经阴道自然腔道内镜手术与经脐单孔腹腔镜手术在治疗肥胖患者子宫良性病变的效果比较  

AComparative efficacy of vNOTES and LESS in the management of benign uterine lesions in obese patients

作　　者：李文元 魏民[1] 韩婕 李瑞锋 王珍 李海兰 许静 靳冬梅[1] 徐凌燕[1] 彭容 张衍 孙新华 LI Wenyuan;WEI Min;HAN Jie;LI Ruifeng;WANG Zhen;LI Hailan;XU Jing;JIN Dongmei;XU Lingyan;PENG Rong;ZHANG Yan;SUN Xinhua(Department of Obstetrics and Gynecology,Qinghai Provincial People's Hospital,Xining 810000,Qinghai,China;不详)

机构地区：[1]青海省人民医院妇产科,青海西宁810000 [2]青海省红十字医院妇产科,青海西宁810000 [3]青海省妇幼保健院妇产科,青海西宁810000

出　　处：《实用医学杂志》2024年第22期3184-3189,共6页The Journal of Practical Medicine

基　　金：青海省卫生健康委员会指导性计划课题(编号:2023-wjzdx-16)。

摘　　要：目的通过比较肥胖患者子宫良性病变时经阴道自然腔道内镜手术(transvaginal natural orifice transluminal endoscopic surgery,vNOTES)与经脐单孔腹腔镜手术(laparoendoscopic single-site surgery,LESS)的全子宫切除术的效果,探讨vNOTES在肥胖患者子宫良性病变的应用价值。方法选取2022年1月至2023年1月妇科肥胖患者(BMI>28.0 kg/m^(2))因良性病变需行全子宫加双侧输卵管切除术100例,按照随机数字表法将患者分为LESS组51例、vNOTES组49例。比较患者一般资料、手术时间、术中出血量、血红蛋白变化情况、疼痛评分、术后首次肛门排气时间、住院时间、盆底功能情况、性生活质量及术后并发症等情况。结果2组患者在出血量、手术前后血红蛋白变化、盆底功能情况、性生活质量以及术后并发症方面差异无统计学意义(P>0.05)。而vNOTES组手术时间、肛门首次排气时间、住院时间均短于LESS组(P<0.05),同时vNOTES组术中疼痛评分小于LESS组(P<0.05)。结论在肥胖的子宫良性病变患者中vNOTES子宫切除术手术时间和术后住院时间更短,术后疼痛评分更低,更符合快速康复外科的理念,值得进一步推广。Objective To compare the outcomes of transvaginal natural orifice transluminal endoscopic surgery(vNOTES)and laparoendoscopic single-site surgery(LESS)for total uterine excision in obese patients with benign uterine lesions,and to investigate the utility of vNOTES in this patient population.Methods A total of 100 obese patients(BMI>28.0 kg/m^(2))diagnosed with benign uterine lesions requiring total uterine and bilateral salpingectomy between January 2022 and January 2023 were included in this study.They were randomly assigned to two groups:the LESS group(n=51)and the vNOTES group(n=49).Patient demographics,surgical duration,intraoperative blood loss,changes in hemoglobin levels,pain scores,time to first flatus postoperatively,length of hospital stay,pelvic floor function,sexual quality of life,and postoperative complications were compared between the two groups.Results The two groups did not show any statistically significant differences in terms of blood loss,pre-and postoperative hemoglobin changes,pelvic floor function,sexual quality of life,or postoperative complications(P>0.05).However,the vNOTES group exhibited shorter surgical durations,time to first flatus postoperatively,and length of hospital stay compared to the LESS group(P<0.05).Additionally,the vNOTES group demonstrated lower intraoperative pain scores than the LESS group.(P<0.05).Conclusions In obese patients with benign uterine lesions,vNOTES total uterine excision surgery demonstrated shorter surgical durations and postoperative hospital stays,lower postoperative pain scores,and better adherence to the principles of en-hanced recovery after surgery(ERAS),indicating its potential for broader application.

关 键 词：经阴道自然腔道内镜手术 经脐单孔腹腔镜手术 肥胖 子宫良性病变 

分 类 号：R713[医药卫生—妇产科学]