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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): 220 -226. doi: 10.3877/cma.j.issn.1674-6899.2023.04.005

论著

单孔腹腔镜子宫肌瘤旋切隔离保护技术的应用
罗曼文, 黄桔园, 刘艳燕, 易跃雄, 陈雨柔, 熊家强, 王景涛, 张蔚†()   
  1. 430071　湖北，武汉大学中南医院妇科
  • 收稿日期:2023-07-26 出版日期:2023-08-30
  • 通信作者: 张蔚
  • 基金资助:
    湖北省科技计划重大科技专项(2023BCA002); 中央高校基本科研业务费专项资金(2042022kf1157)

Application of single-port laparoscopic hysteromyoma excision and isolation protection technology

Manwen Luo, Juyuan Huang, Yanyan Liu, Yuexiong Yi, Yurou Chen, Jiaqiang Xiong, Jingtao Wang, Wei Zhang†()   

  1. Department of Gynecology, Zhongnan Hospital of Wuhan University, Hubei 430071, China
  • Received:2023-07-26 Published:2023-08-30
  • Corresponding author: Wei Zhang
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目的

比较袋内一体化电动旋切与袋内手动冷刀旋切在经脐单孔腹腔镜子宫肌瘤剔除术中的应用效果。

方法

回顾性分析2021年7月至2023年6月期间在武汉大学中南医院妇科行经脐单孔腹腔镜子宫肌瘤剔除术患者的病历信息，包括袋内一体化电动旋切组52例，袋内手动冷刀旋切组61例。分析比较两组患者住院时长、手术时间、术中出血量、术中输血率、术后并发症发生率、术后24 h视觉模拟评分法(visual analogue scale，VAS)疼痛评分、取物袋破损率、术后引流管拔除时间、术后尿管拔除时间、术后肠道通气时间、术前与术后(1 d和3 d)血红蛋白差值及术后病理。

结果

与袋内手动冷刀旋切组相比，袋内一体化电动旋切组手术时间更短[(152.88±43.37)min vs. (176.23±59.45)min，P＝0.021]、取物袋破损率更低[0(0.0%) vs. 8(13.1%)，P＝0.019]差异存在统计学意义(P<0.05)。住院时长、术中出血量、术中输血率、术后并发症发生率、术后24 h VAS疼痛评分、术后引流管拔除时间、术后尿管拔除时间、术后肠道通气时间、术前与术后(1 d和3 d)血红蛋白差值及术后病理，两组差异无统计学意义(P>0.05)。

结论

在经脐单孔腹腔镜子宫肌瘤剔除术中，袋内一体化电动旋切是一种安全可行的方案，可与单孔腹腔镜及电动旋切器配套使用，与袋内手动冷刀旋切相比手术时长更短、取物袋破损率更低，但仍需大样本前瞻性研究进一步验证。

关键词: 子宫肌瘤剔除术, 袋内粉碎, 电动旋切, 经脐单孔腹腔镜, 妇科
Objective

To compare the application of in-bag integrated power morcellation and contained manual scalpel morcellation in transumbilical single-port laparoscopic myomectomy.

Methods

The medical records of patients who underwent transumbilical single-port laparoscopic myomectomy at the Department of Gynecology, Zhongnan Hospital of Wuhan University from Jul. 2021 to Jun. 2023 were retrospectively analyzed. There were 52 patients who underwent in-bag integrated power morcellation and 61 patients who underwent contained manual scalpel morcellation. Compare and analyze the hospitalization time, operation time, intraoperative blood loss, intraoperative blood transfusion rate, postoperative complications, visual analogue scale (VAS) pain score of 24 h after surgery, the rate of bag breakage, postoperative drainage tube removal time, postoperative urinary catheter removal time, postoperative intestinal ventilation time, hemoglobin difference between preoperative and postoperative (1 d and 3 d) and postoperative pathology.

Results

Compared with the contained manual scalpel morcellation group, the in-bag integrated power morcellation group had shorter operation time [(152.88±43.37)min vs. (176.23±59.45)min, P=0.021] and lower rate of bag breakage [0 (0.0%) vs. 8 (13.1%), P=0.019]. The difference was statistically significant (P<0.05). Compared the in-bag integrated power morcellation group with the contained manual scalpel morcellation group, there was no significantly statistical difference (P>0.05) in the hospitalization time, intraoperative blood loss, intraoperative blood transfusion rate, postoperative complications rate, VAS pain score of 24 h after surgery, postoperative drainage tube removal time, postoperative catheter removal time, postoperative intestinal ventilation time, hemoglobin difference between preoperative and postoperative (1 d and 3 d), and postoperative pathology.

