经阴道自然腔道内镜及传统腹腔镜手术治疗卵巢囊肿的临床对比分析

doi:10.3877/cma.j.issn.1674-6899.2019.02.006

目的

对比经阴道自然腔道内镜手术(transvaginal natural orifice transluminal endoscopic surgery, vNOTES)和传统腹腔镜下卵巢囊肿手术治疗的可行性及安全性。

方法

回顾性分析2017年11月至2018年4月，于四川大学华西第二医院同期进行手术治疗的18例卵巢囊肿患者的相关信息，按照手术途经分为vNOTES组及传统腹腔镜组，每组9例。统计并分析患者基线情况、手术相关数据。

结果

18例患者手术均顺利完成，均未改变手术方式，无围手术期并发症的发生。基线情况中的盆腹腔手术史部分，vNOTES组较传统腹腔镜组少，差异有统计学意义(P<0.05)。手术相关数据中vNOTES组与传统腹腔镜组的平均手术时间分别为115 min和108.89 min，术前与术后血红蛋白下降分别为16.22 g/L和16.33 g/L，住院时间分别为2.78 d和3.33 d，疼痛视觉模拟评分(visual analogue scale，VAS)分别为1.89分和2.78分，术后1周美容评分分别为22.67分和17.78分，组间差异均无统计学意义。但在术后4周、术后24周美容评分上vNOTES组满意度较高，vNOTES组与传统腹腔镜组分别为(23.44分vs 18.56分)和(23.89分vs 19.11分)，与传统腹腔镜组存在统计学差异(P<0.05)。

结论

vNOTES较传统腹腔镜手术治疗卵巢囊肿有着独到的美容优势，充分的病情评估及病例选择后vNOTES途经是安全可行的。

关键词: 经阴道, 内镜手术, 卵巢囊肿

Objective

To evaluate and compare the feasibility and safety via transvaginal natural orifice transluminal endoscopic surgery (vNOTES) and laparoscopy for ovarian cysts.

Methods

The present retrospective cases series included consecutive patients who underwent ovarian cysts surgery through vNOTES and laparoscopy access at West China Second Hospital of Sichuan University, between Nov. 2017 and Apr. 2018. There were 18 women, each group contain 9 patients. A statistical analysis for the data of patients and surgery situation was did.

Results

All the 18 surgeries were successfully performed, without convention, there were no noticeable complications during or after operation.For the part of surgery history, the vNOTES group showed less number compared with laparoscopic group(P<0.05). Compared the groups between vNOTES and laparoscopy surgery in terms of the mean operation time was 115 min vs 108.89 min, the mean drop of hemoglobin level was 16.22 g/L vs 16.33 g/L, the mean length of hospitalization was 2.78 d vs 3.33 d, the mean visual analogue scale (VAS) score was 1.89 vs 2.78 at 12 h after operation, the mean time for cosmetic scale (CS) score was 22.67 vs 17.78 for 1 week after surgery, and 23.44 vs 18.56 after 4 weeks, all of them did not show significant differences among the groups. But the vNOTES group showed higher CS score at 4 weeks(23.44 vs 18.56)and 24 weeks(23.89 vs 19.11)compared to the laparoscope (P<0.05).

Conclusions

Since vNOTES showed high patient satisfaction with the scarless result, after fully evaluated and selected, the vNOTES access approaches were feasible and safe compared to laparoscopic surgery for ovarian cystectomy.

Key words: Transvaginal, Endoscopic surgery, Ovarian cysts

图1 经阴道自然腔道内镜手术途经卵巢囊肿剥除手术

表1 vNOTES组与传统腹腔镜组患者的基线情况对比

组别	例数	年龄(岁，±s)	体质量指数(kg/m²，±s)	卵巢体积(cm³，±s)	既往盆腹腔手术史(例)
vNOTES组	9	40±13.32	21.23±1.67	63.56±33.02	1
传统腹腔镜组	9	34±7.81	22.23±3.25	73.9±44.03	5
t值	?	0.27	0.43	0.43	0.04
P值	?	0.09	0.14	0.39	0.04

表1 vNOTES组与传统腹腔镜组患者的基线情况对比

组别	例数	年龄(岁，±s)	体质量指数(kg/m²，±s)	卵巢体积(cm³，±s)	既往盆腹腔手术史(例)
vNOTES组	9	40±13.32	21.23±1.67	63.56±33.02	1
传统腹腔镜组	9	34±7.81	22.23±3.25	73.9±44.03	5
t值	?	0.27	0.43	0.43	0.04
P值	?	0.09	0.14	0.39	0.04

表2 vNOTES组与传统腹腔镜组术中、术后情况对比(±s)

组别	例数	手术时间(min)	术中出血量(ml)	血红蛋白下降(g/L)	住院时间(d)	排气时间(h)
vNOTES组	9	115±36.91	8.44±8.55	16.22±5.78	2.78±0.44	16.78±5.56
传统腹腔镜组	9	108.89±53.37	12.78±7.55	16.33±6.28	3.33±0.50	17.93±5.08
t值	?	0.78	0.27	0.97	0.24	0.65
P值	?	0.11	0.98	0.92	0.33	0.89
组别	例数	下床活动时间 (h)	术后12 h疼痛视觉模拟评分(分)	美容评分(分)
组别	例数	下床活动时间 (h)	术后12 h疼痛视觉模拟评分(分)	术后1周	术后4周	术后24周
vNOTES组	9	17.82±2.47	1.89±1.05	22.67±1.00	23.44±0.53	23.89±0.33
传统腹腔镜组	9	18.51±4.88	2.78±1.09	17.78±1.09	18.56±1.13	19.11±1.76
t值	?	0.71	0.10	0.49	<0.00	<0.00
P值	?	0.16	0.80	0.71	0.02	0.01

表2 vNOTES组与传统腹腔镜组术中、术后情况对比(±s)

组别	例数	手术时间(min)	术中出血量(ml)	血红蛋白下降(g/L)	住院时间(d)	排气时间(h)
vNOTES组	9	115±36.91	8.44±8.55	16.22±5.78	2.78±0.44	16.78±5.56
传统腹腔镜组	9	108.89±53.37	12.78±7.55	16.33±6.28	3.33±0.50	17.93±5.08
t值	?	0.78	0.27	0.97	0.24	0.65
P值	?	0.11	0.98	0.92	0.33	0.89
组别	例数	下床活动时间 (h)	术后12 h疼痛视觉模拟评分(分)	美容评分(分)
组别	例数	下床活动时间 (h)	术后12 h疼痛视觉模拟评分(分)	术后1周	术后4周	术后24周
vNOTES组	9	17.82±2.47	1.89±1.05	22.67±1.00	23.44±0.53	23.89±0.33
传统腹腔镜组	9	18.51±4.88	2.78±1.09	17.78±1.09	18.56±1.13	19.11±1.76
t值	?	0.71	0.10	0.49	<0.00	<0.00
P值	?	0.16	0.80	0.71	0.02	0.01

图2 阴道后穹窿切口愈合情况

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Clinical analysis of ovarian cystectomy by means of access. transvaginal natural orifice transluminal endoscopic surgery and laparoscopy

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Clinical analysis of ovarian cystectomy by means of access. transvaginal natural orifice transluminal endoscopic surgery and laparoscopy