Shibahara Hiroaki, Shimada Kazuhiko, Kikuchi Kumiko, Hirano Yuki, Suzuki Tatsuya, Takamizawa Satoru, Fujiwara Hiroyuki, Suzuki Mitsuaki
Department of Obstetrics and Gynecology, School of Medicine, Jichi Medical University and Center for Reproductive Medicine, Jichi Medical University Hospital, Yakushiji, Shimotsuke, Tochigi, Japan.
J Obstet Gynaecol Res. 2007 Oct;33(5):705-9. doi: 10.1111/j.1447-0756.2007.00636.x.
Transvaginal hydrolaparoscopy (THL) has recently been developed as a less invasive alternative to conventional laparoscopy. There are some reports that described the usefulness and prognostic value of diagnostic THL in infertile women. Moreover, operative THL such as ovarian drilling for unovulatory women with polycystic ovarian syndrome (PCOS) to induce ovulation has also been found to be as effective as that by conventional laparoscopy. The risk of bowel injury and sepsis by transvaginal access with culdoscopy was higher than that with laparoscopy in the previous reports. The purpose of the present study was to examine the risk of diagnostic and operative THL according to two case studies with a literature review.
The authors carried out diagnostic or operative THL in 177 infertile women, aged 22-43 years. Major complications during THL and a review of the literature were analyzed.
Two cases of bowel injury were diagnosed during diagnostic THL. No complication occurred during operative THL. In total, the incidence of bowel injury was 1.1%. The injuries were diagnosed during THL and treated expectantly under strict conditions in both cases. Ten studies in the literature reported a total of 4232 procedures, including 26 bowel injuries (0.61%) and one perforation of a retroflexed uterus (0.02%).
The usefulness of THL for diagnostic and operative purposes is in no doubt. However, informed consent should be obtained and vigilance before and during THL should be maintained, although it can be done on an outpatient clinic basis.
经阴道水腹腔镜检查（THL）最近已被开发出来，作为传统腹腔镜检查的一种侵入性较小的替代方法。有一些报告描述了诊断性THL在不孕女性中的实用性和预后价值。此外，还发现手术性THL，如对患有多囊卵巢综合征（PCOS）的无排卵女性进行卵巢打孔以诱导排卵，与传统腹腔镜检查一样有效。在先前的报告中，经阴道后穹窿镜检查导致肠损伤和败血症的风险高于腹腔镜检查。本研究的目的是通过两个病例研究并结合文献综述来探讨诊断性和手术性THL的风险。
作者对177名年龄在22至43岁之间的不孕女性进行了诊断性或手术性THL。分析了THL期间的主要并发症并进行了文献综述。
在诊断性THL期间诊断出2例肠损伤。手术性THL期间未发生并发症。总体而言，肠损伤的发生率为1.1%。这两例损伤均在THL期间被诊断出来，并在严格条件下进行了保守治疗。文献中的10项研究共报告了4232例手术，其中包括26例肠损伤（0.61%）和1例子宫后屈穿孔（0.02%）。
THL用于诊断和手术目的的实用性毋庸置疑。然而，尽管THL可以在门诊进行，但仍应获得知情同意，并在THL之前和期间保持警惕。
