经脐单孔与传统多孔腹腔镜下全子宫切除术临床疗效随机对照研究的荟萃分析

Clinical Efficacy of Transumbilical Single-Port Versus Multi-Port Laparoscopic Total Hysterectomy: A Meta-Analysis of Randomized Controlled Trials

摘要: 目的：探索经脐单孔与传统多孔腹腔镜下全子宫切除术的临床疗效，评估经脐单孔腹腔镜下全子宫切除术是否优于传统多孔腹腔镜下全子宫切除术。资料和方法：检索PubMed、Pub Scholar、Cell Press、新英格兰医学期刊、中国知网和中华医学期刊网，检索时间从2010年至2024年7月。纳入比较经脐单孔与传统多孔腹腔镜下全子宫切除术在良性妇科疾病患者中应用的随机对照试验。使用科克伦偏倚风险评估工具进行研究评价。计算加权平均差、风险比和95%置信区间。研究观察主要结局是术后疼痛评分，术后肛门首次排气时间，次要结局是并发症发生率、转换率、手术时间、估计失血量、住院时间。所有统计分析和绘图均使用STATA 16.0和Microsoft 365MSO进行。结果：纳入符合研究主题的随机对照试验12项，共纳入1301例患者。经脐单孔腹腔镜下全子宫切除术在术后12小时和24小时疼痛评分更低、术后排气时间更短、手术时间更长，在术中术后并发症，手术转换率、估计失血量、术前术后血红蛋白水平、是否输血、住院时间方面与传统多孔腹腔镜下子宫切除术无显著差异。结论是经脐单孔腹腔镜下全子宫切除术对于减轻患者术后疼痛、加快排气时间方面有明显优势，关于评价手术切口美容效果、患者对手术切口满意度、镇痛药物的使用每个研究制定的评价标准不一致，所以无法将其纳入分析，也是该荟萃分析的不足之处，也意味着需要进一步的长期随访的大型前瞻性随机对照试验来明确经脐单孔腹腔镜下全子宫切除术的优势。

Abstract: Objective: To explore the clinical efficacy of transumbilical single-port laparoscopic total hysterectomy compared with conventional multi-port laparoscopic total hysterectomy and assess whether transumbilical single-port laparoscopic total hysterectomy is superior to conventional multi-port laparoscopic total hysterectomy. Methods: We searched PubMed, PubScholar, Cell Press, The New England Journal of Medicine, CNKI, and China Medical Journal Network for randomized controlled trials (RCTs) comparing transumbilical single-port laparoscopic total hysterectomy with conventional multi-port laparoscopic total hysterectomy in patients with benign gynecological diseases, with a search period from 2010 to July 2024. The Cochrane Risk of Bias tool was utilized to evaluate the included studies. Weighted mean differences, risk ratios, and 95% confidence intervals were calculated. The primary outcomes of interest were postoperative pain scores and the time to first postoperative flatus, while secondary outcomes included complication rates, conversion rates, operative time, estimated blood loss, and length of hospital stay. All statistical analyses and graphical representations were conducted using STATA 16.0 and Microsoft 365MSO. Results: Twelve RCTs, involving a total of 1301 patients, met the inclusion criteria. Transumbilical single-port laparoscopic total hysterectomy was found to result in lower pain scores at 12 and 24 hours postoperatively and a shorter time to first postoperative flatus, but with a longer operative time. There were no significant differences between transumbilical single-port laparoscopic total hysterectomy and conventional multi-port laparoscopic total hysterectomy in terms of intraoperative and postoperative complications, conversion rates, estimated blood loss, preoperative and postoperative hemoglobin levels, blood transfusion requirements, or length of hospital stay. Conclusion: Transumbilical single-port laparoscopic total hysterectomy demonstrates clear advantages in reducing postoperative pain and accelerating the time to first flatus. However, due to inconsistent evaluation criteria among studies regarding surgical incision cosmetic effects, patient satisfaction with surgical incisions, and analgesic medication usage, these outcomes could not be included in the analysis, which constitutes a limitation of this meta-analysis. This underscores the need for large, prospective RCTs with long-term follow-up to further elucidate the benefits of transumbilical single-port laparoscopic total hysterectomy.