改良式经腹筋膜内子宫全切除术90例

1999～ 2 0 0 1年 ,我们对适合经腹全子宫切除指征 90例 ,行改良式经腹筋膜内全子宫切除术 ,该术操作简便、出血少、术后恢复快、痛苦少。1　临床资料1 1　一般情况　年龄 35～ 5 5岁 ,平均 4 5岁。子宫肌瘤 63例 ,子宫肌腺症 2 1例 ,功能性子宫出血 6例。术前宫颈活检或巴氏染色均正常1 2　手术方法　术前于阴道、宫颈、穹隆部涂甲紫 ,持续硬膜外麻醉下开腹 ,用常规方法处理子宫圆韧带、阔韧带前后叶 ,酌情保留或不保留附件 ,剪开子宫、膀胱腹膜反折 ,推下膀胱至子宫颈峡部稍下 ,钳夹切断缝扎双侧子宫动、静脉 ,钳夹并切断双侧部分主韧带约…     

筋膜内全子宫切除300例

1995年8月～1997年1月，我院对子宫良性疾病300例，进行了筋膜内全子宫切除术，使手术时间缩短，术中出血、并发症减少。1临床资料1．1一般情况300例中，年龄35～55岁，平均46岁；子宫肌瘤193例，功能性子宫出血30例，子宫腺肌病77例，均经病理证实。1．2手术方法过腹后自处理圆韧带至子宫血管同筋膜外全子宫切除术。在子宫两侧血管结扎残端之间处，子宫骶骨韧带上方环形切开腹膜及筋膜，深约0．3cm。术者稍用力牵拉子宫体，右手持弯头剪作钝性分离，将筋膜自宫颈剥离至阴道穹窿后，切开明道壁，取下子宫，用组织钳提起阴道残端及宫颈筋膜，…     

阴道骶韧带悬吊术预防子宫全切术后盆底功能障碍的效果评价

 目的 评价骶韧带悬吊术在预防腹式子宫全切术后盆底功能障碍的效果。方法 选择2012-01至2013-06住院的符合子宫全切术指征的良性疾病且子宫体积≥12孕周患者84例,随机分为两组,每组42例。单纯组为单纯腹式子宫全切术,联合组为腹式子宫全切术加骶韧带悬吊术。比较术后6、12个月阴道长度以及脏器脱垂及其程度、压力性尿失禁等情况。结果 术后6、12个月联合组阴道长度分别为(7.72±1.76)cm、(8.13±1.46)cm,均长于单纯组(6.91±1.40)cm、(6.74±1.74)cm。术后12个月联合组发生压力性尿失禁者1例,单纯组8例,两组存在统计学差异(P=0.029)。术后12个月联合组患者发生膀胱膨出者2例,单纯组9例,两组存在统计学差异(P=0.048)。结论 阴道骶韧带悬吊术可预防腹式子宫全切术后的盆底功能障碍。     

经腹改良式筋膜内子宫切除术

目的：探讨经腹改良式筋膜内子宫切除术的优越性。方法：采用经腹改良式筋膜内子宫切除术58例（研究组）及经腹传统子宫切除术50例（对照组）相互比较。结果：两组在手术时间、出血量以及术后恢复方面有显著差异。结论：经腹改良式筋膜内子宫切除术操作简单，切口小而美观，出血少，手术时间短，病人康复快，值得临床推广。     

宫颈锥切术后全子宫切除临床探讨

 目的 探讨宫颈锥切术后子宫切除术的指征、术式、安全性和手术要点.方法 选择宫颈锥切术后行子宫切除152例,其中行经阴道子宫切除术(total vaginal hysterectomy,TVH)99例,腹腔镜辅助下经阴道子宫切除(laproscopic assisted vaginal hysterectomy,LAVH)53例,比较两组手术时间、术中出血量、住院时间、术后康复等.结果 TVH组手术时间、术中出血量均低于LAVH组,差异有统计学意义(P＜0.05);在术后康复、住院时间方面无统计学差异.结论 宫颈锥切后行全子宫切除,TVH具有手术时间短,术中出血少,术后康复快等优点.     

