[1]彭诗寒,陈体平**,赵磊.经脐入路内镜妇科手术49例[J].中国微创外科杂志,2018,18(9):859-861.
　Peng Shihan,Chen Tiping,Zhao Lei..Transumbilical Endoscopic Gynecological Surgery:Report of 49 Cases[J].Chinese Journal of Minimally Invasive Surgery,2018,18(9):859-861.
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经脐入路内镜妇科手术49例()
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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
18
期数:
2018年9期
页码:
859-861
栏目:
经验交流
出版日期:
2018-12-06

文章信息/Info

Title:
Transumbilical Endoscopic Gynecological Surgery:Report of 49 Cases
作者:
彭诗寒; 陈体平**; 赵磊
泸州市人民医院妇产科，泸州646000
Author(s):
Peng Shihan;  Chen Tiping;  Zhao Lei.
Department of Obstetrics and Gynecology, Luzhou People’s Hospital, Luzhou 646000, China
关键词:
经脐入路内镜手术; 腹腔镜; 妇科手术
Keywords:
Transumbilical endoscopic surgery; Laparoscopy; Gynecological surgery
文献标志码:
B
摘要:
目的探讨经脐入路内镜手术（transumbilical endoscopic surgery，TUES）在治疗妇科良性疾病中的临床价值。方法我院2015年2月~2017年4月行TUES妇科手术49例，其中输卵管妊娠25例，卵巢囊肿15例，子宫肌瘤和子宫腺肌瘤9例。取脐孔上缘做弧形切口约1.0 cm长，穿刺置入10 mm trocar建立气腹，置入腹腔镜，探查盆腔。评估经脐单孔腹腔镜手术可行后，脐下缘4、8点位置分别做5 mm切口，穿刺 trocar呈“品”字形，置入操作器械进行操作。输卵管妊娠行患侧输卵管开窗取胚术或患侧输卵管病灶切除术；卵巢囊肿行卵巢囊肿剥除术；子宫肌瘤及子宫腺肌瘤行子宫全切术。结果49例均无中转开腹。输卵管妊娠手术时间（42.5±8.0）min，术中出血量（30.3±12.3）ml，肛门排气时间（16.2±3.8）h，住院时间（33±0.7）d；卵巢囊肿剥除除术时间（42.6±8.8）min，术中出血量（30.3±13.8）ml，肛门排气时间（16.6±3.6）h，住院时间（3.4±0.7）d；子宫全切手术时间（92.2±14.0）min，术中出血量（65.0±12.7）ml，肛门排气时间（17.0±4.0）h，住院时间（5.0±0.9）d。术后病理结果均与术前诊断相符。46例随访3个月，无切口感染、戳孔疝、腹腔内出血、邻近脏器损伤、肩胛部疼痛等并发症的发生，脐部切口隐蔽在皱褶内。结论TUES治疗妇科良性疾病安全、可靠、有效，同时具有微创、美观、无明显腹壁手术瘢痕等优点，具有临床推广价值。
Abstract:
ObjectiveTo explore the clinical value of the transumbilical endoscopic surgery (TUES) in the treatment of gynecological benign disease.MethodsFrom February 2015 to April 2017, 49 cases of TUES gynecological surgery were analyzed retrospectively, including 25 cases of tubal pregnancy, 15 cases of ovarian cysts, and 9 cases of uterine fibroids and uterine adenomyoma. We made an 1-cm arc incision above the umbilicus, and inserted a 10-mm trocar to introduce laparoscopic instruments to explore the pelvic cavity. After confirming surgery was feasible, we respectively made a 5-mm incision under the umbilicus at 4 o′clock and 8 o′clock position to insert apparatus to perform operation. We performed salpingotomy or salpingectomy for the tubal pregnancy, oophorocystectomy for ovarian cysts, and panhysterectomy for uterine myoma and adenomyosis.ResultsThe 49 cases of operations were successful. For salpingotomy or salpingectomy, the operation time was (42.5±8.0) min, the intraoperative hemorrhage was (30.3±13.8) ml, the exhaust time was (16.2±3.8) h, and the postoperative hospital stay was (3.3±0.7) d. For oophorocystectomy, the operation time was (42.6±8.8) min, the intraoperative hemorrhage was (30.3±12.3) ml, the exhaust time was (16.6±3.6) h, and the postoperative hospital stay was (3.4±0.7) d. For panhysterectomy, the operation time was (92.2±14.0) min, the intraoperative hemorrhage was (65.0±12.7) ml, the exhaust time was (17.0±4.0) h, and the postoperative hospital stay was (5.0±0.9) d. Postoperative pathological findings were consistent with preoperative diagnosis. Within follow-ups for 3 months in 46 patients, no wound infection, incision hernia, intraperitoneal hemorrhage, adjacent viscera damage, or shoulder pain was found. The umbilical wound was concealed in the fold.ConclusionsThe TUES gynecological surgery is a safe, reliable and effective procedure in the treatment of gynecological benign diseases, which has the advantages of minimal invasion, good cosmetic outcomes, and no obvious scar. It is worthy of being promoted.

