中国腹腔镜与开腹手术治疗子宫肌瘤疗效与费用比较的系统评价

目的系统评价腹腔镜手术（LM）与开腹手术（TAM）治疗中国人子宫肌瘤的疗效与费用。方法计算机检索Cochrane图书馆（2012年第4期）、PubMed、EMbase、CNKI、CBM和WanFangData，检索时限均为从建库至2012年9月，查找腹腔镜与开腹手术比较治疗中国人子宫肌瘤的随机对照试验，并追溯纳入文献的参考文献。由2位研究者按照纳入与排除标准筛选文献、提取资料并评价质量后，采用RevMan5．1软件进行Meta分析。结果最终纳入8个RCT，共1000例中国患者。Meta分析结果显示：LM组在术后排气时间[WMD=-15．21，95％CI（-20．19，-10．24），P〈0．00001]和术后住院时间[WMD=-3．07，95％CI（-4．25，-1．90），P〈0．00001]方面均优于TAM组，两组差异有统计学意义。但LM组在手术时间[WMD=28．33，95％CI（18．07，38．59），P〈0．00001]和住院费用[WMD=2028．87，95％CI（1190．75，2866．98），P〈0．00001]方面均次于TAM组，两组差异有统计学意义。最小成本法分析结果也显示，LM组的总体费用较TAM组高。两组在术中出血量方面，差异无统计学意义[WMD=-2．78，95％CI（-41．56，36．00），P=0．89]。结论本系统评价结果提示，LM较TAM术后恢复快且术后住院时间短，但手术时间较长且费用偏高，两组在术中出血量方面相当。由于纳入研究存在方法学缺陷和样本量较小，本研究结论尚需未来开展更多高质量的随机对照试验予以验证。

Effectiveness and Cost of Laparoscopic versus Traditional Abdominal Myomectomy in China: A Systematic Review

Objective To systematically evaluate the effectiveness and cost of laparoscopic myomectomy （LM） vs. traditional abdominal myomectomy （TAM） in treating Chinese patients with hysteromyoma. Methods Such databases as The Cochrane Library （Issue 4, 2012）, PubMed, EMbase, CNKI, CBM and WanFang Data were searched from their inception to September, 2012 to collect the randomized controlled trials （RCTs） about LM vs. TAM in treating Chinese patients with hysteromyoma, and the references of the included studies were also retrieved. Two reviewers independently screened the literature according to the inclusion and exclusion criteria, extracted the data and assessed the methodologi- cal quality. Then meta-analysis was conducted using RevMan 5.2 software. Results A total of 8 RCTs involving 1 000 Chinese patients were included. The results of meta-analysis showed that, LM was superior to TAM in postoperative ex- haust time （WMD-- -15.21, 95%CI -20.19 to -10.24, P〈0.000 01） and postoperative hospital stay （WMD= -3.07, 95%CI -4.25 to -1.90, P〈0.000 01）, with significant differences. But it was inferior to TAM in operation time （WMD=28.33, 95%CI 18.07 to 38.59, P〈0.000 01） and hospital costs （WMD=2 028.87, 95%CI 1 190.75 to 2 866.98, P〈0.000 01）, with a significant difference. There was no significant difference in intraoperative bleeding amount between the two groups （WMD= -2.78, 95%CI -41.56 to 36.00, P=0.89）. Conclusion This study shows LM is superior to TAM in fastening post- operative recovery and shortening hospital stay, but it is longer in operation time and higher in cost. The intraoperative bleeding amount is similar in the two groups. Due to low methodological quality and small sample size of the included studies, this conclusion has to be further proved by more high-quality RCTs.