经脐单孔腹腔镜在不同类型全子宫切除术应用

目的探讨分析经脐单孔腹腔镜手术(laparoendoscopic single-site surgery，LESS)技术应用于全子宫切除术的安全性，并根据子宫大小、是否合并盆腔粘连分成单纯型和复杂型全子宫切除术绘制其学习曲线。 方法回顾性分析东南大学附属中大医院2017年3月至2019年11月的80例LESS全子宫切除术的临床资料，均由同一位熟练掌握妇科标准腹腔镜技术的术者施行。定义术中探查子宫大小如孕周数≤8周、无盆腔粘连者为单纯型全子宫切除术，子宫大小如孕周数>8周、合并盆腔粘连者定义为复杂型全子宫切除术。结合手术例数和手术时间绘制2组学习曲线。 结果80例手术全部顺利完成，无术中并发症发生，无术中更改手术方式。所有病例术后随访暂未发现切口感染、脐疝等术后并发症。观察2组学习曲线，单纯型全子宫切除术经过约20例后，手术时间渐趋平稳；复杂型全子宫切除术经过约26例后，手术时间渐趋平稳。 结论LESS在全子宫切除术中是安全、可行的，单纯型和复杂型全子宫切除术的学习曲线分别为20例和26例。

The safety and learning curve of laparoendoscopic single-site surgery in different total hysterectomy: a single-institution experience

ObjectiveTo evaluate the safety of laparoendoscopic single-site surgery(LESS) in total hysterectomy and to describe the learning curves of the simple total hysterectomy and complex total hysterectomy which are divided according to the size of uterus or combing pelvic adhesion. MethodsThe clinical data of 80 cases of laparoendoscopic single-site surgery performed by the same surgeon from Mar.2017 to Nov.2019 in the Zhongda Hospital Affiliated to Southeast University were retrospectively analyzed. The patients′ uterine size less than or equal to 8 gestational weeks and without pelvic adhesions were defined as simple total hysterectomy. While the patients′ uterine size larger than 8 gestational weeks or combined with pelvic adhesions were defined as complex type. Then on the basis of operation time and the number of cases, we drew the learning curves. ResultsAll 80 cases were successfully completed with no surgical changes in surgery, no bleeding puncture, vascular injury and other intraoperative complications. All patients were followed up, which we haven′t found incision infection, umbilical hernia and other postoperative complications yet. Observation of the learning curve, in the simple group about 20 cases′ operation time was gradually stable. While in the complex group, the operation time gradually stabilized after about 26 cases of the surgery. ConclusionsThe laparoendoscopic single-site surgery in total hysterectomy is safe and feasible. The learning curve was approximate 20 cases in simple total hysterectomy.And in complex total hysterectomy, the learning curve was about 26 cases.