单孔无气腹腔镜手术与传统腹腔镜手术对妇科良性疾病患者血流动力学、凝血功能及并发症的影响

Effect of single port airless laparoscopic surgery versus traditional laparoscopic surgery on hemodynamics,coagulation function and complications in patients with gynecological benign diseases

目的比较单孔无气腹腔镜手术与传统腹腔镜手术对妇科良性疾病患者血流动力学、凝血功能及并发症的影响。方法选取80例行腹腔镜手术治疗的妇科良性疾病患者,随机分为对照组与研究组,各40例。对照组采用传统腹腔镜手术治疗,研究组采用单孔无气腹腔镜手术治疗。比较两组手术指标(手术时间、术中出血量、术后肛门排气时间及术后6 h、24 h疼痛程度)、凝血功能指标[凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)及D-二聚体水平]、血流动力学指标[平均动脉压(MAP)、心率、气道峰压、呼气末二氧化碳分压(PetCO_(2))],以及并发症发生情况。结果与对照组比较,研究组手术时间、术后肛门排气时间更短,术中出血量更少,术后6 h、24 h疼痛评分更低(P<0.05);术中30 min、术毕时,研究组PT、APTT、TT及D-二聚体水平低于对照组(P<0.05);术中60 min、术毕时,研究组MAP、心率、气道峰压及PetCO_(2)低于对照组(P<0.05);研究组并发症总发生率低于对照组(P<0.05)。结论相较于传统腹腔镜手术,单孔无气腹腔镜手术在妇科良性疾病的治疗中更具优势,可减少术中出血量,减轻患者疼痛程度,对凝血功能、血流动力学影响更小,并发症发生率更低。

Objective To compare the effect between single port airless laparoscopic surgery and traditional laparoscopic surgery on hemodynamics,coagulation function,and complications in patients with gynecological benign diseases.Methods A total of 80 patients with gynecological benign diseases undergoing laparoscopic surgery for treatment were selected,and they were randomly assigned to control group or study group,with 40 cases in each group.The control group received traditional laparoscopic surgery for treatment,whereas the study group was treated with single port airless laparoscopic surgery.The operative indices(operation duration,intraoperative bleeding volume,postoperative anal exhaust time,and 6-hour and 24-hour postoperative pain degree),and coagulation function indices(prothrombin time[PT],activated partial thromboplastin time[APTT],thrombin time[TT],and D-dimer level),as well as hemodynamic indices(mean arterial pressure[MAP],heart rate,peak airway pressure,partial pressure of end-tidal carbon dioxide[PetCO_(2)]);in addition,the occurrence of complications were compared between the two groups.Results Compared with the control group,the study group exhibited shorter operation duration,postoperative anal exhaust time,less intraoperative bleeding volume,and a lower pain score 6 and 24 hours after operation(P<0.05).The study group yielded shorter PT,APTT,and TT,and a lower level of D-dimer as compared with the control group 30 minutes during surgery and at the end of surgery(P<0.05).The study group interpreted lower MAP,heart rate,peak airway pressure,and PetCO_(2) as compared with the control group 60 minutes during surgery and at the end of surgery(P<0.05).The total incidence rate of complications of the study group was lower than that of the control group(P<0.05).Conclusion Compared with traditional laparoscopic surgery,single port airless laparoscopic surgery for the treatment of gynecological benign diseases exerts more advantages,which can reduce intraoperative bleeding volume,relieve patients'pain degree,exerting smaller effects on coagulation function and hemodynamics,and its incidence rate of complications is lower.