腹腔镜下附件相关手术标本不同取出方式临床分析  

Clinical analysis of different methods of retrieval of specimens during laparoscopic adnexal surgery

作　　者：梁茵 牛菊敏[1] 刘志辉[1] 史玉林[1] LIANG Yin;NIU Jumin;LIU Zhihui;SHI Yulin(Shenyang Women's and Children's Hospital,Liaoning Shenyang 110011,China)

机构地区：[1]沈阳市妇婴医院,辽宁沈阳110011

出　　处：《现代肿瘤医学》2021年第3期495-498,共4页Journal of Modern Oncology

基　　金：辽宁省自然科学基金指导项目(编号:20180550500)。

摘　　要：目的:探讨腹腔镜下附件相关手术中应用"保护袋"及"经阴道路径"取标本的安全性和临床应用价值的前瞻性研究。方法:收集2019年1月至2020年3月以"附件区肿物"为手术指征就诊沈阳市妇婴医院,并行腹腔镜手术的住院患者80例,经阴道后壁中段切口置入"保护袋"行肿物切除并取标本42例(研究组),常规腹腔镜下肿物切除38例(对照组)。结果:所有手术均按预期手术方案完成,研究组均在保护袋内切除肿物并完整取出标本,全程无污染,无手术并发症发生。研究组与对照组手术时间[(43.38±6.51) min vs(44.37±4.96) min]、术中出血量[(28.45±11.39) mLvs (24.61±8.00) mL]、术后发热[3(7.14%) vs 2(5.26%)]、下床时间[(11.7±2.47) h vs (12.0±1.96) h]、住院天数[(3.9±0.34) d vs (4.0±0.65) d]比较,差异均无统计学意义(P> 0.05)。术中取标本时间[(7.45±1.31) min vs (8.11±1.03) min]、术后排气时间[(8.54±0.90) h vs (9.03±0.91) h]比较,差异有统计学意义(P <0.05)。术后随诊阴道切口愈合良好。结论:腹腔镜下"保护袋"内附件区肿物切除并经阴道后壁中段切口取出标本与常规手术方式比较,在不增加手术时间与术中出血量等情况下,可以防止肿瘤的污染及播散,体现了微创手术理念及肿瘤学原则。Objective:To explore the safety and clinical application of using"protective bag"and"midvaginal incision"to take out specimens in laparoscopic adnexal surgery.Methods:Clinical data of 80 cases who underwent laparoscopic adnexal surgery in Shenyang Women's and Children's Hospital from January 2019 to March 2020 were retrospectivdy analyzed.Study group(42 cases)used"protective bag"during gurgery and the retrieval of the specimens via mid-vaginal incision,and control group(38 cases)underwent normal laparoscopic tumor resection.Results:All the operations were completed successfully.The study group taking out the tumor in the protective bag and completely removed the specimens.There was no pollution and no complications during the whole process.The operation time[(43.38±6.51)min vs(44.37±4.96)min],intraoperative blood loss[(28.45±11.39)mL vs(24.61±8.00)mL],postoperative fever[3(7.14%)vs 2(5.26%)],time to get out of bed[(11.7±2.47)h vs(12.0±1.96)h],hospitalization days[(3.9±0.34)vs(4.0±0.65)days]between study and control group did not have statistically significant difference(P>0.05).The time of taking the specimen[(7.45±1.31)min vs(8.11±1.03)min],post-operative exhaust time[(8.54±0.90)h vs(9.03±0.91)h],between the two groups had statistical difference(P>0.05).The vaginal incision healed well after the surgery.Conclusion:Compared with the normal laparoscopic surgery,the dissection of adnexal tumor with"protective bag"and the retrieval of the specimens via the midpart incision of the posterior vaginal wall may prevent the pollution and dissemination of the tumor without increasing the operation time and blood loss.It reflects the concept of minimally invasive surgery and the oncologic principle.

关 键 词：腹腔镜 附件区肿物 阴道切口 保护袋 取标本 

分 类 号：R737.31[医药卫生—肿瘤]