经脐单孔腹腔镜手术治疗卵巢良性肿瘤的研究

A study on transumbilical laparoendoscopic single-site surgery for benign ovarian tumors

目的探讨经脐单孔腹腔镜卵巢良性肿瘤剥除术的可行性。方法选择行经脐单孔腹腔镜卵巢良性肿瘤剥除术患者32例(A组),及同期行传统腹腔镜卵巢良性肿瘤剥除术患者45例(B组),肿瘤最大径线均≤6 cm。对2组患者的临床资料进行比较分析。结果 2组均顺利完成手术。B组手术时间短于A组(45.09±9.65 min vs.56.75±11.31 min,t=-4.862,P<0.001),术中出血量少于A组(19.73±7.60 ml vs.28.72±10.16 ml,t=-4.444,P<0.001),囊肿破裂率低于A组(χ2=9.397,P=0.002),术后第一天疼痛Prince-Henry 5级评分法疼痛程度弱于A组(Z=-2.945,P=0.003),术后24 h内肛门排气率高于A组(χ2=7.022,P=0.008),2组比较差异均有统计学意义;2组术中、术后均无并发症,2组术中卵巢创面缝合比例、术后止痛药使用比例比较,差异无统计学意义(P>0.05)。结论尽管经脐单孔腹腔镜卵巢囊肿剥除术具备隐藏瘢痕、美容、微创的优点,但其操作难度明显增加,目前尚难广泛应用。

Objective To investigate the feasibility of transumbilical laparoendoscopic single-site surgery （LESS） in a eysteetomy for benign ovarian tumors. Methods This study included 32 patients with benign ovarian tumors who underwent a cystectomy via transumbilical LESS （Group A） and 45 patients who were treated with a conventional laparoscopic oophorocystectomy for benign ovarian tumors （ Group B）. The maximum diameters of the tumors were 6 cm or less. The clinical data of the patients in these two groups were compared for analysis. Results The operations were successful for all patients in both groups. The operative time in Group A was longer than that in Group B （56.75 ± 11.31 min vs. 45.09 ± 9. 65 min, t = 4. 862, P 〈 0. 001 ）. The intraoperative blood loss in Group A was greater than that in Group B （28.72 ± 10. 16 ml vs. 19.73 ±7.60 ml, t =4. 444, P 〈0. 001 ）. Group A had a higher rate of intraoperative cyst rupture than Group B （χ^2 =9. 397, P =0. 002）. Using the Prince-Henry pain scale, the pain score within the first 24 hours after surgery in Group A was higher than that in Group B （Z = - 2. 945, P = 0. 003）. Group A had a higher rate of gas passage through the rectum within the first 24 hours after surgery than Group B （χ^2 = 7. 022, P = 0. 008 ）. The differences observed between the two groups were all statistically significant. No intraoperative or postoperative complications occurred in either group. No statistically significant differences were observed in intraoperative ovarian wound closure or the postoperative use of analgesics （ P 〉 0.05 ）. Conclusions Despite its advantages of scar concealment, cosmetic benefits, and minimally invasive nature, transumbilical LESS has not been widely used in cystectomies due to the increased difficulty of the procedure.