A randomized pilot study on single-port versus conventional laparoscopic rectal surgery: effects on postoperative pain and the stress response to surgery
A randomized pilot study on single-port versus conventional laparoscopic rectal surgery: effects on postoperative pain and the stress response to surgery
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DOI：
10.1007/s10151-014-1237-6
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发表时间：
2015-01-01
影响因子：
3.3
通讯作者：
Nielsen, H. J.
中科院分区：
文献类型：
--
作者：
Bulut, O.;Aslak, K. K.;Nielsen, H. J.
单孔腹腔镜手术的潜在好处可能包括改善美容效果、减少术后疼痛、手术创伤和更快恢复。聚焦于单口直肠手术的随机前瞻性研究的结果尚未公布。本研究的目的是比较直肠癌单口手术和传统腹腔镜手术的短期结果，包括术后疼痛和创伤引起的某些生物活性物质的变化。未转移的直肠癌患者被前瞻性地随机分为单口手术(n=20)和传统腹腔镜直肠手术(n=20)。术后分别在休息时、咳嗽时和活动时进行疼痛评分，并在术后6h和随后每天早晨记录疼痛等级，连续4d。测定C-反应蛋白(CRP)、白介素6(IL-6)和金属蛋白酶组织抑制物-1(TIMP-1)水平。分别于术前(基线)、切皮后6、24、48、72、96h采集血样，术后第2、3、4天咳嗽、活动时单口组Pain评分明显降低。单口组患者术后6h及术后第1、3、4天静息时疼痛明显减轻，术后3项指标均较术前显著升高。各时点血浆IL-6、TIMP-1水平两组间差异无统计学意义(P>0.001)，而单口组C反应蛋白水平在切皮后6小时(P<0.05)和24小时(P<0.05)显著低于对照组。单孔组的腹壁切口长度明显缩短(p=0.001)。两组在手术时间、出血量、并发症和死亡率方面无显著差异。两组近期肿瘤学结果相似，单口直肠手术可减轻术后疼痛。虽然C反应蛋白水平在某些时间点较低，但本次随机、先导性研究的结果提示，单口手术创伤引起的炎症反应可能与传统腹腔镜手术创伤引起的炎症反应相似。
Potential benefits of single-port laparoscopic surgery may include improved cosmetic results, less postoperative pain, surgical trauma and faster recovery. Results of randomized prospective studies with a focus on single-port rectal surgery have not yet been presented. The aim of the present study was to compare single-port and conventional laparoscopic surgery for rectal cancer in terms of short-term outcomes including postoperative pain and trauma-induced changes in certain bioactive substances.Patients with non-metastasized rectal cancer were prospectively randomized to single-port (n = 20) or conventional laparoscopic rectal surgery (n = 20). Postoperative pain was assessed at rest, at coughing and during mobilization, with a numeric pain ranking score and was recorded at 6 h after the operation and subsequently every morning daily for 4 days. Levels of C-reactive protein (CRP), interleukin-6 (IL-6) and tissue inhibitor of metalloproteinases-1 (TIMP-1) were determined. Blood samples were collected preoperatively (baseline), and 6, 24, 48, 72 and 96 h after skin incision.Pain scores were significantly reduced in the single-port group on postoperative days 2, 3 and 4 during coughing and mobilization. In addition, the patients in the single-port group suffered significantly less pain at rest at 6 h after surgery and on postoperative days 1, 3 and 4. The levels of the three markers increased significantly after surgery. The increase was similar between groups for plasma IL-6 and TIMP-1 at all time points, while the CRP levels were significantly lower in the single-port group at 6 (p < 0.001) and 24 h (p < 0.05) after skin incision. Abdominal incisions lengths were significantly shorter in the single-port group (p = 0.001). There was no significant difference between groups in operating time and blood loss, morbidity or mortality rate. The short-term oncological outcome in the two groups was similar.Single-port rectal surgery may reduce postoperative pain. Although CRP levels were lower at some time points, results of the present randomized, pilot study suggest that the trauma-induced inflammatory response of single-port operations may be similar to the trauma-induced inflammatory response of conventional laparoscopic surgery.