经阴道和经脐单孔腹腔镜下附件良性疾病手术后生殖道炎症发生的临床分析  

Clinical analysis of the occurrence of reproductive tract inflammation after laparoscopic surgery for benign adnexal diseases through vagina and umbilicus.

作　　者：李燕 黄璐 侯倩男 张强 冯丹 辜定纤 龚照林 何丽 Li Yan;Huang Lu;Hou Qiannan(Chengdu Women's and Children's Central Hospital,School of Medicine,University of Electronic Science and Technology,Chengdu 610000)

机构地区：[1]电子科技大学医学院附属妇女儿童医院成都市妇女儿童中心医院,成都610000

出　　处：《现代妇产科进展》2023年第11期821-824,共4页Progress in Obstetrics and Gynecology

摘　　要：目的:通过比较应用经阴道自然腔道内镜手术(vNOTES)和经脐单孔腹腔镜手术(TU-LESS)治疗附件良性疾病患者术后1月生殖道炎症的发生及术后伤口感染情况,了解vNOTES路径对女性生殖道炎症发生的影响。方法:回顾分析2020年6月至2022年6月在成都市妇女儿童中心医院行附件良性疾病手术的580例患者的临床资料,根据手术路径不同分为vNOTES组(270例)及TU-LESS组(310例),比较两组的一般资料、手术持续时间、术中出血量、术后伤口感染、急性盆腔炎及阴道炎包括清洁度Ⅲ~Ⅳ度、pH值升高、细菌性阴道炎、霉菌性阴道炎、滴虫性阴道炎等情况。结果:两组患者的年龄、体质量指数(BMI)、病变部位(输卵管、卵巢)比较,差异均无统计学意义(P>0.05)。两组的手术持续时间、术中出血量、术后发生急性盆腔炎、切口感染比较,差异无统计学意义(P>0.05)。两组术后白带清洁度Ⅲ~Ⅳ度、pH值升高、细菌性阴道炎、霉菌性阴道炎发生比较,差异均有统计学意义(P<0.05),两组术后滴虫性阴道炎发生率均较低,差异无统计学意义(P>0.05)。结论:vNOTES术后发生阴道菌群失调、阴道炎的风险升高,但并不增加术后伤口感染、急性盆腔炎的发生,可能与专用的vNOTES端口使用、阴道自身防御体系、vNOTES术前的阴道消毒、围手术期预防性应用抗生素等有关。Objective:To compare the incidence of genital tract inflammation and postoperative wound infection in patients with benign adnexal disease treated with transvaginal natural orifice transluminal endoscopic surgery(vNOTES)and transumbilical laparoendoscopic single-site surgery(TU-LESS)one month after surgery,and to explore whether vNOTES pathway had an impact on the occurrence of female genital tract inflammation.Methods:The case data of 580 patients who underwent surgery for benign adnexal diseases in Chengdu Women's and Children's central hospital from June 2020 to June 2022 were retrospectively analyzed.According to the different surgical paths,270 cases were divided into vNOTES group and 310 cases were divided into TU-LESS group.The general data,operation duration,intraoperative blood loss,postoperative wound infection,acute pelvic inflammatory disease and vaginitis,including cleanlinessⅢ~Ⅳ,elevated vaginal pH,bacterial vaginitis,mycotic vaginitis,trichomonas vaginitis,etc were compared between the two groups.Results:There was no significant difference in age,body mass index(BMI)and lesion location(fallopian tube and ovary)between the two groups(P>0.05).There was no significant difference in operation duration,intraoperative blood loss,postoperative acute pelvic inflammatory disease and incision infection between the two groups(P>0.05).There were statistically significant differences between the two groups in the occurrence of postoperative leucorrhea cleanlinessⅢ~Ⅳ,elevated vaginal pH,bacterial vaginitis,and fungal vaginitis(P<0.05).The incidence of postoperative trichomonas vaginitis was low,and there was no statistically significant difference between the two groups(P>0.05).Conclusion:The risk of vaginal flora imbalance and vaginitis increased after vNOTES,but it did not increase the incidence of postoperative wound infection and acute pelvic inflammatory disease,which may be related to the use of dedicated vNOTES port,vaginal self-defense system,vaginal disinfection before vNOTES,perioperative proph

关 键 词：经阴道 单孔腹腔镜 vNOTES 阴道微环境 阴道炎 LESS 

分 类 号：R713[医药卫生—妇产科学]