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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) ›› 2022, Vol. 15 ›› Issue (01): 58 -61. doi: 10.3877/cma.j.issn.1674-6899.2022.01.013

病例报告 上一篇    下一篇

经脐单孔腹腔镜加辅助孔行卵巢巨大恶性肿瘤全面分期手术一例
张葛1, 金振伟2, 李颖1, 刘腾1, 杨晓英3, 徐晓萌1, 马迎春2,†()   
  1. 1. 250014　济南，山东第一医科大学第一附属医院（山东省千佛山医院）妇产科，山东第一医科大学第一附属医院腹腔镜技术实验室；250014　济南，山东第一医科大学（山东省医学科学院）
    2. 250014　济南，山东第一医科大学第一附属医院（山东省千佛山医院）妇产科，山东第一医科大学第一附属医院腹腔镜技术实验室
    3. 250014　济南，山东第一医科大学第一附属医院（山东省千佛山医院）妇产科，山东第一医科大学第一附属医院腹腔镜技术实验室；250014　济南，山东第一医科大学（山东省医学科学院）；261053　潍坊医学院
  • 收稿日期:2021-11-08 出版日期:2022-02-28
  • 通信作者: 马迎春

Comprehensive staging operation for giant malignant ovarian tumor through transumbilical single-port laparoscopy plus one port

Ge Zhang1, Zhenwei Jin2, Ying Li1, Teng Liu1, Xiaoying Yang3, Xiaomeng Xu1, Yingchun Ma2,†()   

  1. 1. Department of Obstetrics and Gynecology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Key Laboratory of Laparoscopic Technology, The First Affiliated Hospital of Shandong First Medical University, Jinan 250014, China.; Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan 250014, China
    2. Department of Obstetrics and Gynecology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Key Laboratory of Laparoscopic Technology, The First Affiliated Hospital of Shandong First Medical University, Jinan 250014, China
    3. Department of Obstetrics and Gynecology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Key Laboratory of Laparoscopic Technology, The First Affiliated Hospital of Shandong First Medical University, Jinan 250014, China.; Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan 250014, China.; Weifang Medical University, Weifang 261053, China
  • Received:2021-11-08 Published:2022-02-28
  • Corresponding author: Yingchun Ma
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目的

探讨经脐单孔腹腔镜手术(transumbilical laparoendoscopic single-site surgery, TU-LESS)下卵巢恶性肿瘤全面分期手术的可行性及体会。

方法

通过回顾性分析1例卵巢巨大恶性肿瘤全面分期手术的临床资料，对TU-LESS下卵巢恶性肿瘤全面分期手术中的优势、难点、应对措施及改进方向进行经验分享，探讨其可行性。

结果

手术顺利完成，术中出血少，术后恢复顺利，无并发症，患者恢复良好。

结论

TU-LESS下行卵巢巨大恶性肿瘤是安全的，但能否为患者带来更好的生存结局仍需要大样本研究。

关键词: 经脐单孔腹腔镜手术, 卵巢巨大恶性肿瘤
Objective

To investigate the feasibility of comprehensive staging surgery in the treatment of malignant ovarian tumors by transumbilical laparoscopic single-site surgery (TU-LESS) and share surgeon′s experience.

Methods

The clinical data of a case of giant malignant ovarian tumor performed TU-LESS comprehensive staging surgery were retrospectively analyzed. The advantages, difficulties, countermeasures and improving direction of TU-LESS comprehensive staging surgery in malignant ovarian tumor were shared, and its feasibility was discussed.

Results

The surgery was completed successfully with minimal intraoperative bleeding and smooth postoperative recovery with no complications. The patient recovered well.

Conclusions

TU-LESS is safe for giant malignant ovarian tumors, but whether it can bring better survival outcomes for patients still needs a large-scale study.

