子宫增大的患者可以进行经阴道自然腔道内镜手术子宫切除术吗？
Can vaginal natural orifice transluminal endoscopic surgery hysterectomy be performed in patients with an enlarged uterus?
作者信息
Güngördük Kemal, Gülseren Varol, Uyar Berican Şahin, Akbaş Özgün, Üstüntaş Serkan, Biton Emre, Özdemir İsa Aykut
机构信息
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Muğla Sıtkı Koçman University, Muğla, Turkey.
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, School of Medicine, İzmir Katip Çelebi University, İzmir, Turkey.
出版信息
J Obstet Gynaecol Res. 2025 Jun;51(6):e16345. doi: 10.1111/jog.16345.
AIM
In this study, the application of vaginal natural orifice transluminal endoscopic surgery (vNOTES) and conventional laparoscopy (CLS) underwent hysterectomy in patients with enlarged uterus was compared.
METHODS
This multicenter study enrolled patients with an enlarged uterus (≥300 g) who underwent minimally invasive hysterectomy using either CLS or vNOTES in the Department of Obstetrics and Gynecology between January 2020 and December 2024.
RESULTS
Among the enrolled patients with an enlarged uterus, 39 (65.0%) underwent conventional laparoscopy, and 21 (35.0%) underwent vNOTES. The median operative times were 80 (50-140) min in the conventional laparoscopy group and 70 (60-130) min in the vNOTES group (p = 0.008). Median blood loss was significantly lower in the vNOTES group (140 [80-210] vs. 160 [90-370] mL; p = 0.013). The length of hospital stay was comparable between groups. Intraoperative bladder injury occurred in one patient in each group-conventional laparoscopy (2.6%) and vNOTES (4.8%) (p = 0.651). Conversion to laparotomy was required in three patients (7.7%) in the CLS group and one patient (4.8%) in the vNOTES group (p = 0.664). The visual analog scale pain score was significantly lower in the vNOTES group at 6, 12, and 24 h postoperatively.
CONCLUSION
vNOTES was confirmed to be a safe, feasible, and effective approach for hysterectomy in patients with an enlarged uterus.
目的
本研究比较了阴道自然腔道内镜手术（vNOTES）和传统腹腔镜手术（CLS）在子宫增大患者行子宫切除术中的应用。
方法
这项多中心研究纳入了2020年1月至2024年12月期间在妇产科接受CLS或vNOTES微创子宫切除术的子宫增大（≥300g）患者。
结果
在纳入的子宫增大患者中，39例（65.0%）接受了传统腹腔镜手术，21例（35.0%）接受了vNOTES。传统腹腔镜手术组的中位手术时间为80（50 - 140）分钟，vNOTES组为70（60 - 130）分钟（p = 0.008）。vNOTES组的中位失血量显著更低（140 [80 - 210] 对比160 [90 - 370] mL；p = 0.013）。两组的住院时间相当。每组各有1例患者发生术中膀胱损伤——传统腹腔镜手术组（2.6%）和vNOTES组（4.8%）（p = 0.651）。CLS组有3例患者（7.7%）需要中转开腹，vNOTES组有1例患者（4.8%）需要中转开腹（p = 0.664）。vNOTES组术后6、12和24小时的视觉模拟评分疼痛得分显著更低。
结论
vNOTES被证实是子宫增大患者行子宫切除术的一种安全、可行且有效的方法。
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