| At present,Hysterectomy is one of the most common procedures in the world.Nine out of 10 patients underwent hysterectomy for benign uterine disease.With the development of medical science and technology,although minimally invasive surgery is used in the treatment of gynecological and uterine diseases,such as radiofrequency ablation,uterine artery embolization,etc.,hysterectomy is still the preferred treatment,the proportion of up to 50% And maintain this ratio steadily [1].Hysterectomy There are several major surgical methods: abdominal hysterectomy(abdominal hysterectomy AH),laparoscopic hysterectomy(laparoscopic hysterectomy LH),laparoscopic-assisted vaginal hysterectomy(laparoscopic-assisted vaginal hysterectomy LAVH)Vaginal hysterectomy(vaginal hysterectomy VH)[2].LH and VH compared with the AH is relatively minimally invasive surgical approach.However,how to guide the clinical choice of the best surgical methods,there is no uniform standard in our country,which is also related to the surgeon’s surgical experience,surgical habits and patients with different conditions.So far,there are many literatures on AH,VH,LH,three surgical methods to study,but no direct analysis of meta-AH,VH and LH.Therefore,this Meta-analysis aims to evaluate which method will lead to the best clinical outcomeObjective: To investigate the feasibility and safety of laparosco pic hysterectomy,vaginal hysterectomy and abdominal hysterectomy in th e treatment of uterine diseases,in order to guide the best clinical choice Surgical approach.And for the surgical treatment of uterine disease to p rovide a decisive basis.Methods : Retrieve all relevant articles from EM BASE,MEDLINE,Pubmed,web of Science and EBM databases for com parisons of at least two of the three surgical modalities LH,VH and AH,time setting 2015-2017,2 panelists Screening Literature,eventually inclu ded 10 articles,a total of 5715 patients included.According to the Jadad standard,the quality of literature was evaluated and relevant data were extracted.Revman 5.3.4 software performed meta-analysis on each group of data.Results: The meta-analysis showed that compared with VH and A H,LH had less blood loss,shorter hospital stay,the least postoperative pai n,and the lowest incidence of major complications.First:Compared with A H,the length of operation was prolonged[MD=16.25,95%CI(-6.13,39.17)(P=0.15)],and the difference was not statistically significant.However,less bloo d loss [MD=-113.14,95%CI(-160.99,-65.29)(P<0.00001)]hospital stay[MD=-1.16,95%CI(-1.42,-0.89)(P<0.00001)],low postoperative analgesia[RR=0.10,95% CI(0.08,0.11)(P<0.00001)],low incidence of total complications[OR=0.55,95%CI(0.38,0.77)(P=0.0005)].The above 4 differences were statisticallysignificant.The total complications were further analyzed,including bleedin g events[OR=0.31,95%CI(0.15,-0.63)(P=0.001)],injury events [OR=0.36,95%CI(0.27,0.48)(P<0.00001)],Infection events[OR = 0.39,95%CI(0.27,-0.56)(P<0.00001)],the incidence of these three indicators are low,the difference was statistically significant.Second: Compared with VH,LH prolonged o peration time[MD=43.99,95%CI(20.26,67.72)(P=0.0003)],intraoperative bloo d loss[MD=-44.94,95%CI(-124.98,35.11)(P=0.27)],bleeding events [OR=0.37,95%CI(0.13,1.02)(P=0.05)],injury events [OR=0.84,95%CI(0.10,7.01)(P=0.88)],conversion to laparotomy[OR=0.69,95% CI(0.21,2.29)(P=0.54)],There were no statistically significant differences in these areas,but hospital sta y was shorter[MD=-0.43,95%CI(-0.60),-0.27)(P<0.00001)],postoperative an algesia requirement was lower [OR=0.47,95%CI(0.26,0.84)(P=0.01)],and th e overall complication rate was lower[OR=0.45,95%CI(0.21,0.96)P=0.04].Conclusion:Although LH has a long operative time,it is more advantag eous than VH and VH in LH indications,given its rich experience and proven laparoscopic techniques.Due to the limited number of literature i nvolved,Methods Some data on sexual function,vaginal length,and lower urinary tract symptoms are not currently available for meta-analysis,but we should pay attention to this issue.When more high-quality clinical t rials are available to provide data and data sets,To analyze. |
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