Academic Surgical Unit, St. Mary's Hospital, Praed Street, London, W2 1NY, UK.
Surg Endosc. 2012 May;26(5):1205-13. doi: 10.1007/s00464-011-2051-0. Epub 2011 Dec 16.
Single-incision laparoscopic surgery (SILS) has gained increasing attention due to the potential to maximize the benefits of laparoscopic surgery. The aim of this systematic review and pooled analysis was to compare clinical outcome following SILS and standard multiport laparoscopic cholecystectomy for the treatment of gallstone-related disease.
An electronic search of Embase and Medline databases for articles from 1966 to 2011 was performed. Publications were included if they were randomised controlled studies in which patients underwent either single-incision or multiport cholecystectomy. The primary outcome measures for the meta-analysis were postoperative complications and postoperative pain score [visual analogue scale (VAS) on the day of surgery]. Secondary outcome measures were operating time and length of hospital stay. Weighted mean difference was calculated for the effect size of SILS on continuous variables, and pooled odds ratios were calculated for discrete variables.
In total, 375 cholecystectomy operations from 7 randomised controlled trials were included, 195 by single-incision (SILS) and 180 by conventional multiport. Operating time was significantly longer in the SILS group compared to the standard multiport laparoscopic cholecystectomy group (weighted mean difference = 2.13; P = 0.0001). There was no significant difference in the incidence of postoperative complications, postoperative pain score (VAS), or the length of hospital stay between the two groups.
The results of this meta-analysis demonstrate that single-incision laparoscopic cholecystectomy is a safe procedure for the treatment of uncomplicated gallstone disease, with postoperative outcome similar to that of standard multiport laparoscopic cholecystectomy. Future high-powered randomized studies should be focused on elucidating subtle differences in postoperative complications, reported postoperative pain, and cosmesis following SILS cholecystectomy in more severe biliary disease.
单切口腹腔镜手术（SILS）由于有可能最大限度地发挥腹腔镜手术的优势，因此越来越受到关注。本系统评价和荟萃分析的目的是比较 SILS 与标准多孔腹腔镜胆囊切除术治疗胆石相关疾病的临床结果。
对 1966 年至 2011 年期间 Embase 和 Medline 数据库进行电子检索，纳入了接受单切口或多孔胆囊切除术的随机对照研究。主要结局指标为术后并发症和术后疼痛评分（手术当天的视觉模拟评分（VAS））。次要结局指标为手术时间和住院时间。对于 SILS 对连续变量的影响大小，计算加权均数差，对于离散变量，计算汇总优势比。
共纳入 7 项随机对照试验的 375 例胆囊切除术，195 例采用单切口（SILS），180 例采用常规多孔。SILS 组的手术时间明显长于标准多孔腹腔镜胆囊切除术组（加权均数差=2.13；P=0.0001）。两组术后并发症发生率、术后疼痛评分（VAS）和住院时间无显著差异。
本荟萃分析的结果表明，单切口腹腔镜胆囊切除术治疗单纯性胆囊结石是一种安全的方法，其术后结果与标准多孔腹腔镜胆囊切除术相似。未来的高质量随机研究应集中阐明在更严重的胆道疾病中，SILS 胆囊切除术后术后并发症、报告的术后疼痛和美容方面的细微差异。
