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1.文章来源：THELANCET.Vol.351.January17,1998DepartmentofSurgery,GastrointestinalUnit,NorfolkandNorwichNHSTrustHospital,NorwichNR13SR,UK(MRhodesFRCS,LSussmanFRCS,LCohenFRCS,MPLewisFRCS)Randomisedtrialoflaparoscopicexplorationofcommonbileductversuspostoperativeendoscopicretrogradecholangiographyforcommonbileductstones胆总管腹腔镜探查术与术后内镜逆行胆管造影治疗胆总管结石的随机比较试验Summary摘要Background:Themanagementofstonesinthecommonbileductinthelaparoscopiceraiscontroversial.Thethreemajoroptionsarepreoperativeendoscopicretrogradecholangiography(ERCP),laparoscopicexplorationofthecommonbileduct(LECBD),orpostoperativeERCP.背景：在腹腔镜时代，处理胆总管结石是有争议的。三种主要选择是：术前内镜逆行胆管造影（ERCP），腹腔镜胆总管探查术（LECBD）,或术后内镜逆行胆管造影。Methods:BetweenAugust,1995,andAugust,1997,471laparoscopiccholecystectomiesweredoneinourdepartment.In427(91%),satisfactorypreoperativecholangiographywasobtained.In80(17%)ofthesecasestherewerestonesinthecommonbileduct.40patientswererandomisedtoLECBDand40topostoperativeERCP.IfLECBDfailed,patientshadeitheropenexplorationofthecommonbileductorpostoperativeERCP.IfonepostoperativeERCPfailed,theprocedurewasrepeateduntilthecommonbileductwasclearedofstonesoranendoprosthesiswasplacedtopreventstoneimpaction.Theprimaryendpointswereduct-clearancerates,morbidity,operatingtime,andhospitalstay.Analyseswerebyintentiontotreat.方法：1995年8月至1997年8月，471患者行腹腔镜胆囊切除术。其中427例（91%）获得满意的术前胆管造影结果。80例（17%）存在胆总管结石。40名患者随机进行了腹腔镜胆总管探查术，40名患者随机进行了术后内镜逆行胆管造影。若腹腔镜胆总管探查术失败，患者可行开腹探查胆总管或术后内镜逆行胆管造影。如一次术后内镜逆行胆管造影不行，可行多次直至清除胆总管结石或者放置内镜置管防止结石嵌顿。主要检测指标为，胆道清除率、发病率、手术时间和住院时间。统计学采用意向性分析。Findings:Ageandsexdistributionofpatientswassimilarintherandomisedgroups.Ductclearanceafterthefirstinterventionwas75%inbothgroups.Bytheendoftreatment,ductclearancewas100%inthelaparoscopicgroupcomparedwith93%intheERCPgroup.Durationoftreatmentwasamedianof90min(range25–310)inthelaparoscopicgroup(includingERCPsforfailedLECBD)comparedwith105min(range60–255)inthepostoperativeERCPgroup(p=0.1,95%CIfordifference-5to40).Hospitalstaywasamedianof1day(range1–26)inthelaparoscopicgroupcomparedwith3.5days(range1–11)intheERCPgroup(p=0.0001,95%CI1–2).发现（结果）：随机分组中年龄和性别分配相同。两组中首次术后胆道清除率达75%。治疗结束时，腹腔镜组胆道清除率达到100%，ERCP组也达到了93%。腹腔镜组中位治疗时间（包括腹腔镜胆总管探查术失败后行内镜逆行胆管造影）为90分钟（范围25-310），而术后胆管造影组为105分钟（p=0.1,95%可信区间差异-5至40）。腹腔镜手术组中位住院时间为1天（范围1-26），胆管造影组为3.5天（p=0.0001，95%可信区间差异1-2）。Interpretation:LECBDisaseffectiveasERCPinclearingthecommonbileductofstones.Thereisanon-significanttrendtoshortertimeintheoperatingtheatreandasignificantlyshorterhospitalstayinpatientstreatedbyLECBD.