腹腔镜子宫肌瘤剔除术与经腹子宫肌瘤剔除术治疗子宫肌瘤临床效果对比分析

目的:腹腔镜子宫肌瘤剔除术与经腹子宫肌瘤剔除术治疗子宫肌瘤临床效果对比分析.方法:探究对象为本院2018年5月至2021年5月接诊134例子宫肌瘤患者.根据手术方法的差异,分为对照组(经腹子宫肌瘤剔除术)和研究组(腹腔镜子宫肌瘤剔除术),每组收入67例.比较在不同手术治疗方法应用下患者的手术指标、生活质量评分、术后不良反应及术后血红蛋白、HCT及氧化应激指标.结果:经治疗后,研究组手术指标明显优于对照组.研究组生活质量评分提升大于对照组.研究组不良事件发生率低于对照组.血红蛋白及HCT下降幅度更优于对照组.研究组氧合应激指标治疗后数据更优于对照组.结论:与经腹子宫肌瘤剔除术相比较,腹腔镜子宫肌瘤剔除术手术治疗效果更佳,保证临床治疗效果的同时降低并发症的发生率,改善患者氧合应激指数,有助于患者病情更好的恢复.     

阴式子宫肌瘤剔除术与腹腔镜子宫肌瘤剔除术治疗子宫肌瘤的临床对比研究

目的对比分析阴式子宫肌瘤切除术与腹腔镜下子宫肌瘤切除术的临床疗效。方法选取我院2014年1月~2014年4月妇科收治的子宫肌瘤患者76例,随机分为甲组和乙组,甲组采用阴式子宫肌瘤切除术治疗,乙组采用腹腔镜子宫肌瘤剔除术治疗,治疗结束后对比分析两组患者的临床疗效。结果阴式手术平均手术时间(54.7±11.8)min显著少于腹腔镜手术的(72.6±10.2min,术中出血量(109.3±30.7)ml显著少于乙组的(133.5±30.2)ml,组间比较差异有统计学意义,<0.05。结论两种治疗方法各有优势,阴式子宫肌瘤剔除术耗时短,患者经济负担轻,基层医院较容易开展,腹腔镜子宫肌瘤剔除术创口小,感染几率低,临床治疗时可根据患者情况适当选择。     

经脐单孔腹腔镜与传统腹腔镜胆囊切除术的疗效比较

目的：探析传统腹腔镜胆囊切除术(LC)与经脐单孔腹腔镜胆囊炎切除术(TUSPLC)治疗胆囊结石并发胆源性胰腺炎(ABP)的临床研究。方法对我院2012年10月~2013年8月胆囊结石并发ABP患者80例,按治疗方法的不同分为两组,各40例,观察组进行经脐单孔腹腔镜手术疗法,对照组予以传统腹腔镜胆囊切除术疗法,比较两组的手术各参数指标情况,比较两组术后并发情况。结果观察组的手术各参数指标显著优于对照组(P<0.05);观察组的术后并发情况显著优于对照组(P<0.05)。结论胆囊结石并发ABP患者进行经脐单孔腹腔镜疗法,可有效促进患者病情恢复,较传统LC术较优势,临床效果确切,可靠安全,值得临床推广。     

腹腔镜与开腹子宫肌瘤剔除术的临床比较

目的比较腹腔镜下子宫肌瘤剔除术和经腹子宫肌瘤剔除术的临床效果。方法回顾性分析腹腔镜子宫肌瘤剔除术50例和开腹子宫肌瘤剔除术58例的患者资料,比较2种手术方式的手术时间、术中出血量、术后肛门排气时间、术后病率、术后住院天数、术后复发率等情况。结果两组间肌瘤总重量、剔除肌瘤个数、最大肌瘤直径、手术时间比较,差异无统计学意义;腹腔镜组术中出血量及剔除肌瘤个数均少于开腹组,差异有统计学意义。腹腔镜组术后病率、肛门排气时间、术后住院时间少于开腹组,差异有统计学意义。结论腹腔镜子宫肌瘤剔除术与经腹手术相比具有手术创伤小、出血量少、术后恢复快的优势。     

