机器人单孔腹腔镜在妇科手术中的初步应用探讨

Primary study on robotic single-site laparoscopy in gynecological surgery

目的探讨机器人单孔腹腔镜在妇科手术中应用的安全性及可行性。方法回顾性分析空军军医大学第一附属医院妇产科2018年1~12月施行机器人单孔腹腔镜下妇科手术共计7例,记录患者的年龄、体质量指数、手术时间、术中出血量、术中及术后相关并发症,手术前后血红蛋白差值,术后排气时间、术后24 h疼痛模拟评分、住院时间、术后随诊情况等指标。计量资料用平均值±标准差统计分析。结果7例机器人单孔腹腔镜手术均顺利完成,其中4例使用筋膜平台、3例使用LAGIPORT。其中6例子宫内膜癌患者行全子宫双附件切除+盆腔淋巴结清扫术、1例子宫腺肌症合并骶韧带DIE患者行全子宫切除+DIE切除术。患者中位年龄45岁(35~57岁),体质量指数22.9 kg/m^2(20.5~25.4 kg/m^2),中位手术时间141 min(115~170 min),中位术中出血量86 ml(50~200 ml),手术前后血红蛋白差值6 g/L(5~10 g/L),中位术后住院时间5 d(4~6 d),术后肠道功能恢复时间16.5 h(12~22 h),术后24 h术后疼痛模拟评分1.7分(1~3分)。术后1个月随访,所有患者脐部伤口及阴道残端愈合良好。结论机器人单孔腹腔镜可安全、有效的用于妇科手术,但需要更多实践和临床研究加以验证。

Objective To investigate the safety and feasibility of robotic single-site laparoscopy in gynecological surgery. Methods Clinical data of seven patients undergoing robotic single-site laparoscopic gynecological surgery in the department of obstetrics and gynecology of the First Affiliated Hospital of Air Force Military Medical University from Jan. to Dec. 2018 were retrospectively analyzed to analyze its clinical efficacy. The perioperative data was analyzed as follows: age, BMI, operative time, blood loss, postoperative VAS pain score, time for bowel movement, and hospital stay. Measurement data was presented as mean standard deviation. Results All the 7 patients successfully completed the operation, among which 4 patients received robotic single-site laparoscopic surgery with fascia platform and 3 patients with LAGIPORT. Among the patients, 6 cases was diagnosed as endometrial carcinoma which underwent bilateral hysterectomy and pelvic lymph node dissection, and 1 case underwent hysterectomy and DIE dissection for adenomyosis combined with sacral ligament. The median age of the patients was 45 years old (35-57 years old ), the body mass index was 22.9 kg/m^2 (20.5-25.4 kg/m^2), the median operative time was 141 min (115-170 min), the median intraoperative blood loss was 86 ml(50-200 ml), the hemoglobin difference before and after the operation was 6 g/L (5-10 g/L), the median postoperative hospital stay was 5 d(4-6 d), the postoperative intestinal function recovery time was 16.5 h(12-22 h), and the pain score was 1.7 (1-3 points) at 24 h after the operation. Umbilical wound and vaginal stump healed well in all patients after one month. Conclusions Robotic single-port laparoscopy can be used safely and effectively in gynecological surgery, but more practical and clinical studies are needed to verify it.