经腹腔镜子宫肌瘤剔除术与阴式子宫肌瘤剔除术治疗子宫肌瘤临床效果比较的Meta分析  

Clinical efficacy of parasternal versus laparoscopic surgery for uterine myomectomy:A Meta analysis

作　　者：刘懿 张旭梅[2] 柳露[2] 邓琦[2] 李芹[2] 马茜[2] 胡彬 刘慧芳 LIU Yi;ZHANG Xumei;LIU Lu;DENG Qi;LI Qin;MA Qian;HU Bin;LIU Huifang(Graduate School,Kunming Medical University,Kunming 650000,China;Yan'an Hospital Affiliated to Kunming Medical University,Kunming 650051,China)

机构地区：[1]昆明医科大学研究生院,云南昆明650000 [2]昆明医科大学附属延安医院妇科,云南昆明650001

出　　处：《中国肿瘤外科杂志》2022年第5期463-473,共11页Chinese Journal of Surgical Oncology

基　　金：昆明市卫生健康委员会“十百千”工程项目(2020-05-01-011)。

摘　　要：目的 运用Meta分析的方法比较经腹腔镜子宫肌瘤剔除术(LM)与阴式子宫肌瘤剔除术(TVM)治疗子宫肌瘤的临床疗效,为临床诊治提供循证医学依据。方法 运用计算机检索中文数据库(中国生物医学文献数据库、维普、中国知网、万方)及英文数据库(Pubmed、Embase、The Cochrane Library、Web of Science)中关于LM与TVM治疗子宫肌瘤的临床随机对照试验(RCT)研究,检索时限均为2019年1月至2021年5月,由研究者根据纳入、排除标准进行文献筛选后,对符合纳入标准的原始文献采用Cochrane评价手册5.1推荐的RCT质量评价工具进行质量评价,采用RevMan 5.3软件及Stata 14软件对结局指标进行Meta分析。结果 最终纳入24项RCT研究文献,共2 123例患者。Meta分析结果显示,与LM组比较,TVM组的术中出血量少[SMD=-1.13,95%CI(-1.84~-0.42),P<0.01],手术时间短[SMD=-1.19,95%CI(-1.76~-0.61),P<0.001],住院时间短[SMD=-1.54,95%CI(-2.07~-1.01),P<0.001],术后肛门首次排气时间早[SMD=-0.92,95%CI(-1.55~-0.29),P=0.004];但两组术中剔除子宫肌瘤直径、术中剔除子宫肌瘤数量及手术并发症发生率差异均无统计学意义(均P>0.05)。结论 LM与TVM治疗子宫肌瘤的效果均较好,TVM在术中出血量、手术时间、住院时间及术后肛门首次排气时间方面更具有优势。Objective To systematically evaluate the clinical efficacy of myomectomy by using the method of Meta-analysis between paracentesis and laparoscopy, and to provide evidence-based medical basis for clinical diagnosis and treatment. Methods A computerized search of Chinese databases(CBM, VIP, CNKI, Wanfang) and English databases(Pubmed, Embase, The Cochrane Library, Web of Science) for clinical randomized controlled trial(RCT) of myomectomy with parasternal and laparoscopic surgery was performed. The original literature that met the inclusion criteria was evaluated for methodological quality by the investigators using the RCT quality assessment tool recommended by Cochrane Evaluation Manual 5.1, and for outcome indicators, Meta-analysis was performed using RevMan 5.3 software and Stata 14 software. Results Twenty-four RCTs with a total of 2 123 patients were finally included. It was found that paracentesis negative myomectomy was associated with less intraoperative bleeding[SMD=-1.13, 95%CI(-1.84~-0.42), P<0.01], shorter operative time [SMD=-1.19, 95%CI(-1.76~-0.61), P<0.001] and shorter hospital stay [SMD=-1.54, 95%CI(-2.07~-1.01), P<0.001], quicker time to first postoperative anal venting [SMD=-0.92, 95%CI(-1.55~-0.29), P=0.004], no statistical difference in intraoperative resected fibroid diameter and number of intraoperative resected fibroids(P>0.05), no statistical difference in surgical complications between the two groups. The incidence of surgical complications was not statistically different between the two groups(P>0.05). Conclusions The cis-vaginal myomectomy and laparoscopic myomectomy both have better efficacy, and the cis-vaginal approach is more advantageous in terms of intraoperative bleeding, operative time, hospital stay, and first postoperative anal venting time.

关 键 词：子宫肌瘤 阴式子宫肌瘤剔除术 腹腔镜子宫肌瘤剔除术 随机对照试验 META分析 

分 类 号：R737.33[医药卫生—肿瘤]