目的:在结直肠手术中,手助腹腔镜手术(HALS)是直腹腔镜(LAP)的替代方法。许多研究在疗效方面对两者进行了比较,并发症,和结果。这项荟萃分析旨在发现转化率是否有任何显著差异,手术时间,体重指数(BMI),切口长度,术中和术后并发症,和逗留时间的长短。
方法:从各自开始到2021年12月16日,对数据库进行了全面搜索,并通过Scopus进行了手动搜索。随机对照试验(RCT),队列研究,包括超过10名患者的病例系列。
结果:共发现47项研究符合纳入标准,有5个RCT,41项队列研究,和1个案例系列。手助腹腔镜手术与较低的转换率相关(比值比[OR]0.41,95CI0.28-0.60,p<0.00001),手术时间较短(平均差异[MD]-8.32分钟,95CI-14.05--2.59,p=0.004),和更高的BMI(MD0.79,95CI0.46-1.13,p<0.00001),但它也与较长的切口长度(MD2.19厘米,95CI1.66-2.73厘米,p<0.00001),术后并发症发生率较高(OR1.15,95CI1.06-1.24,p=0.0004)。与Lap相比,HALS的住院时间没有差异(MD0.16天,95CI-0.06-0.38天,p=0.16,两种技术的术中并发症相同。
结论:手助腹腔镜是直式腹腔镜的合适替代方案,具有益处和风险。虽然有许多队列研究比较了HALS和LAP,为了获得更好的证据质量,需要更多的随机对照试验。
OBJECTIVE: Hand-assisted laparoscopic surgery (HALS) is an alternative to straight laparoscopy (LAP) in colorectal surgery. Many studies have compared the two in terms of efficacy, complications, and outcomes. This meta-analysis aims to uncover if there are any significant differences in conversion rates, operative times, body mass index (BMI), incision lengths, intraoperative and postoperative complications, and length of stay.
METHODS: Comprehensive searches were performed on databases from their respective inceptions to 16 December 2021, with a manual search performed through Scopus. Randomized controlled trials (RCTs), cohort studies, and case series involving more than 10 patients were included.
RESULTS: A total of 47 studies were found fitting the inclusion criteria, with 5 RCTs, 41 cohort studies, and 1 case series. Hand-assisted laparoscopic surgery was associated with lower conversion rates (odds ratio [OR] 0.41, 95%CI 0.28-0.60, p < 0.00001), shorter operative times (Mean Difference [MD] - 8.32 min, 95%CI - 14.05- - 2.59, p = 0.004), and higher BMI (MD 0.79, 95%CI 0.46-1.13, p < 0.00001), but it was also associated with longer incision lengths (MD 2.19 cm, 95%CI 1.66-2.73 cm, p < 0.00001), and higher postoperative complication rates (OR 1.15, 95%CI 1.06-1.24, p = 0.0004). Length of stay was not different in HALS as compared to Lap (MD 0.16 days, 95%CI - 0.06-0.38 days, p = 0.16, and intraoperative complications were the same between both techniques.
CONCLUSIONS: Hand-assisted laparoscopy is a suitable alternative to straight laparoscopy with benefits and risks. While there are many cohort studies comparing HALS and LAP, more RCTs would be needed for a better quality of evidence.