单孔腹腔镜与多孔腹腔镜在妇科手术中应用比较的Meta分析

Comparison between the application of laparoendoscopic single-site and multiport laparoscopy in gynecologic surgery:a Meta-analysis

目的探讨单孔腹腔镜在妇科手术中的应用效果及其对卵巢功能的影响。方法检索PubMed、Embase、Medline、Clinical Trials.gov、Ovid、Cochrane Library、中国知网(CNKI)、万方全文数据库、维普中文科技期刊数据库等数据库。截至2019年5月,按Cochrane系统评价要求由两名研究者独立收集、提取单孔腹腔镜治疗妇科非恶性肿瘤手术的随机对照试验(RCT)以及前瞻性对照试验数据进行Meta分析。结果共纳入17篇RCT及2篇前瞻性临床对照试验,共1905例患者。结果表明,单孔腹腔镜与多孔腹腔镜比较,手术时间(RR=7.78,95%CI:-3.72~19.28)、术中出血量(RR=-2.54,95%CI:-6.41~1.33)和术后12h VAS评分(RR=-0.09,95%CI:-0.33~0.15)比较,差异均无统计学意义(均P>0.05);术后切口满意度评分(RR=0.62,95%CI:0.06~1.17)及卵巢功能影响[FSH:(RR=-0.39,95%CI:-0.57^-0.22)和LH:(RR=-0.61,95%CI:-0.85^-0.36)]比较,差异均具有统计学意义(均P<0.05)。结论在妇科手术中应用单孔腹腔镜是安全、可行的,与多孔腹腔镜比较,患者对术后切口的满意度更高,且对卵巢储备功能影响更小。

Objective To evaluate the surgical effect of application of laparoendoscopic single-site in gynecological surgery and its effect on ovarian function.Methods According to the standard Cochrane methodology,two investigators independently collected and extracted data from randomized controlled trials(RCTs)and prospective controlled trials on laparoendoscopic single-site surgery of gynecological non-malignant tumor as of May 2019,from PUBMED,EMBASE,MEDLINE,Clinical Trials.gov,Ovid,Cochrane Library,China Knowledge Network(CNKI),Wanfang full-text database,Weipu Chinese scientific journal database and other databases.Chinese biomedical literature database,supplemented by manual search.Results A total of 17 RCTS and 2 prospective controlled clinical trials were included,involving a total of 1,905 patients.The results showed that there were no statistically significant differences in the operative time(RR=7.78,95%CI:-3.72~19.28),intraoperative blood loss(RR=-2.54,95%CI:-6.41~1.33)and postoperative VAS score(RR=-0.09,95%CI:-0.33~0.15)between laparoendoscopic single-site and multiport laparoscopy(all P>0.05).Postoperative incision satisfaction score(RR=0.62,95%CI:0.06-1.17)and ovarian function[FSH:(RR=-0.39,95%CI:-0.57^-0.22)and LH:(RR=-0.61,95%CI:-0.85^-0.36)]showed statistically significant differences(all P<0.05).Conclusions Compared with multiport laparoscopy,laparoendoscopic single-site gynecological surgery has less impact on ovarian reserve function,is safer and more feasible,and patients have higher satisfaction with postoperative incision.