免气腹悬吊式单孔腹腔镜在全子宫及附件切除术中的应用效果  

Application effect of gasless single-port laparoscopy assisted with abdominal wall suspension in total hysterectomy and adnexectomy

作　　者：熊敏 卢白玉 刘晓芳[1] 罗爽[1] 唐辰典 XIONG Min;LU Bai-yu;LIU Xiao-fang;LUO Shuang;TANG Chen-dian(Department of Gynecology,Suining Central Hospital,Suining Sichuan 629000,China)

机构地区：[1]遂宁市中心医院妇科,四川遂宁629000

出　　处：《局解手术学杂志》2023年第6期511-515,共5页Journal of Regional Anatomy and Operative Surgery

基　　金：四川省卫生健康委员会卫生健康科研课题推广项目(20PJ283);超声医学工程国家重点实验室开放课题(2020KFKT009)。

摘　　要：目的观察免气腹悬吊式单孔腹腔镜在全子宫及附件切除术中的应用效果。方法选择我院收治的子宫及附件区病变患者共84例,按照手术方式将患者分为传统组(41例,传统腹腔镜全子宫及附件切除术)和免气腹组(43例,免气腹悬吊式单孔腹腔镜全子宫及附件切除术)。对比2组患者临床相关指标;监测2组患者麻醉前(T0)、麻醉后5 min(T1)、气腹或悬吊建立后10 min(T2)、气腹或悬吊建立后30 min(T3)、气腹或悬吊撤除后5 min(T4)的血氧饱和度(SpO_(2))、呼气末二氧化碳分压(PETCO_(2))、气道压力(Paw)、平均动脉压(MAP)、心率(HR);记录2组患者并发症发生情况。结果免气腹组术后肠道功能恢复时间、住院时间短于传统组,住院费用少于传统组(P<0.05)。T1~T4时点,传统组SpO_(2)呈先下降后升高趋势(P<0.05),免气腹组SpO_(2)则无明显波动(P>0.05);免气腹组T1~T3时点SpO_(2)均高于传统组(P<0.05)。T2~T4时点,传统组PETCO_(2)、Paw呈先升高后下降趋势(P<0.05),免气腹组PETCO_(2)、Paw则无明显波动(P>0.05);T2、T3时点,免气腹组PETCO_(2)、Paw均低于传统组(P<0.05)。T1~T4时点,2组患者MAP、HR均呈先升高后下降趋势(P<0.05),且免气腹组MAP、HR均低于传统组(P<0.05)。2组患者并发症发生率比较差异无统计学意义(P>0.05)。结论与传统腹腔镜全子宫及附件切除术相比,免气腹悬吊式单孔腹腔镜全子宫及附件切除术可减轻患者手术损伤,同时还可改善呼吸循环功能,维持血流动力学稳定,有利于患者术后早期恢复。Objective To observe the application effect of gasless single-port laparoscopy assisted with abdominal wall suspension in total hysterectomy and adnexectomy.Methods A total of 84 patients with uterine and adnexal lesions who were admitted to our hospital were selected.According to the surgical method,patients were divided into the traditional group(41 cases of traditional total laparoscopic hysterectomy and adnexectomy)and the non-pneumoperitoneum group(43 cases of gasless single-port total laparoscopic hysterectomy and adnexectomy assisted with abdominal wall suspension).The clinical related indicators of patients in the two groups were compared.The levels of oxygen saturation(SpO_(2)),partial pressure of end-tidal carbon dioxide(PETCO_(2)),airway pressure(Paw),mean arterial pressure(MAP),heart rate(HR)before anesthesia(T0),5 minutes after anesthesia(T1),10 minutes after the establishment of pneumoperitoneum or suspension(T2),30 minutes after the establishment of pneumoperitoneum or suspension(T3),5 minutes after the removal of pneumoperitoneum or suspension(T4)of the patients in the two groups were monitored.The incidence of complications of patients in the two groups were recorded.Results The postoperative recovery time of intestinal function and hospital stay in the nonpneumoperitoneum group were shorter than those in the traditional group,and the hospitalization cost was less than that in the traditional group(P<0.05).At the time points T1 to T4,the level of SpO_(2) in the traditional group showed a trend of first decreasing and then increasing(P<0.05),while the level of SpO_(2) in the non-pneumoperitoneum group showed no significant fluctuations(P>0.05).The levels of SpO_(2) from T1 to T3 in the non-pneumoperitoneum group were higher than those in the traditional group(P<0.05).At the time points T2 to T4,the traditional group showed a trend of first increasing and then decreasing in PETCO_(2) and Paw(P<0.05),while the non-pneumoperitoneum group showed no significant fluctuations in PETCO_(2) and Paw(P>0.05)

关 键 词：免气腹悬吊式装置 单孔腹腔镜 全子宫及附件切除术 呼吸循环功能 血流动力学 

分 类 号：R713[医药卫生—妇产科学]