经脐单孔腹腔镜与传统腹腔镜治疗妇科良性疾病的效果对比

目的 分析经脐单孔腹腔镜与传统腹腔镜治疗妇科良性疾病的方法与效果。方法 选取60例妇科良性疾病患者,按照随机抽签法将其分为对照组与观察组,各30例,分别实施传统腹腔镜与经脐单孔腹腔镜治疗,对比两组手术效果。结果 与对照组对比,观察组术后疼痛评分更低,术后住院时间更短,住院费用更少（P<0.05）。观察组治疗满意度96.67%较对照组的76.67%高（P<0.05）。结论 经脐单孔腹腔镜治疗妇科良性疾病效果更加确切,能够提高患者手术质量与治疗满意度,值得临床推广。     

年轻患者经脐单孔腹腔镜手术32例临床应用研究

目的:探讨经脐单孔腹腔镜手术( LESS)在治疗年轻患者妇科疾病中的应用价值.方法:比较32例LESS(LESS组)与32例同期传统腹腔镜手术(对照组)年轻患者的术中、术后及随访情况.LESS组单孔腹腔镜于脐轮上缘行一2 cm弧形切口,置入单孔腹腔镜穿刺套管,建立人工气腹,进腹腔镜探头及器械进行手术,手术操作步骤同对照组.结果:两组手术均获得成功,LESS组不同疾病及总的平均手术时间与对照组比较,差异有统计学意义(P＜0.05),术中出血量、肛门排气时间、住院时间和术后病率比较差异均无统计学意义(P＞0.05).两组患者均无术中、术后并发症发生,随访6个月,均无切口疝发生.结论:对于妇科年轻患者,LESS微创、安全可行,但手术操作难度相对增大,应尽量选择盆腔无粘连或粘连较轻的患者.     

经阴道自然腔道内镜手术与经脐单孔腹腔镜手术在妇科良性疾病中应用比较的Meta分析

目的:比较经阴道自然腔道内镜手术(V-NOTES)与经脐单孔腹腔镜手术(LESS)在妇科良性疾病中应用的安全性、可行性.方法:检索the Cochrane Library、Embase、Web of science、Pubmed、中国知网(CNKI)、中国生物医学文献服务系统(CBM)、万方全文数据库等,检索时间截至2...     

单孔腹腔镜手术在妇科良性疾病中的应用体会

目的 研究单孔腹腔镜手术在妇科良性疾病中的临床效果。方法 选取100例妇科良性疾病患者,根据随机数字表法分为A组与B组,每组50例。A组实施单孔腹腔镜手术治疗,B组实施多孔腹腔镜手术治疗。比较两组临床效果。结果 两组手术时间比较,差异无统计学意义（P>0.05）,A组术中出血量（34.16±1.54）ml少于B组的（51.08±9.23）ml,差异有统计学意义（P<0.05）。A组术后6、12、24 h的视觉模拟评分法（VAS）评分均明显低于B组,肛门排气时间短于B组,差异有统计学意义（P<0.05）。结论 在妇科良性疾病的治疗中,单孔腹腔镜手术的应用价值确切,可减轻患者术后疼痛,缩短术后肛门排气时间,并增强美观度,值得临床推广与应用。     

改良单孔腹腔镜与传统三孔腹腔镜在妇科良性附件手术中应用的比较

目的 探究改良单孔腹腔镜与传统三孔腹腔镜在妇科良性附件手术中的有效性和安全性.方法 采用简单随机化分组方法,纳入2015年6月至2016年12月于北京大学第一医院因附件良性病变行腹腔镜手术的200例患者,随机分为改良单孔腹腔镜组(研究组,n=100)和传统腹腔镜组(对照组,n=100),比较两组手术时间、术后血红蛋白变...     

经脐单孔腹腔镜体外剥除良性巨大卵巢囊肿的临床分析

目的:探讨经脐单孔腹腔镜体外剥除良性巨大卵巢囊肿的安全性和可行性。方法:回顾性分析成都市第三人民医院2021年10月至2022年9月收治的行经脐单孔腹腔镜治疗的72例良性巨大卵巢囊肿患者的临床资料,其中单孔腹腔镜体外剥除囊肿31例(单孔体外剥除组),单孔腹腔镜体内剥除囊肿41例(单孔体内剥除组),比较两组手术时间、术中气腹使用时间、术中出血量、术中囊液渗漏率、术后肛门排气时间、术后24小时疼痛程度、术后住院时间等。结果:术中囊液渗漏率单孔体外剥除组(0 vs.21.1%)明显低于单孔体内剥除组(P<0.05)。单孔体外剥除组手术时间(60.19±5.64分钟vs.72.02±6.89分钟)、术中气腹使用时间(15.23±2.69分钟vs.53.83±6.74分钟)及术后肛门排气时间(28.16±3.53小时vs.32.24±3.87小时)均短于单孔体内剥除组(P<0.05)。两组术中出血量、术后24小时疼痛视觉模拟(VAS)评分及术后住院时间比较差异无统计学意义(P>0.05)。结论:单孔腹腔镜体外剥除囊肿手术在良性巨大卵巢囊肿剥除术中可以极大程度避免术中囊液腹腔内渗...     

