无入路平台经脐单切口腹腔镜与多孔腹腔镜卵巢囊肿剥除术的临床效果比较
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摘要
目的探讨无入路平台经脐单切口腹腔镜卵巢囊肿剥除术的应用价值。方法将100例需行卵巢囊肿剥除的患者,按照随机数字表法分分为两组,试验组(50例)实施无入路平台经脐单切口腹腔镜卵巢囊肿剥除术,对照组(50例)实施多孔腹腔镜卵巢囊肿剥除术。比较两组的手术时间、术中出血量、住院时间、术后病率、术后肛门排气时间、术后疼痛评分(VAS)、患者满意度等。结果两组患者的术中出血量、手术时间及术后病率差异无统计学意义(P> 0. 05)。试验组住院时间短于对照组,术后疼痛评分(VAS)低于对照组,术后肛门排气时间短于对照组,患者对腹部伤口美容满意度则高于对照组,差异均有统计学意义(P <0. 05)。所有患者手术顺利完成,均无术中、术后严重并发症,无手术死亡病例,无中转开腹手术。结论无入路平台经脐单切口腹腔镜卵巢囊肿剥除术是一种安全、可行、经济,适于在基层医院推广的手术方式,可以达到与单孔腹腔镜一样满意的美容效果和无瘢痕的手术目的,且更容易为患者所接受。
Objective To evaluate the application value of transumbilical single-incision laparoscopic ovarian cystectomy without single port. Methods One hundred patients undergoing the removal of ovarian cysts were randomly divided experimental and control groups.The experimental group( n = 50) was treated with transumbilical single-incision laparoscopic ovarian cystectomy without single port,and the control group( n = 50) was treated by conventional laparoscopic ovarian cystectomy.The operative time,intraoperative blood loss,hospitalization time,postoperative morbidity,postoperative anal exhaust time,VAS score and patients' satisfaction were compared between the two groups.Results There was no significant difference in blood loss,time of operation and postoperative morbidity between the two groups( P > 0. 05).The time of hospitalization,postoperative pain score,postoperative anal exhaust time and the patients' satisfaction were significantly improved in the experimental group when compared to the control group( P < 0. 05).The operation was successful in all cases without postoperative complications,dead cases or failed cases.Conclusion Transumbilical single-incision laparoscopic surgery without single port is a safe,feasible and economical way for ovarian cystectomy.It can achieve the same satisfaction as laparoendoscopic single-site surgery for the purpose of cosmetic and scar-free surgery,and it is more easily accepted by the patients.
Objective To evaluate the application value of transumbilical single-incision laparoscopic ovarian cystectomy without single port. Methods One hundred patients undergoing the removal of ovarian cysts were randomly divided experimental and control groups.The experimental group( n = 50) was treated with transumbilical single-incision laparoscopic ovarian cystectomy without single port,and the control group( n = 50) was treated by conventional laparoscopic ovarian cystectomy.The operative time,intraoperative blood loss,hospitalization time,postoperative morbidity,postoperative anal exhaust time,VAS score and patients' satisfaction were compared between the two groups.Results There was no significant difference in blood loss,time of operation and postoperative morbidity between the two groups( P > 0. 05).The time of hospitalization,postoperative pain score,postoperative anal exhaust time and the patients' satisfaction were significantly improved in the experimental group when compared to the control group( P < 0. 05).The operation was successful in all cases without postoperative complications,dead cases or failed cases.Conclusion Transumbilical single-incision laparoscopic surgery without single port is a safe,feasible and economical way for ovarian cystectomy.It can achieve the same satisfaction as laparoendoscopic single-site surgery for the purpose of cosmetic and scar-free surgery,and it is more easily accepted by the patients.
引文
[1]孙大为.妇科单孔腹腔镜手术学[M].北京:北京大学医学出报社,2015:1-2.
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[3]中华医学会外科学分会腹腔镜与内镜外科学组.单孔腔镜手术技术专家共识.中国实用外科杂志,2010,30(8):665.
[4]吴川江,吴曦.经脐单孔腹腔镜下全腹膜外腹股沟疝修补术的安全性及有效性探讨[J].实用医院临床杂志,2017,14(4):179-181
[5]王梦桥,余建贵,黄河,等.经脐入路腹腔镜阑尾切除术31例手术体会[J].实用医院临床杂志,2012,9(4):180-181.
[6]Dursun P,Gulumser C,Caglar M,et al.Laparoendoscopic single-site surgery for acute adnexal pathology during pregnancy:preliminary experience[J]. The journal of maternal-fetal&neonatal medicine,2013,26(13):1282-1286.
[7]Yoon BS,Park H,Seong SJ,et al.Single-port versus conventional laparoscopic salpingectomy in tubal pregnancy:a comparison of surgical outcomes[J].European journal of obstetrics gynecologyand reproductive biology,2011,159(1):190-193.
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[9]Kim YW,Park BJ,Ro DY,et al.Single-port laparoscopic myomectomy using a new single-port transumbilical morcellation system:initial clinical study[J]. Journal of minimally invasive gynecology,2010,17(5):587-592.
[10]Lee JH,Choi JS,Jeon SW,et al.A prospective comparison of singleport laparoscopically assisted vaginal hysterectomy using transumbilical Gel Port access and multiport laparoscopically assisted vaginal hysterectomy[J].European journal of obstetrics,gynecology,and reproductive biology 2011,158(2):294-297.
