Surgical Clinic Unit I, Department of Surgical Sciences and Integrated Diagnostics (DISC), Genoa University, Genoa, Italy.
Unit of Clinical Epidemiology and Trials, National Institute for Cancer Research, Genoa, Italy.
JSLS. 2022 Jul-Sep;26(3). doi: 10.4293/JSLS.2022.00020.
To assess the safety and efficacy of single-port laparoscopic cholecystectomy (SPLC) for the treatment of symptomatic cholelithiasis in different gallbladder pathologic conditions.
All patients who underwent SPLC in our department between October 1, 2017 and March 31, 2020 were registered consecutively in a prospective database. Patients' charts were retrospectively divided according to histological diagnosis: normal gallbladder (NG) (n = 13), chronic cholecystitis (CC) (n =47), and acute cholecystitis (AC) (n = 10). The parameters for assessing the procedure outcome included operative time, blood loss, use of additional trocars, conversion to laparotomy, intraoperative and postoperative complications, and length of hospital stay. Patient groups were statistically compared.
Seventy patients underwent SPLC. Duration of surgery increased from NG (55 ± 22.7 min) to CC (70 ± 33.5 min), and to AC patients (110.5 ± 50.5 min), which is statistically significant (=.001). Postoperative complication rates were 7.6% in NG patients, 17% in CC, and 30% in AC (=.442). Length of hospitalization was shorter for NG patients (1.0 ± 0.6 days) versus CC (2.0 ± 1.1 days) and AC patients (2.0 ± 4.7 days), with statistical significance (= .020). Multivariate analysis found that pathology type and the occurrence of postoperative complications were independent predictors for prolonged operative times and prolonged hospital stay, respectively.
SPLC is feasible for acute and chronic cholecystitis with good procedural outcomes. Since SPLC technique itself can be sometimes challenging with the existing technology, its application, especially in cases of acute cholecystitis, should be done with caution. Only prospective randomized studies on this approach for acute and chronic gallbladder diseases will assess the complete reliability of this technique.
评估单孔腹腔镜胆囊切除术（SPLC）治疗不同胆囊病理条件下有症状胆石症的安全性和疗效。
我们部门于 2017 年 10 月 1 日至 2020 年 3 月 31 日连续登记了所有接受 SPLC 的患者，将患者的病历根据组织学诊断分为：正常胆囊（NG）（n=13）、慢性胆囊炎（CC）（n=47）和急性胆囊炎（AC）（n=10）。评估手术结果的参数包括手术时间、出血量、使用额外的 Trocar、中转开腹、术中及术后并发症和住院时间。对患者组进行统计学比较。
70 例患者行 SPLC，手术时间从 NG（55±22.7 分钟）增加到 CC（70±33.5 分钟），再增加到 AC 患者（110.5±50.5 分钟），差异有统计学意义（=.001）。NG 患者术后并发症发生率为 7.6%，CC 患者为 17%，AC 患者为 30%（=.442）。NG 患者的住院时间（1.0±0.6 天）明显短于 CC（2.0±1.1 天）和 AC 患者（2.0±4.7 天），差异有统计学意义（=.020）。多变量分析发现，病理类型和术后并发症的发生是手术时间延长和住院时间延长的独立预测因素。
SPLC 治疗急性和慢性胆囊炎是可行的，手术效果良好。由于现有技术，SPLC 技术本身有时具有挑战性，因此其应用，特别是在急性胆囊炎的情况下，应谨慎进行。只有针对急性和慢性胆囊疾病的前瞻性随机研究才能评估该技术的完全可靠性。
