腹腔镜与开腹阑尾切除术的系统评价

目的评价腹腔镜和开腹阑尾切除术的临床效果。方法按照Cochrane系统评价方法,计算机检索PubMed、Wiley Online Library、Medline、Embase、Cochrane图书馆及中国生物医学文献数据库(CBM)、中国学术期刊网全文数据库(VIP)、中文科技期刊全文数据库(CNKI),检索时间截至2011年11月,并手工检索相关文献,查找比较腹腔镜和开腹阑尾切除术的随机对照文献。由2位研究者按照纳入和排除标准筛选文献,评价质量并提取资料后采用RevMan 4.2.2进行Meta分析。分析两种手术方法的伤口感染、住院时间、手术时间、住院费用及腹腔脓肿发生率。结果纳入8篇随机对照试验,Meta分析结果显示,腹腔镜和开腹阑尾切除术的伤口感染〔OR=0.19,95%CI(0.09,0.38),P<0.000 01〕、手术时间〔WMD=3.66,95%CI(0.50,6.82),P=0.02〕及住院费用〔WMD=503.96,95%CI(337.23,670.70),P<0.000 01〕比较,差异均有统计学意义;二者的住院时间〔WMD=-0.11,95%CI(-3.64,3.43),P=0.95〕及腹腔脓肿发生率〔OR=1.40,95%CI(0.23,8.64),P=0.71〕比较,差异无统计学意义。结论腹腔镜阑尾切除手术较开腹阑尾切除术伤口感染率低,但手术时间长,费用高;二者住院时间和腹腔脓肿发生率差异无统计学意义。     

腹腔镜脾切除与开腹脾切除的疗效观察

目的探讨腹腔镜脾切除治疗非外伤性脾肿大的可行性与安全性。方法选取我院2009年1月至2013年6月因非外伤性脾肿大而进行脾切除的患者40例,其中22例行腹腔镜脾切除术为腹腔镜(LS)组,18例行传统开腹的脾切除术作为开腹组(OS),观察两组围手术期的相关指标,并进行对比分析。结果LS组中2例(9.1%)患者因术中出血而中转开腹,6例患者于腔镜下同时行门奇静脉断流术,4例患者于腔镜下同时行胆囊切除术。OS组中7例患者同时行门奇静脉断流术,3例患者同时行胆囊切除术。两组患者的脾重量、体积以及长度均无统计学意义(P值>0.05)。LS组的平均手术时间长于OS组,但LS组术中失血量和术中输血的例数均也少于OS组,差异均有统计学意义(P值<0.05)。LS组术后平均住院时间为7.6±1.8(d),小于OS组的10.1±2.1(d),差异有统计学意义(P值<0.01)。LS组术后并发症率为18.2%,要低于OS组的38.9%(P<0.05),两组均无死亡病例。结论腹腔镜脾切除术治疗非外伤性脾肿大是安全可行的。     

手助腹腔镜及开腹脾切除巨脾的临床疗效比较

目的比较手助腹腔镜(HALS)和开腹切除(OP)巨脾的临床效果。方法回顾性分析2004年—2010年行脾切除术患者的临床资料,比较其中大于20 cm脾脏行HALS和OP的临床疗效。结果大于20 cm的巨脾切除术患者41例,21例为HALS手术,20例为开腹脾切除手术。HALS组的中转开腹率4.7%。HALS和OP组的平均出血量为227 mL和887 mL(P=0.01),平均输血为0和0.6单位(P<0.05)。HALS组的住院时间比OP显著为短(4.3 d vs.8.4 d)(P=0.001)。并发症发生率两者相比无统计学差异(P>0.05)。结论 HALS是一项安全和有效的巨脾(大于20 cm)切除技术。相比开腹脾切除其住院时间更短,出血及输血更少,是一种行之有效的替代方法。     

