Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands.
Colorectal Dis. 2010 Apr;12(4):287-95. doi: 10.1111/j.1463-1318.2009.01827.x. Epub 2009 Mar 6.
This systematic review was performed to answer the question whether hand-assisted laparoscopic surgery (HALS) can preserve the advantages of laparoscopic compared with open surgery in colorectal disease.
Eligible studies were identified from electronic databases (Medline, Embase Cochrane) and cross-reference search. The database search, quality assessment and data extraction were independently performed by two reviewers. Outcome criteria were operative time, number of trocars used, conversion rate, incision length, blood loss, time to passage of flatus, use of analgesia, postoperative morbidity, in-hospital mortality, length of hospital stay, number of lymph nodes and costs.
Out of 162 publications seven publications were selected for comprehensive review. Three randomized controlled trials (RCT) and four non-RCTs, comprising 571 patients, met the inclusion criteria. Because of heterogeneity, the data could not be pooled. The operative time was significantly longer in HALS in four of the seven studies (addition in median operative time of 13-81 min). The conversion rate varied from 0 to 10%. Two of the four reporting studies demonstrated a significantly shorter time to passage of flatus in HALS (averagely one day in advance). Length of hospital stay was significantly shorter in HALS in four of the seven studies (average gain between 2 and 4 days).
Hand-assisted laparoscopic surgery has the advantages of laparoscopic surgery over open surgery while reducing some of the disadvantages of laparoscopic surgery (shorter operative time, lower conversion rates). Especially for indications in which an incision to extract the resection specimen is required, HALS provides an excellent treatment option.
本系统评价旨在回答手助腹腔镜手术（HALS）是否可以保留腹腔镜手术相对于开腹手术在结直肠疾病中的优势。
从电子数据库（Medline、Embase Cochrane）和交叉引用搜索中确定合格的研究。数据库搜索、质量评估和数据提取由两名评审员独立进行。结局指标为手术时间、使用的套管针数量、中转率、切口长度、出血量、排气时间、镇痛药使用、术后发病率、住院死亡率、住院时间、淋巴结数量和成本。
在 162 篇文献中，有 7 篇文献进行了全面综述。3 项随机对照试验（RCT）和 4 项非 RCT 共纳入 571 例患者，符合纳入标准。由于异质性，数据无法合并。在 7 项研究中的 4 项研究中，HALS 的手术时间明显延长（中位数手术时间增加 13-81 分钟）。中转率从 0 到 10%不等。报告的 4 项研究中有 2 项表明 HALS 的排气时间明显缩短（平均提前一天）。7 项研究中的 4 项研究表明 HALS 的住院时间明显缩短（平均缩短 2-4 天）。
HALS 具有腹腔镜手术相对于开腹手术的优势，同时减少了腹腔镜手术的一些缺点（手术时间更短，中转率更低）。对于需要切口取出切除标本的适应证，HALS 提供了一种极好的治疗选择。
