Department of Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Charité Campus Mitte, Campus Virchow Klinikum, Charitéplatz 1, 10117, Berlin, Germany.
Department of General, Visceral and Vascular Surgery, Vivantes Klinikum Am Urban, Dieffenbachstrasse 1, 10967, Berlin, Germany.
Surg Endosc. 2020 Dec;34(12):5533-5539. doi: 10.1007/s00464-019-07351-3. Epub 2020 Jan 28.
Several studies and meta-analysis showed Single-port or Single-incision laparoscopic surgery (SPL) to be superior over Multiport laparoscopic surgery (MPL) mainly in terms of postoperative pain and cosmetic result. But very little is known whether these results are only a short-term effect or are persistent on the long run after SPL. We therefore evaluated and compared long-term outcomes regarding cosmesis and chronic pain after SPL and MPL.
We conducted a comparative study with propensity score matching of all patients undergoing SPL or MPL between October 2008 and December 2013 in terms of postoperative cosmetic results and chronic pain. Follow-up data were obtained from mailed patient questionnaires and telephone interviews. Postoperative cosmesis was assessed using the patients overall scar opinion on a 10-point scale and the Patients scale of the standardized Patient and Observer Scar assessment scale (POSAS). Chronic pain was assessed by 10-point scales for abdominal and umbilical scar pain.
A total of 280 patients were included in the study with 188 patients (67.1%) after SPL and 92 patients (32.9%) following MPL. 141 patients (50.4%) underwent a cholecystectomy and 139 patients (49.6%) underwent an appendectomy. The mean follow-up time was 61.1 ± 19.1 months. The mean wound satisfaction assed by the overall scar and the PSOAS Patients scale score of the patients showed no significant difference between MPL and SPL. Patients after SPL reported more overall complains than after MPL (8.7% vs. 2.5%, respectively), but without statistical significance (p = 0.321). Umbilical pain scores were comparable between the two groups (1.4 ± 1.0 vs. 1.4 ± 1.0, p = 0.831).
We found no difference in long-term cosmetic outcomes after SPL and MPL. Chronic pain at the umbilical incision site was comparable on the long run.
几项研究和荟萃分析表明，单孔或单切口腹腔镜手术（SPL）在术后疼痛和美容效果方面优于多孔腹腔镜手术（MPL）。但目前尚不清楚这些结果是否只是短期效应，还是在 SPL 后长期内持续存在。因此，我们评估并比较了 SPL 和 MPL 术后美容效果和慢性疼痛的长期结果。
我们对 2008 年 10 月至 2013 年 12 月期间所有接受 SPL 或 MPL 的患者进行了倾向评分匹配的回顾性比较研究，比较了术后美容效果和慢性疼痛。通过邮寄患者问卷和电话访谈获得随访数据。术后美容效果采用患者对 10 分制整体疤痕的看法和患者对标准化患者和观察者疤痕评估量表（POSAS）的患者评分来评估。慢性疼痛采用 10 分制评估腹部和脐部疤痕疼痛。
共纳入 280 例患者，其中 SPL 组 188 例（67.1%），MPL 组 92 例（32.9%）。141 例（50.4%）行胆囊切除术，139 例（49.6%）行阑尾切除术。平均随访时间为 61.1±19.1 个月。患者对整体疤痕的满意度评估以及患者对 POSAS 患者评分的评估，MPL 和 SPL 之间没有显著差异。SPL 后患者的总体抱怨比 MPL 后多（分别为 8.7%和 2.5%），但无统计学意义（p=0.321）。两组脐部疼痛评分相当（1.4±1.0 与 1.4±1.0，p=0.831）。
我们发现 SPL 和 MPL 后长期美容效果无差异。长期来看，脐部切口处的慢性疼痛是相当的。
