单切口腹腔镜胆囊切除术的前瞻性、随机、对照临床研究：单中心449例分析

IF 2.4 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Hpb Pub Date : 2025-08-26 DOI:10.1016/j.hpb.2025.08.004

Xiang Pan, Liufan Zha, Huanbing Zhu, Jinhong Wu, Zhiquan Chen, Chao Li, Yangming Hou, Dan Ye, Daren Liu

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引用次数: 0

摘要

背景：单切口腹腔镜胆囊切除术（SILC）是传统腹腔镜胆囊切除术（CLC）的一种微创替代方案，可以改善术后恢复和美容效果，但存在并发症和技术要求方面的问题。这项随机对照试验比较了使用传统腹腔镜器械的SILC和CLC。材料和方法：891例患者随机分为SILC组（n = 449）和CLC组（n = 442）。评估手术参数、术后恢复、并发症和患者报告的结果。主要终点是手术时间、出血量和并发症发生率。次要结局包括住院时间、疼痛评分和美容满意度（温哥华疤痕评分）。结果：SILC的手术时间（55.11±22.88 vs 51.81±23.61 min, p = 0.907）和出血量（10.89±26.37 vs 10.14±14.38 ml, p = 0.475）与CLC相似。SILC患者住院时间较短（1.94±1.87 vs 2.25±2.49天，p < 0.001），疼痛评分较低（2.19±0.88 vs 2.80±0.75,p = 0.016），瘢痕结局较好（2.41±1.81 vs 3.54±1.61,p = 0.020）。胆漏和疝等并发症发生率在SILC中略高，但无统计学意义。结论：SILC是一种安全、有效的替代CLC的方法，具有更好的术后恢复和美容效果。然而，患者选择和手术专业知识对于优化结果和减少并发症至关重要。

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Prospective, randomized, controlled clinical study on single-incision laparoscopic cholecystectomy: an analysis of 449 cases from a single center.

Background: Single-incision laparoscopic cholecystectomy (SILC), a minimally invasive alternative to conventional laparoscopic cholecystectomy (CLC), may improve postoperative recovery and cosmetic outcomes but faces concerns about complications and technical demands. This randomized controlled trial compares SILC and CLC using conventional laparoscopic instruments.

Materials and methods: 891 patients were randomized to SILC (n = 449) or CLC (n = 442). Operative parameters, postoperative recovery, complications, and patient-reported outcomes were evaluated. Primary endpoints were operative time, blood loss, and complication rates. Secondary outcomes included hospital stay, pain scores, and cosmetic satisfaction (Vancouver scar scores).

Results: SILC showed similar operative time (55.11 ± 22.88 vs 51.81 ± 23.61 min, p = 0.907) and blood loss (10.89 ± 26.37 vs 10.14 ± 14.38 ml, p = 0.475) versus CLC. SILC patients had shorter hospitalization (1.94 ± 1.87 vs 2.25 ± 2.49 days, p < 0.001), lower pain scores (2.19 ± 0.88 vs 2.80 ± 0.75, p = 0.016), and better scar outcomes (2.41 ± 1.81 vs 3.54 ± 1.61, p = 0.020). Complication rates like bile leakage and hernias were marginally higher in SILC but not statistically significant.

Conclusion: SILC is a safe, effective alternative to CLC, offering better postoperative recovery and cosmetic results. However, patient selection and surgical expertise are crucial to optimize outcomes and minimize complications.

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来源期刊

Hpb GASTROENTEROLOGY & HEPATOLOGY-SURGERY

CiteScore

5.60

自引率

3.40%

发文量

244

审稿时长

57 days

期刊介绍： HPB is an international forum for clinical, scientific and educational communication. Twelve issues a year bring the reader leading articles, expert reviews, original articles, images, editorials, and reader correspondence encompassing all aspects of benign and malignant hepatobiliary disease and its management. HPB features relevant aspects of clinical and translational research and practice. Specific areas of interest include HPB diseases encountered globally by clinical practitioners in this specialist field of gastrointestinal surgery. The journal addresses the challenges faced in the management of cancer involving the liver, biliary system and pancreas. While surgical oncology represents a large part of HPB practice, submission of manuscripts relating to liver and pancreas transplantation, the treatment of benign conditions such as acute and chronic pancreatitis, and those relating to hepatobiliary infection and inflammation are also welcomed. There will be a focus on developing a multidisciplinary approach to diagnosis and treatment with endoscopic and laparoscopic approaches, radiological interventions and surgical techniques being strongly represented. HPB welcomes submission of manuscripts in all these areas and in scientific focused research that has clear clinical relevance to HPB surgical practice. HPB aims to help its readers - surgeons, physicians, radiologists and basic scientists - to develop their knowledge and practice. HPB will be of interest to specialists involved in the management of hepatobiliary and pancreatic disease however will also inform those working in related fields. Abstracted and Indexed in: MEDLINE® EMBASE PubMed Science Citation Index Expanded Academic Search (EBSCO) HPB is owned by the International Hepato-Pancreato-Biliary Association (IHPBA) and is also the official Journal of the American Hepato-Pancreato-Biliary Association (AHPBA), the Asian-Pacific Hepato Pancreatic Biliary Association (A-PHPBA) and the European-African Hepato-Pancreatic Biliary Association (E-AHPBA).