探讨和分析妊娠期行经脐单孔腹腔镜附件手术的可行性、安全性及对临床妊娠结局的影响。

回顾性分析2018年12月至2021年7月在华西第二医院妇科完成的经脐单孔腹腔镜手术治疗妊娠合并附件肿物的14例患者资料，收集手术时间、术中出血量、住院时间、术后并发症、术后疼痛情况、术后镇痛用药率、术后最高体温、术后肛门排气时间、术后病理类型、围手术期并发症、切口愈合情况，以及随访患者分娩与否、分娩周数、分娩方式、新生儿有无畸形、产时评分、新生儿疾病、有无脐疝等，以此观察其妊娠结局，对该手术方法的安全性做出评价。

14例妊娠合并附件肿物患者中13例妊娠合并卵巢肿物、1例宫内妊娠合并输卵管妊娠。所有患者手术过程均顺利，均未中转为开腹或传统腹腔镜手术。14例患者的平均手术时间(112.93±31.16)min，平均术中出血量(27.14±29.40)ml，平均术后肛门排气时间(1.30±0.37)d，术后体温36.5~37.4℃，术后切口均愈合良好，均无切口感染。围手术期均未发生流产、感染等并发症。患者平均术后疼痛评分(2.93±1.81)分，其中评分1~3分的12例(85.71%)。同时，对术后服用镇痛药情况进行观察，14例患者中使用镇痛药1例(7.14%，1/14)。随访患者分娩情况，9例(64.28%，9/14)最终成功分娩，5例(35.71%，5/14)目前仍处于妊娠期，正常产检无异常。分娩方式，4例(44.44%，4/9)顺产，5例(55.56%，5/9)剖宫产(1例在孕41周行缩宫素引产2 d后行剖宫产，1例臀位妊娠于孕39⁺¹周行剖宫产，1例体外受精-胚胎移植术后臀位妊娠于37⁺³周行剖宫产，2例行剖宫产)。9例新生儿均无畸形，其母亲妊娠过程、产时及产后均未出现脐疝。

经脐单孔腹腔镜手术治疗妊娠合并附件肿物对孕妇的创伤小，康复快，取标本快速安全，技术安全、可行，不影响后续的妊娠及分娩方式；同时由于脐部造口如同开放式腹腔镜手术，有效避免了第一盲穿操作(气腹针或套管针)的损伤，从而提高孕母及胎儿的安全性，值得推广。

To analysis the feasibility, safety, and impact on clinical in pregnancy outcomes of single-port transumbilical laparoscopic surgery for adnexal masses in pregnancy.

A total of 14 cases underwent laparoendoscopic single-site surgery for adnexal masses of the West China Second University hospita in Dec. 2018 to Jul. 2021.To observe its pregnancy outcomes and analyze the safety of surgery by collecting operation time, intraoperative blood volume, hospitalization, postoperative complications, postoperative pain, postoperative analgesic medication rate, postoperative maximum body temperature, postoperative anus exhaust time, postoperative pathological type, perioperative complications, incision healing, follow-up delivery, childbirth week, mode of delivery, fetal malformation, intrapartum score, fetal disease, umbilical hernia, etc.

Among the 14 cases of pregnancy with adnexal mass, 13 cases were pregnancy with ovarian mass, 1 case was intrauterine pregnancy with tubal pregnancy, the operation process was smooth, all of them were not converted to laparotomy or traditional laparoscopy.In 14 patients, the average operation time was(112.93±31.16)min, the average intraoperative bleeding was (27.14±29.40) ml, the average postoperative anal exhaust time was 1. (1.30±0.37)days, and the highest postoperative body temperature was 36.5-37.4℃. All the incisions healed well and there was no incision infection. And no complications such as abortion and infection occurred during the perioperative period. Our study analyzed the postoperative pain scores of all patients, the results showed that the average score of all patients was (2.93±1.81), and the number of patients with scores of 1-3 were 12 cases(85.71%). At the same time, the results showed that the ratio of analgesics who used transumbilical single-port laparoscopic surgery to treat pregnancy with adnexal mass was 1 in 14 patients(7.14%, 1/14). The delivery status of the patients was followed up, and the results showed that 9 patients finally gave birth successfully(64.28%, 9/14), while the other 5 patients(35.71%, 5/14)terminated their pregnancy. The results of pregnancy mode showed that 4 cases (44.44%, 4/9) were normal delivery and 5 cases(55.56%, 5/9) were cesarean section(One patient was given a cesarean section 2 days after oxytocin induction at 41 weeks of gestation, 1 case of breech pregnancy was performed at 39^{+ 1} week gestation, and 1 case of breech pregnancy after in vitro fertilization-embryo transfer was performed at 37^{+ 3} weeks the patient resolutely requested a cesarean section, the other two cases were requested by the patient), the causes of cesarean section were not related to laparoendoscopic single-site surgery with adnexal masses. The results of fetal morphological observation showed that all 14 fetuses had no malformations, and there was no umbilical hernia during pregnancy, delivery, and postpartum.

Single-port transumbilical laparoscopic surgery for pregnancy complicated with adnexal mass has the advantages of less trauma, quick recovery, safe and feasible technique, and does not affect the subsequent pregnancy and delivery mode. At the same time, the umbilical stoma is like an open laparoscopic operation, which effectively avoids the injury of the first blind puncture operation (pneumoperitoneum needle or trocar), thus improving the safety of the mother and fetus, which is worth popularizing.