Conclusion

In transumbilical single-port laparoscopic myomectomy, in-bag integrated power morcellation is a safe and feasible solution. It can be used with single-port laparoscope and electric rotator. Compared with contained manual scalpel morcellation, in-bag integrated power morcellation has shorter operation time and lower bag breakage rate, but it still needs further verification in large-sample prospective studies.

Key words: Myomectomy, In-bag morcellation, Power morcellation, Transumbilical laparoendoscopic single-site surgery, Gynecology
图1 经脐单孔腹腔镜子宫肌瘤剔除术中袋内一体化电动旋切注：A.腹腔镜下已剥离的子宫肌瘤；B.取物袋经入路平台port置入腹腔内；C.将剔除的肌瘤装入取物袋中；D.牵拉取物袋至脐部切口平面；E.内窥镜下，电动旋切器钳夹住肌瘤；F.内窥镜下电动旋切器钳夹后下推套管，刀头收缩于套管内；G.助手辅助撑开取物袋，电动旋切器钳夹住肌瘤；H.助手辅助撑开取物袋，电动旋切器套管下推，刀头收缩于套管内。
图2 单孔腹腔镜一体化电动旋切专用取物袋与普通一次性标本取物袋的对比注：A．装有单孔腹腔镜专用取物袋的取物器(取物袋未弹出)；B.推动单孔腹腔镜专用取物器的白色内管，专用取物袋弹出；C.装有普通一次性标本取物袋的取物器(取物袋未弹出)；D.推动普通一次性标本取物器的内管，取物袋弹出。
图3 经单孔腹腔镜入路平台port实现一体化器械放置注：A.专用取物袋套在切口保护套上；B.入路平台port；C.电动旋切器；D内窥镜。
图4 袋内手动冷刀旋切
表1 两组患者一般情况对比
特征 袋内一体化电动旋切组(n＝52) 袋内手动冷刀旋切组(n＝61) 统计量值 P值
年龄(岁) 39.98±7.08 39.30±7.329 t＝0.504 0.616
BMI(kg/m2) 22.48±3.03 23.14±2.83 t＝－1.187 0.238
症状[n(%)]     / 0.557a
腹痛 11(47.8) 24(47.1)b    
经量增多 5(21.7) 12(23.5)b    
经期不规则 7(30.4) 8(15.7)b    
乏力 0(0.0) 1(2.0)b    
排尿困难 0(0.0) 4(7.8)b    
腹胀 0(0.0) 2(3.9)b    
分娩史[n(%)] 38(73.1) 47(77.0) χ2＝0.238 0.626
盆腹腔手术史[n(%)] 20(38.5) 27(44.3) χ2＝0.389 0.533
术前CA125>35 kU/L[n(%)] 4(8.9) 9(15.5) χ2＝1.009 0.315
肌瘤个数     χ2＝2.455 0.117
1个 38(73.1) 36(59.0)    
≥2个 14(26.9) 25(41.0)    
肌瘤大小c        
肌瘤体积(cm3) 215.01±138.61 247.21±224.98 t＝－0.837 0.405
肌瘤直径(cm) 6.27±1.36 6.24±1.67 t＝0.084 0.933
表2 两组患者观察指标对比
指标 袋内一体化电动旋切组(n＝52) 袋内手动冷刀旋切组(n＝61) 统计量值 P值
住院时长(d) 4.65±1.45 4.75±1.56 t＝－0.352 0.726
手术时间(min) 152.88±43.37 176.23±59.45 t＝－2.348 0.021*
术中出血量(ml) 75.00(20.00，100.00) 50.00(20.00，100.00) Z＝－0.728 0.467
术中输血[n(%)] 2(3.8) 3(4.9) <0.001 >0.999
术后并发症[n(%)] 0(0.0) 0(0.0) / /
术后24 h VAS疼痛评分 1.00(1.00，1.00) 1.00(1.00，1.00) Z＝－0.109 0.835
取物袋破损率[n(%)] 0(0.0) 8(13.1) χ2＝5.481 0.019*
术后引流管拔除时间(d) 2.55±0.76 2.40±0.70 t＝0.745 0.460
术后尿管拔除时间(d) 1.00(1.00，1.00) 1.00(1.00，1.00) Z＝－0.665 0.506
术后肠道通气时间(d) 2.00±0.53 2.15±0.82 t＝－1.123 0.264
术前-术后1 d血红蛋白差值(g/L) 18.02±10.65 20.13±9.45 t＝－1.098 0.275
术前-术后3 d血红蛋白差值(g/L) 14.25±10.52 16.45±10.84 t＝－0.878 0.383
术后病理[n(%)]     / 0.720a
子宫平滑肌瘤 49(94.2) 58(95.1)b    
CL 1(1.9) 2(3.3)b    
MAL 0(0.0) 1(1.6)b    
uIMT 1(1.9) 0(0.0)b    
LG-ESS 1(6.7) 0(0.0)b    
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