经自然腔道内镜外科手术在不明原因腹水诊断中的价值

Value of natural orifice transluminal endoscopic surgery in diagnosis of unexplained ascites

目的探讨经自然腔道内镜外科手术(natural orifice transluminal endoscopic surgery,NOTES)在不明原因腹水诊断中的应用价值。方法收集2015年1月至2017年3月在我科住院的行NOTES术诊断(11例)及行腹腔镜术诊断(12例)不明原因腹水患者的病历资料,比较两组患者确诊率、术后疼痛、术后并发症、住院至手术时间、住院费用等,并进行统计学分析,评价两种诊断方法在不明原因腹水中的价值。结果 23例不明原因腹水患者行NOTES术及诊断性腹腔镜手术后均获确诊,两组患者术后均未出现出血、穿孔、感染等并发症,行NOTES术患者术后疼痛VAS评分显著低于诊断性腹腔镜手术组(P<0.05);NOTES术组患者的住院时间、住院费用显著低于诊断性腹腔镜组(P<0.05)。结论 NOTES术在不明原因腹水的确诊率与诊断性腹腔镜探查术相当,可显著降低患者术后疼痛、缩短住院时间、减少住院费用。

Objective To assess whether natural orifice transluminal endoscopic surgery （NOTES） is a reliable technique for the diagnoses of patients with unexplained ascites. Methods The clinical data of patients with unexplained ascites who were diagnosed by NOTES （n=11） or laparoscopic surgery （n=12） in our institute from January 2015 to March 2017 were collected and analyzed. Diagnosed rate, postoperative pain, postoperative complications, enroll to surgery time, and hospital costs were compared between the 2 groups. Results All 23 patients with unexplained ascites were diagnosed after NOTES or diagnostic laparoscopic surgery. No bleeding, perforation, infection or other complications after surgery were observed in both groups. The visual analogue scale （VAS） of postoperative pain was significantly lower in the patients of NOTES group than those of the laparoscopic surgery group （P〈0.05）. The length of hospital stay and cost of hospitalization were significantly lower in the NOTES group than in the other group （P〈0.05）. Conclusion NOTES can significantly reduce the patient’s postoperative pain, shorten the hospital stay, and reduce the cost of hospitalization. NOTES is a new technology worthy of clinical promotion.