经阴道自然腔道内镜手术在异位妊娠中的应用八例分析

Primary study on transvaginal natural orifice transluminal endoscopic surgery for ectopic pregnancy:a series of 8 cases

目的探索经自然腔道内镜手术(natural orifice transluminal endoscopic surgery,NOTES)在异位妊娠治疗中的可行性、安全性及有效性。方法中国医学科学院北京协和医院妇产科于2015年6月至2016年5月共完成8例经阴道NOTES异位妊娠患侧输卵管切除术。记录患者年龄、体质量指数、阴道分娩数、停经时间、血β-HCG(人绒毛膜促性腺激素)、肿物大小、子宫直肠窝积血、手术时间、术中出血量等指标。结果 8例患者的手术均成功完成,无中转传统腹腔镜手术或开腹手术,无并发症发生。年龄(33±4.8)岁,体质量指数(24.2±1.8)kg/m2,阴道分娩(1.5±0.8)次,停经时间(52.3±4.9)d,术前血β-HCG(10 280±7 948.6)U/ml,肿物大小(2.75±0.5)cm,子宫直肠窝积血(105±98.3)ml,手术时间(41.9±3.7)min,术中出血量(8.4±5.6)ml。术后随访血β-HCG水平下降理想,阴道伤口愈合良好。结论经阴道NOTES可安全、有效完成异位妊娠输卵管切除,但需要进一步前瞻性研究来评估其完整临床应用。

Objective To analyze the feasibility, safety, and efficacy of natural orifice transluminal endoscopic surgery （NOTES） for ectopic pregnancy. Methods Between Jun. 2015 and May 2016, 8 patients diagnosed as ectopic pregnancy underwent transvaginal NOTES to remove fallopian tube in Peking Union Medical College Hospital. Results All 8 cases were successfully completed. No one was converted to laparotomy or conventional laparoscopy. No complications occurred during intraoperative and postoperative time. The average age of patients was （ 33 ± 4.8） y, body mass index was （ 24.2 ±1.8） kg/m2, vaginal delivery history was （ 1.5 ±0.8） times, length of menopause was （52.3 ± 4.9） days, serum β- HCG was （ 10 280 ±7 948.6）U/ml, diameter of adnexal mass was （2.75 ±0.5） cm, hemoperitoneum was （ 105 ± 98.3） ml, operation time was （ 41.9 ±3.7 ） rain, average blood loss during surgery was （ 8.4 ± 5.6 ） ml. During the follow-up period, the serum β-HCG decreased as expected. Vaginal wound healed well. Conclusions Transvagnial NOTES is a feasible, safe, and effective management in the treatment of ectopic pregnancy. Further evaluation of NOTES in a prospective randomized trial is required.