经耻骨联合上小切口腹腔镜手术治疗妇科良性疾病临床分析
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摘要
目的探讨经耻骨联合上小切口腹腔镜手术治疗妇科部分良性疾病的可行性和临床应用价值。方法收集武汉市第一医院妇科2017年1月至2018年10月行经耻骨联合上小切口腹腔镜手术患者80例(观察组),选择同期经传统4孔腹腔镜手术患者82例(传统组)作为对照,回顾性分析两组临床资料。手术方式包括卵巢囊肿剥除术、输卵管开窗取胚术、输卵管切除术、输卵管造口术等。结果观察组和传统组手术均顺利完成,观察组相比传统组在手术时间[(45.31±7.35)minvs.(52.46±9.21)min]、术中出血量[(30.79±7.74)m Lvs.(32.58±5.21)m L]、下床时间[(12.93±3.95)h vs.(14.47±8.51)h]、术后排气时间[(14.29±4.19)h vs.(20.03±4.34)h]、住院时间[(5.76±1.43)d vs.(9.08±2.57)d]等方面差异无统计学意义(P>0.05);而在术后疼痛[(3.14±1.12)分vs.(6.54±1.27)分]和美容评分[(4.7±0.3)分vs.(2.5±0.8)分]方面差异有统计学意义(P<0.05)。结论经耻骨联合上小切口腹腔镜手术治疗妇科部分良性疾病安全有效,手术瘢痕隐秘或无痕,可充分应用已有设备和器械,费用低廉,值得临床推广应用。
Objective To study the feasibility and clinical application value of laparoscopic surgery via suprapubic small incision in the treatment of gynecological benign diseases.Methods A total of 80 patients who received laparoscopic surgery through suprapubic small incison in Wuhan First Hospital from Jan. 2017 to Oct. 2018 were collected as the new-operative group,and 82 patients who received the traditional 4-hole laparoscopic surgery during the same period were included as the controls(traditional group).Their clinical data were analyzed retrospectively.Operative methods included ovarian cyst removal,oviduct fenestration,oviduct resection,salpingostomy,etc.Results The operation was secessful in both groups.There were no significant differences in operation time[(45.31±7.35)min vs.(52.46±9.21)min],bleeding[(30.79±7.74)mL vs.(32.58±5.21)mL],getting out of bed time[(12.93±3.95)h vs.(14.47±8.51)h],anal exhaust time[(14.29±4.19)h vs.(20.03±4.34)h]or hospitalization time[(5.76±1.43)d vs.(9.08±2.57)d]between the new operative group and the traditional group(P>0.05),but there were significant differences in pain score(3.14±1.12 vs.6.54±1.27)and cosmetic score(4.7±0.3 vs. 2.5±0.8)between the new operative group and the traditional group(P<0.05).Conclusion Laparoscopic surgery via suprapubic small incision is safe and effective in the treatment of some gynecological benign diseases. The scar is hidden or no scar is present.It is worth popularizing and applying in clinic because of its low cost and full use of existing equipment and instruments.
Objective To study the feasibility and clinical application value of laparoscopic surgery via suprapubic small incision in the treatment of gynecological benign diseases.Methods A total of 80 patients who received laparoscopic surgery through suprapubic small incison in Wuhan First Hospital from Jan. 2017 to Oct. 2018 were collected as the new-operative group,and 82 patients who received the traditional 4-hole laparoscopic surgery during the same period were included as the controls(traditional group).Their clinical data were analyzed retrospectively.Operative methods included ovarian cyst removal,oviduct fenestration,oviduct resection,salpingostomy,etc.Results The operation was secessful in both groups.There were no significant differences in operation time[(45.31±7.35)min vs.(52.46±9.21)min],bleeding[(30.79±7.74)mL vs.(32.58±5.21)mL],getting out of bed time[(12.93±3.95)h vs.(14.47±8.51)h],anal exhaust time[(14.29±4.19)h vs.(20.03±4.34)h]or hospitalization time[(5.76±1.43)d vs.(9.08±2.57)d]between the new operative group and the traditional group(P>0.05),but there were significant differences in pain score(3.14±1.12 vs.6.54±1.27)and cosmetic score(4.7±0.3 vs. 2.5±0.8)between the new operative group and the traditional group(P<0.05).Conclusion Laparoscopic surgery via suprapubic small incision is safe and effective in the treatment of some gynecological benign diseases. The scar is hidden or no scar is present.It is worth popularizing and applying in clinic because of its low cost and full use of existing equipment and instruments.
