机器人手术巨大子宫切除62例临床经验分析研究  

Clinical experience analysis of robotic hysterectomy in 62 patients with large uteri

作　　者：张海艳[1,2] 范文生 王军童[2] 张博学 赵阳[2] 孟元光 ZHANG Haiyan;FAN Wensheng;WANG Juntong;ZHANG Boxue;ZHAO Yang;MENG Yuanguang(Department of Gynecology and Obstetrics,Chinese PLA General Hospital,Beijing 100853,P.R.China;Department of Gynecology and Obstetrics,Tangshan Workers Hospital,Tangshan,Tianjin 063000,P.R.China)

机构地区：[1]解放军总医院第一医学中心妇产科,北京100853 [2]唐山市工人医院妇产科,河北唐山063000

出　　处：《华西医学》2020年第2期187-191,共5页West China Medical Journal

基　　金：国家重点研发计划课题(2017YFC0110405)

摘　　要：目的总结采用机器人手术系统完成的大子宫和超大子宫切除病例资料,探讨相关临床经验和机器人手术优势。方法回顾性分析2016年1月-2018年12月解放军总医院第一医学中心诊治的各类疾病导致的大子宫并接受机器人手术子宫切除者病历资料。将子宫体积为孕12~16周者分为大子宫组、子宫体积>孕16周者分为超大子宫组。结果共纳入患者62例。其中,大子宫组28例,子宫平均大小为(14.3±2.1)孕周;超大子宫组34例,子宫平均大小为(19.9±2.8)孕周。除子宫大小外(t=8.772,P<0.001),两组患者的年龄、体质量指数、腹部手术史及诊断情况比较,差异均无统计学意义(P>0.05)。大子宫组手术时间少于超大子宫组[(75.4±22.6)vs.(91.7±27.8)min;t=2.495,P=0.015]。62例患者术后并发症发生率为14.5%(9/62),其中大子宫组为14.3%(4/28),超大子宫组为14.7%(5/34)。两组手术出血量、输血率、术中转开腹、住院天数及术后并发症发生率比较,差异均无统计学意义(P>0.05)。结论机器人手术实施巨大子宫切除具有机械臂灵活性、3-D手术视野和操控稳定性等优势,且子宫体积的增大并未导致手术创伤增加、也未对预后造成显著影响。Objective To summarize the data of robotic hysterectomy in patients with large and super-large uterus in single center,and explore the relevant clinical experience and advantages of robotic surgery.Methods The medical records of the patients with large uterus caused by gynecological diseases who underwent robotic hysterectomy in the Chinese PLA General Hospital from January 2016 to December 2018 were retrospectively analyzed.The patients with uterine size from 12 to 16 weeks of gestation were divided into large uterus group and those with uterine volume larger than 16 weeks of gestation were divided into super large uterus group.Results A total of 62 patients were included,including 28 in the large uterus group with the average uterus size of(14.3±2.1)gestational weeks,and 34 in the super large uterus group with the average uterus size of(19.9±2.8)gestational weeks.There was no significant difference in mean age,body mass index,history of abdominal surgery or diagnostic composition between the two groups(P>0.05),except for the size of the uterus(t=8.772,P<0.001).The operation time in the large uterus group was less than that in the superlarge uterus group[(75.4±22.6)vs.(91.7±27.8)min;t=2.495,P=0.015].The incidence of complications after robotic hysterectomy was 14.5%(9/62)in the 62 patients,including 14.3%(4/28)in the large uterus group and 14.7%(5/34)in the super-large uterus group.There was no significant difference in the amount of bleeding,blood transfusion rate,ratio of conversion to open surgery,average hospitalization days or incidence of postoperative complications between the two groups(P>0.05).Conclusions Robotic hysterectomy has the advantages of flexible manipulator,3-D operative field of vision and stability of manipulation.In addition,increased uterine volume does not lead to increased surgical trauma,nor apparently affect the prognosis.

关 键 词：机器人手术 腹腔镜 子宫切除 巨大子宫 微创手术 

分 类 号：R713.42[医药卫生—妇产科学]