经脐单孔腹腔镜卵巢囊肿剥除术在快速康复外科中应用价值的系统评价

目的对已发表的研究进行系统评价,以期评价单孔腹腔镜(laparoendoscopic single site surgery,LESS)卵巢囊肿剥除术在快速康复外科(fast track surgery,FTS)中的应用价值。方法计算机检索英文数据库:Pub Med、Embase等,中文数据库:万方、知网、维普等,并辅以其他检索,收集2019年9月前的相关文献,通过文献筛选纳入、质量评价后提取数据,使用Review Manager 5.3软件进行分析。结果24篇文献,其中LESS组1022例,传统腹腔镜(traditional laparoscopic surgery,TLS)组1139例。经统计学分析,LESS组手术时间较短MD=5.3,95%CI:(2.29,8.31),P<0.05],总住院时间较短MD=-0.92,95%CI:(-1.35,-0.49),P<0.05],术后并发症发生率更低MD=0.29,95%CI:(0.17,0.49),P<0.05],术后肛门排气时间更快MD=-2.23,95%CI:(-4.25,-0.22),P<0.05],术后疼痛评分更低MD=-1.53,95%CI:(-1.96,-1.11),P<0.05],术中失血量与术后住院时间则差异无统计学意义(P>0.05)。结论LESS符合FTS对于术中操作以及术后恢复的理念。但由于现有研究的局限性,需要更大的和多中心的研究来验证。

A systematic review of the value of transumbilical single-site laparoscopic ovarian cystectomy in FTS

Objective To evaluate the advantages of laparoendoscopic single site surgery(LESS)compared with traditional laparoscopic surgery(TLS)in fast-track surgery,and to evaluate the value of single-port laparoscopic ovarian cyst removal in fast-track surgery.Methods English databases such as Pub Med and Embase were searched,and Chinese databases such as Wanfang data,CNKI.net and VIP networkwere searched.Relevant literatures before September 2019 were collected,and data were extracted after literature selection,inclusion and quality evaluation.Review Manager 5.3 software was used for meta analysis.Results There were 24 literatures,including 1022 cases in LESS group and 1139 cases in TLS group.Analysis by using Rev Man 5.3 software:LESS group of shorter operation timeMD=5.3,95%CI:(2.29,8.31),P<0.05],the total length of hospital stay were shorterMD=-0.92,95%CI:(-1.35,-0.49),P<0.05],lower incidence of postoperative complicationsMD=-0.29,95%CI:(-0.17,-0.49),P<0.05],faster postoperative anal exhaust timeMD=-2.23,95%CI:(-4.25,-0.22).P<0.05],postoperative pain was lowerMD=-1.53,95%CI:(-1.96,-1.11),P<0.05],and there was no significant difference between intra operative blood loss and postoperative hospital stay.Conclusion According to the existing evidence,transumbilical LESS is more consistent with the FTS concept than TLS in ovarian cysts removal.However,due to the limitations of our study,further larger and multi-center studies are needed to verify our findings.