经脐单孔腹腔镜在卵巢囊肿剔除手术中的应用

Comparison of surgical results between single-hole laparoscopy and conventional laparoscopy in ovarian cystectomy

目的探讨使用传统腹腔镜器械的单孔腹腔镜与传统腹腔镜在卵巢囊肿剔除手术中的治疗效果对比。方法回顾性分析2016年1月至2018年10月安徽医科大学附属宿州医院同一治疗组收治的卵巢囊肿患者139例,根据所采用手术方式的不同分为单孔腹腔镜组(62例)和传统腹腔镜组(77例)。观察比较两组患者术中、术后的临床指标、雌激素变化情况、T细胞亚群水平、并发症发生情况及患者对手术切口的满意情况。结果单孔腹腔镜组手术时间、术中出血量高于传统腹腔镜组,术后住院天数少于传统腹腔镜组,但差异无统计学意义(P>0.05)。两组术前卵泡刺激素(FSH)、促黄体生成素(LH)、雌二醇(E2)水平比较差异无统计学意义(P>0.05),术后30 d单孔腹腔镜组FSH、LH、E2高于传统腹腔镜组,但差异无统计学意义(P>0.05)。术前两组患者CD_(4)^(+)、CD_(8)^(+)及CD_(4)^(+)/CD_(8)^(+)比较差异无统计学意义(P>0.05),术后3 d单孔腹腔镜组CD_(4)^(+)、CD_(8)^(+)及CD_(4)^(+)/CD_(8)^(+)高于传统腹腔镜组(0.51±0.03比0.47±0.02、0.41±0.23比0.39±0.05、1.36±0.02比1.24±0.02),差异有统计学意义(P<0.05)。两组并发症发生率比较差异无统计学意义(P>0.05)。术后3 d单孔腹腔镜组疼痛评分低于传统腹腔镜组[(1.12±0.21)分比(3.56±0.65)分],差异有统计学意义(P<0.05)。单孔腹腔镜组术后切口满意度高于传统腹腔镜组[90.32%(56/62)比72.73%(56/77)],差异有统计学意义(P<0.05)。结论经脐单孔腹腔镜在卵巢囊肿剔除手术中可安全、顺利实施,并可减轻术后疼痛,对自身细胞免疫力影响小,有更好的美容效果。

Objective To investigate the effect of single-port laparoscopy and conventional laparoscopic surgery in ovarian cystectomy.Methods The clinical data of 139 patients with laparoscopic surgery for ovarian cyst admitted to the same department of gynecology from December 2016 to December 2019 in Suzhou Hospital Affiliated of Anhui Medical University were retrospectively analyzed,and they were divided into single-port laparoscopic surgery group(62 cases)and conventional laparoscopic surgery group(77 cases)according to different surgical methods.The clinical indictors,the levels of estrogen,T lymphocyte subgroups,the complications rate and incision satisfaction rate between two groups were compared.Results The operation in both groups was smooth and there was no conversion to open surgery.Compared with the conventional laparoscopic surgery group,the surgery time,intraoperative blood loss in single-port laparoscopic surgery group were higher,the hospital stays in single-port laparoscopic surgery group was shorter,but there were no significant differences(P>0.05).The levels of follicle-stimulating hormone(FSH),luteinizing hormone(LH),estradiol(E2)in two groups before operation had no significant differences(P>0.05).At 30 d after operation,the levels of FSH,LH and E2 in single-port laparoscopic surgery group were higher than those in conventional laparoscopic surgery group,but the differences were no statistically significant(P>0.05).Before operation,the levels of CD_(4)^(+),CD_(8)^(+)and CD_(4)^(+)/CD_(8)^(+)in two groups has no significant differences(P>0.05).At 3 d after operation,the levels of CD_(4)^(+),CD_(8)^(+)and CD_(4)^(+)/CD_(8)^(+)in single-port laparoscopic surgery group were higher than those in conventional laparoscopic surgery group:0.51±0.03 vs.0.47±0.02,0.41±0.23 vs.0.39±0.05,1.36±0.02 vs.1.24±0.02,and the differences were statistically significant(P<0.05).The rate of complication in two groups had no significant difference(P>0.05).At 3 d after operation,the scores of visual analogue scale(VAS)of pain in single-port laparoscopic surgery group were lower than that in conventional laparoscopic surgery group:(1.12±0.21)scores vs.(3.56±0.65)scores,and the difference was statistically significant(P<0.05).The incision satisfaction rate in single-port laparoscopic surgery group was significantly higher than that in conventional laparoscopic surgery group:90.32%(56/62)vs.72.73%(56/77),and the difference was statistically significant(P<0.05).Conclusions Single-port laparoscopy can be safely and smoothly implemented in ovarian cystectomy,and can reduce postoperative pain,improve cell immunity,and have better cosmetic result.