单孔腹腔镜巨大子宫肌瘤剔除术的适应证选择及手术要点

钟晓盈, 刘海元

中国实用妇科与产科杂志 ›› 2025, Vol. 41 ›› Issue (7) : 710-714.

PDF(889 KB)
PDF(889 KB)
中国实用妇科与产科杂志 ›› 2025, Vol. 41 ›› Issue (7) : 710-714. DOI: 10.19538/j.fk2025070110
专题笔谈

单孔腹腔镜巨大子宫肌瘤剔除术的适应证选择及手术要点

作者信息 +

Selection of indications and key surgical points for single-port laparoscopic removal of giant uterine fibroids

Author information +
文章历史 +

摘要

单孔腹腔镜手术技术在妇科手术中逐渐普及,然而目前尚无指南或共识指导巨大子宫肌瘤的单孔手术适应证及处理方案。文章从术前评估、预处理策略、手术核心技术要点出发,为巨大子宫肌瘤的单孔手术治疗提供诊治经验,并探讨单孔与多孔腹腔镜在手术疗效、产科结局、术后复发等差异,为临床提供诊治依据。

Abstract

The technique of laparoscopic single-site surgery is gradually becoming popular in gynecological surgery,but there is currently no guideline or consensus on the indications and treatment plans for single-port surgery for large uterine fibroids.Regarding preoperative evaluation,pre-processing strategies,and key surgical techniques,this article provides diagnostic and therapeutic experience of single-port surgical treatment for giant uterine fibroids,and explores the differences in surgical efficacy,obstetric outcomes,and postoperative recurrence between single-port and multi-port laparoscopy,providing basis for clinical diagnosis and treatment basis.

关键词

子宫肌瘤 / 巨大子宫肌瘤 / 单孔腹腔镜手术 / 微创

Key words

uterine fibroids / giant uterine fibroids / laparoscopic single-site surgery / minimally invasive

引用本文

导出引用
钟晓盈, 刘海元. 单孔腹腔镜巨大子宫肌瘤剔除术的适应证选择及手术要点[J]. 中国实用妇科与产科杂志. 2025, 41(7): 710-714 https://doi.org/10.19538/j.fk2025070110
ZHONG Xiao-ying, LIU Hai-yuan. Selection of indications and key surgical points for single-port laparoscopic removal of giant uterine fibroids[J]. Chinese Journal of Practical Gynecology and Obstetrics. 2025, 41(7): 710-714 https://doi.org/10.19538/j.fk2025070110
中图分类号: R713.1   

