经脐入路内镜妇科手术49例  

Transumbilical Endoscopic Gynecological Surgery: Report of 49 Cases

作　　者：彭诗寒[1] 陈体平[1] 赵磊 Peng Shihan;Chen Tiping;Zhao Lei(Department of Obstetrics and Gynecology,Luzhou People＇s Hospital,Luzhou 646000,China)

机构地区：[1]泸州市人民医院妇产科,泸州646000

出　　处：《中国微创外科杂志》2018年第9期859-861,共3页Chinese Journal of Minimally Invasive Surgery

基　　金：泸州市科技局科研课题[2015-S-51(1/3)]

摘　　要：目的探讨经脐入路内镜手术(transumbilical endoscopic surgery,TUES)在治疗妇科良性疾病中的临床价值。方法我院2015年2月~2017年4月行TUES妇科手术49例,其中输卵管妊娠25例,卵巢囊肿15例,子宫肌瘤和子宫腺肌瘤9例。取脐孔上缘做弧形切口约1.0 cm长,穿刺置入10 mm trocar建立气腹,置入腹腔镜,探查盆腔。评估经脐单孔腹腔镜手术可行后,脐下缘4、8点位置分别做5 mm切口,穿刺trocar呈"品"字形,置入操作器械进行操作。输卵管妊娠行患侧输卵管开窗取胚术或患侧输卵管病灶切除术;卵巢囊肿行卵巢囊肿剥除术;子宫肌瘤及子宫腺肌瘤行子宫全切术。结果 49例均无中转开腹。输卵管妊娠手术时间(42.5±8.0)min,术中出血量(30.3±12.3)ml,肛门排气时间(16.2±3.8)h,住院时间(3.3±0.7)d;卵巢囊肿剥除除术时间(42.6±8.8)min,术中出血量(30.3±13.8)ml,肛门排气时间(16.6±3.6)h,住院时间(3.4±0.7)d;子宫全切手术时间(92.2±14.0)min,术中出血量(65.0±12.7)ml,肛门排气时间(17.0±4.0)h,住院时间(5.0±0.9)d。术后病理结果均与术前诊断相符。46例随访3个月,无切口感染、戳孔疝、腹腔内出血、邻近脏器损伤、肩胛部疼痛等并发症的发生,脐部切口隐蔽在皱褶内。结论 TUES治疗妇科良性疾病安全、可靠、有效,同时具有微创、美观、无明显腹壁手术瘢痕等优点,具有临床推广价值。Objective To explore the clinical value of the transumbilical endoscopic surgery（ TUES） in the treatment of gynecological benign disease. Methods From February 2015 to April 2017,49 cases of TUES gynecological surgery were analyzed retrospectively,including 25 cases of tubal pregnancy,15 cases of ovarian cysts,and 9 cases of uterine fibroids and uterine adenomyoma. We made an 1-cm arc incision above the umbilicus,and inserted a 10-mm trocar to introduce laparoscopic instruments to explore the pelvic cavity. After confirming surgery was feasible,we respectively made a 5-mm incision under the umbilicus at 4 o＇clock and 8 o＇clock position to insert apparatus to perform operation. We performed salpingotomy or salpingectomy for the tubal pregnancy,oophorocystectomy for ovarian cysts,and panhysterectomy for uterine myoma and adenomyosis. Results The 49 cases of operations were successful. For salpingotomy or salpingectomy,the operation time was（ 42. 5 ± 8. 0） min,the intraoperative hemorrhage was（ 30. 3 ± 13. 8） ml,the exhaust time was（ 16. 2 ± 3. 8） h,and the postoperative hospital stay was（ 3. 3 ± 0. 7） d. For oophorocystectomy,the operation time was（ 42. 6 ± 8. 8） min,the intraoperative hemorrhage was（ 30. 3 ± 12. 3） ml,the exhaust time was（ 16. 6 ± 3. 6） h,and the postoperative hospital stay was（ 3. 4 ± 0. 7） d. For panhysterectomy,the operation time was（ 92. 2 ±14. 0） min,the intraoperative hemorrhage was（ 65. 0 ± 12. 7） ml,the exhaust time was（ 17. 0 ± 4. 0） h,and the postoperative hospital stay was（ 5. 0 ± 0. 9） d. Postoperative pathological findings were consistent with preoperative diagnosis. Within follow-ups for3 months in 46 patients,no wound infection,incision hernia,intraperitoneal hemorrhage,adjacent viscera damage,or shoulder pain was found. The umbilical wound was concealed in the fold. Conclusions The TUES gynecological surgery is a safe,reliable and effective procedure in the treatment of gynecological benign diseases,which has the a

关 键 词：经脐入路内镜手术 腹腔镜 妇科手术 

分 类 号：R713[医药卫生—妇产科学]