半腹膜外筋膜内子宫切除术与常规术式的效果比较

半腹膜外筋膜内子宫切除术是利用子宫下段解剖学上的特点 ,在腹膜外、宫颈筋膜内切除子宫。1994年 4月～ 2 0 0 1年 4月 ,我们有选择地开展半腹膜外筋膜内子宫切除术 ,并与常规子宫切除术式效果比较 ,发现两组手术时间相近 ,但术后体温升高、对胃肠功能影响明显少于或小于常规术式组。1　对象和方法1.1　对象　 10 5例中 ,随机分为半腹膜外筋膜内子宫切除术 (观察 )组 5 5例 ,年龄 39～ 5 2岁 ,平均4 1 4± 3 3岁 ;子宫肌瘤 4 8例 ,子宫肌腺病 5例 ,功能性子宫出血 2例。常规术式组 5 0例 ,年龄 38～5 0岁 ,平均 4 0 .8± 2 .4岁 ;子宫肌瘤 …     

纵形劈开宫颈在腹腔镜辅助阴式子宫全切术中的应用探讨

目的探讨纵形劈开宫颈在腹腔镜辅助阴式子宫全切术中的临床应用价值。方法对40例因各种良性妇科疾病而需行子宫全切除术的患者,采用腹腔镜辅助阴式子宫全切术式,术中转为阴式手术时均采用纵形劈开宫颈处理。结果 40例行腹腔镜辅助阴式子宫全切术中,1例中转开腹手术,中转率2.5%。手术时间60～240 min,平均100 min。出血量约30～400 ml。平均住院日为7 d。结论腹腔镜辅助阴式子宫全切术术中采用纵形劈开宫颈的手术方法术中出血少,手术时间短,住院时间短。     

改良经腹全子宫切除术138例分析

经腹全子宫切除术目前一般都采用苏应宽等编写的《妇产科手术学》术式 (简称苏式 )。针对该术式的不足 ,自1997年以来我院在其阴道残端的处理方法略加改进 ,共施术 138例 ,收到很好效果 ,现介绍如下。1　手术方法1 1　术前准备和麻醉同常规全子宫切除术 ,探查腹腔后 ,手术操作经过中对圆韧带、骨盆漏斗韧带、膀胱子宫反折腹膜、膀胱、宫骶韧带、子宫血管及主韧带的处理按照苏式全子宫切除术操作。1 2　向上牵引宫体及宫颈 ,对阴道残端的处理我们采用了以下改良方法 :用两把大弯止血钳分别在宫颈的两侧紧贴宫颈 ,止血钳口对口钳夹阴道残端 ,…     

子宫良性病变切除子宫时宫颈去留的探讨

子宫良性病变需行子宫切除的疾病主要为子宫肌瘤、子宫肌腺症 ,功能性子宫出血等 ,在选择术式时首先要考虑宫颈的去留问题 ,以往认为年龄较轻患者宫颈细胞学检查无异常 ,可考虑行子宫次全切术 ,而年龄较大者 (4 5岁以上 )无论宫颈刮片性质如何以子宫全切术为主 ,以避免发生宫颈残端癌或残留平滑肌瘤[1] 。但国内报告宫颈残端癌的发生率 0 2 4%～ 1 8% ,国外为 1%～ 4% [2 ] ,故有学者提出应重新评价子宫次全切术的作用与价值[3] 。1　临床资料本组 78例均为在我院因子宫良性病变行子宫次全切除术后 2～ 11年返院复查的患者。随访时年龄为 2…     

改良阴式全切术治疗非脱垂子宫的临床分析

目的探讨改良阴式全切术治疗非脱垂子宫的优点、手术要点、适应证及在基层医院的临床应用价值。方法对30例非脱垂子宫良性病变患者实施改良阴式全子宫切除术,与同期30例非脱垂子宫良性病变患者行经腹全子宫切除术进行对比研究。结果30例改良阴式全切者,无中转开腹、无盆腔脏器损伤,无1例发生术后尿潴留;两组术中出血、手术时间差异无显著性,阴式组排气时间,住院时间显著低于经腹组。结论改良阴式全子宫切除术具有手术时间短、创伤小、术后疼痛轻、并发症少、恢复快、住院时间短、腹部无瘢痕、费用低等优点,是在基层医院值得推广的理想术式。     

后穹隆悬挂术在腹式子宫全切术中的意义探讨

目的：探讨后穹隆悬挂术阻止子宫全切除术后阴道残端脱垂的优越性。方法：88例需进行子宫全切术患者随机分为悬挂组46例，传统子宫切除组42例，用改良Ostrzenski氏法行子宫切除术中后穹隆悬挂，随访1－2．5年。结果：两组手术时间、出血量、术后肛门排气、更年期症状的出现等无显著性差异，但悬挂组术后阴道长度及性生活质量明显好于传统组（P＜0．01）。结论：腹式子宫切除中重造后穹隆及阴道穹隆悬挂能极大改变传统子宫切除术弊端，简便有效地阻止术后阴道残端脱垂，提高性生活质量。     