单孔与传统腹腔镜脾切除术临床效果的系统评价

目的:系统评价单孔法腹腔镜脾切除术(single incision laparoscopic splenectomy,SILS)与传统腹腔镜脾切除术(conventional laparoscopic splenectomy,CLS)的安全性及临床效果。方法:计算机检索Cochrane图书馆、MEDLINE、EMBASE、CBM、CNKI、VIP等数据库,检索时限自1990年1月至2013年4月,纳入SILS与CLS随机对照或病例对照研究。由2名评价者独立评价并交叉核对纳入研究质量后,采用RevMan 5.1.2软件包进行Meta分析。结果:经筛选,最终纳入5个病例对照研究,共135例受试者。NOS评分评价结果显示,5个研究均为中等及以上质量的研究。Meta分析结果表明,SILS组与CLS组患者在术中出血量、手术时间、住院时间、并发症发生率及中转开腹方面差异无统计学意义,尤其SILS组手术时间较LS组并未明显延长。结论:SILS与CLS临床效果及安全性相似,为下一步开展大样本、多中心的随机对照试验提供了初步证据;为获得对SILS更全面、更准确的评价,建议以后的研究重点对美容效果及镇痛效果进行评估。     

腹腔镜与开腹胰十二指肠切除术临床疗效比较

目的 比较腹腔镜与开腹胰十二指肠切除术的临床疗效。方法 回顾性分析南充市中心医院2014 年6 月至2019 年8 月期间完成的104 例胰十二指肠切除术患者资料，其中包含胰头癌47 例，十二指肠乳头癌31 例，胆管下段癌26 例，根据已行的手术方式分为腹腔镜胰十二指肠切除组（A组，n=40）和开腹胰十二指肠切除组（B组，n=64）。比较两组的手术时间、术中出血量、平均排气时间、术后下床活动时间、住院时间及术后并发症发生情况。结果 两组手术时间和术中出血量无统计学差异（P＞0．05），平均排气时间、术后下床活动时间及住院时间A组小于B组（P＜0．05）。其中A组术后发生胰瘘5 例，胆漏4 例，腹腔内出血1 例，胃瘫综合征3 例；B组术后发生胰瘘9 例，胆漏5 例，腹腔内出血1 例，胃瘫综合征4 例，余无明显严重并发症发生；两组术后总并发症发生率无明显差异（P＞0．05）。结论 腹腔镜和开腹胰十二指肠切除术均安全有效，但腹腔镜胰十二指肠切除术后恢复优于开腹胰十二指肠切除术。     

腹腔镜胆囊切除术与传统开腹胆囊切除术治疗胆囊结石临床疗效比较

目的 比较腹腔镜胆囊切除术与开腹胆囊切除术两种术式治疗胆囊结石的临床疗效.方法 选取2012年5月至2013年3月我院行手术治疗胆囊结石患者120例,其中60例行腹腔镜胆囊切除术作为观察组,开腹胆囊切除术手术治疗60例作为对照组.观察并比较两组临床疗效结果.结果 研究组术中出血量少于对照组,手术时间、胃肠道功能恢复时间及术后住院时间短于对照组,两组比较,差异有统计学意义（P＜0.05）;对照组、观察组术后并发症发生率分别为20％、5.0％,差异有统计学意义（P＜0.05）.结论 腹腔镜胆囊切除术具有创伤小、恢复快、住院时间短和并发症少等优点,值得临床推广.     

腹腔镜胆囊切除术中转开腹的临床分析

目的:探讨腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)中转开腹的原因,提高手术安全性。方法:回顾分析3 600例LC术中106例中转开腹的临床资料,并结合文献进行总结。结果:88例主动中转开腹,10例被迫中转开腹,8例术后延期开腹。被迫开腹及术后开腹的原因为出血、胆漏、腹膜炎、医源性损伤;主动开腹的原因为胆囊三角解剖困难,全组3例转上级医院,无死亡病例。结论:中转开腹手术并不意味着手术失败,也不是手术并发症,是明智之举。中转开腹受多种因素影响,术者职业素质及操作技术是手术成功的决定性因素,患者本身疾病状况是手术安全的主要因素,中转开腹本身并无绝对的手术指征,需强调术前风险评估。     

