合并中重度盆腔粘连的经脐单孔腹腔镜大子宫切除术临床分析  

Clinical analysis of single-port transumbilical laparoscopic hysterectomy in patients with moderate to severe pelvic adhesions

作　　者：周金金 刘海燕 廉晓露 ZHOU Jinjin;LIU Haiyan;LIAN Xiaolu(Department of Gynecology,Affiliated Hospital of Yangzhou University,Yangzhou,Jiangsu 225001,China)

机构地区：[1]扬州大学附属医院妇科,江苏扬州225001

出　　处：《手术电子杂志》2024年第6期35-40,45,共7页Electronic Journal of Medical Operations

摘　　要：目的 探讨合并中重度盆腔粘连的经脐单孔腹腔镜大子宫切除临床可行性及安全性。方法 回顾性分析2019年6月—2023年12月在扬州大学附属医院妇科接受经脐单孔腹腔镜全子宫切除±双输卵管/双输卵管卵巢切除手术的患者资料,主要疾病包括子宫肌瘤、子宫腺肌症、子宫内膜异位症、卵巢良性肿瘤等,均合并中重度粘连。选取同时期内因相同疾病行传统腹腔镜全子宫切除±双输卵管/双附件切除为对照组,对比分析两组临床治疗效果。结果 单孔腹腔镜组顺利完成手术,术中未发生严重并发症,无中转开腹手术,术后未发生严重感染,如期出院。单孔腹腔镜组的住院时间、术后通气时间和引流管放置比例均低于多孔腹腔镜组,差异有统计学意义(P<0.05);两组患者术中出血量、术后血红蛋白值、血常规白细胞、中性粒细胞比例、超敏C反应蛋白、凝血功能等相关指标及粘连评分比较,均无明显统计学差异(P>0.05)。结论 术前应对患者全面评估,严格把握手术指征。经脐单孔腹腔镜用于治疗大子宫合并中重度盆腔粘连的患者,手术安全可行,术后恢复快,住院时间缩短。Objective To evaluate the clinical feasibility and safety of transumbilical single-port laparoscopic hysterectomy in patients with moderate to severe pelvic adhesions.Methods A retrospective analysis was conducted on the medical records of patients who underwent transumbilical single-port laparoscopic total hysterectomy with or without bilateral salpingo-oophorectomy at the Affiliated Hospital of Yangzhou University from June 2019 to December 2023.The primary diagnoses included uterine fibroids,adenomyosis,endometriosis and benign ovarian tumors,all complicated by moderate to severe pelvic adhesions.For comparison,a control group was selected comprising patients who underwent traditional multi-port laparoscopic total hysterectomy with or without bilateral salpingo-oophorectomy of similar conditions.The clinical outcomes of both groups were systematically compared and analyzed.Results In the single-port laparoscopy group the surgeries were successfully completed,without serious complications,transfer laparotomy or serious infection,and all patients were discharged as scheduled.The length of hospitalization,postoperative ventilation duration and the proportion of drain placement in the singleport laparoscopy group were lower than those in the multi-port laparoscopy group(P<0.05).There were no significant statistical differences observed in intraoperative bleeding,postoperative hemoglobin value,conventional white blood cells,neutrophil ratio,hypersensitive C-reactive protein,coagulation function or adhesion score(P>0.05).Conclusion A comprehensive preoperative evaluation of patients should be conducted,and surgical indications must be strictly adhered to.Transumbilical single-port laparoscopy is utilized for the treatment of patients with large uterus complicated by moderate to severe pelvic adhesions.This procedure has been demonstrated to be safe and feasible,with rapid postoperative recovery and a shortened hospital stay.

关 键 词：经脐单孔腹腔镜 大子宫 子宫全切术 盆腔粘连 

分 类 号：R713.42[医药卫生—妇产科学]