经脐单孔腹腔镜与传统腹腔镜胆囊切除术有效性及安全性比较的Meta分析

Meta Analysis of the Efficacy and Safety of Ransumbilical Single-incision Laparoscopic and Conventional Laparoscopic Cholecystectomy

目的:评价经脐单孔腹腔镜与传统腹腔镜胆囊切除术治疗胆囊良性疾病有效性及安全性。方法:计算机检索Pub Med、CNKI、万方全文数据库、中国生物医学文献数据库等,检索有关经脐单孔腹腔镜与传统腹腔镜胆囊切除术治疗胆囊良性疾病的随机对照试验(RCT),在客观评价文献质量后采用Rev Man 5.0进行Meta分析。结果:共纳入15篇文献,共2039例患者。Meta分析结果显示:经脐单孔腹腔镜组在术中出血量[WMD=-1.01,95%CI=(-2.77,0.74),P=0.26]、手术总并发症发生率[RR=1.29,95%CI=(0.90,1.85),P=0.17]和术后切口感染发生率[RR=1.05,95%CI=(0.44,2.51),P=0.91]与传统腹腔镜组效果相当;评估术后胃肠功能恢复时间[SMD=-0.49,95%CI=(-0.90,-0.08),P=0.02]和患者对切口满意度[SMD=1.01,95%CI=(-0.43,1.60),P=0.0007]均优于传统腹腔镜组;而传统腹腔镜的手术时间却优于经脐单孔腹腔镜[WMD=17.21,95%CI=(12.25,22.18),P<0.0001]。结论:经脐单孔腹腔镜和传统多孔腹腔镜胆囊切除术应用于胆囊良性疾病治疗都是安全有效的,但前者较传统多孔腹腔镜有一定优势,值得临床推广应用。

Objevtive： To evaluate the efficacy and safety of ransumbilical single-incision laparoscopic and conventional laparoscopic choleeystectomy in the treatment of benign gallbladder disease.Method： PubMed, CNKI, Wanfang database and China biomedical literature database were searched, searching for randomized controlled trial（RCT） for the treatment of benign gallbladder disease by ransumbilical single-incision laparoscopic and conventional laparoscopic cholecystectomy, after the objective evaluation of literature quality, RevMan 5 was used for Meta analysis.Result： A total of 15 articles were included, and 2039 patients were included.Meta-analysis showed： the ransumbilical single-incision laparoscopic group in the intraopemtive bleeding[WMD=-1.01, 95%CI=（-2.77, 0.74）, P--0.26], total surgical complication rate[RR=1.29, 95%CI=（0.90, 1.85）, P=0.17], postoperative wound infection rate[RR=1.05, 95%CI=（0.44, 2.51）, P=0.91], the same effect as the conventional laparoscopic group.Evaluation of postoperative gastrointestinal function recovery time[SMD=-0.49, 95%CI=（-0.90, -0.08）, P=0.02]and patients＇ satisfaction with the incision[SMD=1.01, 95%CI=（-0.43, 1.60）, P=0.0007] were superior to the conventional laparoscopic group, but the conventional laparoscopic operation time was superior to the ransumbilical single-incision laparoscopic group[WMD=17.21, 95%CI=（12.25, 22.18）, P〈0.0001].Conclusion： It is safe and effective to treat benign disease by using the ransumbilical single-incision laparoscopic and conventional laparoscopic cholecystectomy, but the former has certain advantages compared with the traditional one, which is worthy of clinical application.