经阴道内镜手术治疗子宫肌瘤效果及难点分析

Effect and difficulty analysis of transvaginal endoscopic surgery for treating patients with myoma of uterus

目的:探究经阴道内镜(vNOTES)手术治疗子宫肌瘤效果及难点分析。方法:回顾性收集本院妇科2018年10月-2021年10月收治的子宫肌瘤手术治疗患者210例,根据采用的术式不同,分为采用经阴道内镜(内镜组)和采用单孔经脐腹腔镜(腹腔镜组),对两组围术期指标、术后生化指标、术后24h后疼痛视觉模拟评分(VAS)与并发症进行比较。结果:两组手术时长与术中出血量无差异(P>0.05),内镜组术后排气时间(25.4±3.6 h)与住院时间(3.2±0.7 d)均短于腹腔镜组(31.7±4.6 h、4.3±0.9 d)(P<0.05);VAS评分,术后6h两组无差异,内镜组术后12h(4.24±0.98分)和24h后(3.13±0.72分)均低于腹腔镜组(4.67±1.09分、4.13±0.69分)(均P<0.05);手术并发症发生率内镜组(1.0%)与腹腔镜组(3.8%)无差异(P>0.05),术后两组血红蛋白,丙二酫(MDA)和超氧化物歧化酶(SOD)均优于术前,且内镜组MDA(67.87±10.35 umol/L)和SOD(7.82±2.42 U/ml)优于腹腔镜组(75.24±7.38 umol/L、4.77±1.03 U/ml)(均P<0.05)。结论:vNOTES手术治疗子宫肌瘤效果良好,且术后恢复快,未增加并发症发生。

Objective:To explore the effect and difficulty of transvaginal endoscopic surgery for treating patients with myoma of uterus.Methods:A total of 210 patients with myoma of uterus from October 2018 to October 2021 were selected and were divided into observation group(women treated by transvaginal endoscopic surgery)and control group(women treated by single hole transumbilical laparoscopy).The perioperative indexes,the postoperative biochemical indexes,the visual analog score(VAS)in postoperative 24h,and the incidence of complications of the patients were compared between the two groups.Results:There were no significant differences in the operation time and the intraoperative blood loss of the patients between the two groups(P>0.05).Te exhaust time(25.4±3.6 h)and the hospital stay(3.2±0.7 d)of the patients in the observation group were significantly shorter than those(31.7±4.6 h and 4.3±0.9 d)of the patients in the control group(P<0.05).There was no significant difference in VAS score of the patients at the 6th hour after operation between the two groups.The VAS scores of the patients at the 12th and at the 24th hour after operation(4.24±0.98 points and 3.13±0.72 points)in the observation group were significantly lower than those(4.67±1.09 points and 4.13±0.69 point)of the patients in the control group(all P<0.05).There was no significant difference in the incidence of surgical complications(1.0%vs.3.8%)of the patients between the two groups(P>0.05).The levels of MDA(67.87±10.35 umol/L)and SOD(7.82±2.42 U/ml)of the patients in the observation group were significantly were better than those(75.24±7.38 umol/L and 4.77±1.03 U/ml)of the patients in the control group(all P<0.05).Conclusion:Transvaginal endoscopic surgery for treating the patients with myoma of uterus is effective,which has better postoperative recovery and less complication.