目的:虽然腹腔镜手术是异位妊娠的首选手术治疗方法,vNOTES以其良好的光学可见度和避免腹部切口而成为替代路线。作者比较了vNOTES与常规腹腔镜输卵管切除术的人口统计学和结局数据,以治疗异位妊娠。
方法:病例对照研究地点:伦敦大学医院患者:宫外孕不适合接受手术治疗的妇女干预:25例vNOTES与25例常规腹腔镜输卵管切除术的测量和主要结果:患者平均年龄(29.7±53vs31.4±6.7天),奇偶校验(1.2±1.1vs1.6±2.1),BMI(26.7±5.3vs27.2±5.4kg/m3),孕龄(8.44±2.1vs7.3±1.7周)和βhCG水平(3725.4±3674.8vs4376.5±6493.4IU/升)在接受vNOTES和传统腹腔镜输卵管切除术的患者之间具有可比性(p>0.05,t检验).虽然估计失血量相似(218.2±491.7vs173.5±138.7mls)(p>0.001),vNOTES患者的手术时间在统计学上较短(35.8±14.4vs75.8±19.7分钟)(p<0.001,t检验)和住院时间(中位数:11.5vs19.7小时)(U=72,p<0.05,Mann-WhitneyU检验)。vNOTES组中需要术后阿片类药物的患者较少(9%vs25%),24小时疼痛的中位视觉模拟评分(/10)显着降低(2.0vs4.0)(U=75,p<0.05,Mann-WhitneyU检验)。vNOTES组的患者能够更快地恢复到正常的日常活动11.3天(5.8±4.3vs17.1±8.2天)(p<0.05,t检验)。由于商业套件的价格,vNOTES病例的成本大约高出150美元,但这被术中时间的减少所抵消,住院时间和术后镇痛的需要。
结论:接受vNOTES的患者术中时间短,住院时间短,术后疼痛更少,恢复更快,这有助于减轻商业套件产生的更高成本。虽然vNOTES方法用于异位妊娠似乎是安全有效的,我们需要从更大规模的随机研究中获得更可靠的数据.
OBJECTIVE: While the laparoscopic approach is the surgical treatment of choice for ectopic pregnancy, vNOTES is emerging as an alternative route with its good optical visibility and avoidance of abdominal incisions. The authors compare demographics and outcome data of vNOTES vs conventional laparoscopic
salpingectomy for the surgical management of ectopic pregnancy.
METHODS: Case control study SETTING: A London University hospital PATIENTS: Women with ectopic pregnancy unsuitable for medical management who underwent surgical management INTERVENTION: 25 cases of vNOTES vs 25 conventional laparoscopic
salpingectomy MEASUREMENTS AND MAIN RESULTS: The mean patient age (29.7±53 vs 31.4±6.7 days), parity (1.2±1.1 vs 1.6±2.1), BMI (26.7±5.3 vs 27.2±5.4 kg/m3), gestation age (8.44±2.1 vs 7.3±1.7 weeks) and βhCG levels (3725.4±3674.8 vs 4376.5±6493.4 IU/litre) were comparable (p>0.05, t test) between patients having vNOTES vs conventional laparoscopic
salpingectomy. While estimated blood loss was similar (218.2±491.7 vs 173.5±138.7 mls)(p>0.001), vNOTES patients had statistically shorter duration of surgery (35.8±14.4 vs 75.8±19.7 mins)(p<0.001, t test) and length of stay (median: 11.5 vs 19.7 hours)(U=72, p<0.05, Mann-Whitney U test). Less patients in the vNOTES group required postoperative opioids (9% vs 25%) and median Visual Analogue Score (/10) for pain at 24 hours was significantly lower (2.0 vs 4.0)(U=75, p<0.05, Mann-Whitney U test). Patients from the vNOTES group were able to return to normal daily activity 11.3 days quicker (5.8±4.3 vs 17.1±8.2 days)(p<0.05, t test). vNOTES cases cost approximately USD150 more due to the price of the commercial kits but this is offset by reduced intraoperative time, length of stay and need for postprocedure analgesia.
CONCLUSIONS: Patients undergoing vNOTES have shorter intraoperative times and length of stays, less postoperative pain and more rapid recovery, which help mitigate higher cost incurred by commercial kits. While the vNOTES approach for ectopic pregnancy appears safe and efficacious, more robust data from larger randomised studies are needed.