单孔三通道法行单孔腹腔镜手术治疗妇科良性肿瘤

Laparoendoscopic single-site surgery using single port with triple-channel inserted method for gynecologic benign tumor

本文报道了常州市金坛地区首例采用单孔三通道穿刺法进行单孔腹腔镜手术(LESS)治疗妇科良性肿瘤的病例,并初步探讨分析LESS在妇科微创领域中应用的可行性。本例患者为50岁女性,因发现左侧附件包块9 d入院,B超提示为左侧卵巢畸胎瘤。行LESS手术,取脐轮上方弧形切口约2.0 cm,采用单孔三通道穿刺法建立手术通路。手术成功完成,手术总时间55 min,LESS手术时间40 min,穿刺建立手术通路15 min。术中未增加其它通道,无中转开腹。术中出血约5 ml,无需放置腹腔引流管。患者术后1 d即恢复肠蠕动,拔除尿管后即恢复排尿功能。脐部切口为II/甲愈合,与脐轮完美融为一体。术后病理提示为左侧卵巢成熟性囊性畸胎瘤。患者恢复情况良好,对治疗效果十分满意。在严格把握手术适应症的前提下,如缺乏单孔多通道套管(Tri-port)设备,单孔三通道穿刺法LESS手术亦可有效处理卵巢良性肿瘤等妇科疾病。随着手术技巧的提高及手术设备的完善,更为微创化的LESS手术有望成为治疗妇科疾病的有效方法之一。

We reported the first case of laparoendoscopic single-site surgery （LESS）using triple-channel inserted method for gynecologic benign tumor in Jintan district of Changzhou City and discussed the feasibility of LESS in minimally invasive gynecologic surgery.The patient was a 50-year-old postmenopausal woman presented with left adnexal mass for 9 d and B type ultrasonograpy revealed teratoma in left ovary. LESS was performed by using a single port with triple-channel inserted method through a solitary 2.0 cm upper umbilicus incision.The operation was completed successfully.The total operative time was 55 min, the duration of the LESS procedure was 40 min,and the establishment of the operative access took 15 min. No other port incision or transfer to open procedure was needed.The intra-operative blood loss was 5 ml and no peritoneal drainage was needed.Bowel peristalsis and micturition recovered 1 d after the operation.No obvious scar was left on the surface of umbilicus.The post-operative pathology result was mature cystic teratoma in left ovary.The patient recovered well,and was satisfactory with the curative efficacy.As a result,under the indication range,and without the special Tri-port device for LESS,LESS using single port with triple-channel inserted method can be a promising minimally invasive approach to effective management of gynecologic benign tumors.With the improvement of operation skills and development of operation devices,the minimally invasive LESS might be an effective treatment procedure for gynecologic diseases.