【摘要】 目的系统评价阑尾切除术与抗生素比较治疗急性单纯性阑尾炎的疗效和安全性。方法计算机检索Pub Med、EMbase、The Cochrane Library(2016年8期)、Web of Science、CBM、Wan Fang Data和CNKI数据库,搜集关于阑尾切除术与抗生素比较治疗急性单纯性阑尾炎的随机对照试验(RCT),检索时限均从建库至2016年9月。由两位评价员独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用Rev Man 5.3软件进行Meta分析。结果最终纳入10个RCT,包括2 028例患者。Meta分析结果显示:与抗生素治疗单纯性急性阑尾炎相比,阑尾切除术能缩短住院时间[MD=–1.89,95%CI(–2.75,–1.04),P<0.000 01]、抗生素使用时间[MD=–4.42,95%CI(–5.06,–3.79),P<0.000 01],提高有效率[OR=23.48,95%CI(7.99,68.96),P<0.000 01],降低复发率[OR=0.02,95%CI(0.01,0.05),P<0.000 01];但在并发症发生率方面,两组差异无统计学意义[OR=1.35,95%CI(0.31,5.87),P=0.69]。结论现有证据表明,与抗生素相比,阑尾切除术治疗单纯性阑尾炎能缩短住院时间、抗生素使用时间,提高有效率,降低复发率,但两种治疗方式在治疗并发症发生率方面无显著差异。受纳入研究质量的限制,上述结论尚需开展更多高质量的研究予以验证。更多还原

【Abstract】 Objective To systematically review the effectiveness of appendicectomy versus antibiotics for uncomplicated acute appendicitis(UAA). Methods Databases including Pub Med, EMbase, The Cochrane Library(Issue8, 2016), Web of Science, CBM, Wan Fang Data and CNKI were searched to collect randomized controlled trials(RCTs)about appendicectomy versus antibiotics for uncomplicated acute appendicitis from inception to September 2016. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. Then metaanalysis was performed using Rev Man 5.3 software. Results A total of 10 RCTs studies involving 2 028 patients were included. The results of meta-analysis showed that, compared with antibiotics, the appendicectomy could shorten duration of hospital stay(MD=–1.89, 95%CI –2.75 to –1.04, P<0.000 01), the therapeutic time of antibiotics(MD=–4.42,95%CI –5.06 to –3.79, P<0.000 01), improve the efficiency of clinical treatment(OR=23.48, 95%CI 7.99 to 68.96, P<0.000 01),decrease the recurrence rate(OR=0.02, 95%CI 0.01 to 0.05, P<0.000 01), however, there was no significant difference in the incidence of postoperative complications between two groups(OR=1.35, 95%CI 0.31 to 5.87, P=0.69). Conclusion The current evidence shows that, compared with antibiotics, the appendicectomy for uncomplicated acute appendicitis can shorten duration of hospital stay and the therapeutic time of antibiotics, improve the efficiency of clinical treatment,decrease the recurrence rate. Due to the limited quality of included studies, more high quality studies are needed to verify the above conclusion.更多还原