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中华腔镜外科杂志(电子版)

中华腔镜外科杂志(电子版) ›› 2019, Vol. 12 ›› Issue (06): 361 -365. doi: 10.3877/cma.j.issn.1674-6899.2019.06.011

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单孔腹腔镜联合经脐小切口体外妊娠期巨大卵巢囊肿剥除术的临床应用价值
张真 1, 李俐辉 1, 张海滨 1, 郭清 1 , †( ), 侯旭宁 1, 王海兴 1, 崔荣 1   
  1. 1. 050000 石家庄市第四医院妇二科
  • 收稿日期:2019-11-27 出版日期:2019-12-30
  • 通信作者: 郭清

Clinical value of single-hole laparoscopy combined with small umbilical incision in vitro gestation of giant ovarian cysts during pregnancy

Zhen Zhang 1, Lihui Li 1, Haibin Zhang 1, Qing Guo 1 , †( ), Xuning Hou 1, Haixing Wang 1, Rong Cui 1   

  1. 1. Shijiazhuang Maternity Hospital, Shijiazhuang 050000, China
  • Received:2019-11-27 Published:2019-12-30
  • Corresponding author: Qing Guo
  • About author:
    Corresponding author: Guo Qing, Email:
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目的

评估利用单孔腹腔镜联合经脐小切口体外剥除妊娠期巨大卵巢囊肿的临床意义和治疗效果。

方法

回顾性分析2018年5～11月在石家庄市第四医院实施单孔腹腔镜联合经脐小切口体外妊娠期巨大卵巢囊肿(10～11 cm)剥除术的6例患者的临床资料。

结果

6例患者均顺利完成单孔腹腔镜联合经脐小切口体外巨大卵巢囊肿剥除。6例患者中，1例输卵管系膜囊肿扭转，2例卵巢囊肿蒂扭转，3例患者恢复正常解剖结构后卵巢均未发生坏死，行囊肿剥除术。中位囊肿直径10 cm(10～11 cm)，中位手术时间51.50 min(43.75～63.50 min)，中位术中出血7.5 ml( 5～20 ml)，平均住院时间( 3.50±0.43) d。随访，6例患者中，5例(83.33%)妊娠至足月分娩，1例(16.67%)早产；其中2例(33.33%)行剖宫产，4例(66.67%)顺产；中位新生儿体质量3 050 g(2 750～3 162.5 g)。6例患者的新生儿均无畸形及窒息。

结论

对妊娠期巨大卵巢囊肿，应用单孔腹腔镜联合经脐小切口体外巨大卵巢囊肿剥除术是安全可行的，值得临床推广。

关键词: 单孔腹腔镜, 经脐小切口手术, 妊娠期, 巨大卵巢囊肿
Objective

To evaluate the clinical significance and therapeutic effect of single-hole laparoscopy combined with small umbilical incision for excision of giant ovarian cysts during pregnancy.

Methods

A retrospective analysis was performed on the clinical outcomes of 6 patients undergoing single-hole laparoscopy combined with a small umbilical incision and external giant ovarian cyst (10-11 cm) pregnancy during May to Nov. 2018. data.

Results

All 6 patients successfully completed the excision of giant ovarian cysts with single-hole laparoscopy combined with a small umbilical incision. In 6 patients, two patient′s ovarian cysts were twisted, one patient’s mesentery cysts were twisted, and other three patient′s ovaries had normal anatomical structure. No necrosis occurred, and cystectomy was performed. The median operation time was 51.50 min(43.75-63.50 min), the median intraoperative blood loss was 7.5 ml (5-20 ml), and the average hospital day was (3.50 ± 0.43) days. Follow-up, of the 6 patients, 5 were pregnant to full-term delivery (83.33%), 1 was premature (16.67%); 2 of them underwent cesarean section (33.33%), 4 were delivered in labor (66.67%); median newborn weight 3 050 g (2 750-3 162.5 g). There were no deformities and asphyxia in the newborns of 6 patients.

Conclusion

After sufficient pre-operative and intra-operative evaluations to rule out the possibility of severe malignant ovarian tumors and pelvic adhesions, single-hole laparoscopy combined with a small umbilical incision to remove giant ovarian cysts during pregnancy. The technique is safe and feasible and worthy of clinical promotion.

Key words: Single-port laparoscopy, Transumbilical small incision, Pregnancy, Giant ovarian cyst
图4 术后脐部小切口
表1 6例实施单孔腹腔镜联合经脐小切口妊娠期巨大卵巢囊肿体外剥除术患者术前情况
序号 年龄(岁) 体质量指数( kg/m2) 孕产(次) CA125(U/ml) 病灶位置 囊肿直径(cm) 孕(周)
1 29 37.5 G2P1 15.6 左侧 10 10
2 24 22.9 G0P0 13.0 左侧 10 19＋5
3 28 19.5 G0P0 15.4 右侧 11 14＋1
4 27 20.3 G1P1 17.7 右侧输卵管系膜 10 14＋4
5 28 28.9 G2P1 30.6 左侧 10 18＋4
6 28 19.1 G0P0 18.6 左侧 11 10
表2 6例实施单孔腹腔镜联合经脐小切口妊娠期巨大卵巢囊肿体外剥除术患者术中、术后情况和新生儿情况及随访
序号 手术时间(min) 术中出血量(ml) 住院时间(d) 术后并发症 术后病理类型 术后有无复发 分娩周数 分娩方式 新生儿性别 新生儿体质量(g) 新生儿有无畸形
1 48 10 3 无 符合黄体囊肿伴出血 无 38周 剖宫产 男 3 150 无
2 45 20 4 无 卵巢黏液性囊腺瘤 无 39＋4周 剖宫产 男 3 200 无
3 40 5 4 无 卵巢囊性畸胎瘤，可见神经胶质成分 无 40＋2周 顺娩 男 3 050 无
4 63 5 5 无 副中肾管囊腺纤维瘤 无 40＋3周 顺娩 男 3 050 无
5 65 5 3 无 黏液性囊腺瘤 无 38＋4周 顺娩 男 3 000 无
6 55 20 2 无 成熟性囊性畸胎瘤 无 35＋5周 顺娩 男 2 000 无
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