经阴道NOTES在妇科手术中的临床应用进展

Clinical application of transvaginal NOTES in gynecological surgery

经自然腔道内镜手术(natural orifice transluminal endoscopic surgery,NOTES)是指不经体表切口,利用内镜通过人体自然孔道进入体内进行手术,女性具有阴道这一天然通道,绝大多数NOTES通过经阴道途径完成。经阴道NOTES可应用于卵巢及输卵管手术、子宫肌瘤剔除术、子宫切除手术、恶性肿瘤手术及盆底手术。具有体表无瘢痕、对机体干扰少、标本易取出、减轻术者疲劳、手术安全性提高等优势。但也存在子宫直肠凹陷状态判断困难,操作空间有限、学习曲线长等问题。经阴道NOTES是安全可行的,未来应用前景广阔。

Natural orifice transluminal endoscopic surgery(NOTES)refers to the use of endoscopy to conduct surgery through the natural orifice of the human body without incision on the body surface.The majority of NOTES are completed through vagina,a natural channel in women.Transvaginal NOTES can be used in ovarian and fallopian tube surgeries,i.e.myomectomy,hysterectomy,malignant tumor surgery and pelvic floor surgery.It has advantages such as no scar on the body surface,less interference in the body,easy specimen removal,reducing fatigue for the operator and improved surgical safety.However,it is difficult to judge the status of uterine rectum depression and has limited operating space,long learning curve,risk of bladder and rectal injuries,and other problems.Overall,transvaginal NOTES is safe and feasible.