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目的:通过Meta分析综合比较机器人子宫肌瘤剔除术和腹腔镜子宫肌瘤剔除术的有效性与安全性,为临床治疗与后续的研究提供依据。方法:计算机检索Embase、Pub Med、Web of Science、Cochrane Library Databases、中文科技期刊数据库(VIP)、中国期刊全文数据库(CNKI)、中国生物医学文献数据库(CBM)、万方数字化期刊全文数据库和google学术,检索时限均从建库到2015年6月。由两位研究者按照纳入与排除标准独立筛选文献、提取资料和评价纳入研究的质量后,采用Review Manager5.3和Stata 11.2进行Meta分析。结果:共纳入9项研究,涉及1000例患者接受了机器人辅助腹腔镜子宫肌瘤剔除手术或腹腔镜子宫肌瘤剔除手术。Meta分析显示RALM与LM相比,术中失血量(WMD=-34.66,95%CI=-63.55~-5.78,P=0.020)、中转开腹率(OR=0.34,95%CI=0.13~0.88,P=0.030)、并发症发生率(OR=0.52,95%CI=0.32~0.85,P=0.009)明显降低,输血人数、住院时间、手术时间和最大肌瘤直径没有明显差异。结论:RALM比LM更安全、更有效。RALM相比LM,术中失血量显著降低、中转开腹率和并发症发生率显著减少,输血人数、手术时间、住院时间和最大肌瘤直径没有明显差异。
OBJECTIVE: To compare the effectiveness and safety of robotic myomectomy and laparoscopic myomectomy with Meta-analysis to provide a basis for clinical treatment and follow-up studies. Methods: The computer searches of Embase, Pub Med, Web of Science, Cochrane Library Databases, Chinese Science and Technology Database (VIP), Chinese Journal Full-text Database (CNKI), China Biomedical Literature Database (CBM), Wanfang Digital Periodicals Full Text Database and google Academic, search time from the construction of the library to June 2015. Meta-analysis was performed using Review Manager 5.3 and Stata 11.2 after two investigators independently screened the literature for inclusion and exclusion, extracted data, and assessed the quality of the included studies. RESULTS: Nine studies were included involving 1000 patients who underwent robotic-assisted laparoscopic myomectomy or laparoscopic myomectomy. Meta-analysis showed that the intraoperative blood loss (WMD = -34.66,95% CI = -63.55-5.78, P = 0.020), the rate of laparotomy (OR = 0.34, 95% CI = 0.13-0.88 , P = 0.030). The complication rate (OR = 0.52, 95% CI = 0.32-0.85, P = 0.009) was significantly lower than that of the control group. There was no significant difference in the number of transfusions, length of hospital stay, operation time and maximum fibroid diameter. Conclusion: RALM is safer and more effective than LM. RALM compared with LM, intraoperative blood loss was significantly reduced, the conversion rate of laparotomy and the incidence of complications was significantly reduced, the number of transfusions, operation time, length of stay and the largest fibroids diameter no significant difference.