回顾性分析单孔腹腔镜子宫肌瘤剔除术及多孔腹腔镜子宫肌瘤剔除术对巨大子宫肌瘤的治疗效果及围术期安全性。

回顾性分析2022年8月至2024年9月北京协和医院普通妇科中心行单孔腹腔镜子宫肌瘤剔除术及腹腔镜子宫肌瘤剔除术共482例患者的临床资料，筛选出单个子宫肌瘤最大直径至少为10 cm的患者，其中单孔腹腔镜组24例，多孔腹腔镜组64例，通过手术指标(手术时间、加套管针、术后血红蛋白下降、输血次数、周围脏器损伤)、围术期恢复及安全性指标(术后6 h、24 h、48 h疼痛评分、术后有无发热、住院时间、住院费用、围术期并发症)、瘢痕美容评估与评级量表三大方面评估两组手术效果。

单孔腹腔镜组和多孔腹腔镜组手术时间分别为136.81 ± 56.82 min和119.85 ± 42.07 min；两组间差异有统计学意义(P＝0.025)；单孔组术后血红蛋白下降水平18.26 ± 8.01 g/L，多孔组17.04 ± 7.70 g/L(P＝0.480)；单孔组术后6 h、24 h、48 h视觉模拟评分(visual analogue scale，VAS)均低于多孔组(3.88±1.14分vs. 4.51±1.15分、2.83±0.96分vs. 3.18±1.03分、1.57±0.83分vs. 1.83±0.90分，P均<0.05)，两组在住院时间、住院费用方面的差异无统计学意义；术后瘢痕评分上，单孔组总得分为1.21±1.18分，多孔腹腔镜组为5.36±2.45分，差异有统计学意义(P<0.001)，其中在瘢痕扩展、红斑、色素异常、手术痕迹及肥厚/萎缩五个方面，单孔腹腔镜组均优于多孔腹腔镜组(0.29±0.56 vs. 1.56±0.82、0.04±0.20 vs. 0.89±0.69、0.33±0.48 vs. 0.73±0.45、0.21±0.41 vs. 0.98±0.13、0.25±0.44 vs. 0.80±0.68，P均<0.001)。

单孔腹腔镜手术对巨大子宫肌瘤而言是一种安全且可行的治疗方式，尤其在术后疼痛控制和美容效果方面优于多孔腹腔镜手术。

To retrospectively analyzed the therapeutic efficacy and perioperative safety of single-port laparoscopic myomectomy (SPLM) versus multiport laparoscopic myomectomy (MPLM) for large uterine fibroids.

A retrospective analysis was conducted on the clinical data of 482 patients who underwent SPLM or MPLM at the General Gynecology Center of Peking Union Medical College Hospital between Aug. 2022 and Sep. 2024. Patients with a single uterine fibroid of maximum diameter ≥10 cm were selected, including 24 cases in the SPLM group and 64 cases in the MPLM group. Surgical outcomes were evaluated based on three main aspects: 1) surgical parameters (operative time, additional trocar use, postoperative hemoglobin decrease, frequency of blood transfusion, adjacent organ injury); 2) perioperative recovery and safety indicators (pain scores at 6 h, 24 h, and 48 h postoperatively, postoperative fever, hospital stay, hospitalization costs, perioperative complications); and 3) scar cosmesis assessed using a scar evaluation and rating scale. Statistical analysis was performed using SPSS 27.0 software, with a P-value<0.05 considered statistically significant.

The operative time was 136.81±56.82 min for the SPLM group and 119.85±42.07 min for the MPLM group, with a significant difference between groups (P=0.025). The postoperative hemoglobin decrease was 18.26±8.01 g/L in the SPLM group and 17.04±7.70 g/L in the MPLM group (P=0.480). Postoperative VAS scores at 6 h, 24 h, and 48 h were significantly lower in the SPLM group compared to the MPLM group (3.88±1.14 vs. 4.51±1.15, 2.83±0.96 vs. 3.18±1.03, 1.57±0.83 vs. 1.83±0.90, respectively; all P<0.05). No statistically significant differences were found between the two groups regarding hospital stay or hospitalization costs. The total scar score was significantly lower in the SPLM group (1.21±1.18) compared to the MPLM group (5.36±2.45, P<0.001). Specifically, the SPLM group demonstrated superior outcomes in scar spread, erythema, pigmentation abnormality, suture marks, and hypertrophy/atrophy compared to the MPLM group (0.29±0.56 vs. 1.56±0.82, 0.04±0.20 vs. 0.89±0.69, 0.33±0.48 vs. 0.73±0.45, 0.21±0.41 vs. 0.98±0.13, 0.25±0.44 vs. 0.80±0.68, respectively; all P<0.001).

Single-port laparoscopic surgery is a safe and feasible treatment option for large uterine fibroids. It is superior to multiport laparoscopic surgery, particularly in terms of postoperative pain control and cosmetic outcomes.