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中华腔镜外科杂志(电子版)

中华腔镜外科杂志(电子版) ›› 2016, Vol. 09 ›› Issue (03): 146 -151. doi: 10.3877/cma.j.issn.1674-6899.2016.03.006

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单孔与多孔腹腔镜胆囊切除术的安全性Meta分析
郑凯欣 1, 许锐锐 1, 韩慧 1, 吴成亮 1, 陈耿臻 1 , †( )   
  1. 1. 515041 汕头大学医学院第二附属医院微创医学中心
  • 收稿日期:2016-03-07 出版日期:2016-06-30
  • 通信作者: 陈耿臻
  • 基金资助:
    汕头大学医学院临床研究提长计划项目(201408)

Single incision versus multiport laparoscopic cholecystectomy: Meta-analysis

Kaixin Zheng 1, Ruirui Xu 1, Hui Han 1, Chengliang Wu 1, Gengzhen Chen 1 , †( )   

  1. 1. The Second Affiliated Hospital of Shantou University Medical College, Shantou 515041, China
  • Received:2016-03-07 Published:2016-06-30
  • Corresponding author: Gengzhen Chen
  • About author:
    Corresponding author: Chen Gengzhen, Email:
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目的

系统评价经脐单孔腹腔镜胆囊切除术(SILC)与传统多孔腹腔镜胆囊切除术(CMLC)的有效性和安全性。

方法

计算机检索CBM、CNKI、PubMed、EMbase、The Cochrane Library数据库，筛选截至2015年7月关于比较SILC与CMLC的随机对照试验(RCT)，采用RevMan 5.3软件进行Meta分析。

结果

本研究共纳入34篇RCT文献，合计2 951例患者(SICL组1 502例，CMLC组1 449例)。SILC组的手术时间长于CMLC组，差异有统计学意义[MD＝11.56，95%CI(8.97，14.16)，Z＝8.75，P<0.000 01]。相比CMLC组，SILC组的手术转换率更高，差异有统计学意义[RR＝4.01，95%CI(2.56，6.29)，Z＝6.06，P<0.000 01]。SILC组患者切口美容评分高于CMLC组，差异有统计学意义[SMD＝1.34，95%CI(0.74，1.94)，Z＝4.39，P<0.000 1]。两组术中出血量、术后并发症、术后24 h疼痛评分、住院时间及恢复工作时间比较，差异无统计学意义(P>0.05)。

结论

SILC是一项安全有效的手术操作方式，具有更好的美容效果，但手术时间长、术中转换率高，对术者经验和手术技巧要求更高，需综合考虑选择。

关键词: 胆囊切除术, 经脐单孔, 腹腔镜, Meta分析
Objective

To systematically evaluate the availability and safety of single incision versus conventional multiport laparoscopic cholecystectomy.

Methods

Electronical search CBM, CNKI, PubMed, EMbase, The Cochrane Library, screened for randomized controlled trials(RCT) comparing single incision laparoscopic cholecystectomy(SILC) and conventional multiport laparoscopic cholecystectomy(CMLC) until Jul. 2015.The RevMan5.3 software was used for meta-analysis.

Results

We included 34 trials involving 2 951 patients: 1 502 to SILC versus 1 449 to CMLC.Meta-analysis revealed that the operative time in SILC group was longer than that in CMLC group[MD=11.56, 95%CI(8.97, 14.16), Z=8.75, P<0.000 01]. Compared with CMLC group, SILC group was higher in conversion rate[RR=4.01, 95%CI(2.56, 6.29), Z=6.06, P<0.000 01]. Furthermore, wound satisfaction score was [SMD=1.34, 95%CI(0.74, 1.94), Z=4.39, P<0.000 1.There was no significant difference between SILC group and CMLC group for blood loss, postoperative complications, 24 h postoperative pain score, hospital stay and time to return to work(P> 0.05).

Conclusions

SILC is a safe and effective surgical procedure with the advantage of a better cosmetic result.However, SILC requires surgeon’s skill and experience to reduce operative time and conversion rate.

Key words: Cholecystectomy, Single incision, Laparoscopic, Meta-analysis
图1 纳入文献的偏倚风险百分图
图2 纳入文献的偏倚风险评估一览
图3 纳入文献的手术时间比较Meta分析森林图
图4 纳入文献的术中出血量比较Meta分析森林图
图5 纳入文献的手术转换率比较Meta分析森林图
图6 纳入文献的术后并发症比较Meta分析森林图
图7 纳入文献的术后24 h疼痛评分比较Meta分析森林图
图8 纳入文献的切口美容评分比较Meta分析森林图
图9 纳入文献的住院时间比较Meta分析森林图
图10 纳入文献的术后并发症发生率倒漏斗图分析
图11 纳入文献的恢复工作时间比较Meta分析森林图
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