單孔腹腔鏡與傳統多孔腹腔鏡膽囊切除術療效比較的Meta分析_《中國循證醫學雜志》

作者：

謝富佳 ¹ , 楊雀 ¹ , 范哲林 ¹ , 李鑫 ¹ , 王旭鋒 ¹ ,  曹農 ²

1. 蘭州大學第一臨床醫學院（蘭州 730000）；2. 蘭州大學第一醫院普外一科（蘭州 730000）;

關鍵詞：

膽囊切除術單孔腹腔鏡傳統多孔腹腔鏡系統評價 Meta分析隨機對照試驗

DOI：

10.7507/1672-2531.20130249

視頻：

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目的　系統評價單孔腹腔鏡與傳統多孔腹腔鏡膽囊切除術比較的有效性及安全性。
方法　計算機檢索PubMed、EMbase、The Cochrane Library（2013年第1期）、CBM、CNKI、VIP及WanFang Data等數據庫，查找比較單孔腹腔鏡與傳統多孔腹腔鏡膽囊切除術的隨機對照試驗，檢索時限均從建庫至2013年1月1日。按Cochrane系統評價方法篩選文獻、提取資料并評價質量后，采用RevMan 5.2軟件進行Meta分析。
結果　最終納入17個研究，共1 233例患者。Meta分析結果顯示：相比傳統多孔腹腔鏡，單孔腹腔鏡組的術后24 h疼痛程度更輕［SMD= –0.40，95%CI（–0.76，–0.04），P=0.03］，且具有更高的術后美容評分［SMD=1.56，95%CI（0.70，2.43），P=0.000 4］，但手術時間較長［MD=13.11，95%CI（7.06，19.16），P lt;0.000 1］。兩組患者術后6 h疼痛程度、術后并發癥、術后切口疝發生率及留院時間無明顯差異。
結論　單孔腹腔鏡膽囊切除術應用于膽囊良性疾病治療是安全有效的，且其較傳統多孔腹腔鏡膽囊切除術有一定優勢，值得臨床應用。

引用本文： 謝富佳,楊雀,范哲林,李鑫,王旭鋒,曹農. 單孔腹腔鏡與傳統多孔腹腔鏡膽囊切除術療效比較的Meta分析. 中國循證醫學雜志, 2013, 13(12): 1455-1462. doi: 10.7507/1672-2531.20130249 復制

