摘要
目的:探讨达芬奇机器人辅助单孔腹腔镜(robotic laparo-endoscopic single site surgery，R-LESS)在子宫良性疾病的临床应用的安全性和可行性。方法:回顾性分析西安国际医学中心妇科肿瘤医院2020年6月至2022年11月收治的63例子宫良性病变的患者，行R-LESS手术的患者临床资料，观察手术时间、术中出血量、术中并发症、术后短期及长期并发症、术后24 h、48 h、72 h疼痛评分、排气时间、拔除尿管时间、是否放置引流管及放置时间、术后住院时间、随访3～18月。结果:63例患者均顺利完成R-LESS下子宫良性疾病的手术，无中转开腹或达芬奇机器人辅助多孔腹腔镜手术(robotic laparo-endoscopic multiple site surgery，R-LEMS)，平均手术时间200(150～245)min，平均术中出血量150(80～300)ml，术中输血7例(11.1%)，术后短期内并发症有3例，分别为腹腔积液、肺栓塞、下肢深静脉血栓形成，术后24 h、48 h、72 h疼痛轻微，排气时间2.0±0.6 d，79.4%患者术后未放置引流管，20.6%放置引流管，平均于术后3(2～4)d拔除，平均术后住院时间4(4～5)d，随访3～18月，有1例阔韧带肌瘤切除术后3月因下腹痛不适，发现盆腔3.3 cm血肿，药物对症治疗后好转，无腹部切口愈合不良或切口疝形成。结论:R-LESS下子宫良性疾病手术安全可行，术后疼痛轻、恢复快、美容效果好，具有临床推广价值。
Abstract
Objective:To explore the safety and feasibility of clinical application value of the da Vinci robotic laparo-endoscopic single site surgery (R-LESS) for benign gynecological diseases.Methods:The data of patients who underwent the R-LESS for benign gynecological diseases from Jun. 2020 to Nov. 2022 in Department of Gynecology Cancer Hospital, Xi'an International Medical Center were retrospectively analyzed, including 63 cases. The operation time, blood loss, intraoperative complications, short-term and long-term postoperative complications, postoperative 24 h, 48 h, 72 h visual analogue scale(VAS)score, exhaust time, time for removing urinary catheter, whether to place catheter and removal time after surgery, postoperative hospital stay, follow up for 3-18 months.Results:63 patients successfully completed the operation udner the R-LESS for benign gynecological diseases, without conversion to laparotomy or robotic laparo-endoscopic multiple site surgery(R-LEMS), the operation time was 200 (150-245) min, the blood loss was 150 (80-300) ml, and 7 patients (11.1%) received intraoperative blood transfusion. Short-term postoperative complications occurred in 3 cases, including ascites, pulmonary embolism, thrombosis of deep veins of lower limbs, the VAS score was slight, and the exhaust time was 2.0 ± 0.6 days. 79.4% of the patients did not place catheter and 20.6% who placed and pulled it out 3 (2-4) days after operation. The postoperative hospital stay time was 4 (4-5) days, and 1 case was found 3.3 cm hematoma in the pelvic cavity due to abdominal pain and discomfort 3 months after operation, after symptomatic treatment, it become better, and no abdominal incision healed poorly or incisional hernia was formed during follow up for 3-18 months.Conclusion:The operation for benign gynecological diseases under R-LESS is safe and feasible, the VAS score was slight, fast recovery and good cosmetic effect, which has clinical promotion value.
万方数据