{"paper_id":"bc4d589b-577e-4d7d-92cb-d908aea73f28","body_text":"中华腔镜外科杂志(电子版) ›› 2019, Vol. 12 ›› Issue (03) : 154 -158. doi: 10.3877/cma.j.issn.1674-6899.2019.03.007\n论著\n机器人单孔腹腔镜在妇科手术中的初步应用探讨\n- 1. 710032 西安，空军军医大学第一附属医院妇产科\n2. 710032 西安，解放军第九八六医院腔镜外科\n- 1. Department of Obstetrics and Gynecology, Xi Jing Hospistal, The Air Force Military Medical University, Xi′an 710032, China\n2. Department of Endoscopic Surgery, the PLA 986st Hospital, Xi′an 710032, China\n目的\n探讨机器人单孔腹腔镜在妇科手术中应用的安全性及可行性。\n方法\n回顾性分析空军军医大学第一附属医院妇产科2018年1～12月施行机器人单孔腹腔镜下妇科手术共计7例，记录患者的年龄、体质量指数、手术时间、术中出血量、术中及术后相关并发症，手术前后血红蛋白差值，术后排气时间、术后24 h疼痛模拟评分、住院时间、术后随诊情况等指标。计量资料用平均值±标准差统计分析。\n结果\n7例机器人单孔腹腔镜手术均顺利完成，其中4例使用筋膜平台、3例使用LAGIPORT。其中6例子宫内膜癌患者行全子宫双附件切除＋盆腔淋巴结清扫术、1例子宫腺肌症合并骶韧带DIE患者行全子宫切除＋DIE切除术。患者中位年龄45岁(35～57岁)，体质量指数22.9 kg/m2(20.5～25.4 kg/m2)，中位手术时间141 min(115～170 min)，中位术中出血量86 ml(50～200 ml)，手术前后血红蛋白差值6 g/L(5～10 g/L),中位术后住院时间5 d(4～6 d)，术后肠道功能恢复时间16.5 h(12～22 h)，术后24 h术后疼痛模拟评分1.7分(1～3分)。术后1个月随访，所有患者脐部伤口及阴道残端愈合良好。\n结论\n机器人单孔腹腔镜可安全、有效的用于妇科手术，但需要更多实践和临床研究加以验证。\nObjective\nTo investigate the safety and feasibility of robotic single-site laparoscopy in gynecological surgery.\nMethods\nClinical data of seven patients undergoing robotic single-site laparoscopic gynecological surgery in the department of obstetrics and gynecology of the First Affiliated Hospital of Air Force Military Medical University from Jan. to Dec. 2018 were retrospectively analyzed to analyze its clinical efficacy. The perioperative data was analyzed as follows: age, BMI, operative time, blood loss, postoperative VAS pain score, time for bowel movement, and hospital stay. Measurement data was presented as mean standard deviation.\nResults\nAll the 7 patients successfully completed the operation, among which 4 patients received robotic single-site laparoscopic surgery with fascia platform and 3 patients with LAGIPORT. Among the patients, 6 cases was diagnosed as endometrial carcinoma which underwent bilateral hysterectomy and pelvic lymph node dissection, and 1 case underwent hysterectomy and DIE dissection for adenomyosis combined with sacral ligament. The median age of the patients was 45 years old (35-57 years old ), the body mass index was 22.9 kg/m2 (20.5-25.4 kg/m2), the median operative time was 141 min (115-170 min), the median intraoperative blood loss was 86 ml(50-200 ml), the hemoglobin difference before and after the operation was 6 g/L (5-10 g/L), the median postoperative hospital stay was 5 d(4-6 d), the postoperative intestinal function recovery time was 16.5 h(12-22 h), and the pain score was 1.7 (1-3 points) at 24 h after the operation. Umbilical wound and vaginal stump healed well in all patients after one month.