切换至 "中华医学电子期刊资源库"

中华腔镜外科杂志(电子版) ›› 2018, Vol. 11 ›› Issue (01): 28 -31. doi: 10.3877/cma.j.issn.1674-6899.2018.01.008

所属专题: 文献资源库

论著 上一篇    下一篇

"筷子法"单孔腹腔镜技术在宫颈癌中的应用
王延洲 1, 陈诚 1, 徐嘉莉 1, 李宇迪 1, 邓黎 1, 陈功立 1, 梁志清 1 , ( )   
  1. 1. 400038 重庆,陆军军医大学第一附属医院妇产科
  • 收稿日期:2017-12-29 出版日期:2018-02-28
  • 通信作者: 梁志清
  • 基金资助:
    第三军医大学第一附属医院临床新技术原始创新型重点项目(SWH2016YSCXZD-07)

The application of "chopsticks technique" single-site laparoscopic surgery technology in cervical cancer

Yanzhou Wang 1, Cheng Chen 1, Jiali Xu 1, Yudi Li 1, Li Deng 1, Gongli Chen 1, Zhiqing Liang 1 , ( )   

  1. 1. Department of Obstetrics and Gynecology, Southwest Hospital, Third Military Medical University, Chongqing 400038, China
  • Received:2017-12-29 Published:2018-02-28
  • Corresponding author: Zhiqing Liang
  • About author:
    Corresponding author: Liang zhiqing, Email:
目的

描述新型"筷子法"单孔腹腔镜手术技术,探讨"筷子法"单孔腹腔镜广泛子宫切除及盆腔淋巴结清扫治疗宫颈癌的可行性、安全性及围手术期结局。

方法

2016年10月至2017年10月,前瞻性纳入陆军军医大学第一附属医院妇产科诊断为宫颈癌患者,采用"筷子法"单孔腹腔镜技术,行单孔腹腔镜广泛子宫切除+盆腔淋巴结清扫术。对患者人口学特征和围手术期效果进行总结分析。

结果

53例患者尝试手术,除1例因术中探查Ⅳ期子宫内膜异位症中转为多孔腹腔镜手术外,52例(98%)成功完成。52例均采用"筷子法"单孔腹腔镜技术,其中40例采用"单切口3通道"入路平台,12例为采用软性入路平台。中位手术时间212 min,平均术中出血量134 ml。2例术中血管损伤、1例膀胱损伤,均发生在最初的20例手术中,且均在术中单孔腹腔镜下完成修补。术后14 d发生输尿管阴道瘘1例,行输尿管膀胱再植术修补成功。

结论

采用"筷子法"单孔腹腔镜技术治疗宫颈癌是可行的,初步临床观察发现围手术期临床结局与文献报道的多孔腹腔镜手术类似,但在技术开展初期应重视预防术中并发症发生。

Objective

To describe the new "chopsticks technique" single-site laparoscopic surgery technology, and to explore the feasibility, safety and peri operative outcome of laparoendoscopic single-site radical hysterectomy and pelvic lymphadenectomy using "chopsticks technique" .

Methods

From Oct.2016 to Oct. 2017, Patients diagnosed with cervical cancer were prospectively enrolled in obstetrics and Gynecology Department of Southwest Hospital, Third Military Medical University. The demographic characteristics of the patients and the effect of perioperative period were summarized and analyzed.

Results

53 cases were operated on, and 52 cases(98%) were successfully completed , and 1 cases were converted to 3-port laparoscopy due stage Ⅳ endometriosis. All the 52 cases were used "chopsticks technique" , of which 40 cases were used "single incision three channel" approach platform, and 12 cases were soft access platform. The median operation time was 212 min, and the average blood loss was 134 ml during the operation. 2 cases of vascular injury and 1 cases of bladder injury occurred in the first 20 cases, and all of them were repaired by single-site laparoscopy during the operation. 1 case of ureteral vaginal fistula occurred 14 days after the operation, and the ureterovesical reimplantation was successfully repaired.

