经腹壁瘢痕入路单孔腹腔镜下输卵管再通术  

Trans-abdominal Scar Approach Laparoendoscopic Single-site Surgery for Tubal Recanalization

作　　者：秦真岳 鲍明月 陈继明 王慧慧 郑亚峰 肖惠超 马洋 蒋云芬 施如霞 QIN Zhen-yue;BAO Ming-yue;CHEN Ji-ming;WANG Hui-hui;ZHENG Ya-feng;XIAO Hui-chao;MA Yang;JIANG Yun-fen;SHI Ru-xia(Dalian Medical University, Dalian 116000, Liaoning, China;Department of Gynecology, the Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, Changzhou 213000, Jiangsu, China)

机构地区：[1]大连医科大学研究生院,辽宁大连116000 [2]大连医科大学,辽宁大连116000 [3]南京医科大学附属常州第二人民医院妇科,江苏常州213000

出　　处：《中国现代手术学杂志》2021年第1期55-59,共5页Chinese Journal of Modern Operative Surgery

基　　金：江苏省“333工程”科研资助项目(BRA2019161);江苏省博士后科研资助计划(2019K064);常州市卫生计生委重大科技项目(ZD201812);南京医科大学康达学院2018年度教育研究课题(KD2018JYYJYB055);常州市科技计划项目(CE20175004)。

摘　　要：目的初步探讨经腹壁瘢痕入路单孔腹腔镜下输卵管再通术的可行性与安全性。方法回顾性分析2019年8月至11月在我科行经腹壁瘢痕入路单孔腹腔镜下输卵管再通术的2例患者的临床资料,均为双侧输卵管绝育术后再婚有生育需求的患者。术中纵行垂直切开原剖宫产瘢痕下段长约1.5 cm皮肤,逐层进腹,安装专用单孔腹腔镜手术port,置入腹腔镜器械完成双侧输卵管端端吻合术+双侧输卵管通液术。结果本组2例患者均顺利完成手术,未增加穿刺孔改为传统腹腔镜术式,亦未中转开腹手术。术中双侧输卵管亚甲蓝通液试验提示双侧输卵管通畅,无输尿管、膀胱及结直肠等其他脏器、神经及大血管损伤。2例手术时间分别为160 min和165 min,术中出血量分别为10 ml和30 ml,术后1 d体温分别为37.2℃和37.4℃,均术后1 d排气,术后1 d拔除导尿管后均可自主排尿且无尿潴留发生。术后无须使用镇痛类药物。术后4~5 d出院,伤口恢复良好,无出血、感染、皮下气肿及切口疝的发生。2例患者腹壁切口均甲级愈合,切口疤痕隐蔽。术后患者门诊随访,均恢复良好。结论在单孔腹腔镜技术成熟的前提下,选择合适的病例,经瘢痕入路行单孔腹腔镜下输卵管再通术可能是安全有效的。Objective To investigate the feasibility and safety of laparoendoscopic single-site surgery(LESS)for tubal recanalization via trans-abdominal scar approach.Methods The clinical data of 2 women with the surgical history of bilateral fallopian tubal sterilization underwent trans-abdominal scar approach LESS to make the tube anastomosis from August to November 2019 in our hospital were analyzed retrospectively.During the operation,the lower end of the original caesarean section scar was cut vertically with the length of about 1.5 cm,and the abdominal cavity was opened layer by layer.After the special LESS port installed and laparoscopic instruments inserted,end-to-end tubal anastomosis and tubal patency was carried out in bilateral fallopian tube.Results The operations succeed in all 2 cases without conversion to traditional laparoscopy or laparotomy.Tubal patency was comfirmed in bilateral fallopian tubes by intraoperative patency test of methylene bule.There was no injury of ureter,bladder,colorectal and other organs,nerves and blood vessel.The surgery time was 160 min and 165 min,the intra-operative blood loss volume was 10 ml and 30 ml,the post-operative body temperature of day 1 was 37.2℃and 37.4℃,respectively.The gastrointestinal function was recovered on the 1st day after the surgery in all 2 cases.Both 2 cases restored urination without urinary retention and analgesics application after the surgery.The abdominal incision healed well and concealment without bleeding,infection,subcutaneous emphysema and incision hernia.Conclusion It may be safe and effective to tubal recanalization by trans-abdominal scar approach LESS under the premise of mature LESS techniques and appropriate cases.

关 键 词：输卵管再通术 单孔腹腔镜手术 腹壁瘢痕 手术入路 

分 类 号：R713.53[医药卫生—妇产科学]