妊娠期行经脐单孔腹腔镜巨大卵巢囊肿剥除手术7例临床分析

Clinical Analysis of 7 Cases of Laparoendoscopic Single-site Surgery with Giant Adnexal Masses in Pregnancy

目的 探讨妊娠期巨大卵巢囊肿行经脐单孔腹腔镜卵巢囊肿剥除手术的临床疗效及安全性。方法 选取福建省妇幼保健院行经脐单孔腹腔镜卵巢巨大肿物剥除的7例妊娠患者为研究对象,选取时间为2020年12月至2022年5月,对其临床资料进行回顾性分析。通过收集手术时间、术中出血量、术后并发症、住院时间、术后疼痛情况、术后最高体温、术后肛门排气时间、术后病理类型、围手术期并发症、切口愈合情况,有无脐疝等,以及随访患者分娩与否、分娩周数、分娩方式、新生儿有无畸形,以此观察其妊娠结局,对妊娠期行该手术方法的临床疗效及安全性做出评价。结果 7例妊娠合并卵巢巨大囊肿患者,所有手术均顺利进行,均未中转为开腹或传统腹腔镜手术。7例患者的平均手术时间(84.00±29.89)min,平均术中出血量(11.85±6.76)mL,平均住院时间(7.14±1.57)d,术后平均VAS评分(1.28±1.00)分,术后体温36.2~37.3℃,平均肛门排气时间(1.71±0.95)d。手术病理检查结果均为卵巢良性肿瘤,其中畸胎瘤4例,黏液性囊腺瘤2例,浆液性囊腺瘤1例。术后切口均愈合良好,均无切口感染。围手术期均未发生流产、感染等并发症。随访患者分娩情况,7例最终成功分娩,其中5例顺产,2例剖宫产(1例孕36+2周因胎儿窘迫行剖宫产,1例孕38+2周因臀位行剖宫产)。新生儿均无畸形,其母亲妊娠过程、产时及产后均未出现脐疝。结论 对妊娠期巨大卵巢囊肿,应用单孔腹腔镜卵巢囊肿剥除术临床疗效好,安全可行。

Objective To estimate the safety and feasibility impact on clinical in pregnancy outcomes of laparoendoscopic single-site surgery in pregnant patients with giant adnexal masses.Methods A total of 7 cases underwent laparoendoscopic single-site surgery for giant adnexal masses of Department of Gynecology and Obstetrics,Fujian Provincial Maternity and Children's Health Hospital in Mar 2020 to May 2022.We analyzed the safety of surgery and observe its pregnancy outcomes by collecting surgical results and obstetric and neonatal outcomes,including operation time,intraoperative blood volume,hospitalization,postoperative,complications,postoperative pain,postoperative maximum body temperature,postoperative anus exhaust time,postoperative pathological type,perioperative complications,follow-up delivery,childbirth week,mode of delivery,fetal malformation,umbilical hernia,etc.Results Among the 7cases of pregnancy with Giant adnexal mass,ALL the operation process was smooth,all of them were not converted to laparotomy or traditional laparoscopy.The average operation time was(84.00±29.89) min,the average intraoperative bleeding was(11.85±6.76) mL,the average postoperative anal exhaust time was(7.14±1.57) days,the postoperative pain scores of all patients was(1.28±1.00) scores and the postoperative body temperature was 36.2-37.3 ℃.Postoperative anus exhaust time was(1.71±0.95) days.0f all the cases,the postoperative pathological type were all benign ovarian tumors,including 4 teratoma,2 mucinous cystadenoma and 1 serous cystadenoma.All the incisions healed well and there was no incision infection and no complications such as abortion and infection occurred during the perioperative period.The delivery status of the patients was followed up,and the results showed that 5 cases were normal delivery and 2cases were cesarean section(one patient was given a cesarean section for fetal distress at 36+2 week gestation.And one patient was for breech positionat 38+2 week gestation).The results of fetal morphological observation showed that all 7 fetuses had no malformations,and there was no umbilical hernia during pregnancy,delivery,and postpartum.Conclusions Laparoendoscopic single-site surgery with giant adnexal masses appears to be safe for both the mother and the fetus.