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目的:评价宫腹腔镜联合手术与经阴式手术治疗子宫切口憩室的效果。方法:检索the Cochrane Central Register of Controlled Trials(CENTRAL)、Pub Med、SCIE、EMbase、CNKI、VIP、万方数据库等数据库,查找宫腹腔镜联合手术与经阴式手术治疗子宫切口憩室的随机对照试验(RCT)相关文献,同时手检纳入文献的参考文献。按纳入排除标准由2名评价员独立进行RCT的筛选、资料提取和质量评估后,采用Rev Man5.1软件进行Meta分析。结果:纳入文献14篇,共884例患者,其中481例行宫腹腔镜联合手术或宫腔镜电切手术或开腹手术(观察组),403例仅行经阴式手术(对照组)。Meta分析显示,与经阴式手术比较,宫腹腔镜联合手术患者的手术时间较长(MD=13.99,95%CI为4.76~23.23,P=0.003),术中出血少(MD=-13.08,95%CI为-22.98~-3.18,P=0.01),住院时间短(MD=-2.10,95%CI为-3.45~-0.75,P=0.002),治疗费用多(SMD=6.93,95%CI为4.50~9.35,P<0.00001),术后总并发症发生率低(RR=0.38,95%CI为0.19~0.75,P=0.006),术后阴道出血时间短(MD=-3.16,95%CI为-5.26~-1.05,P=0.003),术后肛门排气时间差异无统计学意义(MD=0.26,95%CI为-0.22~0.75,P=0.29),术后月经恢复情况好(OR=1.89,95%CI为1.11~3.20,P=0.02),术后憩室修复情况好(OR=2.16,95%CI为1.20~3.88,P=0.010)。结论:宫腹腔镜联合手术与经阴式手术治疗子宫切口憩室比较,手术时间较长,治疗费用高,术后肛门排气时间无明显差异,但住院时间短,术后阴道出血时间短,术中出血少,安全性更高;可提高月经恢复情况、憩室修复情况。但原始研究质量均较低,建议临床上审慎选择使用;需更多高质量、大样本研究进一步验证。
Objective: To evaluate the effect of hysteroscopic laparoscopic combined surgery and vaginal surgery in the treatment of uterine incision diverticulum. Methods: A randomized controlled trial was conducted to search the Cochrane Central Register of Controlled Trials (CENTRAL), Pub Med, SCIE, EMbase, CNKI, VIP and Wanfang database for hysteroscopic combined surgery and vaginal surgery (RCT) related literature, while hand-checked into the literature reference. According to inclusion criteria, two reviewers independently performed RCT screening, data extraction and quality assessment, and Meta-analysis was performed using Rev Man5.1 software. Results: A total of 14 articles were included in the literature, of which 884 were enrolled in the study. 481 patients underwent laparoscopic hysteroscopic or hysteroscopic resection or open surgery (observation group), and 403 patients underwent transvaginal surgery (control group). Meta-analysis showed that patients undergoing laparoscopic surgery combined with laparoscopic surgery had longer operation time (MD = 13.99, 95% CI 4.76-23.23, P = 0.003) and less bleeding during surgery (MD = -13.08, 95% CI was -22.98 ~ -3.18, P = 0.01), hospitalization time was short (MD = -2.10, 95% CI -3.45-0.75, P = 0.002) (4.50 ~ 9.35, P <0.00001). The incidence of postoperative complications was low (RR = 0.38, 95% CI 0.19-0.75, P = 0.006) CI = -5.26 ~ -1.05, P = 0.003). There was no significant difference in postoperative anal exhaust time between the two groups (MD = 0.26, 95% CI -0.22 ~ 0.75, P = 0.29) OR = 1.89, 95% CI 1.11-3.20, P = 0.02). Postoperative diverticulum repair was good (OR = 2.16, 95% CI 1.20-3.88, P = 0.010). Conclusion: The laparoscopic hysterectomy combined with vaginal surgery in the treatment of uterine incision diverticulum, the operation time is longer, the treatment cost is high, there is no significant difference in the time of anal exhaust, but the hospitalization time is short, the postoperative vaginal bleeding time is short, Less bleeding, higher safety; can improve menstrual recovery, diverticulum repair situation. However, the quality of the original research is low, so it is recommended to use it prudently in clinical practice. More high-quality and large sample studies are needed for further validation.