经脐单孔腹腔镜子宫肌瘤剔除术的应用进展
昆明医科大学, 第一附属医院妇科, 云南昆明 650032
| 摘 要： | 子宫肌瘤是生育期女性最常见的妇科良性肿瘤，常导致贫血、流产、不孕，严重影响患者身心健康。目前，子宫肌瘤的治疗手段包括保守观察、药物治疗及手术治疗等，而对于有保留子宫需求的患者而言，腹腔镜子宫肌瘤剔除术是目前首选手术方式。近年来，随着微创技术的发展，经脐单孔腹腔镜技术（transumbilical laparoendoscopic single-site surgery, TU-LESS）已广泛应用于妇科微创手术，相较于传统的腹腔镜手术而言，TU-LESS在保证手术效果的基础上，具有创伤更小、恢复更快、术后无痕等优势，尤其适合于女性患者；但由于存在着视野局限、“筷子效应”、难以形成“操作三角”、缝合及取瘤困难等问题，TU-LESS在子宫肌瘤剔除术中的应用相对滞后、在手术操作过程中仍有诸多手术难点需要攻克，要熟练掌握手术技巧需要一定的学习曲线。在不断实践和探索中，随着操作技巧的总结、特殊器械的发明，经脐单孔腹腔镜子宫肌瘤剔除术（single-port laparoscopic myomectomy, SPLM）的应用将越加成熟。现对经脐单孔腹腔镜在子宫肌瘤剔除术中的应用进展及学习该术式的重点、难点作一综述。 |
| 关 键 词： | 经脐单孔腹腔镜手术; 腹腔镜手术; 子宫肌瘤剔除术; 学习曲线 |
| DOI： | 10.57237/j.mrf.2022.01.003 |
View:
Downloads:
收稿日期: 2022-09-30
接受日期: 2022-11-11
在线出版日期: 2022-12-01
Application Progress of Transumbilical Single-Port Laparoscopic Surgery for Myomectomy
Department of Gynecology, The First Affiliated Hospital of Kunming Medical University, Kunming 650032, China
| Abstract: | Uterine fibroids are the most common gynecological benign tumors in women during reproductive period, which often lead to anemia, abortion, infertility, and seriously affect the physical and mental health of patients. At present, the treatment of uterine fibroids includes conservative observation, drug therapy and surgical treatment. For patients with uterine preservation needs, laparoscopic myomectomy is currently the preferred surgical method for uterine fibroid preservation. In recent years, with the development of minimally invasive technology, transumbilical single-site surgery (TU-LESS) has been widely used in gynecological minimally invasive surgery. Compared with traditional laparoscopic surgery, TU-LESS can not only ensure the operation effect, but also has the advantages of less trauma, faster recovery and no trace after operation, especially suitable for female patients; However, due to the problems of limited visual field, "chopstick effect", difficulty in forming "operation triangle", difficulty in suturing and tumor extraction, the application of TU-LESS in myomectomy is relatively backward, and there are still many surgical difficulties to be overcome in the process of operation, which requires a certain learning curve to master the surgical skills. With the continuous practice and exploration, the application of transumbilical single-port laparoscopic myomectomy (SPLM) will become more and more mature with the summary of operation skills and the invention of special instruments. This article reviews the application progress of transumbilical single-port laparoscopy in myomectomy and the key points and difficulties in learning this operation. |
| Keywords: | Transumblical Single-Port Laparoendoscopic Surgery; Laparoscopic Surgery; Myomectomy; Learning Curve |
参考文献
| [1] | 参王思义. 经脐单孔与多孔腹腔镜子宫切除术的安全性和有效性评价 [J]. 生物医学工程与临床, 2020, 24 (6): 743-747. |
| [2] | 王晨, 陈奕. 子宫肌瘤与妊娠相互关系的研究进展 [J]. 中国临床医生杂志, 2017, 45 (11): 6-9. |
| [3] | 孙文艳.腹腔镜子宫肌瘤切除术临床效果评估[J].临床医学研究与实践, 2016, 1 (15): 68. |