Conclusions

The "chopsticks technique" single port laparoscopic surgery is feasible for the treatment of cervical cancer. Preliminary clinical observation shows that the perioperative clinical outcomes are similar to those reported by literature. However, in the initial stage of technology, we should pay attention to prevent intraoperative complications.

[1]
Wang Y, Deng L, Xu H, et al. Laparoscopy versus laparotomy for the management of early stage cervical cancer[J]. Bmc Cancer, 2015, 15(1): 928-931.
王延洲,陈功立,徐嘉莉,等. 单孔腹腔镜广泛子宫切除盆腔淋巴结清扫治疗宫颈癌:一项单中心的初步研究[J]. 第三军医大学学报,2017, 39(13):1392-1395.
[3]
孙大为,张俊吉,熊巍,等. 单孔腹腔镜下子宫内膜癌分期手术的临床报告[J/CD]. 中华腔镜外科杂志(电子版), 2014,7(1):10-13.
[4]
孙大为,张颖. 单孔腹腔镜手术在异位妊娠诊治中的应用[J]. 中国实用妇科与产科杂志,2017, 33(9):903-906.
[5]
Ishikawa N, Arano Y, Shimizu S, et al. Single incision laparoscopic surgery (SILS) using cross hand technique[J]. Minim Invasive Ther Allied Technol, 2009, 18(6): 322-324.
[6]
Garrett LA. Laparoendoscopic single-site radical hysterectomy: the first report of LESS type Ⅲ hysterectomy involves a woman with cervical cancer[J]. American Journal of Obstetrics & Gynecology, 2012, 207(6): 1-2.
[7]
Boruta DM, Fagotti A, Bradford LS, et al. Laparoendoscopic single-site radical hysterectomy with pelvic lymphadenectomy: initial multi-institutional experience for treatment of invasive cervical cancer[J]. Journal of Minimally Invasive Gynecology, 2014, 21(3): 394-398.
[8]
Figurelli J, Bresson L, Narducci F, et al. Single-port access laparoscopic surgery in gynecologic oncology: outcomes and feasibility[J]. International Journal of Gynecological Cancer Official Journal of the International Gynecological Cancer Society, 2014, 24(6): 1126-1132.
[9]
Bedaiwy MA, Sheyn D, Eghdami L, et al. Laparoendoscopic single-site surgery for benign ovarian cystectomies[J]. Gynecologic & Obstetric Investigation, 2015, 79(3): 179-183.
[10]
Park JY, Kim DY, Kim SH, et al. Laparoendoscopic single-site compared with conventional laparoscopic ovarian cystectomy for ovarian endometrioma[J]. Journal of Minimally Invasive Gynecology, 2015, 22(5): 813-819.
[11]
Lee J, Kim S, Nam EJ, et al. Single-port access versus conventional multi-port access total laparoscopic hysterectomy for very large uterus[J]. 2015, 58(3): 239-245.
