notes及单孔腹腔镜胆囊切除术

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1、JOURNALOFLAPAROENDOSCOPIC&ADVANCEDSURGICALTECHNIQUESFullReportsVolume22,Number1,2012ªMaryAnnLiebert,Inc.DOI:10.1089/lap.2011.0341AreNaturalOrificeTransluminalEndoscopicSurgeryandSingle-IncisionSurgeryViableTechniquesforCholecystectomy?1,23JamesScottPollard,MBChB,MSc,MRCSEd,AndrewKai-Yi

2、pFung,BMedSci,MBChB,MRCSEd,3,4andIrfanAhmed,FCPS,MD,FRCSAbstractBackground:Naturalorificetransluminalendoscopicsurgery(NOTES)andsingle-incisionsurgery(SIS)arelessinvasivealternativestotraditionallaparoscopictechniques.Concernsexistoverthesafetyofthesenewap-proaches,andrandomizedcontrol

3、ledtrialshaveyettoconfirmanetbenefit.IfNOTESandSIStechniquesaretobecomestandardpractice,thentheyshouldbeshowntobesafeandholdclearbenefitstopatients.Weaimatcomparingtheavailableresultsbyusingthesetechniquesinastandardlaparoscopicoperation(cholecystectomy).Methods:Asystematicreviewusingava

4、ilabledatabases(MEDLINE,EMBASE,andtheCochraneControlledTrialsRegister)andthepublishedEnglishlanguagemedicalliteraturewasperformed.Allthearchivedarticleswerecross-referenced.OutcomedataobtainedfromaCochranereviewoflaparoscopiccholecystectomywereusedasthecontrolgroup.Alltheoperationsper

5、formedviaasingleincisionweregroupedunderSIS,andoperationsinwhichanaturalorifice(aloneorasahybridtechnique)wasanalyzed,underNOTESgroup.Mortalityandcomplicationsweretheprimaryoutcomemeasures.Results:Onehundredthirty-fivepapersincluding4703patients(714NOTES,3989SIS)wereselectedforanalysis.

6、Overallcomplicationratewas4.2%intheNOTESgroupversus4.3%intheSISgroup,withadistinctcomplicationprofile.Nomortalitywasreportedineithergroup.NOTESprocedureshadalongermeanoper-ativetimethanSIStechniques(107versus79minutes).TheconversionratebetweenNOTESandSILSwassimilar(3.4%versus3.3%,respe

7、ctively).Discussion:Nodifferenceintheincidenceofcomplicationswasobservedwiththenewertechniques.Ade-quatelypoweredrandomizedcontroltrialsareneededtoclarifywhetherSIS/NOTEScholecystectomyhasasimilarlengthofhospitalstaytotraditionallaparoscopiccholecystectomy.Theincreasedoccurrenceofspec

8、ificty