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中华腔镜外科杂志(电子版)

中华腔镜外科杂志(电子版) ›› 2018, Vol. 11 ›› Issue (01): 20 -23. doi: 10.3877/cma.j.issn.1674-6899.2018.01.006

所属专题： 经典病例； 文献资源库；

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经阴道自然腔道内镜手术在异位妊娠中的应用八例分析
刘海元 1, 陈欣 1, 孙大为 1 , †( ), 张俊吉 1, 冷金花 1, 朱兰 1, 刘珠凤 1, 樊庆泊 1, 史宏晖 1, 郎景和 1   
  1. 1. 100730 北京，中国医学科学院北京协和医院妇产科
  • 收稿日期:2017-11-02 出版日期:2018-02-28
  • 通信作者: 孙大为

Primary study on transvaginal natural orifice transluminal endoscopic surgery for ectopic pregnancy: a series of 8 cases

Haiyuan Liu 1, Xin Chen 1, Dawei Sun 1 , †( ), Junji Zhang 1, Jinhua Leng 1, Lan Zhu 1, Zhufeng Liu 1, Qingbo Fan 1, Honghui Shi 1, Jinghe Lang 1   

  1. 1. Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing 100730, China
  • Received:2017-11-02 Published:2018-02-28
  • Corresponding author: Dawei Sun
  • About author:
    Corresponding author: Sun Dawei, Email:
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目的

探索经自然腔道内镜手术(natural orifice transluminal endoscopic surgery，NOTES)在异位妊娠治疗中的可行性、安全性及有效性。

方法

中国医学科学院北京协和医院妇产科于2015年6月至2016年5月共完成8例经阴道NOTES异位妊娠患侧输卵管切除术。记录患者年龄、体质量指数、阴道分娩数、停经时间、血β－HCG(人绒毛膜促性腺激素)、肿物大小、子宫直肠窝积血、手术时间、术中出血量等指标。

结果

8例患者的手术均成功完成，无中转传统腹腔镜手术或开腹手术，无并发症发生。年龄(33 ± 4.8)岁，体质量指数(24.2 ± 1.8)kg/m2，阴道分娩(1.5 ± 0.8)次，停经时间(52.3 ± 4.9)d，术前血β－HCG(10 280 ± 7 948.6)U/ml，肿物大小(2.75 ± 0.5)cm，子宫直肠窝积血(105 ± 98.3)ml，手术时间(41.9 ± 3.7)min，术中出血量(8.4 ± 5.6)ml。术后随访血β－HCG水平下降理想，阴道伤口愈合良好。

结论

经阴道NOTES可安全、有效完成异位妊娠输卵管切除，但需要进一步前瞻性研究来评估其完整临床应用。

关键词: 经自然腔道内镜手术, 异位妊娠, 输卵管切除术
Objective

To analyze the feasibility, safety, and efficacy of natural orifice transluminal endoscopic surgery (NOTES)for ectopic pregnancy.

Methods

Between Jun. 2015 and May 2016, 8 patients diagnosed as ectopic pregnancy underwent transvaginal NOTES to remove fallopian tube in Peking Union Medical College Hospital.

Results

All 8 cases were successfully completed. No one was converted to laparotomy or conventional laparoscopy. No complications occurred during intraoperative and postoperative time. The average age of patients was (33±4.8)y, body mass index was (24.2±1.8)kg/m2, vaginal delivery history was (1.5±0.8)times, length of menopause was (52.3±4.9) days, serum β-HCG was (10 280±7 948.6)U/ml, diameter of adnexal mass was (2.75±0.5) cm, hemoperitoneum was (105±98.3)ml, operation time was (41.9±3.7)min, average blood loss during surgery was (8.4±5.6)ml. During the follow-up period, the serum β-HCG decreased as expected. Vaginal wound healed well.

Conclusions

Transvagnial NOTES is a feasible, safe, and effective management in the treatment of ectopic pregnancy. Further evaluation of NOTES in a prospective randomized trial is required.

Key words: Natural orifice transluminal endoscopic surgery, Ectopic pregnancy, Salpingectomy
图1 经阴道自然腔道内镜手术在异位妊娠中的应用
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