目的:本研究旨在比较使用经阴道自然腔道内镜手术(vNOTES)或经脐腹腔镜单部位手术(TU-LESS)进行子宫切除术治疗良性妇科疾病的患者的围手术期结果。
方法:选取2018年10月至2021年12月在华西第二医院因良性子宫疾病行子宫切除术的314例患者为研究对象。vNOTES(n=157)和TU-LESS(n=157)受体在子宫体积方面1:1匹配。操作时间,失血,术后血红蛋白减少,子宫重量,术后住院时间,术后12h疼痛评分,术后留置尿管时间,比较两组患者的临床指标。
结果:所有314例患者均顺利完成手术,两组有相似的基线特征,没有统计学差异。关于术中结果,vNOTES组的手术时间短于TU-LESS组(80vs100分钟,P=0.04),术中失血量无显著差异,术中输血率,术后血红蛋白减少,或子宫重量。关于术后结果,vNOTES子宫切除术在住院时间方面明显优于TU-LESS子宫切除术(3vs4天,P<0.001),术后12小时疼痛视觉模拟评分(P=0.04),术后留置尿管时间(39.5hvs64.0h,P<0.001),术后排气时间(24.0vs42.0h,P<0.001)。两组术后并发症无明显差异。
结论:vNOTES和TU-LESS对于子宫切除术似乎是安全可行的,但VNOTES子宫切除术更有利于患者的术后康复,创伤较小,更少的痛苦,和更好的美容效果比TU-LESS子宫切除术。作为一种新兴的手术方法,更多研究,包括大样本,多中心,随机对照试验,需要验证我们的发现。
OBJECTIVE: This study aimed to compare the perioperative outcomes of patients who underwent hysterectomy for benign gynecologic diseases using transvaginal natural orifice transluminal endoscopic surgery (vNOTES) or transumbilical laparoendoscopic single-site surgery (TU-LESS).
METHODS: A total of 314 patients who underwent hysterectomy for benign uterine disease at West China Second University Hospital between October 2018 and December 2021 were enrolled in this retrospective study. vNOTES (n = 157) and TU-LESS (n = 157) recipients were matched 1:1 in terms of uterine volume. The operation time, blood loss, postoperative decrease in hemoglobin, uterus weight, postoperative hospital stay, postoperative pain score at 12 h, postoperative indwelling catheter time, and other clinical indicators were compared between the two groups.
RESULTS: All 314 patients successfully completed the surgery, and the two groups had similar baseline characteristics, with no statistical difference. Regarding intraoperative outcomes, the operation time was shorter in the vNOTES group than in the TU-LESS group (80 vs 100 min, P = 0.04), and there were no significant differences in intraoperative blood loss, intraoperative blood transfusion rate, postoperative decrease in hemoglobin, or uterine weight. Concerning postoperative outcomes, vNOTES hysterectomy was significantly superior to TU-LESS hysterectomy in terms of the length of hospital stay (3 vs 4 days, P < 0.001), visual analog scale score for pain at 12 h after surgery (P = 0.04), postoperative indwelling catheter time (39.5 vs 64.0 h, P < 0.001), and postoperative exhaust time (24.0 vs 42.0 h, P < 0.001). There were no significant differences in postoperative complications between the two groups.
CONCLUSIONS: vNOTES and TU-LESS seem safe and feasible for hysterectomy, but vNOTES hysterectomy was more conducive to the postoperative rehabilitation of patients, with less trauma, less pain, and better cosmetic effects than TU-LESS hysterectomy. As an emerging surgical approach, more studies, including large-sample, multicenter, randomized controlled trials, are needed to validate our findings.