Section of Colon and Rectal Surgery, New York Presbyterian Hospital and Weill Cornell Medical College, New York, NY 10021, USA.
Ann Surg. 2012 Apr;255(4):667-76. doi: 10.1097/SLA.0b013e31823fbae7.
The aim of this review was to evaluate the feasibility, safety, and potential benefits of single-incision laparoscopic colectomy (SILC).
We conducted a comprehensive review for the years 1983 to March 2011 to retrieve all relevant articles.
A total of 23 studies with 378 patients undergoing SILC were reviewed. All studies except 2 used a commercially available single-port device. Range of body mass index was 20.9 to 30.0 kg/m². Ranges of operative times and estimated blood losses were 83 to 225 minutes and 0 to 115 mL, respectively. Of 378 cases, a total of 6 cases (1.6%) were converted to open, 6 (1.6%) to hand-assisted laparoscopic (HALC), and 14 (4.0%) to conventional (multiport) laparoscopic colectomy (MLC) (overall conversion rate, 6.9%). An additional laparoscopic port was used in 4.9% (12/247) cases. Range of harvested lymph nodes number for malignant cases was 13.5 to 27 and surgical margins were negative in all cases. Overall mortality and morbidity rates were 0.5% (2/378) and 12.9% (45/349), respectively. The length of hospital stay (LOS) varied across reports (1.9-9.8 days). Among 4 case-matched studies, 2 showed shorter LOS after SILC than after HALC (2.7 vs 3.3 days) or after MLC/HALC (3.4 vs 4.6/4.9 days). Furthermore, one of these studies reported that maximum pain score on postoperative days 1 and 2 was significantly lower in SILS than in MLC and HALC.
In early series of highly selected patients, SILC appears to be feasible and safe when performed by surgeons who are highly skilled in laparoscopy. Despite technical difficulties, there may be potential benefits associated with SILC over MLC/HALC but it is yet to be proven objectively.
本综述旨在评估单切口腹腔镜结肠切除术（SILC）的可行性、安全性和潜在益处。
我们进行了一项全面的综述，检索了 1983 年至 2011 年 3 月期间的所有相关文章。
共纳入 23 项研究，总计 378 例患者接受 SILC 治疗。除 2 项研究外，所有研究均使用市售的单孔装置。体重指数范围为 20.9 至 30.0kg/m²。手术时间和估计失血量范围分别为 83 至 225 分钟和 0 至 115mL。在 378 例患者中，共有 6 例（1.6%）转为开腹手术，6 例（1.6%）转为手助腹腔镜（HALC），14 例（4.0%）转为传统（多孔）腹腔镜结肠切除术（MLC）（总转化率为 6.9%）。另外有 4.9%（12/247）的病例使用了额外的腹腔镜端口。恶性病例的淋巴结清扫数量范围为 13.5 至 27 个，所有病例的手术切缘均为阴性。总的死亡率和发病率分别为 0.5%（2/378）和 12.9%（45/349）。住院时间（LOS）在不同报道中存在差异（1.9-9.8 天）。在 4 项病例匹配研究中，有 2 项研究表明 SILC 后的 LOS 短于 HALC（2.7 天比 3.3 天）或 MLC/HALC（3.4 天比 4.6/4.9 天）。此外，其中一项研究报告称，SILS 术后第 1 天和第 2 天的最大疼痛评分明显低于 MLC 和 HALC。
在早期的高度选择患者系列中，当由熟练的腹腔镜外科医生进行操作时，SILC 似乎是可行且安全的。尽管存在技术困难，但 SILC 可能具有优于 MLC/HALC 的潜在益处，但这仍有待客观证明。
