Primary study on laparoendoscopic single-site surgery in deeply infiltrating endometriosis

doi:10.3877/cma.j.issn.1674-6899.2018.06.007

Abstract

Abstract:

Objective

To analyze the feasibility, safety and perioperative outcome of laparoscopic single-site surgery in deeply infiltrating endometriosis.

Methods

Between May 2017 and Aug. 2018, 6 patients were diagnosed as deeply infiltrating endometriosis who underwent laparoscopic single-site surgery in Xi Jing Hospital. The perioperative data was analyzed as follows: age, BMI, operative time, blood loss, postoperative VAS pain score, time for bowel movement, size of lesion and hospital stay.

Results

All 6 cases were successfully completed. No one was converted to conventional laparoscopy or laparotomy. No complications occurred during intraoperative and postoperative time. The clinical data were as follows: age (32.3±6.3) years old, body mass index (23.8±5.6) kg/m^2, operation time (106.5±47.3) minutes, intraoperative blood loss (27.6±35.4) ml, postoperative exhaust time (12.4±6.7)h and hospital stay (3.5±2.7) d.

Conclusions

Laparoscopic single-site surgery is a feasible, safe and effective management in the treatment of deeply infiltrating and isolated endometriosis. Further evaluation of laparoscopic single-site surgery with increased number of patients is required.

Key words: Laparoendoscopic single-site surgery, Deeply infiltrating endometriosis

Xiaohui Lyu, Xin Guo, Jia Li, Junli Ge, Yanli He, Jian Wang, Shujuan Liu, Biliang Chen, Wei Zhang. Primary study on laparoendoscopic single-site surgery in deeply infiltrating endometriosis[J]. Chinese Journal of Laparoscopic Surgery(Electronic Edition), 2018, 11(06): 339-343.

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URL: https://zhqjwkzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-6899.2018.06.007

https://zhqjwkzz.cma-cmc.com.cn/EN/Y2018/V11/I06/339

Figures/Tables 4

References 16

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项目	平均值±标准差	范围
年龄(岁)	32.3±6.3	28.0～38.0
体质量指数(kg/m²)	23.8±5.6	19.8～28.4
产(次)	1.1±0.6	0.0～2.0
病灶直径(cm)	3.5±1.6	2.0～6.0

项目	平均值±标准差	范围
年龄(岁)	32.3±6.3	28.0～38.0
体质量指数(kg/m²)	23.8±5.6	19.8～28.4
产(次)	1.1±0.6	0.0～2.0
病灶直径(cm)	3.5±1.6	2.0～6.0

项目	平均值±标准差	范围
手术时间(min)	106.5±47.3	83.0～243.0
术中出血量(ml)	27.6±35.4	20.0～100.0
手术前后血红蛋白差值(g/L)	8.6±2.5	5.0～17.0
术后疼痛模拟评分(分)	2.1±2.5	1.0～4.0
术后排气时间(h)	12.4±6.7	8.0～19.0
住院时间(d)	3.5±2.7	3.0～6.0

项目	平均值±标准差	范围
手术时间(min)	106.5±47.3	83.0～243.0
术中出血量(ml)	27.6±35.4	20.0～100.0
手术前后血红蛋白差值(g/L)	8.6±2.5	5.0～17.0
术后疼痛模拟评分(分)	2.1±2.5	1.0～4.0
术后排气时间(h)	12.4±6.7	8.0～19.0
住院时间(d)	3.5±2.7	3.0～6.0

患者序号	术前体格检查	术中所见	手术方式
1	阴道后穹隆偏左侧可见紫蓝色结节，可触及直径2 cm质硬结节，子宫活动度尚可，直肠黏膜光滑，与触痛结节似有间隙	子宫后位，长大，左后壁与左侧固有韧带粘连挛缩，靠近左侧骶韧带见瘢痕挛缩，术中游离左侧输尿管、下推直肠后见病灶与直肠间隙清楚	单孔腹腔镜阴道直肠隔深部浸润型子宫内膜异位症病灶切除
2	阴道后穹窿黏膜光滑，可扪及触痛结节，子宫后位，如孕2个月大小，活动度欠佳，骶韧带增粗，缩短，触痛，直肠黏膜光滑	子宫后倾，固定，球形增大如孕2个月大小，子宫直肠窝封闭，分离粘连后见双侧骶韧带增粗、缩短	单孔腹腔镜全子宫＋双侧骶韧带深部浸润型子宫内膜异位症病灶切除＋双侧输卵管切除
3	阴道后穹窿偏右侧见点状紫蓝色突起，触及直径3 cm质硬结节，子宫活动度可，直肠黏膜光滑，与结节有间隙	子宫后位，常大，活动度好，右侧骶韧带内侧见瘢痕挛缩改变，术中游离右侧输尿管、下推直肠后见病灶与直肠间隙清楚	单孔腹腔镜阴道直肠隔深部浸润型子宫内膜异位症病灶切除
4	阴道后穹窿光滑，子宫左后壁下段扪及直径2 cm触痛结节，与骶韧带分界不清	子宫后倾，常大，左侧骶韧带与子宫左后壁下段粘连	单孔腹期左侧骶韧带深部浸润型子宫内膜异位症病灶切除
5	阴道后穹窿光滑，有触痛结节，子宫如孕2个月大小，饱满，活动度差，左附件区扪及直径5 cm囊性包块，固定	子宫后位，球形增大如孕2个月大小，左侧卵巢囊性增大，直径5 cm，与左侧盆壁腹膜、子宫左后壁粘连固定，分离粘连后左侧骶韧带增粗缩短	单孔腹腔镜全子宫＋左附件切除＋右侧输卵管＋左侧骶韧带深部浸润型子宫内膜异位症病灶切除
6	阴道后穹窿光滑，有触痛结节，子宫常大，活动度可，右附件区扪及直径约6 cm囊性包块，活动度可	子宫前位，常大，宫后方见右侧卵巢囊性增大，直径6 cm，内为黏稠巧克力样液体，右侧骶韧带增粗挛缩	单孔腹腔镜下右侧子宫内膜异位囊肿剥除＋右侧骶韧带深部浸润型子宫内膜异位症病灶切除

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