Department of Clinical Epidemiology and Health Economics (Drs. Shigemi, Aso, Matsui, and Yasunaga), School of Public Health, The University of Tokyo, Tokyo, Japan.
Department of Clinical Epidemiology and Health Economics (Drs. Shigemi, Aso, Matsui, and Yasunaga), School of Public Health, The University of Tokyo, Tokyo, Japan.
J Minim Invasive Gynecol. 2019 Mar-Apr;26(3):501-506. doi: 10.1016/j.jmig.2018.06.008. Epub 2018 Aug 2.
To compare fetal, maternal, and operative outcomes of laparoscopic surgery versus laparotomy for major benign diseases including appendicitis, cholecystitis, adnexal masses, and uterine myoma during pregnancy.
Retrospective cohort study (Canadian Task Force classification II-2).
The Diagnosis Procedure Combination database, a national inpatient database for acute care inpatients in Japan.
Eligible patients (n = 6018) underwent abdominal surgery (4047 laparotomy and 1971 laparoscopy patients) from July 2010 through March 2016.
The 2 groups were compared using propensity score matching analysis.
The primary outcome was fetal adverse events, including abortion or stillbirth within 7 days after surgery and premature delivery during hospitalization. Secondary outcomes were operative time, blood transfusion, and length of hospital stay after surgery. Propensity score matching created 740 pairs. Significant difference was observed in the primary outcome between propensity score-matched patients in the laparotomy versus laparoscopy group (1.8% vs .41%, respectively; risk difference, -1.4%; 95% confidence interval, -2.4 to -.30; p = .01). Compared with the laparotomy group, the laparoscopy group had a significantly lower incidence of blood transfusion (2.3% vs .41%, p = .002), shorter operative time (115 vs 95 minutes, p <.001), and shorter hospital stay (9.2 vs 5.9 days, p <.001).
Our current study using propensity score matching suggests the advantages of laparoscopic surgery for benign diseases compared with laparotomy because laparoscopic surgery had advantages in short-term fetal adverse events, incidence of blood transfusion, operative time, and hospital stay.
比较腹腔镜手术与剖腹手术治疗妊娠合并阑尾炎、胆囊炎、附件肿块和子宫肌瘤等主要良性疾病的胎儿、产妇和手术结果。
回顾性队列研究（加拿大任务组分类 II-2）。
日本急性住院患者全国诊断程序组合数据库。
2010 年 7 月至 2016 年 3 月期间，符合条件的患者（n=6018 例）接受了腹部手术（4047 例剖腹手术和 1971 例腹腔镜手术）。
使用倾向评分匹配分析比较两组。
主要结果是胎儿不良事件，包括手术后 7 天内流产或死胎以及住院期间早产。次要结果是手术时间、输血和手术后住院时间。进行倾向评分匹配后创建了 740 对。在剖腹手术与腹腔镜手术组的倾向评分匹配患者中，主要结局存在显著差异（分别为 1.8%和 0.41%；风险差异，-1.4%；95%置信区间，-2.4 至 -.30；p=0.01）。与剖腹手术组相比，腹腔镜手术组输血发生率显著降低（2.3%比 0.41%，p=0.002），手术时间更短（115 分钟比 95 分钟，p<.001），住院时间更短（9.2 天比 5.9 天，p<.001）。
我们目前使用倾向评分匹配的研究表明，与剖腹手术相比，腹腔镜手术治疗良性疾病具有优势，因为腹腔镜手术在短期胎儿不良事件、输血发生率、手术时间和住院时间方面具有优势。
