经脐单孔腹腔镜手术增加辅助孔治疗妇科疾病的临床分析

Clinical outcome of transumbilical laparoendoscopic single-site surgery with an auxiliary port in gynecological diseases

目的评估经脐单孔腹腔镜手术术中增加1个辅助孔治疗妇科疾病的可行性和安全性。方法回顾性分析2017年8月—2020年7月间因妇科疾病在同济大学附属第一妇婴保健院妇科行经脐单孔腹腔镜手术(TU-LESS)的56例患者的临床资料。术中根据手术需求在主刀医师同侧或对侧增加1个5 mm辅助孔,并根据患者病情进行手术操作。记录患者的手术时间、术中出血量、术中有无输血及脏器损伤;术后12 h疼痛VAS评分、手术前后血红蛋白差值、术后排气时间、术后住院时间和远期并发症的发生情况。结果56例患者均于TU-LESS术中增加1个辅助孔,手术均顺利完成。其中,42例患者在反麦氏点增加辅助孔,14例患者在麦氏点增加辅助孔。56例患者的手术时间范围为60~330 min,术中出血量范围为10~600 mL。手术前后血红蛋白差值范围为-2.00~41.00 g/L。术后12 h疼痛VAS评分范围为1~2分,术后排气时间范围为12~45 h,术后住院时间范围为3~10 d。56例患者中,28例伴有盆、腹腔严重粘连,11例系巨大病灶(子宫肌瘤直径≥7 cm或卵巢囊肿直径≥10 cm),11例病变部位特殊,6例术中创面渗血活跃。结论TU-LESS增加1个辅助孔兼具单孔腹腔镜手术恢复快、疼痛轻和多孔腹腔镜便于操作的优势,适用于单孔腹腔镜难以开展的手术。

Objective To evaluate the feasibility and safety of adding an auxiliary port in transumbilical laparoendoscopic single-site surgery for gynecological diseases.Methods A retrospective analysis was conducted in 56 patients with gynecological diseases who underwent transumbilical laparoendoscopic single-site surgery in our hospital between August 2017 and July 2020.The 5 mm auxiliary port was added in the same side or the opposite side of the surgeon according to the need of the operation.Operation time,intraoperative blood loss,blood transfusion and organ damage were evaluated,and 12-hour postoperative pain visual analog scale(VAS)score,hemoglobin difference(preoperative/postoperative),postoperative exhaust time,postoperative hospital stay and late complications were observed.Results An auxiliary hole was added during the operation in all the 56 patients,and the operation was successfully completed.There were 42 auxiliary holes on the anti-McBurney point and 14 holes on the McBurney point.The operation time ranged from 60 to 330 min.Intraoperative blood loss ranged from 10 to 600 mL.The preoperative/postoperative hemoglobin difference ranged from-2.00 to 41.00 g/L.The VAS pain score ranged from 1 to 2 at 12 h postoperatively.Exhaust time was 12 to 45 h postoperatively.Postoperative hospital stay was 3 to 10 d.Of the 56 patients,28 had severe adhesions in the pelvic and abdominal cavity,11 had huge lesions(uterine fibroids diameter≥7 cm or ovarian cyst diameter≥10 cm),11 had abnormal lesion site,and 6 had intraoperative active blood oozing from the wound.Conclusion The addition of an auxiliary hole in transumbilical laparoendoscopic single-site surgery has the advantages of fast recovery,less pain and easy operation.It is suitable for operations difficult to be carried out by single-site laparoscope.