经阴道自然腔道内镜全子宫双附件切除术临床分析

Clinical analysis of total hysterectomy with bilateral adnexectomy by transvaginal natural orifice transluminal endoscopic surgery

目的探讨经阴道自然腔道内镜(transvaginal natural orifice transluminal endoscopic surgery,V-NOTES)全子宫双侧附件切除术的临床效果。方法收集沈阳市第四人民医院妇科2018年1月至2019年1月间实施的V-NOTES全子宫双侧附件切除术20例,手术的所有操作均在V-NOTES下完成,采用传统直杆腹腔镜器械及普通10 mm 30°电子镜,电凝及切割组织采用能量器械(双极、超声刀)。经阴道切下全子宫后,置入PORT,在腹腔镜下离断切除双侧附件。结果20例患者切除的平均子宫质量(794±115)g,平均手术时间(125±22)min,平均术中出血量(150+58)ml,平均术后疼痛视觉模拟评分(2.7±0.7)分,平均术后肠道功能恢复时间(24±1.92)h,平均术后住院时间(3.85±0.42)d。20例患者均未发生并发症,平均术后随访时间(45±22)d。术后随诊,所有患者均无明显自觉症状,尿便正常,阴道分泌物正常,阴道残端切口均愈合良好。结论V-NOTES全子宫双侧附件切除术安全可行,腹部无切口,术中可同时探查盆腹腔。

Objective To investigate the clinical effect of total hysterectomy with bilateral adnexectomy with transvaginal natural orifice transluminal endoscopic surgery(V-NOTES).Methods 20 cases of total hysterectomy with bilateral adnexectomy were completed under V-NOTES in Shenyang Fourth People′s Hospital of department of gynaecology from Jan.2018 to Jan.2019.All operations are completed under the V-NOTES with the traditional straight rod laparoscopic instruments and 10 mm and 30 degrees of ordinary mirror.The electric coagulation and cutting organizations adopt energy equipment(bipolar,ultrasonic knife).After vaginal excision of the entire uterus,PORT was inserted and bilateral adnexal excision was performed under laparoscope.Results The average weight of uterine was(794±115)g,the average operation time was(125±22)min,the intraoperative blood loss was(150+58)ml,the average postoperative visual analogue score(VAS)was(2.7±0.7),the average postoperative recovery time of intestinal function was(24±1.92)h,and the average postoperative hospitalized time was(3.85±0.42)d.No complications occurred in the 20 patients,and the average postoperative follow-up time was(45±22)d.There were no obvious self-conscious symptoms in patients following the surgery,with normal urine and bowel moving,normal vaginal discharge,and good healing of vaginal stump incision.Conclusions Total hysterectomy with bilateral adnexectomy with V-NOTES is safe and feasible,with no incision in the abdomen.During the operation,the pelvic cavity and abdomen can be simultaneously explored.