阴道自然腔内窥镜手术与腹腔镜单部位手术卵巢囊肿切除术的比较：系统回顾和荟萃分析。

IF 1.6 4区医学 Q3 OBSTETRICS & GYNECOLOGY

Journal of gynecology obstetrics and human reproduction Pub Date : 2025-09-26 DOI:10.1016/j.jogoh.2025.103041

Zainah Abdulbari Mohammed Alhebshi , Marwah Nasir Ahmad , Husna Irfan Thalib , Ayah Nabil Al Jehani , Amal Mahmoud , Retaj Jameel Tallab , Rasil Fayez A. Alahmadi , Alanood Abdullah Banafea , Saeed Baradwan

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引用次数: 0

摘要

背景：阴道自然孔腔内窥镜手术（vNOTES）和腹腔镜单部位手术（LESS）是卵巢囊肿切除术的微创方法，但它们的相对安全性、有效性和以患者为中心的结果仍未得到充分评估，因此有必要进行本系统综述和荟萃分析。材料和方法：在2024年12月，我们使用PubMed、Ovid Medline和Ovid Cochrane进行了系统检索。使用非随机研究方法学指数（methods Index for non - random Studies，简称：minor）和修订后的Cochrane Risk of Bias （RoB 2）工具进行偏倚风险评估。结果：从最初的588条记录中，纳入了4项研究（576例患者：197例vNOTES， 379例LESS）。荟萃分析显示，与LESS相比，vNOTES显着减少了手术时间（合并平均差(MD) -13.62分钟，P = 0.02）和住院时间（MD -0.44天，P = 0.03），敏感性分析强化了这些发现（例如，MD -18.23分钟和-0.63天）。术后疼痛评分（视觉模拟评分（VAS））明显低于vNOTES (MD -1.09, P < 0.00001)，排气恢复时间较短（MD -3.72小时，P < 0.00001）。术中出血量（MD -6.99 mL, P = 0.27）、转化率（比值比（OR） 1.15, P = 0.91）或总不良事件（OR 0.70, P = 0.41）方面均无显著差异，但在回顾性亚组分析中仍存在异质性（手术时间和疼痛评分I² = 72-96%）。结论：这些研究结果表明vNOTES是卵巢囊肿切除术的有利选择，其疗效和安全性优于LESS；然而，需要进一步的随机对照试验来加强这些结论。

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Comparing outcomes of ovarian cystectomy by vaginal natural orifice transluminal endoscopic surgery versus laparoendoscopic single-site surgery: A systematic review and meta-analysis

Background

Vaginal natural orifice transluminal endoscopic surgery (vNOTES) and laparoendoscopic single-site surgery (LESS) are minimally invasive approaches for ovarian cystectomy, yet their comparative safety, efficacy, and patient-centered outcomes remain insufficiently evaluated, necessitating this systematic review and meta-analysis.

Materials and Methods

In December 2024, we conducted a systematic search using PubMed, Ovid Medline, and Ovid Cochrane. The Methodological Index for Non-Randomized Studies (MINORS) and the Revised Cochrane Risk of Bias (RoB 2) tools have been used for the risk of bias assessment.

Results

From an initial 588 records, four studies (576 patients: 197 vNOTES, 379 LESS) were included. Meta-analysis revealed that vNOTES significantly reduced operative time (pooled mean difference (MD) -13.62 min, P = 0.02) and hospital stay (MD -0.44 days, P = 0.03) compared to LESS, with sensitivity analyses strengthening these findings (e.g., MD -18.23 min and -0.63 days post-exclusion). Postoperative pain scores (by visual analogue score (VAS)) were markedly lower for vNOTES (MD -1.09, P < 0.00001), and time to flatus recovery was shorter (MD -3.72 h, P < 0.00001). No significant differences were observed in intraoperative blood loss (MD -6.99 mL, P = 0.27), conversion rates (odds ratio (OR) 1.15, P = 0.91), or overall adverse events (OR 0.70, P = 0.41), though heterogeneity persisted in retrospective subgroup analyses (I² = 72–96 % for operative time, and pain scores).

Conclusion

These findings position vNOTES as a favorable option for ovarian cystectomy, offering improved efficacy with safety comparable to LESS; however, further RCTs are needed to strengthen these conclusions.

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来源期刊

Journal of gynecology obstetrics and human reproduction Medicine-Obstetrics and Gynecology

CiteScore

3.70

自引率

5.30%

发文量

210

审稿时长

31 days

期刊介绍： Formerly known as Journal de Gynécologie Obstétrique et Biologie de la Reproduction, Journal of Gynecology Obstetrics and Human Reproduction is the official Academic publication of the French College of Obstetricians and Gynecologists (Collège National des Gynécologues et Obstétriciens Français / CNGOF). J Gynecol Obstet Hum Reprod publishes monthly, in English, research papers and techniques in the fields of Gynecology, Obstetrics, Neonatology and Human Reproduction: (guest) editorials, original articles, reviews, updates, technical notes, case reports, letters to the editor and guidelines. Original works include clinical or laboratory investigations and clinical or equipment reports. Reviews include narrative reviews, systematic reviews and meta-analyses.