Key words: Transumbilical laparoendoscopic single-site surgery(TU-LESS), Giant malignant ovarian tumor
图1 术前CT轴位面显示卵巢肿瘤最大截面
图2 术前CT重建矢状面卵巢肿瘤
图3 肌瘤旋切器
图4 自制经脐单孔腹腔镜手术入路平台
图5 腹腔探查子宫与附件的关系
图6 上腹部的探查情况
图7 术中切断骨盆漏斗韧带
图8 密封标本袋内以旋切器单孔取瘤
图9 术中探查输尿管
图10 淋巴结清扫及大网膜切除后的盆腔
图11 术后左侧卵巢肿瘤HE染色病理切片
1
Song Taejong, Cho Juhee, Kim Tae-Joong, et al. Cosmetic outcomes of laparoendoscopic single-site hysterectomy compared with multi-port surgery: randomized controlled trial[J]. The Journal of Minimally Invasive Gynecology, 2013，20(4)：460-467.
2
Siedhoff Matthew T, Wheeler Stephanie B, Rutstein Sarah E, et al. Laparoscopic hysterectomy with morcellation vs abdominal hysterectomy for presumed fibroid tumors in premenopausal women: a decision analysis[J]. American journal of obstetrics and gynecology, 2015，212(5)：1-8.
3
Demirayak Gökhan, Özdemir Isa Aykut , Comba Cihan, et al. Comparison of laparoendoscopic single-site (LESS) surgery and conventional multiport laparoscopic (CMPL) surgery for hysterectomy: long-term outcomes of abdominal incisional scar[J]. Journal of Obstetrics and Gynaecology, 2020，40(2)：217-221.
4
Fagotti A, Boruta DM, Scambia G, et al. First 100 early endometrial cancer cases treated with laparoendoscopic single-site surgery: a multicentric retrospective study[J]. Am J Obstet Gynecol, 2012，206(4)：1-6.
5
Park JY, Bae J, Lim MC, et al. Laparoscopic and laparotomic staging in stage Ⅰ epithelial ovarian cancer: a comparison of feasibility and safety[J]. International journal of gynecological cancer : official journal of the International Gynecological Cancer Society, 2010，18(6)：1202-1209.
6
Fagotti A, Bottoni C, Vizzielli G, et al. Postoperative pain after conventional laparoscopy and laparoendoscopic single site surgery (LESS) for benign adnexal disease: a randomized trial[J]. Fertil Steril, 2011，96(1)：255-259.
7
Masoomi Hossein, Nguyen Ninh T, Dolich Matthew O, et al. Comparison of laparoscopic versus open appendectomy for acute nonperforated and perforated appendicitis in the obese population[J]. The American Journal of Surgery, 2011，202(6)：733-739.
8
Eltabbakh Gamal H, Piver M Steven, Hempling Ronald E, et al. Laparoscopic surgery in obese women[J]. Obstetrics & Gynecology, 1999，94(5)：704-708.
9
Fathi Amir H, Soltanian Hooman, Saber Alan A. Surgical anatomy and morphologic variations of umbilical structures[J]. The American Surgeon, 2012，78(5)：540-544.
10
Döbrönte Z, Wittmann T, Karácsony G. Rapid development of malignant metastases in the abdominal wall after laparoscopy[J]. Endoscopy, 1978，10：127-130.
11
马迎春．单孔腹腔镜技术在妇科手术中的应用：优势、并发症与难点探讨[J]．山东大学学报(医学版)，2019，57(12)：31-36.
12
Larraín Demetrio, Rabischong BenoÎt, Khoo Chong Kiat, et al. "Iatrogenic" parasitic myomas: unusual late complication of laparoscopic morcellation procedures[J]. The Journal of Minimally Invasive Gynecology, 2010，17(6)：719-724.
13
Bortoletto Pietro , Hariton Eduardo, Salas Sophia, et al. Update on fibroid morcellation[J]. Current Obstetrics and Gynecology Reports, 2017，6(1)：62-66.
14
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.
15
庄良武，吕新萍，陈捷．增加辅助孔的经脐单孔腹腔镜巨大卵巢囊肿手术[J]．中国微创外科杂志，2020，20(4)：314-317.
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