Tolcher Mary Catherine, Kalogera Eleftheria, Hopkins Matthew R, Weaver Amy L, Bingener Juliane, Dowdy Sean C
Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA.
JSLS. 2012 Jul-Sep;16(3):413-20. doi: 10.4293/108680812X13462882735854.
To evaluate the efficacy and safety of culdotomy as a surgical approach to access the peritoneal cavity and discuss its implications for natural orifice transluminal endoscopic surgery (NOTES).
A retrospective chart review of women undergoing culdotomy for tubal sterilization (N 219) between January 1995 and December 2005 was performed. The Accordion Grading System was used for the severity of complications.
No intraoperative complications were noted. Postoperative complications occurred in 7 patients (3.2%): 6 infections (grade 2) and 1 case of hemorrhage (grade 3). Conversion to laparoscopy was necessary in 10 patients (2.2%) due to anatomical constraints or pelvic adhesions; however, culdotomy with entry into the abdominal cavity was nevertheless successful in all 10 cases. The difference in the proportion with a history of pelvic surgery between the conversion and nonconversion groups was not statistically significant (P = .068). Patients with BMI ≥30 had a higher conversion rate compared to patients with BMI <30 (11.4% versus 1.5%, P = .011). Tubal sterilization via culdotomy was successfully performed in all 11 women with no prior vaginal deliveries.
Culdotomy appears to be a safe surgical approach to access the peritoneal cavity and is associated with a low complication rate. These data support the feasibility and safety of utilizing the cul-de-sac as an access portal for natural orifice transluminal endoscopic surgery.
评估后穹窿切开术作为进入腹腔的手术方法的有效性和安全性，并讨论其对经自然腔道内镜手术（NOTES）的意义。
对1995年1月至2005年12月期间因输卵管绝育术接受后穹窿切开术的219名女性进行回顾性病历审查。采用手风琴分级系统评估并发症的严重程度。
未观察到术中并发症。7名患者（3.2%）出现术后并发症：6例感染（2级）和1例出血（3级）。由于解剖结构限制或盆腔粘连，10名患者（2.2%）需要转为腹腔镜手术；然而，所有10例患者经后穹窿切开术进入腹腔均获成功。转为腹腔镜手术组和未转为腹腔镜手术组有盆腔手术史的患者比例差异无统计学意义（P = 0.068）。与BMI<30的患者相比，BMI≥30的患者转化率更高（11.4%对1.5%，P = 0.011）。所有11名未顺产过的女性经后穹窿切开术成功实施了输卵管绝育术。
后穹窿切开术似乎是一种安全的进入腹腔的手术方法，并发症发生率低。这些数据支持将阴道后穹窿作为经自然腔道内镜手术的进入途径的可行性和安全性。
