微通道单孔腹腔镜技术在子宫肌瘤全子宫切除术中的应用

Application of micro-channel single-port laparoscopic technique in total hysterectomy for uterine fibroids

目的探讨自制单孔腹腔镜入路平台以及微通道经脐单孔腹腔镜全子宫切除术治疗子宫肌瘤的可行性和安全性。方法将114例患有子宫肌瘤疾病需行全子宫切除术的患者分为3组:微通道经脐单孔腹腔镜组38例(微通道组)、标准通道经脐单孔腹腔镜组25例(标准通道组)、多孔腹腔镜组51例(多孔组),其中微通道组和标准通道组使用自制单孔腹腔镜入路平台。比较3组患者手术时间、术中出血量、术前术后血红蛋白数值变化、术后VAS疼痛评分、切口美容评分、术后并发症、术后胃肠道恢复时间、治疗费用及住院天数。结果微通道组相对于其他两组,术中出血更少,住院时间更短,术后恢复更快,术后VAS评分更低,术后美容评分更高,差异有统计学意义(P<0.05);经脐单孔腹腔镜手术相较于多孔腹腔镜组有更短的出院时间、更低的疼痛评分、更好的美容评分,差异有统计学意义(P<0.05);3组术后并发症的发生率,术后使用止疼药的比率,术后血红蛋白的改变无统计学差异(P>0.05)。结论微通道经脐单孔腹腔镜能安全、有效治疗子宫肌瘤,提高患者的治疗效果;自制单孔腹腔镜入路平台安全有效,能减轻患者治疗费用。

Objective To investigate the feasibility and safety of transumbilical single-port laparoscopic total hysterectomy with a self-made single-port laparoscopic platform for uterine fibroids.Methods 114 patients with uterine fibroids who needed total hysterectomy were divided into 3 groups:Microchannel transumbilical single-port laparoscopy group(group Micro-channel,n=38),standard access transumbilical single-port laparoscopy group(group Single-port,n=25)and traditional laparoscopy group(group Traditional,n=51),in which self-made single-port laparoscopic access platform was used in group Micro-channel and group Single-port.The operation time,intraoperative blood loss,preoperative and postoperative hemoglobin value changes,postoperative VAS pain score,incision cosmetic score,postoperative complications,postoperative gastrointestinal recovery time,treatment costs and hospital stay were compared among the three groups.Results Compared with the other two groups,Microchannel transumbilical single-port laparoscopy group had less intraoperative blood loss,shorter hospital stay,faster postoperative recovery,lower postoperative VAS score and higher postoperative cosmetic score,and the differences were statistically significant(P<0.05).Transumbilical single-port laparoscopic surgery had shorter discharge time,lower pain scores,and better cosmetic scores than traditional laparoscopic surgery,and the differences were statistically significant(P<0.05).There was no significant difference in the incidence of postoperative complications,the rate of postoperative analgesic use and the change of postoperative hemoglobin among the three groups(P>0.05).Conclusion Microchannel transumbilical single-port laparoscopic surgery is safe and effective in the treatment of uterine fibroids,and can improve the therapeutic effect of patients.The self-made single-port laparoscopic platform is safe and effective,and can reduce the cost of treatment for patients.