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) ›› 2022, Vol. 15 ›› Issue (03) : 174 -180. doi: 10.3877/cma.j.issn.1674-6899.2022.03.011

论著

"筷子技术"用于经脐单孔腹腔镜全子宫切除术的可行性和安全性研究
钟魁艳1, 邓黎1, 李宇迪1, 姚远洋1, 唐帅1, 胡群英1, 凌开建1, 王延洲1,()   
  1. 1. 400030 重庆,陆军军医大学附属第一医院妇产科
  • 收稿日期:2022-01-25 出版日期:2022-06-30
  • 通信作者: 王延洲

Feasibility and safety of "chopsticks technique" for the laparoendoscopic single-site surgery total hysterectomy

Kuiyan Zhong1, Li Deng1, Yudi Li1, Yuanyang Yao1, Shuai Tang1, Qunying Hu1, Kaijian Ling1, Yanzhou Wang1,()   

  1. 1. Department of Gynecology and Obstetrics, First Affilisted Hospital, Army Medical University, Chongqing 400030, China
  • Received:2022-01-25 Published:2022-06-30
  • Corresponding author: Yanzhou Wang
引用本文:

钟魁艳, 邓黎, 李宇迪, 姚远洋, 唐帅, 胡群英, 凌开建, 王延洲. "筷子技术"用于经脐单孔腹腔镜全子宫切除术的可行性和安全性研究[J/OL]. 中华腔镜外科杂志(电子版), 2022, 15(03): 174-180.

Kuiyan Zhong, Li Deng, Yudi Li, Yuanyang Yao, Shuai Tang, Qunying Hu, Kaijian Ling, Yanzhou Wang. Feasibility and safety of "chopsticks technique" for the laparoendoscopic single-site surgery total hysterectomy[J/OL]. Chinese Journal of Laparoscopic Surgery(Electronic Edition), 2022, 15(03): 174-180.

目的

"筷子技术"用于经脐单孔腹腔镜(laparoendoscopic single-site surgery,LESS)全子宫切除术与传统多孔腹腔镜(traditional laparoscopic,TL)全子宫切除术,进行围手术期结局,验证其可行性和安全性。

方法

采用回顾性队列研究,纳入2016年12月至2019年6月期间,于陆军军医大学附属第一医院妇产科,行LESS全子宫切除术与同期TL全子宫切除术的患者。比较两组的手术时间、术中出血量、术后排气时间、术后12 h和24 h疼痛视觉模拟评分(visual analogue scale, VAS)、术后住院时间、术中和术后并发症发生情况。

结果

研究共纳入297例患者临床资料,其中LESS全子宫切除术107例(LESS组)、TL全子宫切除术190例(TL组)。两组均顺利完成手术,无中转开腹。两组患者基线均衡。LESS组和TL组的手术时间分别为131 min(102,155)min和125.5 min (92.8,155)min,差异无统计学意义(P>0.05);术中出血量分别为100 ml(100,200)ml和100 ml(100,150)ml,差异无统计学意义(P >0.05);术后排气时间、术后12 h和24 h VAS、围手术期并发症等,差异无统计学意义(P>0.05);两组阴道残端均愈合良好。LESS组术后住院时间比TL组短,差异有统计学意义(P<0.05)。分别比较子宫≥12孕周、子宫<12孕周的患者,LESS组与TL组的手术时间、术中出血量、术后排气时间、术后12 h和24 h VAS、围手术期并发症,差异无统计学意义(P >0.05)。子宫<12孕周LESS组比TL组的术后住院时间缩短,差异有统计学意义(P<0.05)。

结论

"筷子技术"用于LESS全子宫切除的围手术期结局与TL相似,初步证实了其在LESS术中的可行性和安全性。

Objective

To the feasibility and safety of "chopsticks technique" for the laparoendoscopic single-site surgery total hysterectomy were confirmed by peroperative outcome was compared with traditional laparoscopic total hysterectomy.

Methods

A retrospective cohort study was used in this study. Patients who were included in the laparoendoscopic single-site surgery total hysterectomy and the traditional laparoscopic total hysterectomy of the First Affiliated Hospital of the Army Military Medical University from Dec. 2016 to Jun. 2019. The operation time, intraoperative bleeding amount, postoperative exhaust time, VAS score after surgery (12 h, 24 h), postoperative hospitalization time and postoperative complications of the two groups were compared.

