单孔腹腔镜对Ⅰ期子宫内膜癌手术患者疼痛及负性情绪的影响分析

Effects of laparoendoscopic single-site surgery on pain and negative emotion in patients undergoing stage-Ⅰendometrial cancer surgery

目的探究单孔腹腔镜手术(laparoscopic single-site surery,LESS)对Ⅰ期子宫内膜癌手术患者术后疼痛、焦虑、抑郁等不良情绪的影响,探讨其影响因素的同时评估临床应用效果。方法采用回顾性病例对照研究方法,收集2018年1月至2020年7月在贵州医科大学附属医院妇科住院接受腹腔镜手术治疗的62例Ⅰ期子宫内膜癌患者的围手术期病例资料并进行分析,根据手术方式不同分为LESS(30例,LESS组)和传统多孔腹腔镜手术(conventional multiport laparoscopic surgery,CMPL)(32例,CMPL组),比较分析两组的手术时间、术中出血量、术后肛门排气时间、术后24 h疼痛视觉模拟评分(visual analogue scale,VAS)、术后切口美容满意度评分(cosmetic score,CS)、住院时间、住院费用、病情知晓率、术后短期并发症等指标。同时,采用宗氏焦虑自评量表(self-rating anxiety scale,SAS)和宗氏抑郁自评量表(self-rating depression scale,SDS)对患者的焦虑、抑郁负性情绪进行评估。结果LESS组患者术后胃肠道功能恢复更快(P=0.034)、术后疼痛评分更低(P=0.024)、CS更高(P<0.001);LESS组的手术时间较CMPL组长(P=0.004);LESS组的住院时间(M=5.00)较CMPL组短(M=8.00,P=0.001);两组的术中出血量、住院总费用、术后短期并发症无明显差异。病情知晓情况及手术方式的不同,SAS术后评分差异有统计学意义(P<0.05)。SAS术后评分与术前住院时间及手术时间呈正相关关系(P<0.05),SDS术后评分与术前住院时间呈正相关关系(P=0.032)。结论LESS在Ⅰ期子宫内膜癌手术中应用是安全、有效的,能有效减少术后早期疼痛,更好的改善患者术后切口美容效果。影响患者术后负性情绪的因素很多,其中手术方式、手术时间、术前住院时间、术前病情知晓情况可能与患者负性情绪相关,LESS可能有助于改善患者负性情绪。

Objective To explore the single-port laparoscopy in patients undergoing stageⅠendometrial cancer surgery for patients with pain,anxiety,depression,bad mood,discuss the influence factors and to evaluate the clinical application effect.Methods A retrospective analysis were performed on the perioperative case data of patients who underwent laparoscopic surgery for stageⅠendometrial cancer in the Department of Gynecology of the Affiliated Hospital of Guizhou Medical University from Jan.2018 to Jul.2020,including a total of 62 patients.According to the different surgical methods,the patients were divided into the single-port laparoscopic group(30 cases)and the conventional multiport laparoscopic group(32 cases).The operative time,intraoperative blood loss,postoperative exhaust time,24 h postoperative pain visual analogue score,postoperative incision cosmetic score,hospital stay,hospital cost,disease awareness rate,short-term postoperative complications and other indicators were compared and analyzed between the two groups.Meanwhile,Self-rating anxiety scale and Self-rating depression scale were used to evaluate the patients′anxiety,depression and negative emotions.Results In the single-port laparoscopic group,the postoperative gastrointestinal function recovered faster(P=0.034),the postoperative pain score was lower(P=0.024),and the cosmetic score was higher(P<0.001).The operation time of the single-port laparoscopic group was longer than that of the conventional multiport laparoscopic group(P=0.004).The length of stay in the single-port laparoscopic group(M=5.00)was shorter than that in the conventional multiport laparoscopic group(M=8.00,P=0.001).There were no significant differences in intraoperative blood loss,total hospitalization cost and postoperative short-term complications between the two groups.The difference in postoperative score of SAS was statistically significant with different condition awareness and different surgical methods(P<0.05).The postoperative score of SAS was positively correlated with the length of hospital stay before operation and the duration of operation(P<0.05).The postoperative score of SDS was positively correlated with the length of hospital stay before surgery(P=0.032).Conclusions Single-port laparoscopic surgery is safe and effective in the operation of stageⅠendometrial cancer,which can effectively reduce the early postoperative pain and better improve the incision beauty of patients.There are many factors that affect patients′negative emotions after surgery,among which the operation method,operation time,preoperative hospitalization time and preoperative condition awareness may be related to patients′negative emotions.Less may help improve patients′negative emotions.