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首页> 外文期刊>Surgical Endoscopy >Is smaller necessarily better? A systematic review comparing the effects of minilaparoscopic and conventional laparoscopic cholecystectomy on patient outcomes
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Is smaller necessarily better? A systematic review comparing the effects of minilaparoscopic and conventional laparoscopic cholecystectomy on patient outcomes

机译：较小一定更好吗？系统评价比较了微型腹腔镜和常规腹腔镜胆囊切除术对患者预后的影响

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BACKGROUND: In recent years, minilaparoscopic cholecystectomy (MLC; total size of trocar incision < 25 mm) has been increasingly advocated for the removal of the gallbladder, due to potentially better surgical outcomes (e.g., better cosmetic result, reduced pain, shorter hospital stay, quicker return to activity), but an evidence-based approach has been lacking. The current systematic review was undertaken to evaluate the importance of total size of trocar incision in improving surgical outcomes in adult laparoscopic cholecystectomy (LC). METHODS: The literature was systematically reviewed using MEDLINE and EmBASE. Only randomized controlled trials in English, investigating minilaparoscopic versus conventional LC (total size of trocar incision > or = 25 mm) and reporting pain scores were included. Quantitative analyses (meta-analyses) were performed on postoperative pain scores and other patient outcomes from more than one study where feasible and appropriate. Qualitative analyses consisted of assessing the number of studies showing a significant difference between the techniques. RESULTS: Thirteen trials met the inclusion criteria. There was a trend towards reduced pain with MLC compared with conventional LC, without reduction in opioid use. Patients in the MLC group had slightly reduced length of hospital stay, but there were no significant differences for return to activity. The two interventions were also similar in terms of operating times and adverse events, but MLC was associated with better cosmetic result (largely patient rated). There was a significantly greater likelihood of conversion to conventional LC or to open cholecystectomy in the MLC group than there was of conversion to open cholecystectomy in the conventional LC group [OR 4.71 (95% confidence interval 2.67-8.31), p < 0.00001]. CONCLUSIONS: The data included in this review suggest that reducing the size of trocar incision results in some limited improvements in surgical outcomes after LC. However, it carries a higher risk of conversion to conventional LC or open cholecystectomy.
机译：背景：近年来，由于潜在的更好的手术效果（例如，更好的美容效果，减轻的痛苦，更短的住院时间），越来越多地主张采用微型腹腔镜胆囊切除术（MLC;套管针切口的总尺寸<25 mm）来切除胆囊，可以更快地恢复活动），但一直缺乏基于证据的方法。目前进行的系统评价是为了评估套管针切口的总大小对改善成人腹腔镜胆囊切除术（LC）的手术效果的重要性。方法：使用MEDLINE和EmBASE系统地复习文献。仅包括英语随机对照试验，研究微型腹腔镜与传统LC（套管针切口的总尺寸> 25 mm或= 25 mm）并报告疼痛评分。在可行和适当的情况下，对一项以上的研究进行了术后疼痛评分和其他患者预后的定量分析（元分析）。定性分析包括评估显示技术之间显着差异的研究数量。结果：十三项试验符合纳入标准。与传统LC相比，MLC有减轻疼痛的趋势，而阿片类药物的使用却没有减少。 MLC组患者的住院时间略有缩短，但恢复活动没有明显差异。两种干预措施在手术时间和不良事件方面也相似，但MLC与更好的美容效果相关（大部分患者评价较高）。与传统LC组相比，MLC组转换为常规LC或开腹胆囊切除术的可能性要大得多[OR 4.71（95％置信区间2.67-8.31），p <0.00001]。结论：本评价中包括的数据表明，减少套管针切口的尺寸会导致LC术后手术结局的有限改善。但是，它具有转换为常规LC或开腹胆囊切除术的较高风险。

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