Sood Sumit, Imsirovic Anja, Sains Parv, Singh Krishna K, Sajid Muhammad S
Department of General Surgery, University Hospitals of Coventry and Warwickshire, United Kingdom.
Department of Digestive Diseases & Gastrointestinal Surgery, Brighton & Sussex University Hospitals NHS Trust, The Royal Sussex County Hospital, Eastern Road, Brighton, West Sussex, BN2 5BE, United Kingdom.
Ann Med Surg (Lond). 2020 May 25;55:244-251. doi: 10.1016/j.amsu.2020.05.017. eCollection 2020 Jul.
The objective of this article is to compare the surgical outcomes for epigastric port or umbilical port retrieval of the gallbladder (GB) following laparoscopic cholecystectomy (LC).
The data retrieved from the published randomized, controlled trials (RCT) comparing the surgical outcomes for epigastric port or umbilical port retrieval of the GB following LC was analysed using the principles of meta-analysis. The summated outcome of continuous variables was expressed as standardized mean difference (SMD) and dichotomous data was presented in odds ratio (OR).
Eight RCTs on 2676 patients comparing the surgical outcomes for epigastric port or umbilical port retrieval of the GB following LC were analysed. In the random effects model analysis using the statistical software Review Manager 5.3, the GB retrieval through epigastric port was associated with the reduced duration of operation (SMD, 0.41; 95% CI, 0.18, 0.64; z = 3.52; P = 0.0004). Epigastric retrieval was also associated with reduced risk of surgical site infection (OR, 1.95; 95% CI, 0.75, 5.11; z = 1.36; P = 0.17), and port site incisional hernia (OR, 4.22; 95% CI, 0.43, 41.40; z = 1.24; P = 0.22) compared to umbilical port retrieval though it did not reach statistical significance. The need for port enlargement to retrieve the GB was similar in both groups. In contrast, the umbilical port retrieval of the GB was associated with significantly less post-operative pain (SMD, -0.51; 95% CI, -0.95, -0.06; z = 2.24; P = 0.03), reduced GB perforation rate, reduced port site bleeding rate and reduced difficulty in GB retrieval.
GB retrieval through epigastric port following LC has clinically proven advantage of reduced retrieval site infection rate, lower operation time and incisional hernia rate but at the cost of increased pain at 24 h, higher risk of GB perforation, port site bleeding and technical difficulties.
本文旨在比较腹腔镜胆囊切除术（LC）后经上腹部端口或脐部端口取出胆囊（GB）的手术效果。
使用荟萃分析原则，对已发表的比较LC后经上腹部端口或脐部端口取出GB的随机对照试验（RCT）数据进行分析。连续变量的汇总结果以标准化均数差（SMD）表示，二分数据以比值比（OR）呈现。
分析了8项针对2676例患者的RCT，比较了LC后经上腹部端口或脐部端口取出GB的手术效果。在使用统计软件Review Manager 5.3进行的随机效应模型分析中，经上腹部端口取出GB与手术时间缩短相关（SMD，0.41；95%CI，0.18，0.64；z = 3.52；P = 0.0004）。与经脐部端口取出相比，经上腹部取出还与手术部位感染风险降低相关（OR，1.95；95%CI，0.75，5.11；z = 1.36；P = 0.17），以及端口部位切口疝风险降低相关（OR，4.22；95%CI，0.43，41.40；z = 1.24；P = 0.22），尽管未达到统计学意义。两组中为取出GB而扩大端口的需求相似。相比之下，经脐部端口取出GB与术后疼痛明显减轻相关（SMD，-0.51；95%CI，-0.95，-0.06；z = 2.24；P = 0.03），胆囊穿孔率降低、端口部位出血率降低以及胆囊取出难度降低。
LC后经上腹部端口取出GB在临床上已证实具有降低取出部位感染率、缩短手术时间和切口疝发生率的优势，但代价是术后24小时疼痛增加、胆囊穿孔风险更高、端口部位出血以及技术难度增加。
