单孔腹腔镜手术治疗妇科良性病变的疗效和安全性研究
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摘要
目的探讨单孔腹腔镜手术治疗妇科良性病变的近远期疗效。方法采用前瞻性研究方法,对在我院2017年3月至2018年4月诊治的妇科良性病变134例,其中附件切除术34例,卵巢剔除术34例,子宫肌瘤剔除术22例,全子宫切除44例,在脐中央做一长约3 cm的切口,置入自制手套做出的穿刺套管(Triport装置),穿刺套管的3孔道可同时插入探头和需操作的手术器械,行单孔腹腔镜手术。同时将2016年3月至2017年4月传统腹腔镜手术治疗的妇科良性病变80例为传统组,其中附件切除术12例,卵巢剔除术24例,子宫肌瘤剔除术20例,全子宫切除24例,对比2组的近期疗效指标包括手术时间、术中出血量、排气时间、术后首次下床活动时间等,以及并发症指标包括切口感染、切口疝、腹胀、恶心呕吐等。结果单孔腹腔镜组的手术时间为(61±10)min,长于传统组,而排气时间为(37±5)h,明显短于传统组,差异具有统计学意义(P<0.05),但单孔组术中出血量为(31.5±7.1)mL,共8例出现术后并发症,发生率为6.0%,切口疼痛、术后镇痛率和疼痛评分与传统组比较差异均无统计学意义(P>0.05)。结论单孔腹腔镜术治疗妇科良性疾病,虽延长了手术时间,但缩短了胃肠功能恢复时间,且不增加术后并发症发生率,具有创伤低、恢复快、安全性高和美容效果佳等优点。
Objective To explore the efficacy and safety of single-port laparoscopic surgery on gynecological benign diseases. Methods A prospective study was conducted on 134 cases of benign gynecological lesions diagnosed and treated in our hospital from March 2017 to April 2018. These included 34 cases of adnexectomy, 34 cases of ovarian cystectomy, 22 cases of hysteromyomectomy, and 44 cases of total hysterectomy. In all these cases, a 3-cm incision was made in the center of the umbilicus, and a Triport device made of homemade gloves was inserted. The endoscopic probe and the surgical instrument could be simultaneously inserted into the three holes of the puncture cannula, so as to facilitate single-port laparoscopic surgery. Meanwhile, 80 cases of gynecological benign lesions treated by traditional laparoscopic surgery from March 2016 to April 2017 were included in the traditional group.These included 12 cases of adnexectomy, 24 cases of ovarian cystectomy, 20 cases of hysteromyomectomy, and 24 cases of total hysterectomy. In this study, short-term efficacy indexes and complication indexes of the two groups were compared. Short-term efficacy indexes included operation time, intraoperative blood loss, exhaust time, postoperative first time to get out of bed, etc. Complication indexes included incision infection, incision hernia, abdominal disten-sion, nausea, vomiting, etc. Results The operation time of single-port laparoscopic group was(61 ±10) min, which was longer than that of the traditional group, and the exhaust time was(37 ±5) h, obviously shorter than that of traditional group(P<0.05), but the bleeding amount in single-port group was(31.5±7.1)mL, and a total of 8 cases had postoperative complications, the incidence was 5.97%. Compared with the traditional group, there was no significance dif-ferences for the rate of incision pain, postoperative analgesia and pain scores(P>0.05). Conclusion In the treatment of gynecological benign diseases with single-port laparoscopy, although the operation time is prolonged, the recovery time of gastrointestinal function is shortened and the incidence of postoperative complications is not increased.
