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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) ›› 2023, Vol. 16 ›› Issue (04): 200 -209. doi: 10.3877/cma.j.issn.1674-6899.2023.04.002

指南与共识

妇科单孔腹腔镜手术镜下联合体外操作模式临床应用专家共识
中国医师协会妇产科医师分会妇科单孔腹腔镜全国科研协作组   
  • 收稿日期:2023-07-14 出版日期:2023-08-30
  • 基金资助:
    江苏省妇幼健康重点人才项目(RC202101); 江苏省"333工程"科研资助项目(BRA2019161); 常州市"十四五"卫生健康高层次人才培养工程项目(2022CZBJ074)

Expert consensus on the clinical application of combined laparoscopic and extracorporeal operation mode for gynaecological laparoendoscopic single-site surgery

National Research Collaboration Group for Gynaecological Laparoendoscopic Single-site Surgery of Obstetricians and Gynaecologists Branch of Chinese Medical Doctor Association   

  • Received:2023-07-14 Published:2023-08-30
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随着单孔腹腔镜技术在妇科疾病诊疗中的广泛应用，该技术操作难度大、学习曲线长等问题逐渐凸显。为了有效解决这些问题，降低妇科单孔腹腔镜手术的操作难度，专家们提出单孔腹腔镜镜下联合体外操作的新技术和新模式。这种联合操作模式结合了传统开腹手术及腹腔镜技术的优点，降低手术难度的同时改善手术治疗的效果。中国医师协会妇产科医师分会妇科单孔腹腔镜全国科研协作组组织了国内妇科单孔腹腔镜手术领域相关专家，制定本专家共识。本专家共识详细介绍了单孔腹腔镜镜下联合体外操作模式的产生背景、临床应用的适应证与禁忌证、技术操作要点及相应的注意事项，以进一步规范完善这一联合操作模式，更好的促进妇科单孔腹腔镜技术的临床应用与推广。

关键词: 妇科单孔腹腔镜手术, 镜下联合体外操作模式, 妇科疾病诊治

With the widespread application of single-site laparoscopic technology in the diagnosis and treatment of gynecological diseases, problems such as high operational difficulty and long learning curve are gradually becoming prominent. In order to effectively solve these problems and reduce the operational difficulty of gynecological laparoendoscopic single-site surgery, experts have proposed a new technology and mode of single-site laparoscopic combined extracorporeal operation. This combined operation mode combines the advantages of traditional open surgery and laparoscopic technology, reducing the difficulty of surgery while improving the effectiveness of surgical treatment. The National Research Collaboration Group for Gynaecological Laparoendoscopic Single-site Surgery of Obstetricians and Gynaecologists Branch of Chinese Medical Doctor Association organized relevant experts in the field of gynecological single-site laparoscopic surgery in China and formulated this expert consensus. This expert consensus provides a detailed introduction to the background, indications and contraindications for clinical application, technical operation points, and corresponding precautions of the single-site laparoscopy combined extracorporeal operation mode, in order to further standardise and improve this combined operation mode, and better promote the clinical application and promotion of the gynaecological single-site laparoscopic technology.

Key words: Gynecological single-site laparoscopic surgery, Laparoscopic combined with extracorporeal operation mode, Diagnosis and treatment of gynecological diseases
图1 单孔腹腔镜镜下联合体外操作模式治疗子宫肌瘤注：A.经瘢痕入路进入腹腔；B.连接切口保护套；C.将子宫牵拉至腹部切口；D.电刀切开肌瘤表面浆肌层；E.肌瘤剥除后，直视下缝合子宫；F.瘤体自腹部切口取出；G.镜下探查腹腔；H.瘤体标本；I.内翻缝合后剖宫产瘢痕切口。(图片来源[21])
图2 单孔腹腔镜镜下联合体外操作模式治疗卵巢囊肿注：A.腹腔镜进腹探查相关情况；B.将卵巢良性肿瘤牵拉至切口处进行充分剥离；C.将卵巢良性肿瘤于镜下进一步完整剥离、切除；D：将剥离下的卵巢良性肿瘤套入标本袋中；E：将卵巢良性肿瘤经切口从标本袋中取出；F：体外剖开卵巢良性肿瘤；G.再次探查盆腔相关情况；H.逐层缝合单切口。
图3 单孔腹腔镜镜下联合体外操作模式进行输卵管再通术注：A.切开原腹壁瘢痕下段长约1.5 cm; B．连接切口保护套；C.注射生理盐水形成水垫；D.插入导丝；E.6点、12点、3点及9点定点缝合；F.宫腔注射美兰；G.双侧输卵管美兰引流通畅；H.缝合浆膜层后的输卵管形态；I.缝合后的剖宫产瘢痕切口。(图片来源[19])
图4 单孔腹腔镜镜下联合体外操作模式治疗卵巢交界性肿瘤注：A.荷包缝合后吸囊液；B.吸净囊液后缝扎切口；C.剪刀剪除凸起，送快速病理；D.完整剥离卵巢肿瘤；E.缝合卵巢重塑卵巢形态；F.切除阑尾；G.随机多点腹膜活检；H.切除大部大网膜；I.切除后大网膜标本。(图片来源[26])
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