General Surgery, Wales Deanery, Health Education and Improvement Wales, Cardiff, UK.
Department of General Surgery, Glan Clwyd Hospital, The Betsi Cadwaladr University Health Board, Rhyl, UK.
Updates Surg. 2021 Apr;73(2):451-471. doi: 10.1007/s13304-021-00982-z. Epub 2021 Feb 15.
To compare the outcomes of three-port and four-port laparoscopic cholecystectomy. In compliance with PRISMA statement standards, electronic databases were searched to identify all comparative studies investigating outcomes of three-port vs four-port laparoscopic cholecystectomy. Two techniques were compared using direct comparison meta-analysis model. The risks of type 1 or type 2 error in the meta-analysis model were assessed using trial sequential analysis model. The certainty of evidence was assessed using GRADE system. Random effects modelling was applied to calculate pooled outcome data. Analysis of 2524 patients from 17 studies showed that both techniques were comparable in terms of operative time (MD:- 0.13, P = 0.88), conversion to open operation (OR:0.80, P = 0.43), gallbladder perforation (OR: 1.43, P = 0.13), bleeding from gallbladder bed (OR:0.81, P = 0.34), bile duct injury (RD: 0.00, P = 0.97), iatrogenic visceral injury (RD: - 0.00, P = 0.81), bile or stone spillage (OR:1.67, P = 0.08), port site infection (OR: 0.90, P = 0.76), port site hernia (RD: 0.00, P = 0.89), port site haematoma (RD: - 0.01, P = 0.23), port site seroma (RD: 0.00, P = 1.00), and need for reoperation (RD: - 0.00, P = 0.94). However, the three-port technique was associated with lower VAS pain score at 12 h (MD: - 0.66, P < 0.00001) and 24 h (MD: - 0.54, P < 0.00001) postoperatively, shorter length of hospital stay (MD:-0.09, P = 0.41), and shorter time to return to normal activities (MD: - 0.79, P = 0.02). Trial sequential analysis confirmed that the meta-analysis was conclusive with no significant risks of type 1 or type 2 error. Robust evidence (level 1 with high certainty) suggests that in an elective setting with uncomplicated cholelithiasis as indication for cholecystectomy, three-port laparoscopic cholecystectomy is comparable with the four-port technique in terms of procedural and morbidity outcomes and may be associated with less postoperative pain, shorter length of hospital stay and shorter time to return to normal activities.
比较三孔法和四孔法腹腔镜胆囊切除术的结果。根据 PRISMA 声明标准，检索电子数据库以确定所有比较三孔法与四孔法腹腔镜胆囊切除术结果的对照研究。使用直接比较荟萃分析模型比较两种技术。使用试验序贯分析模型评估荟萃分析模型中 I 类或 II 类错误的风险。使用 GRADE 系统评估证据的确定性。应用随机效应模型计算汇总结果数据。对来自 17 项研究的 2524 名患者的分析表明，两种技术在手术时间（MD：-0.13，P=0.88）、中转开腹手术（OR：0.80，P=0.43）、胆囊穿孔（OR：1.43，P=0.13）、胆囊床出血（OR：0.81，P=0.34）、胆管损伤（RD：0.00，P=0.97）、医源性内脏损伤（RD：-0.00，P=0.81）、胆汁或结石溢出（OR：1.67，P=0.08）、切口感染（OR：0.90，P=0.76）、切口疝（RD：0.00，P=0.89）、切口血肿（RD：-0.01，P=0.23）、切口血清肿（RD：0.00，P=1.00）和需要再次手术（RD：-0.00，P=0.94）方面无差异。然而，三孔法在术后 12 小时（MD：-0.66，P<0.00001）和 24 小时（MD：-0.54，P<0.00001）时的 VAS 疼痛评分较低、住院时间较短（MD：-0.09，P=0.41）和恢复正常活动的时间较短（MD：-0.79，P=0.02）。试验序贯分析证实，荟萃分析结论具有无显著 I 类或 II 类错误风险。强有力的证据（1 级，高度确定性）表明，在择期手术中，对于有症状的胆囊结石患者，三孔法腹腔镜胆囊切除术与四孔法在手术和并发症结果方面具有可比性，并且可能与术后疼痛减轻、住院时间缩短和恢复正常活动的时间缩短有关。
