常规腹腔镜与单孔腹腔镜在结肠切除术中应用价值比较的Meta分析

摘要

Objective:To compare the validity and safety of conventional multiport laparoscopic colectomy (CMLC) with single-incision laparoscopic colectomy (SILC) and to investigate the potential advantages and application value of SILC. Methods:Studies and relevant literatures comparing SILC to CMLC were searched through PubMed.the Cochrane Library and so on. Operative time,estimated blood loss,the rate of conversion to open surgery or additional port,the rate of postoperative complications,and length of hospital stay were pooled and compared using RevMan 5.0. The relative risk and mean difference were calculated with 95% confidence intervals to evaluate the safety and efficacy of each technique. Results: Eighteen studies comparing 542 patients undergoing SILC to 678 patients undergoing CMLC were reviewed and the data were pooled for analysis. Patients undergoing SILC had a shorter length of hospital stay ( pooled mean difference = -0. 38 ;95% CI: -0. 63 to -0. 13 ; P = 0. 002 ) , less estimated blood loss ( pooled mean difference = -20. 25 ; 95% CI:-30.25 to -1. 24;P =0.04) ,while there was no significant difference in the incidence of postoperative complications (pooled risk ratios = 0. 89 ;95% CI :0.69 to 1. 14;P = 0. 36) , operative time (pooled mean difference = 3. 90;95% CI:-2. 45 to 10. 24;P = 0.23) or the rate of conversion to open surgery/adding ports( pooled risk ratios = 1.67;95% CI:0. 96 to 2. 91 ;P = 0. 07). Conclusions: SILC is safe,feasible and effective,appears to have comparable results to CMLC in the hands of experienced surgeons. Moreover, SILC has the relative benefits of surgical trauma, postoperative recovery, minimally invasiveness, cosmetology and postoperative pain over CMLC,it has broad application value and development prospects. Large scale RCTs and high quality comparative studies are needed to conduct.%目的:通过对比常规腹腔镜与单孔腹腔镜结肠切除术的有效性及安全性,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、Cochrane Library数据库公开发表的常规腹腔镜与单孔腹腔镜结肠切除术对比的文献.通过采用RevMan 5.0统计软件,合并及对比两组手术时间、术中出血量、中转开腹/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,95％的可信区间)及均数差(MD,95％的可信区间)作为效应尺度指标,评估两种术式的有效性及安全性.结果:18项研究符合纳入标准,其中常规腹腔镜结肠手术678例,单孔腹腔镜结肠手术542例,共1 220例.本项Meta分析结果表明单孔腹腔镜结肠切除术中出血少、住院时间短(合并MD分别为-20.25,95％ CI:-30.25 ～-1.24,P=0.04；-0.38,95％ CI:-0.63 ～0.13,P=0.002),而手术时间、中转开腹或增加穿刺孔率、术后并发症发生率两种术式差异无统计学意义(合并MD为3.90,95％ CI:-2.45～10.24,P=0.23；合并RR分别为1.67,95％ CI:0.96～2.91,P=0.07；0.89,95％ CI:0.69-1.14,P=0.36).结论:对于具有丰富腹腔镜手术经验的术者而言,单孔腹腔镜结肠手术是安全、可行、有效的,与常规腹腔镜手术具有相似的手术疗效；手术创伤、术后康复、微创美容、术后疼痛方面单孔腹腔镜结肠切除术更具优势；但尚需开展大样本的随机对照试验及高质量的对比研究以进一步论证.