1.	中華人民共和國國家衛生和計劃生育委員會（前國家衛生部）. 2012中國衛生統計提要, 2012. Available from:URL:http://www.chinacdc.cn/tjsj/gjwstjsj/201206/t20120608_63463.htm.
2.	Mühe, E. The first laparoscopic cholecystectomy. Langenbecks Arch Surg, 1986, 369: 804.
3.	Podolsky ER, Curcillo II, Rottman SJ, et al. Single port access (SPA) surgery-initial experience of a novel minimal access approach applied across surgical specialties. Surg Endosc, 2008, 22(11): 172-174.
4.	Moher D, Alessandro L, Jennifer T, et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Annals of Internal Medicine, 2009, 151(4): 264-269.
5.	陳耀龍, 蔡羽嘉, 王夢書, 等. 循證醫學術語介紹II . 中國循證醫學雜志, 2009, 9(2): 143-146.
6.	吳泰相, 商洪才, 卞兆祥. 隨機對照實況試驗的概念, 設計和實施. 中國循證醫學雜志, 2009, 9(12): 1277-1280.
7.	艾昌林, 段玉蓉, Wiffen P, 等. 系統評價員選擇中文生物醫學期刊數據庫的策略研究. 中國循證醫學雜志, 2010, 10(6): 749-753.
8.	Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions version 5.1. 0 [updated March 2011]. The Cochrane Collaboration, 2011.
9.	陳耀龍, 李曉, 梅又文, 等. 循證醫學術語介紹V. 中國循證醫學雜志, 2009, 9(7): 734-739.
10.	王丹, 翟俊霞, 牟振云, 等. Meta 分析中的異質性及其處理方法. 中國循證醫學雜志, 2009, 9(10): 1115-1118.
11.	Madureira FA, Manso JE, Madureira Fo D, et al. Randomized clinical study for assessment of incision characteristics and pain associated with LESS versus laparoscopic cholecystectomy. Surg Endosc, 2012, 27(3): 1009-1015.
12.	Vilallonga R, Barbaros U, Sümer A, et al. Single-port transumbilical laparoscopic cholecystectomy: a prospective randomised comparison of clinical results of 140 cases. J Minim Access Surg, 2012, 8(3): 74-78.
13.	Sasaki A, Ogawa M, Tono C, et al. Single-port versus multiport laparoscopic cholecystectomy: a prospective randomized clinical trial. Surgical Laparoscopy Endoscopy & Percutaneous Techniques, 2012, 22(5): 396-399.
14.	Chang SK, Wang YL, Shen L, et al. Interim report: A randomized controlled trial comparing postoperative pain in single-incision laparoscopic cholecystectomy and conventional laparoscopic cholecystectomy. Asian J Endosc Surg, 2012, 6(1): 14-20.
15.	Asakuma M, Hayashi M, Komeda K, et al. Impact of single-port cholecystectomy on postoperative pain. Br J Surg, 2011, 98(7): 991-995.
16.	Zheng M, Qin M, Zhao H. Laparoendoscopic single-site cholecystectomy: a randomized controlled study. Minim Invasive Ther Allied Technol, 2012, 21(2): 113-117.
17.	Lirici MM, Califano AD, Angelini P, et al. Laparo-endoscopic single site cholecystectomy versus standard laparoscopic cholecystectomy: results of a pilot randomized trial. Am J Surg, 2011, 202(1): 45-52.
18.	Bucher P, Pugin F, Buchs NC, et al. Randomized clinical trial of laparoendoscopic single-site versus conventional laparoscopic cholecystectomy. Br J Surg, 2011, 98(12): 1695-1702.
19.	Cao ZG, Cai W, Qin MF, et al. Randomized clinical trial of single-incision versus conventional laparoscopic cholecystectomy: short-term operative outcomes. Surg Laparosc Endosc Percutan Tech, 2011, 21(5): 311-313.
20.	Aprea G, Coppola-Bottazzi E, Guida F, et al. Laparoendoscopic single site (LESS) versus classic video-laparoscopic cholecystectomy: a randomized prospective study. Journal of Surgical Research, 2011, 166(2): E109-E112.
21.	Ma J, Cassera MA, Spaun GO, et al. Randomized controlled trial comparing single-port laparoscopic cholecystectomy and four-port laparoscopic cholecystectomy. Ann Surg, 2011, 254(1): 22-27.
22.	Lai EC, Yang GP, Tang CN, et al. Prospective randomized comparative study of single incision laparoscopic cholecystectomy versus conventional four-port laparoscopic cholecystectomy. Am J Surg, 2011, 202(3): 254-258.
