目的

探讨翻转法vNOTES 子宫腺肌病病灶切除术的可行性及安全性。

方法

回顾2024年7月至2024年9月在克拉玛依市中心医院妇科收治的6 例行翻转法经阴道自然腔道内镜手术（transvaginal natural orifice transluminal endoscopic surgery，vNOTES）子宫腺肌病病灶切除术患者的临床资料，观察分析临床资料疗效。

结果

纳入研究的患者中位年龄为44.5 岁（38 ～48 岁），平均体质量指数（body mass index，BMI）为21.30 ±1.18 kg/m²，所有患者均顺利完成翻转法vNOTES 子宫腺肌病病灶切除术，中位手术时间3.22 h（2.25 ～3.92 h），中位术中出血量140 ml（50 ～600 ml），输血患者1 例（17%，1/6），阴道切口延迟愈合1 例（17%，1/6），术后首次月经PBAC 评分97 分（14 ～110 分），术后首次痛经中位视觉模拟评分（visual analogue scale，VAS）为2 分（0 ～5 分）均低于术前水平，所有患者均未出现肠道损伤、输尿管或膀胱损伤、术后感染、阴道切口渗血、阴道断端感染、切口裂开、阴道分泌物异常、下腹部疼痛等并发症。

结论

翻转法vNOTES 子宫腺肌病病灶切除术是一种安全、可行的手术途径，近期疗效理想。

Objective

To investigate the feasibility and safety of flip method transvaginal natural orifice transluminal endoscopic surgery（vNOTES） adenomyosis foci resection.

Methods

The clinical data of 6 patients with adenomyosis admitted to the Department of Gynecology of Kelamayi Central Hospital from Jul. 2024 to Sept. 2024 were reviewed，and the experience was summarized.

Results

The median age of the patients included in the study was 44. 5 years （38-48 years），and the mean BMI was 21. 30 ±1.18 kg/m². All patients underwent successful resection of adenomyosis foci by the vNOTES reversal method，with a median operative time of 3.22 h （2.25-3.92 h），a median operative bleeding of 140 ml（50-600 ml），and 1 patient with blood transfusion （17%，1/6），1 patient with delayed healing of vaginal incision （17%，1/6），first postoperative menstrual PBAC score of 97 （14-110），first postoperative dysmenorrhea median VAS of 2 （0-5） were lower than preoperative levels，and none of the patients had intestinal injuries，ureteral or bladder injuries，postoperative infections，blood leakage from vaginal incision，infection of the severed end of the vagina，or incision dehiscence，complications such as abnormal vaginal discharge and lower abdominal pain.

Conclusions

The flip method of vNOTES adenomyosis foci excision is a safe and feasible surgical route，with favorable results in the near future.