经阴道单孔腹腔镜手术在输卵管妊娠中的应用分析  

Analysis of the application of transvaginal natural orifice transluminal endoscopic surgery in tubal pregnancy

作　　者：高雪晓 脱勋元[2] 闫瑾博文 孟庆伟[1] 吕秋波[1] 魏风华[1] 周丹[1] GAO Xuexiao;TUO Xunyuan;YAN Jinbowen;MENG Qingwei;LV Qiubo;WEI Fenghua;ZHOU Dan(Department of Gynecology and Obstetrics,Beijing Hospital,National Center of Gerontology,Institute of Geriatrics,Chinese Academy of Medical Sciences,Beijing 100730,China;Maternal and Child Health Hospital of Gansu Province,Gansu Provincial Central Hospital,Lanzhou 730050,China)

机构地区：[1]北京医院国家老年医学中心中国医学科学院老年医学研究院妇产科,北京100730 [2]甘肃省妇幼保健院甘肃省中心医院,甘肃兰州730050

出　　处：《中国临床医生杂志》2022年第8期928-931,共4页Chinese Journal For Clinicians

基　　金：北京市科委“首都临床诊疗技术研究及示范应用项目”(Z191100006619018);甘肃省自然科学基金(甘科计[2021]11号,21JR1RA041)。

摘　　要：目的评价经阴道单孔腹腔镜手术(transvaginal single port natural orifice transluminal endoscopic surgery,vNOTES)在输卵管异位妊娠治疗中的可行性、有效性及安全性。方法回顾性分析2018年1月至2021年8月因输卵管妊娠于北京医院行患侧输卵管切除或输卵管开窗术患者的病历资料,根据手术方式分为vNOTES组(26例)和传统腹腔镜组(29例)。记录患者年龄、体重指数、孕次、产次及妊娠物B超最大径线。通过对比vNOTES与传统腹腔镜组的手术成功率、手术时间、术中出血量、术后排气时间、术后24h视觉模拟评分法(visual analogue scale,VAS)、术后并发症情况及术后3个月瘢痕评分等指标,评价经阴道单孔腹腔镜输卵管妊娠手术的安全性及可行性。结果vNOTES组均顺利完成手术,无中转传统腹腔镜或开腹手术,术后随访无并发症发生。vNOTES组和传统腹腔镜组的手术时间和术中出血量比较,差异无显著性(P>0.05);vNOTES组术后排气时间和术后24h VAS评分显著低于传统腹腔镜组,差异有显著性(P均=0.000)。术后3个月门诊复查,vNOTES组瘢痕评分[(1.15±0.56)分]显著低于传统腹腔镜组[(4.54±0.76)分],差异有显著性(t=-3.987,P=0.000)。结论经阴道单孔腹腔镜可安全有效地完成输卵管妊娠保守性输卵管开窗及输卵管切除术,经阴道单孔手术创伤小且术后无痕效果好,更有利于患者术后的康复。Objective To evaluate the feasibility,efficacy and safety of transvaginal natural orifice transluminal endoscopic surgery(vNOTES)in the treatment of tubal pregnancy.Method The medical records of patients who underwent ipsilateral salpingectomy or salpingostomy due to tubal pregnancy in Beijing Hospital from January 2018 to August 2021 were retrospectively analyzed,and they were divided into vNOTES group(26 cases)and conventional laparoscopic surgery group(29 cases)according to the operation method.The patient’s age,body mass index,gravida,parity and ultrasound maximum diameter of pregnancy mass were recorded.By comparing the success rate of operation,operation time,blood loss,the first time of flatus,the visual analogue score(VAS)of pain 24 hours after surgery,operative complications,and the scar scores at 3 months after surgery,the feasibility and safety of vNOTES for tubal pregnancy were evaluated.Result The operations in the vNOTES group were successfully completed without conversion to conventional laparoscopy or laparotomy.And no complications occurred during postoperative follow-up.There was no significant difference in the operation time and blood loss between the vNOTES group and the conventional laparoscopic surgery group(P>0.05).The postoperative exhaust time and 24h VAS score in the vNOTES group were significantly lower than those in the conventional laparoscopic surgery group,and the difference was significant(P=0.000).In the outpatient re-examination 3 months after operation,the scar score in the vNOTES group[(1.15±0.56)points]was significantly lower than that in the conventional laparoscopic surgery group[(4.54±0.76)points],and the difference was significant(t=-3.987,P=0.000).Conclusion Transvaginal laparoscopy can safely and effectively complete conservative tubal fenestration and salpingectomy for tubal pregnancy.In addition,the transvaginal surgical approach is more conducive to postoperative rehabilitation of patients,with less trauma and better traceless effect.

关 键 词：经阴道单孔腹腔镜手术 输卵管妊娠 输卵管开窗术 输卵管切除术 

分 类 号：R714.22[医药卫生—妇产科学]