妇科手术对卵巢储备功能的影响

早发性卵巢功能不全（premature ovarian insufficiency,POI）作为目前亟待解决的生殖内分泌异常疾病，其主要表现为卵巢储备功能降低，生育能力下降。妇科手术被认为是诱发医源性POI的重要因素，其对卵巢储备功能的影响是妇科领域关注的重点问题。文章阐述了临床中不同妇科手术包括卵巢囊肿剥除术、输卵管切除术和子宫切除术对卵巢储备功能的影响。     

腹腔镜卵巢子宫内膜异位囊肿剔除术质量控制

腹腔镜卵巢子宫内膜异位囊肿剔除术是子宫内膜异位囊肿手术治疗的首选术式。术中正常卵巢组织的丢失和能量器械的使用,可能导致卵巢储备功能减退,严重者可致卵巢功能早衰。因此,腹腔镜子宫内膜异位囊肿剔除术中应有效剔除囊肿,合理使用能量器械,尽量保留正常的卵巢组织和保护正常的卵巢功能,以减少对卵巢功能的损害。     

妇科腹腔镜手术中卵巢功能的保护问题

妇科腹腔镜手术中如何保护卵巢功能问题是健康发展该项技术的关键点之一。在妇科腹腔镜手术中要正确认识和利用电外科器械,将电外科器械对卵巢组织的损伤减少到最小。腹腔镜下卵巢囊肿剥除术,卵巢打孔术,子宫切除术和输卵管手术等要注意卵巢功能的保护,严格掌握手术方式和手术适应证。同时要对卵巢功能进行密切的监测。     

良性卵巢肿瘤术后对卵巢储备功能的影响

卵巢良性囊肿是育龄妇女常见的疾病,目前临床上常采用手术剥除为主,卵巢囊肿术后对卵巢功能的影响正日益受到关注,卵巢囊肿剔除或剥除手术,可减小卵巢体积,破坏卵巢血供,影响卵巢分泌性激素及排卵,甚至导致卵巢早衰。卵巢储备功能是评价卵巢囊肿术后的重要指标,具体包括卵巢体积、基础性激素、LH/FSH值等。针对卵巢囊肿手术治疗会对卵巢储备功能造成损害,本文将从卵巢囊肿疾病自身、卵巢囊肿手术及如何评估卵巢储备功能3个方面加以综述。     

腹腔镜内异囊肿保守性手术对卵巢储备功能的影响

子宫内膜异位症（简称内异症）是育龄妇女的常见病,其病理类型可分为腹膜型、卵巢型（卵巢内异囊肿）、深部浸润型及其他。其中卵巢内异囊肿是常见的类型,对年轻的患者来说,腹腔镜下卵巢内异囊肿保守性手术是目前主要的手术方法。但研究发现,现有技术均可导致卵巢正常组织损伤及卵泡损失,加上卵巢内异囊肿本身的特性,更易发生术中出血和脏器损伤,有卵巢储备功能下降,甚至卵巢早衰的风险,因此,充分了解影响卵巢储备功能的相关因素,尽可能保护卵巢功能、提高患者生存质量,是妇科医生面临的重要课题。一、预测卵巢储备功能的主要指标卵巢的储备功能是卵巢内卵泡的数量和质量,目前用于检测的主要指标及实验简述如下。     

“冷处理”腹腔镜卵巢畸胎瘤剥除术(附63例报道)

目的:研究"冷处理"腹腔镜卵巢畸胎瘤剥除术对卵巢功能的影响。方法:对63例卵巢畸胎瘤行"冷处理"腹腔镜剥除术,并对卵巢功能进行跟踪随访。结果:63例患者手术共剥除肿瘤70个,其中11个肿瘤术中发生破裂;手术持续时间(65±8.7)min,术中出血量(36±9.6)ml。术后半年11例妊娠,其余52例月经正常或基本正常,妇科彩超无异常,26例行性腺六项检查,结果正常。结论:"冷处理"腹腔镜卵巢畸胎瘤剥除术简便、易行,能较好地保护卵巢功能。     

