经脐单孔腹腔镜与传统腹腔镜卵巢囊肿剥除术的比较

Comparison Between Transumbilical Single-site Laparoscopy and Traditional Laparoscopy for Ovarian Cystectomy

目的探讨经脐单孔腹腔镜卵巢囊肿剥除术的安全性和临床价值。方法对2017年3月~2019年8月我院87例良性卵巢囊肿剥除术进行回顾性分析,其中单孔腹腔镜卵巢囊肿剥除术43例(单孔腹腔镜组),传统腹腔镜卵巢囊肿剥除术44例(传统腹腔镜组),比较2组手术时间、术中囊肿破裂率、术后血红蛋白(hemoglobin,Hb)下降幅度、术后24 h疼痛视觉模拟评分(Visual Analogue Scale,VAS)、排气时间、住院时间。结果2组患者均无中转开腹和手术并发症发生。单孔腹腔镜组囊肿破裂率81.3%,明显高于传统腹腔镜组56.8%(χ^2=6.137,P=0.013),术后24 h疼痛VAS评分单孔腹腔镜组明显低于传统腹腔镜组[1(0~2)分vs.2(0~3)分,Z=-3.575,P=0.000],排气时间明显早于传统腹腔镜组[(26.5±11.1)h vs.(33.1±11.8)h,t=-2.654,P=0.009]。2组手术时间、术后Hb下降幅度和住院时间差异均无统计学意义(P>0.05)。结论经脐单孔腹腔镜良性卵巢囊肿剥除术是安全和可行的,但囊肿破裂率明显增高,应重视术前良恶性肿瘤的评估,交界性或恶性肿瘤慎用此术式。

Objective To explore the safety and clinical value of transumbilical single-site laparoscopic ovarian cystectomy.Methods Data of 87 patients receiving ovarian cystectomy from March 2017 to August 2019,including single-site laparoscopy group(n=43)and traditional laparoscopy group(n=44),were retrospectively collected.The outcomes of both groups were analyzed and compared,including duration of operation,rate of rupture of cyst during operation,decrease of hemoglobin(Hb),postoperative Visual Analogue Scale(VAS),exhaust time and hospital stay.Results There was no conversion to laparotomy or surgical complications in both groups,and no conversion to conventional laparoscopy in the single-site laparoscopic group.The rupture rate of cyst in the single-site laparoscopy group was significantly higher than that in the traditional laparoscopy group(81.3%vs.56.8%,χ^2=6.137,P=0.013).The postoperative VAS lower in the single-site laparoscopy group than the traditional laparoscopic group[1(0-2)points vs.2(0-3)points,Z=-3.575,P=0.000],and the exhaust time was earlier than that of traditional laparoscopic group[(26.5±11.1)h vs.(33.1±11.8)h,t=-2.654,P=0.009].There was no significant difference in operation time,decrease of Hb,and hospitalization time(P>0.05).Conclusions Transumbilical single-site laparoscopic ovarian cystectomy is safe and feasible,but the rate of rupture of the cyst is obviously increased.We should pay attention to evaluate whether the tumor is benign or malignant before the operation.The operation should be used cautiously for borderline and malignant tumors.