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