单孔腹腔镜与多孔腹腔镜在卵巢良性肿瘤剥除术中应用的Mate分析
摘要
目的系统评价单孔腹腔镜手术(LESS)与传统多孔腹腔镜(CLS)用于卵巢良性肿瘤剥除术的安全性、可行性。方法检索Pubmed、the Cochrane Library、Web of Science等英文数据库及中国知网(CNKI)、万方医学网数据库、维普数据库、中国生物医学文献等中文数据库中,有关LESS(LESS组)与CLS(CLS组)下卵巢肿瘤剥除术的对比研究,对选用的对比研究进行质量评价,应用Rev Man5. 3软件行Meta分析,比较两种方法的手术时间、手术失血量、术后住院时间、术后疼痛情况、术后并发症等。结果共纳入12篇文献,总样本量为1 300例,其中LESS组561例、CLS组739例。纳入研究中随机对照试验研究1个、回顾性病例-对照研究11个。LESS组手术时间长于CLS组(95%CI 7. 56～16. 84,P=0. 000),住院时间短于CLS组(95%CI-0. 84～-0. 07,P=0. 020),术后额外要求止痛病例的百分比小于CLS组(95%CI 0. 34～0. 46,P=0. 000),术后疼痛VAS评分低于CLS组(95%CI-3. 00～0. 98,P=0. 00)。两组术中失血量(95%CI-2. 91～2. 95,P=0. 99)、术后并发症差异均无统计学意义(95%CI 0. 18～1. 99,P=0. 40)。结论 LESS用于卵巢良性肿瘤剥除术是安全、可行的,具有缩短住院时间、减少术后疼痛等优点,且不增加术中出血量及术后并发症。
引文
[1]Lee YY,Kim TJ,Kim CJ,et al.Single port access laparoscopic adnexal surgery versos conventional laparoseopic adnexal surgery:a comparison of perioperative outcomes[J].Eur J Obstet Gynecol Reprod Biol,2010,151(2):181-184.
[2]朱家万,宝宏革,刘浩,等.经脐单孔腹腔镜手术212例报告[J].腹腔镜外科杂志,2012,17(1):19-21.
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[5]Fader AN.Laparoendoscopic single-site surgery(LESS)in gynecologic oncology:technique and initial report[J].Gynecol Oncol,2009,114(2):157-161.
[6]Freschi L,Pluchino N,Angioni S,et al.A novel system for single-port laparoscopic surgery:preliminary experience[J].Gynecol Obstet Invest,2016,81(5):454-460.
[7]Chung W,Yoon Y,Kim JW,et al.Comparing two different techniques of rectus sheath block after single port laparoscopic surgery in benign adnexal mass patients:surgical versus ultrasonography guidance-A randomized,single-blind,case-controlled study[J].Eur J Obstet Gynecol Reprod Biol,2017,217(17):29-33.
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[9]Xiong W,Sun D,Zhang J,et al.Comparative study on transumbilical laparoendoscopic single-site surgery and the three-port laparoscopy in treatment of ovarian cystectomy[J].Zhonghua Fu Chan Ke Za Zhi,2014,49(3):176-178.
[10]lker K,Hüseyino luü.Management of benign ovarian cysts by a novel,gasless,single-incision laparoscopic technique:keyless abdominal rope-lifting surgery(KARS)[J].Surg Endosc,2013,27(1):189-198.
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[12]李小雪,杨新园.单孔腹腔镜对卵巢成熟性囊性畸胎瘤患者临床结局的影响[J].中国妇幼健康研究,2017,28(1):72-74.
[13]刘秀,温蒙科,刘海元,等.单孔腹腔镜与多孔腹腔镜卵巢囊肿剔除术的临床对照研究[J].中华妇产科杂志,2017,52(10):675-678.
[14]王小婕,黄浩,杨尚武,等.单孔腹腔镜在卵巢良性疾病治疗中的应用[J].中国妇幼健康研究,2013,26(5):732-735.
[15]郭刚.单孔腹腔镜与三孔腹腔镜卵巢囊肿剔除术的对比研究[J].浙江创伤外科,2015,20(5):940-942.
[16]殷艳,韦业平.自制经脐单孔腹腔镜装置在卵巢良性包块剔除术中的应用[J].实用妇产科杂志,2015,31(3):235-237.
[17]吴淑芳,代霁虹.微创单孔腹腔镜治疗卵巢囊肿患者手术入路方案研究[J].中国内镜杂志,2016,22(2):61-64.
[18]黄晓斌,柳晓春,郑玉华.经脐单孔腹腔镜手术治疗卵巢良性肿瘤的研究[J].新医学,2015,46(7):482-485.
[19]徐凤秦,朱小朝,何庆,等.单孔腹腔镜手术治疗卵巢良性肿瘤与三孔法手术的对比分析[J].现代妇产科进展,2012,21(10):823-824.
[20]Sandberg EM,la Chapelle CF,van den Tweel MM,et al.Laparoendoscopic single-site surgery versus conventional laparoscopy for hysterectomy:a systematic review and meta-analysis[J].Arch Gynecol Obstet,2017,295(5):1089-1103.
[21]吴碧辉,陶莉莉,彭绍婵,等.单孔腹腔镜对比传统腹腔镜手术治疗输卵管妊娠的Meta分析[J].中国内镜杂志,2017,23(4):35-42.
[22]Escobar PF,Starks DC,Fader AN,et al.Single-port risk-reducing salpingo-oophorectomy with and without hysterectomy:surgical outcomes and learning curve analysis[J].Gynecol Oncol,2010,119(1):43-47.
[23]Song T,Kim TJ,Lee YY,et al.What is the learning curve for single-port access laparoscopic-assisted vaginal hysterectomy[J].Eur J Obstet Gynecol Reprod Biol,2011,158(1):93-96.
