SILS 포트를 이용한 단일공법 복강경하 질식자궁절제술과 삼공법 복강경하 질식자궁절제술의 비교
A COMPARISON OF SINGLE-PORT LAPAROSCOPICALLY ASSISTED VAGINAL HYSTERECTOMY USING TRANSUMBILICAL SILS PORT ACCESS AND THREE-PORT LAPAROSCOPICALLY ASSISTED VAGINAL HYSTERECTOMY
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초록
목적SILS포트를 이용한 단일공법 복강경하 질식자궁절제술을 수술 결과들과 환자 만족도 측면에서 삼공법과 비교하기 위함이다. 연구방법2010년 4월부터 2011년 5월까지 원광대학교병원에서 자궁경부와 자궁체부의 양성질환으로 복강경하 질식자궁절제술을 시행받은 총138명의 환자를 대상으로 하였다. 각각의 수술법은 환자 동의 아래 직접 선택하였고, SILS을 이용한 단일공법 복강경하 질식자궁절제술이시행된 환자 65명과, 삼공법으로 시행된 환자 73명이 대상이 되었다. 결과수술시간(93.4 ± 20.2분 vs. 95.1 ± 28.7분, P = 0.696), 혈색소변화(1.91 ± 0.68 g/dL vs. 1.85 ± 0.87 g/dL, P = 0.667), 절제된 자궁 무게(288.2± 241.1 g vs. 311.8 ± 268.3 g, P = 0.225), 재원기간(5.9±0.9일 vs. 6.4±1.6일, P = 0.063), 추가적인 포트삽입(1.5% vs. 0%,P = 0.471), 개복술로의 전환(0% vs. 4.1%, P = 0.098), 수술 후 통증(시각통증등급)은 두 군 간에 유의한 차이를 보이지 않았다. 하지만 수술6주 후 조사된 환자 만족도는 단일공법군이 만족(52.3% vs. 34.2%, P = 0.032)과 매우 만족(33.8% vs. 17.8%, P = 0.031)에서 통계학적으로 유의하게 높았다. 결론SILS포트를 이용한 단일공법 복강경하 질식자궁절제술은 복강경하 질식자궁절제술을 시행받는 환자에서 삼공법 복강경하 질식자궁절제술에 견줄만한 방법이며, 환자 만족도 측면에서는 삼공법 복강경하 질식자궁절제술에 비해 우수하다.
Abstract
Objective The purpose of this study was to compare surgical outcomes and patients’ satisfaction between single-port access laparoscopically assisted vaginal hysterectomy (SPA-LAVH) and conventional three-port access LAVH (TPA-LAVH) group. Methods A prospective analysis was performed in patients who underwent laparoscopically assisted vaginal hysterectomy at a Wonkwang University Hospital between April 2010 and May 2011, a total of 138 women were enrolled in this study. One of these procedures was chosen by patient and was performed with their consent. Sixty-fi ve women underwent SPA-LAVH using transumbilical SILS port access (SPA-LAVH group), and 73 women underwent conventional three-port LAVH (TPA-LAVH group). Results There were no statistical differences between groups in the patients’ demographic characteristics, mean operating time (93.4 ± 20.2minutes vs. 95.1 ± 28.7 minutes, P = 0.696), postoperative changes in hemoglobin concentration (1.91 ± 0.68 vs. 1.85 ± 0.87 g/dL,P = 0.667), weight of the resected uterus (261.7 ± 205.3 g vs. 311.8 ± 268.3 g, P = 0.225), hospital stay (5.9±0.9 day vs. 6.4±1.6day, P = 0.063), the rate of using an additional trocar (1.5% vs. 0%, P = 0.471), the rate of conversion to laparotomy (0% vs. 4.1%,P = 0.098) and postoperative pain scores (visual analogue scale) for 48 hours. However, patients’ satisfaction after 6 weeks later was signifi cantly greater in SPA-LAVH group than in conventional group, as evidenced by higher rate of fairly satisfactory (52.3%vs. 34.2%, P = 0.032) and very satisfactory (33.8% vs. 17.8%, P = 0.031). Conclusion SPA-LAVH using transumbilical SILS port access is comparable with TPA-LAVH in women undergoing LAVH. However, SPA-LAVH is better than TPA-LAVH in terms of satisfaction of patient.
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