常规器械单孔腹腔镜辅助阴式子宫切除术

Clinical Study of Single-port Laparoscopic-assisted Vaginal Hysterectomy With Conventional Instruments

目的探讨单孔腹腔镜辅助阴式全子宫切除术(laparoscopic-assisted vaginal hysterectomy,LAVH)的应用价值。方法对2016年10月~2018年10月因非恶性妇科疾病行LAVH进行回顾性分析。依照患者意愿分为单孔和三孔组各30例。单孔组使用一次性单孔套管穿刺系统。比较2组手术指标和并发症。结果2组均无中转开腹手术,无肠管、输尿管、膀胱或大血管损伤。单孔组术后血红蛋白降低少[(17.1±6.5)vs.(20.9±8.1)g/L,P=0.045];2组手术时间[(73.1±24.3)vs.(70.3±22.1)min,P=0.639],子宫重量[(311.2±185.3)vs.(339.4±234.3)g,P=0.607],排气时间[(34.1±5.8)vs.(34.2±4.7)h,P=0.961],总住院时间[(4.1±1.1)vs.(4.3±1.0)d,P=0.541],术后并发症发生率(3例vs.3例,P=1.000)差异无显著性。2组术后短暂性麻痹性肠梗阻3例(单孔组2例,三孔组1例),盆腔血肿2例(2组各1例),败血症1例(三孔组),未出现与穿刺器相关的并发症(如脐疝)。结论单孔LAVH显示术中出血较少及几乎无瘢痕的优势,与三孔手术结局及并发症相似。

Objective To explore the application value of single-port laparoscopic-assisted vaginal hysterectomy(LAVH).Methods A retrospective clinical study was performed in patients undergoing hysterectomy for non-malignant gynecological diseases from October 2016 to October 2018.According to the patient’s wishes,they were divided into either single-port group or three-port group,with 30 cases in each.Disposable single-port trocar puncture system was applied in the single-port group.Surgical outcomes and complications were compared between the two groups statistically.Results There was no conversion to open surgery in both groups,and there were no intestinal,ureteral,bladder or large blood vessel injuries.It showed lower postoperative hemoglobin reduction in the single-port group than the three-port group[(17.1±6.5)vs.(20.9±8.1)g/L,P=0.045].There were no significant differences between the two groups in operation time[(73.1±24.3)vs.(70.3±22.1)min,P=0.639],uterine weight[(311.2±185.3)vs.(339.4±234.3)g,P=0.607],intestinal ventilation time[(34.1±5.8)vs.(34.2±4.7)h,P=0.961],total hospital stay[(4.1±1.1)vs.(4.3±1.0)d,P=0.541],and the incidence of postoperative complications(3 vs.3 cases,P=1.000).There were 3 cases of transient paralytic ileus in both groups(2 cases in the single-port group and 1 in the three-port group),2 cases of pelvic hematoma(1 in each group),and 1 case of sepsis(in three-port group).There were no puncture-related complications such as umbilical hernias.Conclusion Single-port LAVH shows advantages of less intraoperative bleeding and almost no scarring,with outcomes and complications similar to the three-port surgery.