[24]简萍,高万里,关宏俊,等.无入路平台单切口腹腔镜与多孔腹腔镜治疗输卵管妊娠的效果比较[J].中国妇幼保健,2017,32(20):4950-4952.
[25]沈刚,李功俊,周立军,等.单孔腹腔镜与多孔腹腔镜手术治疗小儿卵巢囊肿的对比研究[J].腹腔镜外科杂志,2016,21(9):711-713.
[2]朱家万,宝宏革,刘浩,等.经脐单孔腹腔镜手术212例报告[J].腹腔镜外科杂志,2012,17(1):19-21.
[3]Fader AN,Rojas-Espaillat L,Ibeanu O,et al.Laparoendoscopic single-site surgery(LESS)in gynecology:a multi-institutional evaluation[J].Am J Obstet Gynecol,2010,203(5):501.
[4]Park JY,Kim DY,Suh DS,et al.Laparoendoscopic single-site versus conventional laparoscopic surgical staging for early-stage endometrial cancer[J].Int J Gynecol Cancer,2014,24(2):358-363.
[5]Fader AN.Laparoendoscopic single-site surgery(LESS)in gynecologic oncology:technique and initial report[J].Gynecol Oncol,2009,114(2):157-161.
[6]Freschi L,Pluchino N,Angioni S,et al.A novel system for single-port laparoscopic surgery:preliminary experience[J].Gynecol Obstet Invest,2016,81(5):454-460.
[7]Chung W,Yoon Y,Kim JW,et al.Comparing two different techniques of rectus sheath block after single port laparoscopic surgery in benign adnexal mass patients:surgical versus ultrasonography guidance-A randomized,single-blind,case-controlled study[J].Eur J Obstet Gynecol Reprod Biol,2017,217(17):29-33.
[8]Bedaiwy MA,Sheyn D,Eghdami L,et al.Laparoendoscopic single-site surgery for benign ovarian cystectomies[J].Gynecol Obstet Invest,2015,79(3):179-183.
[9]Xiong W,Sun D,Zhang J,et al.Comparative study on transumbilical laparoendoscopic single-site surgery and the three-port laparoscopy in treatment of ovarian cystectomy[J].Zhonghua Fu Chan Ke Za Zhi,2014,49(3):176-178.
[10]lker K,Hüseyino luü.Management of benign ovarian cysts by a novel,gasless,single-incision laparoscopic technique:keyless abdominal rope-lifting surgery(KARS)[J].Surg Endosc,2013,27(1):189-198.
[11]Park JY,Kim DY,Kim SH,et al.Laparoendoscopic single-site compared with conventional laparoscopic ovarian cystectomy for ovarian endometrioma[J].J Minim Invasive Gynecol,2015,22(5):813-819.
[12]李小雪,杨新园.单孔腹腔镜对卵巢成熟性囊性畸胎瘤患者临床结局的影响[J].中国妇幼健康研究,2017,28(1):72-74.
[13]刘秀,温蒙科,刘海元,等.单孔腹腔镜与多孔腹腔镜卵巢囊肿剔除术的临床对照研究[J].中华妇产科杂志,2017,52(10):675-678.
[14]王小婕,黄浩,杨尚武,等.单孔腹腔镜在卵巢良性疾病治疗中的应用[J].中国妇幼健康研究,2013,26(5):732-735.
[15]郭刚.单孔腹腔镜与三孔腹腔镜卵巢囊肿剔除术的对比研究[J].浙江创伤外科,2015,20(5):940-942.
[16]殷艳,韦业平.自制经脐单孔腹腔镜装置在卵巢良性包块剔除术中的应用[J].实用妇产科杂志,2015,31(3):235-237.
[17]吴淑芳,代霁虹.微创单孔腹腔镜治疗卵巢囊肿患者手术入路方案研究[J].中国内镜杂志,2016,22(2):61-64.
[18]黄晓斌,柳晓春,郑玉华.经脐单孔腹腔镜手术治疗卵巢良性肿瘤的研究[J].新医学,2015,46(7):482-485.
[19]徐凤秦,朱小朝,何庆,等.单孔腹腔镜手术治疗卵巢良性肿瘤与三孔法手术的对比分析[J].现代妇产科进展,2012,21(10):823-824.
[20]Sandberg EM,la Chapelle CF,van den Tweel MM,et al.Laparoendoscopic single-site surgery versus conventional laparoscopy for hysterectomy:a systematic review and meta-analysis[J].Arch Gynecol Obstet,2017,295(5):1089-1103.
[21]吴碧辉,陶莉莉,彭绍婵,等.单孔腹腔镜对比传统腹腔镜手术治疗输卵管妊娠的Meta分析[J].中国内镜杂志,2017,23(4):35-42.
[22]Escobar PF,Starks DC,Fader AN,et al.Single-port risk-reducing salpingo-oophorectomy with and without hysterectomy:surgical outcomes and learning curve analysis[J].Gynecol Oncol,2010,119(1):43-47.
[23]Song T,Kim TJ,Lee YY,et al.What is the learning curve for single-port access laparoscopic-assisted vaginal hysterectomy[J].Eur J Obstet Gynecol Reprod Biol,2011,158(1):93-96.
[24]简萍,高万里,关宏俊,等.无入路平台单切口腹腔镜与多孔腹腔镜治疗输卵管妊娠的效果比较[J].中国妇幼保健,2017,32(20):4950-4952.
[25]沈刚,李功俊,周立军,等.单孔腹腔镜与多孔腹腔镜手术治疗小儿卵巢囊肿的对比研究[J].腹腔镜外科杂志,2016,21(9):711-713.