腹腔镜脾切除术治疗巨脾症的临床疗效及其对病人应激反应的影响

目的探讨腹腔镜脾切除术治疗巨脾症的临床疗效及其对病人应激反应的影响。方法将汉川市人民医院2013年1月至2016年6月收治的38例巨脾症病人作为临床研究对象,根据其治疗方式,将19例行腹腔镜脾切除术(laparoscopic splenectomy,LS)病人纳入LS组,19例行开腹脾切除术(open splenectomy,OS)病人纳入OS组,记录两组病人手术切口长度、手术时间、术中出血量、肠功能恢复时间、住院时间及术后并发症发生情况,并检测两组病人术前1 d、术后1 d及7 d C反应蛋白(C-reactive protem,CRP)、降钙素原(procalcitonin,PCT)、白细胞介素6(interleukin-6,IL-6)、肿瘤坏死因子α(tumor necrosis factor-α,TNF-α)等应激反应指标并观察其变化,给予统计学分析后得出结论。结果除手术时间外,在手术切口长度、术中出血量、住院时间、肠道功能恢复时间、术后并发症发生率等比较中,LS组均优于OS组,差异均有统计学意义(P0.05)。在应激反应指标方面,两组病人术后1 d CRP、PCT、IL-6、TNF-α均明显升高,术后7d均明显降低,但两组病人之间比较,LS组术前1d与OS组差异无统计学意义,术后1 d、7 d均明显低于OS组,差异均有统计学意义(P0.05)。结论在巨脾症的临床治疗中,LS对病人术中侵袭度小,术后恢复快,对病人应激反应影响小,术后并发症少。     

腹腔镜与开腹阑尾切除术的临床比较

目的:比较腹腔镜与开腹手术切除阑尾的优缺点。方法:回顾性分析我院2010年1月1日—2012年3月31日292例行阑尾切除术患者的临床资料,根据手术方法分为单孔法腹腔镜阑尾手术组、多孔法腹腔镜阑尾手术组和开腹阑尾手术组,比较手术时间、出血量、术后排气时间、术后住院时间切口愈合等级及感染率。结果:单孔法腹腔镜阑尾手术组中1例转为多孔法,多孔法腹腔镜阑尾手术组中1例中转开腹,其余患者均完成手术。2例多孔法腹腔镜阑尾手术患者术后并发粘连性肠梗阻,经保守治疗后好转。与传统开腹手术相比,腹腔镜阑尾切除术手术时间短、出血量少、术后排气快、术后住院时间短;对于急性单纯性阑尾炎,单孔腹腔镜手术比多孔法出血更少,瘢痕更小。结论:腹腔镜阑尾切除术对腹部干扰少,单孔法切口更为隐蔽,在熟练掌握手术技术的前提下可以广泛应用。     

腹腔镜胆囊切除术与开腹胆囊切除术的临床比较研究

目的比较腹腔镜胆囊切除术与开腹胆囊切除术的疗效和安全性。方法将我院2008年6月～2010年6月收治的96例胆囊疾病患者随机分为观察组（腹腔镜胆囊切除术）和对照组（开腹胆囊切除术）各48例,术后比较两组的手术时间、术中出血量、术后排气时间及并发症情况。结果观察组的手术用时、排气时间、住院时间明显短于对照组（P〈0.05）,且观察组术中出血量明显少于对照组（P〈0.05）,术后观察组1例因胆囊三角区出血,镜下止血失败而中转开腹;1例术后伤口出现感染,对照组出现切口感染4例,胆心反射5例,切口出血4例,胆管损伤、肠粘连各1例,观察组术后并发症的发生率明显低于对照组并发症的发生率（P〈0.05）。结论腹腔镜胆囊切除术与传统开腹手术相比对患者损伤小,术后恢复快,住院时间短,但也存在一些术后并发症,但并发症的发生率较低。     