Objective To explore the efficacy and safety of single-port laparoscopic surgery on gynecological benign diseases. Methods A prospective study was conducted on 134 cases of benign gynecological lesions diagnosed and treated in our hospital from March 2017 to April 2018. These included 34 cases of adnexectomy, 34 cases of ovarian cystectomy, 22 cases of hysteromyomectomy, and 44 cases of total hysterectomy. In all these cases, a 3-cm incision was made in the center of the umbilicus, and a Triport device made of homemade gloves was inserted. The endoscopic probe and the surgical instrument could be simultaneously inserted into the three holes of the puncture cannula, so as to facilitate single-port laparoscopic surgery. Meanwhile, 80 cases of gynecological benign lesions treated by traditional laparoscopic surgery from March 2016 to April 2017 were included in the traditional group.These included 12 cases of adnexectomy, 24 cases of ovarian cystectomy, 20 cases of hysteromyomectomy, and 24 cases of total hysterectomy. In this study, short-term efficacy indexes and complication indexes of the two groups were compared. Short-term efficacy indexes included operation time, intraoperative blood loss, exhaust time, postoperative first time to get out of bed, etc. Complication indexes included incision infection, incision hernia, abdominal disten-sion, nausea, vomiting, etc. Results The operation time of single-port laparoscopic group was(61 ±10) min, which was longer than that of the traditional group, and the exhaust time was(37 ±5) h, obviously shorter than that of traditional group(P<0.05), but the bleeding amount in single-port group was(31.5±7.1)mL, and a total of 8 cases had postoperative complications, the incidence was 5.97%. Compared with the traditional group, there was no significance dif-ferences for the rate of incision pain, postoperative analgesia and pain scores(P>0.05). Conclusion In the treatment of gynecological benign diseases with single-port laparoscopy, although the operation time is prolonged, the recovery time of gastrointestinal function is shortened and the incidence of postoperative complications is not increased.
引文
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[10]国晓梅,曹亚琼,周丽,等.经脐单孔腹腔镜妇科手术32例[J/CD].中华腔镜外科杂志(电子版),2012,5(2):115-117.
[11]Schmitt A,Crochet P,Knight S,et al.Single port laparoscopy versus conventional laparoscopy in benign adnexal diseases:a systematic review and Meta-analysis[J].J Minim Invasive Gynecol,2017,24(7):1083-1095.
[2]龚瑶,周容,代雪林,等.自制入路通道单孔腹腔镜手术治疗妇科良性疾病60例临床分析[J].中国实用妇科与产科杂志,2019,35(3):330-333.
[3]黄琳娟,代雪林,唐均英,等.“三位一体”认识和处理单孔腹腔镜的“筷子效应”[J].医学与哲学,2018,39(9B):76-77.
[4]殷丽丽,杨清,王光伟.单孔腹腔镜乙状结肠代阴道成形术治疗先天性无阴道的临床效果分析[J].中国医科大学学报,2016,45(5):467-469.
[5]王延洲,陈功立,徐嘉莉,等.单孔腹腔镜广泛子宫切除盆腔淋巴结清扫治疗宫颈癌:一项单中心的初步研究[J].第三军医大学学报,2017,39(13):1392-1395.
[6]Chen X,Liu HY,Sun DW,et al.Transvaginal natural orifice transluminal endoscopic surgery for tubal pregnancy and a device innovation from our institution[J].J Minim Invas Gynecol,2019,26(1):169-174.
[7]李莉芳,黄浩,张秀清,等.经脐单孔腹腔镜卵巢囊肿剥除术1例报告[J].中国微创外科杂志,2011,11(3):280-281.
[8]高树生,罗岳西,何元芬,等.经脐单孔腹腔镜异位妊娠输卵管切除术[J].川北医学院学报,2008,23(4):353-354.
[9]王彩芳,高树生,刘艳香,等.经脐单孔腹腔镜卵巢囊肿剔除缝合修补术1例[J].中国微创外科杂志,2012,12(1):93-94.
[10]国晓梅,曹亚琼,周丽,等.经脐单孔腹腔镜妇科手术32例[J/CD].中华腔镜外科杂志(电子版),2012,5(2):115-117.
[11]Schmitt A,Crochet P,Knight S,et al.Single port laparoscopy versus conventional laparoscopy in benign adnexal diseases:a systematic review and Meta-analysis[J].J Minim Invasive Gynecol,2017,24(7):1083-1095.