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目的:评价腹腔镜子宫肌瘤挖除术(laparoscopic myomectomy,LM)与开腹子宫肌瘤挖除术(open myomectomy,OM)治疗子宫肌瘤的手术效果、安全性及远期结果。方法:计算机检索PubMed、EMbase、Ovid、Cochrane library、循证医学数据库、中国生物医学文献数据库、CNKI、万方数字化期刊全文数据库至2012年8月的文献,收集2种术式的随机对照试验(randomized controlled trial,RCT)。用RevMan 5.1.7软件进行Meta分析。结果:最终纳入7个RCT研究(8篇文献),656例患者,其中LM组328例,OM组328例。Meta分析的结果显示:①手术时间:OR=12.02,95%CI=8.45~15.59,P<0.000 01;②术中失血量:OR=-47.20,95%CI=-60.79~-33.61,P<0.000 01;③手术中总的并发症:OR=3.73,95%CI=0.61~22.98,P=0.16;④手术中严重并发症:OR=3.02,95%CI=0.31~29.39,P=0.34;⑤术后排气恢复时间:OR=-15.14,95%CI=-19.05~-11.23,P<0.000 01;⑥术后血红蛋白值变化:OR=-1.04,95%CI=-1.14~-0.93,P<0.000 01;⑦手术后总并发症:OR=0.41,95%CI=0.22~0.77,P=0.005;⑧手术后严重并发症:OR=0.45,95%CI=0.10~2.00,P=0.29;⑨手术后妊娠结局,妊娠率:OR=1.32,95%CI=0.80~2.17,P=0.28;流产率:OR=1.24,95%CI=0.45~3.37,P=0.68;剖宫产率:OR=0.93,95%CI=0.39~2.18,P=0.86;经阴道分娩率:OR=1.08,95%CI=0.46~2.53,P=0.86;早产率:OR=0.67,95%CI=0.10~4.28,P=0.67;⑩手术后子宫肌瘤复发情况:OR=1.15,95%CI=0.60~2.18,P=0.67。结论:2种术式比较,腹腔镜组手术时间、术中失血量、术后排气恢复时间、术后血红蛋白值变化等方面有优势。且术后总的并发症较开腹组低,但术中总并发症、术中严重并发症、术后严重并发症、术后妊娠结局、术后子宫肌瘤复发等方面2种术式没有明显差异。
Objective: To evaluate the efficacy, safety and long-term results of laparoscopic myomectomy (LM) and open myomectomy (OM) in the treatment of uterine fibroids. METHODS: Two randomized controlled trials (PubMed, EMbase, Ovid, Cochrane library, evidence-based medical database, Chinese biomedical literature database, CNKI, Wanfang digital periodical full-text database to August 2012) randomized controlled trial, RCT). Meta-analysis was performed using RevMan 5.1.7 software. RESULTS: Seven RCTs (8 articles) were ultimately enrolled in 656 patients, 328 in the LM group and 328 in the OM group. The results of Meta analysis showed that: ①Operation time: OR = 12.02,95% CI = 8.45 ~ 15.59, P <0.000 01; ② The intraoperative blood loss: OR = -47.20,95% CI = -60.79 ~ -33.61, P < 0.000 01; ③ The total complications in the operation: OR = 3.73, 95% CI = 0.61 ~ 22.98, P = 0.16; ④ serious complications in surgery: OR = 3.02, 95% CI = 0.31-29.39, P = 0.34; ⑤ postoperative exhaust recovery time: OR = -15.14,95% CI = -19.05 ~ -11.23, P <0.000 01; ⑥ postoperative hemoglobin value changes: OR = -1.04,95% CI = -1.14 ~ -0.93, P <0.000 01; ⑦ total postoperative complications: OR = 0.41, 95% CI = 0.22 ~ 0.77, P = 0.005; ⑧ serious complications after surgery: OR = 0.45, 95% CI = 0.10 ~ 2.00, P = ; ⑨ postoperative pregnancy outcome, pregnancy rate: OR = 1.32, 95% CI = 0.80 ~ 2.17, P = 0.28; abortion rate: OR = 1.24,95% CI = 0.45 ~ 3.37, OR = 0.93, 95% CI = 0.39-2.18, P = 0.86; Vaginal delivery rate: OR = 1.08,95% CI = 0.46-2.53, P = 0.86; Preterm birth rate: OR = 0.67,95% CI = 4.28, P = 0.67; ⑩ recurrence of uterine fibroids after surgery: OR = 1.15, 95% CI = 0.60 ~ 2.18, P = 0.67. Conclusion: There are two advantages of laparoscopic surgery, laparoscopic operation time, intraoperative blood loss, postoperative exhaust recovery time and postoperative hemoglobin value. And the total postoperative complications than the open group, but the total complications, intraoperative serious complications, postoperative complications, postoperative pregnancy outcome, postoperative recurrence of uterine fibroids and other two kinds of operation without Significant differences.