腹腔镜脾切除术与开腹脾切除术的疗效观察

目的：比较腹腔镜脾切除术（LS）与开腹脾切除术（OS）的临床疗效。方法2011年7月至2013年7月,选择同期分别行腹腔镜脾切除术（腹腔镜组）和开腹脾切除术（开腹组）的患者,各12例。对比分析两组患者的临床资料,包括手术时间、术中出血量、禁食时间、术后切口疼痛评分、术后住院时间等。结果与开腹组相比,腹腔镜组患者的手术时间[（170±9.7）minvs（89±4.4）min,t=24.087]、术后禁食时间[（40±8.4）hvs（68±5.8）h,t=8.558]以及术后住院时间[（7.3±0.8）d vs（13.2±0.9）d,t=-15.122]更短,术中出血量更少[（94±4.7）ml vs（170±20.7）ml,t=-11.355],术后第1天切口疼痛评分[（3.1±0.8）分vs（5.5±0.5）分,t=8.813]和第3天评分[（1.2±0.4）分vs（2.7±0.5）分,t=8.115]明显优于开腹组,差异均有统计学意义（P＜0.01）。结论腹腔镜脾切除术具有创伤小、术后恢复快、并发症发生率低等特点,值得临床推广应用。     

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目的探讨腹腔镜脾切除术(laparoscopic splenectomy，LS)和腹腔镜辅助脾切除术(laparoscopic assisted splenectomy，LAS)的优缺点。方法1994～2003年共实施脾切除术43例，其中采用LAS行脾切除术13例，完全在腹腔镜下行脾切除术30例，切除副牌6例，4例同时行腹腔镜胆囊切除术。结果手术均获成功，LS术后切口感染1例，并发DIC 1例，平均手术时间160min，术中失血平均120mL，术后平均住院5．4d。LAS平均手术时间132min，术中平均失血90mL，术后平均住院8．6d。结论LS和LAS均安全可行，LAS手术时间短，术中出血少，但病人住院时间长。LS费时费事，术中出血多。     

Laparoscopic vs open pyloromyotomy: a systematic review and meta-analysis

Purpose

The aim of the study was to determine whether laparoscopic pyloromyotomy (LP) or open pyloromyotomy (OP) is the most effective intervention in infants with hypertrophic pyloric stenosis.

Methods

A systematic review of the published literature was undertaken in February 2009. Prospective studies comparing LP and OP were selected. Age, weight, complications, duration of operation, time to full feedings, postoperative vomiting, and postoperative length of stay (LOS) data were extracted.

Results

Six prospective studies (5 level I, 1 level II) with 625 (303 LP, 322 OP) participants met selection criteria. Combined estimates indicated that LP had a lower total complication rate (odds ratio [OR], 0.58 [0.35, 0.97]; P = .04), mostly due to a lower wound complication rate (OR, 0.42 for LP [0.20, 0.91]; P = .03). Patients who underwent LP also had shorter time to full feedings (mean difference [MD], −11.52 hours [−12.77, −10.27]; P < .00001) and shorter postoperative LOS (MD, −5.71 hours [−8.90, −2.52]; P = .0005). No statistically significant differences were noted in the rates of mucosal perforation, wound infection, postoperative emesis, or operating time. Incomplete pyloromyotomy occurred in 6 patients who underwent LP (OR, 7.74 [0.94, 63.38]; P = .06).

Conclusions

This meta-analysis favors the laparoscopic approach with significantly reduced rate of total complications, which is mostly due to a lower wound complication rate.     

Robotic versus laparoscopic hepatectomy for malignancy: A systematic review and meta-analysis

The aim of this study was to compare the clinical safety and efficacy of robotic hepatectomy (RH) versus conventional laparoscopic hepatectomy (LH) for malignancy using meta-analysis. A systematic literature search was performed using PubMed, EMBASE, Medline and the Cochrane Library databases up to September 2020 for studies, which limited to comparative articles of RH or LH for malignant tumors. Stata14.0 was performed in the meta-analysis. Six studies with a total of 1093 patients (345 RH and 748 LH) were eligible for inclusion. Operative time, tumor size, open procedure rate and the proportion of right hepatectomy were found to be significantly different between RH and LH in the pooled analysis (P < 0.05). Compared to LH, RH was associated with longer operative time, larger tumor size, lower open procedure rate and more common use for right hepatectomy. On the other hand, there was no difference in the operative time, estimated blood loss (EBL), blood transfusion rate, hospital stay, R0 resection rate, complications, resection margin, left lateral sectionectomy and left hepatectomy (P > 0.05). For malignant tumors that require hepatectomy, robotic approaches have demonstrated similar safety and feasibility to laparoscopy, with lower open procedure rate, were suitable for larger tumor size, and have a high right hepatectomy utilization rate. These results still need to be confirmed by multicenter, high-quality randomized controlled studies.     

