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首页> 外文期刊>Surgical Endoscopy >Less pain after transvaginal/transumbilical cholecystectomy than after the classical laparoscopic technique: Short-term results of a matched-cohort study
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Less pain after transvaginal/transumbilical cholecystectomy than after the classical laparoscopic technique: Short-term results of a matched-cohort study

机译：经阴道/经脐胆囊切除术后的疼痛比传统的腹腔镜技术少：配对研究的短期结果

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Background: Natural orifice surgery (NOS) is gaining acceptance as an alternative to the traditional laparoscopic technique, especially for cholecystectomy through the transvaginal route. However, NOS remains controversial concerning expected advantages in terms of short- and long-term outcomes and potential side effects. This study was designed to compare short-term outcomes between transvaginal/transumbilical and classical laparoscopic cholecystectomy (LC). Methods: A prospective matched-cohort study compared the authors' first 50 transvaginal/transumbilical cholecystectomies (TVC) with a group of 50 classical LCs from the corresponding period matched in terms of age, body mass index, and American Society of Anesthesiology classification. In both groups, elective surgery was performed for symptomatic cholecystolithiasis. In the NOS group, a hybrid procedure was performed with one transumbilical rigid instrument and two transvaginal rigid instruments. A numeric rating scale was used for daily pain assessment, initiated postoperatively in the recovery room. Both groups were compared with regard to length of surgery, intra- and postoperative complications, length of hospital stay, postoperative pain, and consumption of analgesics. Results: The length of surgery and the rate of complications were similar in the two groups. But significant advantages were found for the transvaginal access in terms of pain using Numeric Rating Scale (NRS) on the day of surgery (NRS, 1.5/10 vs 3.1/10; p = 0.003) as well as in the morning (NRS, 1.9/10 vs 2.8/10; p = 0.047) and in the evening (NRS, 1.1/10 vs 1.8/10; p = 0.025) of postoperative day 1, and with regard to the length of the postoperative hospital stay (2.7 vs 3.4 days; p = 0.035). Conclusions: The findings show that TVC is a safe procedure for female patients. It has a risk comparable with that of classic LC, causes significantly less pain in the early postoperative period, and leads to a significantly shorter hospital stay. Prospective randomized trials are necessary to confirm these results.
机译：背景技术：自然孔口手术（NOS）作为传统腹腔镜技术的替代方法正在获得认可，尤其是通过经阴道途径进行胆囊切除术时。但是，关于短期和长期结果以及潜在的副作用方面的预期优势，NOS仍存在争议。本研究旨在比较经阴道/经脐带和经典腹腔镜胆囊切除术（LC）之间的短期结果。方法：一项前瞻性队列研究比较了作者的前50个经阴道/脐带胆囊切除术（TVC）和一组来自相应时期的50个经典LC，这些LC在年龄，体重指数和美国麻醉学会分类上均相匹配。两组均进行了有症状的胆囊结石症的择期手术。在NOS组中，使用一台经脐刚性器械和两台经阴道刚性器械进行混合手术。数字评分量表用于日常疼痛评估，术后在恢复室开始。比较两组患者的手术时间，术中和术后并发症，住院时间，术后疼痛和镇痛药的使用情况。结果：两组的手术时间和并发症发生率相似。但是，在手术当天（NRS，1.5 / 10与3.1 / 10; p = 0.003）以及早晨（NRS，1.9），使用数字评分量表（NRS）在经痛方面发现了明显的优势。 / 10 vs 2.8 / 10; p = 0.047）和术后第1天晚上（NRS，1.1 / 10 vs 1.8 / 10; p = 0.025），以及术后住院时间（2.7 vs 3.4）天; p = 0.035）。结论：研究结果表明TVC对女性患者是安全的。它具有与经典LC相当的风险，术后初期疼痛明显减轻，住院时间明显缩短。前瞻性随机试验对于确认这些结果是必要的。

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