经脐入路腹腔镜手术在妇科应用的体会

随着微创外科技术的发展,近期腹壁无瘢痕手术(scarless surgery)在外科领域受到国内外临床医牛的推崇,其基本入路是经自然腔道手术(natural orifice transluminal endoscopic surgery,NOTES)和经脐入路内镜手术(transumbilical endoscopic surgery,TUES)[1].在妇科领域,经阴道手术已广泛用于子宫切除术、子宫肌瘤切除术等,单纯的盆腹腔于术目前仍以传统的3～4个切口腹腔镜手术完成为主.我院妇科在传统腹腔镜手术基础上,尝试采用经脐入路腹腔镜手术治疗妇科疾病,现将初步体会总结如下.     

经脐单孔腹腔镜治疗泌尿外科疾病围手术期护理体会

目的:探讨经脐单孔腹腔镜治疗泌尿外科疾病围手术期的护理体会。方法:对我院10例经脐单孔腹腔镜治疗泌尿外科疾病的患者术前进行心理护理、常规护理,加强新技术宣传,术后密切观察各项生命体征及病情动态变化,对于可能出现的并发症采取针对性的护理措施。结果:10例患者均顺利完成经脐单孔腹腔镜手术,无并发症发生,患者住院时间短,疗效好。结论:经脐单孔腹腔镜治疗泌尿外科疾病体现了微创与美容整合的理念,患者满意程度高,认真、细致的围手术期护理可减轻患者术前心理压力,促进患者术后恢复。     

经脐单孔腹腔镜手术治疗妇科良性疾病的临床效果分析

目的 比较经脐单孔腹腔镜与传统腹腔镜治疗妇科良性疾病的临床效果.方法 回顾性分析比较2019年8月至2020年8月于川北医学院附属南充市中心医院初始治疗为手术的妇科良性疾病患者的临床效果,其中卵巢良性肿瘤132例,子宫肌瘤90例,子宫腺肌症48例,卵巢子宫内膜异位囊肿45例,根据手术方式分为经脐单孔腹腔镜(观察组105...     

Management of large adnexal tumors by isobaric laparoendoscopic single-site surgery with a wound retractor

Objective

To report our experience with isobaric transumbilical laparoendoscopic single-site surgery for the management of large adnexal tumors exceeding 500 g of excised tissue weight including cystic contents.

Study design

In each case, a wound retractor was used to make a working port through a 2.5-cm vertical umbilical incision. The surgical view was secured by the abdominal wall-lift method with an intra-abdominal fan retractor system. After the tumor was punctured by a SAND balloon catheter and the cystic contents were aspirated, surgical procedures were performed with conventional laparoscopic instruments under vision with a rigid 30°, 5-mm EndoEYE laparoscope. Clinical data regarding patient demographics and surgical outcomes was retrospectively analyzed.

Results

Between October 2010 and April 2012, 35 patients with large adnexal tumors were treated. The median age of the patients was 31.5 years. Previous abdominal surgery was noted in nine cases. The median tumor diameter was 17.7 cm. Emergency surgery was performed in two cases of adnexal torsion and one case of tumor rupture. Three cases with intrauterine pregnancy were treated in the late first trimester. Unilateral salpingo-oophorectomy was performed in 24 cases. Unilateral cystectomy was performed in five cases. Unilateral salpingo-oophorectomy and contralateral cystectomy, and bilateral cystectomy were performed in two cases each. Unilateral salpingectomy, unilateral salpingo-oophorectomy and contralateral salpingectomy were performed in one case each. The median excised tissue weight was 1100 g. The median surgical duration was 72 min, with median blood loss of 10 mL Extended hospitalization was required in two cases due to elevated inflammatory parameters, one case with pregnancy due to hyperemesis gravidarum and one case with pregnancy due to subchorionic hematoma. Readmission due to postoperative pelvic abscess was noted in one case and was conservatively managed. Major surgical complications were not experienced. The present technique yielded a minimal postoperative scar concealed within the umbilicus.

Conclusion

The transumbilical wound retraction system combined with an intra-abdominal fan retractor appears to contribute favorably to laparoendoscopic single-site surgery for the management of large adnexal tumors, because the device permits flexible and wide circumferential access by efficient wound retraction during instrumentation without the need for closed condition associated with pneumoperitoneum.     

