单孔悬吊腹腔镜手术在妇科良性疾病中的临床应用
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摘要
目的:探讨单孔悬吊腹腔镜手术治疗妇科良性疾病的安全性、可行性、有效性及优越性。方法:回顾分析2015年1月至2017年10月为72例妇科良性疾病患者行单孔悬吊腹腔镜手术的临床资料,包括卵巢囊肿(n=39)、子宫腺肌病(n=16)、子宫内膜病变(n=17)。观察3组患者体重指数、手术时间、手术出血量、术后住院时间、手术并发症。结果:71例成功完成手术。1例子宫腺肌病因合并严重子宫内膜异位症中转开腹。手术时间平均(48.8±14.3)min,其中卵巢囊肿(45.4±16.2)min,子宫腺肌病(51.3±11.5)min,子宫内膜病变(54.6±12.4)min;手术出血量平均(10.3±3.1)mL;术后平均住院(2.7±0.9)d,其中卵巢囊肿(2.2±0.6)d,子宫腺肌病(3.4±1.5)d,子宫内膜病变(3.2±1.1)d。中位随访时间10.8个月,3例出现慢性腹痛,经保守治疗后好转,无其他严重并发症发生。结论:单孔悬吊腹腔镜手术治疗妇科良性疾病是安全、可行、有效的。与常规腹腔镜手术相比,切口瘢痕隐蔽,避免了CO_2气腹对机体的不良影响。
Objective:To investigate the safety,feasibility,effectiveness and superiority of gasless laparoscopic single-site surgery in the treatment of benign gynecological diseases.Methods:Clinical data of 72 patients who suffered from benign gynecological diseases and underwent gasless laparoscopic single-site surgery from Jan.2015 to Oct.2017 were retrospectively analyzed,including ovarian cysts(n=39),uterine adenomyosis(n=16),endometrial lesions(n=17).Body mass index,operative duration,bleeding volume,postoperative hospital stay and surgical complications were recorded.Results:Gasless laparoscopic single-site surgery was successful in 71 cases,while 1 case was converted to open surgery due to adenomyosis with severe endometriosis.The average operation duration was(48.8±14.3)min,ovarian cyst was(45.4±16.2)min,uterine adenomyosis was(51.3±11.5)min,endometrial lesions was(54.6±12.4)min;and the average surgical bleeding volume was(10.3±3.1)mL.The average postoperative hospital stay was(2.7±0.9)d,ovarian cyst was(2.2±0.6)d,uterine adenomyosis was(3.4±1.5)d,endometrial lesions was(3.2±1.1)d.After follow-up of 10.8 months,3 patients underwent chronic abdominal pain and relieved after conservative treatment.There were no other serious complications.Conclusions:The gasless laparoscopic single-site surgery is safe,feasible and effective in the treatment of benign gynecological diseases.Compared with conventional laparoscopic surgery,the gasless laparoscopy avoids adverse effects of CO_2 pneumoperitoneum and its incision scar is invisible.
Objective:To investigate the safety,feasibility,effectiveness and superiority of gasless laparoscopic single-site surgery in the treatment of benign gynecological diseases.Methods:Clinical data of 72 patients who suffered from benign gynecological diseases and underwent gasless laparoscopic single-site surgery from Jan.2015 to Oct.2017 were retrospectively analyzed,including ovarian cysts(n=39),uterine adenomyosis(n=16),endometrial lesions(n=17).Body mass index,operative duration,bleeding volume,postoperative hospital stay and surgical complications were recorded.Results:Gasless laparoscopic single-site surgery was successful in 71 cases,while 1 case was converted to open surgery due to adenomyosis with severe endometriosis.The average operation duration was(48.8±14.3)min,ovarian cyst was(45.4±16.2)min,uterine adenomyosis was(51.3±11.5)min,endometrial lesions was(54.6±12.4)min;and the average surgical bleeding volume was(10.3±3.1)mL.The average postoperative hospital stay was(2.7±0.9)d,ovarian cyst was(2.2±0.6)d,uterine adenomyosis was(3.4±1.5)d,endometrial lesions was(3.2±1.1)d.After follow-up of 10.8 months,3 patients underwent chronic abdominal pain and relieved after conservative treatment.There were no other serious complications.Conclusions:The gasless laparoscopic single-site surgery is safe,feasible and effective in the treatment of benign gynecological diseases.Compared with conventional laparoscopic surgery,the gasless laparoscopy avoids adverse effects of CO_2 pneumoperitoneum and its incision scar is invisible.
