达芬奇机器人系统在复杂性子宫肌瘤剔除术中的应用

Application of Da Vinci robotic-assisted laparoscopic surgery in complex myomectomy

目的:比较达芬奇机器人系统辅助腹腔镜手术与传统开腹手术在复杂性子宫肌瘤剔除术中的临床疗效,探讨达芬奇机器人系统在复杂性子宫肌瘤剔除术中应用的可行性及安全性。方法:选取2016年1月~2019年12月复杂性子宫肌瘤剔除术患者36例进行回顾性分析,纳入的患者皆符合肌瘤数目较多且肌瘤体积较大或肌瘤位于特殊部位,根据手术入路分为达芬奇机器人系统辅助腹腔镜组(15例)及传统开腹组(21例)。结果:达芬奇机器人辅助腹腔镜手术组,术中出血量少于传统开腹手术组(P<0.05),肠道功能恢复时间及术后住院时间均短于传统开腹组(P<0.05),术后48h下床活动时间多于传统开腹组(P<0.05),手术前后血红蛋白及血细胞比容下降水平、术后24h盆腔引流量均低于传统开腹手术组(P<0.05),手术时间较传统开腹手术组延长(P<0.05)。仅传统开腹组术后出现1例慢性盆腔痛、2例术后感染,达芬奇机器人辅助腹腔镜组术后无并发症出现。术后肌瘤残留及复发几率比较,差异无统计学意义。结论:对于肌瘤数目较多且肌瘤体积较大或特殊部位的肌瘤行达芬奇机器人辅助腹腔镜子宫肌瘤剔除术疗效确切,术中出血少、术后恢复快,安全性高。

Objective:To compare the clinical effects and application value of Da Vinci robotic-assisted laparoscopic surgery and traditional laparotomy on treating complex uterine myoma,and to explore the feasibility and safety of Da Vinci robotic-assisted laparoscopic surgery in complex myomectomy.Methods:The clinical data of 36 patients with complex uterine myoma in our hospital from January 2016 to December 2019 were analyzed retrospectively.The patients included in the study were all of larger number and volume of leiomyomas or leiomyomas located in special areas.Patients were divided into the RAL(robot-assisted laparoscopy)group(n=15)and the OS(open surgery)group(n=21)based on different surgical approaches.Results:The amount of intraoperative bleeding in RAL group was less than OS group(P<0.05)and the intestinal function recovery time and postoperative hospital stays of RAL group were shorter than those in OS group(P<0.05).The time of getting out of bed 48 hours after operation in RAL group was more than that in OS group(P<0.05).The reduction of HB(hemoglobin)and HCT(hematocrit)before and after operation in RAL group was lower than OS group,so it was the volume of pelvic drainage 24 hours after operation(P<0.05).The operation time of RAL group was longer than OS group(P<0.05).Only 1 case of chronic pelvic pain and 2 cases of postoperative infection occurred in OS group,while there were no postoperative complications in RAL group.There was no significant difference in residual myoma and recurrence rate after operation.Conclusion:Da Vinci roboticassisted laparoscopic myomectomy is effective in treating uterine myomas with larger number and volume of leiomyomas or leiomyomas located in special areas,which has less bleeding,quicker recovery and higher safety.