单孔与多孔腹腔镜胆囊切除术的安全性Meta分析  

Single incision versus multiport laparoscopic cholecystectomy: Meta-analysis

作　　者：郑凯欣[1] 许锐锐[1] 韩慧[1] 吴成亮[1] 陈耿臻[1] 

机构地区：[1]汕头大学医学院第二附属医院微创医学中心,515041

出　　处：《中华腔镜外科杂志（电子版）》2016年第3期146-151,共6页Chinese Journal of Laparoscopic Surgery(Electronic Edition)

基　　金：汕头大学医学院临床研究提长计划项目(201408)

摘　　要：目的系统评价经脐单孔腹腔镜胆囊切除术(SILC)与传统多孔腹腔镜胆囊切除术(CMLC)的有效性和安全性。方法计算机检索CBM、CNKI、Pub Med、EMbase、The Cochrane Library数据库,筛选截至2015年7月关于比较SILC与CMLC的随机对照试验(RCT),采用Rev Man 5.3软件进行Meta分析。结果本研究共纳入34篇RCT文献,合计2 951例患者(SICL组1 502例,CMLC组1 449例)。SILC组的手术时间长于CMLC组,差异有统计学意义[MD=11.56,95%CI(8.97,14.16),Z=8.75,P<0.000 01]。相比CMLC组,SILC组的手术转换率更高,差异有统计学意义[RR=4.01,95%CI(2.56,6.29),Z=6.06,P<0.000 01]。SILC组患者切口美容评分高于CMLC组,差异有统计学意义[SMD=1.34,95%CI(0.74,1.94),Z=4.39,P<0.000 1]。两组术中出血量、术后并发症、术后24 h疼痛评分、住院时间及恢复工作时间比较,差异无统计学意义(P>0.05)。结论SILC是一项安全有效的手术操作方式,具有更好的美容效果,但手术时间长、术中转换率高,对术者经验和手术技巧要求更高,需综合考虑选择。Objective To systematically evaluate the availability and safety of single incision versus conventional multiport laparoscopic cholecystectomy. Methods Electronical search CBM, CNKI, PubMed, EMbase, The Cochrane Library, screened for randomized controlled trials （RCT） comparing single incision laparoscopic cholecystectomy（ SILC） and conventional multiport laparoscopic cholecystectomy（ CMLC） until Jul. 2015. The RevMan5. 3 software was used for meta-analysis. Results We included 34 trials involving 2 951 pat ientsl 502 to SILC versus 1 449 to CMLC. Meta-analysis revealed that the operative time in SILC group was longer than that in CMLC group[MZ〉 = 11.56 ,95% C/（ 8.97,14.16） ,Z = 8.15 ,P 〈 0 . 00001 ] . Compared with CMLC group,SILC group was higher in conversion rate [RR =4. 01, 9 5% C /（ 2. 5 6 , 6.29 ） , Z =6. 06 〈 0.00001 ]. Furthermore,wound satisfaction score was [ SMD = 1.34,95% C /（ 0.74 ,1.94 ） ,Z =4. 39,P 〈0. 00 1. There was no significant difference between SILC group and CMLC group for blood loss, postoperative complications ,24 h postoperative pain score, hospital stay and time to return to work（P 〉 0. 05 ） . Conclusions SILC is a safe and effective surgical procedure with the advantage of a better cosmetic result. However,SILC requires surgeon,s skill and experience to reduce operative time and conversion rate.

关 键 词：胆囊切除术 经脐单孔 腹腔镜 META分析 

分 类 号：R657.4[医药卫生—外科学]