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

doi:10.3877/cma.j.issn.1674-6899.2021.01.008

目的

对于拟诊晚期卵巢恶性肿瘤的患者，探讨经脐单孔腹腔镜探查在初始评估及组织活检中的可行性及安全性。

方法

回顾性分析重庆医科大学附属第一医院妇科2016年5月至2020年5月对63例拟诊晚期卵巢恶性肿瘤患者实施腹腔镜探查及活检术，其中30例采用经脐单孔腹腔镜探查(单孔组)、33例采用多孔腹腔镜探查(多孔组)。单孔组采用经脐2～3 cm单切口操作，多孔组采用4孔操作。所有患者满足2个条件：缺乏细胞学证据、术前CT评分(Suidan评分)难以完成满意的初期肿瘤细胞减灭术(primary debulking surgery, PDS)。手术包括全面探查评估(Fagotti评分)和组织活检。比较两组的手术资料、围手术期并发症、术后切口愈合及切口转移发生率。

结果

63例患者均顺利完成手术探查及组织活检。单孔组Ⅲ期28例、Ⅳ期2例，无增加穿刺孔，2例中转行开腹PDS；多孔组Ⅲ期31例、Ⅳ期2例，无中转开腹手术。两组平均手术时间[(88.1±22.1)min比(81.4±20.0) min，P>0.05]、术中出血量[(39.7±33.8)ml比(40.6±62.1)ml，P>0.05]。两组的围手术期并发症差异无统计学意义。单孔组无脐疝、无切口转移；多孔组1例脐疝、2例发生切口转移。

结论

在晚期卵巢恶性肿瘤探查及活检中，单孔腹腔镜安全可行，取标本方便，可保护切口，可能优于多孔腹腔镜在此类患者中的应用。

关键词: 晚期卵巢恶性肿瘤, 单孔腹腔镜, 活检

Objective

To evaluate the feasibility and safety of laparoendoscopic single-site surgery (LESS) in exploration and biopsy in patients with suspected advanced ovarian cancer (AOC) who were thought unsuitable for primary debulking surgery (PDS).

Methods

From May 2016 to May 2020, 63 patients with suspected AOC who underwent laparoscopic exploration and biopsy were retrospectively analyzed. Among them, 30 received LESS and 33 received conventional multi-port laparoscopy (MPL). All patients met two conditions: lack of positive cytological pathology, evaluated as unlikelihood of achieving optimal PDS based on Suidan criteria. The laparoscopic procedure included thorough laparoendoscopic exploration (Fagotti score) and biopsy. The perioperative data, complications and port-site metastasis (PSM) based on CT or MRI were compared between the two groups.

Results

All patients were operated uneventfully. In LESS group 28 patients were staged as FIGO Ⅲ and 2 were Ⅳ. No additional trocar was used. Two cased received PDS. In MPL group 31 patients were staged as FIGO Ⅲ and 2 were Ⅳ, no open surgery was conducted. The mean operative time [ (88.1±22.1) min vs (81.4±20.0)min, P>0.05], estimated blood loss [(39.7±33.8)ml vs (40.6±62.1)ml, P>0.05] and complications between two groups were not statistically significant. No incisional hernia or PSM happened in LESS group while 1 umbilical hernia and 2 PSM in MLP group, yet no statistical significance was found.

Conclusions

LESS is possibly superior to conventional MPL in the exploration and biopsy of AOC due to its advantages in minimal invasiveness, specimen collection as well as the protection of umbilical incision.

Key words: Advanced ovarian cancer, Laparoendoscopic single-site surgery, Biopsy

图1 晚期卵巢恶性肿瘤患者单孔腹腔镜手术中情况

表1 两组晚期卵巢恶性肿瘤患者资料

组别	例数	年龄(岁， ±s)	体质量指数(kg/m²， ±s)	Fagotti评分(分， ±s)	手术时间(min， ±s)	术中出血量(ml， ±s)	并发症(例)	切口转移(例)
单孔组	30	61.8±8.9	22.6±3.2	9.3±1.3	88.1±22.1	39.7±33.8	3	0
多孔组	33	60.3±10.7	23.9±2.9	9.4±2.0	81.4±20.0	40.6±62.1	4	2
P值		0.543	0.083	0.767	0.213	0.942	0.555	0.270

表1 两组晚期卵巢恶性肿瘤患者资料

组别	例数	年龄(岁， ±s)	体质量指数(kg/m²， ±s)	Fagotti评分(分， ±s)	手术时间(min， ±s)	术中出血量(ml， ±s)	并发症(例)	切口转移(例)
单孔组	30	61.8±8.9	22.6±3.2	9.3±1.3	88.1±22.1	39.7±33.8	3	0
多孔组	33	60.3±10.7	23.9±2.9	9.4±2.0	81.4±20.0	40.6±62.1	4	2
P值		0.543	0.083	0.767	0.213	0.942	0.555	0.270

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Initial experience of laparoendoscopic single-site surgery in exploration and biopsy in patients with advanced ovarian cancer

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Initial experience of laparoendoscopic single-site surgery in exploration and biopsy in patients with advanced ovarian cancer