[12]
Park JY, Nho J, Cho IJ, et al. Laparoendoscopic single-site versus conventional laparoscopic-assisted vaginal hysterectomy for benign or pre-invasive uterine disease[J]. Surgical Endoscopy & Other Interventional Techniques, 2015, 29(4): 890-897.
[13]
Fagotti A, Bottoni C, Vizzielli G, et al. Laparoendoscopic single-site surgery (LESS) for treatment of benign adnexal disease: single-center experience over 3-years[J]. J Minim Invasive Gynecol, 2012, 19(6): 695-700.
[14]
AbuRustum NR, Gemignani ML, Moore K, et al. Total laparoscopic radical hysterectomy with pelvic lymphadenectomy using the argon-beam coagulator: pilot data and comparison to laparotomy[J]. Gynecologic Oncology, 2003, 91(2): 402-409.
[15]
梁志清,徐惠成,熊光武,等. 腹腔镜在子宫颈癌治疗中的应用:附37例分析[J]. 中国微创外科杂志,2002, 2(1):62-63.
[1] 王一然, 王平. 《巴西肿瘤外科协会盆腔廓清术治疗宫颈癌指南》解读[J]. 中华妇幼临床医学杂志(电子版), 2021, 17(02): 142-151.
[2] 唐明鸣, 李林, 李征宇. 采用传统腹腔镜器械开展经脐单孔腹腔镜手术技术在妇科手术中的应用现状[J]. 中华妇幼临床医学杂志(电子版), 2020, 16(05): 504-509.
[3] 郑晓霞, 李大鹏. 中性粒细胞计数与淋巴细胞计数比值对局部晚期宫颈癌患者新辅助化疗疗效的预测价值[J]. 中华妇幼临床医学杂志(电子版), 2020, 16(05): 558-566.
[4] 苏英杰, 窦磊, 田东立, 芦恩婷, 张颐. 全脏器反位患者机器人辅助下宫颈癌根治术一例[J]. 中华腔镜外科杂志(电子版), 2021, 14(04): 245-247.
[5] 朱可安, 陈灵, 李昭, 黄薇. 应用单孔腹腔镜开展常见妇科手术的可行性探讨[J]. 中华腔镜外科杂志(电子版), 2021, 14(03): 158-162.
[6] 金贝贝, 张玉泉, 李季, 高赛楠, 朱春玉, 丁晓颖, 杨晓清. 普通及机器人辅助经脐单孔腹腔镜在子宫肌瘤剔除术中的应用比较[J]. 中华腔镜外科杂志(电子版), 2021, 14(03): 163-167.
[7] 徐晓钢, 曾纪晓, 刘斐, 兰梦龙, 陶波圆, 林玉珍. 经脐单孔3D腹腔镜手术治疗小儿先天性胆总管囊肿[J]. 中华腔镜外科杂志(电子版), 2021, 14(03): 172-176.
[8] 曹言言, 彭仁国, 文芳, 訾聃. 单孔腹腔镜对Ⅰ期子宫内膜癌手术患者疼痛及负性情绪的影响分析[J]. 中华腔镜外科杂志(电子版), 2021, 14(02): 90-96.
[9] 秦真岳, 王慧慧, 陈继明, 鲍明月, 郑亚峰, 肖惠超, 马洋, 蒋云芬, 施如霞. 单孔腹腔镜手术治疗Ⅲ型(包块型)子宫瘢痕妊娠[J]. 中华腔镜外科杂志(电子版), 2021, 14(02): 122-126.
[10] 王永鹏, 孙大为. 单孔腹腔镜手术治疗妊娠早期子宫圆韧带肌瘤一例[J]. 中华腔镜外科杂志(电子版), 2021, 14(02): 116-118.
[11] 周容, 令狐华, 代雪林, 代凤琴, 龚瑶. 经脐单孔腹腔镜在晚期卵巢恶性肿瘤初始评估及活检中的应用[J]. 中华腔镜外科杂志(电子版), 2021, 14(01): 33-36.
[12] 潘玉英, 孙力, 王桂香, 李华, 杨萌. 腹腔镜手术治疗宫颈癌复发一例[J]. 中华腔镜外科杂志(电子版), 2021, 14(01): 53-57.
[13] 张鑫, 张磊, 赵淑萍. 腹壁缝合钳辅助单孔腹腔镜卵巢囊肿剥除术的疗效分析[J]. 中华腔镜外科杂志(电子版), 2020, 13(06): 367-371.
[14] 郭静, 齐卫红. circ_0000218通过靶向吸附miR-1182对宫颈癌HeLa细胞增殖、迁移和侵袭的影响[J]. 中华细胞与干细胞杂志(电子版), 2021, 11(02): 113-119.
[15] 廖欣, 顾一平, 廖薇. 低强度超声对HeLa肿瘤细胞凋亡的诱导作用及其机制[J]. 中华细胞与干细胞杂志(电子版), 2020, 10(05): 277-282.
阅读次数
全文


摘要