经阴道单孔腹腔镜在子宫输卵管/附件切除术后快速康复中的优势

目的：在施行加速康复外科（ERAS）措施基础上，对比经阴道单孔、经脐单孔和传统腹腔镜三者在子宫输卵管/附件切除术后快速康复中的优势。方法：回顾性分析2018年1月至2020年9月在温州医科大学附属第二医院育英儿童医院住院并施行三种腹腔镜下子宫输卵管/附件切除术的115 例患者的病例资料，围手术期均施加了ERAS措施。主要观察指标包括术后首次下床活动时间、首次肛门排气时间、术后住院时间、术后24 h和48 h疼痛评分，以及恶心、呕吐、腹胀发生率。次要观察指标包括术中出血量、手术时长、术后发热发生率、住院总费用、术中及术后并发症、切口美观度评分。附加指标包括首次排尿时间和尿潴留、尿路感染、排尿困难发生率。结果：经阴单孔组首次下床活动时间最短，首次肛门排气时间最短，住院时间最短，术后24 h及48 h疼痛评分最低（P ＜0.05）；三组术后恶心、呕吐和腹胀发生率差异无统计学意义（P ＞0.05）；经阴单孔组切口美观评分最高（P ＜0.05），术后排尿情况不劣于其他两组。结论：经阴道单孔腹腔镜下子宫附件切除患者术后下床早，疼痛轻，排气早，出院早，恢复快，切口美观度高，与经脐单孔腹腔镜及传统腹腔镜相比更符合快速康复理念。

Advantages of vNOTES hysterectomy combined with salpingectomy/adnexectomy in ERAS

Objective: To compare the advantages of vNOTES, U-LESS and traditional laparoscopy in ERAS after hysterectomy combined with salpingectomy/adnexectomy. Methods: A total of 115 patients who underwent hysterectomy combined with salpingectomy/adnexectomy by vNOTES, U-LESS, and traditional laparoscopy were selected. The primary indicators included the first time off-bed after surgery, postoperative exhaust time, length of hospital stay after operation, the 24-hour pain score and the 48-hour pain score after operation, incidence of nausea, vomiting and abdominal distension. The secondary indicators included intraoperative blood loss, length of operation, the rate of postoperative fever, the cost of hospitalization,intraoperative and postoperative complication rate and incision cosmetic score. Additional indicators included the first urination time after surgery, rate of urinary retention, rate of urinary tract infection rate and the rate of dysuria.Results: In the vNOTES group, the first time to get out of bed was shorter, the time of first anal exhaust was the shortest, the length of hospital stay was the shortest, and the pain score was the lowest at 24 hours and 48 hours after operation (P<0.05). There was no significant difference in postoperative nausea, vomiting and abdominal rate among the three groups (P>0.05); the incision aesthetic score was also the highest (P<0.05); the postoperative micturition was not worse than the other two groups. Conclusion: vNOTES hysterectomy combined with salpingectomy/adnexectomy is worthy of clinical application with the benefits of get out of bed earlier, less pain,earlier exhaust, earlier discharge, sooner recovery and higher incision cosmetic score.