经阴道自然腔道内镜手术与经脐单孔腹腔镜手术在治疗肥胖患者子宫良性病变的效果比较

doi:10.3969/j.issn.1006-5725.2024.22.011

Abstract

Abstract:

Objective To compare the outcomes of transvaginal natural orifice transluminal endoscopic surgery （vNOTES） and laparoendoscopic single-site surgery （LESS） for total uterine excision in obese patients with benign uterine lesions， and to investigate the utility of vNOTES in this patient population. Methods A total of 100 obese patients （BMI > 28.0 kg/m²） diagnosed with benign uterine lesions requiring total uterine and bilateral salpingectomy between January 2022 and January 2023 were included in this study. They were randomly assigned to two groups： the LESS group （n = 51） and the vNOTES group （n = 49）. Patient demographics， surgical duration， intraoperative blood loss， changes in hemoglobin levels， pain scores， time to first flatus postoperatively， length of hospital stay， pelvic floor function， sexual quality of life， and postoperative complications were compared between the two groups. Results The two groups did not show any statistically significant differences in terms of blood loss， pre- and postoperative hemoglobin changes， pelvic floor function， sexual quality of life， or postoperative complications （P > 0.05）. However， the vNOTES group exhibited shorter surgical durations， time to first flatus postoperatively， and length of hospital stay compared to the LESS group （P < 0.05）. Additionally， the vNOTES group demonstrated lower intraoperative pain scores than the LESS group. （P < 0.05）. Conclusions In obese patients with benign uterine lesions， vNOTES total uterine excision surgery demonstrated shorter surgical durations and postoperative hospital stays， lower postoperative pain scores， and better adherence to the principles of enhanced recovery after surgery （ERAS）， indicating its potential for broader application.

Key words: transvaginal natural orifice transluminal endoscopic surgery, laparoendoscopic single-site surgery, obesity, benign uterine lesions

CLC Number:

R713

Wenyuan LI,Min WEI,Jie HAN,Ruifeng LI,Zhen WANG,Hailan LI,Jing XU,Dongmei JIN,Lingyan XU,Rong PENG,Yan ZHANG,Xinhua SUN. Comparative efficacy of vNOTES and LESS in the management of benign uterine lesions in obese patients[J]. The Journal of Practical Medicine, 2024, 40(22): 3184-3189.

