经阴道自然腔道内镜与单孔腹腔镜子宫肌瘤剔除术临床效果

Comparison of clinical effects of transvaginal natural tract endoscopy and single-port laparoscopy for myomectomy

目的:比较经阴道自然腔道内镜(V-NOTES)和单孔腹腔镜下行子宫肌瘤剔除术的临床疗效。方法:选取本院在2018年5月-2020年11月收治的子宫前壁单发肌瘤患者96例,采用随机数字表法分为观察组与对照组各48例。对照组采用单孔腹腔镜子宫肌瘤剔除术,观察组采用V-NOTES子宫肌瘤剔除术。比较两组手术指标、并发症及术后疼痛情况,比较手术前后血红蛋白(Hb)水平、应激反应因子变化等。结果:观察组术后排气时间、术后下床时间、住院时间均低于对照组(P<0.05),两组手术时间、术中出血量无差异(P>0.05)。两组术中及术后临近器官损伤、术后感染、切口愈合不良发生率均无差异(P>0.05)。两组术后4h、12h、24h时疼痛评分均逐渐降低且观察组低于对照组(P<0.05)。术后两组血清Hb、丙二醛(MDA)水平均高于术前,超氧化物歧化酶(SOD)低于术前(P<0.05),两组Hb无差异(P>0.05),观察组血清MDA水平低于对照组、SOD水平高于对照组(P<0.05)。结论:V-NOTES与单孔腹腔镜下子宫肌瘤剔除术均安全有效,但V-NOTES子宫肌瘤剔除术在改善术后恢复、降低术后疼痛、缓解术后应激反应等方面更具优势。

Objective:To compare the clinical effects of uterine myomectomy by vaginal orifice transluminal endoscopic surgery(V-NOTES)and by single-port laparoscopy.Methods:A total of 96 patients with single myoma of the anterior uterine wall were selected,and were randomly divided into two groups(48 cases in each group)according to the random number table from May 2018 to November 2020.The patients in the control group were treated with single-hole laparoscopic uterine myomectomy,and the patients in the observation group were treated with V-NOTES uterine myomectomy.The operation indexes,the situations of complication and postoperative pain of the patients were compared between the two groups.The levels of hemoglobin(Hb)and stress response factors of the patients were compared between before and after the operation.Results:The postoperative exhaust time,the time of postoperative getting out of bed,and the hospital stay time of the patients in the observation group were significantly lower than those of the patients in the control group(P<0.05),but there were no significant differences in the operative time and intraoperative blood loss of the patients between the two groups(P>0.05).There were no significant differences in the incidences of the intraoperative and postoperative adjacent organ injury,the postoperative infection,and the poor wound healing of the patients between the two groups(P>0.05).The VAS scores of the patients in both groups at postoperative 4h,12h and 24h had decreased gradually,and which of the patients in the observation group was significantly lower than that of the patients in the control group(P<0.05).The levels of serum Hb and malondialdehyde(MDA)of the patients in the two groups after operation were significantly higher than those before operation,but the levels of superoxide dismutase(SOD)of the patients in the two groups after operation was significantly lower than those before operation(P<0.05).There was no significant difference in the Hb level of the patients between the two groups(P>0.05),the serum MDA level of the patients in the observation group was significantly lower than that of the patients in the control group,the SOD level of the patients in the observation group was significantly higher(P<0.05).Conclusion:V-NOTES and single-port laparoscopic myomectomy are both safe and effective.However,compared with those of single-port laparoscopic myomectomy,V-NOTES myomectomy has more advantages in improving postoperative recovery,relieving postoperative pain and stress reaction.