腹腔镜手术治疗复发性卵巢巧克力囊肿21例

目的 探讨腹腔镜手术治疗复发性卵巢巧克力囊肿的价值. 方法 2001年5月～2005年6月我院21例复发性卵巢巧克力囊肿依据患者年龄、生育情况、术中情况分别行腹腔镜下卵巢巧克力囊肿剥除术、一侧附件切除术、一侧附件及腹腔镜辅助下阴式子宫切除术、囊肿穿刺术. 结果 腹腔镜下卵巢巧克力囊肿剥除术16例,一侧附件切除2例,一侧附件及子宫切除术2例,囊肿穿刺术1例.无并发症发生.21例随访6～12个月,平均9个月,1例术后10个月再次复发,1例术后5个月妊娠,余19例无复发;症状缓解10例. 结论 复发性卵巢巧克力囊肿可行腹腔镜下囊肿剥除术,附件子宫切除术或囊肿穿刺术.     

经脐单孔腹腔镜手术治疗巨大附件良性肿瘤30例

目的探讨经脐单孔腹腔镜手术治疗巨大附件良性肿瘤可行性和安全性。方法 2017年10月～2018年11月同一术者对30例巨大附件良性肿瘤实施单孔腹腔镜手术,采用经脐入路,1. 5～2. 0 cm切口置入切口保护套及Port,用相关腹腔镜器械完成经脐单孔腹腔镜手术,手术方式包括卵巢囊肿剔除术、附件切除术、全子宫+单附件或双附件切除术。结果 30例均成功完成经脐单孔腹腔镜手术,无一例增加辅助穿刺孔或中转开腹,其中卵巢囊肿剔除术8例,单/双附件切除13例,全子宫+单附件或双附件切除9例。术中囊肿破裂2例(6. 7%)。无一例术中、术后并发症。术后病理均良性肿瘤,无一例交界瘤或恶性肿瘤,其中浆液性囊腺瘤9例,成熟囊性畸胎瘤8例,黏液性囊腺瘤7例,纤维瘤、子宫内膜异位囊肿、单纯囊肿各2例。术后住院时间中位数4 d(1～10 d)。30例中位随访时间6. 5月(1～12个月),无一例复发。结论经脐腹腔镜手术治疗巨大附件良性肿瘤安全、可行。     

经脐单孔腹腔镜手术治疗巨大卵巢囊肿

目的探讨单孔腹腔镜治疗巨大卵巢囊肿(直径≥10 cm)的安全性和有效性。方法 2016年12月～2018年12月,对27例巨大卵巢良性囊肿(囊肿直径10～15 cm)行经脐单孔腹腔镜卵巢囊肿剥除术。脐部切口1. 5～2 cm,置入单孔port和腹腔镜、器械探查,将囊肿提至切口保护套下穿刺抽出囊液,剔除囊肿。结果 27例均在单孔腹腔镜下顺利完成手术,手术时间40～65(51. 3±1. 2) min,术中出血量20～50 ml,术后肛门排气时间6～18 h,术后2～3 d出院。无切口感染、皮下血肿、创面出血、器官损伤等并发症。结论对巨大卵巢囊肿行经脐单孔腹腔镜囊肿剥除术简单易行,安全可靠,疗效确切。     

腹腔镜巨大卵巢囊肿手术的经验体会

目的:探讨巨大卵巢囊肿行腹腔镜手术的手术方法及临床疗效。方法:回顾分析2010年10月至2011年6月收治的10例巨大卵巢囊肿患者的临床资料。全身麻醉后经腹穿刺,缩小囊肿体积后行腹腔镜巨大卵巢囊肿剥除术或患侧附件切除术。结果:10例均顺利完成腹腔镜手术;手术时间平均(45.7±19.1)min,术中出血量平均(55.3±13.1)ml,平均吸出囊内液(2 695.7±120.5)ml。术后病理均提示为良性,其中卵巢浆液性囊腺瘤5例,卵巢成熟型畸胎瘤3例,卵巢巧克力囊肿2例。术后随访均无复发及不适。结论:腹腔镜手术治疗巨大卵巢囊肿是安全、可行的;具有患者创伤小、康复快等优点,适当选择手术病例,手术方法灵活多样、个性化,完全可达到开腹手术的效果,值得临床推广应用。     

