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目的系统评价腹腔镜子宫切除术治疗妇科良性疾病的疗效和安全性。方法计算机检索CENTRAL(Cochrane图书馆2012年第5期)、MEDLINE、EMbase、CNKI、WanFang Data、VIP和CBM数据库,检索时间从建库截至2012年5月,同时手工检索相关灰色文献,查找腹腔镜与开腹手术切除子宫治疗妇科良性病的随机对照试验。由2位研究者按照纳入排除标准筛选文献、提取资料并评价质量后,采用RevMan 5.1软件进行Meta分析。结果纳入22个RCT,共3 304例患者。Meta分析结果显示:与开腹术相比,腹腔镜子宫切除术的住院时间[MD=–2.31,95%CI(–3.03,–1.60),P<0.000 01]和术后恢复正常活动的时间更短[MD=–13.86,95%CI(–17.70,–10.03),P<0.000 01],术后发热及其他非特异性感染发生率更低[OR=0.72,95%CI(0.54,0.95),P=0.02],但术中泌尿系损伤发生率更高[OR=2.41,95%CI(1.21,4.82),P=0.012]且手术时间延长[MD=20.27,95%CI(3.95,36.59),P=0.03]。两组在术中肠道损伤、血管损伤、术后瘘管形成、术后排尿功能障碍及术后阴道残端感染等并发症发生率方面,其差异均无统计学意义(P>0.05)。结论本系统评价结果显示,腹腔镜子宫切除术治疗妇科良性疾病在缩短住院时间及术后恢复正常活动时间优于传统开腹手术,且术后发热及其他非特异性感染发生率更低,但术中泌尿系损伤发生率更高且手术时间更长。由于缺乏术后长期生活质量结局指标的结果,期待未来更多高质量的随机对照试验结果验证。
Objective To evaluate the efficacy and safety of laparoscopic hysterectomy in the treatment of benign gynecological diseases. METHODS: The database of CENTRAL (Cochrane Library 2012, No. 5, 2012), MEDLINE, EMbase, CNKI, WanFang Data, VIP and CBM databases was searched by computer. The search time was from the database until May 2012, Randomized controlled trial of laparotomy for gynecological benign diseases with laparotomy. Two researchers screened the literature according to the exclusion criteria, extracted data and evaluated the quality, and then used RevMan 5.1 software to conduct meta-analysis. Results Twenty-two RCTs were included, with a total of 3 304 patients. Meta-analysis showed that hospital stay laparoscopic hysterectomy compared with open surgery [MD = -2.31,95% CI (-3.03, -1.60), P <0.000 01] and time to return to normal activity after surgery (OR = 0.72, 95% CI (0.54, 0.95)), and the incidence of postoperative fever and other nonspecific infections was much lower (MD = -13.86,95% CI (-17.70, -10.03) , P = 0.02]. However, the incidence of urinary tract injury during operation was higher (OR = 2.41, 95% CI 1.21, 4.82, P = 0.012) ), P = 0.03]. There was no significant difference between the two groups in incidence of intestinal injury, vascular injury, postoperative fistula formation, postoperative urination dysfunction and incidence of postoperative vaginal stump infection (P> 0.05). Conclusions The results of this systematic review show that laparoscopic hysterectomy for gynecological benign diseases is superior to conventional laparotomy in shortening the length of hospital stay and returning to normal activities after surgery, and the incidence of postoperative fever and other non-specific infections is lower Urinary tract injury in the higher incidence and operation longer. Due to the lack of postoperative long-term quality of life outcome indicators, looking forward to more high-quality randomized controlled trials in the future results.