Picerno Toni, Sloan Nancy L, Escobar Pedro, Ramirez Pedro T
Department of Obstetrics and Gynecology, Christiana Care Health System, Newark, DE.
Department of Obstetrics and Gynecology, Christiana Care Health System, Newark, DE.
Am J Obstet Gynecol. 2017 Jan;216(1):10-26. doi: 10.1016/j.ajog.2016.08.040. Epub 2016 Sep 15.
We sought to analyze the published literature on bowel injuries in patients undergoing gynecologic robotic surgery with the aim to determine its incidence, predisposing factors, and treatment options.
Studies included in this analysis were identified by searching PubMed Central, OVID Medline, EMBASE, Cochrane, and ClinicalTrials.gov databases. References for all studies were also reviewed. Time frame for data analysis spanned from November 2001 through December 2014.
All English-language studies reporting the incidence of bowel injury or complications during robotic gynecologic surgery were included. Studies with data duplication, not in English, case reports, or studies that did not explicitly define bowel injury incidence were excluded.
The Guidelines for Meta-Analyses and Systematic Reviews of Observational Studies were used to complete the systematic review with the exception of scoring study quality and a single primary reviewer.
In all, 370 full-text articles were reviewed and 144 met the inclusion criteria. There were 84 bowel injuries recorded in 13,444 patients for an incidence of 1 in 160 (0.62%; 95% confidence interval, 0.50-0.76%). There were no significant differences in incidence of bowel injury by procedure type. The anatomic location of injury, etiology, and management were rarely reported. Of the bowel injuries, 87% were recognized intraoperatively and the majority (58%) managed via a minimally invasive approach. Of 13,444 patients, 3 (0.02%) (95% confidence interval, 0.01-0.07%) died in the immediate postoperative period and no deaths were a result of a bowel injury.
The overall incidence of bowel injury in robotic-assisted gynecologic surgery is 1 in 160. When the location of bowel injuries were specified, they most commonly occurred in the colon and rectum and most were managed via a minimally invasive approach.
我们试图分析已发表的关于接受妇科机器人手术患者肠道损伤的文献，以确定其发生率、诱发因素和治疗选择。
通过检索PubMed Central、OVID Medline、EMBASE、Cochrane和ClinicalTrials.gov数据库来确定纳入本分析的研究。还对所有研究的参考文献进行了审查。数据分析的时间范围从2001年11月至2014年12月。
纳入所有报告机器人妇科手术期间肠道损伤或并发症发生率的英文研究。排除数据重复、非英文、病例报告或未明确界定肠道损伤发生率的研究。
除了对研究质量进行评分和由单一主要审查者进行审查外，采用观察性研究的Meta分析和系统评价指南来完成系统评价。
总共审查了370篇全文文章，144篇符合纳入标准。在13444例患者中记录到84例肠道损伤，发生率为1/160（0.62%；95%置信区间，0.50 - 0.76%）。不同手术类型的肠道损伤发生率无显著差异。损伤的解剖位置、病因和处理方式很少被报告。在肠道损伤中，87%在术中被识别，大多数（58%）通过微创方法处理。在13444例患者中，3例（0.02%）（95%置信区间，0.01 - 0.07%）在术后即刻死亡，且无死亡是由肠道损伤导致的。
机器人辅助妇科手术中肠道损伤的总体发生率为1/160。当明确肠道损伤的位置时，它们最常发生在结肠和直肠，且大多数通过微创方法处理。