23.	Lee PC, Lo C, Lai PS, et al. Randomized clinical trial of single-incision laparoscopic cholecystectomy versus minilaparoscopic cholecystectomy. Br J Surg, 2010, 97(7): 1007-1012.
24.	Sinan H, Demirbas S, Ozer MT, et al. Single-incision laparoscopic cholecystectomy versus laparoscopic cholecystectomy: a prospective randomized study. Surg Laparosc Endosc Percutan Tech, 2012, 22(1): 12-16.
25.	Phillips MS, Marks JM, Roberts K, et al. Intermediate results of a prospective randomized controlled trial of traditional four-port laparoscopic cholecystectomy versus single-incision laparoscopic cholecystectomy. Surg Endosc, 2012, 26(5): 1296-1303.
26.	Tsimoyiannis EC, Tsimogiannis KE, Pappas-Gogos G, et al. Different pain scores in single transumbilical incision laparoscopic cholecystectomy versus classic laparoscopic cholecystectomy: a randomized controlled trial. Surg Endosc, 2010, 24(8): 1842-1848.
27.	耿良元, 白劍峰, 孫躍明, 等. 單切口與傳統腹腔鏡膽囊切除術的隨機對比研究. 腹腔鏡外科雜志, 2012, 17(3): 173- 176.
28.	王萍, 謝蟪旭, 張綺, 等. 如何在 Cochrane 系統評價中設計資料提取表. 中國循證醫學雜志, 2011, 11(3): 341-345.
29.	Kilian M, Raue W, Menenakos C, et al. Transvaginal-hybrid vs. single-port-access vs. ’conventional’ laparoscopic cholecystectomy: a prospective observational study. Langenbecks Arch Surg, 2011, 396(5): 709-715.
30.	Navarra G., Pozza E, Occhionorelli S, et al. One‐wound laparoscopic cholecystectomy. British Journal of Surgery, 1997, 84(5): 695.
31.	Antoniou SA, Pointner R, Granderath FA. Single-incision laparoscopic cholecystectomy: a systematic review. Surg Endosc, 2011, 25(2): 367-377.
32.	Sajid MS, Ladwa N, Kalra L, et al. Single-incision laparoscopic cholecystectomy versus conventional laparoscopic cholecystectomy: meta-analysis and systematic review of randomized controlled trials. World Journal of Surgery, 2012, 36(11): 2644-2653.
33.	Markar SR, Karthikesalingam A, Thrumurthy S, et al. Single-incision laparoscopic surgery (SILS) vs. conventional multiport cholecystectomy: systematic review and meta-analysis. Surgical Endoscopy, 2012, 26(5): 1205-1213.
34.	Joseph M, Phillips M, Rupp CC. Single-incision laparoscopic cholecystectomy: a combined analysis of resident and attending learning curves at a single institution. The American Surgeon, 2012, 78(1): 119-124.
35.	Feinberg EJ, Agaba E, Feinberg ML, et al. Single-incision laparoscopic cholecystectomy learning curve experience seen in a single institution. Surgical Laparoscopy Endoscopy & Percutaneous Techniques, 2012, 22(2): 114-117.
36.	Solomon D, Bell RL, Duffy AJ, et al. Single-port cholecystectomy: small scar, short learning curve. Surg Endosc, 2010, 24(12): 2954-2957.
37.	Tsujie M, Ikenaga M, Miyamoto A, et al. Effectiveness of a surgical glove port with homemade trocars made of syringes for single incision laparoscopic cholecystectomy. Hepato-gastroenterology, 2012, 59(120): 2407-2409.
38.	Arain NA, Rondon L, Hogg DC, et al. Magnetically anchored camera and percutaneous instruments maintain triangulation and improve cosmesis compared with single-site and conventional laparoscopic cholecystectomy. Surgical Endoscopy, 2012, 26(12): 3457-3466.
39.	Kroh M, El-Hayek K, Rosenblatt S, et al. First human surgery with a novel single-port robotic system: cholecystectomy using the da Vinci Single-Site platform. Surgical Endoscopy, 2011, 25(11): 3566-3573.

