The International Translational Medicine and Biomodeling Research team, Moscow Institute of Physics and Technology (State University), Dolgoprudny, Moscow Region, Russia; Institute of Numerical Mathematics, Russian Academy of Sciences, Moscow, Russia; Department of Surgery, Danat Al Emarat Hospital, Abu Dhabi, United Arab Emirates; The New European Surgical Academy (NESA), Berlin, Germany.
The International Translational Medicine and Biomodeling Research team, Moscow Institute of Physics and Technology (State University), Dolgoprudny, Moscow Region, Russia; The New European Surgical Academy (NESA), Berlin, Germany; Department of Obstetrics and Gynecology, Ioannina State General Hospital G. Chatzikosta, Ioannina, Greece.
Gastrointest Endosc. 2018 Feb;87(2):509-516. doi: 10.1016/j.gie.2017.09.039. Epub 2017 Oct 6.
Laparoscopic cholecystectomy (LC) in female individuals has been challenged recently by transvaginal natural orifice transluminal endoscopic surgery cholecystectomy (TVC). TVC has not been widely accepted as a standard procedure, even though it is reported to be a safe and painless alternative to LC. This prospective comparative study aims to not only prove equality of TVC and LC but to underline the advantages of TVC over LC with regard to postoperative pain.
This study presents an analysis of a single-center and single-surgeon study with 226 unselected consecutive cholecystectomies performed as either TVC or LC.
A total of 226 female patients underwent surgery with either LC (136 cases) or TVC (90 cases). There were no postoperative adverse events. Twenty-two patients (24.2%) in the TVC group indicated 0 (no pain) on a visual analog scale postoperatively, whereas only 5 patients (3.7%) did so in the LC group (P = < .0001). Overall consumption of non-steroidal anti-inflammatory drugs was significantly less (P < .0001; t test) in the TVC group (mean, 1.2 ± 0.11 g) compared with the LC group (mean, 2.1 ± 0.1 g). Twenty-three patients (25.5%) in the TVC group needed no postoperative analgesics at all.
TVC is a safe and painless procedure for patients with symptomatic cholelithiasis who are from various ethnic and cultural origins. This benefit, along with an equal safety profile compared with LC, should pave the way for wider application of TVC in women.
腹腔镜胆囊切除术（LC）最近受到经阴道自然腔道内镜手术胆囊切除术（TVC）的挑战。尽管 TVC 被报道为 LC 的一种安全、无痛的替代方法，但它尚未被广泛接受为标准手术。本前瞻性对照研究旨在不仅证明 TVC 和 LC 的平等性，而且强调 TVC 在术后疼痛方面优于 LC。
本研究分析了单中心、单外科医生的研究，共有 226 例未经选择的连续胆囊切除术，分为 TVC 或 LC 组。
共有 226 名女性患者接受了手术，其中 136 例接受了 LC，90 例接受了 TVC。两组均无术后不良事件。TVC 组 22 例（24.2%）患者术后视觉模拟评分（VAS）为 0（无疼痛），而 LC 组仅 5 例（3.7%）（P<0.0001）。TVC 组（平均 1.2±0.11g）的非甾体抗炎药总消耗量明显低于 LC 组（平均 2.1±0.1g）（P<0.0001；t 检验）。TVC 组 23 例（25.5%）患者根本不需要术后止痛药。
对于来自不同种族和文化背景的有症状胆石症患者，TVC 是一种安全、无痛的手术。与 LC 相比，这种优势以及相当的安全性，应有助于 TVC 在女性中的更广泛应用。
