单孔腹腔镜对比传统腹腔镜手术治疗输卵管妊娠的Meta分析

Single-port versus conventional laparoscopic surgery in treatment of tubal pregnancy: a meta-analysis

摘要:

目的??全面评价单孔腹腔镜手术（LESS）治疗输卵管妊娠的安全性、可行性及其他潜在优势。方法?检索Pubmed、the Cochrane Library、Web of Science等英文及知网、中国生物医学文献等中文数据库中有关单孔与传统腹腔镜下输卵管妊娠手术治疗的对比研究，对选用的研究进行质量评价，运用RevMan5.3软件行数据合并分析。结果?最终纳入2个随机对照研究（RCT）和14个病例-对照研究，共1 541个患者，Meta分析结果提示，单孔对比多孔腹腔镜手术，延长了手术时间[加权均数差（WMD）=8.54，95%CI（2.43，14.64），P =0.006]，但并没有增加总并发症[比值比（OR）=0.68，95%CI（0.27，1.71），P =0.410]及术中失血量[WMD=-0.01，95%CI（-2.51，2.48），P =0.990]，也未延长术后肠排气时间[WMD=-0.45，95%CI（-1.72，0.82），P =0.490]，且能缩短术后住院时间[WMD=-0.40，95%CI（-0.75，-0.06），P =0.020]，减少术后止痛治疗[OR=0.38，95%CI（0.22，0.67），P =0.000]。结论?LESS治疗输卵管妊娠，是安全、可行的，而且有住院时间短，术后疼痛轻的优点，有望取代传统腹腔镜手术（CLS）。

Abstract:

Objective?To evaluate the safety, feasibility and other potential advantages of laparoendoscopic single-site surgery (LESS) compared to conventional laparoscopic surgery (CLS) for tubal pregnancy.?Methods?We manually searched Pubmed, the Cochrane Library, web of science, CNKI and China Biology Medicine for the relevant references about comparison of single-port laparoscopic salpingectomy with multi-port laparoscopic salpingectomy in the treatment of tubal pregnancy. The quality of the studies was evaluated, then meta-analysis was conducted using RevMan 5.3 software.?Result?Eventually, 2 RCTS and 14 retrospective studies including a total of 1 541 cases were identified. The results of the meta-analysis for LESS versus CLS were as follows: a longer operative time [WMD=8.54, 95%CI (2.43, 14.64), P = 0.006], no significant differences in terms of total complications [OR = 0.68, 95%CI (0.27,1.71), P = 0.410]/operative blood loss [WMD = -0.01, 95%CI (-2.51,2.48), P = 0.990]/gastrointestinal function recovery time [WMD = -0.45, 95%CI (-1.72,0.82), P = 0.490], but shorter hospital stay [WMD=-0.40, 95% (-0.75, -0.06), P = 0.020], less postoperative analgesic treatment [OR = 0.38, 95%CI (0.22,0.67), P = 0.000].?Conclusions?LESS for surgical treatment of tubal pregnancy is safe and feasible with shorter hospital stay, less postoperative pain. LESS may therefore be a feasible alternative of CLS in the surgical approach of tubal pregnancy.