经阴道自然腔道内镜手术在妇科良性疾病全子宫切除中的应用

Application of Vaginal Natural Orifice Transluminal Endoscopic Surgery in Hysterectomy of Benign Gynecological Diseases

目的:探讨经阴道自然腔道内镜手术(vaginal natural orifice transluminal endoscopic surgery,v-NOTES)在妇科良性疾病全子宫切除术中的可行性和安全性。方法:回顾性分析2018年1月1日-2020年12月31日本院38例经单孔腹腔镜(laparo-endoscopic single-site surgery,LESS)全子宫切除术和19例经阴道自然腔道内镜手术全子宫切除术的患者情况,分别设为LESS组(n=38)与v-NOTES组(n=19),比较两组手术情况,包括手术时间、术中和术后并发症、中转为另一术式、手术前后血红蛋白差值、术后6、24 h VAS评分、肛门排气时间及术后住院天数进行分析。结果:两组均顺利完成手术,无1例中转多孔腹腔镜、开腹手术,无1例出现手术并发症。v-NOTES组术后6 h VAS评分比LESS组低,术后肛门排气时间比LESS组早,差异均有统计学意义(P<0.05)。两组手术时间、手术前后血红蛋白差值、术后24 h VAS评分及术后住院天数对比,差异均无统计学意义(P>0.05)。结论:经阴道自然腔道内镜手术在妇科良性疾病全子宫切除术中的应用是安全、可行的,其具有术后6 h内疼痛更轻、肛门排气时间更早的优点。

Objective:To investigate the feasibility and safety of hysterectomy by vaginal natural orifice transluminal endoscopic surgery in gynecological benign diseases.Method:A total of 38 patients received vaginal natural orifice transluminal endoscopic surgery hysterectomy and 19 patients received laparo-endoscopic single-site surgery were retrospectively analyzed in our hospital from January 1,2018 to December 31,2020,who were selected as the LESS group(n=38)and v-NOTES group(n=19)respectively.The operation situation of the two groups were analysed,which included surgical time,preoperative and postoperative complications,transferred to another operation,the difference in hemoglobin before and after surgery,postoperative 6 and 24 hours VAS scores,anal exhaust time and postoperative hospital stay.Result:All patients of two groups completed the operation successfully,none of patients transformed to porous laparoscopic,laparotomy surgery,and no surgical complications occurred.The VAS scores of v-NOTES group was lower than that of LESS group for 6 hours after surgery,and the exhaust time after surgery was earlier than that of LESS group,the differences were statistically significant(P<0.05).There were no significant differences in the surgical time and hemoglobin before and after surgery,VAS scores within 24 hours after surgery,and postoperative hospital stay(P>0.05).Conclusion:Hysterectomy by vaginal natural orifice transluminal endoscopic surgery in gynecological benign diseases is safe,feasible,which has lighter postoperative pain within 6 hours after surgery and earlier anal exhaust time.