| 摘要: |
| 目的 对比分析经脐单孔腹腔镜子宫肌瘤剔除术、传统多孔腹腔镜子宫肌瘤剔除术与开腹子宫肌瘤剔除术的临床疗效，并探讨经脐单孔腹腔镜对子宫肌瘤剔除术的影响。方法 回顾性分析2020年6月至2021年12月在南方医科大学珠江医院妇产科行子宫肌瘤剔除术治疗的97例患者的临床资料。单孔组24例，行经脐单孔腹腔镜子宫肌瘤剔除术；多孔组42例，行传统多孔腹腔镜子宫肌瘤剔除术；开腹组31例，行经腹子宫肌瘤剔除术。对比分析手术时间、术中出血量等手术指标，术后首次肛门排气时间、术后首次下床活动时间、术后住院时间等术后恢复情况及总住院费用等。根据术前影像学检查对子宫肌瘤患者进一步分层，对比分析单发性、多发性或浆膜下、肌壁间子宫肌瘤患者中分别行经脐单孔腹腔镜、多孔腹腔镜或开腹子宫肌瘤剔除术的临床疗效；对比分析经脐单孔腹腔镜手术对单发性与多发性、浆膜下与肌壁间子宫肌瘤剔除术的临床疗效。结果 与多孔组及开腹组相比，单孔组的术后首次下床活动时间明显缩短（P均＜0.01）。与开腹组相比，单孔组的术后首次肛门排气时间及术后住院时间明显缩短，而手术时间延长、总住院费用较高（P＜0.05，P＜0.01）。单孔组与多孔组的手术时间、术后首次肛门排气时间、术后住院时间及总住院费用差异无统计学意义（P均＞0.05），单孔组前期的术中出血量较多孔组多（P＜0.05），后期两组的术中出血量差异无统计学意义（P＞0.05）。4种不同类型子宫肌瘤患者中，3种术式的手术相关指标对比分析情况与上述总体一致。在经脐单孔腹腔镜手术中，单发性子宫肌瘤组较多发性子宫肌瘤组手术时间缩短（P＜0.05）；浆膜下子宫肌瘤组较肌壁间子宫肌瘤组术后首次下床活动时间缩短（P＜0.01）。结论 经脐单孔腹腔镜下子宫肌瘤剔除术临床疗效与传统多孔腹腔镜及开腹手术相当，但术后恢复更快。单发性及浆膜下子宫肌瘤相比多发性及肌壁间子宫肌瘤而言，更加适合行经脐单孔腹腔镜手术。 |
| 关键词: 子宫肌瘤剔除术 单孔腹腔镜 传统腹腔镜 开腹手术 术式选择 |
| DOI：10.16781/j.CN31-2187/R.20211299 |
| 投稿时间：2021-12-23修订日期：2022-07-01 |
| 基金项目:广东省卫生健康适宜技术推广项目（202006111021198027）. |
|
| Comparative analysis of 3 surgical methods for myomectomy and application of transumbilical single-port laparoscopy |
| ZHUO Aiping,XIE Jiaxin,GAO Meng,ZHU Honglei,FU Xiafei* |
(Department of Obstetrics and Gynaecology, Zhujiang Hospital of Southern Medical University, Guangzhou 510220, Guangdong, China
*Corresponding author) |
| Abstract: |
| Objective To compare the clinical efficacies of transumbilical single-port laparoscopic myomectomy, traditional multi-port laparoscopic myomectomy, and laparotomy myomectomy, and to investigate the effect of transumbilical single-port laparoscopy on myomectomy. Methods The clinical data of 97 patients who underwent myomectomy in the Department of Obstetrics and Gynaecology, Zhujiang Hospital of Southern Medical University from Jun. 2020 to Dec. 2021 were retrospectively analyzed. There were 24 cases in the single-port group (who underwent transumbilical single-port laparoscopic myomectomy), 42 cases in the multi-port group (who underwent traditional multi-port laparoscopic myomectomy), and 31 cases in the laparotomy group (who underwent laparotomy myomectomy). Surgical indicators (including operation time and intraoperative blood loss), postoperative recovery indicators (including the first postoperative exhausting time, first postoperative time out of bed, and postoperative hospital stays), and hospitalization costs were compared and analyzed. According to the preoperative imaging examination, the patients with uterine fibroids were further stratified, and the clinical efficacies of transumbilical single-port laparoscopic, multi-port laparoscopic, or laparotomy myomectomy in patients with single and multiple, subserosal and intramural uterine fibroids were compared and analyzed. The clinical efficacies of transumbilical single-port laparoscopic surgery for single and multiple, subserosal and intermural myomectomy were also compared and analyzed. Results Compared with the multi-port group and laparotomy group, the first postoperative time out of bed in the single-port group was significantly shorter (both P＜0.01). Compared with the laparotomy group, the first postoperative exhausting time and postoperative hospital stays of the single-port group were significantly shorter, while the operation time was significantly longer and the hospitalization costs was significantly higher (P＜0.05, P＜0.01). There were no significant differences in the operation time, first postoperative exhausting time, postoperative hospital stays, or hospitalization costs between the single-port group and multi-port group (all P＞0.05). The single-port group had more intraoperative blood loss than the multi-port group at the early stage (P＜0.05), but there was no significant difference in the intraoperative blood loss between the 2 groups at the later stage (P＞0.05). Among the patients with 4 different types of uterine fibroids, the comparative analysis of the 3 surgical procedures was generally consistent with the above. In the transumbilical single-port laparoscopic surgery, the operation time of the single uterine fibroid group was significantly shorter than that of the multiple uterine fibroid group (P＜0.05), the first postoperative time out of bed in the subserosal uterine fibroid group was significantly shorter than that of the intermural uterine fibroid group (P＜0.01). Conclusion The clinical efficacy of transumbilical single-port laparoscopic myomectomy is equivalent to those of conventional multi-port laparoscopy and laparotomy, but the postoperative recovery is faster. Patients with single and subserosal uterine fibroids are more suitable for transumbilical single-port laparoscopic surgery. |
| Key words: myomectomy single-port laparoscopy conventional laparoscopy open surgery surgical procedure selection |