Application of transvaginal sacrospinous colpopexy in the treatment of pelvic organs prolapse

INTRODUCTION: The incidence of uterovaginal and vaginal vault prolapse appears to be higher due to the increased longevity of women. Sacrospinous ligament colpopexy is a surgery procedure which suspends the vagina up to the sacrospinous ligament and brings upper vagina over the levator plate. This technique is very useful for the primary treatment of uterovaginal prolapse in young women who want to preserve their fertility. The main aim of our study was to present the effectiveness of the us of this technique at our clinic, to investigate the possible intraoperative and postoperative complications of this technique, and to find out its effectiveness in the prevention of repeated vaginal vault prolapse. METHODS: Patients were treated with sacrospinous colpopexy with uterine conservation, vaginal hysterectomy with simultaneous sacrospinous colpopexy or obliteration of the enterocele sac, and sacrospinous colpopexy. Follow-up examinations of the patients we performed at 4 weeks, 6 months and 12 months after the surgery and yearly thereafter. RESULTS: Thirty-seven women were treated with sacrospinous ligament suspension of vaginal vault. The 5 women had vault prolapse following the hysterectomy (the 3 of then had abdominal, and the 2 vaginal hysterectomy), and another 32 women had the various degrees of uterovaginal prolapse. We obtained satisfactory results in 33 patients, in the 3 we noticed asymptomatic cystocele, and the 1 (2.7%) had partial vaginal vault prolapse six months after the surgery. With regard to postoperative complications, 3 patients had Urination disturbance, 3 patients had urinary tract infection, 2 patients had febrile temperature, and the 2 patients had low back pain. DISCUSSION: We performed sacrospinous fixation on the right side, and the postoperative results demonstrated no disturbance in vaginal axis and vault prolapse except in 1 patient. We had no intraoperative complications noted related to sacrospinous ligament colpopexy, such as the damage to the pudendal vessels and nerve, the sciatic nerve and rectum. The possibility of injury to the vessels and nearby nerves was preventid with the careful placement of suture through the sacrospinous ligament in the two fingerbreadths medial to its insertion in the ischial spine. In our series, we had 3 patients with conservation of the uterus. The 3 asymptomatic cystocele in our series were diagnosed 6 months after the operation. Our results were satisfactory, since we hade only one postoperative vault prolapse (2.7%). CONCLUSION: The results of numerous studies, as well as the results of our study, showed that transvaginal sacrospinous colpopexy could be performed along with vaginal hysterectomy and the anterior and posterior vaginal wall repair in the patients with uterovaginal prolapse because of its high success in the prevention of postoperative vaginal vault prolapse and the low intra- and postoperative complication rates. This operative technique is successful in prevention of repeated vaginal vault prolapse.     

ENSEAL G2在广泛性子宫切除术中应用

目的探讨在开腹广泛性子宫切除术中,用ENSEAL G2打开"输尿管隧道"的临床治疗效果。方法选择2015年1月至2017年1月在中国医科大学附属盛京医院妇产科行开腹广泛性子宫切除术43例宫颈癌患者作为研究对象,所有患者FIGO分期为Ⅰb~Ⅱa_1期。根据应用手术器械不同分为两组,其中,A组(n=22)应用ENSEAL打开"输尿管隧道"行广泛性子宫切除术,B组(n=21)应用传统开腹手术器械行广泛性子宫切除术。观察两组患者开腹广泛性子宫切除术的手术时间、术中出血量、副损伤。结果两组患者以不同器械打开"输尿管隧道"行广泛性子宫切除术,其副损伤比较,差异无统计学意义(P>0.05);而与B组比较,A组患者手术时间更短、术中出血量更少(P<0.05)。结论与传统开腹手术比较,应用ENSEAL G2打开"输尿管隧道"行广泛性子宫切除术可以有效减少出血量及手术操作时间。     

背带式子宫缝合术治疗剖宫产术中产后出血临床效果分析

目的探讨背带式子宫缝合术对剖宫产术中产后出血的止血效果。方法将75例剖宫产术中经常规保守治疗无效的子宫收缩乏力性产后出血的患者采用随机数字表法对其进行分组：研究组（n=40例）及对照组（n=35例）,治疗方法分别选用背带式子宫缝合术及传统的宫腔填纱、结扎子宫动脉和子宫切除术,同时比较两组的治疗效果。结果与对照组比较,研究组患者的手术时间明显较短,产后出血量明显较少,产褥病率也明显较低（P〈0．05）,研究组中全部止血成功,无1例行子宫切除术,而对照组有5例因止血失败而行子宫切除术,两组比较有显著性差异（P〈0．05）。结论背带式子宫缝合术是治疗剖宫产术中产后出血的一种行之有效的止血方法,既能有效地减少产后出血量及由严重产后出血带来的一系列并发症,又能有效地保留子宫,且具有使用方便、安全的优点,值得在临床推广应用。     

