中华腔镜外科杂志(电子版)
中華腔鏡外科雜誌(電子版)
중화강경외과잡지(전자판)
CHINESE JOURNAL OF LAPAROSCOPIC SURGERY ( ELECTRONIC EDITION)
2014年
1期
10-13
,共4页
孙大为%张俊吉%熊巍%刘珠凤%冷金花%朱兰%郎景和
孫大為%張俊吉%熊巍%劉珠鳳%冷金花%硃蘭%郎景和
손대위%장준길%웅외%류주봉%랭금화%주란%랑경화
单孔腹腔镜%子宫内膜癌%分期手术
單孔腹腔鏡%子宮內膜癌%分期手術
단공복강경%자궁내막암%분기수술
Laparoendoscopic single site surgery%Endometrial carcinoma%Staging sugery
目的:探索单孔腹腔镜下子宫内膜癌分期手术(LESS staging operation of endometrial carcinoma)的可行性,以拓展单孔腹腔镜在妇科手术领域的应用。方法北京协和医院妇科自2013年3月至2013年8月,共完成单孔腹腔镜下子宫内膜癌分期手术3例,无并发症发生,无失访病例,随访时间42 d至6个月。手术技巧的改良主要是所有操作均在单孔腹腔镜下完成,包括全子宫切除、双侧附件切除、盆腔淋巴结切除,手术操作以传统腹腔镜器械配合特殊单孔腹腔镜器械,电凝及切割组织采用智能能量器械来完成。结果3例子宫重量110~230 g,平均155 g,术后病理证实切除盆腔淋巴结数量14~26个,平均20.6个,手术时间145~169 min,平均156.3 min,术中出血量100~200 ml,平均150 ml,术后疼痛VAS评分2~5分,平均4分,术后肠道功能恢复时间8~24 h,平均14 h,术后住院日3~5 d,平均4 d,术中后均未发生并发症,随访时间14 d至6个月,术后随诊所有患者均无明显自觉症状,二便如常,阴道分泌物正常,脐部伤口愈合良好,脐部伤口愈合为隐蔽伤口,未见明显瘢痕,3例患者阴道残端伤口均愈合良好。结论单孔腹腔镜手术是安全、有效完成子宫内膜癌分期手术的一种可行手术方式,但需要进一步的前瞻性、随机更多样本的研究评估。
目的:探索單孔腹腔鏡下子宮內膜癌分期手術(LESS staging operation of endometrial carcinoma)的可行性,以拓展單孔腹腔鏡在婦科手術領域的應用。方法北京協和醫院婦科自2013年3月至2013年8月,共完成單孔腹腔鏡下子宮內膜癌分期手術3例,無併髮癥髮生,無失訪病例,隨訪時間42 d至6箇月。手術技巧的改良主要是所有操作均在單孔腹腔鏡下完成,包括全子宮切除、雙側附件切除、盆腔淋巴結切除,手術操作以傳統腹腔鏡器械配閤特殊單孔腹腔鏡器械,電凝及切割組織採用智能能量器械來完成。結果3例子宮重量110~230 g,平均155 g,術後病理證實切除盆腔淋巴結數量14~26箇,平均20.6箇,手術時間145~169 min,平均156.3 min,術中齣血量100~200 ml,平均150 ml,術後疼痛VAS評分2~5分,平均4分,術後腸道功能恢複時間8~24 h,平均14 h,術後住院日3~5 d,平均4 d,術中後均未髮生併髮癥,隨訪時間14 d至6箇月,術後隨診所有患者均無明顯自覺癥狀,二便如常,陰道分泌物正常,臍部傷口愈閤良好,臍部傷口愈閤為隱蔽傷口,未見明顯瘢痕,3例患者陰道殘耑傷口均愈閤良好。結論單孔腹腔鏡手術是安全、有效完成子宮內膜癌分期手術的一種可行手術方式,但需要進一步的前瞻性、隨機更多樣本的研究評估。
목적:탐색단공복강경하자궁내막암분기수술(LESS staging operation of endometrial carcinoma)적가행성,이탁전단공복강경재부과수술영역적응용。방법북경협화의원부과자2013년3월지2013년8월,공완성단공복강경하자궁내막암분기수술3례,무병발증발생,무실방병례,수방시간42 d지6개월。수술기교적개량주요시소유조작균재단공복강경하완성,포괄전자궁절제、쌍측부건절제、분강림파결절제,수술조작이전통복강경기계배합특수단공복강경기계,전응급절할조직채용지능능량기계래완성。결과3례자궁중량110~230 g,평균155 g,술후병리증실절제분강림파결수량14~26개,평균20.6개,수술시간145~169 min,평균156.3 min,술중출혈량100~200 ml,평균150 ml,술후동통VAS평분2~5분,평균4분,술후장도공능회복시간8~24 h,평균14 h,술후주원일3~5 d,평균4 d,술중후균미발생병발증,수방시간14 d지6개월,술후수진소유환자균무명현자각증상,이편여상,음도분비물정상,제부상구유합량호,제부상구유합위은폐상구,미견명현반흔,3례환자음도잔단상구균유합량호。결론단공복강경수술시안전、유효완성자궁내막암분기수술적일충가행수술방식,단수요진일보적전첨성、수궤경다양본적연구평고。
Objective To analyze the feasibility, safety, and efficacy of laparoendoscopic single-site (LESS) surgical staging for early-stage endometrial cancer. Methods Retrospectively analyzed 3 consecutive patients with early-stage endometrial cancer who underwent LESS surgical staging,including hysterectomy,bilateral salpingo-oophorectomy(BSO),and pelvic lymph node dissection(PLND). Results No one in the LESS group required additional trocar or conversion to laparotomy. number of total pelvic lymph nodes (average 20. 6)retrieved;uterus weight 110 ~ 230 g,the average (155)g,the operation time of 145 ~ 169 min,average (156.3) min,intraoperative blood loss,100 ~ 200 ml,the average (150)ml,postoperative pain VAS score 2 ~ 5,the average (4),postoperative gastrointestinal function restoration time 8 ~ 24 h,the average (14)h,time for postoperative hospital stay 3 ~ 5 d,the average (4)d,no complications occurred during intraoperative and postoperative time,follow-up of 14 d to 6 months,no obvious postoperative self-conscious symptom. As usual,vaginal discharge is normal,wound healed well,wounds healing hidden in umbillicus,no obvious scar,vaginal stub wound healed well. Conclusion LESS surgical staging that includes hysterectomy and PLND was a feasible, safe, and effective surgical management in patients with early-stage endometrial cancer. Further evaluation of LESS surgical staging in a prospective randomized trial is required.