经脐单孔腹腔镜与传统多孔腹腔镜行胆囊切除术的临床疗效比较

目的：探讨对比分析经脐单孔腹腔镜与传统多孔腹腔镜行胆囊切除术的临床疗效。方法选取86例行腹腔镜胆囊切除术患者,根据手术方式分为经脐单孔腹腔镜组(n=36)和传统三孔腹腔镜组(n=50),比较两组患者术时、术中出血量、术后疼痛、下床活动时间、肛门排气时间、住院时间及花费等指标。结果两组患者在术中出血量、术后疼痛、下床活动时间、肛门排气时间及花费方面的差异无统计学意义(>0.05),经脐单孔腹腔镜组手术用时(58.5±18.2)min明显长于传统三孔腹腔镜组(35.7±8.6)min,经脐单孔腹腔镜组总住院时间(3.8±0.8)d明显短于传统三孔腹腔镜组(6.0±1.2)d,<0.05。结论经脐单孔腹腔镜胆囊切除术临床疗效明显优于传统多孔腹腔镜胆囊切除术,术后疼痛少,感染率低,术后住院时间短。     

经脐单孔与传统三孔腹腔镜胆囊切除术的对比研究

目的：探讨经脐单孔腹腔镜胆囊切除术（LC）的安全性、可行性及临床价值。方法：选择我院收治的胆囊良性病变患者290例,随机分为两组：观察组145例患者,采用经脐单孔LC的方式进行手术;对照组145例患者采用三孔法LC手术方式。对比两组手术时间、术中出血量、术后并发症、术后疼痛程度、开始进食时间及术后住院时间等指标。结果：两组术中出血量、术后进食时间及术后住院时间比较,差异无统计学意义（P〉0．05）;观察组术后疼痛程度明显小于对照组,对照组手术时间则明显短于观察组,两组比较差异均有统计学意义（P〈0．05）。结论：经过本研究可以证实,经脐单孔LC术在临床应用中是安全可行的,其术后疼痛程度明显小于三孔法LC,且具有较佳的美容效果,具有临床推广价值,值得进一步推广。     

腹腔镜下子宫肌瘤剔除术临床应用

目的 评估腹腔镜下子宫肌瘤剔除术(LM)的临床应用价值.方法 2008年1月～2009年12月我院共在腹腔镜下行子宫肌瘤剔除术患者270例,术中肌壁注射垂体后叶素12U,子宫收缩变硬后,在子宫肌瘤最突出部位用单极电凝钩纵切口或横切口切开子宫肌层.如果肌瘤较大,可采用肌瘤表面梭形切口,切去部分肌瘤包膜,再用有齿抓钳钳夹固定瘤核边旋转边向上提拉,钝性分离肌瘤假包膜,完整剥除肌瘤.肌瘤剥除后剖面电凝止血,0-1薇乔线修复子宫.创面小者采用8字缝合,切口大者采用连续及扣锁缝合法.结果 本组病人均成功在腹腔镜下行子宫肌瘤剔除术,术后恢复顺利.结论 腹腔镜下子宫肌瘤剔除术(LM)是一种安全、可行、临床效果好的微创术式.     

探讨开展腹腔镜剔除术治疗子宫肌瘤的临床效果

目的：探讨开展腹腔镜剔除术治疗子宫肌瘤的临床效果。方法将我院收治的86例子宫肌瘤患者作为研究对象,将两组患者随机平均分为对照组和观察组,对照组患者接受传统开腹手术治疗,观察组患者接受腹腔镜剔除术治疗,比较两组患者的术后恢复情况。结果两组患者手术时间比较差异不显著,差异不具有统计学意义(P>0.05);观察组患者的术中出血量、肛门排气时间、下床活动时间和住院时间都优于对照组患者,且两组患者的结果比较具有显著差异,差异具有统计学意义(P<0.05)。结论腹腔镜剔除术治疗子宫肌瘤不仅具有微创、术中出血少的优点,且患者术后恢复速度快,住院时间短,对患者的月经和生育能力影响较小,术后并发症少,既有效治疗了肌瘤,又保留了患者的生育能力。     

