单孔腹腔镜子宫全切除术23例临床分析

Total hysterectomy of laparoendoscopic single site surgery

目的：探讨单孔腹腔镜子宫全切除术（ LESS-TH）的临床效果。方法中国医学科学院北京协和医院妇科2012年1月至2013年8月共实施LESS-TH 23例，子宫全切除术的所有操作均在单孔腹腔镜下完成，以传统腹腔镜器械配合特殊单孔腹腔镜器械，电凝及切割组织采用智能能量器械，在腹腔镜下沿阴道穹隆切下子宫后，使用自固定可吸收缝线（ V-LOC）镜下缝合阴道断端，完成LESS-TH。结果23例患者平均切除的子宫质量（230±38）g，手术时间（73±22）min，术中出血量平均（99±53）ml，术后疼痛视觉模拟评分（VAS）平均（3．9±1．6）分，术后肠道功能恢复时间平均（13±4）h，术后住院日平均（1．8±0．6）d，23例患者均未发生并发症，随访时间14～60 d，平均41．6 d。术后随诊所有患者均无明显自觉症状，大、小便正常，阴道分泌物正常，脐部切口愈合良好，19例未见明显瘢痕，阴道残端切口均愈合良好。结论术中通过弯、直器械的配合、智能能量器械及V-LOC缝合阴道断端的应用，LESS-TH安全有效。

Objective To explore the operation skills of laparoendoscopic single site surgery （ LESS） of total hysterectomy , to expand the application of LESS in the field of in gynecologic surgery . Methods A total of 23 cases of total hysterectomy were completed under laparoendoscopic single site surgery in Peking Union Medical College Hospital from January 2012 to August 2013, applying with combination of the traditional laparoscopic and special LESS apparatuses , intelligent electronic coagulation and excision device and the self-fixed absorbable sutures （ V-LOC）.The datas of the patients during the operations and the follow-up were recorded and analyzed Results Twenty-three cases LESS-TH are accomplished.The weight of uterus was （230＋38） g.The operation time was （73＋22） minutes, with the intraoperative blood loss （99 ±53） ml.The postoperative intestinal function recovery time was （13 ＋4） hours, and postoperative hospitalized time was （ 1.8 ±0.6 ） days, with the postoperative pain visual analogue scale 3.9 ±1.6.There were no complications reported during intraoperative and postoperative time.All of our patients was finished the follow-up from 14 d to 2 months.As usual, vaginal discharge is normal, wound healed well, most of the wounds healing （19/23） hidden in umbillicus, no obvious scar, vaginal stub wound healed well Conclusions （ 1 ） LESS can accomplish total hysterectomy of uterus of gestational age less than 8 weeks safely and effectively .（ 2 ） Combination of traditional laparoscopic and special LESS appatatuses , the use of intelligent energy devices and V-LOC to suture vaginal stub could make the total hysterectomy by LESS much easier and safer .