目的:评估现有的关于2和3D系统在全腹腔镜子宫切除术(TLH)中的手术结果比较的证据。
方法:对电子数据库的系统评价,包括PubMed/MEDLINE和WebofScience,进行了相关研究,比较了TLH中的2D和3D系统。搜索采用医学主题词(MeSH)术语和与主题相关的关键词的组合。包括符合预定义标准的研究,而不直接比较2D和3D系统的病例报告和研究被排除。两名独立审核员评估了研究资格并进行了质量评估。使用荟萃分析技术进行定量合成。
结果:与3D组相比,2D组的手术时间具有统计学意义(7项研究,平均差[MD]:13.67,95%置信区间[CI]9.35-18.00,I2=16%)。然而,在阴道袖带闭合时间方面,组间没有发现统计学上的显著差异(2项研究,MD:3.22,CI-6.58-13.02,I2=96%),并发症发生率(7项研究,优势比[OD]:1.74,CI0.70-4.30,I2=0%),失血(3项研究,MD:2.92,CI-15.44-21.28,I2=0%),和血红蛋白下降(3项研究,MD:0.17,CI-0.08-0.42,I2=1%)。
结论:我们的结果表明,在手术时间上有利于3D系统的显着差异,而在TLH中发现两种系统之间的临床结果具有可比性。然而,进一步研究,特别是具有更大队列和更长期随访的前瞻性研究,以及经济分析,需要为临床医生和医疗保健决策者提供实践和资源分配的基本指导。
OBJECTIVE: To evaluate the existing evidence regarding the comparison between 2 and 3D systems in Total Laparoscopic Hysterectomy (TLH) in terms of surgical outcomes.
METHODS: A systematic review of electronic databases, including PubMed/MEDLINE and Web of Science, was conducted to identify relevant studies comparing 2D and 3D systems in TLH. The search employed a combination of Medical Subject Headings (MeSH) terms and keywords related to the topic. Studies meeting predefined criteria were included, while case reports and studies not directly comparing 2D and 3D systems were excluded. Two independent reviewers evaluated study eligibility and performed quality assessment. The quantitative synthesis was conducted using meta-analysis techniques.
RESULTS: A statistically significant longer operation time in the 2D group compared to the 3D group (7 studies, mean difference [MD]: 13.67, 95% confidence interval [CI] 9.35-18.00, I2 = 16%). However, no statistically significant differences were found between the groups in terms of vaginal cuff closure time (2 studies, MD: 3.22, CI - 6.58-13.02, I2 = 96%), complication rate (7 studies, odds ratio [OD]: 1.74, CI 0.70-4.30, I2 = 0%), blood loss (3 studies, MD: 2.92, CI - 15.44-21.28, I2 = 0%), and Hb drop (3 studies, MD: 0.17, CI - 0.08-0.42, I2 = 1%).
CONCLUSIONS: Our results revealed a significant difference favoring 3D systems in operation time, while clinical outcomes between the two systems were found to be comparable in TLH. However, further research, particularly prospective studies with larger cohorts and longer-term follow-up, along with economic analyses, is needed to provide clinicians and healthcare decision-makers with essential guidance for practice and resource allocation.