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目的采用Meta分析方法评价微创手术及开放手术对于先天性膈疝的治疗效果。方法计算机检索Pubmed、Cochrane、Medline、中国知网、CBM、万方数据资源系统相关文献,检索时间为2006年1月至2016年7月。根据纳入标准查找有关对比微创手术及开放手术对先天性膈疝的治疗效果的文献,由2名评价者独立选择研究、提取数据和评估方法学质量后,采用Stata 12.0软件对文献数据进行Meta分析。结果最终共纳入15项研究,共纳入病例数4 907例。开放手术在以下方面优于微创手术,其差异有统计学意义:总复发率(RR:2.69 95%CI(1.73,4.18));手术时间(SMD:1.98,95%CI(1.14,2.82))。但在随访时间大于1年的亚组分析中,复发率无统计学差异。微创手术预后在以下方面优于开放手术,其差异有统计学意义:术后死亡率(RR:0.15,95%CI(0.07,0.34));住院时间(SMD0.89,95%CI(0.55,1.23));术后机械通气时间(MD:1.78,95%CI(0.53,3.03));术后并发症的发生率(RR:0.70,95%CI(0.51,0.97))。微创手术与开放手术相比,完全肠内营养时间无明显差异。结论与开放手术相比,微创手术治疗先天性膈疝术后复发率较高、手术时间较长,但术后死亡率及并发症发生率较低。微创手术组的住院时间及术后机械通气时间均短于开放手术组。
Objective To evaluate the curative effect of minimally invasive surgery and open surgery on congenital diaphragmatic hernia by Meta-analysis. Methods Pubmed, Cochrane, Medline, CNKI, CBM and Wanfang data source system were searched by computer. The retrieval time was from January 2006 to July 2016. According to the inclusion criteria for literature on the effect of minimally invasive surgery versus open surgery on the treatment of congenital diaphragmatic hernia, two reviewers independently selected studies, extracted data, and assessed methodological quality. Meta-analysis of literature data was performed using Stata 12.0 software . As a result, a total of 15 studies were included. A total of 4 907 cases were included. Open surgery was superior to minimally invasive surgery in terms of overall recurrence rate (RR: 2.69 95% CI 1.73, 4.18); operation time (SMD: 1.98, 95% CI 1.14, 2.82) ). However, in the follow-up of more than 1 year subgroup analysis, the recurrence rate was no significant difference. The prognosis of minimally invasive surgery is superior to open surgery in the following aspects: the postoperative mortality (RR: 0.15, 95% CI 0.07, 0.34); length of stay (SMD 0.89, 95% CI 0.55 , 1.23); postoperative mechanical ventilation time (MD: 1.78, 95% CI (0.53, 3.03)); incidence of postoperative complications (RR: 0.70, 95% CI (0.51, 0.97)). Minimally invasive surgery compared with open surgery, total enteral nutrition time was no significant difference. Conclusion Compared with open surgery, minimally invasive surgery for congenital diaphragmatic hernia recurrence rate was higher, the operation time longer, but the postoperative mortality and complications were lower. The length of hospital stay and the duration of postoperative mechanical ventilation in the minimally invasive surgery group were shorter than those in the open surgery group.