经阴道单孔腹腔镜在24例妇科良性疾病手术中的应用探讨

Application of transvaginal single-orifice laparoscope in 24 surgeries of gynecological benign diseases

目的探讨经阴道单孔腹腔镜手术(vNOTES)在妇科良性疾病中的临床价值。方法回顾性分析2018年6月至2019年12月在芜湖市第二人民医院使用自制的单孔装置进行vNOTES手术的病人24例,作为vNOTES组。同期该院行多孔腹腔镜手术的病人40例,作为多孔组。结果两组病人均顺利完成手术,无一例中转其他手术方式,无术中并发症发生。与多孔组比较,vNOTES组手术时间明显延长[(91.25±37.91)比(65.00±23.86)min],住院时间明显减少[(3.79±0.88)比(4.45±0.85)d],术后24 h疼痛视觉模拟评分法(VAS)评分明显降低[(2.96±0.62)比(3.63±1.03)分](均P<0.05);而在年龄、体质量指数(BMI)、产次、术中出血和术后排气时间方面差异无统计学意义(P>0.05)。结论vNOTES手术结合了腹腔镜和传统阴式手术的优势,是传统阴式手术的升级,对良性妇科疾病安全可行,具有微创、美观、疼痛轻和恢复快的优势,但有一定的学习曲线。

Objective To explore the application value of transvaginal natural orifice transluminal endoscopic surgery(vNOTES)in the treatment of gynecological benign diseases.Methods A retrospective analysis was performed on 24 patients(vNOTES group)who underwent vNOTES with self-made single-site device in Wuhu Second People's Hospital from June 2018 to December 2019.Mean⁃while,another 40 patients(multi-site group)underwent multi-site laparoscopic surgery.Results Patients in both groups successfully completed the operation,and none of them transferred to other surgical methods,and no intraoperative complications occurred.Com⁃pared with the multi-site group,vNOTES group had significantly longer operation time[(91.25±37.91)min vs.(65.00±23.86)min],shortened hospital stay[(3.79±0.88)d vs.(4.45±0.85)d],and decreased visual analog scale(VAS)scores at 24h postoperatively[(2.96±0.62)vs.(3.63±1.03)](all P<0.05).However,there were no significant differences in age,body mass index(BMI),parity,intraoperative blood loss and postoperative exhaust time(P>0.05).Conclusions vNOTES surgery combines the advantages of laparoscopy and tradi⁃tional vaginal surgery,which is an upgrade of traditional vaginal surgery.It is safe and feasible for the treatment of benign gynecological diseases with advantages of minimal invasion,aesthetic,mild pain and quick recovery,but there is a certain learning curve.