Results

A total of 297 patients were included in the study, including 107 laparoendoscopic single-site surgery (LESS group) and 190 traditional laparoscopic(TL group). Both groups successfully completed the operation, no case was transferred to laparotomy. Baseline values of patients were balanced in both groups. The operation time of the LESS and TL groups were 131 min(102, 155)min and 125.5 min (92.8, 155) min with no statistical difference (P> 0.05); intraoperative bleeding was 100 ml(100, 200)ml and 100 ml(100, 150)ml, no statistical difference (P> 0.05); there were no statistical differences in postoperative exhaust time, VAS score after surgery (12 h, 24 h), postoperative complications (P> 0.05); both groups vaginal stump healed well. The LESS group was shorter postoperative hospital stay than the TL group and was statistically significant (P<0.05). For patients at uterine size≥12 weeks gestation and uterine size<12 weeks gestation were compared, there was no statistical difference between LESS group and TL groups in the operation time, postoperative bleeding time, postoperative exhaust time, VAS score after surgery (12 h, 24 h), perioperative complications (P> 0.05). Among them, for the uterine <12 gestational weeks, The LESS group was shorter postoperative hospital stay than the TL group and was statistically significant (P<0.05).

Conclusions

The perioperative outcome of the "chopstick technique" for laparoendoscopic single-site surgery total hysterectomy was similar to that of traditional laparoscopic total hysterectomy. The feasibility and safety in the laparoendoscopic single-site surgery were preliminarily demonstrated.

