经阴道自然腔道内镜手术与经脐单孔腹腔镜手术在妇科良性疾病中应用比较的Meta分析

Meta-analysis of Transvaginal Natural Orifice Transluminal Endoscopic Surgery Versus Laparoendoscopic Single-Site Surgery for Benign Gynaecological Diseases

目的:比较经阴道自然腔道内镜手术(V-NOTES)与经脐单孔腹腔镜手术(LESS)在妇科良性疾病中应用的安全性、可行性。方法:检索the Cochrane Library、Embase、Web of science、Pubmed、中国知网(CNKI)、中国生物医学文献服务系统(CBM)、万方全文数据库等,检索时间截至2021年4月。纳入所有关于对比V-NOTES和LESS治疗妇科良性疾病的随机对照研究、队列研究、病例对照研究,2名研究员独立完成文献检索与筛选、数据提取、质量评价。随机对照研究采用Jadad量表进行文献质量评价,队列研究和病例对照研究运用纽卡斯尔—渥太华量表(NOS)评价标准。使用RevMan5.4.1软件进行Meta分析。结果:共纳入2篇随机对照研究,1篇回顾性队列研究,4篇回顾性病例对照研究,共846例患者。结果表明,V-NOTES组与LESS组相比,手术时间(MD-2.89,95%CI-10.10~4.31,P=0.43)、术中出血量(MD-1.26,95%CI-4.86~2.34,P=0.49)、术后血红蛋白变化值(MD 1.25,95%CI-1.83~4.33,P=0.43)、住院费用(MD-253.73,95%CI-571.42~63.97,P=0.12)、术后住院时间(MD-0.14,95%CI-0.41~0.13,P=0.31)、手术并发症(OR 1.57,95%CI 0.71~3.48,P=0.26)等比较差异无统计学意义。术后排气时间(MD-6.14,95%CI-8.13~-4.15,P<0.00001)、疼痛评分(MD-1.31,95%CI-1.52~-1.11,P<0.00001)、美容评分(MD 1.69,95%CI 0.37~3.00,P=0.01)等比较,差异均有统计学意义。结论:妇科良性疾病中V-NOTES途径及LESS途径均安全可行,与LESS手术相比,V-NOTES疼痛程度更轻,排气时间更短,更符合ERAS理念,且有更佳的无痕美容效果。

Objective:To study the safety and feasibility of benign Gynaecological diseases by Transvaginal natural orifice transluminal endoscopic surgery(V-NOTES)and Laparoendoscopic single site surgery(LESS).Methods:Literature were retrieved from Pubmed,the Cochrane Library,Embase,Web of science,CNKI,the Chinese Biomedicine(CBM),and Wanfang Data published up to April 2021.All randomized controlled trials(RCTs),cohort studies,and case-control studies comparing V-NOTES and LESS in the treatment of gynecological benign diseases were included,and the two researchers independently completed literature retrieval and screening,data extraction,and quality evaluation.The Jadad scale was used for literature quality evaluation in randomized controlled trials,and Newcastle-Ottawa Scale were used in cohort studies and case-control studies.Meta-analysis was performed using RevMan5.4.1.Results:A total of 846 patients were included in 2 RCTs,1 retrospective cohort study and 4 retrospective case-control studies.The results showed that there were no significant differences in the operating time(MD-2.89,95%CI-10.10-4.31,P=0.43),bleeding volume(MD-1.26,95%CI-4.86-2.34,P=0.49),hemoglobin change value(MD 1.25,95%CI-1.83-4.33,P=0.43),hospital costs(MD-253.73,95%CI-571.42-63.97,P=0.12),the length of postoperative hospital stays(MD-0.14,95%CI-0.41-0.13,P=0.31),and complications(OR 1.57,95%CI 0.71-3.48,P=0.26).Statistically significant differences were observed in postoperative exhaust time(MD-6.14,95%CI-8.13--4.15,P<0.00001),pain score(MD-1.31,95%CI-1.52--1.11,P<0.00001),and cosmetic score(MD 1.69,95%CI 0.37-3.00,P=0.01).Conclusions:Both V-NOTES and LESS in gynecological benign diseases were safe and feasible.Compared with LESS,V-NOTES had milder pain and shorter exhaust time,which was more in line with ERAS conception,and has better traceless cosmetic effect.