引文
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[15] Lee J,Kim S,Nam EJ,et al.Single-port access versus conventional multi-port access total laparoscopic hysterectomy for very large uterus[J].Obstet Gynecol Sci,2015,58(3):239-245.
[2] Krishnamoorthy B,Critchley WR,Nair J,et al.Randomized Study Comparing the Effect of Carbon Dioxide Insufflation on Veins Using 2 Types of Endoscopic and Open Vein Harvesting[J].Innovations (Phila),2017,12(5):320-328.
[3] Bedaiwy MA,Farghaly T,Hurd W,et al.Laparoendoscopic single-site surgery for management of ovarian endometriomas[J].JSLS,2014,18(2):191-196.
[4] Carpinteri S,Sampurno S,Malaterre J,et al.Experimental study of delivery of humidified-warm carbon dioxide during open abdominal surgery[J].Br J Surg,2018,105(5):597-605.
[5] Herrmann A,De Wilde RL.Insufflation with humidified and heated carbon dioxide in short-term laparoscopy:a double-blinded randomized controlled trial[J].Biomed Res Int,2015,2015:412618.
[6] Sandberg EM,la Chapelle CF,van den Tweel MM,et al.Laparoendoscopic single-site surgery versus conventional laparoscopy for hysterectomy:a systematic review and meta-analysis[J].Arch Gynecol Obstet,2017,295(5):1089-1103.
[7] Ye G,Qin Y,Xu S,et al.Comparison of transumbilical single-port laparoscopic cholecystectomy and fourth-port laparoscopic cholecystectomy[J].Int J Clin Exp Med,2015,8(5):7746-7753.
[8] Blaney MW,Calton WC,North JH Jr.The effects of preperitoneal carbon dioxide insufflation on cardiopulmonary function in pigs[J].JSLS,1999,3(1):49-55.
[9] Kim NY,Bai SJ,Kim HI,et al.Effects of long periods of pneumoperitoneum combined with the head-up position on heart rate-corrected QT interval during robotic gastrectomy:an observational study[J].J Int Med Res,2018,46(11):4586-4595.
[10] Al-Badawi IA,AlOmar O,Albadawi N,et al.Single-port laparoscopic surgery for benign salpingo-ovarian pathology:a single-center experience from Saudi Arabia[J].Ann Saudi Med,2016,36(1):64-69.
[11] Escobar PF,Haber GP,Kaouk J,et al.Single-port surgery:laboratory experience with the daVinci single-site platform[J].JSLS,2011,15(2):136-141.
[12] Taylor CT,Cummins EP.Regulation of gene expression by carbon dioxide[J].J Physiol,2011,589(Pt 4):797-803.
[13] Lai H,Mo X,Yang Y,et al.Association between duration of carbon dioxide pneumoperitoneum during laparoscopic abdominal surgery and hepatic injury:a meta-analysis[J].PLoS One,2014,9(8):e104067.
[14] Zhao S,Li W,Cheng F,et al.High-pressure carbon dioxide pneumoperitoneum induces oxidative stress and mitochondria-associated apoptotic pathway in rabbit kidneys with severe hydronephrosis[J].Int J Mol Med,2019,43(1):305-315.
[15] Lee J,Kim S,Nam EJ,et al.Single-port access versus conventional multi-port access total laparoscopic hysterectomy for very large uterus[J].Obstet Gynecol Sci,2015,58(3):239-245.