[1]刘艳丽① 郭亮生** 张思佳 戴淑榕 孙白云 任琼珍 陶晓敏 朱维培.经脐手术刀肌瘤分碎术与电动肌瘤分碎术在腹腔镜子宫肌瘤剔除术中应用的比较[J].中国微创外科杂志,2021,01(10):912-917.
　Liu Yanli,Guo Liangsheng*,Zhang Sijia*,et al.A Comparative Study of Transumbilical Scalpel Morcellation and Electric Power Morcellation in Laparoscopic Myomectomy[J].Chinese Journal of Minimally Invasive Surgery,2021,01(10):912-917.
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经脐手术刀肌瘤分碎术与电动肌瘤分碎术在腹腔镜子宫肌瘤剔除术中应用的比较()
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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
01
期数:
2021年10期
页码:
912-917
栏目:
临床研究
出版日期:
2021-10-25

文章信息/Info

Title:
A Comparative Study of Transumbilical Scalpel Morcellation and Electric Power Morcellation in Laparoscopic Myomectomy
作者:
刘艳丽① 郭亮生** 张思佳 戴淑榕 孙白云 任琼珍 陶晓敏 朱维培
(苏州大学附属第二医院妇产科，苏州215004)
Author(s):
Liu Yanli;  Guo Liangsheng*;  Zhang Sijia*;  et al.
*Department of Obstetrics and Gynecology, Second Affiliated Hospital of Soochow University, Suzhou 215004, China
关键词:
腹腔镜; 子宫肌瘤; 组织分碎; 脐
Keywords:
Laparoscopy; Uterine myoma; Morcellation; Umbilicus
文献标志码:
A
摘要:
目的比较腹腔镜子宫肌瘤剔除术中经脐手术刀肌瘤分碎术与传统电动肌瘤分碎术的效果。方法2014年1月~2019年12月120例腹腔镜子宫肌瘤剔除术，其中60例采用经脐手术刀肌瘤分碎术（观察组），60例采用电动肌瘤分碎术（对照组），比较2组患者腹盆腔及切口肌瘤组织碎片残留数量、手术时间、标本取出时间、术中出血量、术后24和48 h疼痛数字评分（Numeric Rating Scale, NRS）、Hollander切口愈合评分、术后住院时间和住院费用。结果2组患者均顺利完成手术。观察组经脐手术刀分碎完成后，均未见取物袋内亚甲蓝液体渗漏，腹腔镜检查腹盆腔也未见亚甲蓝液体和肌瘤组织碎片；对照组见肌瘤组织碎片数1~15个，中位数9个。观察组手术时间明显长于对照组［(114.5±24.3)min vs. (93.4±21.7)min，t=49.809，P=0.000］，标本取出时间明显长于对照组［(23.8±12.7)min vs. (16.9±5.2)min，t=17.174，P=0.000］。2组术中出血量、术后24和48 h疼痛NRS评分、Hollander切口愈合评分、术后住院时间、住院费用差异无统计学意义（P>005）。术后病理富于细胞子宫平滑肌瘤观察组3例，对照组2例，子宫平滑肌肉瘤对照组1例，其余患者均为良性子宫平滑肌瘤。120例术后随访8~79个月，术后发生切口疝观察组2例，对照组1例；2组5例富于细胞子宫平滑肌瘤术后随访16~52个月，均未见复发和转移；对照组1例子宫平滑肌肉瘤术后5个月PETCT提示腹盆腔、肝包膜下多发结节、肿块影伴18F-脱氧葡萄糖代谢异常增高，再次行经腹双侧卵巢、大网膜切除、腹盆腔种植灶减灭术和化疗，术后生存期16个月。结论腹腔镜子宫肌瘤剔除采用经脐手术刀肌瘤分碎术安全可行，有助于减少医源性肿瘤的种植和转移。
Abstract:
ObjectiveTo compare the effect of transumbilical scalpel morcellation and traditional electric power morcellation in laparoscopic myomectomy.MethodsFrom January 2014 to December 2019, 120 cases of uterine fibroids underwent laparoscopic myomectomy. There were 60 cases treated with transumbilical scalpel morcellation (observation group) and 60 cases with electric power morcellation (control group). The number of fibroid fragments in the peritoneal cavity and puncture hole, operation time, specimen retrieval time, intraoperative blood loss, 24 h and 48 h postoperative pain Numeric Rating Scale (NRS), Hollander Wound Evaluation Scale, postoperative hospital duration, and hospital expenses were compared between the two groups.ResultsBoth groups of patients successfully completed the operation. In the observation group, after transumbilical scalpel morcellation was completed, there was no leakage of methylene blue fluid in the collection bag, and no methylene blue fluid or fibroid fragments was found in the peritoneal cavity under laparoscopy. The number of fibroid fragments in the observation group were 1-15 (median, 9). The operation time was longer than that of the control group ［(114.5±24.3) min vs. (93.4±21.7) min, t=49.809, P=0000］. The specimen retrieval time was longer than that of the control group ［(23.8±12.7) min vs. (16.9±5.5) min, t=17174, P=0000］. There was no significant difference between the two groups in terms of intraoperative blood loss, 24 h and 48 h postoperative NRS score, Hollander Wound Evaluation Score, postoperative hospital duration, and hospital expenses (P>0.05). Postoperative pathological outcomes showed 3 cases of cellular leiomyoma in the observation group and 2 cases in the control group, 1 case of uterine leiomyosarcoma in the control group, and benign uterine leiomyoma in the remaining cases. A total of 120 patients were followed up for 8-79 months. There were 2 cases of incisional hernia in the observation group and 1 case in the control group. The 5 cases of cellular leiomyoma in the two groups were followed up for 16-52 months, and no recurrence or metastasis was observed. In the control group, a case of uterine leiomyosarcoma was reviewed with PETCT, which showed multiple nodules and masses in the abdomen, pelvis and liver capsule with abnormal increase of 18F deoxyglucose metabolism. The case was treated with transabdominal bilateral ovariectomy, greater omentum resection, reduction of abdominal and pelvic implant focus and chemotherapy 5 months after operation. The postoperative survival time was 16 months.ConclusionsIt is safe and feasible to use transumbilical scalpel morcellation during laparoscopic myomectomy. Transumbilical scalpel morcellation may help to reduce the implantation and metastasis of iatrogenic tumors.

