单孔腹腔镜与传统多孔腹腔镜胆囊切除术疗效比较的Meta分析  

Efectiveness and Safety of Single-Incision Laparoscopic Cholecystectomy versus Conventional Multiport Laparoscopic Cholecystectomy:A Meta-Analysis

作　　者：谢富佳[1] 杨雀[1] 范哲林 李鑫[1] 王旭锋[1] 曹农[2] 

机构地区：[1]兰州大学第一临床医学院,兰州730000 [2]兰州大学第一医院普外一科,兰州730000

出　　处：《中国循证医学杂志》2013年第12期1455-1462,共8页Chinese Journal of Evidence-based Medicine

摘　　要：目的系统评价单孔腹腔镜与传统多孔腹腔镜胆囊切除术比较的有效性及安全性。方法计算机检索PubMed、EMbase、he Cochrane Library(2013年第1期)、CBM、CNKI、VIP及WanFang Data等数据库,查找比较单孔腹腔镜与传统多孔腹腔镜胆囊切除术的随机对照试验,检索时限均从建库至2013年1月1日。按Cochrane系统评价方法筛选文献、提取资料并评价质量后,采用RevMan 5.2软件进行Meta分析。结果最终纳入17个研究,共1 233例患者。Meta分析结果显示:相比传统多孔腹腔镜,单孔腹腔镜组的术后24 h疼痛程度更轻[SMD=–0.40,95%CI(–0.76,–0.04),P=0.03],且具有更高的术后美容评分[SMD=1.56,95%CI(0.70,2.43),P=0.000 4],但手术时间较长[MD=13.11,95%CI(7.06,19.16),P<0.000 1]。两组患者术后6 h疼痛程度、术后并发症、术后切口疝发生率及留院时间无明显差异。结论单孔腹腔镜胆囊切除术应用于胆囊良性疾病治疗是安全有效的,且其较传统多孔腹腔镜胆囊切除术有一定优势,值得临床应用。Objective To systematically review the effectiveness and safety of single-incision laparoscopic cholecystectomy （SILC） versus conventional multiport laparoscopic cholecystectomy （CMLC）. Methods We electronically searched PubMed, EMbase, The Cochrane Library （Issue 1, 2013）, CBM, CNKI, VIP and WanFang Data for randomized controlled trials （RCTs） on SILC versus CMLC from inception to January 1st, 2013. According to the Cochrane methods, the reviewers screened literature, extracted data, and assessed the methodological quality. Then, meta-analysis was performed using RevMan 5.2 software. Results Finally, 17 RCTs involving 1 233 patients were included. The results of meta-analysis showed that, compared with CMLC, SILC was lower in 24 h postoperative pain score （visual analogue scale, VAS） （SMD= –0.40, 95%CI –0.76 to –0.04, P=0.03）, higher in cosmetic results score （SMD=1.56, 95%CI 0.70 to 2.43, P=0.000 4）, and longer in operative time （MD=13.11, 95%CI 7.06 to 19.16, P〈0.000 1）. However, no significant difference was found in 6 h postoperative pain scores （VAS）, postoperative complications, port-site hernia and hospital stay between the two groups. Conclusion SILC is a safe and effective technique for the treatment of uncomplicated benign gallbladder diseases, and it has certain advantages compared with CMLC, which is recommended in clinical application.

关 键 词：胆囊切除术 单孔腹腔镜 传统多孔腹腔镜 系统评价 META分析 随机对照试验 

分 类 号：R657.4[医药卫生—外科学]