经阴道内镜手术与经脐单孔腹腔镜手术在子宫全切除患者中应用效果

Application of transvaginal endoscopic surgery and transumbilical single hole laparoscopic surgery in patients with total hysterectomy

目的 研究比较经阴道自然腔道内镜手术(V-NOTES)、经脐单孔腹腔镜手术(LESS)在子宫全切除患者中应用效果。方法 选取2018年12月至2020年12月在我院接受子宫全切除+双侧输卵管切除患者106例,依据治疗术式不同分为V-NOTES组(n=52)和LESS组(n=54)。V-NOTES组行V-NOTES,LESS组行LESS。比较两组手术指标、术后康复指标、并发症、术后切口美观满意度、术前、术后1 d、术后3 d氧化应激反应指标[谷胱甘肽过氧化物酶(GPX)、超氧化物歧化酶(SOD)、晚期氧化蛋白产物(AOPP)、丙二醛(MDA)],术前、术后3个月、术后6个月Oswestry功能障碍指数问卷表(ODI)评分。结果 V-NOTES组手术时间、术后住院时间、留置尿管时间及肛门排气时间较LESS组短,术后12 h VAS评分较LESS组低(P<0.05);两组术后1 d、术后3 d血清GPX、SOD水平均较本组术前降低,但V-NOTES组较LESS组高,AOPP、MDA水平均较本组术前提高,但V-NOTES组较LESS组低(P<0.05);与术前相比,两组术后3个月、术后6个月ODI评分均降低,且V-NOTES组优于LESS组(P<0.05);V-NOTES组术后切口美观满意度(96.15%)高于LESS组(81.48%)(P<0.05);两组术后并发症相比,差异无统计学意义(P>0.05)。结论 与LESS比较,V-NOTES应用于子宫全切除可降低患者手术创伤及术后疼痛感,减轻氧化应激反应,促进术后康复进程及功能恢复,提升切口美观度。

Objective To compare the effects of transvaginal endoscopic surgery(V-NOTES) and transumbilical single hole laparoscopic surgery(LESS) in patients with total hysterectomy.Methods 106 patients who underwent hysterectomy + bilateral salpingectomy in our hospital from December 2018 to December 2020 were selected and divided into V-NOTES group(n = 52) and LESS group(n = 54) according to different treatment methods.V-NOTES group line V-NOTES,LESS group line LESS.Compare the two groups of surgical indicators,postoperative rehabilitation indicators,complications,postoperative incision aesthetic satisfaction,preoperative,postoperative 1 d,and postoperative 3 d oxidative stress response indicators [glutathione peroxidase(GPX),superoxide dismutase(SOD),advanced oxidized protein products(AOPP),malondialdehyde(MDA)],Oswestry Disability Index Questionnaire(ODI) scores before surgery,3 months after surgery,and 6 months after surgery.Results The operation time,postoperative hospital stay,indwelling catheter time,and anal exhaust time in the V-NOTES group were shorter than those in the LESS group.The VAS score at 12 h after the operation was lower than that in the LESS group(P<0.05).The two groups were 1 day after surgery.3 d serum GPX and SOD levels were lower than this group before surgery,but the V-NOTES group was higher than the LESS group,and the AOPP and MDA levels were higher than this group before the operation,but the V-NOTES group was lower than the LESS group(P<0.05).Compared with preoperatively,the ODI scores of the two groups were reduced at 3 and 6 months after operation,and the V-NOTES group was better than the LESS group(P<0.05).The postoperative incision aesthetic satisfaction of the V-NOTES group(96.15%) was higher than that in the LESS group(81.48%)(P<0.05).There was no significant difference in postoperative complications between the two groups(P>0.05).Conclusion Compared with LESS,the application of V-NOTES in total hysterectomy can reduce surgical trauma and postoperative pain,reduce oxidative stress,promote postoperative rehabilitation process and functional recovery,and improve the beauty of incision.