盆腔器官脱垂手术新入路：机器人辅助经阴道腹腔镜阴道骶骨固定术

doi:10.3877/cma.j.issn.1674-6899.2021.03.008

中华腔镜外科杂志(电子版) ›› 2021, Vol. 14 ›› Issue (03): 168 -171. doi: 10.3877/cma.j.issn.1674-6899.2021.03.008

刘娟 ¹, 肖媛月 ¹, 王倩青 ², 关振堃 ³, 关小明 ⁴ ^, ^†(

)

^1. 510150 广州医科大学附属第三医院妇产科
^2. 453000 新乡市中心医院微创妇科
^3. 510150 广州医学大学
^4. 77030 休斯顿，贝勒医学院微创妇科

收稿日期:2021-05-01 出版日期:2021-08-18
通信作者: 关小明
基金资助:
国家自然科学基金面上项目(81671440); 广州市科信局项目(202102010004)

A new approach for pelvic organ prolapse: robot-assisted transvaginal laparoscopic sacrocolpopexy

Juan Liu ¹, Yuanyue Xiao ¹, Qianqing Wang ², Zhenkun Guan ³, Xiaoming Guan ⁴ ^, ^†( )

^1. Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou 510150, China
^2. Division of Minimally Invasive Gynecology, Xinxiang Central Hospital, Xinxiang 453000, China
^3. Guangzhou Medical University, Guangzhou 510150, China
^4. Division of Minimally Invasive Gynecology, Baylor College of Medicine, Houston 77030, USA

Received:2021-05-01 Published:2021-08-18
Corresponding author: Xiaoming Guan

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目的

介绍一种治疗盆腔器官脱垂(pelvic organ prolapse，POP)的手术新入路——机器人辅助经阴道腹腔镜阴道骶骨固定术(laparoscopic transvaginal NOTES，LV-NOTES)。

方法

回顾分析2例2020年7月因POP于贝勒医学院就诊并完成机器人辅助LV-NOTES的病例，并通过分析记录的手术时间、术后短期并发症、术后生活能力恢复情况等综合评估手术效果。

结果

病例1患者手术时间227 min，病例2患者手术时间257 min。术后24 h拔除尿管后测量膀胱残余尿均正常，膀胱功能正常。术后3、8周随访均未出现术后疼痛、感染等术后短期并发症。POP-Q分度为0度。

结论

机器人辅助LV-NOTES是一种治疗POP可行、安全、有效的新手术方法，为POP手术提供了新的入路选择方案。

关键词: 盆腔器官脱垂, 经自然腔道内镜手术, 机器人辅助腹腔镜手术, 骶骨固定术

Objective

To introduce a new surgical approach for the treatment of pelvic organ prolapse(POP), robot-assisted transvaginal laparoscopic sacrocolpopexy.

Methods

Retrospective analysis was performed on two patients who underwent robot-assisted transvaginal laparoscopic sacrocolpopexy for POP at Baylor College of Medicine in Jul. 2020, and the surgical effects were comprehensively evaluated by analyzing the recorded operative time, postoperative short-term complications, and postoperative recovery of living ability.

Rerusts

The operation took 227 minutes for Case 1 and 257 minutes for Case 2. The bladders’ residual urine was normal 24 hours after the catheters were removed and the bladders’ function were normal.No postoperative short-term complications, such as postoperative pain and infection were found in the follow-up at 3 weeks and 8 weeks after surgery. And POP-Q indexes are both 0 degrees.

Conclusions

Robot-assisted transvaginal laparoscopic sacrocolpopexy is a feasible, safe and effective new surgical method for the treatment of POP, which provides a new option for POP surgical approach.

Key words: Pelvic organ prolapse, Natural orifice transluminal endoscopic surgery, Rotot-assisted laparoscopy, Sacrocolpopexy

图1 将网片固定于阴道前后壁

图2 达芬奇机器人系统

图3 显露第一骶椎前纵韧带并预留缝线

图4 达芬奇机器人系统

图5 将网片固定在前纵韧带上并缝合,

图6 缝合骶骨前及阴道残端腹膜

图7 缝合阴道残端

图8 将切除的子宫放入标本袋内

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