| [4] | 贾炎峰, 张彦骅, 摆扬, 等. 3 种不同入路方式在经脐单孔腹腔镜子宫切除术中的对比研究 [J]. 实用妇产科杂志, 2020, 36 (10): 777-781. |
| [5] | 孙力, 张旋, 杨萌, 等. 经脐单孔腹腔镜手术治疗巨大附件良性肿瘤30例 [J]. 中国微创外科杂志, 2019, 19 (4): 308-310. |
| [6] | Wheeless, CR; Thompson, BH; Laparoscopic sterilization. Review of 3600 cases. [J]. ObstetGynecol. 1973, 42 (5): 751-8. |
| [7] | 何萃华, 吴慕珍, 郭肇姮. 女性绝育新技术—腹腔镜绝育术 [J]. 北京医学, 1981, 03 (03): 191-192. |
| [8] | 王春阳, 韩璐. 经脐单孔腹腔镜在子宫肌瘤剔除术中的应用研究现状及进展 [J]. 妇产与遗传（电子版）, 2018, 8 (2): 18-22. |
| [9] | Kim YW, Park BJ, Ro DY, et al. Single-port laparoscopic myomectomy using a new single-port transumbilical morcellation system: initial clinical study [J]. J Minim Invasive Gynecol, 2010, 17 (5): 587-592. |
| [10] | 赵万成, 杨清, 王光伟. 经脐单切口腹腔镜在子宫肌瘤剔除术中的应用 [J]. 中国内镜杂志, 2014, 20 (03): 286-289. |
| [11] | 肖术芹, 王春阳, 韩 璐, 等. 经脐单孔腹腔镜在子宫肌瘤剔除术中的应用研究 [J]. 大连医科大学学报, 2018, 40 (4): 340-343. |
| [12] | 田淑娜, 陈琪珍, 马丽, 等. 加速康复外科理念在单孔腹腔镜下子宫肌瘤剔除术中的应用 [J]. 东南国防医药, 2019, 21 (6): 608-611. |
| [13] | 王晓樱, 李妍, 等. 改良经脐单孔腹腔镜子宫肌瘤剔除术[J]. 中国微创外科杂志, 2019, 19 (10): 919-921. |
| [14] | 李晓红, 陈真云, 李国福, 等. 举宫杯联合经脐单孔腹腔镜在子宫肌瘤剔除术中的应用研究 [J]. 中国医学创新, 2020, 17 (25): 157-160. |
| [15] | 雍圆圆, 宋丹, 马远, 等. 经脐单孔腹腔镜在复杂子宫肌瘤剔除手术中的应用优势 [J]. 宁夏医学杂志, 2021, 43 (07): 640-642. |
| [16] | 普俊芳, 孙江川, 等. 单孔腹腔镜子宫肌瘤剔除术的安全性及有效性的系统评价及 Meta 分析 [J]. 科学咨询（科技•管理）, 2022, (5): 64-67. |
| [17] | 刘娟, 梁彬华, 关小明. 经脐单孔腹腔镜在生殖相关手术的安全 性及学习曲线 [J/CD]. 中华腔镜外科杂志 (电子版), 2018, 11 (3): 157-161. |
| [18] | Koyanagi T, Motomura S. Single-incision laparoscopically assisted vaginal hysterectomy: operative outcomes and its learning curve [J]. Experimental & Therapeutic Medicine, 2011, 2 (5): 867-871. |
| [19] | Barnes H, Harrison R, Huffman L, et al. The adoption of singleport laparoscopy for full staging of endometrial cancer: surgical and oncology outcomes and evaluation of the learning curve [J]. J Minim Invasive Gynecol, 2017, 24 (6): 1029-1036. |
| [20] | Lee HJ, Ju YK, Kim SK, et al. Learning curve analysis and surgical outcomes of single-port laparoscopic myomectomy [J]. J Minim Invasive Gynecol, 2015, 22 (4): 607-611. |
| [21] | 唐明鸣, 李林, 李征宇, 等. 采用传统腹腔镜器械开展经脐单孔腹腔镜手术技术在妇科手术中的应用现状 [J]. Chin J Obstet Gynecol Pediatr (Electron Ed), 2020, 16 (5): 504-509. |
| [22] | 杨时如, 胡玉崇. 单孔腹腔镜在妇科领域的应用 [J]. 包头医学院学报, 2020, 36 (4): 131-133. |
| [23] | 金贝贝, 张玉泉, 李季, 等. 普通及机器人辅助经脐单孔腹腔镜在 子宫肌瘤剔除术中的应用比较 [J]. 中国腔镜外科杂志, 2021, 14 (3): 163-167. |
| [24] | Cianci S, Rosati A, Rumolo V, et al. Robotic single-port platform in general, urologic, and gynecologic surgeries: a systematic review of the literature and meta-analysis [J]. World Journal of Surgery, 2019, 43 (10): 2401-2419. |
| [25] | 鲍明月, 秦真岳, 陈继明, 等.微切口单孔腹腔镜妇科手术现状与进展 [J]. 中国实用妇科与产科杂志, 2021, 37 (2): 264-267. |
| [26] | 朱尔曼. 磁技术给单孔腹腔镜创造操作三角 [N]. 健康报, 2019-06-27 (008). |
| [27] | 董鼎辉, 朱皓阳, 马涛, 等. 面向单孔腹腔镜手术应用的水平式微型磁锚定腹腔镜的设计 [J]. 中国医疗设备, 2019, 34 (9): 49-51, 65. |
| [28] | 王慕喆, 邢秀月, 王丽娜, 等. 子宫肌瘤剔除术经脐单孔腹腔镜治疗与传统腹腔镜治疗效果比较 [J]. 中国计划生育学杂志, 2022, 30 (4): 841-845. |
| [29] | 刘海元, 孙大为, 张俊吉, 等.《妇科单孔腔镜手术技术专家共识》解读 [J]. 中华腔镜外科杂志 (电子版), 2017, 10 (1): 1-6. |
