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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): 24 -27. doi: 10.3877/cma.j.issn.1674-6899.2018.01.007

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卵巢囊肿剥除术十例临床分析
朱一萍 1, 赵栋 1, 隋孟松 1, 吉梅 1, 张彦丽 1, 关小明 2, 敬毅 3, 孙静 1 , †( )   
  1. 1. 201204 上海市第一妇婴保健院妇科
    2. 77030 休斯顿贝勒医学院妇科
    3. 610041 成都医学院附属不孕不育医院生殖科
  • 收稿日期:2017-12-25 出版日期:2018-02-28
  • 通信作者: 孙静
  • 基金资助:
    上海市自然科学基金项目(17ZR1421900)

Clinical analysis of 10 cases of ovarian cystectomy via transvaginal natural orifice transluminal endoscopic surgery

Yiping Zhu 1, Dong Zhao 1, Mengsong Sui 1, Mei Ji 1, Yanli Zhang 1, Xiaoming Guan 2, Yi Jing 3, Jing Sun 1 , †( )   

  1. 1. Shanghai First Maternity and Infant Health Hospital, Department of Gynecology, Shanghai 201204, China
    2. Baylor College of Medicine, Minimally Invasive Gynecology Surgery, Houston 77030, China
    3. Chengdu Medical College Affiliated Infertility Hospital, Department of Reproduction, Chengdu 610041, China
  • Received:2017-12-25 Published:2018-02-28
  • Corresponding author: Jing Sun
  • About author:
    Corresponding author: Sun Jing, Email:
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目的

评估经阴道自然腔道内镜(natural orifice transluminal endoscopic surgery，NOTES)卵巢囊肿剥除术的可行性、安全性及术后恢复情况。

方法

回顾分析2017年9－12月在上海市第一妇婴保健院妇科行NOTES卵巢囊肿剥除术患者10例，所有患者取阴道后穹窿入路2.5 cm切口，置入硅胶密封圈后，装上Port，建立气腹后用传统腹腔镜行患侧卵巢囊肿剥除术。统计卵巢囊肿大小、手术时间、术前与术后血色素差值、术中出血量、术后24 h视觉模拟疼痛评分(visual analog scale，VAS)及术后恢复排气时间。

结果

其中1例患者因双侧卵巢成熟性囊性畸胎瘤合并多囊卵巢综合征，由于卵巢门出血略活跃、缝合困难影响手术进展，中转为传统腹腔镜手术之外，其他患者均经阴道腹腔镜完成，手术均无并发症、无输血。9例患者的平均手术时间78.3 min，术前与术后血色素的平均差值18.3 g/L，平均术中出血量23.3 ml，术后24 h VAS平均0.55分，术后平均恢复排气时间17.5 h，平均住院时间4.7 d。

结论

NOTES卵巢囊肿剥除术后患者的切口疼痛感较轻，具有术后恢复快、腹部无瘢痕、美观的优势，合适的病例选择加上灵活的手术技巧，NOTES卵巢良性囊肿剥除是安全可行的。

关键词: 经阴道, 自然腔道内镜, 卵巢囊肿剥除术
Objective

To evaluate the feasibility, safety and postopterative outcomes of transvaginal natural orifice transluminal endoscopic surgery(NOTES) ovarian cystectomy.

Methods

10 patients underwent NOTES ovarian cystectomy between Sept. to Dec.2017 in Shanghai First Maternity and Infant Health Hospital, were retrospectively analyzed. A 2.5 cm colpotomy was made and a port was inserted into the pouch of vagina. A pneumoperitoneum was created and the conventional laparoscopy ovarian cystectomy steps were followed. The perioperative data were analyzed as follows: the size of ovarian cyst, the operation time, the drop in the hemoglobin , the blood loss, the postoperative visual analog scale(VAS) pain score, the time for postoperative bowel movement , the length of the hospitalization.

Results

One patient with bilateral ovarian teratoma and polycystic ovary syndrome was converted to traditional laparoscopy surgery due to difficult stitching because of active hemorrhage. There were no noticeable complications during or after operation. The other 9 cases were accomplished. The mean operation time was 78.3 min.The mean drop of hemoglobin level was 18.3 g/L. The mean blood loss was 23.3 ml.The mean vas score was 0.55 at 24 h after operation. The mean time for postoperative bowel movement was 17.5 hours. The mean length of hospitalization was 4.7 days.

Conclusions

The patients feeled mild pain after NOTES , and the procedure resulted in cosmetic advantages. With appropriate case selection and adroit surgical technique, the NOTES ovarian cystectomy seems to be a safe and feasible approach.

Key words: Transvaginal, Natural orifice transluminal endoscopic surgery, Ovarian cystectomy
表1 10例经阴道自然腔道内镜卵巢囊肿剥除术患者的一般资料和围术期相关数据
项目 平均值 范围
年龄(岁) 35.3 27～50
体质量指数(kg/m2) 20.9 19.9～22.1
产次(次) 1 0～2
手术时间(min) 78.3 70～110
囊肿直径(cm) 5.8 3～11
术中出血量(ml) 23.3 10～50
术前与术后血色素差值(g/L) 18.3 7～29
视觉模拟疼痛评分(分) 0.6 0～2
术后排气时间(h) 17.5 12～20
住院时间(d) 4.7 4～6
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