vNOTES与传统腹腔镜卵巢囊肿切除术治疗卵巢畸胎瘤（皮样囊肿）的结果和成本效益：两种最小手术途径的比较

IF 2.1 4区医学 Q2 OBSTETRICS & GYNECOLOGY

European journal of obstetrics, gynecology, and reproductive biology Pub Date : 2025-05-28 DOI:10.1016/j.ejogrb.2025.114087

Wai Yoong, Zachary Penny , Joachim Ho , Olushola Ariyo, Sarah Wylie

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引用次数: 0

摘要

目的腹腔镜卵巢囊肿切除术是卵巢畸胎瘤的基准手术治疗方法，但vNOTES作为一种避免腹部疤痕、疼痛少、恢复快的替代方法正在兴起。本研究旨在比较卵巢畸胎瘤手术治疗的两种微创途径的结果数据和费用。研究设计：vNOTES与腹腔镜卵巢囊肿切除术的病例对照研究（每组n = 21）。方法收集的数据包括年龄、BMI、畸胎瘤大小、手术时间、估计失血量、住院时间和围手术期并发症。这些程序的支出是用英国国家医疗服务体系成本收集网站核实的单位成本来计算的。结果平均年龄（38.42 vs 39.80岁）、体重指数（29.38 vs 27.90 kg/m3）、胎次（0.91 vs 1.20）、EBL （110.10 vs 93.60 mL）和畸胎瘤大小（7.60 vs 7.20 cm）在统计学上相似，但vNOTES患者的平均住院时间（48.33 vs 92.10分钟）、住院时间（3.94 vs 13.2小时）和24小时VAS （1.90 vs 4.00）较短，阿片类药物需求较少（14.3 vs 33.3%）(均p <；0.05)。vNOTES患者恢复正常的日常活动更快（8.0天vs 20.0天），腹膜内溢漏更少（0天vs 33%） (p和lt；0.05)。腹腔镜卵巢囊肿切除术的费用大约是vNOTES病例的1.5倍（3303.76英镑对2147.76英镑），这是由于更长时间的手术室和恢复床位占用，需要额外的助手和使用内窥镜袋。结论vNOTES手术时间短，住院时间长，美观性好，疼痛少，恢复快，费用低，是卵巢畸胎瘤微创附件切除术的可行选择。

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Outcomes and cost-effectiveness of vNOTES vs conventional laparoscopic ovarian cystectomy for ovarian teratoma (dermoid cysts): A comparison of two minimal access routes of surgery

Objective

Laparoscopic ovarian cystectomy is the benchmark surgical treatment for ovarian teratoma but vNOTES is emerging as an alternative with avoidance of abdominal scars, less pain and more rapid recovery. This study aimed to compare outcome data and expenditure for two minimally invasive routes in the surgical management of ovarian teratoma.

Study design

Case control study of vNOTES vs laparoscopic ovarian cystectomy (n = 21 in each group).

Methods

Data collected included age, BMI, teratoma size, duration of surgery, estimated blood loss, length of stay and peri-operative complications. Expenditure for the procedures were calculated using unit costs verified with NHS England Cost Collection website.

Results

Mean age (38.42 vs 39.80 yrs), BMI (29.38 vs 27.90 kg/m³), parity (0.91 vs 1.20), EBL (110.10 vs 93.60 mL) and teratoma size (7.60 vs 7.20 cm) were statistically similar but vNOTES patients had shorter mean theatre duration (48.33 vs 92.10 mins), length of stay (3.94 vs 13.2 hrs) and VAS at 24 h (1.90 vs 4.00) with less requiring opioids (14.3 vs 33.3 %) (all p < 0.05). vNOTES patients returned to normal daily activity quicker (8.0 vs 20.0 days) and had less intra-peritoneal spillage (0 vs 33 %) (both p < 0.05). Expenditure for laparoscopic ovarian cystectomy is approximately 1.5 times that of vNOTES cases (£3303.76 vs £2147.76) due to longer theatre and recovery bed occupancy, need for additional assistant and use of endoscopic bags.

Conclusion

Shorter theatre duration and length of stay, better cosmesis, less pain and rapid recovery, allied with lower cost support the adoption of vNOTES as a viable option for minimally invasive adnexectomy for ovarian teratoma.

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来源期刊

European journal of obstetrics, gynecology, and reproductive biology 医学-妇产科学

CiteScore

4.60

自引率

3.80%

发文量

898

审稿时长

8.3 weeks

期刊介绍： The European Journal of Obstetrics & Gynecology and Reproductive Biology is the leading general clinical journal covering the continent. It publishes peer reviewed original research articles, as well as a wide range of news, book reviews, biographical, historical and educational articles and a lively correspondence section. Fields covered include obstetrics, prenatal diagnosis, maternal-fetal medicine, perinatology, general gynecology, gynecologic oncology, uro-gynecology, reproductive medicine, infertility, reproductive endocrinology, sexual medicine and reproductive ethics. The European Journal of Obstetrics & Gynecology and Reproductive Biology provides a forum for scientific and clinical professional communication in obstetrics and gynecology throughout Europe and the world.