Division of Gynecologic Endoscopy, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou, and Chang Gung University School of Medicine, Tao-Yuan, Taiwan.
J Minim Invasive Gynecol. 2012 Jul-Aug;19(4):509-13. doi: 10.1016/j.jmig.2012.02.005. Epub 2012 Mar 16.
From August 2010 to June 2011, 10 consecutive patients underwent transvaginal NOTES of the adnexa, including tubal sterilization in 3, salpingectomy because of ectopic pregnancy in 3, and ovarian tumor enucleation in 4. The mean (SD; 95% CI) age of the patients was 34.8 (9.7; 27.9-41.8) years, and their body mass index was 21.6 (2.8; 19.4-23.8). In 9 of the 10 patients, the procedure was completed. The 3 tubal sterilization procedures were completed in 18 to 30 minutes, with negligible blood loss. Operative time for the 3 salpingectomies because of ectopic pregnancy was 62 to 116 minutes. One of these procedures included management of 2000 mL hemoperitoneum. Three of the 4 attempts at ovarian enucleation were successfully completed within 64 to 162 minutes, with estimated blood loss ≤ 50 mL. One NOTES procedure failed because of a misdiagnosed peritoneal mucinous tumor located anterior to the uterus and inaccessible, leading to subsequent conversion to transabdominal laparoscopy. Our preliminary results show that purely transvaginal NOTES is feasible and safe for use in performing uterine adnexal procedures in selected patients. However, the procedure cannot be used in patients with cul-de-sac disease, and could have limited use in treating lesions located anterior to the uterus.
从 2010 年 8 月至 2011 年 6 月，连续 10 例患者接受了经阴道NOTES 附件手术，包括 3 例输卵管绝育术、3 例因异位妊娠行输卵管切除术和 4 例卵巢肿瘤剔除术。患者的平均（标准差；95%CI）年龄为 34.8（9.7；27.9-41.8）岁，体重指数为 21.6（2.8；19.4-23.8）。在 10 例患者中，有 9 例完成了手术。3 例输卵管绝育术在 18 至 30 分钟内完成，几乎没有出血。3 例因异位妊娠行输卵管切除术的手术时间为 62 至 116 分钟。其中 1 例包括处理 2000 毫升血腹。4 例卵巢肿瘤剔除术中有 3 例成功完成，手术时间为 64 至 162 分钟，估计出血量≤50 毫升。1 例NOTES 手术失败，原因是误诊位于子宫前的腹膜粘液性肿瘤，无法进入，导致随后转为经腹腹腔镜。我们的初步结果表明，对于特定患者，经阴道完全 NOTES 行子宫附件手术是可行和安全的。然而，该手术不能用于患有子宫直肠陷凹疾病的患者，并且在治疗位于子宫前的病变方面可能具有有限的用途。
