后入路法经阴道单孔腹腔镜输卵管妊娠手术二例反思  

Reflection on Two Cases of Transvaginal Single Porosity Laparoscopic Tubal Pregnancy by Rear Approach

作　　者：顾建娟 吴静怡 孙桂芳 GU Jian-juan;WU Jing-yi;SUN Gui-fang(Department of Obstetrics and Gynecology,Northern Jiangsu People′s Hospital,Yangzhou 225001,Jiangsu Province,China)

机构地区：[1]苏北人民医院妇产科,江苏省扬州市225001

出　　处：《国际妇产科学杂志》2022年第5期590-593,共4页Journal of International Obstetrics and Gynecology

摘　　要：经阴道自然腔道内镜手术(vaginal natural orifice transluminal endoscopic surgery,v-NOTES)将阴式手术与腹腔镜手术相结合,通常以阴道穹窿作为路径进入腹腔。分析2例输卵管异位妊娠患者行v-NOTES的诊治经过:病例1未婚未育,v-NOTES术中未发现具体病灶部位,选择甲氨蝶呤保守治疗,术后血人绒毛膜促性腺激素β亚单位(β-hCG)持续升高,附件包块增大,后行经脐单孔腹腔镜手术(transumbilical laparo-endoscopic single-site surgery,TU-LESS)发现病灶并切除患侧输卵管;病例2打开后穹窿时发现有盆腔粘连,入路进入困难,切除患侧输卵管后考虑盆腔粘连可能导致妊娠物残留另行TU-LESS。通过2例手术发现,与传统腹腔镜手术相比,v-NOTES存在手术视野局限,影响病灶判定,手术时间相对延长,在异位妊娠治疗中有一定局限性。Vaginal natural orifice transluminal endoscopic surgery combines vaginal surgery with laparoscopic surgery,and usually takes the vaginal vault as the path to enter the abdominal cavity.We analyze two cases who diagnosed with ectopic pregnancy and treated by v-NOTES.One of the patients was unmarried and childless,no specific lesion site was found during v-NOTES,and MTX was selected for conservative medication.Postoperative serumβ-hCG continued to rise,and the adnexal mass increased,thereupon transumbilical laparo-endoscopic single-site surgery(TU-LESS)was performed to remove fallopian tube.Another patient was found pelvic adhesions when the posterior fornix was opened,and it was difficult to enter.After resection of the fallopian tube,considering that pelvic adhesions may lead to residual pregnancy products,TU-LESS was required.Through two cases of operation,v-NOTES was found to be more limited operation field of vision than traditional laparoscopic surgery,which not only affects the determination of lesions,but also leads to a relatively prolonged operation time,and has certain limitations in the treatment of ectopic pregnancy.

关 键 词：妊娠 异位 妊娠 输卵管 腹腔镜检查 脐 阴道 

分 类 号：R713.8[医药卫生—妇产科学]