经阴道自然腔道单孔腹腔镜输卵管切除术的初期临床报告  

Preliminary clinical report of salpingectomy by transvaginal-natural orifice transluminal endoscopic surgery

作　　者：肖惠超 陈卫民 陈继明 钱潘连 秦真岳 魏炜炜 唐斌 郑虹 郑亚峰 蒋云芬 施如霞 XIAO Hui-chao;CHEN Wei-min;CHEN Ji-ming;QIAN Pan-lian;QIN Zhen yue;WEI Wei-wei;TANG Bin;ZHENG Hong;ZHENG Ya-feng;JIANG Yun-fen;SHI Ru-xia(Department of Obstetrics and Gynecology,the Affiliated Changzhou NO.2 People's Hospital of Nanjing Medical University,Changzhou 213000,China)

机构地区：[1]南京医科大学附属常州第二人民医院妇产科,常州213000 [2]浙江省桐乡市妇幼保健院妇产科

出　　处：《妇产与遗传（电子版）》2021年第2期26-30,共5页Obstetrics-Gynecology and Genetics (Electronic Edition)

基　　金：常州市卫生计生委重大科技项目(ZD201812);江苏省博士后科研资助计划(2019K064);江苏省“333工程”科研资助项目(BRA2019161)。

摘　　要：目的总结初期开展经阴道单孔腹腔镜(V-NOTES)输卵管切除术的临床经验,初步探讨该术式的安全性和可行性。方法回顾性分析2018年1月至2018年12月南京医科大学附属常州第二人民医院及浙江省桐乡市妇幼保健院开展的V-NOTES输卵管切除术患者的临床资料,并选择同期传统腹腔镜输卵管切除术患者作为对照。两组输卵管妊娠患者共18例,每组9例患者,分别应用V-NOTES输卵管切除术及传统腹腔镜输卵管切除术。统计分析患者一般情况、手术时间、术中出血量、术后肠道功能恢复时间、术后住院天数、疼痛评分(VAS)、美容评分。结果18例手术均成功完成,术中术后未发生并发症。两组间数据比较,术中出血量、术后住院天数差异无统计学意义(P>0.05)。V-NOTES组的疼痛评分低于传统腹腔镜组[(1.55±0.53)vs(4.22±0.44)],V-NOTES组美容评分高于传统腹腔镜组[(8.56±0.53)vs(5.11±0.78)],V-NOTES组术后肠道功能恢复时间短于传统腹腔镜组[(9.89±1.69)vs(14.56±1.94)],差异均有统计学意义(P<0.01),但传统腹腔镜组手术时间短于V-NOTES组(P<0.05),差异有统计学意义。术后随访所有患者均无明显不适自觉症状,大小便正常,阴道创面愈合良好。传统腹腔镜患者所有穿刺孔皮肤愈合良好。结论V-NOTES输卵管切除术可能安全可行。相比传统腹腔镜术式,V-NOTES在降低疼痛评分、美容评分及减少术后肠道功能恢复时间方面存在明显优势;而初期开展时期,V-NOTES手术时间略长于传统腹腔镜。Objective To summarize the preliminary clinical experience of salpingectomy by transvaginal-natural orifice transluminal endoscopic(V-NOTES)surgery,and to explore its safety and feasibility.Methods the clinical data of patients of fallopian tube pregnancy(n=9)underwent V-NOTES salpingectomy in the Affiliated Changzhou NO.2 People's Hospital of Nanjing Medical University and Tongxiang maternal and Child Health Hospital of Zhejiang Province from January 2018 to December 2018 were retrospectively analyzed,and the patients of fallopian tube pregnancy(n=9)underwent traditional laparoscopic salpingectomy in the same period were selected as the control group.There were 18 cases of fallopian tube pregnancy in the two groups,9 cases in each group.The general condition,operation time,intraoperative blood loss,postoperative intestinal function recovery time,postoperative hospital stay,pain score(VAS)and cosmetic score were statistically analyzed.Results All the 18 operations were successfully completed without any complications.There was no significant difference in intra-operative blood loss and postoperative hospital stay between the two groups(P>0.05).The pain score of the the V-NOTES group was lower than that in the traditional laparoscopic group[(1.55±0.53)vs(4.22±0.44)],the cosmetic score of the the V NOTES group was higher than that in the traditional laparoscopic group[(8.56±0.53)vs(5.11±0.78)],the postoperative intestinal function recovery time of intestinal function in the V-NOTES group was shorter than that in the traditional laparoscopic group[(9.89±1.69)vs(14.56±1.94)],and all the differences were statistically significant(all P<0.05).Through postoperative follow-up,all patients had no obvious discomfort and self-conscious symptoms,normal urination and defecation,and good vaginal wound healing.The skin of all puncture holes in traditional laparoscopic patients healed well.Conclusions V-NOTES salpingectomy may be safe and feasible.Compared with traditional laparoscopic surgery,V-NOTES has obvious advantage

关 键 词：经自然腔道内镜手术 经阴道途径 输卵管切除术 异位妊娠 

分 类 号：R713[医药卫生—妇产科学]