大字形体位在经大腿皮下间隙腔镜下行腹股沟淋巴结清扫手术中的应用体会
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摘要
目的研究大字形体位在经大腿皮下间隙腔镜下行腹股沟淋巴结清扫手术中的应用效果。方法选取2010年7月~2018年3月本院收治的外阴癌患者16例,根据手术体位不同分为研究组(n=8)与对照组(n=8)。两组均行经大腿皮下间隙腔镜下腹股沟淋巴结清扫手术及广泛外阴切除术治疗,对照组腹股沟淋巴结清扫手术过程中采取改良膀胱截石位,研究组腹股沟淋巴结清扫手术过程中采取大字型体位,两组广泛外阴切除术过程中均采取膀胱截石位。对比两组手术时间、引流管放置时间、住院时间、手术医师对手术操作空间满意度及术后并发症发生情况。结果研究组术后引流管放置时间、住院时间较对照组短,差异有统计学意义(P<0.05);研究组术后并发症总发生率12.50%(1/8)较对照组37.50%(3/8)低,但差异无统计学意义;手术医师对研究组手术操作空间满意度为100.00%(8/8),高于对照组75.00%(6/8),但差异无统计学意义。结论经大腿皮下间隙腔镜下行腹股沟淋巴结清扫手术治疗外阴癌患者时采用大字形体位,能有效缩短引流管放置及住院时间,且有利于降低术后并发症发生率,提高手术医师对手术操作空间满意度。
Objective To investigate the application effect of spread-eagled position in lymphoglandulae inguinales dissection under subcutaneous interval laparoscopy via the thighs. Methods From July 2010 to March 2018, 16 patients with carcinoma of vulva admitted to our hospital were divided into study group(n=8) and control group(n=8) according to their operative position. The two groups were treated with lymphoglandulae inguinales dissection under subcutaneous interval laparoscopy via the thighs and general radical vulvectomy. The control group underwent modified bladder lithotomy position during the operation, while the study group underwent spread-eagled position during lymphoglandulae inguinales dissection and modified bladder lithotomy position during general radical vulvectomy. The operative time, placement time of drainage tube, hospital stay,operative satisfaction of the surgeon to the operation space and postoperative complications were compared between the two groups. Results The postoperative placement time of drainage tube and hospitalization time in the study group were shorter than those in the control group, and the difference was statistically significant(P<0.05). The total incidence of postoperative complications in the study group was [12.50%(1/8)], which was lower than that in the control group [37.50%(3/8)], but the difference was not statistically significant. The satisfaction degree of surgeons to the operative space of the study group was 100.00%(8/8), which was higher than that of the control group [75.00%(6/8)], but the difference was not statistically significant. Conclusion Spread-eagled position in lymphoglandulae inguinales dissection under subcutaneous interval laparoscopy via the thighs in the treatment of carcinoma of vulva can effectively shorten the placement time of drainage tube and hospitalization time. It is also helpful for reducing the incidence of postoperative complications and improving surgeon's satisfaction with surgical operation space.
Objective To investigate the application effect of spread-eagled position in lymphoglandulae inguinales dissection under subcutaneous interval laparoscopy via the thighs. Methods From July 2010 to March 2018, 16 patients with carcinoma of vulva admitted to our hospital were divided into study group(n=8) and control group(n=8) according to their operative position. The two groups were treated with lymphoglandulae inguinales dissection under subcutaneous interval laparoscopy via the thighs and general radical vulvectomy. The control group underwent modified bladder lithotomy position during the operation, while the study group underwent spread-eagled position during lymphoglandulae inguinales dissection and modified bladder lithotomy position during general radical vulvectomy. The operative time, placement time of drainage tube, hospital stay,operative satisfaction of the surgeon to the operation space and postoperative complications were compared between the two groups. Results The postoperative placement time of drainage tube and hospitalization time in the study group were shorter than those in the control group, and the difference was statistically significant(P<0.05). The total incidence of postoperative complications in the study group was [12.50%(1/8)], which was lower than that in the control group [37.50%(3/8)], but the difference was not statistically significant. The satisfaction degree of surgeons to the operative space of the study group was 100.00%(8/8), which was higher than that of the control group [75.00%(6/8)], but the difference was not statistically significant. Conclusion Spread-eagled position in lymphoglandulae inguinales dissection under subcutaneous interval laparoscopy via the thighs in the treatment of carcinoma of vulva can effectively shorten the placement time of drainage tube and hospitalization time. It is also helpful for reducing the incidence of postoperative complications and improving surgeon's satisfaction with surgical operation space.
引文
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[7]王宇,李胜云,孙立群,等.改进头低足高“人字形”截石位在老年妇科腹腔镜手术中的效果观察[J].中国实用护理杂志,2017,33(21):1622-1626.
[8]苏婷,梁卫学.自制截石位托架在调强放疗中的应用[J].影像研究与医学应用,2017,1(9):246-247.
[2]张豪锋,张军,贺建业.腔镜辅助小切口腹股沟淋巴结切除术治疗外阴癌[J].中国微创外科杂志,2017,17(3):220-223.
[3]夏丽霞,陈红,赵体玉.弹力绷带预防腔镜膀胱截石位手术患者下肢深静脉血栓[J].护理学杂志,2015,30(10):50-51.
[4]刘宇笛,杨英捷.外阴癌诊治进展[J].当代医学,2018,24(3):176-179.
[5]陈高文,王颖,彭冬先,等.经下肢皮下通路的腹腔镜腹股沟淋巴结切除术在外阴癌治疗中的应用[J].实用妇产科杂志,2016,32(6):431-435.
[6]吴强,赵一兵,孙志华,等.三切口侧入法腔镜下腹股沟淋巴结清扫术的可行性研究(附23例报告)[J].腹腔镜外科杂志,2015,20(12):916-920.
[7]王宇,李胜云,孙立群,等.改进头低足高“人字形”截石位在老年妇科腹腔镜手术中的效果观察[J].中国实用护理杂志,2017,33(21):1622-1626.
[8]苏婷,梁卫学.自制截石位托架在调强放疗中的应用[J].影像研究与医学应用,2017,1(9):246-247.