Laparoendoscopic Single Site (LESS) Versus Classic Video-Laparoscopic Cholecystectomy: A Randomized Prospective Study
Laparoendoscopic Single Site (LESS) Versus Classic Video-Laparoscopic Cholecystectomy: A Randomized Prospective Study
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DOI：
10.1016/j.jss.2010.11.885
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发表时间：
2011-04-01
影响因子：
2.2
通讯作者：
Persico, Giovanni
中科院分区：
文献类型：
--
作者：
Aprea, Giovanni;Bottazzi, Enrico Coppola;Persico, Giovanni
背景资料。腹腔镜胆囊切除术(LC)是治疗胆石症的金标准。近年来，腹腔镜单点手术(LESS)在治疗胆结石以及减肥和结肠手术方面获得了更大的兴趣和推广。然而，目前还没有文献中的随机对照试验证实与经典的腹腔镜术相比少的临床优势。出于这个原因，我们提出了这项随机前瞻性研究的初步结果，该研究比较了传统的腹腔镜技术与少切除的胆囊切除术的可行性和安全性。自2009年10月至2010年4月，50例患者被随机分为三孔经典腹腔镜手术组(n=25)或更小手术组(n=25)。排除标准是：(1)有腹部手术经历，(2)有急性胆囊炎、胆总管结石或急性胰腺炎的体征，(3)ASA III级或以上，(4)缺乏书面知情同意，(5)BMI和Gt；=30 kg/m(2)。记录所有患者的详细情况：年龄、体重、身高、体重指数、手术时间、住院时间、患者疼痛和伤口满意度评分。术后6、12、24小时分别记录腹痛情况。术后第7天记录伤口满意度评分(非常不满意1分，不满意2分，可接受3分，满意4分，非常满意5分)。在性别、年龄、体重、身高和BMI方面，两组之间没有差异。术后住院时间相似(P=0.71)。3例患者(A组1例，B组2例)加装了5 mm套管针。术中胆道造影5例(A组2例，B组3例)。手术次数越少，平均手术时间越长(41.3±12.0比35.6±5.8；P=0.04)。LC组术后腹痛与LC组相似，但较少行胆囊切除术。两组患者伤口满意度评分差异有统计学意义：较少组患者对脐带小量用药的满意度较高(P<；0.05)。在这项随机前瞻性研究中，我们得出的结论是，对于没有腹部手术的无并发症的患者，少做胆囊切除术是传统三孔法的一种极好的选择。虽然在住院时间和术后疼痛方面与经典的腹腔镜胆囊切除术相比没有差异，但在我们的经验中，较少的手术对患者的伤口满意度有显著影响。(C)2011 Elsevier Inc.保留所有权利。
Background. Laparoscopic cholecystectomy (LC) is the gold-standard for the treatment of gallbladder stone disease. In recent years laparoendoscopic single site surgery (LESS) has gained greater interest and diffusion for the treatment of gallstones and also in bariatric and colonic surgery. However, no randomized controlled trials are present in the literature that confirm the clinical advantages of LESS compared with the classic laparoscopic procedures. For this reason, we present the preliminary results of this randomized prospective study regarding the feasibility and safety of LESS cholecystectomy versus classic laparoscopic technique.Methods. Between October 2009 and April 2010, 50 patients were randomly assigned to three-port classic laparoscopic cholecystectomy (n = 25) or LESS procedure (n = 25). Exclusion criteria were: (1) previous abdominal surgery, (2) signs of acute cholecystitis, choledocholithiasis, or acute pancreatitis, (3) ASA grade III or more, (4) lack of written informed consent, and (5) BMI >= 30 Kg/m(2). All the patients' details were recorded: age, weight, height, body mass index, operative time, length of hospital stay, patients' pain and wound satisfaction score. Abdominal pain was registered at 6, 12, and 24 h postoperatively. Wound satisfaction score (very unsatisfied = 1, unsatisfied = 2, acceptable = 3, satisfied = 4, very satisfied = 5) was registered for each patient at the seventh postoperative day.Results. No differences were registered between the two groups about gender, age, weight, height, and BMI. Also postoperative hospital stay was similar (P = 0.71). In three patients (1 in group A and 2 in group B) a 5-mm trocar was added. Intraoperative cholangiography was performed in five patients (2 in group A and 3 in group B). Mean operative time was significantly longer in LESS procedures (41.3 +/- 12.0 versus 35.6 +/- 5.8; P = 0.04). Abdominal postoperative pain was similar in LC and LESS cholecystectomy. Wound satisfaction score showed statistically significant differences between the two groups: in LESS group, patients were more satisfied with the presence of a small umbilical medication (P < 0.05).Conclusion. In this randomized prospective study, we conclude that LESS cholecystectomy is an excellent alternative to traditional three-port cholecystectomy for patients with uncomplicated disease, and no previous abdominal surgery. Although no differences are present about hospital stay and postoperative pain compared with classic laparoscopic cholecystectomy, in our experience LESS has had a significant impact on patients' wound satisfaction. (C) 2011 Elsevier Inc. All rights reserved.