Transvaginal cholecystectomy vs conventional laparoscopic cholecystectomy for gallbladder disease: A meta-analysis
Transvaginal cholecystectomy vs conventional laparoscopic cholecystectomy for gallbladder disease: A meta-analysis
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DOI：
10.3748/wjg.v21.i17.5393
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发表时间：
2015-05-07
影响因子：
4.3
通讯作者：
He, Bin
中科院分区：
文献类型：
--
作者：
Xu, Bin;Xu, Bo;He, Bin
目的：方法：检索PubMed、EMBASE、奥维德、Web of Science、科克伦图书馆、Google Scholar、Meta Register of Controlled Trials、中国医学期刊数据库和万方数据库，比较经阴道胆囊切除术（TVC）与传统腹腔镜胆囊切除术（CLC）治疗胆囊疾病的疗效。数据由两位作者提取。使用固定效应或随机效应模型计算平均差（MD）、标准化平均差（SMD）、比值比和风险率及其95%CI。采用卡方检验评价统计异质性。在不存在统计学显著异质性的情况下使用固定效应模型。结果：9个临床对照试验共纳入730例患者。TVC组和CLC组在人口统计学特征方面无显著差异（P > 0.5），包括麻醉风险评分、年龄、体重指数和腹部手术史。两组的死亡率、发病率和术后恢复工作情况相似。TVC组患者术后第1天的疼痛评分较低SMD：-0.957，95%CI：-1.488 ~-0.426，P < 0.001），术后镇痛用药少（SMD：-0.574，95%CI：-0.807 ~-0.341，P < 0.001），住院时间短（MD：-1.004d，95%CI：-1.779至0.228，P = 0.011），但手术时间较长（MD：17.307min，95%CI：6.789至27.826，P = 0.001）。TVC对术后性功能和生活质量无明显影响。结论：TVC治疗胆囊疾病安全、有效。然而，可能会发生阴道损伤，需要进一步的试验来比较TVC和CLC。
AIM: To compare the results of transvaginal cholecystectomy (TVC) and conventional laparoscopic cholecystectomy (CLC) for gallbladder disease.METHODS: We performed a literature search of PubMed, EMBASE, Ovid, Web of Science, Cochrane Library, Google Scholar, MetaRegister of Controlled Trials, Chinese Medical Journal database and Wanfang Data for trials comparing outcomes between TVC and CLC. Data were extracted by two authors. Mean difference (MD), standardized mean difference (SMD), odds ratios and risk rate with 95% CIs were calculated using fixed-or random-effects models. Statistical heterogeneity was evaluated with the chi(2) test. The fixed-effects model was used in the absence of statistically significant heterogeneity. The random-effects model was chosen when heterogeneity was found.RESULTS: There were 730 patients in nine controlled clinical trials. No significant difference was found regarding demographic characteristics (P > 0.5), including anesthetic risk score, age, body mass index, and abdominal surgical history between the TVC and CLC groups. Both groups had similar mortality, morbidity, and return to work after surgery. Patients in the TVC group had a lower pain score on postoperative day 1 (SMD: -0.957, 95% CI: -1.488 to -0.426, P < 0.001), needed less postoperative analgesic medication (SMD: -0.574, 95% CI: -0.807 to -0.341, P < 0.001) and stayed for a shorter time in hospital (MD: -1.004 d, 95% CI: -1.779 to 0.228, P = 0.011), but had longer operative time (MD: 17.307 min, 95% CI: 6.789 to 27.826, P = 0.001). TVC had no significant influence on postoperative sexual function and quality of life. Better cosmetic results and satisfaction were achieved in the TVC group.CONCLUSION: TVC is safe and effective for gallbladder disease. However, vaginal injury might occur, and further trials are needed to compare TVC with CLC.