Li Yi-Chieh, Ku Fei-Chun, Kuo Hsin-Hong, Tseng Hsiao-Jung, Wang Chin-Jung
Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou, College of Medicine, Chang Gung University, Kwei-Shan, Tao-Yuan, Taiwan.
Biostatistical Center for Clinical Research, Chang Gung Memorial Hospital at Linkou and Clinical Informatics and Medical Statistics Research Center, Chang Gung University, Taoyuan, Taiwan.
Taiwan J Obstet Gynecol. 2017 Jun;56(3):336-341. doi: 10.1016/j.tjog.2017.04.013.
Natural orifice transluminal endoscopic surgery (NOTES) may be useful in gynecologic endoscopic surgery. This study evaluated the efficacy, safety, and perioperative outcomes of combined NOTES and vaginal approach, transvaginal endoscopic surgery-assisted adnexectomy (TVEA), for the surgical treatment of presumed benign ovarian tumors.
Records were reviewed for 33 consecutive TVEA procedures performed between May 2011 and March 2014. Patient age, body mass index, parity, mass size, and mass bilaterality were used to select comparable patients who had undergone conventional laparoscopic adnexectomy (CLA).
A total of 236 patients were included in this study (203 CLAs and 33 TVEAs). No cases switched to abdominal laparotomy. Operating time and length of postoperative stay were significantly longer in the CLA group than in the TVEA group, while total hospital charges were higher in the TVEA group (p < 0.001). There was no difference in febrile morbidity between the two groups; while the estimated blood loss was higher in the TVEA group, the EBL was <30 mL in both groups.
TVEA can be safely performed for benign and large ovarian tumors. In addition, TVEA offers superior operative efficiency compared to CLA.
经自然腔道内镜手术（NOTES）可能在妇科内镜手术中有用。本研究评估了NOTES联合经阴道入路的经阴道内镜手术辅助附件切除术（TVEA）治疗疑似良性卵巢肿瘤的疗效、安全性和围手术期结局。
回顾了2011年5月至2014年3月期间连续进行的33例TVEA手术记录。根据患者年龄、体重指数、产次、肿块大小和肿块双侧性，选择接受传统腹腔镜附件切除术（CLA）的可比患者。
本研究共纳入236例患者（203例CLA和33例TVEA）。无病例转为开腹手术。CLA组的手术时间和术后住院时间显著长于TVEA组，而TVEA组的总住院费用更高（p<0.001）。两组发热发病率无差异；虽然TVEA组估计失血量更高，但两组的估计失血量均<30 mL。
TVEA可安全用于良性和大型卵巢肿瘤。此外，与CLA相比，TVEA具有更高的手术效率。
