经脐单孔腹腔镜前哨淋巴结活检术在早期子宫内膜癌手术中的应用

Application of Transumbilical Single-Port Laparoscopic Sentinel Lymph Node Biopsy in Early Endometrial Cancer Surgery

目的:评价早期子宫内膜癌(endometrial cancer,EC)患者接受单孔腹腔镜行前哨淋巴结活检手术的安全性及可行性。方法:回顾性收集2021年1月至2022年12月于苏州大学附属独墅湖医院接受单孔腹腔镜及传统多孔腹腔镜行早期EC手术的EC患者资料,对两种手术方式的围手术期相关指标进行分析与评估,排除不符合纳入标准的患者后,单孔腹腔镜组最终12例完成经脐单孔腹腔镜前哨淋巴结活检+全子宫双附件切除术,传统腹腔镜组最终14例完成传统多孔腹腔镜前哨淋巴结活检+全子宫双附件切除术。结果:两组患者均顺利完成手术,无中转开腹手术,无术中或术后输血发生。单孔组患者在术中估计出血量少于多孔组、术后住院时长少于多孔组、术后第1天NRS疼痛评分低于多孔组、术后导尿管留置时间少于多孔组,差异均有统计学意义(P<0.05);单孔组与多孔组手术时间、患者术前术后血红蛋白数值差值、术后肛门排气时间,差异无统计学意义(P>0.05);两组患者出院时伤口均愈合良好,术后一月复查均无脐疝、切口感染发生。结论:单孔腹腔镜下前哨淋巴结活检在早期EC手术是安全可行的,与传统多孔腹腔镜相比术中失血量减少、术后恢复快,并具备微创、美观的优点,有临床推广价值。

Objective:To evaluate the safety and feasibility of laparoscopic single-site surgery for sentinel lymph node biopsy in early endometrial cancer(EC)patients.Methods:Patients with early endometrial cancer who underwent single-site laparoscopy and traditional multi-site laparoscopy in Dushu Lake Hospital Affiliated to Soochow University from January 2021 to December 2022 were retrospectively collected.And the perioperative indexes of the two surgical methods were analyzed and evaluated.After excluding the patients who did not meet the inclusion criteria,12 patients in the single-port laparoscopy group finally underwent transumbilical single-port laparoscopic sentinel lymph node biopsy+total hysterectomy plus double adnexa resection,and 14 patients in the conventional laparoscopy group finally underwent conventional multi-port laparoscopic sentinel lymph node biopsy+total hysterectomy plus double adnexa resection.Results:Patients in both groups underwent the surgery successfully without conversion to open surgery,and no intraoperative or postoperative blood transfusion occurred.The intraoperative bleeding of patients in the single-hole group was statistically less than that in the multi-hole group;the postoperative length of stay was statistically less than that in the multi-hole group;the NRS pain scoreI day after surgery was statistically lower than that in the multi-hole group;the postoperative catheter retention was statistically less than in the multi-hole group.(P<O.05);there were no statistically significant differences in the operation time,the difference in preoperative and postoperative hemoglobin,and the postoperative anal venting time between the single-hole group and the muli-hole group(P>0.05);both groups had good wound healing at discharge,and neither umbilical hernia nor incisional infection occurred in both groups I month after surgery.Conclusion:Single-port laparoscopic sentinel lymph node biopsy is safe,feasible,minimally invasive and aesthetically pleasing in the surgery for early-stage endometrial cancer.It has decreased intraoperative blood loss and faster postoperative recovery compared with traditional multiport laparoscopy,which is worth clinical promotion.