【摘要】 目的探讨经阴道自然腔道内镜手术(vNOTES)全子宫切除的可行性及安全性。方法收集2019年8月-2021年6月因良性疾病行全子宫切除术的患者98例,根据手术方式的不同分为两组,其中vNOTES组48例,传统腹腔镜组50例。回顾性分析患者的临床资料,对比分析两组患者的手术时间、术中出血量、术后排气时间、手术前后血红蛋白下降值、术后24和72 h疼痛视觉模拟评分(VAS)、术后72 h美容满意度评分,以及住院时间等,并对患者术后2个月的阴道断端愈合情况和美容满意度评分进行随访。结果 vNOTES组48例中,顺利完成手术47例,中转传统腹腔镜手术1例;传统腹腔镜组50例均顺利完成手术。所有患者术中和术后均未发生并发症,无输血病例,术后2个月复查阴道断端均愈合良好。两组患者术中出血、手术前后血红蛋白下降值、术后排气时间、住院时间等差别无统计学意义(P>0.05)。vNOTES组的手术时间为(117.9±10.0)min,传统腹腔镜组为(104.1±17.8)min,差别有统计学意义(P<0.05);vNOTES组术后24和72 h的VAS评分为(2.5±0.7)和(1.8±0.6)分,传统腹腔镜组为(3.9±1.0)和(1.9±0.5)分;vNOTES组术后3 d和2个月的美容满意度评分为(93.4±1.4)和(96.3±1.1)分,传统腹腔镜组为(92.9±1.4)和(94.5±1.2)分;两组比较,术后24 h VAS评分和术后2个月的美容满意度评分差别有统计学意义(P<0.05)。结论 vNOTES行全子宫切除安全、可行,相比传统腹腔镜手术,其术后疼痛减轻,远期美容满意度高,具有良好的应用推广前景。更多还原

【Abstract】 Objective To explore the feasibility and safety of vNOTES hysterectomy. Methods Ninety-eight patients who underwent total hysterectomy for benign diseases of the uterus and met the inclusion criteria from August 2019 to June 2021 were included in the author’s team. They were divided into two groups according to different surgical methods, vNOTES total hysterectomy(vNOTES group) 48 cases, 50 cases of traditional porous laparoscopic total hysterectomy(traditional porous laparoscopic group). Observe the operation time, intraoperative bleeding, postoperative exhaust time, hemoglobin decline before and after the operation, visual analogue scale(VAS) for pain at 24 hours and 72 hours after operation, 72 hours postoperative beauty satisfaction score, hospitalization days, etc. And followed up 2 months after the operation of the patient’s stump healing, patient satisfaction with cosmetics, etc. Results Of the 48 cases in the vNOTES group, 47 cases successfully completed the operation, and 1 case was transferred to traditional laparoscopic surgery. In the traditional laparoscopic group, the operation was successfully completed without changing the surgical approach. All patients had no intraoperative or postoperative complications, no blood transfusion cases, and reexamination of the vaginal stump healed well 2 months after the operation. There was no significant difference in average intraoperative blood loss, hemoglobin decline before and after the operation, postoperative exhaust time and the hospital stay between the two groups of patients(P>0.05). The operation time was(117.9±10.0) min in the vNOTES group and(104.1±17.8) min in the traditional laparoscopic group, and the difference was statistically significant(P<0.05); VAS scores at 24 hours and 72 hours after surgery were(2.5±0.7) points and(1.8±0.6) points in the vNOTES group, and(3.9±1.0) and(1.9±0.5) points in the traditional laparoscopic group, and 3 days after surgery and The two-month cosmetic satisfaction score vNOTES group was(93.4±1.4) points,(96.3±1.1) points, and the traditional laparoscopy group was(92.9±1.4),(94.5±1.2) points. The observation indexes of the two groups were compared respectively. There was a statistically significant difference in the 24-hour VAS score and the beauty satisfaction score 2 months after the operation(P<0.05). Conclusion vNOTES total hysterectomy is a safe and feasible method; Compared with traditional laparoscopic surgery, vNOTES has advantages in reducing early postoperative pain and higher long-term cosmetic satisfaction; and it has a good application and promotion prospect.更多还原