单孔与多孔腹腔镜脾切除术比较的Meta分析

Single-incision laparoscopic surgery(SILS) vs. conventional multiport splenectomy

目的系统评价单孔腹腔镜(SILS)与传统多孔腹腔镜脾切除术的临床安全及可行性。方法计算机检索PubMed、EMbase、MEDLINE、SCI、CNKI、WanFang Data和The cochrane Library,收集单孔与多孔腹腔镜脾切除术的随机或非随机同期对照试验,检索时限截止到2012年12月。由两名评价者按照纳入与排除标准选择试验、提取资料和评价质量后,采用RevMan 5.0软件进行Meta分析。结果纳入4个非随机对照试验,共104例患者。Meta分析显示两组手术时间(MD=-1.08;95%CI=-37.24 to 35.07;P=0.95),术中出血量(MD=-88.57;95%CI=-211.48 to 34.33;P=0.16),住院天数(MD=-0.10;95%CI=-0.69 to 0.49;P=0.73)均无统计学差异。结论单孔腹腔镜脾切除术是安全、可行的。由于纳入研究数量和质量存在局限性,上述结论仍需大样本、高质量RCT进一步验证。

Objective To systematically evaluate safety and feasibly of single incision laparoscopic surgery （SILS） versus conventional mukiport splenectomy. Methods Databases including PubMed, Embase, MEDLINE, SCI, CNKI, CBM, WanFang Data and The Cochrane Library were searched to collect the randomized controlled trails （RCTs） and non-RCTs about SILS versus conventional multiport splenectomy. The retrieval time was ft＇om inception to Dec. 2012. The studies were screened according to the inclusion and exclusion criteria, the data were extracted and the quality was evaluated by 2 reviewers independently. Then the recta-analysis was conducted using RevMan 5.0 software. Results A total of 4 non-RCTs involving 104 patients were included. The results of meta-analysis showed that： There were no differences in operative time （MD = -1.08： 95% CI = -37.24 to 35.07; P = 0.95）, amount of intra- operative bleeding （MD = -88.57; 95% CI = -211.48 to 34.33; P = 0.16） and length of hospital stay （MD = -0.10; 95% CI = -0.69 to 0.49; P = 0.73）. Conclusion SILS splenectomy is safe and feasible. However, for the quantity and quality limitation of the included studies, this conclusion still requires to be further proved by performing large scale and high quality RCTs.