经阴道自然腔道内镜手术在女性泌尿外科疾病治疗中的应用  

Transvaginal natural orifice transluminal endoscopic surgery in female urologic diseases

作　　者：刘全亮[1] 张国玺[1] 邹晓峰[1] 袁源湖[1] 肖日海[1] 伍耿青[1] 王晓宁[1] 吴玉婷[1] 龙大治[1] 徐辉[1] 刘佛林[1] 杨军[1] 廖云峰[1] 谢天朋[1] 

机构地区：[1]赣南医学院第一附属医院泌尿外科江西省结石防治工程技术研究中心,赣州341000

出　　处：《中华泌尿外科杂志》2017年第10期760-765,共6页Chinese Journal of Urology

基　　金：国家高技术研发计划（863计划）项目（2012AA021100）;江西省“赣鄱英才555工程”领军人才培养计划项目;江西省科技厅重大科技支撑计划项目（20121BBG70032、20132BAB205007）;江西省科技厅科技计划项目（20151BBG70070）

摘　　要：目的 总结经阴道自然腔道内镜手术（natural orifice transluminal endoscopic surgery,NOTES）治疗女性泌尿外科疾病的经验与体会,并评价其临床价值.方法 回顾性分析2010年5月至2017年4月收治的289例行经阴道NOTES患者的临床资料.年龄23～ 76岁,平均39.4岁;体重指数15.4 ～32.6 kg/m2,平均21.8 kg/m2.术前诊断肾上腺肿瘤31例,肾肿瘤46例,上尿路结石致重度肾积水、无功能肾或肾积脓188例,肾囊肿5例,重复肾畸形4例,肾结核7例,肾盂、输尿管肿瘤8例.左侧146例,右侧142例,双侧1例（肾囊肿）.289例分别施行经阴道混合NOTES或经阴道纯NOTES手术,标本均经阴道切口取出.结果 本组术中除6例中转开放手术、2例中转耻骨上辅助经脐单孔腹腔镜手术外,其余281例经阴道NOTES手术均顺利完成.262例行经阴道混合NOTES,其中肾上腺切除术31例,单纯性肾切除术174例,根治性肾切除术32例,肾部分切除术13例,重复肾切除术4例,上尿路全切术8例;平均手术时间为105 min（45 ～310 min）,术中平均出血量为87 ml（20 ～800 ml）,术后平均住院时间为7.3 d（4～13 d）.27例行经阴道纯NOTES,其中肾囊肿去顶术5例,单纯性肾切除术21例,根治性肾切除术1例;平均手术时间为170 min（60～320 min）,术中平均出血量140 ml（20～500 ml）,术后平均住院时间为5.5 d（3～10d）.术中、术后56例（19.38％）出现并发症,其中严重并发症20例（6.92％）,分别为术中17例（10例血管损伤和7例邻近脏器损伤）和术后3例（继发出血、动脉血栓形成、集合系统漏尿各1例）.无术中及术后死亡病例.术后48 h视觉模拟疼痛评分平均为2.4分（1～4分）.215例术后获随访,随访时间3～86个月,平均51个月.215例患者阴道后穹窿切口均“Ⅱ/甲”愈合,肿瘤患者无复发及转移,无腹腔、盆腔感染及切口疝形成;行经阴道混合NOTES者脐部瘢痕不明显,术后3个月患者瘢痕评估问卷评分平均Objective To describe our experience with the transvaginal natural orifice transluminal endoscopic surgery （NOTES） in female patients,and to evaluate its clinical value.Methods Between May 2010 and April 2017,a total of 289 female patients underwent transvaginal NOTES in our center,including 31cases of adrenal tumors,46 cases of renal tumors,188 cases of non-functional kidneys,5 cases of renal cysts,4 cases of duplex kidney,7 cases of renal tuberculosis and 8 cases of renal pelvis tumors.Among them,146 cases were on the left side,142 cases on the right side,and 1 case on both sides （renal cysts）.The median age was 39.4 （range 23 to 76） years,and the median body mass index was 21.8（range 15.4 to 32.6） kg/m2.After general anesthesia,the patients were positioned in lithotomy with ipsilateral lumbar at 30＆#176;-60＆#176; angle to the floor.Hybrid and pure transvaginal NOTES were performed.The specimen was removed through an extended incision at the posterior vaginal fornix.Results Transvaginal NOTES was successfully completed in 281 patients.Two patients required conversion to suprapubic-assisted laparoendoscopic single-site surgery because of the rectal injury in pure transvaginal NOTES nephrectomy.Six patients underwent open conversion.The various transvaginal hybrid NOTES procedures included adrenalectomy （31 cases）,nephrectomy （206 cases;simple 174 cases,radical 32 cases）,partial nephrectomy （13 cases）,heminephroureterctomy for duplex kidney （4 cases） and hybrid endoscopy for nephroureterectomy （7 cases）.The mean operative time was 105 min （45-310 min）,the mean estimated blood loss was 87 ml （20-800 ml）,the mean visual analogue score （VAS） of 48 hours after operation was 2.5 （1-4） points and the mean hospitalization was 7.3 d （4-13 d） for transvaginal hybrid NOTES.The various pure transvaginal NOTES procedures included nephrectomy （22 cases;simple 21,radical 1）,renal cyst excision （5 cases）.The mean operative time was 170 min （60-320 min）,the

关 键 词：经自然腔道内镜手术 经阴道途径 女性 泌尿系统疾病 

分 类 号：R699.7[医药卫生—泌尿科学]