经阴道NOTES辅助腹腔镜下肾切除术对女性性功能和骨代谢的影响

Effects of transvaginal NOTES assisted laparoscopic nephrectomy on female sexual function and bone metabolism

目的探讨经阴道自然腔道内镜手术(NOTES)辅助腹腔镜下肾切除术对女性性功能和骨代谢的影响。方法选取2014年6月至2016年6月空军军医大学唐都医院诊治的46例拟行经阴道NOTES辅助腹腔镜下肾切除术患者作为研究对象。采用骨代谢生化指标、健康调查简表(SF-36)和女性性功能指数问卷(FSFI)评价患者术前及术后4个月、8个月和12个月的性功能、生活质量和骨代谢。结果 46例手术均顺利完成。患者术前及术后4个月、8个月和12个月FSFI评分表中各维度数据之间的比较均无显著性差异(P>0.05);术后4个月、8个月和12个月生理机能、生理职能、情感职能、精力、心理健康、社会功能、躯体疼痛评分均显著优于术前(均P<0.05);术后4个月、8个月和12个月患者血磷、血钙、血钙磷乘积、25羟维生素D_3(25-OH-D3)、全段甲状旁腺激素(iPTH)、骨钙素均明显优于术前,差异具有统计学意义(P<0.05);术后随访12个月显示,患者症状消失或好转,切口愈合较好,手术瘢痕不明显,无脐疝、盆腔感染等并发症。结论经阴道NOTES辅助腹腔镜下肾切除术对女性性功能无负面影响;患者术后生活质量和骨代谢均可获得一定改善。

Objective To explore the effects of transvaginal natural orifice transluminal endoscopic surgery(NOTES) assisted laparoscopic nephrectomy on female sexual function and bone metabolism. Methods 46 patients scheduled to undergo transvaginal NOTES assisted laparoscopic nephrectomy admitted to our hospital from June 2014 to June 2016 were enrolled in this study. The sexual function, quality of life and bone metabolism were evaluated before operation and at 4, 8, 12 months after operation by female sexual function index(FSFI) and Shot Form 36 Health Survey Questionnaire(SF-36). Results 46 cases were successfully completed. There was no significant difference in each dimension data of FSFI between before operation and at 4, 8 and 12 months after operation(P>0.05). The scores of physiological function, physical role, emotional function, mental health, social function and somatic pain at 4, 8 and 12 months after operation were significantly better than those before operation(P<0.05). At 4, 8 and 12 months after operation, the serum phosphorus, serum calcium and calcium-phosphorus product, 25-hydroxyvitamin D3(25(OH) D3), total parathyroid hormone(iPTH) and osteocalcin were significantly better than those before operation(P<0.05). Within 12 months of follow-up after operation, the symptoms were disappeared or improved, and there was good wound healing, unapparent scar, and no complications such as umbilical hernia and pelvic infection. Conclusions Transvaginal NOTES assisted laparoscopic nephrectomy has no negative impact on female sexual function, which can also improve the postoperative quality of life and bone metabolism to some extent.