腹腔镜手术治疗妊娠合并卵巢囊肿蒂扭转26例报告

目的探讨腹腔镜手术治疗妊娠合并卵巢囊肿蒂扭转的经验。方法 2009年1月~2016年12月对26例妊娠合并卵巢囊肿蒂扭转急诊行腹腔镜手术,根据术中情况,腹腔镜下行囊肿剥除术或患侧附件切除术。术后早期妊娠患者黄体酮20~40 mg肌肉内注射,1次/d,连续3 d;中晚期妊娠患者硫酸镁静脉滴注,5 g/d,连续3 d。通过患者再次入院记录、门诊或电话随访妊娠结局。结果 26例均完成腹腔镜手术。术中发现11例卵巢坏死行患侧附件切除术,其余15例行患侧卵巢肿物剥除术。手术时间20~60 min,平均47.8 min。术中出血10~400 ml,平均88.8 ml。住院时间2~16 d,平均5.8 d。术后21例(80.8%)保胎治疗。术后26例均未出现流产、早产症状,继续妊娠至足月分娩,13例顺产,13例剖腹产;新生儿出生后1、5 min Apgar评分8~10分。结论腹腔镜手术治疗妊娠合并卵巢囊肿蒂扭转对妊娠是安全的,但对于大囊肿、妊娠晚期患者手术困难。     

单孔腹腔镜在巨大卵巢囊肿剔除术中的应用

目的探讨单孔腹腔镜技术在卵巢巨大囊肿剥除术中的应用价值。 方法回顾性分析2017年3月至2018年3月在北京协和医院妇产科进行单孔腹腔镜辅助下巨大卵巢囊肿体外剥除术的9例患者的临床资料,其中2例为孕13^＋周;根据术后病理类型分类：其中5例为黏液性囊腺瘤,2例为畸胎瘤,1例为子宫内膜异位囊肿,1例为单纯囊肿。 结果9例患者均顺利在单孔腹腔镜辅助下完成巨大卵巢囊肿体外剥除,无患者中转开腹或多孔腹腔镜,围手术期无手术相关并发症发生。中位手术时间55 min(35～60 min),中位术中出血量10 ml(10～75 ml),平均术后住院时间(5.11±1.41)d。其中2例妊娠患者均顺利足月阴道分娩,1例患者术后3个月自然妊娠,6例患者术后6～12个月复查超声均无复发。 结论术前严格筛查排除恶性卵巢肿瘤可能,行单孔腹腔镜辅助下巨大卵巢囊肿体外剥除术为治疗卵巢巨大囊肿提供了一种安全可行的方法。     

改良腹腔镜下巨大卵巢囊肿剥除术32例报告

目的探讨腹腔镜下简便穿刺抽液和缝合止血治疗巨大卵巢囊肿的安全性及疗效。方法 2012年7月～2015年10月我院行腹腔镜下巨大卵巢囊肿剥除术32例,均为单纯性巨大卵巢囊肿(囊肿直径10～20 cm,平均15 cm),利用trocar的锐利针尖,连同套管鞘一同用力刺入囊肿内,退出trocar,置入吸管抽吸,同时采用快速缝合止血重建卵巢。结果32例卵巢巨大囊肿均在腹腔镜下顺利完成手术,手术时间30～85 min,(45.5±12.5)min;术中出血量20～60 ml,(38.6±9.1)ml。无术中、术后并发症发生。术后肛门排气时间6～24 h,(10.5±3.5)h;住院时间3～5 d,(3.9±0.8)d。术后1、3、6个月门诊随访,月经正常,妇科检查正常,未见其他并发症,B超提示患侧附件正常。结论腹腔镜下巨大卵巢囊肿剥除术简单易行,安全可靠,疗效确切。     

腹腔镜手术治疗妊娠合并附件囊肿扭转12例分析

目的探讨孕期腹腔镜手术的可行性. 方法对1997～2002年应用腹腔镜手术治疗的12例妊娠合并附件肿物急腹症病例进行回顾性分析. 结果 12例均经腹腔镜手术诊断为妊娠合并附件肿物扭转或坏死,实施了扭转附件复位卵巢冠囊肿剥除术2例,肿瘤剥除术3例,附件切除术7例,均治愈.未发生流产及胎儿畸形,随访11名婴儿8～12个月,发育正常.结论孕期腹腔镜手术属于相对禁忌证,选择性使用疗效满意.     

