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单孔胆囊切除术与多孔胆囊切除术的比较:术后并发症的系统评价与Meta分析

Comparing Single-Incision Cholecystectomy and Multiple-Incision Cholecystectomy: A Systematic Review and Meta-Analysis of Postoperative Complications.

作者信息

Linkwinstar Diya, Shine Anu, Naseem Haiqa, Zara Syeda, Jabbir Siti, Ravendran Kapilraj

机构信息

Internal Medicine, Medical University Sofia, Sofia, BGR.

General Surgery, Gradscape, London, GBR.

出版信息

Cureus. 2025 Feb 3;17(2):e78434. doi: 10.7759/cureus.78434. eCollection 2025 Feb.

DOI:10.7759/cureus.78434
PMID:40046348
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11881996/
Abstract

Laparoscopic cholecystectomy is the gold standard for managing benign gallbladder disease, with the conventional multiport technique widely practiced. Single-incision laparoscopic cholecystectomy (SILC) has emerged as an alternative, offering potential benefits such as improved cosmetic outcomes, reduced pain, and quicker recovery; however, its efficacy and safety compared to conventional laparoscopic cholecystectomy (CLC) remain unclear. This meta-analysis, which followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, included 51 studies with 2,069 patients to compare clinical outcomes such as postoperative complications, pain, recovery time, and wound infection rates between SILC and CLC. SILC was associated with slightly higher postoperative pain scores (mean difference, 0.18; 95% CI, 0.09-0.27; p < 0.001), increased wound infection rates (OR, 1.77; 95% CI, 1.30-2.79; p < 0.001), and a marginally longer hospital stay (mean difference, 0.22 days; 95% CI, 0.16-0.28; p < 0.001). Recovery time showed no significant difference (mean difference, 0.01 days; 95% CI, -0.56 to 0.59; p = 0.73). While SILC offers a cosmetic advantage due to fewer incisions, it is associated with marginally less favorable clinical outcomes compared to CLC, highlighting the need for further research to assess its long-term efficacy and refined surgical techniques.

摘要

腹腔镜胆囊切除术是治疗良性胆囊疾病的金标准,传统的多端口技术应用广泛。单切口腹腔镜胆囊切除术(SILC)已成为一种替代方法,具有改善美容效果、减轻疼痛和更快康复等潜在益处;然而,与传统腹腔镜胆囊切除术(CLC)相比,其疗效和安全性仍不明确。这项遵循系统评价和Meta分析的首选报告项目(PRISMA)指南的Meta分析纳入了51项研究,共2069例患者,以比较SILC和CLC之间的临床结局,如术后并发症、疼痛、恢复时间和伤口感染率。SILC与术后疼痛评分略高(平均差异,0.18;95%可信区间,0.09 - 0.27;p < 0.001)、伤口感染率增加(比值比,1.77;95%可信区间,1.30 - 2.79;p < 0.001)以及住院时间略长(平均差异,0.22天;95%可信区间,0.16 - 0.28;p < 0.001)相关。恢复时间无显著差异(平均差异,0.01天;95%可信区间, - 0.56至0.59;p = 0.73)。虽然SILC因切口较少而具有美容优势,但与CLC相比,其临床结局略逊一筹,这突出表明需要进一步研究以评估其长期疗效和完善手术技术。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d77b/11881996/8c41fa6e7080/cureus-0017-00000078434-i08.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d77b/11881996/e659a589156f/cureus-0017-00000078434-i01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d77b/11881996/e7160e00f7e7/cureus-0017-00000078434-i02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d77b/11881996/19452019df18/cureus-0017-00000078434-i03.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d77b/11881996/14a498156546/cureus-0017-00000078434-i04.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d77b/11881996/75bc70cb1b71/cureus-0017-00000078434-i05.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d77b/11881996/fe4b7c5d9bc9/cureus-0017-00000078434-i06.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d77b/11881996/c3af01dee6ac/cureus-0017-00000078434-i07.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d77b/11881996/8c41fa6e7080/cureus-0017-00000078434-i08.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d77b/11881996/e659a589156f/cureus-0017-00000078434-i01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d77b/11881996/e7160e00f7e7/cureus-0017-00000078434-i02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d77b/11881996/19452019df18/cureus-0017-00000078434-i03.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d77b/11881996/14a498156546/cureus-0017-00000078434-i04.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d77b/11881996/75bc70cb1b71/cureus-0017-00000078434-i05.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d77b/11881996/fe4b7c5d9bc9/cureus-0017-00000078434-i06.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d77b/11881996/c3af01dee6ac/cureus-0017-00000078434-i07.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d77b/11881996/8c41fa6e7080/cureus-0017-00000078434-i08.jpg

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Outcome of single-incision laparoscopic cholecystectomy compared to three-incision laparoscopic cholecystectomy for acute cholecystitis.单切口腹腔镜胆囊切除术与三切口腹腔镜胆囊切除术治疗急性胆囊炎的疗效比较
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Pharmacotherapeutic pain management in patients undergoing laparoscopic cholecystectomy: A review.
腹腔镜胆囊切除术患者的药物治疗性疼痛管理:综述。
Adv Clin Exp Med. 2022 Nov;31(11):1275-1288. doi: 10.17219/acem/151995.
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The PRISMA 2020 statement: an updated guideline for reporting systematic reviews.《PRISMA 2020声明:报告系统评价的更新指南》
Syst Rev. 2021 Mar 29;10(1):89. doi: 10.1186/s13643-021-01626-4.
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Risk-of-bias VISualization (robvis): An R package and Shiny web app for visualizing risk-of-bias assessments.风险偏倚可视化 (robvis):一个用于可视化风险偏倚评估的 R 包和 Shiny 网络应用程序。
Res Synth Methods. 2021 Jan;12(1):55-61. doi: 10.1002/jrsm.1411. Epub 2020 May 6.
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