Hong Mun-Kun, Chu Tang-Yuan, Wang Jen-Huang, Ding Dah-Ching
Department of Obstetrics and Gynecology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan.
Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan.
Tzu Chi Med J. 2017 Jul-Sep;29(3):165-170. doi: 10.4103/tcmj.tcmj_61_17.
To report our initial experience with and the short-term outcomes of two-phase laparoendoscopic single-site cervical ligament-sparing hysterectomy (LESS-CLSH).
A retrospective case study included 40 women who underwent LESS-CLSH from January 2014 to December 2016 at Buddhist Tzu Chi General Hospital. Uterine specimens were extracted through contained manual morcellation with a tissue pouch. The first phase was LESS supracervical hysterectomy and conization of the internal orifice of the cervix. The second phase was transvaginal cervical conization and cylinderization. Women with a uterus diameter of >12 cm, a broad ligament myoma, or severe pelvic adhesion were categorized into a difficult group, and others were categorized into a nondifficult group.
The difficult group required more time and had more blood loss than the nondifficult group. The mean surgical time was 187.2 ± 33.9 and 139.1 ± 20.7 min, and the mean blood loss was 533.3 ± 333.3 and 225.3 ± 168.2 mL in the difficult and nondifficult groups, respectively. The overall visual analog scale (VAS) pain scores at 0-4, 24, and 48 h after surgery were 7.1 ± 1.9, 4.2 ± 1.6, and 2.3 ± 1.5, respectively; no difference in the VAS pain scores, pain relief score, and hospitalization duration was observed between the two groups. Minor surgical complications or adverse events on follow-up were noted. Three months after surgery, the diameter and thickness of the cervix were decreased by approximately 0.5 and 1.0 cm, respectively.
LESS-CLSH is a minimally invasive, safe, and feasible approach, even for difficult laparoscopic hysterectomy. Contained manual morcellation enables more controlled specimen removal than morcellation only.
报告我们在两阶段经腹腔镜单孔宫颈韧带保留子宫切除术（LESS-CLSH）方面的初步经验及短期结果。
一项回顾性病例研究纳入了2014年1月至2016年12月在佛教慈济综合医院接受LESS-CLSH手术的40名女性。子宫标本通过使用组织袋进行封闭手动粉碎术取出。第一阶段是LESS次全子宫切除术和宫颈内口锥切术。第二阶段是经阴道宫颈锥切术和柱状切除术。子宫直径>12 cm、阔韧带肌瘤或严重盆腔粘连的女性被归为难治组，其他女性被归为非难治组。
难治组比非难治组需要更多时间且失血更多。难治组和非难治组的平均手术时间分别为187.2±33.9分钟和139.1±20.7分钟，平均失血量分别为533.3±333.3毫升和225.3±168.2毫升。术后0-4小时、24小时和48小时的总体视觉模拟量表（VAS）疼痛评分分别为7.1±1.9、4.2±1.6和2.3±1.5；两组之间在VAS疼痛评分、疼痛缓解评分和住院时间方面未观察到差异。随访时发现有轻微手术并发症或不良事件。术后三个月，宫颈直径和厚度分别减少了约0.5厘米和1.0厘米。
LESS-CLSH是一种微创、安全且可行的方法，即使对于困难的腹腔镜子宫切除术也是如此。封闭手动粉碎术比单纯粉碎术能更可控地取出标本。