筋膜内子宫切除60例临床观察

目的探讨筋膜内子宫切除术的效果及其安全性。方法采用筋膜内子宫切除术60例,与传统经腹全子宫切除术50例作对照。结果筋膜内子宫切除术与对照组比较手术时间短,术中出血少,恢复快,术后病率低。结论筋膜内子宫切除术优于传统经腹全子宫切除术。     

Injuries of the lateral collateral ligaments of the ankle: assessment with MR imaging

The aim of this study was to evaluate the ability of MRI to display injuries of the lateral collateral ligamentous complex in patients with an acute ankle distorsion trauma. The MR examinations of 36 patients with ankle pain after ankle distorsion were evaluated retrospectively without knowledge of clinical history, outcome and/or operative findings. The examinations were performed on a 1.5-T whole-body imager using a flexible surface coil. The signs for ligamentous abnormality were as follows: complete or partial discontinuity, increased signal within, and irregularity and waviness of the ligament. The results were compared with operative findings in 18 patients with subsequent surgical repair. Eighteen patients with conservative therapy had a follow-up MR examination after 3 months. There was 1 sprain, 3 partial and 32 complete tears of the anterior talofibular ligament, and 5 sprains, 5 partial, and 7 complete tears of the calcaneofibular ligament. There were no lesions of the posterior talofibular ligament. Compared with surgery, MRI demonstrated in 18 of 18 cases the exact extent of anterior talofibular ligament injuries and underestimated the extent in 2 of 8 cases of calcaneofibular ligament injury. In patients with follow-up MRI after conservative therapy, a thickened band-like structure was found along the course of the injured ligament in 17 of 18 cases. The absence of ligament repair after conservative treatment was confirmed during operative revision in one case. The MRI technique allows for grading of the extent of injury of the lateral collateral ligamentous complex after acute ankle strain. It seems to be suitable for monitoring the healing process after conservative-functional treatment of ligament tears. Received: 29 June 1998; Revision received: 21 October 1998; Accepted: 22 October 1998     

Clinical outcomes after combined meniscal allograft transplantation and anterior cruciate ligament reconstruction

BACKGROUND: Concomitant meniscal transplantation performed at the time of ligament surgery may help to protect the anterior cruciate ligament graft. PURPOSE: To determine the objective and subjective clinical outcomes after combined anterior cruciate ligament reconstruction and meniscal allograft transplantation. STUDY DESIGN: Uncontrolled retrospective review. METHODS: Twenty-eight patients who underwent anterior cruciate ligament reconstruction along with meniscal transplantation were retrospectively evaluated postoperatively at an average of 2.8 years (range, 1.8 to 5.6). RESULTS: On the International Knee Documentation Committee overall subjective assessment, 86% had normal or nearly normal scores. The SF-36 physical and mental component summary scores were at higher levels than those of the patients' age- and sex-matched populations. Objectively, nearly 90% had normal or nearly normal Lachman and pivot shift test scores. The KT-1000 arthrometer testing at 30 pounds and maximum manual both demonstrated an average increased anterior translation of 1.5 mm compared with the contralateral knee. Joint space narrowing of the transplanted compartments was not significantly different from that of the contralateral knee. CONCLUSIONS: Meniscal transplantation with anterior cruciate ligament reconstruction can be a beneficial procedure in properly selected patients with either chronic anterior cruciate ligament insufficiency or failed anterior cruciate ligament surgery. Restoration of meniscal function may provide protection for the articular cartilage and improve joint stability.     

颈椎病患者后纵韧带的磁共振影像及临床意义

目的：探讨颈椎病后纵韧带的磁共振影像特点及其临床意义。方法：对2000年4月。2002年4月的42例颈椎病的磁共振影像和临床资料进行回顾性分析。结果：磁共振检查提示后纵韧带骨化9例，后纵韧带肥厚17例，颈椎问盘脱出16例。16例行颈椎后路手术，26例行颈椎前路手术切除后纵韧带。平均改善率为61．8％，优11例，占31．4％；良14例，占40％；一般8例，占22．9％；差2例，占5．7％。结论：MRI对后纵韧带骨化、后纵韧带肥厚和颈椎问盘脱出的诊断有重要价值，对手术方案的选择有重要意义。