[11]Chen YJ,Wang PH,Ocampo EJ,et al. Single-port compared with conventional laparoscopic-assisted vaginal hysterectomy:a randomized controlled trial[J]. Obstetrics and gynecology,2011,117(4):906-912.
[12]Park JY,Kim DY,Suh DS,et al.Laparoendoscopic single-site versus conventional laparoscopic surgical staging for early-stage endometrial cancer[J]. International journal of gynecological cancer,2014,24(2):358-363.
[13]Boruta DM,Fagotti A,Bradford LS,et al.Laparoendoscopic single-site radical hysterectomy with pelvic lymphadenectomy:initial multi-institutional experience for treatment of invasive cervical cancer[J].Journal of minimally invasive gynecology,2014,21(3):394-398.
[14]宗行万之助.疼痛的估价——用特殊的视觉模拟评分法作参考(VAS)[J].实用疼痛学杂志,1994,2(4):153.
[15]张俊吉,孙大为,熊巍,等.单孔腹腔镜子宫全切除术23例临床分析[J].中华妇产科杂志,2014,49(4):287-289.
[16]Bedaiwy MA,Sheyn D,Eghdami L,et al.Laparoendoscopic single-site surgery for benign ovarian cystectomies[J].Gynecologic and obstetric investigation,2015,79(3):179-183.
[17]Figurelli J,Bresson L,Narducci F,et al. Single-port access laparoscopic surgery in gynecologic oncology:outcomes and feasibility[J].International journal of gynecological cancer:official journal of the International Gynecological Cancer Society,2014,24(6):1126-1132.
[18]Park JY,Kim DY,Kim SH,et al.Laparoendoscopic Single-site Compared With Conventional Laparoscopic Ovarian Cystectomy for Ovarian Endometrioma[J].Journal of minimally invasive gynecology,2015,22(5):813-819.
[2]陈艳.单孔腹腔镜技术在妇科手术中的应用和进展[J].国际妇产科学杂志,2013,40(4):350-352.
[3]中华医学会外科学分会腹腔镜与内镜外科学组.单孔腔镜手术技术专家共识.中国实用外科杂志,2010,30(8):665.
[4]吴川江,吴曦.经脐单孔腹腔镜下全腹膜外腹股沟疝修补术的安全性及有效性探讨[J].实用医院临床杂志,2017,14(4):179-181
[5]王梦桥,余建贵,黄河,等.经脐入路腹腔镜阑尾切除术31例手术体会[J].实用医院临床杂志,2012,9(4):180-181.
[6]Dursun P,Gulumser C,Caglar M,et al.Laparoendoscopic single-site surgery for acute adnexal pathology during pregnancy:preliminary experience[J]. The journal of maternal-fetal&neonatal medicine,2013,26(13):1282-1286.
[7]Yoon BS,Park H,Seong SJ,et al.Single-port versus conventional laparoscopic salpingectomy in tubal pregnancy:a comparison of surgical outcomes[J].European journal of obstetrics gynecologyand reproductive biology,2011,159(1):190-193.
[8]Yoon A,Kim TJ,Lee YY,et al.endoscopic single-site(LESS)myomectomy:characteristics of the appropriate myoma[J]. European journal of obstetrics,gynecology,and reproductive biology,2014,175:58-61.
[9]Kim YW,Park BJ,Ro DY,et al.Single-port laparoscopic myomectomy using a new single-port transumbilical morcellation system:initial clinical study[J]. Journal of minimally invasive gynecology,2010,17(5):587-592.
[10]Lee JH,Choi JS,Jeon SW,et al.A prospective comparison of singleport laparoscopically assisted vaginal hysterectomy using transumbilical Gel Port access and multiport laparoscopically assisted vaginal hysterectomy[J].European journal of obstetrics,gynecology,and reproductive biology 2011,158(2):294-297.
[11]Chen YJ,Wang PH,Ocampo EJ,et al. Single-port compared with conventional laparoscopic-assisted vaginal hysterectomy:a randomized controlled trial[J]. Obstetrics and gynecology,2011,117(4):906-912.
[12]Park JY,Kim DY,Suh DS,et al.Laparoendoscopic single-site versus conventional laparoscopic surgical staging for early-stage endometrial cancer[J]. International journal of gynecological cancer,2014,24(2):358-363.
[13]Boruta DM,Fagotti A,Bradford LS,et al.Laparoendoscopic single-site radical hysterectomy with pelvic lymphadenectomy:initial multi-institutional experience for treatment of invasive cervical cancer[J].Journal of minimally invasive gynecology,2014,21(3):394-398.
[14]宗行万之助.疼痛的估价——用特殊的视觉模拟评分法作参考(VAS)[J].实用疼痛学杂志,1994,2(4):153.
[15]张俊吉,孙大为,熊巍,等.单孔腹腔镜子宫全切除术23例临床分析[J].中华妇产科杂志,2014,49(4):287-289.
[16]Bedaiwy MA,Sheyn D,Eghdami L,et al.Laparoendoscopic single-site surgery for benign ovarian cystectomies[J].Gynecologic and obstetric investigation,2015,79(3):179-183.
[17]Figurelli J,Bresson L,Narducci F,et al. Single-port access laparoscopic surgery in gynecologic oncology:outcomes and feasibility[J].International journal of gynecological cancer:official journal of the International Gynecological Cancer Society,2014,24(6):1126-1132.
[18]Park JY,Kim DY,Kim SH,et al.Laparoendoscopic Single-site Compared With Conventional Laparoscopic Ovarian Cystectomy for Ovarian Endometrioma[J].Journal of minimally invasive gynecology,2015,22(5):813-819.
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