单孔腹腔镜联合经脐小切口体外妊娠期巨大卵巢囊肿剥除术的临床应用价值

目的评估利用单孔腹腔镜联合经脐小切口体外剥除妊娠期巨大卵巢囊肿的临床意义和治疗效果。 方法回顾性分析2018年5～11月在石家庄市第四医院实施单孔腹腔镜联合经脐小切口体外妊娠期巨大卵巢囊肿(10～11 cm)剥除术的6例患者的临床资料。 结果6例患者均顺利完成单孔腹腔镜联合经脐小切口体外巨大卵巢囊肿剥除。6例患者中,1例输卵管系膜囊肿扭转,2例卵巢囊肿蒂扭转,3例患者恢复正常解剖结构后卵巢均未发生坏死,行囊肿剥除术。中位囊肿直径10 cm(10～11 cm),中位手术时间51.50 min(43.75～63.50 min),中位术中出血7.5 ml( 5～20 ml),平均住院时间( 3.50±0.43) d。随访,6例患者中,5例(83.33%)妊娠至足月分娩,1例(16.67%)早产;其中2例(33.33%)行剖宫产,4例(66.67%)顺产;中位新生儿体质量3 050 g(2 750～3 162.5 g)。6例患者的新生儿均无畸形及窒息。 结论对妊娠期巨大卵巢囊肿,应用单孔腹腔镜联合经脐小切口体外巨大卵巢囊肿剥除术是安全可行的,值得临床推广。     

超脐巨大卵巢囊肿腹腔镜辅助下手术配合

目的:探讨超脐水平巨大卵巢囊肿行腹腔镜辅助微小切口保留卵巢功能手术配合及其安全性、依从性.方法:对21例巨大卵巢囊肿患者行腹腔镜辅助下卵巢囊肿剥除术,镜下行囊肿穿刺抽吸囊液,经2cm～3cm Trocar切口将囊肿拉出腹壁外剥除,并行卵巢成形术送回腹腔.结果:21例手术均在腹腔镜辅助微小切口下顺利完成,平均手术时间(56±13.1)min,平均出血(40±8.4)ml,囊肿平均直径24.8cm,吸出囊内液平均4800 ml.结论:腹腔镜辅助微小切口行巨大卵巢囊肿手术具有安全、有效、创伤小的优点,全面、安全的手术配合对病人术后有着积极有效的作用.     

卵巢囊肿蒂扭转保留卵巢腹腔镜手术62例报告

目的：探讨卵巢囊肿蒂扭转保留卵巢腹腔镜手术的价值。方法2007年1月～2012年6月我院收治卵巢囊肿蒂扭转62例,其中合并妊娠12例,腹腔镜下先高位结扎卵巢动、静脉,再将扭转的卵巢复位,剔除卵巢囊肿。结果62例均成功保留患侧卵巢。蒂扭转180°～1080°,其中＜360°19例,360°～720°21例,＞720°22例;颜色紫黑色26例,紫色或正常36例。手术时间（57±23）min;术中出血量5～130 ml,平均50．6 ml;术后肛门排气时间（24±13）h。无血栓形成、感染等,妊娠患者无流产等发生。术后1～3个月性激素水平恢复正常,6～24个月43例患侧卵巢有排卵。结论腹腔镜下高位结扎卵巢动静脉,剔除卵巢囊肿,既避免血栓脱落的可能,又能保留卵巢,是一种较好的手术方法,但对医师腹腔镜手术操作技能的要求较高。     

Laparoscopic management of ovarian cysts in newborns

Background: Cysts are the most common ovarian masses found in newborn girls. Spontaneous regression, which occurs in ∼25–50% of cases, is more frequent with smaller cysts. Pre- or postnatal complications are common; these complications may consist of intracystic bleeding, torsion of the cyst or corresponding annex, or self-amputation of the cyst. When the cyst is <4 cm it is possible to perform a simple echographic monitoring to check for the possibility of spontaneous involution; all other cases require surgery. Methods: Between February 1985 and June 1997, we treated 22 neonatal ovarian cysts laparoscopically. In 14 cases, the right side was involved; in eight cases, it was the left. The patients' ages ranged between 7 days and 5 months (median, 45 days). In all cases, we used three trocars. An intraperitoneal cystectomy was done in eight cases, a transparietal cystectomy in four cases, an ovariectomy in seven cases, and the simple removal of the cyst in one case where self-amputation had occurred. In two cases of bilateral pathology, the cysts, which were <1 cm, were left untreated. Results: Average operating time was 40 min (range, 25–60 min). Intraabdominal pressure never exceeded 6–8 mmHg during the intervention. The postoperative course was always under 3 days. No intra- or postsurgical complications were recorded, and long-term ultrasonographic follow-ups were all normal. Conclusion: Our experience indicates that the laparoscopic approach is a reliable and safe technique in the treatment of neonatal ovarian cysts. Received: 30 July 1997/Accepted: 24 October 1997     

