机器人辅助腹腔镜子宫肌瘤剔除术与腹腔镜子宫肌瘤剔除术比较的Meta分析

Comparioson between robotic-assisted laparoscopic myomectomy and laparoscopic myomectomy:a Meta analysis

目的:通过Meta分析综合比较机器人子宫肌瘤剔除术和腹腔镜子宫肌瘤剔除术的有效性与安全性,为临床治疗与后续的研究提供依据。方法:计算机检索Embase、Pub Med、Web of Science、Cochrane Library Databases、中文科技期刊数据库(VIP)、中国期刊全文数据库(CNKI)、中国生物医学文献数据库(CBM)、万方数字化期刊全文数据库和google学术,检索时限均从建库到2015年6月。由两位研究者按照纳入与排除标准独立筛选文献、提取资料和评价纳入研究的质量后,采用Review Manager5.3和Stata 11.2进行Meta分析。结果:共纳入9项研究,涉及1000例患者接受了机器人辅助腹腔镜子宫肌瘤剔除手术或腹腔镜子宫肌瘤剔除手术。Meta分析显示RALM与LM相比,术中失血量(WMD=-34.66,95%CI=-63.55^-5.78,P=0.020)、中转开腹率(OR=0.34,95%CI=0.13~0.88,P=0.030)、并发症发生率(OR=0.52,95%CI=0.32~0.85,P=0.009)明显降低,输血人数、住院时间、手术时间和最大肌瘤直径没有明显差异。结论:RALM比LM更安全、更有效。RALM相比LM,术中失血量显著降低、中转开腹率和并发症发生率显著减少,输血人数、手术时间、住院时间和最大肌瘤直径没有明显差异。

Objective ：To compare the relative merits between robotic-assisted laparoscopic myomectomy and laparoscopic myomectomy by conducting a meta-analysis to provide the basis for clinical treatment of uterine fibroids. Methods：Embase, PubMed, Web of Sci- ence, Cochrane Library databases, VIP, CNKI, Chinese biomedical literature database, Wanfang digital journals database and google scholar were searched from the built of the databases to June 2015 by computer. Literature screening, data extraction and quality assessment were applied independently by two reviewers, and then statistical analysis and publication bias test were made with Re- view Manager 5.3 and Stata 11.2. Dichotomousvariables were presented by pooled odds ratios with 95% confidence intervals and con- tinuous variables were presented by weighted mean differences with 95% confidence intervals. Results：Nine studies were included in the meta-analysis. These studies involved a total of 1 000 patients who underwent both robotic-assisted laparoscopic myomectomy and laparoscopic myomectomy. Estimated blood loss （WMD=-34.66,95%CI= -63.55 to -5.78, P=0.020）, the number of conversions （OR = 0.34,95%CI=0.13 to 0.88,P=0.030） and the number of complications （OR=0.52,95%CI=0.32 to 0.85, P=0.009） were significantly lower in robotic-assisted laparoscopic myomectomy and the number of transfusions, the length of hospital stay , operating time and the size of the largest fibroids were not significant different between robotic-assisted laparoscopic myomectomy and laparoscopic myomectomy. Conclusion：Robotic-assisted laparoscopie my- omectomy is safer and more reliable than laparoscopic my- omectomy for patients with uterine fibroids. Robotic-assisted la- paroscopic myomectomy is associated with significantly lowered intra-operative blood loss, number of conversions and complications than laparoscopic myomectomy. There is no significant difference between robotic-assisted laparoscopic myomectomy and laparoscopic myomectomy concerning length of hospital stay,operating time, number of transfusions and the diameter of the largest fibroids.