Hensel M, Schernikau U, Schmidt A, Arlt G
Park-Klinik Weißensee, Anästhesiologie und Intensivmedizin, Berlin, Deutschland.
Zentralbl Chir. 2012 Feb;137(1):48-54. doi: 10.1055/s-0030-1247332. Epub 2010 May 5.
Natural orifice transluminal endoscopic surgery (NOTES) appears to be established in specialised surgical centres. Potential advantages of these operating techniques include surgery without scars as well as faster and more comfortable recovery. However, to date there are no controlled studies evaluating the assumed advantages of NOTES compared with both minimally invasive and open surgery. PATIENT / MATERIAL AND METHODS: In this retrospective case-controlled study 47 women undergoing transvaginal cholecystectomy (TV-ChE) have been compared with 46 women undergoing conventional laparoscopic cholecystectomy (LAP-ChE). Both groups were evaluated with regard to intraoperative respiratory and oxygenation parameters, pain intensity and need for analgesics postoperatively, rate of postoperative nausea and vomiting (PONV), duration of stay in recovery room as well as hospital stay.
Demographic data of both groups were comparable to a great extent. However, in comparison with the women of TV-ChE group those of the LAP-ChE group were 5 years older on average (49 ± 15 vs. 54 ± 16 years). Even so, there were no differences in preoperative risk assessment (ASA classification) as well as intraoperative respiratory and haemodynamic parameters. Compared to the LAP-ChE group, women of TV-ChE group reported less postoperative pain (p < 0.001), less nausea or vomiting (p < 0.001) and a lower analgesic consumption in both opiates (p < 0.001) and non-opiates (p < 0.001). Furthermore, the duration of stay in recovery room was shorter in the TV-ChE group (40 minutes vs. 60 minutes, p < 0.001). Hospital stay in the TV-ChE group was 3 days on average compared to 4 days for the LAP-ChE group. The rate of general and surgical complications was lower in TV-ChE group (1 / 47) compared to the LAP-ChE group (4 / 46). In 9 women undergoing transvaginal cholecystectomy negligible vaginal bleeding was seen which stopped spontaneously in each case.
The transvaginal cholecystectomy is a safe and less invasive surgical technique. Compared to laparoscopic cholecystectomy, there seem to be some advantages such as better cosmetic results, lower need for analgesics, faster mobilisation, more comfortable recovery and shorter hospital stay. These effects should be confirmed in prospective controled studies.
经自然腔道内镜手术（NOTES）似乎已在专业外科中心得以确立。这些手术技术的潜在优势包括无瘢痕手术以及更快且更舒适的恢复。然而，迄今为止，尚无对照研究评估NOTES相较于微创和开放手术的假定优势。
患者/材料与方法：在这项回顾性病例对照研究中，将47例行经阴道胆囊切除术（TV-ChE）的女性与46例行传统腹腔镜胆囊切除术（LAP-ChE）的女性进行了比较。对两组患者的术中呼吸和氧合参数、疼痛强度、术后镇痛需求、术后恶心呕吐发生率（PONV）、恢复室停留时间以及住院时间进行了评估。
两组的人口统计学数据在很大程度上具有可比性。然而，与TV-ChE组女性相比，LAP-ChE组女性平均年龄大5岁（49±15岁对54±16岁）。即便如此，术前风险评估（ASA分级）以及术中呼吸和血流动力学参数并无差异。与LAP-ChE组相比，TV-ChE组女性术后疼痛更轻（p<0.001），恶心或呕吐更少（p<0.001），阿片类药物（p<0.001）和非阿片类药物（p<0.001）的镇痛药物消耗量均更低。此外，TV-ChE组在恢复室的停留时间更短（40分钟对60分钟，p<0.001）。TV-ChE组平均住院时间为3天，而LAP-ChE组为4天。TV-ChE组（1/47）的全身及手术并发症发生率低于LAP-ChE组（4/46）。9例行经阴道胆囊切除术的女性出现轻微阴道出血，均自行停止。
经阴道胆囊切除术是一种安全且侵入性较小的手术技术。与腹腔镜胆囊切除术相比，似乎具有一些优势，如美容效果更好、镇痛需求更低、更快恢复活动、恢复更舒适以及住院时间更短。这些效果应在前瞻性对照研究中得到证实。
