老年女性经阴道单孔腹腔镜附件切除手术的安全性和疗效分析  

Analysis of the safety and efficacy of transvaginal natural orific transluminal endoscopic adnexectomy in elderly women

作　　者：周丹[1] 闫瑾博文 孟庆伟[1] 脱勋元[2] 吕秋波[1] Zhou Dan;Yan Jinbowen;Meng Qingwei;Tuo Xunyuan;Lyu Qiubo(Department of Obstetrics and Gynecology,Beijing Hospital,National Center for Geriatrics,Institute of Geriatrics,Chinese Academy of Medical Sciences,Beijing,100730,China;Department of Obstetrics and Gynecology,Gansu Provincial Central Hospital,Gansu Maternal and Child Health Hospital,Lanzhou 730050,China)

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

出　　处：《中华老年医学杂志》2022年第12期1508-1511,共4页Chinese Journal of Geriatrics

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(21JR1RA041)。

摘　　要：目的探讨经阴道自然腔道单孔腹腔镜(vNOTES)进行老年女性附件切除术的可行性和安全性。方法采用随机对照的研究方法,将北京医院妇科2019年1月至2021年12月收治的符合研究入选标准的卵巢良性肿瘤老年女性90例按1∶1随机分至vNOTES组和对照组(传统腹腔镜行附件除术)。比较两组患者术前基线情况、手术成功率、手术时间、术中出血量、术后并发症、术后24 h及1周内视觉模拟评分(VAS)、术后瘢痕评分、术后性功能评分等相关数据。结果90例患者手术顺利完成,未在术中转变术式,无术中、术后各类并发症的发生。vNOTES组和对照组术前一般情况、手术时间、术中出血量、健康状况评分及性功能评估差异无统计学意义(均P>0.05)。vNOTES组和对照组患者手术结束时机械通气气道峰压(21.9±1.8)cmH_(2)O(1 cmH_(2)O=0.098 kPa)比(29.7±2.6)cmH_(2)O、呼气末CO_(2)分压(36.6±1.4)mmHg(1 mmHg=0.133 kPa)比(39.9±2.0)mmHg、术后排气时间(8.8±1.7)h比(21.9±2.7)h、术后24 h内VAS疼痛评分(1.3±1.2分)比(4.6±2.8)分、术后1个月、3个月、6个月的瘢痕评分(1.7±1.1)分比(6.5±2.0)分、(0.4±0.3)分比(4.0±1.6)分、(0.0±0.0)分比(2.5±1.0)分,vNOTES组均低于对照组患者(均P<0.01);术后6个月健康情况评分vNOTES组(124.8±10.6)分,高于对照组(119.9±10.7)分(P<0.05)。结论对于老年女性vNOTES进行附件切除术是安全可行,具有对心肺功能影响小、疼痛轻、瘢痕小、身体恢复快等优势,是更加微创的手术方式,可作为老年女性良性卵巢肿瘤治疗的手术方式。Objective To investigate the feasibility and safety of transvaginal natural orific transluminal endoscopic surgery(vNOTES)in elderly women with adnexectomy.Methods Using a prospective randomized controlled study method,90 patients with benign ovarian tumors who met the study inclusion criteria and were treated in the Department of Gynecology of Beijing Hospital from January 2019 to December 2021 were randomly assigned to the experimental group(vNOTES group)according to 1∶1.The conventional laparoscopy group(CL group)and the control group underwent ovarian cystectomy.Preoperative baseline conditions,surgical success rate,operation time,intraoperative blood loss,postoperative complications,visual analogue scale(VAS)within 24 hours and one week after operation,postoperative scar score,and postoperative sexual function score were compared between the two groups.and other related data.Results The operation of 90 patients was successfully completed,and there was no intraoperative and postoperative complications.There were no significant differences in preoperative general condition,operation time,intraoperative blood loss,health status score and sexual function evaluation between the two groups(P>0.05).The peak airway pressure of mechanical ventilation(21.9±1.8)cmH_(2)O(1 cmH_(2)O=0.098 kPa),end-expiratory CO_(2) partial pressure(36.6±1.4)mmHg(1 mmHg=0.133 kPa),postoperative exhaust time(8.8±1.7)h,and VAS pain score within 24 hours after surgery(1.3±1.2 points)and scar scores at 1 month,3 months and 6 months after surgery(1.7±1.1、0.4±0.3、0.0±0.0)were all lower than the control group(29.7±2.6)cmH_(2)O;(39.9±2.0)mmHg;(21.9±2.7)h;4.6±2.8、6.5±2.0、4.0±1.6、2.5±1.0,(P<0.01).6 months after the operation,the health condition score of the experimental group(124.8±10.6)was higher than that of the TL group.(119.9±10.7)points(P<0.05).Conclusions For elderly women,transvaginal laparoscopic adnexectomy is safe and feasible,with unique advantages such as less impact on cardiopulmonary function,less pain,les

关 键 词：阴道 腹腔镜 卵巢肿瘤 

分 类 号：R713[医药卫生—妇产科学]