探索和建立使用后入路法经阴道自然腔道内镜手术(vaginal natural orifice transluminal endoscopic surgery，vNOTES)在子宫肌瘤切除术中的技术和应用价值。

选择上海市第一妇婴保健院妇科2017年11月至2019年3月期间21例后壁子宫肌瘤患者行vNOTES子宫肌瘤切除术，收集并分析手术时间、术中出血量、术后并发症发生率、术后住院时间，术后视觉模拟评分(visual analogue scale，VAS)、术后肠道功能恢复时间等临床资料。

其中1例因后入路失败转经脐单孔腹腔镜操作，手术未造成其他脏器损伤；其余20例手术均顺利完成。20例患者的年龄32～48岁，平均(39.9±4.2)岁；体质量指数17.63～23.03 kg/m²，平均(20.7±1.73)kg/m²；手术时间80～135 min，平均(116.07±23.38)min；肌瘤直径5～9 cm，平均(6.96±1.22)cm；术中出血量50～300 ml，平均(78.57±69.93)ml；术后12 h VAS 2～4分，平均(2.14±0.66)分；术后排气时间12～46 h，平均(28.57±7.42)h；术后住院时间2.5～4 d，平均(3.3±0.67)d。无中转开腹手术，未输血，未发生手术并发症，经术后随访，未发生泌尿系及肠管损伤、切口愈合不良。

vNOTES子宫肌瘤切除术对子宫后壁肌瘤是一种安全可行的可选术式，且较经脐单孔腹腔镜更加微创。

To explore and establish the value of the technique and application of transvaginal vaginal natural orifice transluminal endoscopic surgery(vNOTES)by posterior approach in myomectomy.

21 patients with hysteromyoma of posterior wall who underwent hysteromyomectomy via vNOTES from Nov. 2017 to Mar. 2019 in Shanghai First Maternity and Infant Hospital were selected. Then clinical data including operation time, blood loss, postoperative complications, postoperative hospital stay, postoperative pain score, and recovery time of intestinal function were collected and analyzed.

One case was transferred to transumbilical single-port laparoscopy due to failure of posterior approach, and the operation did not cause any organ damage. The other 20 cases were successfully completed. The age of 20 patients ranged from 32 to 48 years, with an average age of (39.9±4.2) years; body mass index 17.63-23.03 kg/m², with an average of (20.7±1.73) kg/m²; operation time was 80-135 min, with an average of (116.07±23.38) min; The diameter of the leiomyoma was 5-9 cm, with an average of (6.96±1.22) cm; the intraoperative blood loss was 50-300 ml, with an average of (78.57±69.93) ml; the VAS score was 2-4 at 12 hours after operation, with an average of (2.14±0.66) points; the postoperative exhaust time was 12-46 h, with an average of (28.57±7.42) h; the postoperative hospital stay was 2.5-4 days, with an average of (3.3±0.67) days. There was no conversion to open surgery, no blood transfusion, no surgical complications, no urinary and intestinal injuries and poor wound healing occurred.

Hysteromyomectomy via vNOTES is a safe and feasible option for posterior hysteromyoma, and is more minimally invasive than transumbilical single-port laparoscopy.