| Objective:Uterine leiomyoma is a benign tumor formed by the proliferation of uterine smooth muscle tissue,which is the most common benign tumor in women,seriously endangering women’s physical and mental health and quality of life.With the improvement of people’s living standards,the desire to retain the uterus is getting stronger and stronger,which makes uterine myomectomy more and more accepted by the majorit y of patients with uterine leiomyoma.Surgery is the main clinical treatment of uterine leiomyoma,but the traditional laparotomy is more traumatic,which is not conducive to the recovery of patients after operation.With the development of minimally invas ive technology,laparoscopy has been widely used in the clinical treatment of uterine leiomyoma and achieved certain effects.however,in the process of minimally invasive myomectomy,there is a long time to remove the tumor,the high placement rate of pel vic drainage tube and the risk of myoma dissemination and implantation,especially for patients with uterine sarcoma,there is a risk of increased clinical stage of the tumor,which violates the principle of tumor-free clinical diagnosis and treatment.TU-LESS(Transumbilical laparoendoscopic single-sites urgery,transumbilical single-hole laparoscopic surgery),as a new minimally invasive surgical approach compared with porous laparoscopic surgery,has been used by clinicians in the diagnosis and treatment of various gynecological diseases.Seeking a method that can not only achieve minimally invasive effect,but also safe,beautiful,fast recovery and convenient operation and reduce the risk of myoma dissemination and implantation has become a new research hotspot.The purpose of this study is to understand the safety,effectiveness and technical advantages of transumbilical laparoendoscopic single-site laparoscopy in the diagnosis and treatment of uterine leiomyoma.Methods:The patients who underwent trans umbilical laparoendoscopic single-site surgery in Wuhu Hospital Affiliated to East China Normal University(The Second People’s Hospital of Wuhu),from January 2020 to June 2021 were divided into transumbilical single-site laparoscopy group and conventiona lmulti-hole laparoscopy group.There were 93 patients in transumbilical single-site laparoscopy group and conventional multi-hole laparoscopy group,including45 cases of single-site laparoscopic myomectomy and 48 cases of conventional laparoscopic surgery.The preoperative,intraoperative and postoperative indexes of the two groups were collected,and the effects of basic indexes before and after operation were collected.the time of operation,the tumor removal time,the change of hemoglobin before and aft er operation,intraoperative blood loss,visual ananlogue scale(VAS),cosmetic score(CS),body image scale score(BIS)and quality of life score were compared and analyzed using statistical method of SPSS 23.0.Results:There was no significant difference in general basic indexes between transumbilical single-site laparoscopic surgery and conventional multi-hole laparoscopic surgery,and there was no significant difference between the two groups.The pain VAS scores of patients in the transumbilical single-site laparoscopy group at 12,24 and 72-hours after operation(4.82±1.134,3.11±0.647,1.07±0.252,respectively)were significantly lower than those in the conventional multi-hole laparoscopic surgery group(5.33 ±1.209,3.73 ±0.86 and 1.73 ±0.707,respec tively).One month after operation,the cosmetic score of the conventional multi-hole laparoscopy group(36.54 ±1.611)was significantly lower than that of the transumbilical single-site laparoscopy group(39.20 ±2.149).The difference was also found in the body image scale(5.04 ±0.976 and 5.96 ±0.771,respectively).The improvement of quality of life after transumbilical single-site laparoscopic surgery(85.73 ±4.245)was significantly higher than that of conventional muti-hole laparoscopic surgery(79.63 ±3.456).The time of transumbilical single-site laparoscopic myomectomy(101.21 ±5.995min)was significantly higher than that of conventional laparoscopic surgery(90.91 ±6.779 min),and the difference was statistically significant.There was significant difference in tumor removal time during operation,that is,the tumor removal time of single hole laparoscopy(7.53 ± 1.32 min)was shorter than that of conventional multi hole laparoscopy(12.29 ± 1.58 min),which was statistically significant(P< 0.01).In the evaluation of operative safety,the intraoperative blood loss of transumbilical laparoscopic surgery(104.22±5.946ml)was higher than that of conventional laparoscopic surgery(102.63±5.189ml)and there was no significant difference between the two gro ups,but there was significant difference in the change of hemoglobin before and after operation(15.66±5.323 g/L and 12.58±4.068 g/L,respectively).For the comparison of postoperative recovery,the first anal exhaust time(24.69±1.952h),out of bed time(14.40±1.543 h)and hospital stay(6.60±0.780 d)of umbilical laparoscopic myomectomy were lower than those of muti-pole laparoscopic surgery(26.77±2.723 h,15.40±1.567 h,7.63±1.123 d,respectively).The cost was lowerthan that of conventional muti-pole laparoscopic surgery(11552.33±636.292 yuan and 12165.06±566.883 yuan,respectively).Conclusion:Compared with conventional muti-pole laparoscopic surgery,transumbilical single-hole laparoscopic surgery is safe and effective in the operation of uterine leio myoma.It can reduce postoperative pain,promote postoperative recovery,improve incision beauty and improve postoperative quality of life.However,there are certain requirements for surgical instruments,and special instruments are required.The operatio n time of transumbilical single-site laparoscopic surgery is longer than that of conventional muti-pole laparoscopic surgery,but the tumor removal time of single hole laparoscopywas shorter thanthat of conventional multi hole laparoscopy.The degree of hem oglobin changes before and after cleaning up is higher than that in the conventional muti-pole laparoscopic surgery group.As a new approach of surgery,we need to be familiar with and master it through continuous learning.In a word,transumbilical laparo scopic surgery is a safe and effective surgical treatment,which can be widely used in the diagnosis and treatment of myomectomy. |
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