Takahashi Hidekazu, Hamabe Atsushi, Hata Tsuyoshi, Nishizawa Yuji, Nishimura Atsushi, Itoh Masaaki, Takemasa Ichiro
Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 562-0015, Japan.
Department of Surgery, Surgical Oncology and Science, Sapporo Medical University, S-1, W-17, Chuo-ku, Sapporo, 060-8543, Japan.
Surg Today. 2020 Jul;50(7):734-742. doi: 10.1007/s00595-019-01946-y. Epub 2020 Jan 20.
The relevance of transvaginal specimen extraction (TVSE) combined with reduced port surgery (RPS) remains unknown. This study investigated the feasibility of TVSE with RPS according to short-term outcomes and cosmesis.
This prospective multicenter study enrolled ten patients at three institutions. For the semi-quantification of each parameter, we administered questionnaires to assess pain (visual analogue scale), subjective/objective wound healing esthetics [photo series questionnaires (PSQ)], and quality of life (QOL).
No operative complications occurred, except one case of urinary tract infection, which was promptly cured with antibiotics. On day 0, pain was rated at 2.3 ± 0.67 at rest and 4.9 ± 0.82 during sneezing; these ratings gradually declined over time. The PSQ showed that the patient ratings of wound esthetics after TVSE were not inferior to ratings from patients after conventional laparoscopy or single incision laparoscopic surgery, and they were significantly higher than the patient ratings of wounds after laparotomy (P < 0.05). The QOL scores showed that, in comparison to before surgery, after surgery, patients reported significant deterioration of their physical function (96.67 ± 1.49 vs. 87.33 ± 2.71), emotional function (93.33 ± 2.72 vs. 86.67 ± 2.22), fatigue (7.78 ± 3.72 vs. 26.67 ± 8.31), and pain (6.67 ± 3.69 vs. 18.33 ± 4.61).
TVSE with RPS for colorectal cancer was feasible and was associated with a low degree of postoperative pain.
经阴道标本提取（TVSE）联合减孔手术（RPS）的相关性尚不清楚。本研究根据短期结果和美容效果探讨TVSE联合RPS的可行性。
这项前瞻性多中心研究在三个机构招募了10名患者。为了对每个参数进行半定量，我们发放问卷以评估疼痛（视觉模拟量表）、主观/客观伤口愈合美观度[照片系列问卷（PSQ）]和生活质量（QOL）。
除1例尿路感染经抗生素迅速治愈外，未发生手术并发症。术后第0天，静息时疼痛评分为2.3±0.67，打喷嚏时为4.9±0.82；这些评分随时间逐渐下降。PSQ显示，TVSE术后患者对伤口美观度的评分不低于传统腹腔镜手术或单切口腹腔镜手术后患者的评分，且显著高于开腹手术后患者对伤口的评分（P<0.05）。QOL评分显示，与手术前相比，手术后患者的身体功能（96.67±1.49对87.33±2.71）、情感功能（93.33±2.72对86.67±2.22）、疲劳（7.78±3.72对26.67±8.31）和疼痛（6.67±3.69对18.33±4.61）均有显著恶化。
TVSE联合RPS用于结直肠癌手术是可行的，且术后疼痛程度较低。
