Moulton Laura J, Jernigan Amelia M, Michener Chad M
Obstetrics, Gynecology and Women's Health Institute, Cleveland Clinic, Cleveland, Ohio.
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Louisiana State University Healthcare Network, New Orleans, Louisiana.
J Minim Invasive Gynecol. 2017 Nov-Dec;24(7):1136-1144. doi: 10.1016/j.jmig.2017.06.023. Epub 2017 Jun 30.
To report surgical and pathologic outcomes after single-port laparoscopy (SPL) for adnexal masses in patients referred to a gynecologic oncology practice at a single academic institution.
A retrospective analysis (Canadian Task Force Classification II.2).
A single academic institution with multiple hospital centers.
Women who underwent at least 1 single-port laparoscopic surgery for the treatment of an adnexal mass from 2009 to 2015 after referral to a gynecologic oncology practice.
Data were collected on the surgical procedure, patient demographic variables, 30-day surgical outcomes, and hernia development.
Three hundred twenty-five surgeries were performed in 322 patients with a median follow-up of 42.7 months. The median age was 54.5 years, and the median body mass index was 28.1 kg/m. All patients underwent unilateral or bilateral salpingectomy or oophorectomy with or without hysterectomy (26.5%). The median operative time was 90.0 minutes. The median mass dimension was 6.4 cm with 17.9% (n = 60) greater than 10 cm. Masses were categorized as simple (11.4%) and complex (69.5%). Although the majority (87.4%) of masses were benign, 7.4% were malignant, and 5.2% were borderline. Benign masses were physiologic (16.6%), serous cystadenomas (19.1%), mucinous cystadenomas (6.8%), endometriomas (12.3%), myomas (12.3%), and mature teratomas (9.2%). In malignant cases (7.4%), serous carcinoma was the most frequent histology (58.3%). The rate of adverse outcomes within 30 days, including reoperation (0.0%), intraoperative injury (1.5%), venous thromboembolism (0.3%), and transfusion (0.6%), was low. The development of incisional cellulitis was 4.6%. The rate of incisional hernia was 4.0%, with a median occurrence of 18.3 months. Diabetes mellitus (p = .03) and obesity (p = .04) were significant predictors for a hernia, but mass complexity (p = .28), American Society of Anesthesiologists class (p = .83), and smoking (p = .82) were not.
In patients undergoing SPL for the removal of adnexal masses in a gynecologic oncology practice, the rate of benign disease is high. SPL removal of adnexal masses is feasible and safe with favorable surgical outcomes, rare short-term adverse outcomes, and a low incisional hernia rate.
报告在单一学术机构的妇科肿瘤诊疗中心，单孔腹腔镜手术（SPL）治疗附件包块的手术及病理结果。
回顾性分析（加拿大工作组分类II.2）。
一所拥有多个医院中心的单一学术机构。
2009年至2015年转诊至妇科肿瘤诊疗中心后接受至少1次单孔腹腔镜手术治疗附件包块的女性。
收集手术过程、患者人口统计学变量、30天手术结果及疝气发生情况的数据。
322例患者共进行了325例手术，中位随访时间为42.7个月。中位年龄为54.5岁，中位体重指数为28.1kg/m²。所有患者均接受了单侧或双侧输卵管切除术或卵巢切除术，部分患者同时进行了子宫切除术（26.5%）。中位手术时间为90.0分钟。包块中位大小为6.4cm，17.9%（n = 60）大于10cm。包块分为单纯性（11.4%）和复杂性（69.5%）。虽然大多数（87.4%）包块为良性，但7.4%为恶性，5.2%为交界性。良性包块包括生理性（16.6%）、浆液性囊腺瘤（19.1%）、黏液性囊腺瘤（6.8%）、子宫内膜异位症（12.3%）、肌瘤（12.3%）和成熟畸胎瘤（9.2%）。在恶性病例（7.4%）中，浆液性癌是最常见的组织学类型（58.3%）。30天内不良结局发生率较低，包括再次手术（0.0%）、术中损伤（1.5%）、静脉血栓栓塞（0.3%）和输血（0.6%）。切口蜂窝织炎发生率为4.6%。切口疝发生率为4.0%，中位发生时间为18.3个月。糖尿病（p = 0.03）和肥胖（p = 0.04）是疝气的显著预测因素，但包块复杂性（p = 0.28）、美国麻醉医师协会分级（p = 0.83）和吸烟（p = 0.82）不是。
在妇科肿瘤诊疗中心接受SPL切除附件包块的患者中，良性疾病发生率较高。SPL切除附件包块可行且安全，手术效果良好，短期不良结局罕见，切口疝发生率低。