| [30] | Cipriani F, Catena M, Rati F, et al. LESS technique forliver resection: the progres of the mini-invasive approach: a single-centre experience [J]. Minim Invasive Ther Alied Technol, 2012, 21 (1): 55-58. DOI: 10.3109/13645706. 2011.632013. |
| [31] | Rao PP, Rao PP, Bhagwat S. Single-incision laparoscopicsurgery-curent status and controversies [J]. J Minim Aces Surg, 2011, 7 (1): 6-16. DOI: 10.4103/0972-9941.72360. |
| [32] | Dong J, Zu Q, Shi L, et al. Retroperitoneal laparoendoscopic single-site radical nephrectomy using a low-cost, self-madedevice: initial experience with 29 cases [J]. Surg Innov, 2013, 20 (4): 403-410. DOI: 10.1177/1553350612460768. |
| [33] | 强萍, 杨婷婷, 邵洋, 等. 应用普通器械行改良单孔腹腔镜下输卵管切除术的临床研究 [J]. 现代仪器与医疗, 2018, 24 (5): 108-110. DOI: 10.11876/mimt201805044. |
| [34] | 綦小蓉, 陈思敬, 郑莹. 单孔腹腔镜在妇科恶性肿瘤治疗中的利与弊 [J]. 中华腔镜外科杂志 (电子版), 2018, 11 (6): 370-373. |
| [35] | Yang YS, Oh KY, Hur MH, et al. Laparoendoscopic single- site surgery using conventional laparoscopic instruments and glove port technique in gynecology: a single surgeon′s experience [J]. J Minim Invasive Gynecol, 2015, 22 (1): 87- 93. DOI: 10.1016/j.jmig.2014.07.013. |
| [36] | 崔茹婷, 赵福杰. 经脐单孔腹腔镜套扎法在子宫肌壁间肌瘤切除术中的应用 [J]. 中国医科大学学报, 2022, 51 (7): 622-626. |
| [37] | Song T, Kim TJ, Lee YY, et al. What is the learning curve for single - port access laparoscopic - assisted vaginal hys- terectomy? [J]. Eur J Obstet Gynecol Reprod Biol, 2011, 158 (1): 93-96. |
| [38] | 王春阳, 韩璐, 郭凤. 悬吊线法经脐单孔腹腔镜在妇科手术的应用 [J/CD]. 中华腔镜外科杂志 (电子版), 2018, 11 (1): 35-38. 谢德玲, 张莉亚, 毛轶凡, 等. 经阴道单孔腹腔镜在 24 例妇科良性疾病手术中的应用探讨[J]. 安徽医药, 2022, 26 (3): 560-563. |
| [39] | SONG T, KIM TJ, LEE SH, et al. Laparoendoscopic single-site myo- mectomy compared with conventional laparoscopic myomectomy: a multicenter, randomized, controlled trial [J]. Fertil Steril, 2015, 104 (5): 1325-1331. DOI: 10.1016/j.fertnstert.2015.07.1137. |
| [40] | 孙大为. 单孔腹腔镜手术在妇科的应用探讨[J/CD]. 中华腔镜外科杂志 (电子版), 2013, 6 (1): 5-8. |
| [41] | 马迎春, 关小明. 机器人单孔腹腔镜手术在妇科领域中的应用 [J]. 妇产与遗传(电子版), 2015, 5 (3): 44-47. |
| [42] | Won S, Lee N, Kim M, et al. Robotic single-site myomectomy: a hybrid technique reducing operative time and blood loss [J]. The International Journal of Medical Robotics and Computer Assisted Surgery, 2020, 16 (1): 2061-2061. |
| [43] | HALASKA MJ, HAIDOPOULOS D, GUYON F, et al. European society of gynecological oncology statement on fibroid and uterine morcellation [J]. Int J Gynecol Cancer, 2017, 27 (1): 189-192. DOI: 10.1097/IGC.0000000000000911. |
| [44] | 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[J]. 中国实用妇科与产科杂志, 2020, 36 (7): 626-632. DOI: 10.19538/j.fk2020070113. |
| [45] | DESAI VB, WRIGHT JD, LIN HQ, et al. Laparoscopic hysterectomy route, resource use, and outcomes: change after power morcellation warning [J]. Obstet Gynecol, 2019, 134 (2): 227-238. DOI: 10.1097/AOG.0000000000003375. |
| [46] | 谢德玲, 张莉亚, 毛轶凡, 等. 经阴道单孔腹腔镜在24例妇科良性疾病手术中的应用探讨 [J]. 安徽医药, 2022, 26 (3): 560-563. |