Figures/Tables 3

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References 33

1	ALEIXO G F， FONSECA M C M， BORTOLINI M A T， et al. Pelvic floor symptoms 5 to 14 years after total versus subtotal hysterectomy for benign conditions： A systematic review and meta-analysis ［J］. Int Urogynecol J， 2019， 30（2）：181-191. doi:10.1007/s00192-018-3811-3 doi: 10.1007/s00192-018-3811-3
2	张春花，范晓东，关小明. 妇科单孔腹腔镜手术的应用现状和未来的发展趋势［J］. 中国临床新医学， 2020， 13（8）：747-751.
3	BAEKELANDT J F， DE MULDER P A， LE ROY I， et al. Hysterectomy by transvaginal natural orifice transluminal endoscopic surgery versus laparoscopy as a day-care procedure： A randomised controlled trial［J］. BJOG， 2019， 126（1）：105-113. doi:10.1111/1471-0528.15504 doi: 10.1111/1471-0528.15504
4	LOWENSTEIN L， MATANES E， LAUTERBACH R， et al. Feasibility and Learning Curve of Transvaginal Natural Orifice Transluminal Endoscopic Surgery for Hysterectomy and Uterosacral Ligament Suspension in Apical Compartment Prolapse［J］. Female Pelvic Med Reconstr Surg， 2021， 27（1）： e171-e176. doi:10.1097/spv.0000000000000875 doi: 10.1097/spv.0000000000000875
5	GOLDENBERG M， BURKE Y Z， MATANES E， et al. Transvaginal Natural Orifice Transluminal Endoscopic Surgery （vNOTES） for prophylactic bilateral salpingo-oophorectomy［J］. Surg Oncol， 2020， 35：79-80. doi:10.1016/j.suronc.2020.07.006 doi: 10.1016/j.suronc.2020.07.006
6	谢嘉欣，朱洪磊，高萌，等. 经脐单孔腹腔镜在超重肥胖患者卵巢囊肿剥除术中的应用［J］. 实用医学杂志， 2022， 38（8）：997-1000. doi:10.3969/j.issn.1006-5725.2022.08.016 doi: 10.3969/j.issn.1006-5725.2022.08.016
7	TIAN Q， LI M. Risk factors of deep vein thrombosis of lower ex⁃ tremity in patients undergone gynecological laparoscopic surgery： What should we care［J］. BMC Womens Health， 2021， 21（1）：130. doi:10.1186/s12905-021-01276-7 doi: 10.1186/s12905-021-01276-7
8	BRUNES M， JOHANNESSON U， HÄBEL H， et al. Effects of obesity on peri⁃ and postoperative outcomes in patients undergoing robotic versus conventional hysterectomy［J］. J Minim Invasive Gynecol， 2021， 28（2）：228⁃236. doi:10.1016/j.jmig.2020.04.038 doi: 10.1016/j.jmig.2020.04.038
9	ROBERT C A， ROBERT M P， PATEL R S. Does obesity and procedure type increase the risk of in hospital mortality in laparoscopic hysterectomy：A report from the United States hospitals［J］. Cureus， 2020， 12（7）： e9332. doi:10.1016/j.jmig.2020.08.078 doi: 10.1016/j.jmig.2020.08.078
10	靳冬梅，伍冬月，尹正芳，等. 经阴道自然腔道内镜与经脐单孔腹腔镜全子宫切除术的比较［J］. 中国妇产科临床杂志， 2021， 21（1）：70-71. doi:10.13390/j.issn.1672-1861.2021.01.026 doi: 10.13390/j.issn.1672-1861.2021.01.026
11	HOUSMANS S， NOORI N， KAPURUBANDARA S， et al. Systematic Review and Meta-Analysis on Hysterectomy by Vaginal Natural Orifice Transluminal Endoscopic Surgery （vNOTES） Compared to Laparoscopic Hysterectomy for Benign Indications［J］. J Clin Med， 2020， 9（12）：3959. doi:10.3390/jcm9123959 doi: 10.3390/jcm9123959
12	MAT E， KALE A， GUNDOGDU E C， et al. Transvaginal natural orifice endoscopic surgery for extremely obese patients with early-stage endometrial cancer［J］. J Obstet Gynaecol Res， 2021， 47（1）：262-269. doi:10.1111/jog.14509 doi: 10.1111/jog.14509
13	王延州，梁志清. 单孔腹腔镜手术及经自然腔道内镜手术技术应用于女性盆底功能障碍性疾病的利弊探索［J］. 中国计划生育和妇产科， 2019， 11（3）：8-10.
14	陈琳，郑莹，闵玲，等. vNOTES与TU-LESS行子宫全切除术的临床队列研究［J］. 中华妇产科杂志， 2020， 55（12）：843-847.
15	严斌，缪慧娴，王酉，等. 经阴道内镜与单孔腹腔镜在子宫切除术中的应用比较［J］. 中华腔镜外科杂志（电子版）， 2024， 17（1）：39-44.
16	KAYA C， YILDIZ Ş， ALAY İ， et al. The Comparison of Surgical Outcomes following Laparoscopic Hysterectomy and vNOTES Hysterectomy in Obese Patients［J］. J Invest Surg， 2022， 35（4）：862-867. doi:10.1080/08941939.2021.1927262 doi: 10.1080/08941939.2021.1927262
17	DANIELS J. Reducing post-laparoscopy shoulder pain： are simple strategies enough？［J］. BJOG， 2018， 125（11）：1478. doi:10.1111/1471-0528.15251 doi: 10.1111/1471-0528.15251
18	汪海金，王克功，龚廷，等. 腹腔镜引导下双侧子宫骶韧带区域神经阻滞在妇科腔镜子宫肌瘤剔除手术中的应用［J］. 实用医学杂志， 2023， 39（9）： 1127-1131.
19	BASOL G， CORA A O， GUNDOGDU E C， et al. Hysterectomy via transvaginal natural orifice transluminal endoscopic surgery versus single-port laparoscopy： Comparison of early outcomes［J］. J Obstet Gynaecol Res， 2021， 47（9）：3288-3296. doi:10.1111/jog.14874 doi: 10.1111/jog.14874
20	王春月，贾丽华，王雪，等. 经阴道内镜手术治疗子宫肌瘤效果及难点分析［J］. 中国计划生育学杂志， 2023， 31（1）：187-190.
21	蔡鑫，夏宗燕，唐英，等. 经阴道自然腔道内镜与经脐单孔腹腔镜全子宫切除术的Meta分析［J］. 医学信息， 2024， 37（14）：56-61.
22	TINELLI A， TSIN D A， FORGIONE A， et al. Exploring the umbilical and vaginal port during minimally invasive surgery［J］. J Turk Ger Gynecol Assoc， 2017， 18（3）： 143-147.
23	朱静，孙滨州，邵长好. vNOTES与开腹手术、腹腔镜手术对全子宫切除患者组织创伤、体液免疫及性功能影响的比较研究［J］. 东南大学学报（医学版）， 2023， 42（2）：312-317.
24	HOUSMANS S， NOORI N， KAPURUBANDARA S， et al. Systematic review and meta-analysis on hysterectomy by vaginal natural orifice transluminal endoscopic surgery （vNOTES） compared to laparoscopic hysterectomy for benign indications［J］. J Clin Med， 2020， 9（12）：3959. doi:10.3390/jcm9123959 doi: 10.3390/jcm9123959
25	MARCHAND G J， MASOUD A T， ULIBARRI H， et al. Systematic review and meta-analysis of vaginal natural orifice transluminal endoscopic surgery vs laparoscopic hysterectomy［J］. AJOG Glob Rep， 2024， 4（1）：100320. doi:10.1016/j.xagr.2024.100320 doi: 10.1016/j.xagr.2024.100320
26	吴能秀，林超琴，李迎，等. 经阴道自然腔道内镜手术全子宫切除临床分析［J］. 福建医科大学学报， 2021， 55（6）：545-549.
27	陈珂瑶，孙力，李华，等. 经阴道自然腔道内镜全子宫切除手术的临床对比分析［J］. 中华腔镜外科杂志（电子版）， 2020， 13（2）：96-102.
28	BAEKELANDT J， KAPURUBANDARA S. Benign Gynaecological procedures by vaginal Natural Orifice Transluminal Endoscopic Surgery （vNOTES）： Complication data from a series of 1000 patients［J］. Eur J Obstet Gynecol Reprod Biol， 2021， 256：221-224. doi:10.1016/j.ejogrb.2020.10.059 doi: 10.1016/j.ejogrb.2020.10.059
29	冷沿宏，王晖，李庆，等. 不同入路单孔腹腔镜子宫全切术治疗子宫良性疾病的疗效比较［J］. 安徽医学， 2021， 42（11）：1224-1227.
30	XU D， HE L， LIN Y， et al. Does transvaginal natural orifice transluminal endoscopic surgery affect female sexual function？： A prospective cohort study［J］. BMC Womens Health， 2023， 23（1）：405. doi:10.1186/s12905-023-02566-y doi: 10.1186/s12905-023-02566-y
31	SENER T E， SAHIN B， FICHERA M， et al. Does Vaginal Wall Surgical Trauma During Hybrid Transvaginal NOTES Nephrectomy Have Traumatic Effects On Sexual Functions？ A Prospective Study［J］. J Invest Surg， 2021， 34（8）：914-921. doi:10.1080/08941939.2019.1710627 doi: 10.1080/08941939.2019.1710627
32	孙滨州，黄立，朱静. 经阴道自然腔道内镜手术对全子宫切除术患者红细胞免疫和泌尿功能的影响［J］. 发育医学电子杂志， 2023， 11（3）：181-186.
33	CHEN Y， ZHOU Y， TAN L， et al. Comparative analysis of transvaginal natural orifice transluminal endoscopic surgery versus laparoendoscopic single-site sacrocolpopexy for pelvic organ prolapse： A propensity score matching study［J］. Heliyon， 2023， 9（9）：e19698. doi:10.1016/j.heliyon.2023.e19698 doi: 10.1016/j.heliyon.2023.e19698

