增加辅助孔的经脐单孔腹腔镜巨大卵巢囊肿手术

Transumbilical Laparoendoscopic Single-site Surgery With Auxiliary Port for Giant Ovarian Cyst

目的探讨改良经脐单孔腹腔镜治疗巨大(>10 cm)卵巢囊肿的安全性。方法2018年6月~2019年12月,行改良经脐单孔腹腔镜巨大卵巢囊肿手术57例,经脐开放式入路,切口2~2.5 cm,置入切口保护套及单孔Port,左下腹置5 mm trocar和器械协助。行卵巢囊肿剥除18例,附件切除25例,全子宫+单/双附件切除10例,全子宫+双附件+大网膜+盆腔淋巴结切除4例(其中2例加行阑尾切除术)。结果3例因严重粘连加右下腹5 mm trocar双人配合操作,其余54例均单人操作行增加一个辅助孔的经脐单孔腹腔镜手术,无中转开腹。术后随访1~18个月,平均12.3月,1例黏液性囊腺瘤剥除术后6个月复发。结论增加辅助孔的经脐单孔腹腔镜技术治疗巨大卵巢囊肿具有良好的器械操控性,可行切口保护,可安全、快速取出标本,具有一定的临床推广价值。

Objective To investigate the safety of the modified transumbilical laparoendoscopic single-site surgery(LESS)for giant ovarian cyst(more than 10 cm in diameter).Methods From June 2018 to December 2019,57 cases of giant ovarian cyst were treated by modified transumbilical LESS.The incision was 2-2.5 cm.The protective sheath and single-site surgery port were placed.The left lower abdomen was punctured with a 5 mm trocar,and the instruments were placed to assist in the operation.There were 18 cases of cystectomy,25 cases of adnexectomy,10 cases of total hysterectomy and unilateral/bilateral adnexectomy,and 4 cases of total hysterectomy+bilateral adnexectomy+omentectomy+pelvic lymphadenectomy(2 cases of which had appendicectomy).Results Three cases were treated with an additional right lower abdominal port with a 5 mm trocar because of serious adhesions.The other 54 cases were operated via single-site surgery port and left lower abdomen port by single person without conversion to laparotomy.All the patients were followed up for 1-18 months(mean,12.3 months).Recurrence was found in 1 case of mucinous cystadenoma 6 months after operation.Conclusions Transumbilical LESS with auxiliary port for giant ovarian cyst has good instrument manipulation,feasible incision protection,safe and rapid specimen extraction.The technique has clinical application value.