Ostlie Daniel J, Sharp Nicole E, Thomas Priscilla, Sharp Susan W, Holcomb George W, St Peter Shawn D
Department of Surgery, University of Wisconsin, Madison, WI 53792, USA.
J Laparoendosc Adv Surg Tech A. 2013 Jun;23(6):553-5. doi: 10.1089/lap.2013.0245.
The single-incision laparoscopic approach for cholecystectomy has been reported to be cosmetically superior in the traditional four-port technique in several case series; however, prospective comparative data are lacking. We conducted a 60-patient, prospective, randomized trial comparing single-incision laparoscopic cholecystectomy with standard four-port cholecystectomy, including validated scar assessment evaluation around 6 weeks and 18 months after the operation in an effort to determine if a cosmetic advantage existed.
Patients over 12 years of age and parents of patients under 12 years of age enrolled in the trial were asked to complete the validated Patient Scar Assessment Questionnaire (PSAQ). The PSAQ consists of four subscales: Appearance, Consciousness, Satisfaction with Appearance, and Satisfaction with Symptoms. The Symptoms subscale is omitted from analysis per PSAQ instructions because of insufficient reliability. Each subscale is a set of items with 4-point categorical responses (from 1=most favorable to 4=least favorable). The sum of the questions quantifies each subscale. Data are expressed as mean±standard deviation values.
Eighteen single-site patients and 8 four-port patients completed early questionnaires, in which there was no difference in overall scar assessment (P=.17). Telephone follow-up was accomplished for 17 single-site patients and 24 four-port patients and revealed that the overall scar assessment significantly favored the single-site approach (P=.04).
Patients or parents of patients do not identify an overall superior scar assessment at early follow-up after single-site laparoscopic versus four-port cholecystectomy. However, they do perceive a superior scar assessment at long-term follow-up, suggesting that there is a cosmetic benefit favoring the single-site approach.
在一些病例系列报道中，单切口腹腔镜胆囊切除术在美容效果上优于传统的四孔技术；然而，缺乏前瞻性对比数据。我们进行了一项纳入60例患者的前瞻性随机试验，比较单切口腹腔镜胆囊切除术与标准四孔胆囊切除术，并在术后约6周和18个月进行了有效的瘢痕评估，以确定是否存在美容优势。
纳入试验的12岁以上患者及12岁以下患者的父母被要求完成有效的患者瘢痕评估问卷（PSAQ）。PSAQ由四个子量表组成：外观、在意程度、对外表的满意度和对症状的满意度。根据PSAQ说明，由于可靠性不足，症状子量表在分析中被省略。每个子量表是一组具有4分分类回答的项目（从1 = 最有利到4 = 最不利）。问题总和量化每个子量表。数据以均值±标准差表示。
18名单切口患者和8名四孔患者完成了早期问卷，总体瘢痕评估无差异（P = 0.17）。对17名单切口患者和24名四孔患者进行了电话随访，结果显示总体瘢痕评估明显有利于单切口方法（P = 0.04）。
在单切口腹腔镜与四孔胆囊切除术后的早期随访中，患者或患者父母并未发现总体瘢痕评估有明显优势。然而，他们在长期随访中确实认为单切口方法的瘢痕评估更好，这表明单切口方法在美容方面有优势。
