经脐小切口肌瘤分碎术在腹腔镜子宫肌瘤剔除术中的应用

Application of morcellation through small umbilical incision in laparoscopic myomectomy

探讨经脐小切口肌瘤分碎术在腹腔镜子宫肌瘤剔除术中的应用效果。回顾性分析2018年2月至2019年10月苏州大学附属第二医院行腹腔镜子宫肌瘤剔除手术患者67例,采用将肌瘤装入一次性腹腔镜手术切除组织收集器,经脐小切口手术刀分碎后取出。67例患者均经脐部小切口顺利取出肌瘤,腹盆腔及穿刺孔均未见肌瘤组织碎片残留,收集器无渗漏,术前术后腹盆腔冲洗液细胞学检查未见子宫平滑肌梭形细胞或恶性肿瘤细胞。术后病理诊断为子宫平滑肌瘤64例,富于细胞型平滑肌瘤2例,子宫平滑肌瘤囊性变1例。子宫肌瘤重量110~420(227±106)g;手术时间58~274(107±45)min;取出标本时间8~27(18.4±10.6)min;缝合脐部切口时间4~11(7.8±4.6)min;术后24、48、72 h切口疼痛数字评分(NRS)分别为4~6(4.5±1.2)分、2~4(2.7±1.1)分、1~2(1.6±0.4)分;Hollander切口愈合评分3~5(4.6±0.5)分。术后脐部切口美观,愈合好。经脐小切口肌瘤分碎术是一种安全实用的标本取出方法,有助于减少医源性肿瘤播散。

To investigate the effect of morcellation through small umbilical incision in laparoscopic myomectomy.A total of 67 patients who underwent laparoscopic myomectomy in the Second Affiliated Hospital of Soochow University from February 2018 to October 2019 were retrospectively analyzed.Fibroids were loaded into disposable laparoscopic collection bags and then retrieved through small umbilical incision.The operation of all 67 patients were successfully completed.There were no leakage of collection bags or fibroids fragments found in the peritoneal cavity and the puncture holes.There were no spindle cells or malignant cells found in the peritoneal lavage cytology before and after operation.There were 64 cases of uterine leiomyoma,2 cases of cellular leiomyoma,and 1 case of leiomyoma with cystic degeneration in postoperative pathological diagnosis.The weight of fibroid was 110-420(227±106)g;the operation time was 58-274(107±45)min;the time for retrieving specimen was 8-27(18.4±10.6)min;the time for suturing umbilical incision was 4-11(7.8±4.6)min;the score of pain numeric rating scale(NRS)at 24 h,48 h,72 h after operation was 4-6(4.5±1.2)points,2-4(2.7±1.1)points,and 1-2(1.6±0.4)points,respectively;the Hollander wound evaluation score was 3-5(4.6±0.5)points.The umbilical incisions looked and healed well after operation.Morcellation through small umbilical incision in laparoscopic myomectomy is a safe and practical method of specimen removal,which may help to reduce the dissemination of iatrogenic tumors.