经脐单孔免气腹腹腔镜全子宫切除术25例报告

Gasless transumbilical single-port laparoscopic hysterectomy:a report of 25 cases

目的:探讨经脐单孔免气腹腹腔镜全子宫切除术的应用价值及可行性。方法:分析为25例患者行经脐单孔免气腹腹腔镜全子宫切除术的临床资料。结果:24例手术获得成功,1例子宫腺肌病患者因粘连较重、出血难以暴露术中改行常规腹腔镜手术,无一例中转开腹。术中出血量50~150 ml,平均(70.9±10.6)ml;手术时间30~65 min,平均(48.5±4.8)min。术后6 h进流质饮食,排气时间7~15 h,平均(10.8±2.9)h,无气腹刺激症状发生。术后2 d拔除尿管,术后4 d出院,出院10~15 d返院复查,脐部切口均愈合良好。结论:单孔免气腹腹腔镜全子宫切除术对腹腔脏器干扰少,出血少,手术时间短,术后腹部切口疼痛轻,腹胀不明显,无气腹刺激症状,下床活动早,术后康复快,手术瘢痕小且隐匿,具有一定的美容效果。

Objective：To evaluate the clinic value and feasibility of gasless transumbilical single-port laparoscopic hysterectomy.Methods：Retrospective analysis was made on the clinical data of 25 patients who underwent gasless transumbilical single-port laparoscopic hysterectomy between Jan.2015 and Mar.2016.Results：Twenty-four operations were finished successfully with no conversion to laparotomy.However,one adenomyosis case was converted to conventional laparoscopic surgery because of serious adhesion and bleeding.The intraoperative blood loss ranged from 50 to 150 ml with a mean of（70.9 ± 10.6） ml.The operation time ranged from 30 to 65 min with the average of（48.5 ± 4.8） min.All patients had liquid diet at 6 h after surgery.The time of exhaust ranged from 7 to15 h with a mean value of（10.8 ± 2.9） h,and no pneumoperitoneum-related complications were found.The urinary catheter was pulled out on the 2nd day after surgery.All patients were discharged on 4th d after surgery and incisions were well healed during the return visit about 10-15 d later.Conclusions：The gasless transumbilical single-port laparoscopic hysterectomy is a reliable procedure with little disturbance,bleeding and pain and short operation time.Besides,the low incidence of abdominal distention and pneumoperitoneum-related complications,early ambulation,fast recovery and good cosmetic effect are also the advantages of this procedure.