1. 中華人民共和國國家衛生和計劃生育委員會（前國家衛生部）. 2012中國衛生統計提要, 2012. Available from:URL:http://www.chinacdc.cn/tjsj/gjwstjsj/201206/t20120608_63463.htm.
2. Mühe, E. The first laparoscopic cholecystectomy. Langenbecks Arch Surg, 1986, 369: 804.
3. Podolsky ER, Curcillo II, Rottman SJ, et al. Single port access (SPA) surgery-initial experience of a novel minimal access approach applied across surgical specialties. Surg Endosc, 2008, 22(11): 172-174.
4. Moher D, Alessandro L, Jennifer T, et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Annals of Internal Medicine, 2009, 151(4): 264-269.
5. 陳耀龍, 蔡羽嘉, 王夢書, 等. 循證醫學術語介紹II . 中國循證醫學雜志, 2009, 9(2): 143-146.
6. 吳泰相, 商洪才, 卞兆祥. 隨機對照實況試驗的概念, 設計和實施. 中國循證醫學雜志, 2009, 9(12): 1277-1280.
7. 艾昌林, 段玉蓉, Wiffen P, 等. 系統評價員選擇中文生物醫學期刊數據庫的策略研究. 中國循證醫學雜志, 2010, 10(6): 749-753.
8. Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions version 5.1. 0 [updated March 2011]. The Cochrane Collaboration, 2011.
9. 陳耀龍, 李曉, 梅又文, 等. 循證醫學術語介紹V. 中國循證醫學雜志, 2009, 9(7): 734-739.
10. 王丹, 翟俊霞, 牟振云, 等. Meta 分析中的異質性及其處理方法. 中國循證醫學雜志, 2009, 9(10): 1115-1118.
11. Madureira FA, Manso JE, Madureira Fo D, et al. Randomized clinical study for assessment of incision characteristics and pain associated with LESS versus laparoscopic cholecystectomy. Surg Endosc, 2012, 27(3): 1009-1015.
12. Vilallonga R, Barbaros U, Sümer A, et al. Single-port transumbilical laparoscopic cholecystectomy: a prospective randomised comparison of clinical results of 140 cases. J Minim Access Surg, 2012, 8(3): 74-78.
13. Sasaki A, Ogawa M, Tono C, et al. Single-port versus multiport laparoscopic cholecystectomy: a prospective randomized clinical trial. Surgical Laparoscopy Endoscopy & Percutaneous Techniques, 2012, 22(5): 396-399.
14. Chang SK, Wang YL, Shen L, et al. Interim report: A randomized controlled trial comparing postoperative pain in single-incision laparoscopic cholecystectomy and conventional laparoscopic cholecystectomy. Asian J Endosc Surg, 2012, 6(1): 14-20.
15. Asakuma M, Hayashi M, Komeda K, et al. Impact of single-port cholecystectomy on postoperative pain. Br J Surg, 2011, 98(7): 991-995.
16. Zheng M, Qin M, Zhao H. Laparoendoscopic single-site cholecystectomy: a randomized controlled study. Minim Invasive Ther Allied Technol, 2012, 21(2): 113-117.
17. Lirici MM, Califano AD, Angelini P, et al. Laparo-endoscopic single site cholecystectomy versus standard laparoscopic cholecystectomy: results of a pilot randomized trial. Am J Surg, 2011, 202(1): 45-52.
18. Bucher P, Pugin F, Buchs NC, et al. Randomized clinical trial of laparoendoscopic single-site versus conventional laparoscopic cholecystectomy. Br J Surg, 2011, 98(12): 1695-1702.
19. Cao ZG, Cai W, Qin MF, et al. Randomized clinical trial of single-incision versus conventional laparoscopic cholecystectomy: short-term operative outcomes. Surg Laparosc Endosc Percutan Tech, 2011, 21(5): 311-313.
20. Aprea G, Coppola-Bottazzi E, Guida F, et al. Laparoendoscopic single site (LESS) versus classic video-laparoscopic cholecystectomy: a randomized prospective study. Journal of Surgical Research, 2011, 166(2): E109-E112.
21. Ma J, Cassera MA, Spaun GO, et al. Randomized controlled trial comparing single-port laparoscopic cholecystectomy and four-port laparoscopic cholecystectomy. Ann Surg, 2011, 254(1): 22-27.
22. Lai EC, Yang GP, Tang CN, et al. Prospective randomized comparative study of single incision laparoscopic cholecystectomy versus conventional four-port laparoscopic cholecystectomy. Am J Surg, 2011, 202(3): 254-258.
