【摘要】 目的探讨经阴道自然腔道内镜手术(natural orifice transluminalendoscopic surgery,NOTES)腹膜外骶骨子宫固定术治疗子宫脱垂的可行性、安全性和短期临床结局。方法 2016年12月至2017年12月前瞻性纳入第三军医大学西南医院妇产科诊断为子宫脱垂的患者,行经阴道NOTES腹膜外骶骨子宫固定术。统计患者人口学特征、围手术期参数和临床疗效。结果 14例患者尝试手术,其中13例(93%)成功完成; 1例因术中腹膜破裂,无法维持腹膜外腔压力转为多孔腹腔镜手术。患者中位年龄49岁,体质量指数23. 6 kg/m2,中位手术时间156 min,中位术中出血量100 ml。1例骶前出血,于术中双极电凝成功止血。术前POP-Q评分为Aa:0分; Ba:1分; C:2分; Ap:-3分;Bp:-3分。术后平均随访10个月,POP-Q评分为Aa:-2分; Ba:-2分; C:-7分; Ap:-3分; Bp:-3分。相关症状消失或明显改善,无性生活不适及性交痛,无网片侵蚀、暴露、感染等并发症。客观治愈率100%。结论 NOTES可安全、有效地完成经阴道NOTES腹膜外骶骨子宫固定术,但需要进一步的进行临床研究,评估其完整的临床应用。更多还原

【Abstract】 Objective To describe the feasibility,safety,and outcomes of women with uterine prolapse treated with extraperitoneal sacral hysteropexy by natural orifice transluminalendoscopic surgery,NOTES. Methods Prospective descriptive study of patient with uterine prolapse that treated in Southwest Hospital from Dec. 2016 to Dec. 2017. NOTES as the primary therapy. Demographic data,perioperative outcomes and clinical efficacy were analyzed. Results 14 patients were identified in whom a NOTES was attempted,13( 93%) successfully underwent the procedure and 1 had converted to 3-port laparoscopy because of the rupture of the peritoneum. The median age of the patients was 49 years,the body mass index was 23. 6 kg/m2,the median operative time was 156 min,and the median operative blood loss was 100 ml.1 cases of presacral hemorrhage were successfully treated by bipolar coagulation. Preoperative POP-Q score was Aa: 0,Ba: 1,C: 2,Ap:-3,Bp:-3. The average follow-up period of 10 months after operation,POPQ score: Aa:-2,Ba:-2,C:-7,Ap:-3,Bp:-3. Related symptoms disappeared or obviously improved,no sexual discomfort,no erosion,exposure,infection and other complications. The rate of objective cure was100%. Conclusions NOTES is feasible,safe and effective in the treatment of uterine prolapse,but further clinical studies are needed to assess its complete clinical application.更多还原