改良套管在单孔辅助下阴式子宫切除术中的应用

The application of improved trocar on transumbilical single port laparoscopic-assisted vaginal hysterectomy

目的探讨改良套管用于单孔腹腔镜辅助下阴式子宫切除术的应用价值及学习曲线。方法回顾分析广东省东莞市妇幼保健院2011年3月～2012年10月利用改良套管完成的单孔腹腔镜辅助下阴式子宫切除手术30例，观察其手术时间、术中失血量、术后肛门恢复排气时间，术中、术后并发症等情况。将单孔腹腔镜组患者按照手术先后顺序分为2组（A组、B组），对比其手术时间，并将手术顺序与手术时间绘制成散点图，计算二者的spearman等级相关系数，评估二者有无相关性，探讨学习曲线。结果所有手术均获得成功，无一例中为传统腹腔镜手术或开腹手术，无术中、术后并发症。前15例所用时间[（94．58±28．08）min]长于后15例[（70．02±25．14）min]，差异有统计学意义（P〈0．05）。Spearman等级相关非参数检验显示，手术顺序与手术时间呈负相关（r8=-0．540，P〈0．05），随着手术经验的积累，手术时间相应缩短。术后随访4～12个月，所有患者腹壁切口恢复好，无切口感染、出血及切口疝发生，腹壁基本无瘢痕，达到完美的美容效果。结论改良穿刺套管可以改善单孔腹腔镜手术器械拥挤打架现象，降低了单孔腹腔镜手术的操作难度。单孔腹腔镜辅助下阴式子宫切除术尚处于起步阶段，手术有一定的难度，手术时间延长是可以接受的，随着手术量的积累可以缩短手术时间。因此单孔腹腔镜下阴式手术在妇科子宫良性疾病中是可以学习和推广的，具有一定的应用前景。

Objective To discuss the value and learning curve of improved trocar used in single-port laparoscopic assisted vaginal hysterectomy. Methods The clinical data of 30 cases of Obsteric and Gynecolog Department of Dongguan Maternity and Child Healthcare Hospital in Guangdong Province with transumbilical single-port laparoscopic assisted vaginal totally hysterectomy from March 2011 to October 2012 were retrospective analyzed. The operation time, intraoperative blood loss, postoperative anal recovery exhaust time, intraoperative and postoperative complications were observed. The patients were di- vided into two groups （group A and group B） according to the chronological order of the operation, the average operation time were compared between the two groups. Scattered point diagram was drawn according to the operation sequence and operation time. The Spearman product-moment correlation coefficient had been calculated between the two groups, the presence of cor- relation was assessed, learning curve was discussed. Results All operations were successful which neither one case was trans- formed into conventional laparoscopic surgery or open surgery and no intraoperative and postoperative complications. The op- eration time of the later 15 cases was significantly less than the former 15 cases [（94.58±28.08） rain vs （70.02±25.14） rain, P 〈 0.05]. Spearman rank correlation non-parametric test demonstrated that there was a significantly negative relationship be- tween the operating time and cases sequence （r8 = -0.540, P 〈 0.05）, the operation time shortened with increasing operation experience. All patients were followed up for 4 to 12 months after treatment, during which no incisional hernia, hemorrhage, or incision infection occurred. No apparent scar could be noticed in the umbilicus of the patients, which has a good cosmetic outcome. Conclusion Modified trocar can improve the single port laparoscopic operation instruments interfere with each other, and also reduce the operation difficulty of laparoscopic single-site surgery. Since the SPA-LAVH operation is difficult to practice and is in the infant stage, prolonging operation time is acceptable. The operation time shortened with increasing oper- ation experience. Therefore, transumbilical single port laparoscopic-assisted vaginal hysterectomy is worthy of study and pro- motion, and has certain application prospect in gynecological benign diseases.