目的:套管针的直接插入是气腹针插入的另一种方法。我们进行了系统评价和荟萃分析,以比较这两种封闭技术。
方法:对PubMed,MEDLINE,Embase,Scopus,和EBSCO。
方法:文献检索一直持续到2022年5月1日,围绕“Vestress,\"\"直接套管针,\"\"针,插入\"\",“和”腹腔镜进入方式。“这项系统评价是根据2020年PRISMA声明报告的。
结果:16项对照试验(RCTs)和5项观察性研究纳入系统评价。我们发现DTI和VN之间在进入操作期间发生主要并发症的风险没有显着差异:肠损伤(OR=0.76,95%CI:0.24-2.36,P=0.63),主要血管损伤(OR=1.74,95%CI0.56-5.38,P=0.34),口疝(OR=2.41,95%CI:0.28-20.71,P=0.42)。DTI具有较低的风险,例如皮下肺气肿(OR=5.1995%CI:2.27-11.87,P<0.0001),腹膜外充气(OR=5.9395%CI:1.69-20.87,P=0.006),网膜气肿(OR=18.41,95%CI:7.01-48.34,P<0.00001),大网膜出血(OR=2.32,95%CI:1.18~4.55,P=0.01),不成功的输入或吹气尝试次数较少(OR=2.25,95%CI:1.05-4.81,P=0.04)。两组在实现完全吹气所需的时间方面没有发现显着差异(MD=-15.53,95%CI:-91.32至60.27,P=0.69),套管针部位出血(OR=0.66,95%CI,0.25-1.79,P=0.42),套管针部位感染(OR=1.19,95%CI,0.34~4.20,P=0.78)。
结论:在DTI和VN之间的进入操作期间,主要并发症的风险没有统计学上的显著差异。与Verress通路相比,DTI中观察到的轻微并发症数量较少。
OBJECTIVE: Direct insertion of the trocar is an alternative method to Veress needle insertion for the creation of pneumoperitoneum. We conducted a systematic review and meta-analysis to compare these two entry closed techniques.
METHODS: A systematic review of the literature was done on PubMed, MEDLINE, Embase, Scopus, and EBSCO.
METHODS: The literature search was constructed until May 01, 2022, around search terms for \"Veress,\" \"direct trocar,\" \"needle,\" \"insertion,\" and \"laparoscopic ways of entry.\" This systematic review was reported according to the PRISMA Statement 2020.
RESULTS: Sixteen controlled trials (RCTs) and 5 observational studies were included in the systematic review. We found no significant differences in the risk of major complication during the access manoeuvres between DTI and VN: bowel injuries (OR = 0.76, 95% CI: 0.24-2.36, P = 0.63), major vascular injuries (OR = 1.74, 95% CI 0.56-5.38, P = 0.34), port site hernia (OR = 2.41, 95% CI: 0.28-20.71, P = 0.42). DTI has a lower risk of minor complications such as subcutaneous emphysema (OR = 5.19 95% CI: 2.27-11.87, P < 0.0001), extraperitoneal insufflation (OR = 5.93 95% CI: 1.69-20.87, P = 0.006), omental emphysema (OR = 18.41, 95% CI: 7. 01-48.34, P < 0.00001), omental bleeding (OR = 2.32, 95% CI: 1.18-4.55, P = 0.01), and lower number of unsuccessful entry or insufflation attempts (OR = 2.25, 95% CI: 1.05-4.81, P = 0.04). No significant differences were found between the two groups in terms of time required to achieve complete insufflation (MD = - 15.53, 95% CI: - 91.32 to 60.27, P = 0.69), trocar site bleeding (OR = 0.66, 95% CI, 0.25-1.79, P = 0.42), and trocar site infection (OR = 1.19, 95% CI, 0.34-4.20, P = 0.78).
CONCLUSIONS: There were no statistically significant differences in the risk of major complications during the access manoeuvres between DTI and VN. A lower number of minor complications were observed in DTI compared with those in Veress access.