Bernhardt Joern, Steffen Holger, Schneider-Koriath Sylke, Ludwig Kaja
Department of Diagnostic und Interventional Endoscopy, Klinikum Suedstadt, Rostock, Germany,
Int J Colorectal Dis. 2015 Feb;30(2):259-67. doi: 10.1007/s00384-014-2081-x. Epub 2014 Dec 23.
The proposed advantages of NOTES are aimed to assess the comparison with standard procedures. Complications are a major focus of its evaluation. We initiated a prospective comparison between transvaginal hybrid appendectomy versus laparoscopic appendectomy.
For each, NOTES and laparoscopic appendectomy, 10 consecutive female patients participated in the study with follow-up documentation for 35 days and after 1 year. Transvaginal appendectomy was considered a non-standard medical procedure and required individual patient's consent. Pre- and postoperative gynecological examinations were performed. Questionnaire-based evaluation included issues related to quality of life in addition to objective clinical findings. The study is approved by the ethics committee of the University of Rostock.
All women returned questionnaires for evaluation. Age and BMI are comparable. Overall procedure time was significantly shorter in laparoscopy. The only postoperative complication consisted of an intra-abdominal abscess after laparoscopic appendectomy. One patient of the NOTES group suffered from new abdominal pain 3 weeks postoperatively; a mini-laparoscopy showed a normal situation. Significant differences (p < 0.05) of the questionnaire-based comparison with advantages for the NOTES group were found in following items: reduced activity at day 1-14, postoperative pain at day 1, general health conditions at day 1-3 and quality of life at day 3. NOTES patients wished significantly earlier to be discharged and started significantly earlier with activities, but no differences existed after 4 weeks.
Transvaginal flexible appendectomy appears to be a safe procedure performed in hybrid technique. Data from the study point to shortened recovery intervals and improved quality of life.
经自然腔道内镜手术（NOTES）的预期优势旨在评估与标准手术的比较。并发症是其评估的主要重点。我们开展了一项经阴道杂交阑尾切除术与腹腔镜阑尾切除术的前瞻性比较研究。
NOTES组和腹腔镜阑尾切除术组各有10名连续入选的女性患者参与本研究，随访记录35天及1年后的情况。经阴道阑尾切除术被视为非标准医疗程序，需要患者个人同意。进行了术前和术后妇科检查。基于问卷的评估除客观临床发现外，还包括与生活质量相关的问题。本研究经罗斯托克大学伦理委员会批准。
所有女性均返回问卷进行评估。年龄和体重指数（BMI）具有可比性。腹腔镜手术的总体手术时间明显更短。唯一的术后并发症是腹腔镜阑尾切除术后的腹腔内脓肿。NOTES组有1例患者术后3周出现新的腹痛；迷你腹腔镜检查显示情况正常。基于问卷的比较中，NOTES组在以下项目中存在显著差异（p < 0.05）且具有优势：第1 - 14天活动减少、第1天术后疼痛、第1 - 3天总体健康状况以及第3天生活质量。NOTES组患者希望出院的时间明显更早，开始活动的时间也明显更早，但4周后无差异。
经阴道柔性阑尾切除术似乎是一种采用杂交技术实施的安全手术。研究数据表明恢复间隔缩短，生活质量得到改善。