解释（结论）：在清除胆总管结石方面，腹腔镜胆总管探查术和内镜逆行胆管造影效果相同。腹腔镜胆总管探查术，手术时间不明显缩短，但住院时间明显缩短。（梁平修订）2．文章来源：Lancet2005;365:1718–26PierreJGuillou,PhilipQuirke,HelenThorpe,JoanneWalker,DavidGJayne,AdrianMHSmith,RichardMHeath,JuliaMBrown,fortheMRCCLASICCtrialgroupShort-termendpointsofconventionalversuslaparoscopicassistedsurgeryinpatientswithcolorectalcancer(MRCCLASICCtrial):multicentre,randomisedcontrolledtrial常规与腹腔镜手术治疗大肠癌患者的短期疗效（MRCCLASICC试验）：多中心随机对照试验Summary摘要Background:Laparoscopic-assistedsurgeryforcolorectalcancerhasbeenwidelyadoptedwithoutdatafromlarge-scalerandomisedtrialstosupportitsuse.Wecomparedshort-termendpointsofconventionalversuslaparoscopicassistedsurgeryinpatientswithcolorectalcancertopredictlong-termoutcomes.背景：腹腔镜辅助大肠癌手术已经被广泛应用，但缺乏大规模随机试验的数据支持。我们比较常规与腹腔镜辅助手术治疗大肠癌患者的短期效果以预测其长期的结果。Methods:BetweenJuly,1996,andJuly,2002,weundertookamulticentre,randomisedclinicaltrialin794patientswithcolorectalcancerfrom27UKcentres.Patientswereallocatedtoreceivelaparoscopic-assisted(n=526)oropensurgery(n=268).Primaryshort-termendpointswerepositivityratesofcircumferentialandlongitudinalresectionmargins,proportionofDukes‘C2tumours,andin-hospitalmortality.Analysiswasbyintentiontotreat.ThistrialhasbeenassignedtheInternationalStandardRandomisedControlledTrialNumberISRCTN74883561.方法：1996年7月至2002年7月，我们在来自英国27个医疗中心的794名大肠癌患者中进行了多中心随机临床实验。患者或分配实施腹腔镜手术（n=526）或分配实施开放手术（n=268）。主要短期疗效指标为，周围及纵向切除的阳性率（周围转移及蔓延率）、DukesC2期肿瘤比例和院内死亡率。统计学采用意向性分析。本试验为国际标准随机对照试验编号ISRCTN74883561。Findings:Sixpatients(two[open],four[laparoscopic])hadnosurgery,and23hadmissingsurgicaldata(nine,14).253and484patientsactuallyreceivedopenandlaparoscopic-assistedtreatment,respectively.143(29%)patientsunderwentconversionfromlaparoscopictoopensurgery.ProportionofDukes’C2tumoursdidnotdifferbetweentreatments(18[7%]patients,openvs.34[6%],laparoscopic;difference–0.3%,95%CI–3.9to3.4%,p=0.89),andneitherdidin-hospitalmortality(13[5%]vs.21[4%];–0.9%,–3.9to2.2%,p=0.57).Apartfrompatientsundergoinglaparoscopicanteriorresectionforrectalcancer,ratesofpositiveresectionmarginsweresimilarbetweentreatmentgroups.Patientswithconvertedtreatmenthadraisedcomplicationrates.结果：六名患者（开放手术组2名，腹腔镜手术组4名）没有进行手术，23名患者手术数据丢失（开放手术组9名，腹腔镜手术组14名）。253名和484名患者分别接受了开放手术和腹腔镜辅助手术。143名患者（29%）由腹腔镜手术转为开腹手术。两种治疗的Duckes’C2期肿瘤患者没有显著性差异（18例[7%]开腹，34例[6%]腹腔镜，差异-0.3%，95%可信区间-3.9至3.4%，p=0.89），两种治疗的住院死亡率也没有显著性差异（13例[5%]开腹，21例[4%]腹腔镜，差异-0.9%，95%可信区间-3.9至2.2%，p=0.57）。除了接受前入路腹腔镜切除直肠的病例，两种治疗组的切除阳性率基本相同。转换治疗方法的患者并发症发生率较高。Interpretation:Laparoscopic-assistedsurgeryforcancerofthecolonisaseffectiveasopensurgeryintheshort