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目的:探讨自主研发的国家专利产品多通道操作套管(Zou-Port)在经阴道纯NOTES手术中的应用价值。方法:自2011年4月开始应用Zou-Port施行经阴道纯NOTES手术20例,其中肾囊肿4例,左侧3例,双侧1例;重度肾积水并无功能肾15例,左侧3例,右侧12例;右肾肿瘤1例。分别施行经阴道纯NOTES肾囊肿去顶术、单纯肾切除术及根治性肾切除术。结果:本组20例,除1例经阴道纯NOTES肾切除术中在应用ZouPort建立经阴道操作通道时分离钳戳破直肠壁外,其余19例腹部均未置Trocar,均完全经阴道完成手术,且未发生腹腔、盆腔脏器及大血管损伤等严重并发症;1例纯NOTES单纯肾切除术后发生右侧髂外动脉血栓,急诊成功行血栓取出术。经阴道纯NOTES肾囊肿去顶术平均手术时间为75(60~90)min,术中平均失血量25(20~50)ml;经阴道纯NOTES肾切除术平均手术时间185(160~320)min,术中平均失血量160(100~500)ml。患者阴道后穹窿切口均“Ⅱ/甲”愈合,19例成功完成手术患者体表均无切口或穿刺孔。术后随访6~52个月,无盆腔或腹腔感染、子宫脱垂等并发症。1例肾肿瘤患者无肿瘤复发或转移。结论:应用Zou-Port行经阴道纯NOTES手术安全可行,便利手术操作,降低了手术难度,能有效避免腹腔和盆腔脏器副损伤,临床效果良好。
Objective: To explore the value of independently researched and developed national patent product multi-channel operation cannula (Zou-Port) in transvaginal pure NOTES operation. Methods: From April 2011, 20 cases of transvaginal NOTES were performed with Zou-Port. Among them, 4 cases were renal cysts, 3 cases were left and 1 case was bilateral. In severe hydrops, 15 cases had no renal function, 3 cases, right in 12 cases; right kidney tumor in 1 case. Transvaginal pure NOTES renal cyst debridement, simple nephrectomy and radical nephrectomy were performed. Results: The group of 20 cases, except one case of transvaginal pure NOTES nephrectomy in the use of ZouPort established when the vaginal patency channel separation colostomy puncture the wall of the rectum, the remaining 19 cases of abdomen were not placed Trocar, were completely transvaginal surgery , And no serious complications such as peritoneal cavity, pelvic organ and great vessel injury occurred. One case of pure NOTES nephrectomy developed a right external iliac artery thrombosis, and the emergency department successfully performed thrombectomy. The average operation time of transvaginal NOTES renal cyst debridement was 75 (60-90) min and intraoperative average blood loss was 25 (20-50) ml. The average operative time of transvaginal NOTES nephrectomy was 185 (160-320) min, intraoperative blood loss 160 (100 ~ 500) ml. Patients with vaginal fornix incision were “Ⅱ / A” healing, 19 patients successfully completed surgery without incision or puncture of the body surface. All the patients were followed up for 6 to 52 months without complications of pelvic or abdominal infection and uterine prolapse. One patient had no tumor recurrence or metastasis. Conclusion: It is safe and feasible to use vaginal pure NOTES operation by Zou-Port to facilitate surgical operation and reduce the difficulty of operation. It can effectively avoid side and pelvic organ injury and has good clinical effect.