妇科腹腔镜治疗进展

200912366JIntObstetGynecol，December2009，Vol.36，No.6··：100038，，、。，。，，。。（naturalorificetransluminalendoscopicsurgery，NOTES）NOTES。：，、、，，、、，，。NOTES：①、，。②、。③，。④、。⑤，，，。⑥，，。⑦，，NOTES。NOTES，（fertiloscopy），。，，，，。、。NOTES。NOTES，，《》2008。，NOTES，。NOTES。NOTES，，、，【】，，，，、、。，，，，，，。【】；；；ProgressofLaparoscopicTherapyinGynecologyXIAEn-lan.FuxingHospital,CapitalMedicalUniversity,Beijing100038,China【Abstract】Inrecentfewyears,withtheprogressofupdateidea,instruments,theaccumulationofexperienceandtechnologynaturalorificeendoscopicsurgery,singleorificelaparoscopicsurgeryandroboticsurgeryetc.newla-paroscopictechniqueemerged.Traditionallaparoscopictechniqueshavemadeinnovations,eggaslesslaparoscopicsurgeryissupplementaryofgaslaparoscopy.Indicationsandoperatingabilityofoperatorweregreatlyemphasizedonlaparoscopichysterectomyandmyomectomy.Laparoscopictubalconservativeoperationcouldgethigherintrauterinepregnancyrateaftersurgery.Narrowbandimagingimprovedlaparoscopicendometriosisdiagnosticaccuracy.Laparoscopicsurgeryingynecologiccancerwasalmostthesamewithlaparotomy.Progressoflaparoscopicequipmentandinstrumentsincreasedthesaftyoflaparoscopicsurgery.【Keywords】Laparoscopy;Naturalorifice;Robot;Narrowbandimaging（JIntObstetGynecol，2009,36：413-416）413··200912366JIntObstetGynecol，December2009，Vol.36，No.6NOTES。，3（Triport），“”，，。4、3，，4、3，，，（Realhands）。2008Sotelo［1］，28（laparo-endoscopicsinglesite，LESS）。5，112（90～160）min，118（100～160）mL，LESS，。NOTES，，4、3，，。（roboticlaparoscopy）2000（FDA）［2］，，，，，。、、，［3］。，，，，，；，“”，；。，。，。、，CO2，，。（gaslesslaparoscopicsurgeryusingtheabdominalwalllifting，AWL），，，［4］。、、、、、、。，、，，，。。、，，，。，。［5-7］。，，。。：①：，，，。②：，。③：，，，。2，，。④：，，、EndoGIALigasure，。，，。。、、。，、，，。，，，。。，，。、（TLM）TLM、，，，。。Malzoni［8］：①。②≥4cm，≤10cm，414··200912366JIntObstetGynecol，December2009，Vol.36，No.6。③≤10。④。：①。②。③＜3cm，“”，。④，10。：①，，12cm，，GnRHa3。②，，、、、。TLM，。（laparoscopiccryomyolysis）［9］，，，，［10］。、，。：；。，80%，。Ego［11］1561.4%，15.4%，，38.1%，9.8%；54.5%，20.4%。，。Bouyer［12］，：80%、73%、53%。，5%～20%，β（β-hCG），，3β-hCG20%210%，（MTX），。、、。、（EMs）［13］EMs，，。，，。EMs，。EMs。，（narrowbandimaging，NBI），，［（415±30）nm］，。（415nm），，。，，。，NBI，，，EMs，。，，NBI。。NBIEMs。、，：①。②。③，。，、，，，、。Muzii［14］，，，，。，①：，，，，“”。②：CO2。，CO237℃，，≤14mmHg（1mmHg=0.133kPa），＜5L/min。③：，、，。、，、、415··200912366JIntObstetGynecol，December2009，Vol.36，No.6，80℃，＜5μm，、，，，，3～4mm，，。Ligasure7mm，，1.5～2mm。PK，＜100℃，＜1mm，7mm，300mmHg。VIO，、、、。VIO，7mm，，。、———2001Liu［15］87，97.7%，，，。2005Holub［16］TLM70.1mL∶33.9mL，P＜0.05，TLM。，、、、，。，［17-18］，（UAE），UAE，［19］，MTX［20］，。，，，，，。，，。NOTES，“”、，。，，21，。