Sodergren Mikael H, Markar Sheraz, Pucher Philip H, Badran Ismail A, Jiao Long R, Darzi Ara
Department of Surgery and Cancer, St Mary's Hospital, Imperial College London, London 10th Floor QEQM Building, St. Mary's Hospital South Wharf Road, London, W2 1NY, UK,
Surg Endosc. 2015 Aug;29(8):2077-90. doi: 10.1007/s00464-014-3915-x. Epub 2014 Nov 26.
Despite increasing data regarding clinical outcomes following transvaginal hybrid NOTES cholecystectomy (TVC), a consensus regarding safety based on comparative studies has yet to be reached. The aim of this systematic review and meta-analysis was to compare safety and clinical outcomes of TVC with conventional laparoscopic cholecystectomy (CLC) for the treatment of benign gallstone disease.
A comprehensive search for published studies comparing TVC and CLC was performed. Review of each study was conducted and data were extracted. All pooled outcome measures were determined using random-effects models.
Data were retrieved from 14 studies describing 1,145 patients. There was no difference in total complications (POR = 0.68; 95 % CI 0.40-1.14; P = 0.14), incidence of bile duct injury (POR = 1.33; 95 % CI 0.31-5.66; P = 0.70), Clavien-Dindo Grade II (POR = 0.48; 95 % CI 0.14-1.60; P = 0.23) or Grade III (POR = 0.63; 95 % CI 0.24-1.65; P = 0.34) complications between TCV and CLC. Time of return to normal activities was significantly reduced in the TVC group (WMD = -4.86 days; 95 % CI -9.33 to -0.39; P = 0.03), and there was a non-significant reduction in postoperative pain on days 1 (WMD = -0.80; 95 % CI -1.60 to 0.01; P = 0.05) and 3 (WMD = -0.89; 95 % CI -1.77 to -0.01; P = 0.05).
TVC is safe when performed by appropriately trained surgeons and may be associated with a faster return to normal activities and decreased postoperative pain.
尽管经阴道混合NOTES胆囊切除术（TVC）后临床结局的数据越来越多，但基于比较研究的安全性共识尚未达成。本系统评价和荟萃分析的目的是比较TVC与传统腹腔镜胆囊切除术（CLC）治疗良性胆结石疾病的安全性和临床结局。
对比较TVC和CLC的已发表研究进行全面检索。对每项研究进行审查并提取数据。所有汇总结局指标均使用随机效应模型确定。
从14项描述1145例患者的研究中检索到数据。TCV和CLC之间在总并发症（比值比[POR]=0.68；95%可信区间[CI]0.40-1.14；P=0.14）、胆管损伤发生率（POR=1.33；95%CI 0.31-5.66；P=0.70）、Clavien-Dindo二级（POR=0.48；95%CI 0.14-1.60；P=0.23）或三级（POR=0.63；95%CI 0.24-1.65；P=0.34）并发症方面无差异。TVC组恢复正常活动的时间显著缩短（加权均数差[WMD]=-4.86天；95%CI -9.33至-0.39；P=0.03），术后第1天（WMD=-0.80；95%CI -1.60至0.01；P=0.05）和第3天（WMD=-0.89；95%CI -1.77至-0.01；P=0.05）的术后疼痛有非显著性减轻。
由经过适当培训的外科医生进行TVC是安全的，并且可能与更快恢复正常活动和减轻术后疼痛相关。
