgery in patients with acute cholecystitis published in recent years at home and abroad. Meta-analysis was performed using random effects model. The quality of the literature was evaluated, and then Rev Man 5.0.21 software was used to calculate the RR and 95% CI of timing and timing of surgery, intraoperative blood loss and postoperative complications. Results A total of 13 articles were included in the meta-analysis. There were 8 articles in Chinese and 5 in English. A total of 2535 cases were included, of which 1401 cases were in the early operation group and 1134 in the delayed operation group, 10 were at low risk of bias and 3 were in the middle Risk of bias. Meta-analysis of random effects model showed that the operation time of the early operation group was significantly shorter than that of the delayed operation group (P = 0.00, RR = -20.25, 95% CI = -24.97 ~ 15.33) = -12.58, 95% CI = -29.36 ~ 5.78), postoperative complications were also significantly reduced (P = 0.00, RR = 0.63, 95% CI = 0.47 ~ 0.84). Conclusions Acute cholecystitis patients using laparoscopic surgery within 72 hours of onset can not only shorten the operation time and reduce the amount of intraoperative bleeding, but also reduce the postoperative complications.