妇科腹腔镜手术脐部切口入路及缝合方法的探讨

Analysis of the entrance and suture method of umbilical incision in gynecological laparoscopy

目的探讨妇科腹腔镜手术脐部切口入路和缝合方法。方法回顾性分析2013至2016年度在首都医科大学附属北京同仁医院接受妇科腹腔镜手术的患者，共204例。采用2种脐部切口入路：经脐窝切口和脐周切口（根据脐部天然皮肤皱褶的形态和走行做纵／横／斜／弧形等切口）。进行两种缝合方法：皮内“U”字缝合和皮下组织全层间断缝合。根据脐部穿刺口的切开方法和缝合方法，随机设立2组。每组均102例。对3组患者手术中和术后出血、术后切口脂肪液化及感染、术后痛感、术后脐部切口外观满意度和愈合满意度进行比较分析。结果选择经脐周做切口术中及术后切口出血、切口脂肪液化及感染等并发症发生率少。采用皮下组织全层间断缝合，术后切口痛感低是有效的减痛缝合。2种切口人路和2种缝合方法术后患者外观满意度差异无统计学意义（P〉0．05），而患者愈合满意度：经脐周切口、行皮下组织全层间断缝合明显高于经脐切口、皮内“U”字缝合（P〈0．05）。结论选择经脐周天然皮肤皱褶做妇科腹腔镜手术入路，行皮下组织全层间断缝合，其安全性和实用性高，手术瘢痕隐蔽，美容效果佳，减痛效果确切，患者满意度高，是值得推广的好方法。

Objective To explore the entrance and suture method of umbilical incision in gynecological laparoscopy. Methods A total of 204 cases of gynecologic laparoscopy in our hospital from 2013 to 2016 were reviewed respectively. All the cases used two kinds of approach of umbilical incision： intra-umbilical incision and peri-umbilical incision （longitudinal/transverse oblique/arc incision according to the bellybutton natural skin folds） and two methods of suture： the suture of ＂U＂ and the suture of the whole subcutaneous tissue. Two groups were randomly assigned based on the entrance and suture method with each group 102 cases. The peri-operative outcomes were compared, including intra-operative and postoperative bleeding, postoperative incision fat liquefaction and infection, incision pain, incision appearance satisfaction and incision healing satisfaction. Results The difference was statistically significant in the intra-operative and postoperative bleeding between two groups of intra-umbilical incision and peri-umbilical incision （ P 〈 0. 05）. There was statistically significant difference in postoperative incision fat liquefaction, infection and incision pain between two groups of the suture of ＂U＂ and the suture of the whole subcutaneous tissue （P 〈 0. 05）. The incision appearance satisfaction showed no difference （P 〉 0. 05 ）, but the difference was statistically significant （P 〈 0.05 ） in the incision healing satisfaction between two groups. Conclusion The peri-umbilical incision （ longitudinal/transverse oblique/arc incision according to the bellybutton natural skin folds ） and suture of the whole subcutaneous tissue can be the feasible modified methods with high practicability and security, good cosmetic result. It should be promoted in gynecologic laparoscopy.