参考文献/References:

[1]朱兰,范融.腹腔镜下电动旋切器热点问题.中国实用妇科与产科杂志,2019,35(8):855-856.
[2]Parker WH, Pritts EA, Olive DL. What is the future of open intraperitoneal powermorcellation of fibroids? Clin Obstet Gynecol,2016,59(1):73-84.
[3]Zhang HM, Christianson LA, Templeman CL, et al. Nonmalignant sequelae after unconfined power morcellation. J Minim Invasive Gynecol,2019,26(3):434-440.
[4]孙雪洁,韩璐.腹腔镜子宫肌瘤剔除术后寄生性平滑肌瘤2例报告并文献复习.中国微创外科杂志,2018,18(10):955-957.
[5]Chalas E. Morcellation in gynecologic oncology. Curr Opin Obstet Gynecol,2018,30(1):96-98.
[6]朱熠,石宇,刘红,等.《实施腹腔镜下子宫(肌瘤)分碎术的中国专家共识》解读.肿瘤预防与治疗,2020,33(8):633-637.
[7]王毅,吴东,李静,等.全膝关节置换术皮肤切口不同缝合方式的对比研究.中华骨与关节外科杂志,2019,12(2):117-121.
[8]Desai VB, Wright JD, Lin H, et al. Laparoscopic hysterectomy route, resource use, and outcomes: Change after power morcellation warning. Obstet Gynecol,2019,134(2):227-238.
[9]Pedra Nobre S, Hensley ML, So M, et al. The impact of tumor fragmentation in patients with stage Ⅰ uterine leiomyosarcoma on patterns of recurrence and oncologic outcome. Gynecol Oncol. 2021,160(1):99-105.
[10]Bogani G,Ditto A,Martinelli F, et al. Morcellator’s portsite metastasis of a uterine smooth muscle tumor of uncertain malignant potential after minimally invasive myomectomy. J Minim Invasive Gynecol,2016,23(4):647-649.
[11]王晓樱,李妍.改良经脐单孔腹腔镜子宫肌瘤剔除术.中国微创外科杂志,2019,19(10):919-921.
[12]中国医师协会妇产科医师分会妇科肿瘤专业委员会（学组）.实施腹腔镜下子宫（肌瘤）分碎术的中国专家共识.中国实用妇科与产科杂志,2020,36(7):626-632.
[13]石宇,刘红,张国楠,等.一次性使用内窥镜标本取物袋在腹腔镜子宫（肌瘤）分碎术中应用的有效性与安全性分析.肿瘤预防与治疗,2020,33(5):300-305.

备注/Memo

备注/Memo:
基金项目：江苏省卫生健康委员会科研项目（QNRC2016881，F201922）；苏州市科技计划项目（SYSD2019106，SYS2020134）；苏州市卫生健康委员会科研项目（GSWS2020028)**通讯作者，Email:gls2135@sina.com ①（核工业四一七医院苏州大学附属第二医院西安分院妇产科，西安710600）
更新日期/Last Update: 2022-02-08