目的 探讨经阴道自然腔道内镜手术(V-NOTES)治疗输卵管妊娠的临床应用效果。方法 选取2019年6月至2022年12月乌鲁木齐市妇幼保健院妇科收治的144例输卵管妊娠患者为研究对象，按手术方式分为V-NOTES组(28例)、经脐单孔腹腔镜手术(TU-LESS)组(43例)、传统多孔腹腔镜手术组(传统腹腔镜组，73例)，收集3组患者术前、术中及术后相关临床资料进行比较。结果 3组年龄、BMI、停经时间、盆腔手术史、肿物最大径，以及术前WBC、Hb、红细胞容积(Hct)、β-人绒毛膜促性腺激素(β-HCG)水平等基线资料均无明显差异(P>0。05)。所有患者均顺利完成手术，无中转开腹手术及传统腹腔镜手术者，术中、术后无严重并发症。V-NOTES组和TU-LESS组手术时间均长于传统腹腔镜组，差异有统计学意义(P<0。05);与TU-LESS组和传统腹腔镜组相比，V-NOTES组术中出血量最大，术后48 h疼痛视觉模拟量表(VAS)评分最低，差异均有统计学意义(P<0。05);V-NOTES组术后24 h肛门排气率高于TU-LESS组，差异有统计学意义(P<0。05)。3组术中输血率、盆腔粘连评分、盆腔积血量，术后48 h WBC、Hb、Hct及β-HCG水平，以及术后发热率、切口感染率和住院时间均无明显差异(P>0。05)。结论 V-NOTES用于异位妊娠输卵管切除有一定的临床疗效。
Application of transvaginal natural orifice transluminal endoscopic surgery in tubal pregnancy
Objective To investigate the clinical effect of transvaginal natural orifice transluminal endo-scopic surgery (V-NOTES) in the treatment of tubal pregnancy.Methods A total of 144 patients with tubal pregnancy in the Department of Gynecology of Urumqi Maternal and Child Health Hospital from June 2019 to December 2022 were selected as the study objects,and were divided into the V-NOTES group (28 cases),tran-sumbilical laparoendoscopic single-site surgery (TU-LESS) group (43 cases),and traditional porous laparo-scopic surgery group (traditional laparoscopic group,73 cases) according to the surgical methods.The preoperative,in-traoperative and postoperative clinical data of the three groups were collected and compared.Results There was no significant difference in age,BMI,duration of menopause,history of pelvic surgery,maximum tumor diameter, and preoperative WBC,Hb,hematocrit (Hct) and β-human chorionic gonadotropin (β-HCG) levels among the three groups (P>0.05).All patients successfully completed the operation,and none of them required conver-sion to open surgery and traditional laparoscopic surgery.No serious complications occured during and after the operation.The operation time of the V-NOTES group and TU-LESS group was longer than that of the traditional laparoscopic group,and the difference was statistically significant (P<0.05).Compared with the TU-LESS group and traditional laparoscopic group,the V-NOTES group had the largest intraoperative blood loss and the lowest visual analogue scale (VAS) pain score in the first 48 hours of postoperative course,and the differencees were statistically significant (P<0.05).The anal exhaust rate within 24 h after operation in the V-NOTES group was higher than that in the TU-LESS group,and the difference was statistically signifi-cant (P<0.05).There was no significant difference in ratio of intraoperative blood transfusion,pelvic adhe-sion score,pelvic blood volume,WBC,Hb,Hct,and β-HCG levels at 48 h after operation,postoperative fever rate,incision infection rate and length of hospital stay among the three groups (P>0.05).Conclusion V-NOTES for salpingectomy in women with tubal pregnancy has a certain clinical effect.
万方数据
维普
