经脐单孔腹腔镜在子宫良性疾病手术中的应用研究

Application of laparoendoscopic single-site surgery for benign uterine diseases

目的探讨3种不同入路方式的单孔腹腔镜手术(LESS)在子宫良性疾病中应用的优劣性。方法分析2017年9月—2018年9月甘肃省妇幼保健院完成的子宫良性疾病手术77例,其中传统多孔腹腔镜(MPLS) 42例,专用入路平台单孔腹腔镜手术(SPLS) 22例,手套自制入路平台单孔腹腔镜手术(HPLS) 13例,观察手术时间、住院费用、伤口愈合情况等指标。结果 77例中除子宫切除术SPLS组1例中转传统腹腔镜,其余均顺利完成手术。子宫切除术及子宫肌瘤剔除术3组之间在手术时间差异上均有统计学意义(P <0.05),子宫肌瘤剔除术住院费用SPLS组与HPLS组及MPLS组差异有统计学意义(P <0.05),子宫肌瘤剔除术美容问卷评分MPLS组与HPLS组及SPLS组差异有统计学意义(P <0.05)。术后随访3个月伤口愈合良好,均无切口疝、出血、切口感染等并发症。结论 LESS应用于子宫切除术及子宫肌瘤剔除术具有创伤小、伤口隐蔽、'无瘤原则'等特点,且自制入路平台不增加经济成本。

Objective To explore the advantages and disadvantages of three different approaches of laparoscopic single-port surgery for benign uterine diseases.Methods From Sep.2017 to Sep.2018,we performed surgery on 77 patients with benign uterine diseases in Gansu Provincial Maternity and Child-care Hospital,and of them 42 for multiple-incision laparoscopic surgery(MPLS),22 for single-port laparoscopic surgery(SPLS)and 13 for homemade-port laparoscopic surgery(HPLS).The procedures of LESS surgical techniques were described,the operative time,time for postoperative hospital stay,the hospitalization expense,wound healing were recorded.Results 76 patients were operated on successfully without using an additional trocar and 1 patients required an additional trocar.There were differences between MPLS and SPLS,HPLS group(P<0.05)in the operation time of hysterectomy and myomectomy.As for the expenses,SPLS was different from HPLS and MPLS for myomectomy(P<0.05),as for cosmetic score,MPLS was different from HPLS and SPLS for myomectomy(P<0.05).All the patients manifested no obvious postoperative self-conscious symptom.Conclusion The application of LESS in hysterectomy and myomectomy is characterized by minimal trauma,concealed wound and'no tumour principle'and HPLS does not increase the economic cost.