单孔腹腔镜与非单孔腹腔镜胆囊切除术安全性及有效性的荟萃分析

目的系统评价单孔腹腔镜与非单孔腹腔镜胆囊切除术安全性及有效性。方法计算机检索Pubmed和万方数据库中有关单孔腹腔镜与非单孔腹腔镜胆囊切除术的随机对照实验(RCT)文献,依据Cochrane评价手册评价偏倚风险,并提交手术时间、术后疼痛评分、术后并发症发生率及术后美容评分等的相关数据进行荟萃分析。结果纳入4篇RCT文献,共236例患者。荟萃分析结果显示相比非单孔腹腔镜胆囊切除术,单孔腹腔镜技术不会显著性影响手术并发症的发生(OR 1.47;95%CI 0.73～2.97;P=0.28),且具有更高的术后美容评分(SMD 0.70;95%CI 0.40～0.99;P<0.00 001)。结论单孔腹腔镜胆囊切除术具有更好的美容效果和一定的安全性。但评价该术式和非单孔腹腔镜胆囊切除术在其他发面的优劣势,仍需要更多设计严谨和大样本的随机对照研究。

Meta-analysis of the Transumbilical Single-incision Laparoscopic Cholecystectomy and the Conventional Laparoscopic Cholecystectomy in Efficacy and Safety

Objective To evaluate the safety,feasibility and advantages of transumbilical single-incision laparoscopic cholecystectomy.Methods PubMed and Wanfang database were reviewed using meta-analysis.Randomized controlled trials(RCT) describing the length of operation time,pain levels,postoperative complications and postoperative beauty score between the transumbilical single-incision laparoscopic cholecystectomy and the conventional laparoscopic cholecystectomy were collected.Cochrane review methodology was used for assessing the trial quality and efficacy.Results Only 4 clinical studies were selected and 236 eligible patients were included in the systematic review.Meta-analysis showed that there were no differences between two groups in the risk of postoperative complications(OR 1.47;95% CI 0.73~2.97;P=0.28).But it showed significant difference in postoperative beauty score(SMD 0.70;95% CI 0.40~0.99;P<0.00001).Conclusions Transumbilical single-incision laparoscopic cholecystectomy is safe with better cosmetic effect comparing to the conventional laparoscopic cholecystectomy.However,it still need a large number of randomized and controlled study for evaluation of the other advantages and disadvantages of these two operation methods.