超声刀与电刀在腹腔镜胆囊切除术中疗效对比的Meta分析

Efficacy of ultrasonic versus electrosurgical scalpel in laparoscopic cholecystectomy:a Meta analysis

摘要:

目的：系统评价超声刀与单极电刀在腹腔镜胆囊切除术中的疗效。方法：通过检索PubMed、Cochrane library、EMbase、Ovid、中国知网全文数据库（CNKI）、万方、维普等在线数据库并追查已纳入文献的参考文献，系统收集国内外相关的随机对照试验（randomized controlled trial，RCT）。由2名评价者独立完成文献的筛选、质量评价和资料提取，使用RevMan 5.1软件完成Meta分析。结果：经筛选，共纳入10个随机对照研究，总样本量1 199例，其中超声刀组604例，电刀组595例。Meta分析结果显示，与单极电刀组相比，超声刀组：①平均手术时间明显更短（WMD（-11.75），95%CI[-16.61，-6.89]，P<0.000 01）；②胆囊穿孔率更低（RR 0.40，95%CI[0.31，0.51]，P<0.000 01）；③平均术中出血量更少（WMD（-24.38），95%CI[-40.88，-7.89]，P=0.004]；④平均住院时间更短（WMD（-0.40），95%CI[-0.68，-0.11]，P=0.006）；⑤术后24 h视觉模拟疼痛评分（visual analogue scale，ＶＡＳ）更低（WMD（-1.12），95%CI[-1.23，-1.01]，P<0.000 01）；⑥术后并发症发生率更低[RR 0.47，95%CI（0.25，0.88），P=0.02]；⑦在中转开腹发生率上，两组差异无统计学意义（RR 0.54，95％CI[0.23，1.27]，P=0.16）。结论：对于非急性结石性胆囊炎的患者择期行腹腔镜胆囊切除术，使用超声刀在手术时间、胆囊穿孔率、术中出血、术后24 h VAS以及术后并发症方面优于电刀组。但因纳入文献的质量较低和样本量有限，需要大样本及高质量的临床RCT来提供更好的循证证据。

Abstract:

Objective：To systematically review and evaluate the effctiveness of ultrasonic and monopolar electrosurgical scalpel in la－paroscopic cholecystectomy. Methods：Randomized clinical trials related with ultrasonic or monopolar electrosurgical scalpel used in laparoscopic cholecystectomy with adult patients of symptomatic gallstone disease were searched from PubMed，Cochrane library，EMbase，Ovid，CNKI，WanFang and VIP. Two reviewers independently assessed the quality and extracted the data. All data were ana－lyzed by using RevMan 5.1. Results：Ten trials with a total of 1 199 patients met the inclusion criteria（604 patients in ultrasonic scalpel group and 595 patients in electrosurgical scalpel group）. Meta analysis showed that compared with those in monopolar electro－surgical scalpel group：①average operating time was significantly shorter in ultrasonic scalpel group（WMD（-11.75），95%CI[-16.61，-6.89]，P<0.000 01）；②gallbladder perforation rate was lower in ultrasonic scalpel group（RR 0.40，95%CI[0.31，0.51]，P<0.000 01）；③average intraoperative blood loss was less in ultrasonic scalpel group（WMD（-24.38），95%CI[-40.88，-7.89]，P=0.004）；④av－erage hospital duration was shorter in ultrasonic scalpel group（WMD（-0.40），95%CI[0.68，-0.11]，P=0.006）；⑤visual ana－logue scale scores at 24 h postoperatively was significantly lower in ultrasonic scalpel group（WMD（-1.12），95%CI[-1.23，-1.01]，P<0.000 01）；⑥the postoperative complication risk was lower in ultrasonic scalpel group（RR 0.47，95%CI[0.25，0.88]，P=0.02）. How－ever，there was no statistical difference in rate of conversion to open surgery between the two groups（RR 0.54，95％CI[0.23，1.27]，P=0.16）. Conclusions：Ｒesults show that ultrasonic scalpel can shorten the operating time，reduce gallbladder perforation rate，blood loss，postoperative 24 h visual analogue scale scores and postoperative complication rate for patients with non-acute calculous chole－cystitis underwent elective laparoscopic cholecystomy. Because of the limits of the sample and quality of included studies，this con－clusion has to be verified with more strictly designed large scale randomized controlled trials.