腹腔镜与阴式子宫肌瘤剔除术临床疗效比较

目的观察比较腹腔镜与阴式子宫肌瘤剔除术的临床疗效。方法符合手术指征的90例子宫肌瘤患者分为腹腔镜组和阴式组(每组45例),比较疗效。结果二组疗效相似,且术后无并发症发生,住院时间相当。阴式组手术时间、术中出血量、术后排气时间、住院费用明显低于腹腔镜组。结论与腹腔镜手术相比,经阴道手术直视下操作精确、快捷,价格低廉,适应症宽。但由于阴道空间狭窄,易损伤邻近脏器。临床应根据不同情况选择不同的手术方法,达到满意的治疗效果。     

腹腔镜手术与开腹手术治疗子宫肌瘤的比较分析

目的　探讨腹腔镜手术对子宫肌瘤的治疗价值。方法　 12 0例子宫肌瘤患者随机分为腹腔镜手术组和剖腹手术治疗组 ,对两组手术时间、术中出血量、手术并发症、术后恢复情况及疾病复发进行比较分析。结果　 60例腹腔镜手术时间平均 12 8.6min ,术中出血平均 92 .4ml ,剖腹手术组手术时间平均 10 4.3min ,术中出血平均 88.2ml。腹腔镜和剖腹手术组术后并发症发生率分别为 7.7%和 15 %。腹腔镜组手术时间明显长于剖腹手术组 (P <0 .0 1)。结论　腹腔镜下子宫肌瘤切除术用于治疗子宫肌瘤具有创伤小、并发症发生率低的优点     

腹腔镜下子宫动脉阻断后子宫肌瘤剔除术的临床应用价值

目的探讨腹腔镜下子宫动脉阻断后子宫肌瘤剔除术临床应用价值。方法选择2011年1月至2015年1月我院接诊的子宫肌瘤80例患者进行研究。随机分为对照组和观察组,对照组(40例)实施腹腔镜下子宫肌瘤剔除术,观察组(40例)实施腔镜下子宫动脉阻断后子宫肌瘤剔除术,记录分析2组患者手术时间、住院时间、术中出血量、病发率和复发情况。结果 2组患者平均手术时间比较,差异无统计学意义(P0.05);观察组在排气时间与住院时间上均明显短于对照组,差异具有统计学意义(P0.05),对照组的术中出血量(145.20±35.50)mL,明显高于观察组(50.80±21.60)mL,差异具有统计学意义(χ~2=14.367 5,P=0.000 0);观察组术后月经过多改善率达100%,对照组仅为25%,2组比较差异具有统计学意义(χ~2=4.599 6,P=0.032 0);观察组无术后病率(体温高于38℃)、复发的情况发生,对照组术后病率和复发分别为5例(12.50%)和11例(27.50%),2组患者比较差异具有统计学意义(P0.05)。结论腹腔镜下子宫动脉阻断后子宫肌瘤剔除可显著降低患者术中出血量,缩短患者住院时间,降低患者术后并发症发生率,对子宫肌瘤的复发起到很好的抑制作用。     

Surgical treatment of uterine myoma (conservative myomectomy)]

As many as 56 patients with uterine myoma underwent conservative myomectomy. In 40 patients (group I), it was performed by laparotomy and in 16 (group II) ++trans-cervically under the control of hysteroscopy. The group I patients' age amounted on the average to 33.2 +/- 0.6 years, in group II, it was 46.3 +/- 0.8 years. Before operation the size of the uterus ranged from 6 to 32 weeks of pregnancy. Uterine incisions were made with regard to the site of myomatous nodes and the architectonics of the myometrium and vessels. To additionally strengthen++ sutures on the uterus, use was made of containing which provided for more favourable conditions for the formation of the scar on the uterus. Every second patient of the reproductive age manifested menstrual function improvement and 4 women conceived. The data obtained point out that the carrying out of conservative myomectomy is desirable in different age groups. The choice of the surgical technique is dependent on the primary site of myomatous nodes, their dimensions, the patient's age and concomitant extragenital pathology.     

Ultrasound evaluation of uterine wound healing following laparoscopic myomectomy: preliminary results.

