United Lincolnshire Hospitals NHS Trust, UK.
Nottingham University Hospitals NHS Trust, UK.
Ann R Coll Surg Engl. 2023 Nov;105(8):709-720. doi: 10.1308/rcsann.2022.0132. Epub 2023 Oct 16.
There has been an increase in colorectal cancer resections worldwide and in the UK. Initially conducted as an open procedure, this was replaced with the conventional multiport technique. Laparoscopic colectomy became the standard surgical technique in 1991. With innovation in surgical technology, single incision laparoscopy (SIL) has attracted more attention as the possible next step in colorectal resection. The aim of this review was to compare outcomes between SIL and conventional laparoscopy (CL).
A literature search was carried out in accordance with the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines. The PubMed, MEDLINE, Embase, Google Scholar™ and Cochrane Library databases were used to extract randomised controlled trials (RCTs) published between January 2000 and May 2021. Statistical analysis was performed with RevMan software.
A total of 11 RCTs were extracted with 1,370 patients (686 SIL, 684 CL). There was no significant difference between SIL and CL for operative time (standardised mean difference [SMD]: 0.01, 95% confidence interval [CI]: -0.19 to 0.22, z=0.11, =0.91), length of hospital stay (SMD: -0.10, 95% CI: 0.22 to 0.02, z=1.61, =0.11) or overall complications (odds ratio [OR]: 0.99, 95% CI: 0.75 to 1.30, z=0.09, =0.93). SIL had a shorter mean incision (SMD: -0.99, 95% CI: -1.35 to -0.62, z=5.25, <0.00001). Patients undergoing SIL had a higher conversion rate to CL or an open approach (OR: 3.10, 95% CI: 0.95 to 10.14, z=1.87, =0.06) but this just missed statistical significance.
SIL can be considered a safe alternative to CL if performed by experienced surgeons.
在全球范围内，包括英国在内，结直肠癌的切除手术数量有所增加。最初，这些手术以开放性手术的方式进行，后来被传统的多孔技术所取代。1991 年，腹腔镜结直肠切除术成为标准的外科手术技术。随着外科技术的创新，单切口腹腔镜（SIL）作为结直肠切除的下一个可能步骤，引起了更多的关注。本综述的目的是比较 SIL 和传统腹腔镜（CL）的结果。
根据 PRISMA（系统评价和荟萃分析的首选报告项目）指南进行文献检索。使用 PubMed、MEDLINE、Embase、Google Scholar 和 Cochrane 图书馆数据库提取 2000 年 1 月至 2021 年 5 月期间发表的随机对照试验（RCT）。使用 RevMan 软件进行统计分析。
共提取了 11 项 RCT，涉及 1370 名患者（686 名 SIL，684 名 CL）。SIL 和 CL 在手术时间（标准化均数差 [SMD]：0.01，95%置信区间 [CI]：-0.19 至 0.22，z=0.11，=0.91）、住院时间（SMD：-0.10，95% CI：0.22 至 0.02，z=1.61，=0.11）或总体并发症方面（比值比 [OR]：0.99，95% CI：0.75 至 1.30，z=0.09，=0.93）方面无显著差异。SIL 的平均切口较短（SMD：-0.99，95% CI：-1.35 至 -0.62，z=5.25，<0.00001）。接受 SIL 治疗的患者，转为 CL 或开放手术的转化率更高（OR：3.10，95% CI：0.95 至 10.14，z=1.87，=0.06），但这只是略微超过了统计学意义。
如果由经验丰富的外科医生进行，SIL 可以被视为 CL 的安全替代方案。
