传统腹腔镜手术与经阴道自然腔道内镜手术（vNOTES）治疗良性妇科疾病后性生活质量的比较
Sexual quality of life after hysterectomy performed by conventional laparoscopy versus Vaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES) in benign gynaecology.
作者信息
Timmermans Marie, Hovsepyan Hripsime, Tanos Panayiotis, Nisolle Michelle, Karampelas Stavros
机构信息
Department of Obstetrics and Gynaecology, University of Liège, CHU of Liège-Citadelle site, Liège, Belgium.
Department of Obstetrics and Gynaecology, Centre Hospitalier Universitaire Brugmann, Université Libre de Bruxelles, Brussels, Belgium.
出版信息
Facts Views Vis Obgyn. 2025 Mar 28;17(1):68-74. doi: 10.52054/FVVO.2024.13784.
BACKGROUND
Hysterectomy is a common surgical procedure in gynaecology, performed through abdominal, vaginal, and laparoscopic techniques. The vaginal route is typically preferred for benign conditions like fibroids, adenomyosis, and uterine prolapse due to shorter operative time, faster recovery, reduced pain, and fewer complications. In cases where the uterus is large or vaginal access is restricted, a laparoscopic approach may be necessary. A minimally invasive alternative, Vaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES), allows hysterectomy via vaginal access using a combination of endoscopic and laparoscopic techniques.
OBJECTIVES
To evaluate if sexual quality of life (sQoL) is impaired by using vNOTES for hysterectomy compared to conventional laparoscopy in benign gynaecology.
METHODS
A retrospective monocentric study. One hundred and twenty seven patients were included in the study. Of these, 91 underwent TLH and 36 vNOTES hysterectomies between September 2020 and October 2022 at Brugmann University Hospital.
MAIN OUTCOME MEASURES
This study compares sQoL after hysterectomy performed via conventional laparoscopy versus vNOTES for benign gynecological conditions.
RESULTS
Regarding surgical characteristics, there were no differences between the two groups in terms of operative time, drop in blood haemoglobin levels and days of hospitalisation. Arousal and Orgasm scores are improved post-operatively in patients suffering from adenomyosis (4.47 vs. 3.91 0.04 for arousal and 5.07 vs. 4.26, 0.016 for orgasm).
CONCLUSIONS
The vNOTES method shows shorter hospital stay and faster re-introduction to sexual life over conventional laparoscopy for total hysterectomy in patients with benign gynaecology.
WHAT IS NEW
Our study shows that in patients suffering from adenomyosis, sQoL improved after hysterectomy using the vNOTES approach.
背景
子宫切除术是妇科常见的外科手术，可通过腹部、阴道和腹腔镜技术进行。由于手术时间短、恢复快、疼痛减轻且并发症少，对于子宫肌瘤、子宫腺肌病和子宫脱垂等良性疾病，通常首选经阴道途径。在子宫较大或经阴道入路受限的情况下，可能需要采用腹腔镜手术。一种微创替代方法，即经阴道自然腔道内镜手术（vNOTES），允许通过阴道入路，结合内镜和腹腔镜技术进行子宫切除术。
目的
评估在良性妇科疾病中，与传统腹腔镜手术相比，使用vNOTES进行子宫切除术是否会损害性生活质量（sQoL）。
方法
一项回顾性单中心研究。127例患者纳入研究。其中，2020年9月至2022年10月期间，在布鲁格曼大学医院，91例行全腹腔镜子宫切除术（TLH），36例行vNOTES子宫切除术。
主要观察指标
本研究比较了在良性妇科疾病中，经传统腹腔镜手术与vNOTES进行子宫切除术后的sQoL。
结果
在手术特征方面，两组在手术时间、血红蛋白水平下降和住院天数方面无差异。子宫腺肌病患者术后的性唤起和性高潮评分有所改善（性唤起：4.47对3.91，P = 0.04；性高潮：5.07对4.26，P = 0.016）。
结论
对于良性妇科疾病患者的全子宫切除术，vNOTES方法与传统腹腔镜手术相比，住院时间更短，恢复性生活更快。
新发现
我们的研究表明，对于子宫腺肌病患者，采用vNOTES方法进行子宫切除术后sQoL有所改善。
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