阴道自然孔 妇科瘤手术的透光内镜手术:系统性审查
Nina Reza Pour1,2,3, Charlotte Benton-Bryant4, Jan Baekelandt5,6
1Sydney West Advanced Pelvic Surgical Unit (SWAPS), Sydney, New South Wales, Australia.
Gynecologic and obstetric investigation
|October 13, 2025
概括
阴道自然孔透光内镜手术 (vNOTES) 显示出没有切除子宫的妇科瘤手术的前景. 这种微创手术为复杂的骨盆手术提供了潜在的替代方案,尽管需要进一步的研究.
科学领域:
- 最少侵入性的手术
- 妇科瘤学 妇科瘤学
- 手术创新 在外科创新.
背景情况:
- 自然孔透光内镜手术 (NOTES) 提供最少的侵入性访问,阴道NOTES (vNOTES) 作为一个关键的适应.
- 对于vNOTES的长期安全性数据有限,特别是在除了切除子宫外的妇科瘤学中.
- 本次审查侧重于vNOTES在瘤和妇科手术中的可行性和结果,不包括子宫切除术.
研究的目的:
- 评估vNOTES在妇科瘤手术中的可行性和结果.
- 评估vNOTES在没有同时进行子宫切除术的瘤症候群的安全性和有效性.
- 确定vNOTES在复杂的妇科癌症手术中的潜在应用.
主要方法:
- 按照PRISMA指南进行系统审查,并注册在PROSPERO (CRD42022380581) 中.
- 在MEDLINE,Embase,CINAHL,SCOPUS和CENTRAL进行搜索,截至2023年3月31日.
- 包括涉及女性接受vNOTES的研究,用于没有切除子宫的瘤指示,使用特定的关键词和MeSH/Emtree术语.
主要成果:
- 四篇文章 (n=6) 符合没有切除子宫的瘤手术的纳入标准.
- 程序包括腹膜 (n=3),子宫内膜 (n=2) 和子宫癌 (n=1) 的分期.
- 平均手术时间为93.5分钟,平均血液损失为17.2毫升,没有转化. 一名患者 (12.5%) 患有术后发烧,经过保守的治疗.
结论:
- 有限但有希望的证据支持vNOTES在妇科瘤学中超出了子宫切除术.
- 在复杂的骨盆手术中,vNOTES 提供了一个潜在的最小入侵的选择,包括 retroperitoneal 访问.
- 建议包括仔细选择患者,利用研究环境,以及为安全实施注册潜在病例.
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