经阴道与经脐单孔腹腔镜在子宫肌瘤手术中的应用比较

Clinical application of myomectomy via vaginal natural orifice transluminal endoscopic surgery

摘要:

目的 对比分析经阴道自然腔道内镜手术（V-NOTES）与经脐单孔腹腔镜在子宫肌瘤切除术中的优缺点。方法 选取2019年1月－2019年10月因子宫前壁单发肌瘤住院行经阴道自然腔道子宫肌瘤切除术的患者23例（观察组）、经脐单孔腹腔镜子宫肌瘤切除术的患者44例（对照组），对比分析两组患者手术时间、术中出血量、术后肛门排气时间、术后第1天疼痛情况［数字评分法（NRS）］、术后住院时间、术后平均峰值体温和住院费用。结果 观察组术后肛门排气时间（25.52±4.17）h较对照组（32.72±3.06）h短（P < 0.05），观察组术后第1天NRS疼痛评分（2.65±0.98）分低于对照组（4.50±1.00）分（P < 0.05）；两组患者手术时间、术中出血量、住院时间、术后平均峰值体温和住院费用比较，差异均无统计学意义（P > 0.05）。结论 V-NOTES用于子宫前壁单发肌瘤切除是可行的，患者术后肛门排气时间更短、疼痛程度更轻。

Abstract:

Objective To compare the merits and demerits of vaginal natural orifice transluminal endoscopic surgery (V-NOTES) and transumbilical laparoendoscopic single-site surgery (TU-LESS) in myomectomy.Methods Sufferring from single leiomyoma in the anterior wall of the uterus, 23 patients who underwent V-NOTES (observation group) and 44 patients who underwent TU-LESS (control group) were enrolled in the study from January 2019 to October 2019. The operation time, intraoperative hemorrhage volume, postoperative anal exhaust time, pain scale at the first day after surgery (NRS digital grading score), postoperative hospital stay, postoperative mean peak body temperature and hospitalization costs were compared.Results The postoperative anal exhaust time was shorter in the observation group (25.52 ± 4.17) h than that in the control group (32.72 ± 3.06) h (P < 0.05); The NRS pain score at the first day after operation of the observation group (2.65 ± 0.98) score was lower than that in control group (4.50 ± 1.00) score (P < 0.05); There were no significant difference in the operation time, intraoperative hemorrhage volume, postoperative hospital stay, postoperative mean peak body temperature and hospitalization cost between the two groups (P > 0.05).Conclusion Vaginal natural orifice transluminal endoscopic surgery is feasible in the treatment of single leiomyoma in the anterior wall of the uterus. The recovery time of gastrointestinal function is shorter, the pain is lighter, and it is worth promoting.