经阴道自然腔道内镜卵巢囊肿剥除术十例临床分析

目的评估经阴道自然腔道内镜(natural orifice transluminal endoscopic surgery，NOTES)卵巢囊肿剥除术的可行性、安全性及术后恢复情况。 方法回顾分析2017年9－12月在上海市第一妇婴保健院妇科行NOTES卵巢囊肿剥除术患者10例，所有患者取阴道后穹窿入路2.5 cm切口，置入硅胶密封圈后，装上Port，建立气腹后用传统腹腔镜行患侧卵巢囊肿剥除术。统计卵巢囊肿大小、手术时间、术前与术后血色素差值、术中出血量、术后24 h视觉模拟疼痛评分(visual analog scale，VAS)及术后恢复排气时间。 结果其中1例患者因双侧卵巢成熟性囊性畸胎瘤合并多囊卵巢综合征，由于卵巢门出血略活跃、缝合困难影响手术进展，中转为传统腹腔镜手术之外，其他患者均经阴道腹腔镜完成，手术均无并发症、无输血。9例患者的平均手术时间78.3 min，术前与术后血色素的平均差值18.3 g/L，平均术中出血量23.3 ml，术后24 h VAS平均0.55分，术后平均恢复排气时间17.5 h，平均住院时间4.7 d。 结论NOTES卵巢囊肿剥除术后患者的切口疼痛感较轻，具有术后恢复快、腹部无瘢痕、美观的优势，合适的病例选择加上灵活的手术技巧，NOTES卵巢良性囊肿剥除是安全可行的。

Clinical analysis of 10 cases of ovarian cystectomy via transvaginal natural orifice transluminal endoscopic surgery

ObjectiveTo evaluate the feasibility, safety and postopterative outcomes of transvaginal natural orifice transluminal endoscopic surgery(NOTES) ovarian cystectomy. Methods10 patients underwent NOTES ovarian cystectomy between Sept. to Dec.2017 in Shanghai First Maternity and Infant Health Hospital, were retrospectively analyzed. A 2.5 cm colpotomy was made and a port was inserted into the pouch of vagina. A pneumoperitoneum was created and the conventional laparoscopy ovarian cystectomy steps were followed. The perioperative data were analyzed as follows: the size of ovarian cyst, the operation time, the drop in the hemoglobin , the blood loss, the postoperative visual analog scale(VAS) pain score, the time for postoperative bowel movement , the length of the hospitalization. ResultsOne patient with bilateral ovarian teratoma and polycystic ovary syndrome was converted to traditional laparoscopy surgery due to difficult stitching because of active hemorrhage. There were no noticeable complications during or after operation. The other 9 cases were accomplished. The mean operation time was 78.3 min.The mean drop of hemoglobin level was 18.3 g/L. The mean blood loss was 23.3 ml.The mean vas score was 0.55 at 24 h after operation. The mean time for postoperative bowel movement was 17.5 hours. The mean length of hospitalization was 4.7 days. ConclusionsThe patients feeled mild pain after NOTES , and the procedure resulted in cosmetic advantages. With appropriate case selection and adroit surgical technique, the NOTES ovarian cystectomy seems to be a safe and feasible approach.