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1、1. 文章来源：THE LANCET. Vol. 351. January 17, 1998Department of Surgery, Gastrointestinal Unit, Norfolk and Norwich NHS Trust Hospital, Norwich NR1 3SR, UK (M Rhodes FRCS, L Sussman FRCS, L Cohen FRCS, M P Lewis FRCS)Randomised trial of laparoscopic exploration of common bile duct versus postoperative e
2、ndoscopic retrograde cholangiography for common bile duct stones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: The management of stones in the common bile duct in the laparoscopic era is controversial. The three major options are preoperative endoscopic retrograde cholangiography (ERCP), lap
3、aroscopic exploration of the common bile duct (LECBD), or postoperative ERCP.（注意时态）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: Between August, 1995, and August, 1997, 471 laparoscopic cholecystectomies were done in our department. In 427 (91%), satisfactory
4、preoperative cholangiography was obtained. In 80 (17%) of these cases there were stones in the common bile duct. 40 patients were randomised to LECBD and 40 to postoperative ERCP. If LECBD failed, patients had either open exploration of the common bile duct or postoperative ERCP. If one postoperativ
5、e ERCP failed, the procedure was repeated until the common bile duct was cleared of stones or an endoprosthesis was placed to prevent stone impaction. The primary endpoints were duct-clearance rates, morbidity, operating time, and hospital stay. Analyses were by intention to treat.方法：1995年8月至1997年8月
6、，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: Age and sex distribution of patients was similar in the randomised groups
7、. Duct clearance after the first intervention was 75% in both groups. By the end of treatment, duct clearance was 100% in the laparoscopic group compared with 93% in the ERCP group. Duration of treatment was a median of 90 min (range 25310) in the laparoscopic group (including ERCPs for failed LECBD
8、) compared with 105 min (range 60255) in the postoperative ERCP group (p=0.1, 95% CI for difference -5 to 40). Hospital stay was a median of 1 day (range 126) in the laparoscopic group compared with 3.5 days (range 111) in the ERCP group (p=0.0001, 95% CI 12). 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%。
9、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: LECBD is as effective as ERCP in clearing the common bile duct of stones. There is a non-significant tr
10、end to shorter time in the operating theatre and a significantly shorter hospital stay in patients treated by LECBD.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：Lancet 2005; 365: 171826Pierre J Guillou, Philip Quirke, Helen Thorpe, Joanne Walker, David G Jayne,
11、Adrian MH Smith, Richard M Heath, Julia M Brown, for the MRC CLASICC trial groupShort-term endpoints of conventional versus laparoscopic assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial常规与腹腔镜手术治疗大肠癌患者的短期疗效（MRC CLASICC试验）：多中心随机对照试验Summa
12、ry摘要Background: Laparoscopic-assisted surgery for colorectal cancer has been widely adopted without data from large-scale randomised trials to support its use. We compared short-term endpoints of conventional versus laparoscopic assisted surgery in patients with colorectal cancer to predict long-ter
13、m outcomes.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。（注意时态）Methods: Between July, 1996, and July, 2002, we undertook a multicentre, randomised clinical trial in 794 patients with colorectal cancer from 27 UK centres. Patients were allocated to receive laparoscopic-assi
14、sted (n=526) or open surgery (n=268). Primary short-term endpoints were positivity rates of circumferential and longitudinal resection margins, proportion of Dukes C2 tumours, and in-hospital mortality. Analysis was by intention to treat. This trial has been assigned the International Standard Rando
15、mised Controlled Trial Number ISRCTN74883561.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）、Dukes C2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: Six patients (two open, four laparoscopic) had no surgery,
16、 and 23 had missing surgical data (nine, 14). 253 and 484 patients actually received open and laparoscopic-assisted treatment, respectively. 143 (29%) patients underwent conversion from laparoscopic to open surgery. Proportion of DukesC2 tumours did not differ between treatments (18 7% patients, open vs. 34 6%, laparoscopic; difference 0.3%, 95% CI 3.9 to 3.4%, p=0.89), and neither did in-hospital mortality (13 5