腹腔镜卵巢巧克力囊肿剥除术电凝止血对卵巢储备功能的影响

目的:探讨腹腔镜下卵巢巧克力囊肿剥除术中创面采用电凝止血方法对术后卵巢功能的影响.方法:选取有腹腔镜手术适应证的卵巢巧克力囊肿患者39例,术中创面采用电凝法止血.于术前、术后及术后6个月抽血检测FSH、LH、E2及阴道B超探测窭状卵泡数(Fo)、卵巢间质动脉血流的收缩期峰值(PSV)以判断卵巢储备功能.结果:术后及术后6个月较术前的PSH显著升高(P<0.05),E2、Fo、PSV显著降低(P<0.01);患者术前基础内分泌指标、窦状卵泡数及PSH/LH的比值均在正常范围.术后检查共发现8例(24.2%)卵巢储备功能下降的患者.结论:腹腔镜下卵巢巧克力囊肿剥除术中电凝止血法易致卵巢储备功能降低.     

妇科手术对抗苗勒管激素及卵巢储备功能的影响

随着妇科手术方式层出不穷,尤其是微创手术的广泛开展,如何最大限度地保护卵巢储备功能是医患共同关心的话题。卵巢储备功能反映女性的生育能力,是指卵巢内存在的可受精的卵母细胞的数量和质量,评估指标有年龄、基础卵泡刺激素、雌二醇、黄体生成激素、抑制素B、基础窦状卵泡数和卵巢体积等,但是都存在一定的局限性。抗苗勒管激素(anti-Müllerian hormone,AMH)由卵巢的颗粒细胞分泌,在整个月经周期保持相对稳定,测定不受月经周期影响,是预测卵巢储备的可靠指标。综述临床中不同妇科手术对卵巢储备功能的影响。     

子宫内膜异位症患者抗苗勒管激素基础水平研究进展

子宫内膜异位症(EMs)是育龄期妇女的常见病,包括腹膜型、深部结节型、卵巢型。EMs影响约2%的生殖期女性,约40%的EMs患者为卵巢型EMs,合并不孕者为40%~50%,并且具有易复发的特点。治疗方法包括药物保守治疗和手术治疗。近年来,有研究报道卵巢型EMs患者手术治疗后,卵巢功能下降,甚至出现卵巢功能早衰。而EMs本身,尤其是卵巢型EMs对卵巢储备功能的影响报道较少。抗苗勒管激素(AMH)是近年来评估卵巢储备功能的可靠标志物。通过分析3种不同类型EMs患者的AMH基础水平总结评价EMs对卵巢功能的影响,从而进一步指导临床工作。     

妇科手术对抗苗勒管激素及卵巢储备功能的影响

随着妇科手术方式层出不穷,尤其是微创手术的广泛开展,如何最大限度地保护卵巢储备功能是医患共同关心的话题。卵巢储备功能反映女性的生育能力,是指卵巢内存在的可受精的卵母细胞的数量和质量,评估指标有年龄、基础卵泡刺激素、雌二醇、黄体生成激素、抑制素B、基础窦状卵泡数和卵巢体积等,但是都存在一定的局限性。抗苗勒管激素(anti-Müllerian hormone,AMH)由卵巢的颗粒细胞分泌,在整个月经周期保持相对稳定,测定不受月经周期影响,是预测卵巢储备的可靠指标。综述临床中不同妇科手术对卵巢储备功能的影响。     

微创手术治疗妇科疾病的应用进展

近些年,微创手术取得了快速发展,已成为医学领域的一个研究热点。随着科学及医疗技术的不断发展,微创手术在妇科领域的应用同样取得了长足的进步。尽管传统的开腹手术在妇科领域仍具有重要地位,但是,微创手术正受到学者们越来越多的关注及喜爱。当前微创手术的代表传统腹腔镜已成为治疗妇科疾病的标准微创术式,包括妇科恶性肿瘤的治疗。传统腹腔镜已是一项成熟的技术,现着重阐述另外两大正在兴起的微创手术,即经自然孔道内镜外科手术及机器人辅助腹腔镜手术,并对其在妇科的最新进展及应用进行综述。     