SoteloR,AstiguetaJC,CarmonaO,etal.Laparo-endoscopicsinglesite（LESS）［J］.ActasUrolEsp,2009,33（2）:172-181.PalepJH.Roboticassistedminimallyinvasivesurgery［J］.JMinimAccessSurg,2009,5（1）:1-7.HolubZ,LukacJ,KlimentL,etal.Variabilityoftheoriginoftheuterineartery:laparoscopicsurgicalobservation［J］.JObstetGynaecolRes,2005,31（2）:158-163.IshikawaM,NakagawaT,NishiokaM,etal.Costsandbenefitsoflaparoscopiccholecystectomy:abdominalwallliftingvs.pneu-moperitoneumprocedure［J］.Hepatogastroenterology,2006,53（70）:497-500.WattiezA,CohenSB,SelvaggiL.Laparoscopichysterectomy［J］.CurrOpinObstetGynecol,2002,4（14）:417-422.AbdollahiSF,BahlouliA,MostafaPG,etal.Comparisonoflaparoscopy-assistedhysterectomieswithconventionalhysterec-tomies［J］.SaudiMedJ,2009,30（6）:813-816.WalshCA,WalshSR,TangTY,etal.Totalabdominalhysterectomyversustotallaparoscopichysterectomyforbenigndisease:ameta-analysis［J］.EurJObstetGynecolReprodBiol,2009,144（1）:3-7.MalzoniM,RotondM,PeroneC,etal.Fertilityafterlaparoscopicmyomectomyoflargeuterinemyomas:operativetechniqueandpreliminaryresults［J］.EurJGynaecolOncol,2003,24（1）:79-82.ZupiE,MarconiD,SbraciaM,etal.Directedlaparoscopiccryomy-olysisforsymptomaticleiomyomata:one-yearfollowup［J］.JMinimInvasiveGynecol,2005,12（4）:343-346.CiavattiniA,TsiroglouD,LittaP,etal.Pregnancyoutcomeafterlaparoscopiccryomyolysisofuterinemyomas:reportofninecases［J］.JMinimInvasiveGynecol,2006,13（2）:141-144.EgoA,SubtilD,CossonM,etal.Survivalanalysisoffertilityafterectopicpregnancy［J］.FertilSteril,2001,75（3）:560-566.BouyerJ,Job-SpiraN,PoulyJL,etal.Fertilityfollowingradical,conservative-surgicalormedicaltreatmentfortubalpregnancy:apopulation-basedstudy［J］.BJOG,2000,107（6）:714-721.FarrugiaM,NairMS,KotronisKV.Narrowbandimaginginendometriosis［J］.JMinimInvasiveGynecol,2007,14（4）:393-394.MuziiL,MaranaR,CaruanaP,etal.Postoperativeadministrationofmonophasiccombinedoralcontraceptivesafterlaparoscopictreat-mentofovarianendometriomas:aprospective,randomizedtrial［J］.AmJObstetGynecol,2000,183（3）:588-592.LiuWM,NgHT,WuYC,etal.Laparoscopicbipolarcoagulationofuterinevessels:anewmethodfortreatingsymptomaticfibroids［J］.FertilSteril,2001,75（2）:417-422.HolubZ,JaborA,LukacJ,etal.Laparoscopicmyomectomywithlateraldissectionoftheuterineartery［J］.JSLS,2005,9（4）:447-453.LiuWM,TzengCR,Yi-JenC,etal.Combiningtheuterinedeple-tionprocedureandmyomectomymaybeusefulfortreatingsymp-tomaticfibroids［J］.FertilSteril,2003,82（1）:205-210.ChenYJ,WangPH,YuanCC,etal.Successfulpregnancyinawomanwithsymptomaticfibroidswhounderwentlaparoscopicbipolarcoagulationofuterinevessels［J］.FertilSter