悬吊线法经脐单孔腹腔镜在妇科手术的应用

Clinical application of transumbilical suture-suspension single port laparoscopic in gynecological surgerye

目的探讨"悬吊线法"经脐单孔腹腔镜在妇科手术应用的可行性。方法收集2017年1-12月大连医科大学附属大连市妇产医院收治的135例卵巢囊肿、子宫肌瘤患者的临床资料,观察组采用"悬吊线法"行单孔腹腔镜手术,其中卵巢囊肿剔除术30例,子宫肌瘤剔除术15例;对照组行多孔腹腔镜手术,其中卵巢囊肿剔除术60例,子宫肌瘤剔除术30例。观察两组的手术时间、术中出血量、术后血红蛋白下降幅度、术后24 h发热的最高体温、术后住院时间、术后并发症、术后24 h视觉模拟评分法(visual analogue scale/score,VAS)评分、体象量表(body image scale,BIS)评分、切口美观满意度CS评分等指标。结果 135例均成功完成手术。比较观察组与对照组的术中出血量[(48.44±7.97)ml vs(40.07±8.62)ml]、术后血红蛋白下降幅度[(13.27±6.05)g/L vs(12.44±5.91)g/L]、术后24 h发热的最高体温[(37.32±0.23)℃vs(37.29±0.18)℃]、术后住院时间[(4.22±1.66)d vs(4.44±1.22)d],差异均无统计学意义(P>0.05);比较观察组与对照组的手术时间[(77.44±28.10)min vs(54.00±27.89)min]、术后24h VAS评分[(5.33±0.74)分vs(5.56±1.31)分]、BIS评分[(5.13±0.41)分vs(5.44±0.91)分]、切口美观满意度CS评分[(41.23±1.04)分vs(39.29±2.02)分],差异有统计学意义(P<0.05)。结论经脐单孔腹腔镜手术在妇科良性疾病中应用是可行的,"悬吊线法"在一定程度上降低了单孔腹腔镜手术中的手术难度。

Objective The feasibility of using suture-suspension in laparoendoscopic single-site surgery in gynecologic surgery. Methods Collected the clinical data of 135 patients, with ovarian cysts or uterine fibroids, who were admitted to Dalian Maternity Hospital affiliated to Dalian Medical University from Jan. to Dec. 2017, Observation group had treated by suture-suspension single port laparoscopic surgery, Ovarian cyst excision in 30 cases, Myomectomy in 15 cases; The control group had treated by line porous laparoscopic surgery, Ovarian cyst excision in 60 cases, Myomectomy in 30 cases, operation time, intraoperative bleeding, postoperative hemoglobin （Hb） decline, the highest temperature after surgery in 24 h, postoperative hospitalization, postoperative complications, VAS score after surgery in 24 h, body image scale BIS score, cutting aesthetic satisfaction CS score etc clinical data were observed between the two groups. Results All the 135 cases were successfully operated. There is not statistical significance（P 〉 0.05 ） of comparing intraoperative blood loss [ （48.44 ± 7.97 ） ml vs （40.07 ± 8.62） ml ] , postoperative Hb decline [ （ 13.27±6.05 ）g/L vs （ 12.44 ± 5.91 ） g/Ll, the highest temperature after surgery in 24 h [（37.32 ± 0.23）℃ vs （37.29 ±0.18）℃], postoperative exhaust time [ （ 4. 22 ± 1.66）d vs（4.44 ± 1.22 ） d] of observation group and control group ; There is statistical significance （ P 〈 0.05 ） of comparing the operation time[ （77.44 ± 28. 10） min vs（54. 00 ± 27.89） min] ,VAS score after surgery in 24 h [（5.33 ± 0.74） vs（5. 56 ± 1. 31）],BIS score[（5. 13 ± 0. 41） vs（5. 44 ± 0. 91）1, CS score[ （41.23 ± 1.04）vs （39.29 ± 2.02）] of observation group and control group. Conclusions Transumbilical single port laparoscopic surgery in gynecological benign diseases surgery is feasible, suture-suspension to a certain extent, reduce the difficulty of laparoendoscopic single-site surgery.