腹腔镜手术治疗盆腔包裹性积液99例分析

目的探讨腹腔镜手术治疗盆腔包裹性积液的的可行性和安全性。方法2009年1月~2018年4月我科99例术前盆腔肿物性质不明,术后病理诊断为盆腔包裹性积液。年龄<40岁、有生育需求者行腹腔镜患侧附件囊肿剥除术;绝经期、年龄>45岁且无生育需求者行腹腔镜患侧附件切除术;年龄40~45岁,根据既往手术史、有无生育需求并结合患者个人意愿决定行腹腔镜患侧附件囊肿剥除术或患侧附件切除。结果98例完成腹腔镜手术,1例因粘连严重中转开腹。术中见99例均存在粘连,其中重度粘连(mAFS评分5~6分)76例。行患侧囊肿剥除术69例,患侧附件切除术30例,同时行粘连松解术。手术时间19~285 min,中位数88 min。术中出血量5~200 ml,中位数25 ml。截止2019年3月,随访78例,其中30例随访不足1年,48例随访1~10年(中位随访时间3.5年),6例(12.5%)超声检查示再发盆腔包块(复发时间术后2个月~5年,中位数20个月),其中2例出现下腹痛等症状,其余均为无症状复发。结论腹腔镜手术治疗盆腔包裹性积液安全、可行。

Laparoscopic Surgery for Pelvic Fluid Collections:a Study of 99 Cases

Objective To discuss the safety and feasibility of laparoscopic surgery for pelvic fluid collections.Methods Ninety-nine patients suffering from pelvic mass with unclear diagnosis underwent laparoscopic surgery and were diagnosed as encapsulated effusion by postoperative pathology from January 2009 to April 2018 in our hospital.Laparoscopic ipsilateral cystectomy was performed in patients younger than 40 years old with fertility needs,while adnexectomy in those in menopause period,or older than 45 years old without fertility needs.For patients aged 40-45 years old,surgical decision was based on previous surgical history,fertility needs and patient’s wishes.Results Ninety-eight patients were successfully treated by laparoscopy but one was converted to open surgery due to extensive dense adhesion.Pelvic adhesion was found in all the patients,76 of which were found with severe adhesion(mAFS score 5-6 points).Sixty-nine patients underwent ipsilateral cystectomy and 30 patients underwent adnexectomy with adhesiolysis.The operation time was 19-285 min,with a median of 88 min.The intraoperative blood loss was 5-200 ml,with a median of 25 ml.As of March 2019,78 cases were followed up,including 30 cases for less than 1 year and 48 cases for more than 1 year(range,1-10 years;median,3.5 years).Ultrasound examination showed recurrence of pelvic mass in 6 cases(12.5%),and the recurrence time was 2 months to 5 years after surgery,with a median of 20 months.Two patients had symptoms such as lower abdominal pain,and the remaining patients were asymptomatic.Conclusion Laparoscopic surgery is a safe and feasible approach for treatment of pelvic fluid collections.