图1 病例资料筛选流程
表1 两组全子宫切除术患者一般资料比较
表2 两组全子宫切除术患者围手术期指标对比
表3 LESS组107例患者不同子宫大小的临床资料比较
表4 两组子宫大小≥12孕周患者的临床资料比较
表5 两组子宫大小<12孕周患者的临床资料比较
1
Aarts JW, Nieboer TE, Johnson N, et al. Surgical approach to hysterectomy for benign gynaecological disease[J]. Cochrane Database Syst Rev20152015(8): 3677.
2
Demirayak G, Özdemir ĪA, Comba C, et al. Comparison of laparoendoscopic single-site (LESS) surgery and conventional multi port laparoscopic (CMPL) surgery for hysterectomy: long-term outcomes of abdominal incisional scar[J]. J Obstet Gynaecol202040(2):217-221.
3
Pelosi MA. Laparoscopic hysterectomy with bilateral salpingo-oophorectomy using a single umbilical puncture[J]. N J Med199188(10):721-726.
4
荣风年,赵珊.限制单孔腹腔镜技术发展的因素分析[J].山东大学学报:医学版201957(12):26-30.
5
刘海元,孙大为,张俊吉,等. 《妇科单孔腔镜手术技术专家共识》解读[J/CD]. 中华腔镜外科杂志(电子版)201710(1):1-6.
6
王延洲,陈诚,徐嘉莉,等. "筷子法"单孔腹腔镜技术在宫颈癌中的应用[J/CD].中华腔镜外科杂志(电子版 )201811(1):28-31.
7
Ferreira H, Campo R. Surgical steps of total laparoscopic hysterectomy part 1: benign disease by the european society for gynaecological endoscopy (ESGE)[J]. Facts, News and Views, 2019, 11:103-110.
8
许丽娜,李立峰.腹腔镜下大子宫切除87例临床分析[J].腹腔镜外科杂志200510(4):233-234.
9
李光仪,冯虹.腹腔镜全子宫切除术357例总结 [J].中国内镜杂志19995(1):28-29.
10
Kim SM, Park EK, Jeung IC, et al. Abdominal, multi-port and single-port total laparoscopic hysterectomy: eleven-year trends comparison of surgical outcomes complications of 936 cases[J]. Arch Gynecol Obstet2015291(6):1313-1319.
11
Chung JH, Baek JM, Chung K, et al. A comparison of postoperative pain after transumbilical single-port access and conventional three-port total laparoscopic hysterectomy: a randomized controlled trial[J]. Acta Obstet Gynecol Scand201594(12):1290-1296.
12
Sandberg EM, Chapelle CF, Tweel MM, et al. Laparoendoscopic single-site surgery versus conventional laparoscopy for hysterectomy: a systematic review and meta-analysis[J]. Arch Gynecol Obstet2017295(5):1089-1103.
13
Weiss HG, Brunner W, Biebl MO, et al. Wound complications in 1145 consecutive transumbilical single-incision laparoscopic procedures[J]. Ann Surg2014259(1):89-95.
14
王晓樱,李妍. 单孔腹腔镜全子宫切除术临床疗效分析[J]. 中国现代手术学杂志2019, 23(3):5.
15
Michener CM, Lampert E, Yao M, et al. Meta-analysis of laparoendoscopic single-site and vaginal natural orifice transluminal endoscopic hysterectomy compared with multiport hysterectomy: real benefits or diminishing returns[J]. J Minim Invasive Gynecol202128(3):698-709.
16
Walsh CA, Walsh SR, Tang TY, et al. Total abdominal hysterectomy versus total laparoscopic hysterectomy for benign disease: a meta-analysis[J]. Eur J Obstet Gynecol Reprod Biol2009144(1):3-7.
17
刘海元,孙大为,陶陶,等.单孔腹腔镜大子宫切除术初步探讨[J/CD].中华腔镜外科杂志(电子版)20158(5):2-4.
18
金振伟,李颖,张广英,等.经脐单孔腹腔镜下巨大子宫切除术1例报道并文献复习[J].山东大学学报:医学版201957(12):114-117.
[1] 李凯, 陈淋, 向涵, 苏怀东, 张伟. 一种U型记忆合金线在经脐单孔腹腔镜阑尾切除术中的临床应用[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(01): 15-15.
[2] 易明超, 汪鑫, 向涵, 苏怀东, 张伟. 一种T型记忆金属线在经脐单孔腹腔镜胆囊切除术中的临床应用[J/OL]. 中华普外科手术学杂志(电子版), 2023, 17(06): 599-599.
[3] 孟飞龙, 华帅, 张莹, 路广海. 经脐单孔腹腔镜后鞘后入路在全腹膜外腹股沟疝修补术中的应用[J/OL]. 中华普外科手术学杂志(电子版), 2023, 17(06): 658-660.
[4] 易明超, 汪鑫, 向涵, 苏怀东, 张伟. 一种T型记忆金属线在经脐单孔腹腔镜胆囊切除术中的临床应用[J/OL]. 中华普外科手术学杂志(电子版), 2023, 17(06): 599-599.
[5] 蒋露, 郑莹, 杨帆, 王乔, 王娜, 阳川华, 陈宇, 苟嘉妮, 邓露丝, 杨旭. 经脐单孔腹腔镜联合上腹部开腹行晚期卵巢癌肿瘤细胞减灭术[J/OL]. 中华腔镜外科杂志(电子版), 2024, 17(03): 177-181.
[6] 刘洪云, 李翠, 张海堂, 张玉英, 黄成香. 经脐单孔腹腔镜技术在子宫内膜癌手术中的应用[J/OL]. 中华腔镜外科杂志(电子版), 2024, 17(03): 182-184.
[7] 张秩坤, 李中策, 郑奕菲, 戚士芹. 经脐单孔腹腔镜脾部分切除在儿童脾病中的应用体会[J/OL]. 中华腔镜外科杂志(电子版), 2024, 17(02): 116-119.
[8] 周树林, 姜旖, 邱江南, 吴姗, 罗成燕, 袁琳, 程文俊. 经脐单孔腹腔镜全子宫双输卵管切除术[J/OL]. 中华腔镜外科杂志(电子版), 2024, 17(01): 58-61.
[9] 吕名蕊, 刘世佳, 任冉, 韩璐. 大子宫切除术-单孔腹腔镜与vNOTES谁优谁劣[J/OL]. 中华腔镜外科杂志(电子版), 2024, 17(01): 16-20.
[10] 封意兰, 赵仁峰. 经脐单孔腹腔镜剔除特殊部位子宫肌瘤[J/OL]. 中华腔镜外科杂志(电子版), 2024, 17(01): 26-29.
[11] 严斌, 缪慧娴, 王酉, 狄文, 楼微华. 经阴道内镜与单孔腹腔镜在子宫切除术中的应用比较[J/OL]. 中华腔镜外科杂志(电子版), 2024, 17(01): 39-44.
[12] 钟魁艳, 邓黎, 姚远洋, 凌开建, 邓媛, 李秋蓉, 王延洲. "筷子技术"于经脐单孔腹腔镜全子宫切除手术的可行性和学习曲线[J/OL]. 中华腔镜外科杂志(电子版), 2024, 17(01): 45-50.
[13] 张海滨, 魏春娜, 侯旭宁, 于彩虹, 姚景润, 张真. 妇科良性疾病经脐单孔腹腔镜手术后疼痛程度与美观效果研究[J/OL]. 中华腔镜外科杂志(电子版), 2024, 17(01): 51-54.
[14] 高洁, 王金玉, 范亚洲, 赵娜, 关乐, 安欣裕, 苏永区. 孕前经脐单孔腹腔镜极简式宫颈环扎术治疗宫颈机能不全[J/OL]. 中华腔镜外科杂志(电子版), 2023, 16(06): 361-364.
[15] 沈志强, 蔡丽萍, 刘福军, 张琦玲. 改良经脐单孔腹腔镜手术治疗巨大卵巢囊肿效果分析[J/OL]. 中华腔镜外科杂志(电子版), 2023, 16(06): 338-341.
阅读次数
全文


摘要