23. Lee PC, Lo C, Lai PS, et al. Randomized clinical trial of single-incision laparoscopic cholecystectomy versus minilaparoscopic cholecystectomy. Br J Surg, 2010, 97(7): 1007-1012.
24. Sinan H, Demirbas S, Ozer MT, et al. Single-incision laparoscopic cholecystectomy versus laparoscopic cholecystectomy: a prospective randomized study. Surg Laparosc Endosc Percutan Tech, 2012, 22(1): 12-16.
25. Phillips MS, Marks JM, Roberts K, et al. Intermediate results of a prospective randomized controlled trial of traditional four-port laparoscopic cholecystectomy versus single-incision laparoscopic cholecystectomy. Surg Endosc, 2012, 26(5): 1296-1303.
26. Tsimoyiannis EC, Tsimogiannis KE, Pappas-Gogos G, et al. Different pain scores in single transumbilical incision laparoscopic cholecystectomy versus classic laparoscopic cholecystectomy: a randomized controlled trial. Surg Endosc, 2010, 24(8): 1842-1848.
27. 耿良元, 白劍峰, 孫躍明, 等. 單切口與傳統腹腔鏡膽囊切除術的隨機對比研究. 腹腔鏡外科雜志, 2012, 17(3): 173- 176.
28. 王萍, 謝蟪旭, 張綺, 等. 如何在 Cochrane 系統評價中設計資料提取表. 中國循證醫學雜志, 2011, 11(3): 341-345.
29. Kilian M, Raue W, Menenakos C, et al. Transvaginal-hybrid vs. single-port-access vs. ’conventional’ laparoscopic cholecystectomy: a prospective observational study. Langenbecks Arch Surg, 2011, 396(5): 709-715.
30. Navarra G., Pozza E, Occhionorelli S, et al. One‐wound laparoscopic cholecystectomy. British Journal of Surgery, 1997, 84(5): 695.
31. Antoniou SA, Pointner R, Granderath FA. Single-incision laparoscopic cholecystectomy: a systematic review. Surg Endosc, 2011, 25(2): 367-377.
32. Sajid MS, Ladwa N, Kalra L, et al. Single-incision laparoscopic cholecystectomy versus conventional laparoscopic cholecystectomy: meta-analysis and systematic review of randomized controlled trials. World Journal of Surgery, 2012, 36(11): 2644-2653.
33. Markar SR, Karthikesalingam A, Thrumurthy S, et al. Single-incision laparoscopic surgery (SILS) vs. conventional multiport cholecystectomy: systematic review and meta-analysis. Surgical Endoscopy, 2012, 26(5): 1205-1213.
34. Joseph M, Phillips M, Rupp CC. Single-incision laparoscopic cholecystectomy: a combined analysis of resident and attending learning curves at a single institution. The American Surgeon, 2012, 78(1): 119-124.
35. Feinberg EJ, Agaba E, Feinberg ML, et al. Single-incision laparoscopic cholecystectomy learning curve experience seen in a single institution. Surgical Laparoscopy Endoscopy & Percutaneous Techniques, 2012, 22(2): 114-117.
36. Solomon D, Bell RL, Duffy AJ, et al. Single-port cholecystectomy: small scar, short learning curve. Surg Endosc, 2010, 24(12): 2954-2957.
37. Tsujie M, Ikenaga M, Miyamoto A, et al. Effectiveness of a surgical glove port with homemade trocars made of syringes for single incision laparoscopic cholecystectomy. Hepato-gastroenterology, 2012, 59(120): 2407-2409.
38. Arain NA, Rondon L, Hogg DC, et al. Magnetically anchored camera and percutaneous instruments maintain triangulation and improve cosmesis compared with single-site and conventional laparoscopic cholecystectomy. Surgical Endoscopy, 2012, 26(12): 3457-3466.
39. Kroh M, El-Hayek K, Rosenblatt S, et al. First human surgery with a novel single-port robotic system: cholecystectomy using the da Vinci Single-Site platform. Surgical Endoscopy, 2011, 25(11): 3566-3573.

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《中國循證醫學雜志》

單孔腹腔鏡與傳統多孔腹腔鏡膽囊切除術療效比較的Meta分析

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