vNOTES入路建立与缝合技术关键点

doi:10.3877/cma.j.issn.1674-6899.2024.01.002

经自然腔道内窥镜手术(natural orifice transluminal endoscopic surgery，NOTES)是近年来发展起来的一种微创技术，经阴道NOTES(transvaginal natural orifice transluminal endoscopic surgery，vNOTES)是一种以无瘢痕愈合、术后疼痛轻为代表的妇科微创手术。vNOTES入路建立和缝合有其特殊性，是该术式的难点，撰文分享。

关键词: 自然腔道内窥镜手术, 经阴道自然腔道内窥镜手术, 入路, 缝合

Natural orifice transluminal endoscopic surgery (NOTES) is a minimally invasive technique developed in recent years.Transvaginal natural orifice transluminal endoscopic surgery (vNOTES) is a minimally invasive gynecologic surgery represented by no scar healing and less postoperative pain. The establishment of vNOTES approach as well as intraperitoneal suture has its own particularity, which is the difficulty of such operations.We will share our experience by this paper.

Key words: Natural orifice transluminal endoscopic surgery (NOTES), Transvaginal natural orifice transluminal endoscopic surgery (vNOTES), Approach, Suture

图1 距宫颈口约1.5 cm处横行切开阴道前壁黏膜层，充分上推膀胱，暴露腹膜和宫颈表面筋膜层

图2 用无齿卵圆钳钳夹住切口保护器硅胶密封圈经切口置入盆腔

图3 暴露宫颈和后穹窿，于宫颈阴道黏膜交界下方约1.5 cm处的阴道壁正中部位横行切开

图4 推开肠管暴露后腹膜

图5 打开后腹膜进入盆腔

图6 经切口置入硅胶密封圈

图7 腹膜与阴道壁缝合

图8 关闭阴道切口

图9 正向持针缝合

图10 反向持针缝合

图11 倒夹针法

图12 上挑打结

图13 下压打结

图14 前20例和后续23例手术相比，平均手术时间明显减少

表1 vNOTES子宫肌瘤剥除术个人学习曲线

	病例1～20	病例21～43	P值
手术时间(min)	113±31.4	86±35.5	0.014
出血量(ml)	60±26.2	75±115.2	0.578

表1 vNOTES子宫肌瘤剥除术个人学习曲线

	病例1～20	病例21～43	P值
手术时间(min)	113±31.4	86±35.5	0.014
出血量(ml)	60±26.2	75±115.2	0.578

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Key points of vNOTES approach establishment and suture technology

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Key points of vNOTES approach establishment and suture technology