\nConclusions\nRobotic single-port laparoscopy can be used safely and effectively in gynecological surgery, but more practical and clinical studies are needed to verify it.\n| 1 |\nSinno AK, Fader AN. Robotic-assisted surgery in gynecologic oncology[J]. Fertil Steril, 2014，102(4):922-932.\n|\n| 2 |\nOrady M，Hrynewych A，Nawfal AK，et al.Comparison of robotic-assisted hysterectomy to other minimally invasive approaches[J]．JSLS，2012，16(4): 542-548.\n|\n| 3 |\nCunningham MJ，Dorzin E，Nguyen L，et al.Body mass index，conversion rate and complications among patients undergoing roboticsurgery for endometrial carcinoma[J]．J Robot Surg，2015，9(4): 339-345.\n|\n| 4 |\nChen SH，Li ZA，Huang R, et al.Robot-assisted versus conventional laparoscopic surgery for endometrial cancer staging: a meta-analysis[J]．Taiwan J Obstet Gynecol, 2016，55(4): 488-494.\n|\n| 5 |\n孙大为. 中国大陆妇科单孔腹腔镜及NOTES手术的探索发展及现状[J/CD]. 中华腔镜外科杂志(电子版), 2018，11(1):1-3.\n|\n| 6 |\nCorrado G，Cutillo G，Mancini E，et al.Robotic single site versus robotic multiport hysterectomy in early endometrial cancer: a case control study[J]．J Gynecol Oncol，2016，27(4):39-39.\n|\n| 7 |\nScheib SA，Fader AN.Gynecologic robotic laparoendoscopic single-site surgery: prospective analysis of feasibility，safety, and technique[J]．Am J Obstet Gynecol, 2015，212(2): 1-8.\n|\n| 8 |\nMoukarzel LA，Fader AN，Tanner EJ. Feasibility of robotic- assisted laparoendoscopic single-site surgery in the gynecologic oncology setting[J]. J Minim Invasive Gynecol，2017，24(2): 258-263.\n|\n| 9 |\nEscobar PF，Fader AN，Paraiso MF，et al. Robotic-assisted laparoendoscopic single-site surgery in gynecology: initial report and technique[J]. Journal of Minimally Invasive Gynecology，2009，16 (5):589-591.\n|\n| 10 |\nVizza E，Corrado G，Mancini E，et al.Robotic single-site hysterectomy in low risk early endometrial cancer: a pilot study[J]．Annals of Surgical Oncology, 2013, 20(8): 2759-2764.\n|\n| 11 |\nFanfani F，Monterossi G，Fagotti A，et al.Laparoendoscopic singlesite hysterectomy: is it safe and feasible[J]．Current Opinion in Obstetrics & Gynecology, 2014，26(4): 275-280.\n|\n| 12 |\nMoukarzel LA，Sinno AK，Fader AN，et al.Comparing single-site and multiport robotic hysterectomy with sentinel lymph node mapping for endometrial cancer: surgical outcomes and cost analysis[J]．Journal of Minimally Invasive Gynecology, 2017，24(6): 977-983.\n|\n| 13 |\nGomes M，Machado A，Podgaec S，et al.Initial experience with singleport robotic hysterectomy[J]．Einstein，2017，15(4): 476-480.\n|\n| 14 |\n吕小慧，郭欣，李佳，等. 单孔腹腔镜在深部浸润型子宫内膜异位症中的应用及初步探讨[J/CD]．中华腔镜外科杂志(电子版)，2018，11(6):339-343.