NOTES-经自然腔道(阴道)内镜下胆囊切除术31例

NOTES-transvagina endoscopic cholecystectomy:report of 31 cases

目的:探讨临床开展经自然腔道(阴道)内镜下胆囊切除术的可行性、安全性和优越性。方法:31例胆囊疾病患者行经阴道内镜下胆囊切除术。脐下缘做—5 mm切口,置入腹腔镜引导胃镜和NOTES操作器械经阴道后穹窿15 mm切口进入腹腔。胃镜获得稳定图像后,撤出脐部腹腔镜置入普通腹腔镜操作器械。在胃镜监视下,通过脐部和阴部两把操作器械完成胆囊切除术。结果:31例患者均顺页利完成经阴道内镜胆囊切除术。手术时间60～150 min,平均85 min。未放置引流,无出血、胆瘘等并发症发生。腹壁无明显瘢痕遗留,术后疼痛轻微,平均住院日缩短,医疗花费降低。结论:经阴道内镜下胆囊切除术技术可行,操作安全,相比传统腹腔镜手术有明显优越性,建议在有条件的医院逐步推广应用。

Objective：To investigate the feasibility, safety and superiority of transvagina endoscopic cholecystectomy used in clinical application. Methods： 31 patients with gall-bladder diseases were treated in transvagina endoscopic cholecystectomy. Through a 5mm cut below the umbilicus, inserted taparoscopic guide gastroscope and NOTES manipulator enter abdominal cavity through posterior fornix 15mm cut. After the gastroscope can capture stable vision, withdraw the laparoscope and insert normal laparoscopic manipulator. With the gastroscope monitoring, accomplish cholecystectomy using umbilical and pudendum manipulator. Result： All of patients were accepted this new type operation. The operation time was 60 - 150 minutes, and the average time was 85 minutes. No postoperative draining, bleeding and biliary fistula occurred in those patients. There was no obvious scar in belly, and all of patients felt no pains after operation. The average inpatient time was shorten, the medical cost decreased. Conclusion： Transvagina endoscopic cholecystectomy is feasible and safety. Comparing to traditional laparoscopic operation, it has obviously superiority. Transvagina endoscopic cholecystectomy should be widely applied in good condition hospitals.