探讨经阴道自然腔道内镜手术(natural orifice transluminal endoscopic surgery，NOTES)全子宫切除＋双侧附件(或输卵管)切除的可行性和安全性。

2017年5月至12月在北京协和医院因良性子宫疾病、子宫内膜不典型增生或子宫颈上皮内瘤变拟行腹腔镜全子宫切除术＋双侧附件(或输卵管)切除术遴选入组进行经阴道NOTES。

12例经阴道NOTES均成功完成，无一例中转传统多孔腹腔镜手术或开腹手术，患者年龄(49.17 ± 4.28)岁，平均产次1.5次，平均体质量指数23.9 kg/m²，手术时间(98.92 ± 13.39)min，术中出血量(53.75 ± 21.33)ml；子宫重量55～195 g，平均(105.83 ± 39.19)g；术前血红蛋白(119 ± 13.2)g/L与术后血红蛋白(118 ± 12.7)g/L相比，无明显变化。术中及术后均无并发症发生。术后住院时间(2.5 ± 0.52)d，术后胃肠道功能恢复时间(9.42 ± 2.81)h，术后视觉模拟评分法评分(3.00 ± 0.74)分，术后随诊时间(4.17 ± 2.04)个月，所有患者的阴道残端切口愈合良好，无瘢痕形成。

经阴道NOTES全子宫切除＋双侧附件(或双侧输卵管)切除是一种安全、可行的方法，手术效果与传统腹腔镜手术及单孔腹腔镜手术相当，且手术无切口瘢痕，在美容效果及术后康复方面与前两者相比具有一定优势。

To evaluate the feasibility and safety of performing hysterectomy via the transvaginal natural orifice transluminal endoscopic surgery (NOTES).

From May through Dec. 2017, 12 patients with benign uterine diseases or endometrial atypical hyperplasia or cervical intraepithelial neoplasia who were eligible for laparoscopic hysterectomy were recruited to undergo transvaginal NOTES in Peking Union Medical College Hospital. The intraoperative and postoperative data were recorded and analyzed.

All of the 12 cases of hysterectomy and bilateral adnexectomy ( or bilateral salpingectomy) were succeed and performed completely under NOTES without any complications. The average age of 12 patients was (49.17 ± 4.28)year, the average para was 1.5, and the average BMI was 23.9 kg/m². The mean of the operation time was(98.92 ± 13.39)minutes. The mean blood loss during the NOTES operation was(53.75 ± 21.33)ml. And the average weight of uterine was(105.83 ± 39.19)g, 55-195 g. There was no significant difference in mean hemoglobin level between preoperative and postoperative(119 ± 13.2)g/L in preoperative and(118 ± 12.7)g/L in postoperative). There is no complications in all 12 cases. The average hospitalization time of 12 cases was (2.5 ± 0.52)days. Mean postoperative recovery of gastrointestinal exhaust was (9.42 ± 2.81) hours. And the Vasual analog scoring were (3.00 ± 0.74). After follow-up for(4.17 ± 2.04)months, all the patients′vaginal stump healed well without scar formation.

Hysterectomy and bilateral adnexectomy (or bilateral salpingectomy) via the transvaginal natural orifice transluminal endoscopic surgery (NOTES) is a safe and feasible surgical procedure. The effects of hysterectomy and bilateral adnexectomy (or bilateral salpingectomy) via NOTES are comparable to those of traditional laparotomy or laparascopic surgery. Because there is no scar on the abdomen and VAS was much lower, so hysterectomy via NOTES has an advantage in cosmetic results and rapid postoperative recovery.