单孔腹腔镜联合经脐小切口体外妊娠期巨大卵巢囊肿剥除术的临床应用价值

Clinical value of single- hole laparoscopy combined with small umbilical incision in vitro gestation of giant ovarian cysts during pregnancy

目的评估利用单孔腹腔镜联合经脐小切口体外剥除妊娠期巨大卵巢囊肿的临床意义和治疗效果。方法回顾性分析2018年5~11月在石家庄市第四医院实施单孔腹腔镜联合经脐小切口体外妊娠期巨大卵巢囊肿(10~11 cm)剥除术的6例患者的临床资料。结果6例患者均顺利完成单孔腹腔镜联合经脐小切口体外巨大卵巢囊肿剥除。6例患者中,1例输卵管系膜囊肿扭转,2例卵巢囊肿蒂扭转,3例患者恢复正常解剖结构后卵巢均未发生坏死,行囊肿剥除术。中位囊肿直径10 cm(10~11 cm),中位手术时间51.50 min(43.75~63.50 min),中位术中出血7.5 ml(5~20 ml),平均住院时间(3.50±0.43)d。随访,6例患者中,5例(83.33%)妊娠至足月分娩,1例(16.67%)早产;其中2例(33.33%)行剖宫产,4例(66.67%)顺产;中位新生儿体质量3050 g(2750~3162.5 g)。6例患者的新生儿均无畸形及窒息。结论对妊娠期巨大卵巢囊肿,应用单孔腹腔镜联合经脐小切口体外巨大卵巢囊肿剥除术是安全可行的,值得临床推广。

Objective To evaluate the clinical significance and therapeutic effect of single-hole laparoscopy combined with small umbilical incision for excision of giant ovarian cysts during pregnancy.Methods A retrospective analysis was performed on the clinical outcomes of 6 patients undergoing single-hole laparoscopy combined with a small umbilical incision and external giant ovarian cyst(10-11 cm)pregnancy during May to Nov.2018.data.Results All 6 patients successfully completed the excision of giant ovarian cysts with single-hole laparoscopy combined with a small umbilical incision.In 6 patients,two patient′s ovarian cysts were twisted,one patient’s mesentery cysts were twisted,and other three patient′s ovaries had normal anatomical structure.No necrosis occurred,and cystectomy was performed.The median operation time was 51.50 min(43.75-63.50 min),the median intraoperative blood loss was 7.5 ml(5-20 ml),and the average hospital day was(3.50±0.43)days.Follow-up,of the 6 patients,5 were pregnant to full-term delivery(83.33%),1 was premature(16.67%);2 of them underwent cesarean section(33.33%),4 were delivered in labor(66.67%);median newborn weight 3050 g(2750-3162.5 g).There were no deformities and asphyxia in the newborns of 6 patients.Conclusion After sufficient pre-operative and intra-operative evaluations to rule out the possibility of severe malignant ovarian tumors and pelvic adhesions,single-hole laparoscopy combined with a small umbilical incision to remove giant ovarian cysts during pregnancy.The technique is safe and feasible and worthy of clinical promotion.