Department of Obstetrics and Gynecology, University of Insubria, Varese, Italy.
Am J Obstet Gynecol. 2012 Aug;207(2):112.e1-6. doi: 10.1016/j.ajog.2012.05.016. Epub 2012 May 23.
We sought to compare transumbilical (TU) and transvaginal (TV) route for retrieval of surgical specimens at laparoscopy.
Women scheduled for a laparoscopic resection of an adnexal mass were randomized to have their surgical specimen removed either through a posterior colpotomy (n = 34) or the umbilical port site (n = 32). Group allocation was concealed from patients and bedside clinicians. The primary outcome was postoperative incisional pain assessed by a 10-cm visual analog scale at 1, 3, and 24 hours after surgery.
TV retrieval caused less postoperative pain than TU specimen extraction at each time point (visual analog scale score at 1 hour: 2.6 ± 2.9 vs 1.2 ± 2.0, P = .03; at 3 hours: 2.4 ± 2.0 vs 1.4 ± 2.0, P = .02; and at 24 hours: 1.1 ± 1.5 vs 0.5 ± 1.4, P = .02). A higher proportion of women in the TU group than in the TV group indicated the umbilicus as the most painful area at 1 and 3 hours postoperatively. Two months after surgery, the participants scored similarly as to their overall satisfaction, cosmetic outcome, and dyspareunia upon resumption of intercourse.
A TV approach for specimen removal after laparoscopic resection of adnexal masses offers the advantage of less postoperative pain than TU retrieval.
我们旨在比较经脐（TU）和经阴道（TV）途径在腹腔镜下获取手术标本。
计划行腹腔镜附件肿块切除术的女性患者被随机分为经后穹窿切开术（n = 34）或脐部穿刺器（n = 32）取出手术标本。患者和床边临床医生均不知道分组情况。主要结局是术后 1、3 和 24 小时通过 10cm 视觉模拟量表评估的切口疼痛。
TV 取标本比 TU 标本提取在每个时间点都引起更少的术后疼痛（术后 1 小时视觉模拟评分：2.6 ± 2.9 比 1.2 ± 2.0，P =.03；术后 3 小时：2.4 ± 2.0 比 1.4 ± 2.0，P =.02；术后 24 小时：1.1 ± 1.5 比 0.5 ± 1.4，P =.02）。TU 组中比 TV 组中有更多的女性在术后 1 和 3 小时表示脐部是最疼痛的区域。术后 2 个月，两组患者对总体满意度、美容效果和恢复性生活后的性交痛评分相似。
腹腔镜附件肿块切除术后经 TV 途径取出标本比 TU 回收具有术后疼痛较轻的优势。
