免气腹单孔腹腔镜治疗妊娠合并 卵巢囊肿的随机对照研究

Single-site gasless laparoscopic ovarian cystectomy during pregnancy: Comparison with laparotomy

摘要:

目的 评价免气腹单孔腹腔镜治疗妊娠合并卵巢囊肿的临床效果。方法 45例需手术的妊娠合并卵巢囊肿患者随机分成免气腹腹腔镜组（23例）和开腹组（22例）。比较两组术中出血、手术时间、术后疼痛评分、术后镇痛剂使用、术后肛门排气时间、住院时间、术后发热和术后切口感染等方面的差异。结果 术中出血和术后切口感染两组差异无显著性（P >0.05），与开腹组相比，免气腹腹腔镜组的手术时间短且术后发热少（P <0.05），术后疼痛轻、术后镇痛剂使用少、术后肛门排气恢复快和住院时间短（P <0.01）。结论 免气腹单孔腹腔镜治疗妊娠合并卵巢囊肿具有疼痛轻、恢复快、并发症少、住院时间短且腹壁切口更小等优点，是一种安全有效的治疗选择，适合具备熟练腹腔镜操作技术的单位推广。

Abstract:

【Objectives】 This RCT aimed at evaluating the efficacy and safety of single-site gasless laparoscopic ovarian cystectomy during pregnancy compared with those of conventional laparotomy. 【Methods】 A total of 45 patients with ovarian cyst requiring ovarian cystectomy were randomly allocated to the single-site gasless laparoscopy group (23 cases) or the laparotomy group (22 cases). All the procedures were performed with epidural anesthesia. Main outcome measures were blood loss, operating time, postoperative visual analog scale (VAS), postoperative use of paregoric, time to flatus, postoperative hospital stay, postoperative fever, and postoperative wound infection. 【Results】 No patients in the single-site gasless laparoscopy group encountered complications during the intra- and post-operative periods. No significant differences were noticed between the single-site gasless laparoscopy group and the laparotomy group for blood loss and postoperative wound infection (P >0.05). There were significant differences for operating time and postoperative fever (P <0.05). There were also significant differences for postoperative VAS, postoperative use of paregoric, time to flatus and postoperative hospital stay (P <0.01). 【Conclusion】 Single-site gasless laparoscopic ovarian cystectomy during pregnancy by an experienced team, is a safe and effective procedure. Compared to the traditional laparotomy, it allows a shorter hospital stay, a reduced rate of post-operative complications and a decreased maternal and fetal morbidity. Single-site gasless laparoscopy is a feasible and safe approach in the surgical treatment of ovarian cystectomy in pregnancy.