使用传统腹腔镜器械的经阴道阑尾切除术

Transvaginal appendectomy with traditional laparoscopic tools

目的探索和建立使用传统腹腔镜手术器械的经阴道阑尾切除术的技术和方法。方法选择中国医科大学附属盛京医院妇科2010年11月至2011年11月3例既往有反复发作的慢性阑尾炎病史的子宫肌瘤患者在阴式子宫切除术完成后暂不闭合阴道断端，经阴道断端置入Trocar，导入腹腔镜和传统腹腔镜手术器械施行经阴道阑尾切除，手术结束闭合阴道断端。收集分析手术时间、出血量、术后并发症发生率、出院时间等临床资料。结果3例经阴道入路手术均成功完成。阑尾切除部分手术时间分别为34、23和26min，术中均无明显失血，术后均无阑尾残端瘘等并发症发生．术后3d痊愈出院，与传统多孔法和经脐单孔法腹腔镜阑尾切除术相比无明显差异且腹部无任何瘢痕。结论成功建立了经阴式子宫切除后的阴道断端施行阑尾切除术的技术和方法，且该术式安全可行，是经自然腔道内镜手术在临床上的新探索。

Objective To establish the technique and methodology of appendectomy throughtransvaginal natural orifice transluminal endoscopic surgery （NOTES）under laparoscopy. Methods Three cases of chronic appendicitis were selected to receive laparoscopic transvaginal resection of appendixes with concurrent vaginal hysterectomies for uterine fibroids at Shengjing Hospital of China Medical University from November 2010 to November 2011. The procedure was performed by a multidisciplinary team composed of surgeons and gynecologists. The clinical data such as operative duration, bleeding volume, morbidity and stay duration were collected and analyzed. Results Appendectomies were performed with the working laparoscopic tools inserted through vagina. The en bloc resection was removed transvaginally through laparoscope. It took 34, 23 and 26 minutes respectively to complete the appendectomies. And the blood loss volume was minimal. There were no postoperative complications. And the patients were discharged scar-free after 3 days. Conclusions Transvaginal appendectomy is both feasible and safe when performed by a muhidisciplinary team. As an emerging innovation, natural orifice transluminal endoscopic surgery is mini- invasive, better tolerated and more respectful of esthetics.