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中华腔镜外科杂志(电子版)

中华腔镜外科杂志(电子版) ›› 2024, Vol. 17 ›› Issue (01) : 16 -20. doi: 10.3877/cma.j.issn.1674-6899.2024.01.005

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大子宫切除术-单孔腹腔镜与vNOTES谁优谁劣
吕名蕊1, 刘世佳1, 任冉2, 韩璐2,†()   
  1. 1. 116033　辽宁，大连市妇女和儿童医疗中心（集团）妇科　国家妇产科临床重点专科建设项目，辽宁省儿童和妇女恶性肿瘤早期诊断与生物治疗实验室；116044　辽宁，大连医科大学研究生院
    2. 116033　辽宁，大连市妇女和儿童医疗中心（集团）妇科　国家妇产科临床重点专科建设项目，辽宁省儿童和妇女恶性肿瘤早期诊断与生物治疗实验室
  • 收稿日期:2024-01-23 出版日期:2024-02-28
  • 通信作者: 韩璐

Major hysterectomy-single-port laparoscopy with vNOTES who is good who is inferior

Mingrui Lv1, Shijia Liu1, Ran Ren2, Lu Han2,†()   

  1. 1. Department of Gynecology, Dalian Women And Children's Medical Centre (Group), National Clinical Key Specialist Construction Project of Obstetrics and Gynecology, Laboratory of Early Diagnosis and Biotherapy of Malignant Tumors in Children and Women in Liaoning Province, Liaoning116033, China; Graduate School of Dalian Medical University, Liaoning 116044, China
    2. Department of Gynecology, Dalian Women And Children's Medical Centre (Group), National Clinical Key Specialist Construction Project of Obstetrics and Gynecology, Laboratory of Early Diagnosis and Biotherapy of Malignant Tumors in Children and Women in Liaoning Province, Liaoning116033, China
  • Received:2024-01-23 Published:2024-02-28
  • Corresponding author: Lu Han
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吕名蕊, 刘世佳, 任冉, 韩璐. 大子宫切除术-单孔腹腔镜与vNOTES谁优谁劣[J]. 中华腔镜外科杂志(电子版), 2024, 17(01): 16-20.

Mingrui Lv, Shijia Liu, Ran Ren, Lu Han. Major hysterectomy-single-port laparoscopy with vNOTES who is good who is inferior[J]. Chinese Journal of Laparoscopic Surgery(Electronic Edition), 2024, 17(01): 16-20.

子宫切除术可通过传统腹腔镜、经脐单孔腹腔镜(laparoen-doscopic single-site surgery，TU-LESS)、经阴道自然腔道内镜(vaginal natural orifice transluminal endoscopic surgery，vNOTES)等多种途径进行。TU-LESS因切口隐藏于脐孔，具有美观、术后疼痛轻等特点，在大子宫切除术时具有距两侧宫旁的距离相等，操作上无明显区别的优势，但存在"筷子效应"、精细操作困难等问题；vNOTES大子宫子宫切除术具有体表无瘢痕、术后疼痛轻、恢复快、取出标本容易、减轻术者疲劳等优势，但需术前全面、严格的评估。本文重点阐述大子宫的国内外标准、TU-LESS和vNOTES大子宫切除术的手术精要以及优与劣等的相关问题。

关键词: 子宫切除术, 大子宫, TU-LESS, vNOTES

Hysterectomy can be performed through various methods such as traditional laparoscopy, laparoen-doscopic single-site surgery (TU-LESS), and vaginal natural orifice transluminal endoscopic surgery (vNOTES). TU-LESS, due to its hidden incision in the umbilical foramen, has the advantages of beauty and mild postoperative pain. During major hysterectomy, it has the advantage of equal distance between the two sides of the uterus and no significant difference in operation. However, there are problems such as "chopstick effect" and difficulty in precise operation; vNOTES hysterectomy has advantages such as scarless body surface, mild postoperative pain, fast recovery, easy specimen removal, and reduced operator fatigue, but requires comprehensive and rigorous preoperative evaluation. This article focuses on the domestic and international standards for major uterus, the surgical essence of TU-LESS and vNOTES hysterectomy, and the related issues of superiority and inferiority.

Key words: Hysterectomy, Large uterus, TU-LESS, vNOTES
图1 MRI检查示大子宫宫底达脐上三横指
图2 MRI检查示大子宫宫底达脐上四横指(9 cm宫颈肌瘤)
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