常规器械免举宫经脐单孔腹腔镜全子宫切除术  

Transumbilical Single-port Total Laparoscopic Hysterectomy by Conventional Instruments Without Uterine-lifting

作　　者：朱其舟[1] 肖仲清[1] 龙生根[1] 王丽君[1] 杨晶 舒宽勇 Zhu Qizhou;Xiao Zhongqing;Long Shenggen(Department of Gynecological Oncology,Jiangxi Maternal and Child Health Hospital,Nanchang 330006,China)

机构地区：[1]江西省妇幼保健院肿瘤科,南昌330006 [2]南昌大学研究生院医学部,南昌330006

出　　处：《中国微创外科杂志》2024年第2期98-101,共4页Chinese Journal of Minimally Invasive Surgery

基　　金：江西省应用研究培育计划(20212BAG70045)。

摘　　要：目的探讨常规器械免举宫经脐单孔腹腔镜全子宫切除术治疗宫颈病变的应用价值。方法选择2021年12月~2023年6月因宫颈高级别鳞状上皮内病变(high-grade squamous intraepithelial lesion,HSIL)或宫颈癌ⅠA1期行腹腔镜全子宫切除术60例,按患者意愿行经脐单孔腹腔镜手术及多孔腹腔镜手术各30例,均使用常规器械,不使用举宫器,比较2组手术指标。结果2组均未出现中转开腹及泌尿系、肠道或大血管等损伤。单孔组出血量较少[(54.6±20.5)ml vs.(67.5±27.0)ml,P=0.041],排气较早[(27.6±8.0)h vs.(32.2±9.0)h,P=0.040],总住院时间较短[(4.4±1.5)d vs.(5.1±1.2)d,P=0.044]。2组子宫重量、手术时间以及术后并发症差异无显著性(P>0.05)。2组切口愈合良好,未出现与穿刺器相关的近期并发症(如穿刺孔感染、出血)或远期并发症(如脐疝、切口疝)。结论免举宫经脐单孔腹腔镜全子宫切除术出血少,术后恢复快,瘢痕最小化,并发症与传统腹腔镜手术相似。Objective To investigate the application value of transumbilical single-port total laparoscopic hysterectomy by conventional instrument without uterine-lifting in the treatment of cervical lesions.Methods We selected 60 cases of total laparoscopic hysterectomy due to cervical high-grade squamous intraepithelial lesion(HSIL)or cervical cancer stageⅠA1 from December 2021 to June 2023.According to the patients’preference,30 cases of single-port laparoscopy through the umbilicus and 30 cases of multi-port laparoscopy were performed,both using conventional instruments without uterine-lifting.The surgical indicators of the two groups were compared.Results No conversion to open surgery occurred in both groups,and no intraoperative injuries to the urinary system,bowel,or major blood vessels occurred.As compared with the multi-port group,the single-port group had significantly reduced amount of bleeding during surgery[(54.6±20.5)ml vs.(67.5±27.0)ml,P=0.041],earlier anal exhaust time[(27.6±8.0)h vs.(32.2±9.0)h,P=0.040],and shorter total hospitalization time[(4.4±1.5)d vs.(5.1±1.2)d,P=0.044].There were no significant differences in uterine weight,surgical time,and postoperative complications between the two group(P>0.05).The healing of the abdominal wall puncture wounds in both groups of patients were satisfied.There were no short-term complications related to the puncture device(such as puncture wound infection and bleeding)or long-term complications(such as umbilical hernia and incisional hernia).Conclusion Transumbilical single-port total laparoscopic hysterectomy without uterine-lifting presents advantages of less intraoperative bleeding,faster postoperative recovery,and almost no scarring,with complications similar to traditional laparoscopic surgery.

关 键 词：经脐单孔腹腔镜手术 全子宫切除术 高级别鳞状上皮内病变 宫颈癌 

分 类 号：R713.42[医药卫生—妇产科学]