目的 对开腹手术和腹腔镜微创手术治疗多发性子宫肌瘤患者的效果对比资料进行Meta分析.方法 对国内外2015年1月1日至2018年2月30日公开发表的开腹手术与腹腔镜微创手术治疗多发性子宫肌瘤的研究进行检索,并评价所选文献的质量,借助RevMan5.1软件包将检索的文献中关于效果的报道进行Meta分析.结果 本研究共提取10篇国内外相关报道(8篇国内文献,2篇国外文献),共纳入2241例患者,其中采用腹腔镜微创手术治疗者共1229例,采用开腹手术治疗者共1012例;手术时间、术中出血量、术后住院时间、术后并发症发生率异质性检验结果分别为P=0.44,I2=0.02;P=0.56,I2=0.01;P=0.52,I2=0.01;P=0.48,I2=0.01.固定效应模型分析结果显示SMD=―0.35,95%CI(―1.25,1.03),P=0.03;SMD=1.28,95%CI(―1.23,1.49),P=0.02;SMD=1.33,95%CI(1.12,1.87),P=0.03;SMD=1.30,95%CI(1.09,1.92),P=0.02;漏斗图分析发现均无明显的偏倚.结论 对多发性子宫肌瘤患者实施腹腔镜微创手术相较于开腹手术可明显延长手术时间,但是术中出血量少、住院时间明显缩短,并发症显著减少,优势明显.%Objective To evaluate the efficacy and safety of laparotomy and minimally invasive laparoscopic surgery in the treatment of multiple uterine myoma by means of evidence-based medicine.Methods Wanfang Med Database,China National Knowledge Infrastructure,Cochran,EMbase etc.were retrieved for randomized con-trolled trials(RCTs)of laparotomy and minimally invasive laparoscopic surgery for multiple uterine myoma.The extracted data was analyzed with the RevMan5.1 software.Results Ten RCTs involving 2 241 patients met the inclusion criteria,and the laparoscopic group was minimally invasive laparoscopic surgery(n=1 229),while the open group was laparotomy(n = 1 012).The operation time,intraoperative blood loss,postoperative hospital stay,and complication rates were compared.The meta-analysis showed that in patients treated with laparoscopic surgery,the operation time was significantly increased,while the intraoperative blood loss,postoperative hospital stay,and complication rate were significantly decreased(P < 0.05),compared to those treated with laparoto-my.Conclusion Minimally invasive laparoscopic surgery for multiple myoma patients can significantly prolong op-eration time compared with laparotomy,but with less bleeding volume,shorter hospitalization time and fewer complications,which has obvious advantages.
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