经阴道NOTES 与传统腹腔镜手术主要临床结局比较的系统评价和荟萃分析。

Comparison of Major Clinical Outcomes Between Transvaginal NOTES and Traditional Laparoscopic Surgery: A Systematic Review and Meta-analysis.

机构信息

Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China.

Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China; Key Laboratory of Obstetrics and Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second Hospital, Sichuan University, Chengdu, Sichuan, China.

出版信息

J Surg Res. 2019 Dec;244:278-290. doi: 10.1016/j.jss.2019.06.012. Epub 2019 Jul 11.

DOI:10.1016/j.jss.2019.06.012

PMID:31302326

Abstract

BACKGROUND

The advent of transvaginal natural orifice transluminal endoscopic surgery (transvaginal NOTES) aims to minimize surgical trauma and reduce recovery time.

MATERIALS AND METHODS

Clinical trials comparing transvaginal NOTES and traditional laparoscopy were identified by searching EMBASE, MEDLINE, and Web of Science (from 2004 to March 2018). Major outcomes evaluated were risk of postoperative complications and secondary outcomes were pain on postoperative day (POD) 1, POD2, and POD3, time needed for full recovery, risk of intraoperative complications, the duration of surgery, and hospital stay. The results of the meta-analysis are presented as standardized mean difference (SMD) and risk difference (RD) with 95% confidence intervals (CIs).

RESULTS

Thirteen trials with 1340 patients were identified. There were no statistical differences for risk of complications between transvaginal NOTES and traditional laparoscopy (intraoperative complications: RD -0.01, 95% CI -0.03 to 0.01; P = 0.37; postoperative complication: RD -0.02, 95% CI -0.05 to 0.01; P = 0.148). The pain score was lower in transvaginal NOTES on POD1 (SMD: -0.71, 95% CI: -1.30 to -0.11, P = 0.019), on POD2 (SMD -0.41, 95% CI -0.75 to -0.07; P = 0.018), and on POD3 (SMD -0.43, 95% CI -0.63 to -0.23; P < 0.001). Patients in transvaginal NOTES needed much shorter time to fully recover after surgery (SMD -1.36, 95% CI -1.84 to -0.87; P < 0.001). In addition, patients underwent transvaginal NOTES had less pain and shorter time of recovery.

CONCLUSIONS

It is recommended that patients have cholecystectomy, adnexectomy, and appendectomy using transvaginal NOTES as it is safe and minimally invasive.

摘要

背景

经阴道自然腔道内镜手术（transvaginal NOTES）的出现旨在最大限度地减少手术创伤并缩短恢复时间。

材料和方法

通过搜索 EMBASE、MEDLINE 和 Web of Science（从 2004 年到 2018 年 3 月），确定了比较经阴道 NOTES 和传统腹腔镜的临床试验。主要评估的结果是术后并发症的风险，次要结果是术后第 1 天（POD1）、第 2 天（POD2）和第 3 天（POD3）的疼痛、完全恢复所需的时间、术中并发症的风险、手术持续时间和住院时间。荟萃分析的结果以标准化均数差（SMD）和风险差（RD）表示，并带有 95%置信区间（CI）。

结果

共确定了 13 项试验，涉及 1340 名患者。经阴道 NOTES 与传统腹腔镜相比，并发症风险无统计学差异（术中并发症：RD -0.01，95%CI -0.03 至 0.01；P=0.37；术后并发症：RD -0.02，95%CI -0.05 至 0.01；P=0.148）。经阴道 NOTES 在术后第 1 天（SMD：-0.71，95%CI：-1.30 至 -0.11，P=0.019）、第 2 天（SMD：-0.41，95%CI：-0.75 至 -0.07；P=0.018）和第 3 天（SMD：-0.43，95%CI：-0.63 至 -0.23；P<0.001）的疼痛评分较低。经阴道 NOTES 患者术后完全恢复所需时间明显缩短（SMD：-1.36，95%CI：-1.84 至 -0.87；P<0.001）。此外，经阴道 NOTES 患者疼痛较轻，恢复时间较短。