无入路平台经脐单切口腹腔镜治疗输卵管妊娠临床分析

Single-incision laparoscopic surgery without access platform using conventional laparoscopic instruments versus multi-port laparoscopic surgery for tubal pregnancy

目的探讨无入路平台经脐单切口腹腔镜治疗输卵管妊娠的可行性及安全性。方法回顾性分析2019年1月-2022年6月笔者所在团队诊治的因输卵管妊娠行输卵管切除术的患者的临床资料,根据手术方式不同分为3组,无入路平台经脐单切口腹腔镜组(A组)66例,经脐单孔腹腔镜组(B组)60例,传统腹腔镜组(C组)70例。比较3组患者手术时间、术中出血量、术后排气时间、术后住院时间、术后24 h切口疼痛VAS评分、术后1年切口美容满意度评分等。结果3组患者均顺利完成手术,无更改手术入径,无术中、术后并发症发生。A、B、C 3组的手术时间、术中出血量、术后排气时间、术后住院时间、术后24 h切口疼痛VAS评分比较,差异均无统计学意义(P>0.05),术后1年切口美容满意度评分A、B组之间差异无统计学意义(P>0.05),而A、B组与C组之间差异均有统计学意义(P<0.05)。进一步分析A组(无入路平台单切口组)不同级别主刀医师手术时间显示,副主任及以上职称医师组手术时间略短,但差异无统计学意义(P>0.05)。结论无入路平台经脐单切口腹腔镜输卵管切除术安全可行,学习曲线不长,容易掌握,无需专用单孔入路平台,而效果与经脐单孔腹腔镜相当,值得基层推广。

Objective To investigate the feasibility and safety of transumbilical single-incision laparoscopy without an access platform in the treatment of tubal pregnancy.Methods A total of 196 patients with tubal pregnancy undergoing tubectomy were included in this retrospective cohort study.The patients were divided into three groups according to the different surgical methods,including transumbilical single-incision laparoscopy group without an access platform(group A,n=66),transumbilical single-port laparoscopy group(group B,n=60),and traditional laparoscopy group(group C,n=70).The operative duration,intraoperative bleeding volume,postoperative flatus time,postoperative hospital stay,postoperative 24-hour incision pain VAS score,postoperative 1-month incision cosmetic satisfaction score,and intraoperative and postoperative complications were compared among the three groups.Results The operation was successfully conducted on all patients in the three groups.There was no statistically significant difference in the comparison of operative duration,intraoperative blood loss,postoperative flatus time,postoperative hospital stay,and VAS scores of incision pain 24 hours after operation among groups A,B,and C.The cosmetic satisfaction score of incision one year after the operation had no significant difference between groups A and B,while there were significant differences between group C and group A,and between group C and group B.Further comparative analysis of the operative duration by surgeons of different grades in the group A showed no significant difference in the operative duration among physicians of different grades in the three groups.Conclusion Single-incision laparoscopic surgery without an access platform using conventional laparoscopic instruments for tubal pregnancy is safe,feasible and achieves comparable cosmetic result to transumbilical single-port laparoscopy,which is worth promoting in county-level hospitals.