背景:子宫肌瘤切除术是患有子宫肌瘤且有生育要求的女性的首选治疗方法。在临床实践中,子宫肌瘤切除术有三种方式:腹部子宫肌瘤切除术(AM),腹腔镜子宫肌瘤切除术(LM),和机器人辅助腹腔镜子宫肌瘤切除术(RLM)。
目的:比较RLM的围手术期和术后结局,AM,和LM。
方法:我们搜索了PubMed,WebofScience,Embase,以及2000年1月至2023年1月发表的相关文献的临床试验。
方法:我们纳入了所有报告子宫肌瘤患者子宫肌瘤切除术围手术期和术后结局的研究。手术治疗被归类为RLM,LM,或AM。
方法:两名或更多作者独立选择研究,评估的偏见风险,并提取数据。我们得出每个结果的均差(MD)或比值比(OR),95%置信区间(CI),根据患者特征和肌瘤特征进行分组试验。我们使用I2统计量量化异质性,并在适当时使用随机效应模型进行荟萃分析。我们使用漏斗图来评估发表偏倚。
结果:共纳入32项研究,共6357名患者,其中1982年女性接受了RLM。手术时间明显延长(MD=43.58,95%置信区间[CI]:25.22-61.93,P<0.001),子宫肌瘤切除术后剖宫产的发生率明显低于LM(OR=0.27,95%CI:0.10-0.78,P=0.02)。与AM相比,手术时间,失血,输血率,并发症发生率,总成本,住院时间,RLM患者的妊娠率差异有统计学意义。
结论:RLM的安全性和有效性优于AM,但劣于LM。
BACKGROUND: Myomectomy is the preferred treatment for women with uterine fibroids and fertility requirements. There are three modalities are used in clinical practice for myomectomy: abdominal myomectomy (AM), laparoscopic myomectomy (LM), and robot-assisted laparoscopic myomectomy (RLM).
OBJECTIVE: To compare the perioperative and postoperative outcomes of RLM, AM, and LM.
METHODS: We searched PubMed, Web of Science, Embase, and Clinical Trials for relevant literature published between January 2000 and January 2023.
METHODS: We included all studies reporting peri- and postoperative outcomes of myomectomy in patients with uterine myomas. Surgical treatments were classified as RLM, LM, or AM.
METHODS: Two or more authors selected studies independently, assessed risk of bias, and extracted data. We derived mean difference (MD) or odds ratio (OR) with 95% confidence intervals (CIs) for each outcome, subgrouping trials by the patient characteristics and myoma characteristics. We used the I2 statistic to quantify heterogeneity and the random-effects model for meta-analysis when appropriate. We used the funnel plot to assess the publication bias.
RESULTS: A total of 32 studies with 6357 patients were included, of which 1982 women had undergone RLM. The operating time was significantly longer (MD = 43.58, 95% confidence interval [CI]: 25.22-61.93, P < 0.001), and the incidence of cesarean section after myomectomy was significantly lower (OR = 0.27, 95% CI: 0.10-0.78, P = 0.02) in RLM than in LM. Compared with AM, the operation time, blood loss, blood transfusion rate, complication rate, total cost, length of hospital stay, and pregnancy rate of patients with RLM were significantly different.
CONCLUSIONS: The safety and effectiveness of RLM are superior to those of AM but inferior to those of LM.