经脐单孔腹腔镜在子宫肌瘤剔除术中的应用研究

Clinical application of transumblical single-port laparoendoscopy in hysteromyomectomy

关键词:  经脐单孔腹腔镜  妇科手术  子宫肌瘤

Key words:  transumblical single-port laparoendoscopic  gynecologic operation  hysteromyoma

摘要:

目的　探讨经脐单孔腹腔镜技术在子宫肌瘤剔除手术中应用的安全可行性。方法　收集2017年1月至12月大连市妇幼保健院收治的经由同一术者施术的腹腔镜下子宫肌瘤剔除术患者60例的临床资料，分为单孔腹腔镜组（单孔组）和多孔腹腔镜组（多孔组），各30例。比较两组手术时间、术中出血量、术后血红蛋白下降幅度、术后住院时间、术后病率（术后24 h至术后5天有连续2天体温≥38 ℃）、术后并发症、术后24 h VAS评分、体象量表BIS评分、切口美观满意度CS评分等指标。结果　60例均成功完成手术，无改变手术方式。单孔组与多孔组手术时间［(89.00±14.04）vs.（55.23±15.47）min］比较差异有统计学意义（P＜0.05）。单孔组与多孔组术中出血量［(44.00±8.21）vs.（40.00±6.32）mL］、术后Hb下降幅度［(11.13±3.89）vs.（9.33±2.41）g/L］、术后住院时间［(4.40±0.74）vs.（4.87±0.64）d］、术后病率比较差异均无统计学意义（P＞0.05）。单孔组与多孔组术后24 h VAS评分［(5.03±0.39）vs.（5.90±0.61）］、BIS评分［(5.07±0.26）vs.（5.87±0.74）］、CS评分［(40.27±1.28）vs.（36.47±2.07）］比较，差异有统计学意义（P＜0.05）。两组患者术后均无切口出血、感染、切口疝、黏连性肠梗阻等并发症，单孔组1例切口延期愈合。结论　经脐单孔腹腔镜技术在子宫肌瘤剔除术中应用是可行的，并具有和常规多孔腹腔镜一样的效果与安全性，比多孔腹腔镜更美观并迎合女性患者爱美的需求。

Abstract:

Objective To explore the safety and feasibility of transumblical single-port laparoendoscopy in hysteromyomectomy. Methods Clinical data of 60 patients, who underwent laparoendoscopic myomectony by the same operator in Dalian Maternal and Child Care Service Hospital from January to December 2017, were collected. The patients were divided into two groups: 30 patients with single-port laparoendoscopy (single-port group) and 30 patients with multi-ports laparoendoscopy (multi-ports group). The indicators of both groups were analyzed and compared, including operation time, intraoperative bleeding, hemoglobin change, postoperative hospitalization, postoperative morbidity, postoperative complications, postoperative pain score, body image scale and cosmetic score, etc. Results All procedures were performed successfully in both groups without conversion to open surgery. No significant differences（P＞0.05）werr observed in intraoperative blood loss ［(44.00±8.21）vs.（40.00±6.32）mL］, hemoglobin change ［(11.13±3.89）vs.（9.33±2.41）g/L］, postoperative hospitalization ［(4.40±0.74）vs.（4.87±0.64）d］, and postoperative morbidity between the single-port group and the multi-ports group. The operation time was ［(89.00±14.04）vs.（55.23±15.47）min］, postoperative pain score ［(5.03±0.39）vs.（5.90±0.61）］, body image scale ［(5.07±0.26）vs.（5.87±0.74）］, cosmetic score ［(40.27±1.28）vs.（36.47±2.07）］, these clinical parameters were statistical different (all P<0.05). None of the groups showed postoperative morbidity. No patient had postoperative complications except one’s incision was healed late. Conclusions Transumblical single-port laparoendoscopic myomectomy is feasible and has the same safety and therapeutic effectiveness as the conventional laparoendoscopy. The postprocedural appearance is more beautiful than multi-ports laparoendoscopy and caters to the beauty needs of women.