经脐单孔腹腔镜手术在妇科附件手术中应用的对比研究

目的探讨经脐单孔腹腔镜手术治疗年轻患者妇科附件良性病变中的应用价值。方法 2010年7月～2011年12月36例妇科附件良性病变行经脐单孔腹腔镜手术(单孔腹腔镜组),于脐轮上缘做一2 cm弧形切口,置入单孔腹腔镜穿刺套管,建立人工气腹,置入腹腔镜探头及器械进行手术,手术操作步骤同传统腹腔镜手术,并与同期38例传统腹腔镜妇科手术(传统腹腔镜组)进行对比。结果 2组手术均获成功。与传统腹腔镜组比较,单孔腹腔镜手术时间长单侧卵巢成熟性畸胎瘤/浆液性囊腺瘤剥除术:(50.3±9.1)min vs.(35.6±8.5)min,t=4.340,P=0.000;输卵管整形术:(32.3±7.6)min vs.(15.7±5.3)min,t=5.383,P=0.001;输卵管切除术:(34.1±5.2)min vs.(14.4±3.5)min,t=6.864,P=0.000;输卵管开窗取胚术:(29.6±7.2)min vs.(16.5±5.7)min,t=4.003,P=0.001]。2组术中出血量(29.9±11.1)ml vs.(30.6±12.0)ml,t=-0.260,P=0.796]、排气时间(36.5±4.1)h vs.(35.2±5.4)h,t=1.162,P=0.249]、住院时间(3.4±0.7)d vs.(3.2±0.9)d,t=1.063,P=0.291]和术后病率8例vs.7例,χ2=0.165,P=0.684]无统计学差异。2组患者术后随访6个月,均无切口疝发生。结论经脐单孔腹腔镜手术治疗年轻患者妇科附件良性病变达到了微创与美观的结合,安全可行。

Laparoendoscopic Single-site Surgery for Adnexal Diseases

Objective To investigate the value of laparoendoscopic single-site surgery(LESS) for gynecological adnexal diseases.Methods From July 2010 to December 2011,we performed LESS on 36 patients with benign adnexal lesions.We made a 2-cm arc incision above the umbilicus,inserted the laparoendoscopic instruments,and then established pneumoperitoneum so that to perform a same procedure as conventional surgeries.The results of the operation were compared with 38 cases of conventional laparoscopic surgery that were carried out during the same period,and served as a control.Results The procedures were completed successfully in both the groups.Compared with the conventional group,LESS group had longer operation time unilateral ovarian mature teratoma/ serous cystadenoma resection:(50.3±9.1) min vs.(35.6±8.5) min,t=4.340,P=0.000;salpingoplasty:(32.3±7.6) min vs.(15.7±5.3) min,t=5.383,P=0.001;salpingectomy:(34.1±5.2) min vs.(14.4±3.5) min,t=6.864,P=0.000;salpingostomy:(29.6±7.2) min vs.(16.5±5.7) min,t=4.003,P=0.001].No significant difference existed in the intraoperative blood loss,recovery time of gastrointestinal function,hospital stay,and postoperative morbidity between the two groups (29.9±11.1) ml vs.(30.6±12.0) ml,t=-0.260,P=0.796;(36.5±4.1) h vs.(35.2±5.4) h,t=1.162,P=0.249;(3.4±0.7) d vs.(3.2±0.9) d,t=1.063,P=0.291;and 8 cases vs.7 cases,χ2=0.165,P=0.684].Both the groups were followed up for 6 months,during which no incisional hernia occurred.Conclusions LESS is feasible,safe and minimally invasive with good cosmetic outcomes.It is a good option for young patients.