经阴道自然腔道内镜手术治疗子宫内膜癌的可行性和安全性分析

目的探讨经阴道自然腔道内镜手术(transvaginal natural orifice transluminal endoscopic surgery，NOTES)治疗子宫内膜癌的可行性、安全性。 方法2017年8月至2018年7月前瞻性纳入第三军医大学第一附属医院妇产科诊断为子宫内膜癌的患者，行NOTES。统计患者人口学特征、围手术期参数和临床疗效。 结果5例患者均成功完成手术。其中2例阴式子宫切除，3例NOTES子宫切除，所有5例附件切除均在NOTES下完成。3例盆腔淋巴结清扫，1例盆腔前哨淋巴结活检，1例盆腔淋巴结清扫＋腹主动脉周围淋巴结切除。中位手术时间195 min(130～235 min)，中位术中出血量100 ml (50～200 ml)，中位术后住院时间5 d(4～9 d)。中位术后肠道功能恢复时间17 h(12～32 h)，中位术后12 h疼痛评分1分(1～2分)，中位术后24 h疼痛评分1分(1～1分)。术后中位随访时间4个月，所有患者阴道残端切口愈合良好。 结论NOTES可安全、有效地用于子宫内膜癌全面分期手术，但需要进一步的进行临床研究，评估其完整的临床应用。

Natural orifice transvaginal endoscopic surgery for endometrial cancer: feasibility and safety analysis

ObjectiveTo investigate the feasibility and safety of transvaginal natural endoscopic surgery (NOTES) for endometrial carcinoma. MethodsFrom Aug. 2017 to Jul. 2018, patients with endometrial carcinoma were prospectively enrolled in the Department of Obstetrics and Gynecology of the First Affiliated Hospital of Third Military Medical University. Demographic characteristics, perioperative parameters and clinical outcome were statistically analyzed. ResultsAll 5 patients were successfully operated. Vaginal hysterectomy was performed in 2 patients, NOTES hysterectomy was performed in 3 patients, and all 5 cases of bilateral salpingo-oophorectomy were performed under NOTES. Pelvic lymphadenectomy was performed in 3 patients, sentinel lymph node biopsy was performed in 1 patient, and pelvic lymphadenectomy plus para-aortic lymphadenectomy was performed in 1 patient. The median operative time was 195 minutes (130-235 minutes), the median blood loss was 100 ml (50-200 ml), and the median postoperative hospital stay was 5 days (4-9 days). The median postoperative recovery time was 17 hours (12-32 hours), the median postoperative 12 hours pain score was 1 (1-2) and the median postoperative 24 hours pain score was 1 (1-1). The median follow-up time were 4 months, the vaginal stump incision healed well in all patients. ConclusionsNOTES is a safe and effective method for surgical staging of endometrial carcinoma, but further clinical studies are needed to evaluate its complete clinical application.