经阴道自然腔道内镜手术在巨大卵巢良性肿瘤中的应用初探

Application of transvaginal natural orifice endoscopic surgery in the treatment of giant benign ovarian tumors

目的探讨经阴道自然腔道内镜手术(vaginal natural orifice transluminal endoscopic surgery,vNOTES)应用于巨大卵巢良性肿瘤的安全性、可行性及相关优势。方法回顾性分析2020年5月至2022年6月在贵州医科大学附属医院和贵州省人民医院开展手术治疗的巨大卵巢良性肿瘤(直径≥10 cm)患者的临床资料,根据不同手术方式分为vNOTES组(16例)、经脐单孔腹腔镜手术(laparoscopic single-site surgery,LESS)组(54例)、传统多孔腹腔镜手术(multiport laparoscopic surgery,MLS)组(38例),比较分析三组的手术时间、术中囊液外溢率、术中出血量、术后首次肛门排气时间、术后24 h疼痛视觉评分(visual analogue scale,VAS)、术后住院时间、总住院费用、术后切口美容满意度评分( cosmetic score,CS)及术后短期并发症等指标。结果vNOTES组术中囊液外溢率、术后首次肛门排气时间、术后24 h VAS与LESS组及MLS组相比,差异有统计学意义(P<0.05)。三组的手术包块直径、术中出血量、手术时间、总住院费用、术后并发症、术后炎症指标、卵巢肿瘤标志物等相比较,差异均无统计学意义(P>0.05)。结论vNOTES治疗巨大卵巢良性肿瘤患者是安全、可行的,与LESS和MLS相比,具有更微创、囊液外溢率低、术后加速康复、体表无瘢痕等优势。

Objective To evaluate the safety, feasibility and advantages of transvaginal natural orifice transluminal endoscopic surgery (vNOTES) in the treatment of giant ovarian benign tumors.Methods The clinical data of patients who underwent surgery for giant benign ovarian tumors (diameter≥10 cm) in the Affiliated Hospital of Guizhou Medical University and Guizhou Provincial People′s Hospital from May 2020 to Jun. 2022 were retrospectively analyzed. According to different surgery methods, the patients were divided into vNOTES (16 cases), laparoscopic single-site surgery (LESS, 54 cases) and traditional multiport laparoscopic surgery (MLS, 38 cases). The operative time, cyst fluid leakage rate, intraoperative blood loss, postoperative exhaust time, 24 h postoperative pain visual analogue score, hospital stay, hospitalization cost, postoperative incision cosmetic score and short-term postoperative complication were compared and analyzed among the three groups.Results Compared with the LESS group and the MLS group, the vNOTES group had statistically significant differences in the cystic fluid leakage rate, postoperative exhaust time and pain score at 24 hours after operation (P< 0.05). There were no significant differences in the mass diameter size, intraoperative blood loss, operation time, total hospitalization cost, postoperative complications, postoperative inflammatory indicators, and ovarian tumor markers among the three groups (P> 0.05).Conclusions vNOTES surgery is safe and effective in the giant benign ovarian tumors. Compared with LESS and MLS groups, vNOTES surgery has the advantages of minimally invasive, lower cyst fluid leakage rate, shorter postoperative recovery time, and no scar on the body surface.