妇科恶性肿瘤腹腔镜手术学习曲线的研究进展

妇科恶性肿瘤是威胁女性生命健康的主要杀手。目前,手术治疗仍是大多数妇科恶性肿瘤的主要治疗方式。随着显微外科技术的发展,腹腔镜手术应用于妇科恶性肿瘤的治疗已得到推崇及广泛开展。学习曲线又称经验曲线,是指在一定时间内获得知识或技能的速率,广泛用于研究外科手术技能的学习规律。学习曲线的主要评判标准有手术时间、术中出血量、中转开腹率、淋巴结清扫数、术中及术后并发症和术后住院时间等。目前国际上子宫内膜癌、宫颈癌、卵巢癌、阴道癌、外阴癌等妇科恶性肿瘤的腹腔镜手术技术已日趋成熟,但所报道的各妇科恶性肿瘤的腹腔镜手术学习曲线不尽相同,使用的评判标准、影响因素、现存缺陷等问题仍缺乏统一论述。就妇科恶性肿瘤的腹腔镜手术学习曲线的研究进展进行综述。     

Laparoscopic treatment of adnexal cystic masses

Operative laparoscopy has become the gold standard for the surgical treatment of numerous gynecological benign conditions. In the case of ovarian cysts, however, the use of the laparoscopic approach has been debated due to the possibility of encountering an unexpected ovarian malignancy at the time of surgery. This would upstage a IA or IB ovarian malignancy to IC. In this review, the authors evaluate the preoperative parameters that could help in the selection of the patients who are candidate to a laparoscopic approach. In particular, the authors consider the age related risk of the patients, the use of sonography and color-Doppler velocimetry, the use of CA 125, and as a last diagnostic step, the findings at laparoscopy. In a personal series of 1.584 cysts in patients under 40 years of age, the first author encountered 7 unexpected borderline tumors and 1 mucinous G1 adenocarcinoma, while no malignancy was found in a group of strictly selected postmenopausal patients. These data have been compared with those found in scientific literature. There is no sound evidence that the stripping procedure determines a reduction of the ovarian reserve when performed with strict microsurgical principles. Recent evidence in the literature suggests that the decreased ovarian responsiveness reported by some authors following ovarian cystectomy may not be a consequence of surgery. The concern of a possible reduction of the ovarian reserve needs to be balanced with the benefits obtained with surgery. Finally, it should always be kept in mind the risk of an unexpected malignancy, even in cysts apparently benign, malignancy that can only be diagnosed through surgery obtaining a specimen for pathology.     

Evaluation of immediate laparoscopic surgery for gynecologic disorders

The purpose of this study was to obtain information to aid in deciding the timing of immediate laparoscopic surgery for gynecological disorders. We evaluated immediate laparoscopic surgery (within 12 h after admission) performed at our institution between January 2005 and March 2010. Of the total 287 laparoscopic surgeries performed for patients with gynecological disorders during this period, 70 (24.4%) were immediate laparoscopic surgeries, 33 (47.1%) of which were for ectopic pregnancy, and 24 (34.3%) for ovarian tumor. Among the 24 surgeries for ovarian tumor, there were almost equal proportions of surgeries for mature cystic teratoma (ten cases, 41.7%) and endometrioma (nine cases, 37.5%). As to the breakdown of immediate surgery by pathology, immediate surgeries were performed in 20.8% of mature cystic teratoma cases and in 12.9% of endometrioma cases during this study period. In the 24 immediate surgeries for ovarian tumor, 10 cases (41.7%) had neither torsion nor rupture, 7 cases (29.2%) had torsion with mature cystic teratoma, serous cystadenoma or follicular cyst, and 7 cases (29.2%) had rupture of the tumor, all of which were endometrioma. Preoperatively, there were no significant differences between torsion and non-torsion cases in serum white blood cell (WBC) count or C-reactive protein (CRP) levels in peripheral blood. However, serum WBC and CRP levels tended to be elevated in cases of rupture with endometrioma. Especially in patients with ovarian tumor, presumed pathology is important in deciding the timing of immediate laparoscopic surgery.     

