经腹壁瘢痕入路单孔腹腔镜子宫肌瘤剥除术临床分析

Clinical analysis of single-port laparoscopic myomectomy via abdominal scar approach

目的:初步探讨经腹壁瘢痕入路单孔腹腔镜子宫肌瘤剥除术的安全性和可行性。方法:回顾性分析2020年6月至2023年7月在南京医科大学附属常州第二人民医院妇科行单孔腹腔镜子宫肌瘤剥除术的42例子宫肌瘤患者临床资料。根据手术方式分为经腹壁瘢痕入路单孔腹腔镜组14例和同期匹配的经脐入路单孔腹腔镜组28例。观察并比较两组患者的手术时间、术中出血量、血红蛋白下降值、术后首次肛门排气时间、术后住院天数、治疗费用、美容评分(cosmetic score,CS)和疼痛视觉模拟评分(visual analog score,VAS)。结果:两组患者的手术均顺利完成,术中未更改手术方式,术后未出现并发症。两组患者的术后住院天数、治疗费用、CS评分和术后12 h VAS评分比较无统计学差异(P>0.05)。经腹壁瘢痕入路单孔组的手术时间、术中出血量和血红蛋白下降值明显少于经脐入路单孔组;但经脐入路单孔组的术后首次肛门排气时间要短于经腹壁瘢痕入路单孔组,差异均有统计学意义(P<0.05)。结论:经腹壁瘢痕入路单孔腹腔镜子宫肌瘤剥除术安全、可行,既秉承了微创手术疼痛轻、恢复快、"无痕"的理念,又优化手术步骤,缩短手术时间,减少术中出血,易于临床推广应用。

Objective To investigate the safety and feasibility of single-port laparoscopic myomectomy via of abdominal scar approach.Methods Clinical data of 42 patients with uterine fibroids who underwent single-port laparoscopic uterine myomectomy in the Department of Gynecology of the Affiliated Changzhou Second People's Hospital of Nanjing Medical University from Jun.2020 to Jul.2023 were retrospectively analyzed.The patients were divided into the single-port laparoscopic group with transabdominal scar approach(14 cases)and in the simultaneous matched single-port laparoscopic group with transumbilical approach(28 cases)according to the surgical methods.The operation time,the loss of blood,the change of hemoglobin,the recovery time of gastrointestinal function,postoperative hospitalization days,treatment cost,cosmetic score(CS),and visual analog score(VAS)of pain were observed and compared between the two groups.Results All operations were successfully completed in both groups,no intraoperative surgical changes and no postoperative complications.There was no statistically significant difference in the postoperative hospitalization days,treatment cost,CS score,and VAS score at 12 h after surgery between the two groups(P>0.05).The operation time,the loss of blood and hemoglobin drop were significantly lower in the transabdominal scar approach group than in the transumbilical single-port group,however,the recovery time of gastrointestinal function was shorter in the transumbilical approach group than in the transabdominal scar approach group,with statistically significant differences(P<0.05).Conclusion Single-port laparoscopic myomectomy transabdominal scar approach is safe and feasible,which adheres to the concept of minimally invasive surgery with less pain,faster recovery and"no scar",and optimizes the surgical steps,shortens the surgical time,reduces intraoperative bleeding,and is easy to be promoted for clinical application.