“画碗式”全子宫切除术在单孔及多孔腹腔镜手术中临床效果分析

The clinical efficacy of"bowl drawing"hysterectomy in single and multi-port laparoscopy

目的评估"画碗式"腹腔镜全子宫切除术(total laparoscopic hysterectomy,TLH)在经脐单孔及多孔TLH的可行性及临床优势。方法前瞻性纳入2016年3月至2021年6月重庆医科大学附属第一医院妇科,拟诊良性疾病拟行TLH患者311例,手术由同一医师主刀。经术中探查后,对符合条件的患者采用"画碗式"程序化进行手术。"画碗式"TLH包括三大特征:大小适中、一笔到底、分侧完成。手术处理遵循"一个中心两个基本点"。术后1个月和3个月门诊随访。记录患者围手术期及随访资料。最终入组患者215例,其中114例多孔TLH、101例经脐单孔TLH。结果所有入组患者均按照"画碗式"TLH完成手术,无重大并发症发生。两组间的一般资料、术中出血量、住院时间、术后并发症等差异无统计学意义。多孔组平均手术时间(83.6±22.6)min,经脐单孔组平均手术时间(98.1±22.6)min,差异有统计学意义(P<0.05)。结论"画碗式"TLH安全、高效,适用于多孔及经脐单孔TLH操作,适合临床推广。

Objective To evaluate the feasibility and clinical advantages of"bowl drawing"hysterectomy in single and multi-port laparoscopy.Methods From Mar.2016 to Jun.2021,311 patients with benign diseases were prospectively included in the present study.All total laparoscopic hysterectomy(TLH)were performed by one surgeon for uniformity.After intraoperative exploration,the eligible patients were operated following a fixed procedure like drawing a simple bowl,including 3 points:a moderate size,one stroke to the end and from side to side.Surgical principles follow"one center task and two basic points".All patients were followed up at 1 and 3 months after operation.The perioperative and follow-up data were recorded.A total of 215 patients were enrolled,including 114 cases of multi-port TLH and 101 cases of single port TLH.Results All patients underwent"bowl drawing"TLH without major complications.There was no significant difference in general data,intraoperative bleeding,hospital stay and postoperative complications between the two groups.The average operation time was(83.6±22.6)min in the multi-port TLH group and(98.1±22.6)min in the single port TLH(P<0.05).Conclusions"bowl drawing"TLH is safe and efficient.It is suitable for both multi-port and single port TLH.