Qiu Jianguo, Yuan Haichao, Chen Shuting, He Zhiliang, Han Ping, Wu Hong
1 Department of Hepato-biliary Pancreatic Surgery, West China Hospital, Sichuan University , Chengdu, Sichuan Province, China .
J Laparoendosc Adv Surg Tech A. 2013 Oct;23(10):815-31. doi: 10.1089/lap.2013.0040.
Although current guidelines recommend performing cholecystectomy via laparoscopy, consensus on the application of single-incision laparoscopic surgery for cholecystectomy is still lacking. The aim of the current study was to perform a meta-analysis of randomized controlled trials (RCTs) and nonrandomized comparative studies (NRCSs), comparing single-port laparoscopic cholecystectomy (SPLC) and conventional multiport laparoscopic cholecystectomy (CMLC) for benign gallbladder diseases.
A systematic review of the literature was performed to identify studies published between January 1997 and December 2012 comparing SPLC and CMLC. Operative outcomes, postoperative parameters, complications, cosmetic results, and quality of life were evaluated.
Forty studies were included in the analyses (16 RCTs, 24 NRCSs) that included 3711 patients (1865 SPLCs, 1846 CMLCs). SPLC had higher conversion rates (odds ratio [OR], 4.21; 95% confidence interval [CI], 2.71-6.56; P<.001), longer operating time (mean difference [MD], 16.1; 95% CI, 9.93-22.26 minutes; P<.001), and shorter hospital stay (MD, 0.16; 95% CI, -0.28 to -0.04 day; P=.01) than CMLC. There were no significant differences between the two procedures for early (MD, -0.1; 95% CI, -0.44 to 0.24; P=.57) or late (MD, -0.13; 95% CI, -0.45 to 0.19; P=.42) visual analog scale pain scores and overall complications (OR, 1.21; 95% CI, 0.92-1.61; P=.18). Cosmetic outcomes favored SILC at 2 weeks (MD, -1.39; 95% CI, -2.66 to -0.12; P=.03) and 1 month (MD, -0.13, 95% CI, -2.05 to 0.55; P=.0007) after surgery (index score, 0-10).
SPLC can be performed safely and effectively with better cosmetic results than with the CMLC technique for benign gallbladder diseases.
尽管当前指南推荐通过腹腔镜进行胆囊切除术，但对于单切口腹腔镜手术在胆囊切除术中的应用仍缺乏共识。本研究的目的是对随机对照试验（RCT）和非随机对照研究（NRCS）进行荟萃分析，比较单孔腹腔镜胆囊切除术（SPLC）和传统多孔腹腔镜胆囊切除术（CMLC）治疗良性胆囊疾病的效果。
对1997年1月至2012年12月期间发表的比较SPLC和CMLC的研究进行系统的文献回顾。评估手术结果、术后参数、并发症、美容效果和生活质量。
分析纳入了40项研究（16项RCT，24项NRCS），共3711例患者（1865例行SPLC，1846例行CMLC）。与CMLC相比，SPLC的中转率更高（优势比[OR]，4.21；95%置信区间[CI]，2.71 - 6.56；P <.001），手术时间更长（平均差[MD]，16.1；95% CI，9.93 - 22.26分钟；P <.001），住院时间更短（MD，0.16；95% CI， - 0.28至 - 0.04天；P =.01）。两种手术在早期（MD， - 0.1；95% CI， - 0.44至0.24；P =.57）或晚期（MD， - 0.13；95% CI， - 0.45至0.19；P =.42）视觉模拟评分疼痛评分及总体并发症方面无显著差异（OR，1.21；95% CI，0.92 - 1.61；P =.18）。术后2周（MD， - 1.39；95% CI， - 2.66至 - 0.12；P =.03）和1个月（MD， - 0.13，95% CI， - 2.05至0.55；P =.0007）时美容效果方面SPLC更具优势（评分范围0 - 10分）。
对于良性胆囊疾病，SPLC可以安全有效地进行，且美容效果优于CMLC技术。
