基于倾向性评分匹配的经脐单孔腹腔镜与传统腹腔镜手术治疗卵巢囊肿的疗效分析

Comparison of the Efficacy of Transumbilical Laparoendoscopic Single Site Surgery and Traditional Laparoscopic Surgery in the Treatment of Ovarian Cysts:a Propensity Score Matching Study

目的探讨经脐单孔腹腔镜手术治疗卵巢囊肿的疗效和安全性。方法回顾性分析2020年1月~2021年12月我院252例腹腔镜卵巢囊肿剥除术的临床资料,其中单孔腹腔镜卵巢囊肿剥除术58例(单孔组),传统腹腔镜卵巢囊肿剥除术194例(四孔组),经倾向性评分匹配(propensity score matching,PSM),最终49对数据成功匹配,比较2组手术时间、术中出血量、术后胃肠道恢复排气时间、住院时间、术中囊肿溢出率、术后围术期疼痛评分、术后瘢痕满意度、术后并发症发生率、住院总费用及囊肿复发率等。结果单孔组和四孔组比较,住院总费用较高[15125.3(13851.2,16420.0)元vs.13439.3(11993.1,15804.9)元,Z=-2.995,P=0.003],术后胃肠道恢复排气时间缩短[15.8(14.0,18.0)h vs.19.0(16.6,22.2)h,Z=-4.973,P=0.000],住院时间缩短[5(5,6)d vs.7(6,7)d,Z=-4.376,P=0.000],术后24 h疼痛评分较低[4(4,5)分vs.5(4,6)分,Z=-4.225,P=0.000],术后切口瘢痕满意度较高(97.9%vs.87.3%,χ^(2)=4.404,P=0.036)。2组手术时间[80(60,90)min vs.70(50,90)min,Z=-1.005,P=0.315]、术中出血量[20(10,50)ml vs.20(10,50)ml,Z=-0.154,P=0.878]、术中囊肿溢出率[20.4%(10/49)vs.20.4%(10/49),χ^(2)=0.000,P=1.000]、术后并发症发生率[4.1%(2/49)vs.8.2%(4/49),χ^(2)=0.178,P=0.673]均无统计学差异。2组患者短期随访均无囊肿复发。结论单孔腹腔镜卵巢囊肿剥除术是一种安全、有效的术式,术后短期疼痛及切口满意度较传统腹腔镜手术具有显著优势。

Objective To investigate the efficacy and safety of transumbilical laparoendoscopic single site surgery(TU-LESS)in the treatment of ovarian cysts.Methods Clinical data of 252 patients who underwent laparoscopic ovarian cystectomy in our hospital from January 2020 to December 2021 were analyzed retrospectively.There were 58 cases of single-port laparoscopy resection(single-port group)and 194 cases of traditional laparoscopic resection(four-port group).By using the propensity score matching(PSM),a total of 49 pairs of data were successfully matched.The operation time,intraoperative blood loss,postoperative gastrointestinal recovery exhaust time,hospitalization time,intraoperative cyst overflow rate,postoperative pain visual analogue score(VAS),postoperative scar satisfaction,postoperative complication rate,total hospitalization cost,and cyst recurrence rate were compared between the two groups.Results Compared with the four-port group,the single-port group had higher total cost of hospitalization[15125.3(13851.2,16420.0)yuan vs.13439.3(11993.1,15804.9)yuan,Z=-2.995,P=0.003],earlier postoperative gastrointestinal recovery exhaust time[15.8(14,18)h vs.19.0(16.6,22.2)h,Z=-4.973,P=0.000],shorter hospital stay[5(5,6)d vs.7(6,7)d,Z=-4.376,P=0.000],lower VAS score at 24 hours after operation[4(4,5)points vs.5(4,6)points,Z=-4.225,P=0.000],and higher satisfaction of postoperative incision scar(97.9%vs.87.3%,χ^(2)=4.404,P=0.036).There were no significant differences in operation time[80(60,90)min vs.70(50,90)min,Z=-1.005,P=0.315],intraoperative blood loss[20(10,50)ml vs.20(10,50)ml,Z=-0.154,P=0.878],intraoperative cyst discharge rate[20.4%(10/49)vs.20.4%(10/49),χ^(2)=0.000,P=1.000],postoperative complication rate[4.1%(2/49)vs.8.2%(4/49),χ^(2)=0.178,P=0.673]between the two groups.There was no cyst recurrence in both groups during short-term follow-ups.Conclusion For ovarian cystectomy,TU-LESS is a safe,effective approach with less short-term pain and better incision satisfaction than traditional laparoscopic surgery.