单孔腹腔镜全子宫切除术临床疗效分析

The Clinical Effect of Total Hysterectomy with Laparoendoscopic Single-site Surgery

目的 探讨单孔腹腔镜下全子宫切除术的安全性及效果。方法 回顾性分析我院2017年1月~2018年4月行腹腔镜下全子宫切除术的87例患者的临床资料,按不同腹腔镜入路及阴道断端缝合方法分为三组:A组30例,采用单孔腹腔镜手术经阴道缝合阴道断端;B组20例,采用单孔腹腔镜手术经腹腔镜缝合阴道断端;C组37例,采用传统腹腔镜手术经腹腔镜缝合阴道断端。比较三组患者术中出血量,手术时间,术后疼痛评分,恢复排气时间,首次离床活动时间,引流管留置时间,并发症发生率,术后住院时间及费用等临床指标。结果 三组患者手术顺利,术中均无并发症发生,无一例转开腹手术。单孔腹腔镜组均未额外添加操作孔。A组手术时间与C组比较无统计学差异(P>0.05),但B组手术时间明显长于C组,差异有统计学意义(P<0.05)。A、B组患者术后排气时间、首次离床活动时间明显早于C组,术后48 h内各时点VAS评分低于C组,差异均有统计学意义(P<0.05),但术中出血量、引流管留置时间、住院时间及住院费用与C组比较均无统计学差异(P>0.05)。结论单孔腹腔镜全子宫切除术具有术后疼痛轻、恢复快、美观等优势,是一种安全有效的手术方法,值得临床推广应用。阴道断端的缝合可依术者经验灵活选择。

Objective To investigate the safety and efficacy of total hysterectomy with laparoendoscopic single-site surgery (LESS).Methods A retrospective review of 87 patients undergoing laparoscopic total hysterectomy from January 2017 to April 2018 in our hospital was carried out.According to the different methods of laparoscopic approach and vaginal end suturing,87 cases were divided into three groups: 30 cases of group A were performed LESS and vaginal edge suturing to closure;20 cases of group B were performed LESS and vaginal edge suturing under laparoscope;37 cases of group C were performed total hysterectomy and vaginal end suturing by three-holes laparoscopy.The bleeding volume,operation time,post-operative pain scores,recovery time of exhaust,first off-bed activity time,indwelling time of drainage tube,incidence of complications,hospitalization time and cost were compared among the three groups.Results All cases accomplished the operation successfully without intra-operative complications and no conversion to open surgery.No additional operation holes were added in the group A and B.There was no significant difference in operation time between group A and group C (P>0.05),but the operation time was longer in group B than that in group C (P<0.05).The exhaust time and the first off-bed activity time was earlier and the VAS scores of different time points within 48h were lower in group A and B than those in group C (P<0.05),but there was no statistical difference in intra-operative blood loss,indwelling time of drainage tube,hospitalization time and cost(P>0.05).Conclusions LESS is a safe and effective procedure for total hysterectomy with the advantages of mild post-operative pain,quick recovery and beautiful appearance,and it is worthy of extensive clinical application.The suture of the vaginal stump can be flexibly selected according to the experience of the surgeon.