Contribution of celioscopy in the early diagnosis of ovarian cancers]

Four hundred and eighty-one patients with an ovarian cyst considered to be benign on the basis of clinical and ultrasonographic findings underwent diagnostic laparoscopy. All malignant tumours (9 cases) were recognized by diagnostic laparoscopy and were treated immediately via laparotomy. When a cyst was identified as being benign on laparoscopy, the diagnosis was always confirmed by histological examination. Sixty one patients (64 cysts) were treated via laparotomy immediately after laparoscopy for the following reasons: malignant or suspicious lesions (19 cases) dense adhesions or anatomical conditions making laparoscopic surgery difficult (42 cases). 420 patients (444 cysts) were treated by laparoscopic surgery with either intraperitoneal cystectomy or transparietal cystectomy. The postoperative course following laparoscopic surgery for annexal cysts was uneventful in 417 cases (3 patients developed a complication).     

腹腔镜下巨大卵巢囊肿穿刺抽液的一种简便方法

目的 探讨腹腔镜下巨大卵巢囊肿穿刺抽液的简便方法.方法 2008年6月~2012年1月,68例单纯性巨大卵巢囊肿行腹腔镜下卵巢囊肿剥除术或切除术,囊肿直径10~20 cm,平均15 cm.术中使用穿刺套管（套管鞘cannula＋棱锥形套管针trocar）稍用力穿刺囊壁进入囊腔,退出trocar,然后插入吸管,抽吸囊内液体.结果 手术均在腹腔镜下完成,术中6例囊液外溢.手术时间30~55 min,平均40 min,术中出血30~100 ml,平均55 ml,术后病理回报均为良性肿瘤（57例浆液性囊腺瘤,11例黏液性囊腺瘤）,未发生并发症.结论 该方法应用于腹腔镜下巨大卵巢囊肿剥除术或切除术中,简单易行,安全有效,值得临床推广使用.     

An alternative system for transvaginal removal of dermoid cyst and a comparative study with laparoscopy

The objective was to introduce a new system for transvaginal removal of ovarian cyst and to evaluate its feasibility. With a new transvaginal system, ultrasound-assisted culdotomy, and laparoscopy supported cystectomy if vaginal procedure failed. The authors conducted a retrospective review in which 35 cases using new vaginal ovarian cystectomy were compared with 40 cases of laparoscopic cystectomy for the treatment of dermoid cyst. All cystectomies were completed without conversion to laparotomy and complications. In a case from vaginal group, laparoscopy was required. No differences existed in operating time, hemoglobin decrease, and C-reactive protein value between groups. Laparoscopically supported vaginal ovarian cystectomy with ultrasound-guided culdotomy was equivalent to laparoscopic cystectomy as to invasiveness and preserved the option of a completely vaginal approach. When a presumed benign dermoid cyst is located in cul-de-sac, this operation may represent a preferable alternative to an exclusively laparoscopic or exclusively vaginal ovarian cystectomy.     

Laparoscopic extracorporeal oophorectomy and ovarian cystectomy in second trimester pregnant obese patients.