参考文献

[1]
Stewart EA, Cookson CL, Gandolfo RA, et al. Epidemiology of uterine fibroids: a systematic review[J]. BJOG, 2017, 124(10):1501-1512. DOI:10.1111/1471-0528.14640.
[2]
Ahmad A, Kumar M, Bhoi NR, et al. Diagnosis and management of uterine fibroids: current trends and future strategies[J]. J Basic Clin Physiol Pharmacol, 2023, 34(3):291-310. DOI:10.1515/jbcpp-2022-0219.
[3]
Wang Y, Zhang S, Li C, et al. Minimally invasive surgery for uterine fibroids[J]. Ginekol Pol, 2020, 91(3):149-157. DOI:10.5603/GP.2020.0032.
[4]
Wozniak A., Wozniak S. Ultrasonography of uterine leiomyomas[J]. Menopause Rev, 2017, 16:113-117. DOI: 10.5114/pm.2017.72754.
[5]
Bajaj S, Gopal N, Clingan MJ, et al. A pictorial review of ultrasonography of the FIGO classification for uterine leiomyomas[J]. Abdom Radiol (NY), 2022, 47(1):341-351. DOI:10.1007/s00261-021-03283-6.
[6]
Wojtowicz K, Góra T, Guzik P, et al. Uterine myomas and sarcomas - clinical and ultrasound characteristics and differential diagnosis using pulsed and color doppler techniques[J]. J Ultrason, 2022, 22(89):100-108. DOI:10.15557/JoU.2022.0017.
[7]
Tordjman L, Amirian H, Alvarez A, et al. Do MRI structured reports with FIGO classifications of leiomyomas contain adequate information for clinical decision making?[J]. Int J Gynaecol Obstet, 2025:1-7. DOI:10.1002/ijgo.70163.
[8]
Wang L, Li S, Zhang Z, et al. Prevalence and occult rates of uterine leiomyosarcoma[J]. Medicine (Baltimore), 2020, 99(33):e21766. DOI:10.1097/MD.0000000000021766.
[9]
Zouzoulas D, Tsolakidis D, Pavlidi OI, et al. Rate of leiomyosarcomas during surgery for uterine fibroids: 8-year experience of a single center[J]. J Clin Med, 2023, 12(24):7555. DOI:10.3390/jcm12247555.
[10]
Mühlenbrock MV, Navarrete-Rey P, Kovoor E, et al. Incidence of occult uterine sarcoma and other unexpected pathologies in patients having surgery for presumed myomas: A retrospective observational study[J]. J Gynecol Obstet Hum Reprod, 2021, 50(7):101992. DOI:10.1016/j.jogoh.2020.101992.
[11]
Roller LA, Wan Q, Liu X, et al. MRI,clinical,and radiomic models for differentiation of uterine leiomyosarcoma and leiomyoma[J]. Abdom Radiol (NY), 2024, 49(5):1522-1533. DOI:10.1007/s00261-024-04198-8.
[12]
Tu W, Yano M, Schieda N, et al. Smooth muscle tumors of the uterus at MRI: focus on leiomyomas and FIGO Classification[J]. Radiographics, 2023, 43(6):e220161. DOI:10.1148/rg.220161.
[13]
Lethaby A, Puscasiu L, Vollenhoven B. Preoperative medical therapy before surgery for uterine fibroids[J]. Cochrane Database Syst Rev, 2017, 11(11):CD000547. DOI:10.1002/14651858.CD000547.pub2.
[14]
Lumsden MA, Hamoodi I, Gupta J, et al. Fibroids:diagnosis and management[J]. BMJ, 2015,351:h4887. DOI:10.1136/bmj.h4887.
[15]
ACOG. Management of Symptomatic Uterine Leiomyomas: ACOG Practice Bulletin,Number 228 [J]. Obstet Gynecol, 2021, 137(6): e100-e115.DOI:10.1097/AOG.0000000000004401.
[16]
AAGL. Evidence-Based Practice for Minimization of Blood Loss During Laparoscopic Myomectomy: An AAGL Practice Guideline:The Practice Guideline Committee of AAGL[J]. J Minim Invasive Gynecol, 2025, 32(2): 113-32.DOI:10.1016/j.jmig.2024.09.021.
[17]
Donnez J, Donnez O, Dolmans MM. With the advent of selective progesterone receptor modulators,what is the place of myoma surgery in current practice[J]. Fertil Steril, 2014, 102(3):640-648. DOI:10.1016/j.fertnstert.2014.06.041.
[18]
Chang WC, Chu LH, Huang PS, et al. Comparison of laparoscopic myomectomy in large myomas with and without leuprolide acetate[J]. J Minim Invasive Gynecol, 2015, 22(6):992-996. DOI:10.1016/j.jmig.2015.04.026.
[19]
Zhang S, Yu H, Dong Z, et al. Laparoendoscopic single-site surgery for deep infiltrating endometriosis based on retroperitoneal pelvic spaces anatomy: a retrospective study[J]. Sci Rep, 2023, 13(1):10785. DOI:10.1038/s41598-023-38034-8.
