vNOTES与TU-LESS在子宫肌瘤剥除术中的对比研究

A Comparative Study of vNOTES and TU-LESS in Myomectomy

目的探讨经阴道自然腔道内镜手术(vNOTES)与经脐单孔腹腔镜手术(TU-LESS)在子宫肌瘤剥除术中的应用。方法选取行腹腔镜子宫肌瘤剥除术的70例子宫平滑肌瘤患者,分为实验组(行vNOTES子宫肌瘤剥除术,20例)和对照组(行TU-LESS子宫肌瘤剥除术,50例)。比较两组患者一般资料、术中及术后相关指标、术后患者躯体及四肢的舒适度情况。结果两组患者均顺利完成手术。实验组患者手术时间较对照组长,术后通气时间较对照组短,术后首次下床活动时间较对照组早,术后24 hVAS疼痛评分、术后患者躯体及四肢舒适度评分均较对照组低(P均<0.05);两组患者术中剥除子宫肌瘤个数、剥除子宫肌瘤最大直径、术中出血量、术后住院时间和住院费差异均无统计学意义(P均>0.05)。结论与TU-LESS相比,vNOTES用于非特殊部位及非特殊类型的子宫肌瘤剥除同样安全、可行,且术后通气时间更短、下床活动更早、疼痛程度更轻、术后恢复更快,患者更加舒适。

Objective To discuss the application of vNOTES and TU-LESS in myomectomy.Methods 70 cases of leiomyoma patients with laparoscopic hysteromyoma were selected and divided into experimental group(vNOTES myomectomy,20 cases)and control group(TU-LESS myomectomy,50 cases).The general data,intraoperative and postoperative indicators,and the comfortable level of the body and limbs of operators were compared between the two groups.Results The operation was completed successfully in both groups.The operative time of the experimental group,the postoperative ventilation time,the time of the first postoperative activity,the VAS pain score 24 hours after surgery,the postoperative body and limb comfort score of the experimental group was better than the control group,with statistical difference(P all<0.05).There were no significant differences in the number of hysteromyoma resected during operation,the maximum diameter of hysteromyoma resected,the amount of intraoperative blood loss,the length of postoperative hospital stays and hospitalization cost between the two groups(P all>0.05).Conclusion vNOTES was equally safe and feasible for myomectomy and TU-LESS,but patients performed vNOTES have shorter postoperative ventilation time,earlier floor movement,less pain,no postoperative scar,and faster postoperative recovery.Moreover,vNOTES could ensure the curative effect and quality of the operation,and made the operator more comfortable after the operation.