单孔腹腔镜与传统多孔腹腔镜结肠切除术对比的荟萃分析  

Meta-analysis of single-incision laparoscopic colectomy versus conventional multiport laparoscopic colectomy

作　　者：于晓天[1] 鱼海峰[1] 蒋超[1] 张楷[1] 张淼[1] 张云[1] 

机构地区：[1]江苏大学附属宜兴医院普通外科,江苏宜兴214200

出　　处：《外科理论与实践》2013年第4期369-375,共7页Journal of Surgery Concepts & Practice

摘　　要：目的:比较单孔腹腔镜与传统多孔腹腔镜结肠切除手术的有效性和安全性,探讨单孔腹腔镜结肠切除术的潜在优势及应用价值。方法:检索PubMed、Embase、the Cochrane Library数据库公开发表的单孔腹腔镜与传统多孔腹腔镜结肠切除术比较的研究文献。采用RevMan 5.0统计软件,合并及比较两者手术时间、术中出血量、中转开腹和(或)增加穿刺孔率、术后并发症发生率、住院时间等,选择计算相对危险度(RR)和均数差值(MD)作为效应尺度指标来评估两种手术方式的有效性及安全性。结果:18项研究符合纳入标准,共计1 220例病人。本项荟萃分析结果表明实施单孔腹腔镜结肠切除术的病人术中出血少(合并MD为-20.25,95%CI:-39.25^-1.24,P=0.04)、住院时间短(合并MD为-0.38,95%CI:-0.63^-0.13,P=0.002),而在手术时间(合并MD为3.90,95%CI:-2.45~10.24,P=0.23)、中转开腹和(或)增加穿刺孔率(合并RR为1.67,95%CI:0.96~2.91,P=0.07)、术后并发症发生率(合并RR为0.89,95%CI:0.69~1.14,P=0.36)方面两者没有统计学差异。结论:单孔腹腔镜结肠手术安全可行、有效,与传统多孔腹腔镜具有相似的手术疗效,且在手术创伤和术后恢复方面,单孔腹腔镜结肠切除术更具优势。Objective Investigate the potential advantages and application value of SILC by comparing single- incision laparoscopic colectomy （SILC） with conventional multiport laparoscopic colectomy （CMLC）. Methods The relevant literatures comparing SILC with CMLC were searched through PubMed, Embase and the Cochrane Library. Operative time, blood loss, the rate of conversion to open or additional port, the rate of postoperative complications, and length of stay were pooled and compared using RevMan 5.0 software. The risk ratios and their 95% confidence intervals were calculated to evaluate the safety and efficacy of each technique. Results A total of 1 220 patients in 18 studies were reviewed and the data were pooled for analysis. Patients undergoing SILC had less blood loss （pooled mean difference=-20.25; 95% CI： -39.25 to -1.24; P=0.04）, shorter length of stay （pooled mean difference=-0.38; 95% CI： -0.63 to -0.13; P=0.002）. No significant difference was present in operative time （pooled mean difference=3.90; 95% CI： -2.45 to 10.24; P=0.23）, the rate of conversion to open surgery/adding ports （pooled risk ratios=1.67; 95% CI： 0.96 to 2.91; P=0.07） or the rate of postoperative complications （pooled risk ratios=0.89; 95% CI： 0.69 to 1.14; P=0.36）. Conclusions SILC appears to have comparable results to CMLC. It has the relative benefits on surgical trauma, and postoperative recovery over CMLC.

关 键 词：单孔腹腔镜 传统多孔腹腔镜 结肠切除术 荟萃分析 

分 类 号：R656.9[医药卫生—外科学]