OBJECTIVES: To determine whether a modified technique for laparoscopic extracorporal oophorectomy is less complicated and safer than traditional laparoscopic oophorectomy. METHODS: Four obese patients in their second trimester underwent open laparoscopy for treatment of large ovarian cysts. A Cook Ob/Gyn special cyst aspirator with a 14-gauge aspirating needle was inserted into the abdomen to drain the ovary through a separate 10-mm port; the site of insertion depends on the location of the ovary. After the cyst was decompressed, the 10-mm incision was enlarged to 3 cm, and either extracorporal oophorectomy or cystectomy was performed. RESULTS: No complications occurred. Average blood loss was less than 15 cc; average carbon dioxide insufflation time was less than 20 minutes. Average operating time was 40 minutes, which was significantly less than traditional laparoscopic oophorectomy. The patients were discharged in less than 23 hours. Patient A had a 500-cc dermoid cyst, and subsequently had a normal vaginal delivery at term. Patient B had a 1600-cc cyst removed. She had a cesarian delivery due to cephalopelvic disproportion. Pathological analysis of the specimen identified the mass as a dermoid cyst and serous cystadenoma. Patient C had a 3200-cc ovarian cyst. Currently, she is in her 24th week of gestation. Patient D had a 700-cc simple ovarian cyst removed at her 16th week of gestation. CONCLUSIONS: Laparoscopic extracorporal oophorectomy requires significantly less CO2 insufflation time and a shorter operation time, hence, decreasing the adverse effects on the fetus. The enlarged second trimester uterus made traditional laparoscopy more complicated. Performing the procedure extracorporally decreased the possibility of operative complications.     

Treatment of ovarian dermoid cysts

The purpose of this study was to discuss the place and the specific modalities of laparoscopic surgery in the management of ovarian dermoid cysts. This retrospective and noncomparative study was carried out in 65 patients who presented dermoid ovarian cyst between January 1986 and December 1990 in our institution. The surgical treatment was performed purely by laparoscopy in 86.2% of the cases (56 patients). The modalities of laparoscopic surgery were as follows: ovariectomy (8 cases; 14.3%), transparietal cystectomy (4 cases; 7.1%) and intraperitoneal cystectomy (44 cases; 78.6%). In 15 cases (15/44=34%) the intraperitoneal cystectomy was carried out without opening the cyst and the intact cyst was extracted using an endoscopic impermeable sack. We observed no cases of chemical peritonitis. The risk of recurrence after conservative treatment is 4% (two patients) and out of the ten patients for whom a second-look laparoscopy was performed only two (20%) presented adhesions. Laparoscopic treatment of dermoid ovarian cysts is feasible, safe, and effective. The treatment can be conservative in over 80% of the cases. The specific risk of chemical peritonitis can be countered by a change in the cystectomy technique. The use of an impermeable laparoscopic sack permits extraction of the cyst without any peritoneal contamination.     

单孔悬吊腹腔镜辅助手术治疗卵巢良性肿物30例

目的探讨单孔悬吊腹腔镜辅助手术治疗卵巢良性肿物的疗效。方法 2007年12月～2011年4月采用腹壁皮下单点悬吊术,选取腹壁麦氏点或反麦氏点单切口,应用无气腹腹腔镜辅助技术治疗30例育龄期卵巢良性肿物,其中行卵巢肿物剥除术24例(畸胎瘤10例,巧克力囊肿6例,囊腺瘤2例,卵巢囊肿6例),单侧附件切除术6例(巧克力囊肿2例,囊腺瘤4例)。结果 30例手术均获成功,病理诊断:囊性成熟畸胎瘤10例,卵巢巧克力囊肿8例,浆液性囊腺瘤6例,卵巢囊肿6例。手术时间30～80 min,平均46.8 min;术中出血量30～100 ml,平均56.5 ml。术后住院4～7 d,平均5.2 d。28例术后随访3～6个月,平均4.5月,无复发和并发症发生。结论 单孔悬吊式腹腔镜辅助手术损伤小、并发症少、安全省时、简单经济。     

Single incision laparoscopic surgery ovarian cystectomy in large benign ovarian cysts using conventional instruments

We describe a technique for the management of large benign ovarian cysts by single incision laparoscopic surgery (SILS) through the umbilicus. The paucity of intra-abdominal working space in large ovarian cysts poses a technical challenge. Moreover, difficult convergence of operating instruments and competition for operating space outside the abdomen during the SILS makes the procedure quite demanding, especially with the conventional instruments. The concept of providing traction by taking sutures from the abdominal wall, as done in SILS laparoscopic cholecystectomy, was applied for SILS cystectomy in large ovarian cysts. Two sutures taken through the abdominal wall and then through the cyst wall provide excellent traction and "hang" the cyst from the abdominal wall, making it convenient to dissect and operate. This technique demonstrates that SILS ovarian cystectomy is feasible, safe and technically unchallenging even in large benign ovarian cysts.