参考文献/References:

[1]Kalloo AN, Singh VK, Jagannath SB, et al. Flexible transgastric peritioneoscopy: a novel approach to diagnostic and therapeutic interventions in the peritoneal cavity. Gastrointest Endosc,2004,60(1):114-117.
[2]Kanwarjit SD, Divya A, Arshbir SD, et al. Natural orifice transluminal endoscopic surgery (hybrid) cholecystectomy: The Dhillon technique. J Minim Access Surg,2017,13(3):176-181.
[3]Lee GC,Sylla P. Shifting paradigms in minimally invasive surgery: applications of transanal natural orifice transluminal endoscopic surgery in colorectal surgery. Clin Colon Rectal Surg,2015,28(3):181-193.
[4]臧光辉,张治国,贺厚光,等.经自然腔道内镜手术内切开引流治疗肾盂旁囊肿.中华腔镜外科杂志(电子版),2017,10(3):163-165.
[5]张伟,赵国良.经自然腔道内镜手术及其在临床中的应用进展.胃肠病学和肝病学杂志,2015,24(3):364-366.
[6]周小林,周宏,杨颖,等.基于文献计量的国内自然腔道内镜手术发展现状分析.局解手术学杂志,2017,26(7):492-495.
[7]郑兰,金延泽.经阴道路径NOTES在妇科手术中的应用价值.中国妇幼保健,2014,29(30):5012-5016.
[8]Podolsky E, Curcillo IP, Rottman SJ, et al. Single port access (SPA) surgery initial experience of a novel minmal access approach applied across surgical speciatlties. Surg Endosc,2008,22(1):172-173.
[9]朱江帆,胡海,马颖璋,等.经脐入路腹腔镜手术的初步临床报告.中国微创外科杂志,2008,8(1):75-77.
[10]王宁,姚健,罗黔,等.经脐入路腹腔镜胆囊与肾脏联合切除初步体会(附1例报告).中国内镜杂志,2013,19(11):1231-1232.
[11]彭诗寒,桑晓梅,姚健.经脐入路腹腔镜妇科与胆囊联合手术的初步体会.检验医学与临床,2014,11(15):2049-2050.
[12]纪妹,苏玥辉,赵曌,等.经脐单孔腹腔镜手术在妇科附件手术中应用的对比研究.中国微创外科杂志,2012,12(7):631-634.
[13]刘木彪,蔡慧华.全国首例单孔腹腔镜手术治疗妇科恶性肿瘤.南方医科大学学报,2011,31(9):1619-1621.
[14]Ju YP, Yoo MK, Yoo YL, et al. Laparoendoscopic single-site radical hysterectomy for early stage cervical cancer. Obstet Gynecol Sci,2017,60(1):110-114.
[15]姚健,桑晓梅,罗黔.3D高清腹腔镜手术的临床应用探讨.西部医学,2013,25(4):513-514.
[16]罗丹,姚健,桑晓梅,等.3D腹腔镜在悬吊式经脐全子宫切除术中的应用.腹腔镜外科杂志,2015,20(12):893-895.

备注/Memo

备注/Memo:
基金项目：泸州市科技局科研课题［2015-S-51（1/3）］**通讯作者：E-mail：2605786306@qq.com
更新日期/Last Update: 2018-12-06