引文
[1]张盛苗,夏宝国,楚蔚昕,等.腹腔镜在晚期上皮性卵巢癌诊治中的价值[J].中国实用妇科与产科杂志,2018,34(1):114-118.
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[6]中华医学会妇产科学分会妇科单孔腹腔镜手术技术协作组.妇科单孔腹腔镜手术技术的专家意见[J].中华妇产科杂志,2016,51(10):724-726.
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[8]Lamm SH,Zerz A,Steinemann DC.Scarless surgery:a vision becoming reality?[J].Praxis(Bern 1994),2016,105(8):453-456.
[9]Zheng Z,Li J,Wang J,et al.Hidden Scar Dissection of Benign Parotid Gland Tumors via a V-Shaped Minimal Facelift Incision[J].J Craniofac Surg,2018,29(8):2299-2303.
[10]殷易钰,张宏伟,曹慧,等.腹腔镜手术治疗婴幼儿阑尾脓肿[J].腹腔镜外科杂志,2012,17(2):305-307.
[11]卢柳媚,周倩珺,江彬,等.耻骨上辅助经脐双孔腹腔镜手术治疗异位妊娠[J].牡丹江医学院学报,2018,39(2):64-66.
[12]Tyagi S,Sinha R,Tyagi A.Single incision laparoscopic cholecystectomy:less scar,less pain[J].J Minim Access Surg,2017,13(2):118-123.
[13]王中显,白静,向媛媛,等.腹腔镜手术治疗老年卵巢囊肿临床疗效观察[J].中国实用妇科与产科杂志,2017,33(9):967-969.
[2]Son EJ,Joo E,Hwang WY,et al.Predictors of Acute Postoperative Urinary Retention after Transvaginal Uterosacral Suspension Surgery[J].J Menopausal Med,2018,24(3):163-168.
[3]Wroblewski TM,Kobryn K,Nazarewski L,et al.Minilaparoscopic cholecystectomy-the new non-visible scars technique.Preliminary report of first series[J].Wideochir Inne Tech Maloinwazyjne,2015,10(2):150-154.
[4]Young JR,Sih C,Hogg MM,et al.Qualitative Assessment of Face Validity and Cross-Cultural Acceptability of the Faces Pain Scale:"Revised"in Cameroon[J].Qual Health Res,2018,28(5):832-843.
[5]Ertem M,Gok H,Ozveri E.Single-incision(with multi-input single-port)laparoscopic colorectal procedures:early results[J].Ulus Cerrahi Derg,2013,29(3):119-123.
[6]中华医学会妇产科学分会妇科单孔腹腔镜手术技术协作组.妇科单孔腹腔镜手术技术的专家意见[J].中华妇产科杂志,2016,51(10):724-726.
[7]Marks JH,Montenegro GA,Salem JF,et al.Transanal TATA/TME:a case-matched study of ta TME versus laparoscopic TMEsurgery for rectal cancer[J].Tech Coloproctol,2016,20(7):467-473.
[8]Lamm SH,Zerz A,Steinemann DC.Scarless surgery:a vision becoming reality?[J].Praxis(Bern 1994),2016,105(8):453-456.
[9]Zheng Z,Li J,Wang J,et al.Hidden Scar Dissection of Benign Parotid Gland Tumors via a V-Shaped Minimal Facelift Incision[J].J Craniofac Surg,2018,29(8):2299-2303.
[10]殷易钰,张宏伟,曹慧,等.腹腔镜手术治疗婴幼儿阑尾脓肿[J].腹腔镜外科杂志,2012,17(2):305-307.
[11]卢柳媚,周倩珺,江彬,等.耻骨上辅助经脐双孔腹腔镜手术治疗异位妊娠[J].牡丹江医学院学报,2018,39(2):64-66.
[12]Tyagi S,Sinha R,Tyagi A.Single incision laparoscopic cholecystectomy:less scar,less pain[J].J Minim Access Surg,2017,13(2):118-123.
[13]王中显,白静,向媛媛,等.腹腔镜手术治疗老年卵巢囊肿临床疗效观察[J].中国实用妇科与产科杂志,2017,33(9):967-969.
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