Randomised controlled trial of laparoscopic versus mini cholecystectomy. The McGill Gallstone Treatment Group.
Randomised controlled trial of laparoscopic versus mini cholecystectomy. The McGill Gallstone Treatment Group.
复制标题
腹腔镜与小型胆囊切除术的随机对照试验。
作者：
J. Barkun;A. Barkun;J. Sampalis;G. Fried;B. Taylor;M. Wexler;C. Goresky;J. Meakins
腹腔镜胆囊切除术（LC）已被广泛接受为首选开腹胆囊切除术治疗胆石症，但它还没有正式比较小胆囊切除术（MC）。我们在一项随机试验中比较了这两种技术。70例经超声证实的胆石症患者被随机分配LC（38例）或MC（32例）;分别有37例和25例接受了指定的手术。LC组的平均住院时间（包括术前1天）显著短于MC组（中位数3 [四分位距2-3] vs 4 [3-5]，p = 0.001），恢复期持续时间也是如此（平均11.9 [SD 9.1] vs 20.2 [16.5]天，p = 0.04）。LC组恢复正常活动的比率是MC组的1.77倍（95%置信区间1.01-3.11，p = 0.03）。在回归分析中，胆囊切除术的类型是唯一与恢复期显著相关的变量。尽管两组患者术后三项生活质量评分均有显著改善，但LC患者的改善速度快于MC患者。这项随机试验显示LC治疗胆石症的疗效上级MC。
Laparoscopic cholecystectomy (LC) has gained wide acceptance for treatment of cholelithiasis in preference to open cholecystectomy, though it has not been formally compared with mini cholecystectomy (MC). We have compared these two techniques in a randomised trial. 70 patients with ultrasound-proven cholelithiasis were randomly allocated LC (38) or MC (32); 37 and 25, respectively, underwent the assigned procedure. The mean hospital stay (including 1 preoperative day) was significantly shorter in the LC than the MC group (median 3 [interquartile range 2-3] vs 4 [3-5], p = 0.001) as was duration of convalescence (mean 11.9 [SD 9.1] vs 20.2 [16.5] days, p = 0.04). The rate of return to normal activities was 1.77 times greater in the LC group than in the MC group (95% confidence interval 1.01-3.11, p = 0.03). In regression analysis, the type of cholecystectomy done was the only variable significantly associated with the duration of convalescence. Although there was significant postoperative improvement in all of three quality of life scores in both groups, LC patients improved more quickly than did MC patients. This randomised trial shows the superior effectiveness of LC over MC in treating cholelithiasis.