妇科肿瘤腹腔镜手术的围手术期处理

随着腹腔镜技术的逐步推广,妇科肿瘤腹腔镜手术技术日渐成熟,已成为治疗妇科良、恶性肿瘤的有效手段,围手术期的处理直接影响手术疗效、决定着手术的成败,所以围手术期处理特别重要。     

Resultados de 1.000 cirugías ginecológicas laparoscópicas sucesivas

Objectives

To review the indications and outcomes of 1,000 consecutive laparoscopic surgeries.

Material and methods

We carried out an observational, retrospective study of the first 1,000 gynecological laparoscopic procedures performed in our hospital. Data on complications and conversions were recorded.

Results

Between January 2005 and November 2011, we performed 1000 laparoscopic surgeries: 452 (45.2%) ovarian procedures, 200 (20%) hysterectomies for benign causes, 105 (10.5%) gynecological neoplasms, 88 (8.8%) tubal ligations, 75 (7.5%) diagnostic laparoscopies, 56 (5.6%) myomectomies, 19 (1.9%) sacropexies and 5 (0.5%) appendectomies. There were 22 major complications (2.2%) and 32 conversions to open surgery (3.2%).

Conclusion

The laparoscopic approach to gynecological surgery is safe and effective.     

妇科腹腔镜手术术前术后的护理

随着医学科学的进步,妇科手术逐渐由传统的单纯开腹手术向各种微创手术方式变化,同时腹腔镜手术发展迅速,现已逐渐成为许多妇科良性疾病如良性肿瘤、异位妊娠、子宫内膜异位症、盆腔炎等首选的手术方式。与普通开腹手术相比,腹腔镜手术具有较小的手术创伤、无碍美观的手术切口、迅速的术后恢复等优点护理也有很多不同之处。随着腹腔镜手术应用范围的拓宽和操作难度的增加,腹腔镜手术的并发症也不容忽视,认真做好腹腔镜术前术后的护理以及并发症的观察和处理是进一步体现腹腔镜治疗模式优势的重要环节。     

妇科腹腔镜手术的临床进展

妇科腹腔镜手术近年来发展迅速,有损伤小、术后痛苦少、住院时间短、机体恢复快、美容效果好、医疗负担轻等优点。在妇科恶性肿瘤的诊治上,相对传统开腹手术,腹腔镜有自己独特的优势。随着手术器械设备的更新,医生经验的积累和技能的成熟,术中保护措施的研发,腹腔镜手术的并发症明显减少,安全性大大提高,临床运用范围愈加广泛。如今在传统腹腔镜手术的基础上又开发了微型腹腔镜手术,无气腹腹腔镜手术,机器人手术等新的手术方式。其各具特点,各有临床发展的潜力。就妇科腹腔镜手术近年来临床实践探索的新进展做综述。     

Surgical treatment of ovarian endometriomas: state of the art?

To define the role of surgery in the treatment of endometriomas, we review the literature available via PubMed and cross-reference the published data. We analyze the arguments in favor of and against surgical treatment of endometriomas and compare surgical techniques. Pain relief and pregnancy rates of more than 50% after surgery are the most important arguments in favor of surgery. Histologic and biologic markers of ovarian reserve show a risk of decreased ovarian reserve that should be taken into consideration, especially in cases of repeated surgery. Considerable surgical expertise is required, and the lack of comparative studies yields no conclusions on the best surgical technique. Despite the risk of decreased ovarian reserve due to the surgical procedure, surgery has an important role in the treatment of ovarian endometriomas, and more studies are required to define the most appropriate surgical technique.