经阴道自然腔道内镜与经脐单孔腹腔镜全子宫切除术的Meta分析

Meta-analysis of Transvaginal Natural Orifice Transluminal Endoscopy and Transumbilical Laparoendoscopic Single-site Surgery for Total Hysterectomy

目的 系统评价经阴道自然腔道内镜(vNOTES)与经脐单孔腹腔镜(LESS)全子宫切除术的有效性与安全性。方法 检索中国生物医学文摘数据库(CBM)、万方全文数据库、中国知网全文数据库(CNKI)、PubMed、EMbase、The Cochrane Library等电子数据库,收集比较vNOTES和LESS对于子宫切除术的效果的临床对照试验,检索时间均为建库至2022年10月。由2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RevMan 5.3进行Meta分析。结果 最终纳入9篇文献,共955例患者。vNOTES组手术时间短于LESS组(MD=-13.11,95%CI:-19.09~-7.12,P<0.05);vNOTES组术后排气时间短于LESS组(MD=-14.11,95%CI:-20.06~-8.17,P<0.05);vNOTES组VAS评分低于LESS组(MD=-0.60,95%CI:-1.04~-0.17,P<0.05);vNOTES组住院时间短于LESS组(MD=-0.75,95%CI:-1.31~-0.20,P<0.05);但v NOTES组与LESS组术中出血量(MD=1.09,95%CI:-1.23~3.42,P>0.05)、HGB下降水平(MD=-1.08,95%CI:-2.39~0.23,P>0.05)以及并发症发生率(MD=0.70,95%CI:0.35~1.39,P>0.05)比较,差异无统计学意义。结论 v NOTES全子宫切除术较LESS具有体表不留痕、手术时间短、术后疼痛轻、恢复快的优势,但在术中出血量与手术并发症方面未表现出优势。

Objective To systematically evaluate the efficacy and safety of transvaginal natural orifice transluminal endoscopy surgery(vNOTES)and transumbilical laparoendoscopic single-site surgery(LESS)for total hysterectomy.Methods Electronic databases such as CBM,Wanfang,CNKI,PubMed,Embase and The Cochrane Library were searched to collect clinical controlled trials comparing the effects of vNOTES and LESS on hysterectomy.The retrieval time was from the establishment of the database to October 2022.Two reviewers independently screened literature according to the inclusion and exclusion criteria,extracted data,and evaluated the quality of included studies.Meta-analysis was performed using RevMan 5.3.Results A total of 9 articles involving 955 patients were included.The operation time of vNOTES group was shorter than that of LESS group(MD=-13.11,95%CI:-19.09 to-7.12,P<0.05);postoperative exhaust time in vNOTES group was shorter than that in LESS group(MD=-14.11,5%CI:-20.06 to-8.17,P<0.05);the VAS score in vNOTES group was lower than that in LESS group(MD=-0.60,95%CI:-1.04 to-0.17,P<0.05);the length of hospital stay in vNOTES group was shorter than that in LESS group(MD=-0.75,95%CI:-1.31 to-0.20,P<0.05).However,there was no significant difference in intraoperative blood loss(MD=1.09,95%CI:-1.23 to 3.42,P>0.05),HGB decrease(MD=-1.08,95%CI:-2.39 to 0.23,P>0.05)and complication rate(MD=0.70,95%CI:0.35 to 1.39,P>0.05)between vNOTES group and LESS group.Conclusion Compared with LESS,vNOTES has the advantages of no scar on the body surface,shorter operation time,less postoperative pain and faster recovery,but it has no advantages in intraoperative blood loss and surgical complications.