摘要
目的探索单孔腹腔镜下子宫内膜癌分期手术（LESSstagingoperationofendometrialcarcinoma）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42d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—230g，平均155g，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145～169min，平均156-3min，术中出血量100～200ml，平均150ml，术后疼痛VAS评分2～5分，平均4分，术后肠道功能恢复时间8～24h，平均14h，术后住院日3～5d，平均4d，术中后均未发生并发症，随访时间14d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。
Objective To analyze the feasibility, safety, and efficacy of laparoendoscopie 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-oophoreetomy （BSO）, and pelvic lymph node dissection （PLND）. Results No one in the LESS group required additional troear 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 rain, 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 6months,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.
出处
《中华腔镜外科杂志（电子版）》
2014年第1期10-13,共4页
Chinese Journal of Laparoscopic Surgery(Electronic Edition)
基金
国家高技术研究发展计划(863计划)(2012AA021103)
关键词
单孔腹腔镜
子宫内膜癌
分期手术
Laparoendoscopic single site surgery
Endometrial carcinoma
Staging sugery
