单孔腹腔镜与传统多孔腹腔镜胆囊切除术疗效对比荟萃分析

Single-incision laparoscopic cholecystectomy versus multi-incision laparoscopic cholecystectomy: a meta-analysis of randomized clinical trials

关键词:  单孔腹腔镜胆囊切除术  荟萃分析  胆囊疾病

Key words:  single-incision laparoscopic cholecystectomy  meta-analysis  gallbladder disease

摘要:

目的　对单孔腹腔镜胆囊切除术（single-incision laparoscopic cholecystectomy，SILC）与传统腔镜胆囊切除术（conventionallaparoscopic cholecystectomy，CLC）疗效进行系统评价。 方法　检索2010年1月至2015年1月Medline（Ovid SP）,PubMed，Embase，Science Citation Index，Cochrane Central Register of Controlled Trials等外文数据库以及中国生物医学文献数据库。按照纳入排除标准筛选符合标准的文献，Cochrane风险评估偏倚工具进行文献质量评价。使用Review Manager.2对术中出血量、术后疼痛评分、外观满意度评分、手术时间、术后住院时间、正常活动恢复时间及不良事件发生率等指标进行荟萃分析。结果　本研究共纳入12项随机对照试验，1022例(SILC34例;CLC88例)胆囊疾病患者。SILC在术后6～8 h疼痛、患者外观满意度方面显著优于CLC(P=0.001; P<0.00001）,差异有显著性意义。与CLC相比，SILC手术时间相对较长(P=0.002)，差异有显著性意义。SILC与CLC在术中出血、不良事件发生率、术后住院时间、正常活动恢复时间方面无差异。结论　SILC提供与CLC相当的安全性和有效性，且具有更好的微创、美观和术后疼痛减轻等特点，值得临床应用。

Abstract:

Objective In order to evaluate outcomes of single-incision laparoscopic cholecystectomy (SILC) and conventional laparoscopic cholecystectomy (CLC）.Methods Randomized controlled trials that compared SILC with CLC were identified.The trials data were extracted and statistical analyzed using Review Manager.2 (Rev Man; Cochrane Collaboration，Copenhagen，Denmark).We performed a meta-analysis to estimate which kind of cholecystectomy is better.Results Twelve tials were selected for final analysis.The total number of patients was022(including34 patients with SILC and88 patients with CLC）.There was significant improvement in patients with SILC in postoperative (6-8 h) pain (P=0.001) andcosmetic satisfaction (P<0.00001) by VAS score.There was no significant difference in intraoperative bleeding,adverse events，postoperative hospital stay and return to the activities of daily living.Compared with the traditional laparoscopic cholecystectomy，single-incision laparoscopic surgery time is longer (P=0.002).Conclusion Single incision laparoscopic cholecystectomy affords comparable safety and efficacy as to the conventional laparoscopic cholecystectomy.