一般资料	vNOTES（n = 49）	LESS（n = 51）	t/χ²/Z值	P值
年龄（x ± s）/岁	44.12 ± 5.90	43.71 ± 6.29	0.314	0.734
BMI（x ± s）/（kg/m²）	31.75 ± 2.04	31.39 ± 1.79	0.952	0.343
孕次［M（P₂₅，P₇₅）］/次	3.0（2.0， 3.0）	3.0（2.0， 3.0）	0.027	0.979
产次［M（P₂₅，P₇₅）］/次	2.0（1.5， 3.0）	2.0（2.0， 2.0）	0.135	0.893
疾病种类/［例（%）］			0.583	0.953^*
肌壁间子宫肌瘤	20（40.9）	19（37.3）
浆膜下子宫肌瘤	18（36.7）	21（41.2）
子宫腺肌症	8（16.3）	9（17.6）
子宫内膜息肉	3（6.1）	2（3.9）
既往腹部手术史/［例（%）］	13（26.5）	12（23.5）	0.120	0.729
子宫大小（孕周）［M（P₂₅，P₇₅）］/周	9.0（9.0，10.0）	10.0（9.0，11.0）	0.855	0.393

组别	例数	手术时间（x ± s）/min	出血量［M（P₂₅，P₇₅）］/mL	血红蛋白变化（x ± s）/（g/L）	疼痛评分（术后6 h）［M（P₂₅，P₇₅）］/分	术后肛门首次排气时间（x ± s）/h	住院时间［M（P₂₅，P₇₅）］/d
vNOTES组	49	128.02 ± 10.54	20.0（15.0，35.0）	1.49 ± 0.49	2.0（2.0，3.0）	9.57 ± 3.11	5.0（5.0，6.0）
LESS组	51	227.65 ± 37.42	30.0（20.0，35.0）	1.67 ± 0.44	3.0（2.0，4.0）	15.39 ± 3.09	7.0（6.0，7.0）
t/Z值		-18.274	1.450	-1.930	3.450	-9.393	5.905
P值		<0.001	0.147	0.057	0.001	< 0.001	< 0.001

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Comparative efficacy of vNOTES and LESS in the management of benign uterine lesions in obese patients

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