三种不同腹腔镜入路行大子宫切除术临床疗效评估

Evaluation of clinical efficacy of three different laparoscopic approaches for large hysterectomy

目的:研究比较经阴道自然腔道内镜手术(vaginal natural orifice transluminal endoscopic surgery,vNOTES)、经脐单孔腹腔镜手术(transumbilical laparoendoscopic single-site surgery,TU-LESS)、传统腹腔镜手术(multi-port laparoscopic surgery,MPLS)在大子宫切除术中的临床应用效果。方法:选取2018年1月至2020年12月在山东第一医科大学第一附属医院接受全子宫+输卵管±卵巢切除术的大子宫患者138例,根据手术入路的不同分为MPLS组(n=40)、TU-LESS组(n=37)、vNOTES组(n=61),对比分析三组手术的临床应用效果。结果:三组患者均顺利完成手术,未中转其他手术方式。vNOTES组手术时间最短,术后首次肛门排气时间最短,术后0 h、24 h疼痛视觉模拟评分(visual analogue scale,VAS)最低,体象量表评分(body image scale,BIS)最低,美容评分(cosmetology score,CS)最高;三组间术后住院时间差异无统计学意义(P>0.05)。三组间术中出血量、住院总花费、术后住院时间、手术并发症和术后随访情况:阴道断端愈合情况、手术满意情况进行比较,差异均无统计学意义(P>0.05)。结论:vNOTES、TU-LESS、MPLS均可以顺利完成大子宫切除+输卵管±卵巢切除手术,与TU-LESS和MPLS相比,vNOTES在行大子宫切除术时具有手术时间短、术后胃肠道功能恢复快、术后疼痛轻、腹部无瘢痕的优势。

Objective To compare the clinical effects of transvaginal natural endoscopic surgery(vNOTES),transumbilical single-site laparoscopic surgery(TU-LESS)and traditional laparoscopic surgery(MPLS)in large hysterectomy.Methods A total of 138 patients with large uterus who underwent total uterine+salpinx±oophorectomy in The First Affiliated Hospital of Shandong First Medical University&Shandong Provincial Qianfoshan Hospital from Jan.2018 to Dec.2020 were selected and divided into MPLS group(n=40),TU-LESS group(n=37)and vNOTES group(n=61)according to different surgical approaches,and the clinical application effects of the three groups were compared and analyzed.Results All operations in the three groups were successfully completed without transferring to other surgical methods.vNOTES group had the shortest operation time,the shortest time of first postoperative anal exhaust,the lowest score of O h and 24 h VAS,the lowest score of BIS and the highest score of CS.There was no significant difference in postoperative hospital stay among the three groups(P>0.05).There were no significant differences in the amount of intraoperative blood loss,total hospitalization cost,postoperative hospital stay,surgical complications and postoperative follow-up,the healing of the broken end of the vagina and the satisfaction of the operation among the three groups(P>0.05).ConclusionsS vNOTES,TU-LESS and MPLS can successfully complete large hysterectomy plus tubal±ovariectomy.Compared with TU-LESS and MPLS,vNOTES has the advantages of shorter operation time,faster recovery of gastrointestinal function after surgery,less postoperative pain,and no scar in the abdomen during large hysterectomy.