Department of Surgical Sciences, University of Turin, Corso Dogliotti 14, 10126 Turin, Italy.
Surg Endosc. 2013 Jul;27(7):2293-304. doi: 10.1007/s00464-012-2763-9. Epub 2013 Jan 26.
Single-incision laparoscopic cholecystectomy (SILC) is gaining popularity. It is not evident whether the benefits of this procedure overcome the potential increased risk. We performed a systematic review and meta-analysis to compare SILC with conventional multi-incision laparoscopic cholecystectomy (MILC).
Data from randomized, controlled trials published up to December 2011 and comparing SILC versus MILC were extracted. The primary end point was overall morbidity. A fixed-effect model was applied to summarize the study outcomes in the meta-analysis, and a random-effect model was used in the sensitivity analysis. The outcome measures were relative risk (RR) and mean difference (MD); a RR of <1.0 or a negative MD indicated a more favorable outcome after SILC. Publication bias was assessed by a funnel plot, and heterogeneity was tested by the I (2) measure and subgroup analyses.
A total of 12 trials (996 patients) were included. Mortality was nil in both treatment groups; the overall RR for morbidity was 1.36 (p = 0.098). The mean operating time was 47.2 min for MILC and 58.1 min for SILC (MD 9.47 min; p < 0.001). The visual analog scale pain score at 24 h after surgery was 2.96 in MILC and 2.34 in SILC (MD -0.64; p = 0.058), but sensitivity analysis of the four studies deemed at low risk of bias for pain assessment, according to blinding and postoperative analgesic protocols, showed significance at -0.43 points (95 % confidence interval -0.87 to 0.00; p = 0.049). Cosmetic outcome scored better in the SILC group, with its standardized MD being equal to 1.16 (95 % confidence interval 0.57 to 1.75; p < 0.001).
In selected patients, SILC has similar overall morbidity compared with MILC; further, it results in better cosmetic satisfaction and reduced postoperative pain despite longer operative time.
单切口腹腔镜胆囊切除术（SILC）越来越受欢迎。尚不清楚该手术的益处是否超过了潜在的风险增加。我们进行了一项系统评价和荟萃分析，以比较 SILC 与传统的多孔腹腔镜胆囊切除术（MILC）。
提取截至 2011 年 12 月发表的比较 SILC 与 MILC 的随机对照试验的数据。主要终点是总发病率。固定效应模型用于荟萃分析中总结研究结果，随机效应模型用于敏感性分析。结果指标为相对风险（RR）和均数差（MD）；RR<1.0 或 MD 为负值表示 SILC 后结果更有利。通过漏斗图评估发表偏倚，并用 I（2）度量和亚组分析检验异质性。
共纳入 12 项试验（996 例患者）。两组死亡率均为零；发病率的总 RR 为 1.36（p = 0.098）。MILC 的平均手术时间为 47.2 分钟，SILC 为 58.1 分钟（MD 9.47 分钟；p<0.001）。术后 24 小时视觉模拟评分（VAS）在 MILC 为 2.96，在 SILC 为 2.34（MD-0.64；p = 0.058），但根据疼痛评估的盲法和术后镇痛方案，对四项被认为低偏倚风险的研究进行敏感性分析显示，差异有统计学意义，为 -0.43 分（95%置信区间 -0.87 至 0.00；p = 0.049）。SILC 组的美容效果更好，其标准化 MD 等于 1.16（95%置信区间 0.57 至 1.75；p<0.001）。
在选择的患者中，SILC 与 MILC 相比总体发病率相似；此外，尽管手术时间较长，但 SILC 术后疼痛减轻，美容满意度更高。
