腹腔镜子宫切除术治疗妇科良性疾病疗效的系统评价  

Laparoscopic Hysterectomy for Benign Gynecological Diseases: A Systematic Review

作　　者：贺红英[1] 李力[2] 陈江鸿[1] 李晶晶[1] 唐移忠[1] 钟华[1] 

机构地区：[1]广西医科大学第四附属医院,柳州545005 [2]广西医科大学附属肿瘤医院,南宁530021

出　　处：《中国循证医学杂志》2013年第1期62-69,共8页Chinese Journal of Evidence-based Medicine

摘　　要：目的系统评价腹腔镜子宫切除术治疗妇科良性疾病的疗效和安全性。方法计算机检索CENTRAL(Cochrane图书馆2012年第5期)、MEDLINE、EMbase、CNKI、WanFang Data、VIP和CBM数据库,检索时间从建库截至2012年5月,同时手工检索相关灰色文献,查找腹腔镜与开腹手术切除子宫治疗妇科良性病的随机对照试验。由2位研究者按照纳入排除标准筛选文献、提取资料并评价质量后,采用RevMan 5.1软件进行Meta分析。结果纳入22个RCT,共3 304例患者。Meta分析结果显示:与开腹术相比,腹腔镜子宫切除术的住院时间[MD=–2.31,95%CI(–3.03,–1.60),P<0.000 01]和术后恢复正常活动的时间更短[MD=–13.86,95%CI(–17.70,–10.03),P<0.000 01],术后发热及其他非特异性感染发生率更低[OR=0.72,95%CI(0.54,0.95),P=0.02],但术中泌尿系损伤发生率更高[OR=2.41,95%CI(1.21,4.82),P=0.012]且手术时间延长[MD=20.27,95%CI(3.95,36.59),P=0.03]。两组在术中肠道损伤、血管损伤、术后瘘管形成、术后排尿功能障碍及术后阴道残端感染等并发症发生率方面,其差异均无统计学意义(P>0.05)。结论本系统评价结果显示,腹腔镜子宫切除术治疗妇科良性疾病在缩短住院时间及术后恢复正常活动时间优于传统开腹手术,且术后发热及其他非特异性感染发生率更低,但术中泌尿系损伤发生率更高且手术时间更长。由于缺乏术后长期生活质量结局指标的结果,期待未来更多高质量的随机对照试验结果验证。Objective To assess the safety and effectiveness of laparoscopic hysterectomy （LH） for women with benign gynecological diseases. Methods Such databases as CENTRAL （The Cochrane Library, Issue 5, 2012）, MED- LINE, EMbase, CNKI, WanFang Data, VIP and CBM were searched from the date of their establishment to May 2012, meanwhile the relevant gray literature was also retrieved to identify the randomized controlled trials （RCTs） about LH versus abdominal hysterectomy （AH） for benign gynecological diseases. The literature was screened according to the inclusion and exclusion criteria by two reviewers independently, and the methodology quality was evaluated after extract- ing the data, then RevMan 5.1 software was used for meta-analysis. Results A total of 22 RCTs involving 3 304 patients were included. The results of meta-analysis showed that, compared with AH, LH was shorter in the time of both hospital stay （MD=-2.31, 95%CI -3.03 to -1.60, P〈0.000 01） and postoperative recovery （MD=-13.86, 95%CI -17.70 to -10.03, P〈0.000 0 t）, and lower in the incidences of both postoperative fever and other nonspecific infections （OR=0.72, 95%CI 0.54 to 0.95, P=0.02）, but it was higher in the incidence rate of intraoperative urinary systematic injuries （OR=2.41, 95%CI 1.21 to 4.82, P=0.012）, and longer in the operation time （MD=20.27, 95%CI 3.95 to 36.59, P=0.03）. There were no significant differences between the two groups in the incidence of complications such as intraoperative intestinal injuries, vessel injuries, postoperative fistulizaion, postoperative urethral dysfunction, postoperative vaginal infection, etc. （P〉0.05）. Conclusion This systematic review shows when treating benign gynecological diseases, LH is superior to AH in shortening the time of hospital stay and postoperative recovery, and in decreasing the incidence of operative fever and other nonspecific infections, but it results in a higher incidence of intraoperative urinary systematic injuries and longer operative time.

关 键 词：腹腔镜子宫切除术 开腹子宫切除术 妇科良性疾病 META分析 系统评价 随机对照试验 

分 类 号：R713[医药卫生—妇产科学]