经阴道内镜手术在输卵管妊娠中的运用探索

Application of transvaginal natural orifice transluminal endoscopic surgery in tubal pregnancy

目的探索经阴道内镜手术在输卵管妊娠治疗中的可行性、安全性及有效性。方法选取2018年11月至2019年4月于成都市妇女儿童中心医院妇产科就诊,高度怀疑输卵管妊娠拟行输卵管切除术的患者37例,随机分为经阴道内镜组16例和经腹腔镜手术组21例。比较两组患者年龄、体质量指数、手术时间、出血量、术后并发症(感染、输尿管、膀胱、肠管损伤)等各项指标。结果两组患者都按既定手术路径完成手术,经阴道内镜组无中转多孔腔镜及开腹手术,两组患者均未发生术后感染、泌尿系统、肠管损伤等并发症。经阴道内镜组患者术后疼痛评分低于经腹腔镜手术组,手术时间长于经腹腔镜手术组,差异有统计学意义(P<0. 05)。两组患者术中出血量,术后排气时间比较,差异无统计学意义(P> 0. 05)。结论与传统腹腔镜相比较,在严格筛选患者的情况下,经阴道内镜下妊娠输卵管切除术,具有相同的可行性、安全性和有效性,能够降低患者术后疼痛,但需要更加深入的、多中心、前瞻性的随机对照研究加以评估。

Objective To analyze the feasibility,safety,and efficacy of transvaginal natural orifice transluminal endoscopic surgery( v NOTES) in women with ectopic pregnancy. Methods From November 2018 to April 2019,37 patients with highly suspected tubal pregnancy who underwent salpingectomy in the Department of Obstetrics and Gynecology,Chengdu Women and Children's Central Hospital,each of whom needed to be scheduled for a salpingectomy because of a tubal ectopic pregnancy were enrolled,and randomized them into two groups: v NOTES group( n = 16) and laparoscopy group( n = 21). The age,body mass index,operation time,blood loss,postoperative complications( infection,ureter,bladder,intestinal injury) and other indicators were recorded and compared. Results All the patients in the two groups completed the operation in accordance with the established surgical path. None of the v NOTES group was converted to laparotomy or conventional laparoscopy. No complications occurred during intraoperative and postoperative time. The postoperative pain scores of the patients in v NOTES group were lower than those in the laparoscopy group,and the operation time was longer than that in the laparoscopy group. The difference was statistically significant( P<0. 05). There was no significant difference in the amount of intraoperative blood loss and postoperative exhaust time between the two groups( P>0. 05). Conclusion Under the strict inclusion criteria,the feasibility,safety and efficacy of v NOTES for tubal ectopic pregnancy are equivalent to those of the laparoscopic procedure. Less postoperative pain was found in patients receiving v NOTES.Further evaluation of v NOTES in a multicenter,prospective,randomized controlled studies are needed.