单孔腹腔镜手术治疗妇科良性病变的疗效和安全性研究

The efficacy and safety of single-port laparoscopic surgery on gynecological benign diseases

目的探讨单孔腹腔镜手术治疗妇科良性病变的近远期疗效。方法采用前瞻性研究方法,对在我院2017年3月至2018年4月诊治的妇科良性病变134例,其中附件切除术34例,卵巢剔除术34例,子宫肌瘤剔除术22例,全子宫切除44例,在脐中央做一长约3cm的切口,置入自制手套做出的穿刺套管(Triport装置),穿刺套管的3孔道可同时插入探头和需操作的手术器械,行单孔腹腔镜手术。同时将2016年3月至2017年4月传统腹腔镜手术治疗的妇科良性病变80例为传统组,其中附件切除术12例,卵巢剔除术24例,子宫肌瘤剔除术20例,全子宫切除24例,对比2组的近期疗效指标包括手术时间、术中出血量、排气时间、术后首次下床活动时间等,以及并发症指标包括切口感染、切口疝、腹胀、恶心呕吐等。结果单孔腹腔镜组的手术时间为(61±10)min,长于传统组,而排气时间为(37±5)h,明显短于传统组,差异具有统计学意义(P<0.05),但单孔组术中出血量为(31.5±7.1)mL,共8例出现术后并发症,发生率为6.0%,切口疼痛、术后镇痛率和疼痛评分与传统组比较差异均无统计学意义(P>0.05)。结论单孔腹腔镜术治疗妇科良性疾病,虽延长了手术时间,但缩短了胃肠功能恢复时间,且不增加术后并发症发生率,具有创伤低、恢复快、安全性高和美容效果佳等优点。

Objective To explore the efficacy and safety of single-port laparoscopic surgery on gynecological benign diseases.Methods A prospective study was conducted on 134 cases of benign gynecological lesions diagnosed and treated in our hospital from March 2017 to April 2018.These included 34 cases of adnexectomy,34 cases of ovarian cystectomy,22 cases of hysteromyomectomy,and 44 cases of total hysterectomy.In all these cases,a 3-cm incision was made in the center of the umbilicus,and a Triport device made of homemade gloves was inserted.The endoscopic probe and the surgical instrument could be simultaneously inserted into the three holes of the puncture cannula ,so as to facilitate single-port laparoscopic surgery.Meanwhile,80 cases of gynecological benign lesions treated by traditional laparoscopic surgery from March 2016 to April 2017 were included in the traditional group.These included 12 cases of adnexectomy,24 cases of ovarian cystectomy,20 cases of hysteromyomectomy,and 24 cases of total hysterectomy.In this study,short-term efficacy indexes and complication indexes of the two groups were compared.Short-term efficacy indexes included operation time,intraoperative blood loss,exhaust time,postoperative first time to get out of bed,etc.Complication indexes included incision infection,incision hernia,abdominal distension,nausea,vomiting,etc.Results The operation time of single-port laparoscopic group was (61±10) min,which was longer than that of the traditional group,and the exhaust time was (37±5) h,obviously shorter than that of traditional group(P<0.05),but the bleeding amount in single-port group was (31.5±7.1)mL,and a total of 8 cases had postoperative complications,the incidence was 5.97%.Compared with the traditional group,there was no significance differences for the rate of incision pain,postoperative analgesia and pain scores(P>0.05).Conclusion In the treatment of gynecological benign diseases with single-port laparoscopy,although the operation time is prolonged,the recovery time of gastrointestinal function is shortened and the incidence of postoperative complications is not increased.