悬吊式腹腔镜辅助治疗巨大卵巢囊肿

Gasless Laparoscopy for Giant Ovarian Cyst

目的探讨悬吊式腹腔镜辅助手术在巨大卵巢囊肿治疗中的临床应用价值。方法 2006年1月～2009年12月对89例巨大卵巢囊肿(囊肿直径≥10 cm)分别采用悬吊式腹腔镜、气腹腹腔镜、开腹手术3种不同方式进行治疗,比较3种术式在手术时间、术中出血量、术后排气时间、术后疼痛、皮下气肿及血肿发生率、住院时间等方面的差异,术后随访3个月观察月经情况。结果 3组手术时间、术中出血量、术后疼痛、排气时间、住院时间均有显著性差异(P<0.05)。3组术中并发症及皮下气肿、血肿发生率无明显差异(P>0.05)。悬吊组手术时间(38.4±10.5)min显著短于气腹组(110.5±12.2)min(q=30.758,P<0.05)和开腹组手术时间(65.3±14.6)min(q=11.566,P<0.05);悬吊组术中出血量(40.3±12.8)ml明显少于气腹组(150.8±30.2)ml(q=26.598,P<0.05)及开腹组(95.7±20.1)ml(q=13.440,P<0.05);悬吊组术后排气时间(14.4±4.3)h明显短于气腹组(24.9±5.9)h(q=10.157,P<0.05)及开腹组(50.8±6.2)h(q=35.490,P<0.05);悬吊组住院时间(3.2±0.8)d明显少于开腹组(6.7±0.7)d(q=18.681,P<0.05)。悬吊组肩胛疼痛2例(7.1%),明显少于气腹组10例(33.3%)(χ2=6.054,P=0.014);悬吊组皮下气肿发生率0,明显低于气腹组6例(20.0%)(Fisher’s检验,P=0.015);悬吊组术后腹壁疼痛5例(17.8%),明显低于开腹组26例(83.9%)(χ2=25.711,P=0.000)。术后3个月气腹组月经异常发生率为13.4%(4/30),悬吊组及开腹组分别为3.6%(1/28)和6.4%(2/31)3,组比较无显著性差异(χ2=2.036,P=0.361)。结论悬吊式腹腔镜辅助治疗巨大卵巢囊肿优于气腹腹腔镜手术和传统开腹手术。

Objective To access gasless laparoscopic operation for large ovarian cysts. Methods From January 2006 to December 2009, 89 patients with giant ovarian cyst （≥ 10 cm in diameter） received gasless laparoscopy, pneumoperitoneum laparoscopy, or open surgery respective in our hospital. The operation time, intraoperative blood loss, postoperative gastrointestinal function recovery time, rate of postoperative pain, and hospital stay were compared among the three groups. The patients were followed up for three months to observe menstruation. Results Significant difference existed in the operation time, intraoperative blood loss, postoperative pain, gastrointestinal function recovery time, and hospital stay （ P 〈 0. 05 ） among the three groups, but not in the rates of subcutaneous emphysema and hematoma （P 〉 0.05 ）, The gasless group showed significantly shorter operation time, less intraoperativeblood loss, and shorter gastrointestinal function recovery time than both the pneumoperitoneum and open groups [ （38.4±10.5 ） min vs. （110.5±12.2） min （q=30.758, P〈0.05） and （65.3±14.6） min （q-11.566, P〈0.05）; （40.3±12.8） mlvs. （150.8±30.2） ml （q=26.598, P〈0.05） and （95.7±20.1） ml （q=13.440, P〈0.05）; （14.4±4.3） h vs. （24.9±5.9） h （q= 10.157, P〈0.05） and （50.8±6.2）h （q=35.490, P〈0.05）]; shorter hospital stay than the open group [（3.2±0.8） d vs.（6.7±0.7 ） d, q = 18. 681, P 〈 0.05 ） ] ; lower rates of shoulder pain and subcutaneous emphysema then the pneumoperitoneum group [2cases （7.1%） vs. lOcases （33.3%）,X^2 =6.054, P=0.014）;0vs. 6 cases （20.0%）, Fisher＇stestP=0.015]; and lower rate of abdominal pain than the open group [ 5 cases （17.8%） vs. 26 cases （83.9%）, X2 = 25. 711, P = 0. 000 ]. The rate ofabnormal menstruation in three months was 13.4% （4/30）, 3.6% （ 1/28）, and 6.4% （2/31） in pneumoperitoneum, gasless, and open groups respectively （X2 = 2. 036, P = 0. 361 ）. Conclusion Gasless laparoscopic operation is superior to pneumoperitoneum laparoscopy and open surgery in the treatment of large ovarian cysts.