Ghezzi Fabio, Cromi Antonella, Bergamini Valentino, Uccella Stefano, Beretta Paolo, Franchi Massimo, Bolis Pierfrancesco
Department of Obstetrics and Gynecology, University of Insubria, Del Ponte Hospital, Varese, Italy.
J Minim Invasive Gynecol. 2006 Jul-Aug;13(4):269-75. doi: 10.1016/j.jmig.2006.02.003.
To assess the technical feasibility and surgical outcome of a 5 mm-ports technique in a consecutive series of women with endometrial cancer laparoscopically managed.
Prospective collaborative cohort study (Canadian Task Force classification II-2).
Two gynecologic oncology units of university hospitals.
A series of consecutive patients undergoing laparoscopic hysterectomy, bilateral salpingo-oophorectomy, and pelvic lymphadenectomy for the treatment of endometrial cancer.
A 10-mm zero-degree umbilical operative laparoscope and three 5-mm suprapubic trocars were used. The lymph nodes were removed with the use of a specimen bag through the umbilical port. Intraoperative and postoperative details and complications were prospectively collected.
A total of 101 patients were enrolled. Twenty-two (21.8%) had a body mass index (BMI) of 30 kg/m2 or higher, and nine (8.9%) were severely obese (BMI > or =35 kg/m2). One hundred procedures (99%) were carried out entirely with only three 5-mm ancillary trocars. In one patient, a 5-mm trocar was replaced with a 10-mm trocar because of a lesion of the external iliac vein requiring the placement of vascular clips. One procedure needed to be converted to laparotomy. Intraoperative complications occurred in three patients (one bladder injury and one iliac vein injury, both managed laparoscopically, and one subcutaneous emphysema). Postoperative complications occurred in 10 (10%) patients. The only complication requiring a subsequent intervention was a symptomatic pelvic lymphocyst. No difference was found in surgical outcomes between obese women and those of ideal BMI.
The use of only 5-mm ancillary trocars for the laparoscopic treatment of endometrial cancer can further minimize surgical invasiveness without compromising surgical efficacy and safety in patients with high BMI as well as for women with ideal BMI.
评估在一系列接受腹腔镜治疗的子宫内膜癌女性患者中采用5mm穿刺孔技术的技术可行性和手术结果。
前瞻性协作队列研究（加拿大工作组分类II-2）。
大学医院的两个妇科肿瘤科室。
一系列连续接受腹腔镜子宫切除术、双侧输卵管卵巢切除术和盆腔淋巴结清扫术以治疗子宫内膜癌的患者。
使用10mm零度脐部手术腹腔镜和三个5mm耻骨上穿刺套管针。通过脐部穿刺孔使用标本袋取出淋巴结。前瞻性收集术中、术后细节及并发症情况。
共纳入101例患者。22例（21.8%）体重指数（BMI）为30kg/m²或更高，9例（8.9%）为重度肥胖（BMI≥35kg/m²）。100例手术（99%）完全仅使用三个5mm辅助穿刺套管针完成。1例患者因髂外静脉损伤需要放置血管夹，将一个5mm穿刺套管针换成了10mm穿刺套管针。1例手术需要转为开腹手术。3例患者发生术中并发症（1例膀胱损伤和1例髂静脉损伤，均通过腹腔镜处理，1例皮下气肿）。10例（10%）患者发生术后并发症。唯一需要后续干预的并发症是有症状的盆腔淋巴囊肿。肥胖女性与BMI理想的女性在手术结果上未发现差异。
对于BMI高的患者以及BMI理想的女性，在腹腔镜治疗子宫内膜癌时仅使用5mm辅助穿刺套管针可进一步降低手术创伤，且不影响手术疗效和安全性。
