经脐单孔腹腔镜下全子宫切除术与经阴道单孔腹腔镜下全子宫切除术在无生育要求子宫肌瘤患者中的应用效果比较

Comparison of Application Effect of Transumbilical Single-port Laparoscopic Panhysterectomy and Transvaginal Single-port Laparoscopic Panhysterectomy in Patients with Uterine Fibroids without Fertility Requirements

目的:探讨经脐单孔腹腔镜下全子宫切除术与经阴道单孔腹腔镜下全子宫切除术在无生育要求子宫肌瘤患者中的应用效果。方法:选取2018年9月-2020年3月本院收治的60例拟行单孔腹腔镜下全子宫切除术无生育要求子宫肌瘤患者,根据信封法将其分为A组和B组,每组30例。A组给予经脐单孔腹腔镜下全子宫切除术,B组给予经阴道单孔腹腔镜下全子宫切除术。比较两组围手术期指标、并发症发生情况、术后镇痛药物使用情况、术后血红蛋白(Hb)下降水平,切口满意度及术后1、3、7 d的疼痛评分。结果:两组术前准备时间、术中出血量、腹腔引流量及术后排气时间比较,差异均无统计学意义(P>0.05);B组手术时间和住院时间均短于A组,差异均有统计学意义(P<0.05)。术后1、3 d,B组VAS评分均低于A组,差异均有统计学意义(P<0.05);术后7 d,B组VAS评分低于A组,但差异无统计学意义(P>0.05)。术后3、7 d,两组VAS评分均低于术后1 d,差异均有统计学意义(P<0.05);术后7 d,两组VAS评分均低于术后3 d,差异均有统计学意义(P<0.05)。A组并发症发生率低于B组,差异有统计学意义(P<0.05)。两组术后7 d镇痛药物使用情况、术后Hb下降水平及切口满意度评分比较,差异均无统计学意义(P>0.05)。结论:经脐单孔腹腔镜下全子宫切除术和经阴道单孔腹腔镜下全子宫切除术均具有术中创伤小、术中出血量小、术后恢复快、减少术后镇痛剂使用量和术后无瘢痕等优点,但经阴道单孔腹腔镜下全子宫切除术能缩短手术时间和住院时间,并减轻患者术后疼痛程度,而经脐单孔腹腔镜下全子宫切除术则能减少术后并发症,临床需结合两种术式优缺点,严格遵守手术适应证,合理选择合适术式,以提高手术成功率和安全性。

Objective:To explore the application effect of transumbilical single-port laparoscopic panhysterectomy and transvaginal single-port laparoscopic panhysterectomy in patients with uterine fibroids without fertility requirements.Method:A total of 60 patients with uterine fibroids without fertility requirements who planned to undergo single-port laparoscopic panhysterectomy from September 2018 to March 2020 were selected,and they were divided into group A and group B according to envelope method,30 patients in each group.Group A was given transumbilical single-port laparoscopic panhysterectomy,and group B was given transvaginal single-port laparoscopic panhysterectomy.The perioperative indicators,the incidence of complications,the use of postoperative analgesics,the decrease of postoperative hemoglobin (Hb),incision satisfaction were compared between two groups,and pain scores at 1,3 and 7 d after operation were compared between two groups.Result:There were no significant differences in preoperative preparation time,intraoperative blood loss,abdominal drainage volume and postoperative exhaust time between two groups (P>0.05).The operation time and hospitalization time of group B were shorter than those of group A,and the differences were statistically significant (P<0.05).At 1 and 3 d after operation,VAS scores of group B were lower than those of group A,the differences were statistically significant (P<0.05);at 7 d after operation,VAS score of group B was lower than that of group A,and the difference was not statistically significant (P>0.05).At 3,7 d after operation,VAS scores of both groups were lower than those of 1 d after operation,the differences were statistically significant (P<0.05);at 7 d after operation,VAS scores of at both groups were lower than those of 3 d after operation,the differences were statistically significant (P<0.05).The incidence of complications of group A was lower than that of group B,and the difference was statistically significant (P<0.05).There were no significant differences in the use of analgesics at 7 d after operation,the decreased level of postoperative Hb and incision satisfaction scores between two groups (P>0.05).Conclusion:Transumbilical single-port laparoscopic panhysterectomy and transvaginal single-port laparoscopic panhysterectomy both have the advantages of small trauma,quick postoperative recovery,mild pain and no incision scar after operation.Among them,transvaginal single-port laparoscopic panhysterectomy can shorten the operative time and hospital stay,and reduce the postoperative incision pain,but transumbilical single-port laparoscopic panhysterectomy can reduce the risk of postoperative complications,and it is necessary to reasonably select the appropriate operative treatment by combining clinical operative indications and disease condition of patients.