Securing the appendiceal stump in laparoscopic appendectomy: evidence for routine stapling?
Securing the appendiceal stump in laparoscopic appendectomy: evidence for routine stapling?
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DOI：
10.1007/s00464-005-0525-7
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发表时间：
2006-09-01
影响因子：
3.1
通讯作者：
Sauerland, S.
中科院分区：
文献类型：
--
作者：
Kazemier, G.;in't Hof, K. H.;Sauerland, S.
背景资料：本荟萃分析旨在比较内镜直线吻合和环结扎用于确保基础的appendic.Methods：随机对照试验阑尾残端闭合在腹腔镜阑尾切除术进行了系统的搜索和严格的评价。并发症发生率，手术时间和住院时间方面的结果汇总了标准的荟萃分析techniques.Results：427例患者的数据从四个研究。使用线圈时，手术时间延长9分钟（p = 0.04）。当阑尾残端用斯台普斯而不是线圈固定时，浅表伤口感染（比值比[OR]，0.21; 95%置信区间（CI），0.06-0.71; p = 0.01）和术后肠梗阻（OR，0.36; 95% CI，0.14-0.89; p = 0.03）的发生率显著降低。在10例术中阑尾破裂中，有7例发生在使用袢治疗的患者中（p = 0.46）。术后腹腔内脓肿的住院时间和频率也可比环治疗和吻合器治疗patients.Conclusions：临床证据残端闭合方法在腹腔镜阑尾切除术有利于常规使用内镜吻合器。
Background: This metaanalysis aimed to compare endoscopic linear stapling and loop ligatures used to secure the base of the appendix.Methods: Randomized controlled trials on appendix stump closure during laparoscopic appendectomy were systematically searched and critically appraised. The results in terms of complication rates, operating time, and hospital stay were pooled by standard metaanalytic techniques.Results: Data on 427 patients from four studies were included. The operative time was 9 min longer when loops were used (p = 0.04). Superficial wound infections (odds ratio [OR], 0.21; 95% confidence interval (CI), 0.06-0.71; p = 0.01) and postoperative ileus (OR, 0.36; 95% CI, 0.14-0.89; p = 0.03) were significantly less frequent when the appendix stump was secured with staples instead of loops. Of 10 intraoperative ruptures of the appendix, 7 occurred in loop-treated patients (p = 0.46). Hospital stay and frequency of postoperative intraabdominal abscess also were comparable in loop-treated and staple-treated patients.Conclusions: The clinical evidence on stump closure methods in laparoscopic appendectomy favors the routine use of endoscopic staplers.