单孔与传统腹腔镜胆囊切除术的比较:随机对照试验的Meta分析

Single-incision laparoscopic cholecystectomy versus conventional laparoscopic cholecystectomy: a Meta-analysis of randomized controlled trials

目的：评价单孔腹腔镜胆囊切除术（SILC）与传统腹腔镜胆囊切除术（CLC）的安全性和有效性。方法：计算机检索各数据库中有关SILC与CLC的前瞻性随机对照试验。检索时限均为建库至2012年11月。按Cochrane系统评价员手册对纳入文献的方法学质量进行评价后，提取数据，采用RevMan5．1统计软件行Meta分析。结果：筛选后最终纳入17个研究，共1267例患者，其中SILC组654例，CLC组613例。Meta分析结果显示，手术时间SILC组长于CLC组（WMD=13．02，95％CI=7．95—18．09，P〈0．001）；术后切口外观评分和患者满意度评分SILC组优于CLC组（WMD=1．21，95％CI=0．70～1．72，P〈0．001；WMD=O．76，95％CI=0．53～1．00，P〈0．001）；术后并发症、术后疼痛评分和住院时间两组间差异无统计学意义（RR=1．13，95％CI=0．87～1．48，P=0．35；WMD=O．03，95％CI=-0．82～0．88，P=0．95；WMD=-0．06，95％CI=-0．40～0．28，P=0．73）。结论：对于治疗非复杂性的胆囊良性疾病，SILC是一项安全而有效的手术操作；它具有良好的切口外观和患者满意的优点。

Objective： To evaluate the efficiency and safety of single-incision laparoscopic cholecystectomy （SILC） and conventional laparoscopic cholecystectomy （CLC）. Methods： The literature of randomized controlled trials （RCTs） concerning SILC versus CLC was retrievedby searching the electronic databases from their inception date to November 2012. Methodological quality of the included trials was assessed using the Cochrane Reviewers＇ Handbook criteria, and data were extracted and combined into a Meta-analysis by using RevMan 5.1 analysis software. Results： Seventeen studies were finally selected after screening, with a total of 1 267 patients, of whom, 654 cases underwent SILC and 613 cases underwent CLC. Meta-analysis results demonstrated that the operative time in SILC group was longer than that in CLC group （WMD=13.02, 95%CI=7.95-18.09, P〈0.001）; the scores for the postoperative appearance of incision and patient-satisfaction in SILC group were higher than those in CLC group （WMD=I.21, 95%CI=0.70-1.72, P〈0.001; WMD=0.76, 95%CI=0.53-1.00, P〈0.001）; the postoperative complications, postoperative pain scores and lengths of hospital stay between the two group showed no statistical difference （RR=I.13, 95%CI=0.87-1.48, P=0.35; WMD=O.03, 95%CI=-0.82-0.88, P=0.95; WMD=-O.06, 95%CI=-0.40-0.28, P=0.73）. Conclusion： For uncomplicated cases of benign gallbladder disease, SILC is a safe and effective surgical procedure with the advantages of a good cosmetic incision and high patient satisfaction.