"筷子技术"用于经脐单孔腹腔镜全子宫切除术的可行性和安全性研究

Feasibility and safety of"chopsticks technique"for the laparoendoscopic single-site surgery total hysterectomy

目的"筷子技术"用于经脐单孔腹腔镜(laparoendoscopic single-site surgery,LESS)全子宫切除术与传统多孔腹腔镜(traditional laparoscopic,TL)全子宫切除术,进行围手术期结局,验证其可行性和安全性。方法采用回顾性队列研究,纳入2016年12月至2019年6月期间,于陆军军医大学附属第一医院妇产科,行LESS全子宫切除术与同期TL全子宫切除术的患者。比较两组的手术时间、术中出血量、术后排气时间、术后12 h和24 h疼痛视觉模拟评分(visual analogue scale,VAS)、术后住院时间、术中和术后并发症发生情况。结果研究共纳入297例患者临床资料,其中LESS全子宫切除术107例(LESS组)、TL全子宫切除术190例(TL组)。两组均顺利完成手术,无中转开腹。两组患者基线均衡。LESS组和TL组的手术时间分别为131 min(102,155)min和125.5 min(92.8,155)min,差异无统计学意义(P>0.05);术中出血量分别为100 ml(100,200)ml和100 ml(100,150)ml,差异无统计学意义(P>0.05);术后排气时间、术后12 h和24 h VAS、围手术期并发症等,差异无统计学意义(P>0.05);两组阴道残端均愈合良好。LESS组术后住院时间比TL组短,差异有统计学意义(P<0.05)。分别比较子宫≥12孕周、子宫<12孕周的患者,LESS组与TL组的手术时间、术中出血量、术后排气时间、术后12 h和24 h VAS、围手术期并发症,差异无统计学意义(P>0.05)。子宫<12孕周LESS组比TL组的术后住院时间缩短,差异有统计学意义(P<0.05)。结论"筷子技术"用于LESS全子宫切除的围手术期结局与TL相似,初步证实了其在LESS术中的可行性和安全性。

Objective To the feasibility and safety of"chopsticks technique"for the laparoendoscopic single-site surgery total hysterectomy were confirmed by peroperative outcome was compared with traditional laparoscopic total hysterectomy.Methods A retrospective cohort study was used in this study.Patients who were included in the laparoendoscopic single-site surgery total hysterectomy and the traditional laparoscopic total hysterectomy of the First Affiliated Hospital of the Army Military Medical University from Dec.2016 to Jun.2019.The operation time,intraoperative bleeding amount,postoperative exhaust time,VAS score after surgery(12 h,24 h),postoperative hospitalization time and postoperative complications of the two groups were compared.Results A total of 297 patients were included in the study,including 107 laparoendoscopic single-site surgery(LESS group)and 190 traditional laparoscopic(TL group).Both groups successfully completed the operation,no case was transferred to laparotomy.Baseline values of patients were balanced in both groups.The operation time of the LESS and TL groups were 131 min(102,155)min and 125.5 min(92.8,155)min with no statistical difference(P>0.05);intraoperative bleeding was 100 ml(100,200)ml and 100 ml(100,150)ml,no statistical difference(P>0.05);there were no statistical differences in postoperative exhaust time,VAS score after surgery(12 h,24 h),postoperative complications(P>0.05);both groups vaginal stump healed well.The LESS group was shorter postoperative hospital stay than the TL group and was statistically significant(P<0.05).For patients at uterine size≥12 weeks gestation and uterine size<12 weeks gestation were compared,there was no statistical difference between LESS group and TL groups in the operation time,postoperative bleeding time,postoperative exhaust time,VAS score after surgery(12 h,24 h),perioperative complications(P>0.05).Among them,for the uterine<12 gestational weeks,The LESS group was shorter postoperative hospital stay than the TL group and was statistically significant(P<0.05).Conclusions The perioperative outcome of the"chopstick technique"for laparoendoscopic single-site surgery total hysterectomy was similar to that of traditional laparoscopic total hysterectomy.The feasibility and safety in the laparoendoscopic single-site surgery were preliminarily demonstrated.