妇科单孔腹腔镜手术器械选择

文章从历史发展的角度介绍了妇科单孔腹腔镜手术相关器械的演变历程,重点阐述了相关器械的优劣及其改进的原因以及对妇科单孔腹腔镜手术发展的影响。有助于读者在了解相关历史的基础上,更好地选择合适的器械。     

Isobaric laparoendoscopic single-site surgery with wound retractor for adnexal tumors: a single center experience with the initial 100 cases

Objective

To report our experience with isobaric (gasless) transumbilical laparoendoscopic single-site (LESS) surgery in 100 patients with adnexal tumors at a single center.

Study design

In each case, a wound retractor was used as a working port through a 2.5-cm vertical umbilical incision. The surgical view was secured with the subcutaneous abdominal wall-lift method. Surgical procedures were performed using conventional laparoscopic instruments under vision with a rigid 30°, 5-mm EndoEYE laparoscope. Clinical data regarding patient demographics and surgical outcomes were retrospectively analyzed.

Results

Between August 2009 and July 2010, one hundred and seventeen tumors from 100 cases were treated with isobaric LESS surgery (unilateral salpingo-oophorectomy, 46; unilateral cystectomy, 33; bilateral cystectomy, 8; bilateral salpingo-oophorectomy, 6; unilateral cystectomy and contralateral cyst wall ablation, 4; unilateral cystectomy and contralateral salpingo-oophorectomy, 2; and unilateral salpingectomy, 1). Three normal adnexa were prophylactically resected at the same time as contralateral salpingo-oophorectomy of a diseased ovary. Previous abdominal surgery was noted in 20 cases. Emergency surgery was performed in 7 cases. Six pregnant women were treated in the late first trimester. Median tumor diameter was 6.9 cm. Median surgical duration was 55 min and median blood loss was 10 mL. Conversion to conventional laparoscopic surgery was noted in one case of recurrent endometriotic cyst with severe adhesion. Laparotomic conversion was not experienced. Prolonged administration of antibiotics with extended hospitalization was required in 7 cases due to elevated inflammatory parameters. There were no major surgical complications in this series. The technique yielded excellent cosmetic results with minimum postoperative scar concealed within the umbilicus. With exclusion of 4 endometriotic cysts treated with cyst wall ablation, pathological diagnosis was obtained for 113 tumors (dermoid cyst, 54; endometriotic cyst, 21; serous cystadenoma, 19; mucinous cystadenoma, 9; paraovarian cyst, 8; serous borderline tumor, 1; and paraovarian serous papillary borderline tumor, 1).

Conclusions

With efficient wound retraction to create a wide and flexible orifice during instrumentation, the transumbilical wound retraction system combined with the subcutaneous abdominal wall-lift method contributes favorably to LESS surgery as a safe, feasible and reproducible alternative for a variety of ablative and reconstructive applications in the management of adnexal tumors.     

Early experience with isobaric laparoendoscopic single-site surgery using a wound retractor for the management of ectopic pregnancy

Objective

To report our initial experience with isobaric (gasless) transumbilical laparoendoscopic single-site (LESS) surgery using a wound retractor for the management of ectopic pregnancy.

Study design

Twelve consecutive cases of ectopic pregnancy were managed by isobaric LESS surgery with the subcutaneous abdominal wall-lift method. In each case, a wound retractor was used as a transumbilical working port with insertion into the peritoneal cavity through a 2.5-cm vertical umbilical incision. Subsequent surgical procedures were performed with multiple conventional laparoscopic instruments through single umbilical port.

Results

All cases of ectopic pregnancy were successfully managed by isobaric LESS surgery. Procedures included salpingectomy in eight cases of ampullary pregnancy and two cases of isthmic pregnancy, salpingectomy and local methotrexate injection in one case of isthmic pregnancy, and salpingo-oophorectomy for one case of ovarian pregnancy. Neither extraumbilical incisions nor conversion to laparotomy was required. In a case of ruptured ampullary pregnancy with massive hemoperitoneum, intraoperative autologous blood salvage and donation avoided the need for the transfusion of bank blood. Although postsurgical umbilical seroma was noted in one case and systemic methotrexate administration was required for persistent ectopic pregnancy in one case of isthmic pregnancy respectively, there were no major surgical complications in this series. The technique yielded excellent cosmetic results with minimum postoperative scar concealed within umbilicus. Retrospective comparison of surgical parameters including surgical duration, estimated blood loss, frequency of postoperative analgesic use, time of bowel recanalization, postoperative inflammatory response and postoperative hospital stay did not show any significant differences between isobaric LESS surgery group and conventional isobaric multiport laparoscopic surgery group.

Conclusions

Based on the satisfactory outcome achieved in these initial 12 cases of ectopic pregnancy treated by isobaric LESS surgery, the wound retraction system combined with the subcutaneous abdominal wall-lift method appears to contribute favorably to LESS surgery for the management of ectopic pregnancy because the device permits free circumferential access and retraction during procedures without the closed condition required during pneumoperitoneum.