Laparoscopic sleeve gastrectomy versus Roux-en-Y gastric bypass for quality of life: a systematic review and meta-analysis

Laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB) are the mainstays of bariatric surgery in recent years. In addition, there has been an increased interest in the quality of life (QoL) of obese patients after surgery. This study examined the QoL of patients who had undergone either LSG or LRYGB. We retrieved the literature from PubMed, Web of Science, Embase, and the Cochrane Library database before November 2019. A total of 10 articles and 2327 obese patients were included in our meta-analysis. The QoL scoring tools included in the statistical analysis are the following: the gastrointestinal quality of life index, 36-items short-form health survey, bariatric analysis and reporting outcome system, and the Moorehead-Ardelt quality of life questionnaire II. Although the QoL score of the LRYGB group was higher than that of the LSG group in the bariatric analysis and reporting outcome system subgroup, statistical analysis showed no difference in the postoperative QoL of LSG and LRYGB. In our study, no difference was found in the QoL between LSG and LRYGB. Therefore, in terms of postoperative QoL, surgical methods should be selected on the basis of the patients’ condition and level of understanding of the surgeries.     

Low-pressure versus standard-pressure pneumoperitoneum for laparoscopic cholecystectomy: a systematic review and meta-analysis

Background

The feasibility and safety of low-pressure pneumoperitoneum in laparoscopic cholecystectomy remain unclear.

Methods

A meta-analysis of randomized controlled trials comparing low-pressure with standard-pressure pneumoperitoneum was performed.

Results

A total of 1,263 patients were included. Low-pressure pneumoperitoneum was associated with significantly decreased postoperative pain. The requirement for increased pressure was significantly greater in the low-pressure group (risk ratio = 6.16; P < .001). Operative time was similar, with only a slight statistical significance (weighted mean difference = 2.07; P < .001). Length of hospital stay was shorter in the low-pressure group (weighted mean difference = −.27; P = .01). No significant differences were found in surgical complications or conversion to open surgery.

Conclusions

Low-pressure pneumoperitoneum is feasible and safe and results in reduced postoperative pain and near-equal operative time compared with standard-pressure pneumoperitoneum. More studies are required to investigate the potential benefits of the reduced length of hospital stay.     

Feasibility and safety of single-incision laparoscopic splenectomy: a systematic review

Objective

The aim of this review was to evaluate the feasibility, safety, and potential benefits of single-incision laparoscopic splenectomy (SILS-Sp).

Methods

We conducted a systemic review of literature between 2009 and 2012 to retrieve all relevant articles.

Results

A total of 29 studies with 105 patients undergoing SILS-Sp were reviewed. Fifteen studies used a commercially available single-port device. The range of body mass index was 14.7–41.4 kg/m². Six studies described combined operations including cholecystectomy (n = 8), mesh-pexy (n = 1), and pericardial devascularizaion (n = 1). The ranges of operative times and estimated blood losses were 28–420 min and 0–350 mL, respectively. Of 105 patients, three patients (2.9%) required additional ports, two patients (1.9%) were converted to open, and three patients (2.9%) to conventional multiport laparoscopic splenectomy (overall conversion rate, 4.8%). Postoperative bleeding occurred in two patients (1.9%) who both required reoperation. Overall mortality was 0% (0/105). The length of postoperative stay varied across reports (1–11 d). Among four comparative studies, one showed greater estimated blood loss and lower numeric pain rating scale score in the SILS-Sp group than in the multiport laparoscopic splenectomy group (206.25 ± 142.45 versus 111.11 ± 99.58 mL) and (3.81 ± 0.91 versus 4.56 ± 1.29), respectively. Another comparative study showed that SILS-Sp was associated with a shorter operative time (92.5 versus 172 min; P = 0.003), lower conversion rate, equivalent length of hospital stay, reduced mortality, similar morbidity, and comparable postoperative narcotic requirements.

Conclusions

In early series of highly selected patients, SILS-Sp appears to be feasible and safe when performed by experienced laparoscopic surgeons. However, as an emerging operation, publication bias is a factor that should be considered before we can draw an objective conclusion.