Department of Gynecology, Division of Gynecologic Oncology, Greater Baltimore Medical Center/Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
J Minim Invasive Gynecol. 2012 Jan-Feb;19(1):40-5. doi: 10.1016/j.jmig.2011.09.002. Epub 2011 Oct 26.
To estimate the risk of umbilical hernia and other latent complications in women who underwent laparoendoscopic single-site surgery (LESS) for a gynecologic indication.
Retrospective, nonrandomized clinical study (Canadian Task Force classification II-2).
Four tertiary care academic medical centers.
Women undergoing LESS for a benign or malignant gynecologic indication from 2009 to 2011.
A total of 211 women underwent LESS via a single 1.5- to 2.0-cm umbilical incision. All surgeries were performed by advanced gynecologic laparoscopists. Incisions were repaired with a running, delayed absorbable suture. Subject demographics and clinical variables were collected and surgical outcomes analyzed.
Median age and body mass index were 45 years and 30 kg/m(2), respectively. Approximately half of study subjects underwent a hysterectomy with or without salpingo-oophorectomy, and 15% had a diagnosis of cancer. Overall, 0.9% of women were diagnosed with a preoperative umbilical hernia, and 2.4% of women experienced a major perioperative complication. After a median postoperative follow-up time of 16 months, 2.4% had development of an umbilical hernia. However, 4/5 of these women had significant risk factors for fascial weakening independent of LESS, including requirement for a second abdominal surgery in 1 subject and a cancer diagnosis with postoperative chemotherapy administration in 2 subjects. When these subjects deemed "high risk" for incisional disruption were excluded from the analysis, the umbilical hernia rate was 0.5% (1/207). On univariable analysis, obesity was the only factor associated with complications (p = .04).
When performed by advanced laparoscopic surgeons, laparoendoscopic single-site gynecologic surgery is associated with a low risk of major adverse events. Additionally, the overall umbilical hernia rate was 2.4% and was lower (0.5%) in subjects without significant comorbidities.
评估因妇科适应证行腹腔镜单部位手术（LESS）的女性发生脐疝和其他潜在并发症的风险。
回顾性、非随机临床研究（加拿大任务组分类 II-2）。
四家三级保健学术医疗中心。
2009 年至 2011 年因良性或恶性妇科适应证行 LESS 的女性。
共有 211 名女性通过 1.5 至 2.0cm 的单一脐部切口行 LESS。所有手术均由高级妇科腹腔镜医师进行。切口采用连续可吸收缝线延迟缝合修复。收集受试者的人口统计学和临床变量，并分析手术结果。
中位年龄和体重指数分别为 45 岁和 30kg/m2。研究对象中约有一半行子宫切除术，同时行或不行输卵管卵巢切除术，15%的诊断为癌症。总体而言，术前诊断脐疝的女性占 0.9%，发生主要围手术期并发症的女性占 2.4%。中位术后随访 16 个月后，2.4%的女性发生脐疝。然而，其中 4/5 例女性有独立于 LESS 的筋膜薄弱的显著危险因素，包括 1 例需要再次腹部手术，2 例诊断癌症并接受术后化疗。当将这些被认为切口破裂“高风险”的受试者从分析中排除时，脐疝发生率为 0.5%（207 例中的 1 例）。单变量分析显示，肥胖是唯一与并发症相关的因素（p =.04）。
由高级腹腔镜医师施行的经脐腹腔镜单部位妇科手术与不良事件风险低相关。此外，整体脐疝发生率为 2.4%，无明显合并症的患者发生率较低（0.5%）。
