经阴道自然腔道内镜手术在妇科良性疾病治疗中的应用

The transvaginal-natural orifice transluminal endoscopic surgery in the treatment of benign gynecological diseases

目的研究经阴道自然腔道内镜手术(transvaginal-natural orifice transluminal endoscopic surgery,vNOTES)在妇科良性疾病手术治疗中的可行性、安全性及优势。方法回顾分析2019年9月至2022年2月于云南省第一人民医院生殖妇科住院患者病例资料,其中全子宫切除vNOTES组34例,单孔腹腔镜组、传统腹腔镜组各40例;子宫肌瘤剥除vNOTES组23例,单孔腹腔镜组、传统腹腔镜组各30例;卵巢囊肿剥除vNOTES组25例,单孔腹腔镜组、传统腹腔镜组各30例。统计分析纳入患者一般资料、手术时间、术中出血量、手术前后血红蛋白差值、术后住院时间(不包括手术当天)、术后引流天数、术后肛门排气时间、术后首次下床活动时间、术后12 h和24 h疼痛视觉模拟评分(visual analogue scale,VAS)、术后体温峰值、住院费用、术中或术后是否出现并发症。结果比较3种不同途径行全子宫切除术、子宫肌瘤剥除术、卵巢囊肿剥除术患者的一般资料,其中卵巢囊肿剥除术患者的年龄差异有统计学意义(P<0.05)。经3种不同途径行全子宫切除术和子宫肌瘤剥除术的手术时间差异有统计学意义(P<0.05);经3种不同途径行全子宫切除术、子宫肌瘤剥除术、卵巢囊肿除术,患者术中出血量比较差异均无统计学意义(P>0.05)。经3种不同途径行全子宫切除、子宫肌瘤剥除、卵巢囊肿剥除,手术前后血红蛋白差值、术后住院时间、术后引流时间、术后体温峰值、术后12 h、24 hVAS评分及住院费用差异无统计学意义(P>0.05);经3种不同途径行全子宫切除术、卵巢囊肿剥除术患者术后肛门排气时间、首次下床时间差异有统计学意义(P<0.05)。所有纳入患者均顺利完成手术、未更改手术途径,未出现术中、术后并发症,无术中出血需输血治疗病例及其他脏器损伤,术后病理均为良性,术后复查均愈合良好。结论vNOTES的手术效果与单孔腹腔镜手术及传统腹腔镜手术相当,在妇科良性疾病的手术治疗中是安全、可行的。尽管vNOTES手术耗时长,但具有无瘢痕、快速康复的优势。

Objective To compare the feasibility,safety and advantages of transvaginal-natural orifice transluminal endoscopic surgery(vNOTES)in the surgical treatment of benign gynecological diseases.Methods From Sep.2019 to Feb.2022,the clinical data of patients admitted to the First People′s Hospital of Yunnan Province who underwent vNOTES,trans-umbilical single-port laparoscopic surgery and traditional laparoscopic surgery,including total hysterectomy,hysteromyoma stripping and ovarian cyst stripping,were retrospectively analyzed.Total hysterectomy was performed in 34 cases by vNOTES,40 cases by trans-umbilical single-port laparoscopy and 40 cases by conventional laparoscopy.vNOTES hysteromyoma stripping were performed in 23 cases,trans-umbilical single-port laparoscopy and traditional laparoscopy in 30 cases respectively.There were 25 cases of vNOTES ovarian cyst exfoliation,30 cases in trans-umbilical single-port laparoscopy and 30 cases in conventional laparoscopy.The clinical data were compared,including general information,operative time,intraoperative blood loss,hemoglobin difference before and after surgery,postoperative hospital stay(excluding the day of surgery),postoperative drainage days,postoperative anal exhaust time,postoperative first ambulation time,visual analogue scale(VAS)for pain 12 and 24 h after surgery,postoperative peak temperature,hospitalization costs,and intraoperative or postoperative complications.Results Among patients undergoing ovarian cyst exfoliation by three different methods,age difference was statistically significant(P<0.05).There was statistically significant difference in operation time in total hysterectomy and hysteromyoma stripping using three different methods(P<0.05).As for the blood loss,no statistically significant difference was found(P>0.05).There were no significant differences in hemoglobin difference before and after surgery,postoperative hospital stay,postoperative drainage time,postoperative peak temperature,VAS score at 12 and 24 hours after operation and hospitalization costs among patients undergoing total hysterectomy,hysteromyoma stripping and ovarian cyst stripping by three different approaches(P>0.05).But the differences in postoperative anal exhaust time,postoperative first ambulation time were statistically significant(P<0.05).All included patients had successfully completed surgery,no intraoperative or postoperative complications,no blood transfusion or other organ injuries.All of the patients had benign gynecological diseases and healed well.Conclusion The surgical effect of vNOTES is comparable to that of single-port laparoscopic surgery and traditional laparoscopic surgery,and vNOTES is safe and feasible in the surgical treatment of benign gynecological diseases.Although VNOTE takes a long operation time,but it has the advantage of scar free and rapid recovery.