经脐单孔与传统腹腔镜胆囊切除术随机对照试验的Meta分析

A meta-analysis on randomized clinical trials comparing single-incision with conventional laparoscopiccholecystectomy

目的评价经脐单孔和传统腹腔镜胆囊切除术的安全性和疗效。方法电子检索1997年1月至2012年4月的PubMde数据库、EMBASE、the Cochrane Controlled Trials Register、中国生物医学文献数据库。纳入比较经脐单孔与传统行腹腔镜胆囊切除术，并观察两组术中中转、术中出血、手术时间、术后并发症、切口满意度、术后疼痛和住院时间的随机对照研究。由两名评价员独立收集数据并对所得数据及试验质量进行评价，采用Cochrane协作网专用软件RevMan5．1版进行统计分析。结果共有12项试验、892例患者符合纳入标准。Meta分析结果提示：与传统腹腔镜胆囊切除术相比，经脐单孔腹腔镜胆囊切除术在术中中转（0R一0．70，95％CI：0．13～3．77，P=0．68）、术后并发症（OR=1．13，95％CI：0．72～1．78，P=0．59）和术后疼痛（WMD=-0．18，95％CI：-0．78～-0．43，P=0．57）方面差异无统计学意义。而在术中出血（WMD=l_43，95％CI：0．09～2．78，P〈0．05）、手术时间（WMD16．79，95％CI：9．05～24．52，P〈0．01）、切口满意度（WMD一1．28，95％CI：1．09～1．47，P〈0．01）和住院天数（WMD=-0．30，95％CI：-0．58～-0．02，P〈0．05）方面，差异均有统计学意义。结论分析显示，经脐单孔电视腹腔镜相比于传统多孑L电视腹腔镜胆囊切除术，虽然术中出血增多、手术时间延长，但具有术后切口满意度高、恢复快的优点。

Objectives To evaluate the eiticacy and safety of stogie-incision versus conventional laparoscopic cholecystectomy. Methods We searched electronic databases （PubMed, EMBASE, Cochrane Library, Chinese Biomedicine databases） from January 2000 to April 2012. Personal contact with experts in the field of laparoscopic cholecystectomy was performed to identify further potentially relevant clinical trials. Randomized controlled trials conducted on single-incision versus conventional Laparoscopic cholecystectomy were analysed to compare conversion rates, blood loss, operation time, postoperative complications, wound satisfaction score, postoperative pain score and postoperative duration of hospitalization. Data were extracted by two reviewers independently. Statistical analysis was performed by using the RevMan 5.1 software. Results Twelve studies involving 915 patients met the inclusion criteria. When compared with conventional laparoscopic cholecystectomy （LC）, the single- incision laparoscopic cholecystectomy （SILC） group showed no significant difference in conversion rate （0R=0.70, 95%CI： 0.13-3.77, P=0.68）, postoperative complications （OR=1.13, 95%CI, 0.72-1.78, P=0.59） and postoperative pain scores （WMD= -0. 18, 95%CI; --0. 78--0. 43, P=0.57） o There was a significant increase in operative blood loss （WMD=1. 43, 95%CI： O. 09-2.78, P^0.05）, increase in operative time （WMD：16.79, 95%CI： 9.05=24.52, P〈0.01）, but an increase in wound satisfaction score （WMD：I. 28, 95%CI.. 1.09-1.47, P〈0.01）. The postop- erative duration of hospitalization was significantly shorter （WMD= -- O. 30, 95 a.q/00 CI： -- O. 58 --0.02, P^0.05）. Conclusions Current evidence suggests that there is no significant difference in conversion rate or postoperative complications between SILC and LC. Although SILC requires a longer operative time and there is more blood loss when compared with LC, the SILC is superior in woundsatisfaction score and in duration of hospitalization.