Velanovich V
Department of Surgery, Henry Ford Hospital, Detroit, MI 48202-2689, USA.
Surg Endosc. 2000 Jan;14(1):16-21. doi: 10.1007/s004649900003.
The purported advantages of laparoscopic surgery over conventional open techniques are less pain and faster return to normal functional status. Very few studies have included validated measures of quality of life as end points. This study prospectively assessed the health status outcomes of patients undergoing four types of laparoscopic and open operations.
Preoperatively, patients undergoing elective inguinal hernioplasty, esophageal surgery, cholecystectomy, and splenectomy completed the SF-36, a well-tested, validated health-status instrument. This instrument measures physical functioning (PF), role-physical (RP), role-emotional (RE), bodily pain (BP), vitality (VT), mental health (MH), social functioning (SF), and general health (GH) health status domains. Patients then underwent either laparoscopic or open surgery. Patients were reassessed with the instrument > or =6 weeks after surgery. A total of 100 patients underwent these procedures.
Compared to preoperative values, median SF-36 scores for laparoscopic cholecystectomy patients were improved in the domains of PF (85 vs 95, p = 0.01), BP (42 vs 75, p = 0.002), and VT (47.5 vs 70, p = 0.04); open cholecystectomy patients did not show statistically significant improvements over preoperative values. In addition, laparoscopic cholecystectomy patients had a better score than open cholecystectomy patients in the BP domain (75 vs 41, p = 0.05). Laparoscopic esophageal surgery patients had better scores than open surgery patients in the domains of RP (100 vs 0, p = 0.02) and VT (65 vs 52.5, p = 0.05). Compared to preoperative values, laparoscopic splenectomy patients had an improved score in GH (52 vs 77, p = 0.02) and better scores than open splenectomy patients in PF (90 vs 45, p = 0.05) and BP (84 vs 55.5, p = 0.01). Compared to preoperative values, open mesh hernioplasty patients showed improved scores in PF (70 vs 92.5, p = 0.03) and MH (72 vs 84, p = 0.05). Laparoscopic hernioplasty did not produce improved scores compared to either preoperative values or open hernioplasty.
Laparoscopic surgery has demonstrably better quality-of-life outcomes than open surgery for cholecystectomy, splenectomy, and esophageal surgery. However, open hernioplasty has at least as good, if not better, health status outcomes than laparoscopic repair.
与传统开放手术相比，腹腔镜手术据称具有疼痛较轻、能更快恢复至正常功能状态的优势。极少有研究将经过验证的生活质量测量指标作为终点。本研究前瞻性地评估了接受四种类型腹腔镜手术和开放手术患者的健康状况结局。
术前，接受择期腹股沟疝修补术、食管手术、胆囊切除术和脾切除术的患者完成了SF - 36，这是一种经过充分测试且验证有效的健康状况评估工具。该工具测量身体功能（PF）、身体角色功能（RP）、情绪角色功能（RE）、身体疼痛（BP）、活力（VT）、心理健康（MH）、社会功能（SF）和总体健康（GH）等健康状况领域。然后患者接受腹腔镜手术或开放手术。术后≥6周用该工具对患者进行重新评估。共有100例患者接受了这些手术。
与术前值相比，腹腔镜胆囊切除术患者的SF - 36中位数评分在PF（85对95，p = 0.01）、BP（42对75，p = 0.002）和VT（47.5对70，p = 0.04）领域有所改善；开放胆囊切除术患者与术前值相比未显示出统计学上的显著改善。此外，腹腔镜胆囊切除术患者在BP领域的得分高于开放胆囊切除术患者（75对41，p = 0.05）。腹腔镜食管手术患者在RP（100对0，p = 0.02）和VT（65对52.5，p = 0.05）领域的得分高于开放手术患者。与术前值相比，腹腔镜脾切除术患者在GH领域得分有所改善（52对77，p = 0.02），在PF（90对45，p = 0.05）和BP（84对55.5，p = 0.01）方面的得分高于开放脾切除术患者。与术前值相比，开放网片疝修补术患者在PF（70对92.5，p = 0.03）和MH（72对84，p = 0.05）方面得分有所改善。与术前值或开放疝修补术相比，腹腔镜疝修补术并未产生更高的得分。
对于胆囊切除术、脾切除术和食管手术，腹腔镜手术在生活质量结局方面明显优于开放手术。然而，开放疝修补术的健康状况结局即便不比腹腔镜修补术更好，至少也一样好。