[20]
Huang KJ, Lin KT, Wu CJ, et al. Single incision laparoscopic surgery using conventional laparoscopic instruments versus two-port laparoscopic surgery for adnexal lesions[J]. Sci Rep, 2021, 11(1):4118. DOI:10.1038/s41598-021-82204-5.
[21]
Uppal S, Frumovitz M, Escobar P, et al. Laparoendoscopic single-site surgery in gynecology: review of literature and available technology[J]. J Minim Invasive Gynecol, 2011, 18(1):12-23. DOI:10.1016/j.jmig.2010.07.013.
[22]
中华医学会妇产科学分会妇科单孔腹腔镜手术技术协助组. 妇科单孔腹腔镜手术技术的专家意见[J]. 中华妇产科杂志, 2016, 51(10):724-726. DOI:10.3760/cma.j.issn.0529-567x.2016.10.002.
[23]
Zaliznyak M, Chen A, Kuhlmann P, et al. Optimal instrument length for transumbilical laparoendoscopic single site (U-LESS) surgery[J]. J Robot Surg, 2022, 16(1):53-58. DOI:10.1007/s11701-021-01208-5.
[24]
Paul MD. Bidirectional barbed sutures for wound closure: evolution and applications[J]. J Am Col Certif Wound Spec, 2009, 1(2):51-57. DOI:10.1016/j.jcws.2009.01.002.
[25]
Hafermann J, Silas U, Saunders R. Efficacy and safety of V-Loc barbed sutures versus conventional suture techniques in gynecological surgery: a systematic review and meta-analysis[J]. Arch Gynecol Obstet, 2024, 309(4):1249-1265. DOI:10.1007/s00404-023-07291-3.
[26]
Nakayama K, Razia S, Ishikawa M, et al. Comparison between bidirectional Stratafix® barbed suture and conventional suture in laparoscopic myomectomy: a retrospective study[J]. BMC Womens Health, 2020, 20(1):164.DOI:10.1186/s12905-020-01030-5.
[27]
Nambi Gowri K, King MW. A review of barbed sutures-evolution,applications and clinical significance[J]. Bioengineering (Basel), 2023, 10(4):419. DOI:10.3390/bioengineering10040419.
[28]
Matsushita T, Sekizawa A, Jacobs LK. Racial disparities in response to a US Food and Drug Administration safety communication regarding the use of power morcellation for the treatment of uterine leiomyoma[J]. J Minim Invasive Gynecol, 2020, 27(1):178-185.e1. DOI:10.1016/j.jmig.2019.03.019.
[29]
Xie W, Zhang Z, Wang Z, et al. Laparoendoscopic single site myomectomy versus conventional laparoscopic myomectomy for uterine myomas: a systematic review and meta-analysis[J]. Int J Surg,2025:1-33. DOI:10.1097/JS9.0000000000002590.
[30]
邢庭玮, 缪妙, 陈继明, 等. 经脐单孔腹腔镜镜下联合体外操作模式治疗卵巢良性肿瘤效果评价[J]. 中国实用妇科与产科杂志, 2024, 40(10):1047-1050.DOI:10.19538/j.fk2024100117.
[31]
王永军. 妇科良性疾病经脐单孔腹腔镜子宫切除术的优劣势评价[J]. 中国实用妇科与产科杂志, 2023, 39(5):508-511.DOI:10.19538/j.fk2023050107.
[32]
闫瑾博文, 周丹, 张烁, 等. 经阴道自然腔道单孔腹腔镜行卵巢囊肿剥除术的可行性和安全性研究[J]. 中国实用妇科与产科杂志, 2023, 39(4):452-456.DOI:10.19538/j.fk2023040114.
[33]
张楠, 狄文. 卵巢良性肿瘤手术中的无瘤防御[J]. 中国实用妇科与产科杂志, 2023, 39(1):25-27.DOI:10.19538/j.fk2023010108.
[34]
Zhou SF, Wang HY, Wang K. An analysis of the surgical outcomes of laparoendoscopic single-site myomectomy and multi-port laparoscopic myomectomy[J]. Ann Transl Med, 2021, 9(11):927. DOI:10.21037/atm-21-1862.
[35]
Ma J, Yang J, Cheng S, et al. The learning curve of laparoendoscopic single-site surgery in benign gynecological diseases[J]. J Invest Surg, 2022, 35(2):363-370. DOI:10.1080/08941939.2020.1867673.
[36]
Kim JY, Kim KH, Choi JS, et al. A prospective matched case-control study of laparoendoscopic single-site vs conventional laparoscopic myomectomy[J]. J Minim Invasive Gynecol, 2014, 21(6):1036-1040. DOI:10.1016/j.jmig.2014.04.017.
[37]
Hong YH, Song E, Kim SK, et al. Operative and obstetric outcomes after single-port laparoscopic myomectomy: a retrospective single-center analysis of 504 cases[J]. J Minim Invasive Gynecol, 2021, 28(12):2080-2088. DOI:10.1016/j.jmig.2021.06.011.
[38]
Kim SJ, Park MH, Lee JH. Comparison of operative and fertility outcomes of single-incision robotic myomectomy: a retrospective single-center analysis of 286 cases[J]. J Robot Surg, 2023, 17(6):2945-2953. DOI:10.1007/s11701-023-01743-3.

PDF(889 KB)

Accesses

Citation

Detail

段落导航
相关文章

/