改良单孔腹腔镜卵巢囊肿剔除在基层医联体的推广应用

Popularization and application of modified single-port laparoscopic ovarian cystectomy in primary medical conjoined hospitals

目的探讨改良单孔腹腔镜行卵巢囊肿剔除术在基层医联体医院推广应用的可行性。方法以柳州市柳铁中心医院医联体内医院为推广单位,选择2018年1月至2019年11月行卵巢囊肿剔除术患者86例,随机分为改良单孔腹腔镜组和传统腹腔镜组,分析患者的手术时间、术中出血量、住院时间、术后首次肛门排气时间、术后24 h视觉疼痛模拟评分(visual analogue scale,VAS)、切口美容满意度(BIS量表评分和CS量表评分)、住院费用、炎症指标等。结果2组均顺利完成手术,无中转开腹手术,术后无相关并发症,患者的手术时间、术中出血量、住院费用比较,差异无统计学意义(P>0.05)。与传统腹腔镜组相比,改良单孔腹腔镜组摘除卵巢囊肿及缝合卵巢所需时间较长,但取标本时间较短,差异有统计学意义(P<0.05),改良单孔腹腔镜组住院时间、术后肛门排气时间及术后24 h VAS均低于传统腹腔镜组,BIS量表评分低于传统腹腔镜组,CS量表评分高于传统腹腔镜组,差异均有统计学意义(P<0.05);术后WBC及超敏C反应蛋白(hs-CRP)升高的比例较传统腹腔镜组较小,差异有统计学意义(P<0.05)。结论改良单孔腹腔镜行卵巢囊肿剔除术在医联体内医院的推广是安全可行的。

Objective To explore the feasibility of ovarian cystectomy with modified single-port laparoscopy in primary medical conjoined hospitals.Methods A total of 86 patients who underwent ovarian cystectomy from Jan.2018 to Nov.2019 were randomly divided into modified single-port laparoscopy group and traditional laparoscopy group.The indexes of patients were analyzed and compared,including operation time,blood loss,length of hospital stay,the time of first anal exhaust after operation,VAS score,cosmetic satisfaction after operation,hospitalization cost and postoperative inflammation index.Results The operation was successfully completed in both groups,there was no conversion to laparotomy,and there were no related complications after operation.There was no significant difference in total operation time,intraoperative blood loss and hospitalization cost between the two groups(>0.05).Compared with the traditional group,the modified single-port group needed longer time to remove ovarian cyst and suture ovary,but the time of collecting samples was shorter.The hospital stay,postoperative anal exhaust time and VAS score in the modified single-port group were lower than those in the traditional group,and the cosmetic satisfaction of the abdominal wound in the modified single-port group was significantly higher than that in the traditional group(<0.05).The percentage of white blood cells and hypersensitive C-reactive protein(hs-CRP)increased after operation in the modified single-hole group was lower than that in the traditional group,and the difference was statistically significant(<0.05).Conclusions Ovarian cystectomy with modified single-port laparoscopy is safe and feasible in conjoined hospitals.