经脐单孔腹腔镜囊肿剥除术中增加辅助孔治疗巨大卵巢囊肿效果

Effect observation of transumbilical laparoendoscopic single-site combined with auxiliary port used in cystectomy of the patients with giant ovarian cyst

目的:探讨经脐单孔腹腔镜囊肿剥除术增加辅助孔治疗巨大卵巢囊肿的临床疗效及安全性。方法:回顾性分析2017年1月—2020年6月在本院接受手术治疗的84例巨大卵巢囊肿(直径≥10 cm)患者临床资料,根据术式不同分组,接受增加辅助孔的经脐单孔腹腔镜囊肿剥除术治疗41例为单孔组,接受常规多孔腹腔镜卵巢囊肿剥除术43例为多孔组。比较两组手术相关指标、腹壁外观满意度及并发症发生情况,术后24h、72h评价疼痛视觉模拟量表(VAS)评分,术前及术后1、3个月检测血清雌二醇(E_(2))、促卵泡生成素(FSH)、促黄体生成素(LH)、抗苗勒氏管激素(AMH)。结果:单孔组手术时间(78.7±16.9min)长于多孔组,肛门排气时间(25.7±8.1h)短于多孔组(均P<0.05),两组术中出血量、术后住院时间及术后血红蛋白下降量无差异(P>0.05)。囊液渗漏率单孔组(2.4%)低于多孔组(16.3%)(P<0.05)。术后24h、72h时单孔组的VAS评分均低于多孔组,术后1个月单孔组的腹壁外观满意度评分高于多孔组(均P<0.05)。术后1个月,单孔组E2、AMH高于多孔组,FSH、LH低于多孔组(均P<0.05),术后3个月时两组E2、AMH、FSH、LH水平无差异(P>0.05)。结论:增加辅助孔的经脐单孔腹腔镜囊肿剥除术治疗巨大卵巢囊肿具有良好的器械操控性及安全性,能够减轻术后疼痛、缩短胃肠功能康复时间并提高腹壁外观满意度,且囊液渗漏风险更低。

Objective:To explore the clinical efficacy of transumbilical laparoendoscopic single-site combined with auxiliary port used in cystectomy of the patients with giant ovarian cyst.Methods:The clinical data of 84 patients with giant ovarian cyst(diameter≥10cm)from January 2017 to June 2020 were analyzed retrospectively.According to the surgery,these patients were divided 41 patients experienced transumbilical laparoendoscopic single-site cystectomy with auxiliary port in group A and 43 patients experienced routine porous laparoscopic cystectomy in group B.The surgery-related indicators,the satisfaction of abdominal wall appearance,and the complications rate of the patients were compared between the two groups.The pain visual analog scale(VAS)score was evaluated the pain degree of the patients at 24h and 72h after surgery.The levels of serum estradiol(E2),follicle stimulating hormone(FSH),luteinizing hormone(LH),and anti-Müllerian hormone(AMH)of the patients were measured before surgery,and 1 and 3 month after surgery.Results:The operative time(78.7±16.9min)of the patients in group A was significant longer than that of the patients in group B,and the anal exhaust time(25.7±8.1h)of the patients in group A was significant shorter than that of the patients in group B(both P<0.05).There were no significant differences in intraoperative blood loss,postoperative hospital stay time,and postoperative hemoglobin reduction value of the patients between the two groups(P>0.05).The rate of fluid leakage(2.4%)of the patients in group A was significant lower than that(16.3%)of the patients in group B(P<0.05).The VAS scores of the patients in group A in postoperative 24h and 72h were significant lower than those of the patients in group B,and the satisfaction score of abdominal wall appearance of the patients in postoperative 1 month in group A were significant higher than those of the patients in group B(P<0.05).1 month after surgery,the levels of E2 and AMH of the patients in group A were significant higher than those of the patients in group B,but the levels of FSH and LH of the patients in group A were significant lower than those of the patients in group B(P<0.05),there were no significant differences in the levels of E2,AMH,FSH,and LH of the patients in 3 months after surgery between the two groups(P>0.05).Conclusion:The transumbilical laparoendoscopic single-site combined with auxiliary port used in cystectomy of the patients with giant ovarian cyst has good instrument manipulation and safety,which can reduce the postoperative pain,shorten the recovery time of gastrointestinal function,and improve the satisfaction of abdominal wall appearance,and has lower risk of cystic fluid leakage.