\n|\n| 15 |\nSiesto G，Ieda N，Rosati R，et al.Robotic surgery for deep endometriosis: a paradigm shift[J]．Int J Med Robot，2014，10(2): 140-146.\n|\n| 16 |\nNezhat C，Lewis M，Kotikela S，et al.Robotic versus standard laparoscopy for the treatment of endometriosis[J]．Fertil Steril，2010，94(7): 2758-2760.\n|\n| 17 |\nEl Hachem L, Andikyan V, Mathews S, et al. Robotic single-site and conventional laparoscopic surgery in gynecology: clinical outcomes and cost analysis of a matched case-control study[J]. Journal of Minimally Invasive Gynecology，2016，23(5): 760-768.\n|\n| 18 |\nMorelli L，Guadagni S，Franco GD，et al.Da Vinci single site surgical platform in clinical practice: a systematic review[J]．International Journal of Medical Robotics & Computer Assisted Surgery，2015，12(4): 724-734.\n|\n| [1] | 任俊筱, 浦路桥, 王志豪, 施洪鑫, 刘爱峰, 齐保闯, 徐永清, 李川. 机器人辅助全膝关节置换术的临床疗效对照研究[J/OL]. 中华关节外科杂志(电子版), 2024, 18(04): 469-476. |\n| [2] | 丁莹莹, 宋恺, 金姬延, 田华. 机器人辅助膝髋关节置换术后精细化临床护理[J/OL]. 中华关节外科杂志(电子版), 2024, 18(04): 553-557. |\n| [3] | 王振宁, 杨康, 王得晨, 邹敏, 归明彬, 王雅楠, 徐明. 机器人与腹腔镜手术联合经自然腔道取标本对中低位直肠癌患者远期疗效比较[J/OL]. 中华普通外科学文献(电子版), 2024, 18(06): 437-442. |\n| [4] | 母德安, 李凯, 张志远, 张伟. 超微创器械辅助单孔腹腔镜下脾部分切除术[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 14-14. |\n| [5] | 庄宝雄, 邓海军. 单孔+1腹腔镜直肠癌侧方淋巴结清扫术[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 601-601. |\n| [6] | 嵇晋, 吴胜文, 姜明瑞, 汪刘华, 王伟, 任俊, 王道荣, 马从超. 三种方式关闭盆底联合改良造口在直肠癌腹会阴联合切除术的对比研究[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(04): 406-410. |\n| [7] | 孙昭, 刘琪, 王殿琛, 姜建武, 符洋. 机器人对比腹腔镜及开放式腹股沟疝修补术的Meta 分析[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(05): 588-598. |\n| [8] | 刘明昊, 李晨, 王冰, 万政, 田文. 机器人与腹腔镜食管裂孔疝修补术对比研究[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(04): 376-382. |\n| [9] | 胡启明, 鄢潇, 尤志学, 黄骁昊. 经瘢痕处单孔腹腔镜下切除多病灶腹壁子宫内膜异位症[J/OL]. 中华腔镜外科杂志(电子版), 2024, 17(05): 314-317. |\n| [10] | 张蕾, 彭超, 周应芳. 直肠阴道隔子宫内膜异位症腹腔镜手术技巧[J/OL]. 中华腔镜外科杂志(电子版), 2024, 17(05): 257-261. |\n| [11] | 徐敬云, 丁波, 蒋宇慧, 沈杨. 妊娠期单孔腹腔镜手术实施行与思[J/OL]. 中华腔镜外科杂志(电子版), 2024, 17(05): 262-266. |\n| [12] | 魏孔源, 仵正, 王铮, 黎韡. 机器人胰腺中段切除后远端胰腺消化道不同重建方式初探[J/OL]. 中华腔镜外科杂志(电子版), 2024, 17(05): 295-300. |\n| [13] | 曾纪晓, 徐晓钢, 王欣星, 刘斐, 兰梦龙, 陶波圆, 梁子建, 叶志华, 罗媛圆. 达芬奇机器人辅助Swenson-like巨结肠根治术[J/OL]. 中华腔镜外科杂志(电子版), 2024, 17(04): 239-243. |\n| [14] | 李凯, 陈淋, 苏怀东, 向涵, 张伟. 超微创器械在改良单孔腹腔镜巨大肝囊肿开窗引流及胆囊切除中的应用[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(01): 144-144. |\n| [15] | 芦煜, 李振宇, 吴承东, 周仲伍. 肛周子宫内膜异位症一例报告[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(05): 431-434. |\n| 阅读次数 | |||||\n|\n全文 |\n|\n||||\n|\n摘要 |\n|\n||||\n版权所有 中华医学会 中华医学电子音像出版社有限责任公司 京ICP备14006079号-1 网络出版服务许可证：(署)网出证(京)字第075号\nAI\n小\n编\nAI小编","source_license":"CC0","license_restricted":false}