Meta-analysis Of Efficacy And Safety Of NOTES Cholecystectomy And Laparoscopic Cholecystectomy

Objective:To compare the efficacy and safety of natural cholecystectomy and laparoscopic cholecystectomy.Methods:The Chinese database includes: China Knowledge Network,Wanfang Medical Database,VIP database,English database includes: PubMed database,EMBASE database,The Cochrane Library,using keywords: "Cholecystectomy","Laparoscopic Cholecystectomy","Natural orifice transluminal endoscopic surgery","NOTES","LC",search strategies include: "prospective","RCTs" Or "observational studies",retrieval time from January 2000 to January 2018,systematically searched for randomized controlled trials on the safety and efficacy of natural cholecystectomy and laparoscopic cholecystectomy,by two authors Independently selected the literature on the experimental design,the characteristics of the study object,screening out the documents that meet the inclusion criteria,using the Review Manager 5.3 software for statistical analysis,drawing out the forest map and funnel diagram.The operation time,the amount of blood loss in the surgery,postoperative complications,postoperative pain scores,postoperative length of stay of patients as comprehensive evaluations of the efficacy of the two surgical indicators.The odds ratio(OR),mean difference(MD),and 95%confidence interval(95% CI)were used to evaluate the efficacy,and the results were finally collated.Results:After screening,15 articles met the inclusion criteria,including 1 in Chinese and 14 in English.A total of 1420 patients included 686 patients undergoing natural cholecystectomy and 734 patients undergoing laparoscopic cholecystectomy.The results showed that: There was no significant difference in age between the groups;in terms of BMI,natural cholecystectomy was lower than laparoscopic cholecystectomy;in terms of operation time,the time of the natural cholecystectomy group was longer than that of laparoscopic cholecystectomy group.Length: The MD value was-31.27 with a 95%confidence interval [-44.36,-18.18],P < 0.00001;in the intraoperative blood loss,there was no difference between the spontaneous cavity cholecystectomy group and the laparoscopic cholecystectomy group.Statistically,the MD value was 3.00,95%confidence interval was [-4.89,10.90],P=0.46;in terms of postoperative complications:no difference between the spontaneous cavity cholecystectomy group and the laparoscopic cholecystectomy group.Statistically significant,the OR was 0.79 with a95% confidence interval [0.42,1.46],P = 0.46;in terms of postoperative pain scores:pain in the spontaneous cavity cholecystectomy group compared with the laparoscopic cholecystectomy group Lighter,MD 4.50,95% confidence zone For [3.94,5.06],P =0.001;In the days of postoperative hospital stay,the pain was shorter in the spontaneous cavity cholecystectomy group compared with the laparoscopic cholecystectomy group,the SMD value was 1.08,and the 95% confidence interval was [0.06,2.09],P=0.04.Conclusion:In terms of operative time,laparoscopic cholecystectomy was shorter and had superiority in terms of postoperative pain and postoperative hospital stay in the natural cholecystectomy group.In terms of intraoperative blood loss and postoperative complications,there was no statistical difference between the two groups.