The purpose of our work was to study the evolution of the uterine scar following laparoscopic myomectomy, as imaged by ultrasonography and Doppler velocimetry of the uterine arteries. We prospectively studied 30 patients. In the first phase, 15 patients were submitted to two-dimensional (2D) endovaginal ultrasound on day -1, 1, 7, 30 and 60 (surgery = day 0). In the second phase an additional 15 patients were studied by both 2D ultrasound and by Doppler velocimetry. The resistance index (RI) was calculated from the flow velocity waveform of the uterine arteries, at the origin of their ascending branch. Only one ultrasonic pattern was found, which was a dense echogenic area having an ill-defined, heterogeneous texture. In one case a small anechoic area (1 cm) was detected in the scar, possibly due to a haematoma. The evolution of uterine healing showed a progressive reduction in the size of the scar. On day 1 its mean diameter was 37.04% less than the myoma diameter and on day 30 71.7% less. The difference was significant at P < 0.001. A further significant (P < 0.001) reduction was found at day 60 in the 15 patients studied in phase I. On both day 1 and day 30 following surgery, there was no correlation between the sizes of the myoma and the scar. There was a statistically significant increase (P < 0.01) in the RI value of the ipsilateral uterine artery from 0.64 on day -1 to 0.79 on day 1. On day 30, 12/15 (80%) cases had RI values ranging between 0.80 and 0.98, while in three cases there was absence of end diastolic flow. The RI values of the contralateral uterine artery were high (0.90) before surgery and did not change afterwards. There was no correlation between the size of the myoma and the increase in the uterine artery RI value following surgery. Considering the velocimetric findings, 30 days are a reference point for assessing the healing process. Ultrasound imaging and Doppler velocimetry can be used for studying the evolution of the uterine scar following myomectomy.     

Ultrasound evaluation of uterine healing after laparoscopic intracapsular myomectomy: an observational study

STUDY QUESTION Can uterine scar healing after laparoscopic intracapsular myomectomy (LIM) be adequately monitored by traditional two-dimensional (2D) ultrasound (US) and Doppler velocimetry? SUMMARY ANSWER The myometrial area of the scar after LIM can be followed by 2D US and Doppler velocimetry. WHAT IS KNOWN ALREADY Apart from post-surgical adhesions, the main concern linked to laparoscopic myomectomy is the quality of healing of the myometrial incision: it has been suggested that US could be useful for assessing uterine scars after myomectomy. However, no diagnostic method has yet been widely accepted to assess the healing process. STUDY DESIGN, SIZE, DURATION A cohort prospective study (level of evidence II-2), run in University-affiliated hospitals: 149 women with symptomatic uterine fibroids (UFs) underwent LIM, between January 2007 and October 2011. During follow up 13 patients withdrew from the study. PARTICIPANTS/MATERIALS, SETTING, METHODS After LIM, all patients were followed by traditional 2D US scanning and Doppler velocimetry on Days: 0, 1, 7, 30 and 45. Authors evaluated: number, size and location of UFs, scar diameter and Doppler velocimetry and resistance index (RI) of the uterine arteries, at their ascending branch. MAIN RESULTS AND THE ROLE OF CHANCE The uterine examination showed a significant (P < 0.05) progressive reduction of uterine scar area from 78% of the previous UF location on the first day, to 19% on 30th day, and <4% on the 45th day. There was no correlation with the size of the fibroid or the relative reduction in the size of the scar, on both Days 1 and 45. There was a significant (P < 0.05) increase in the RI of the ipsilateral uterine arteries from 0.65 on the first post-operative day to 0.83 after 7 days followed by a decrease to 0.71 on the 30th and 0.61 on the 45th post-operative day. LIMITATIONS, REASONS FOR CAUTION This is a cohort investigation on a limited number of patients and it does not surgically compare LIM and 'classic' myomectomy in the scar US follow up. WIDER IMPLICATIONS OF THE FINDINGS LIM avoided intraoperative bleeding and excessive tissue damage, as post-operative US follow up showed, with just two intra-myometrial hematomas (1.5%). The 2D US and Doppler velocimetry, a non-invasive safe method to check the myometrium after LIM, can detect post-operative hematoma and disechogenic, heterogeneous or ill-defined scar area, all unfavorable signs for myometrial scarring. Moreover, Doppler transvaginal monitoring, evaluating the pulsatility index (PI) and RI of the uterine arteries at their ascending branch, could identify patients with altered PI and RI parameters, possible markers of impaired wound healing. STUDY FUNDING/COMPETING INTEREST(S) None.     

Cell culture and senescence in uterine fibroids

The in vitro growth of cells from uterine fibroids is characterized by an early onset of senescence. Often, an even lower growth potential than that of matching myometrial cells is noted. Also, the tremendous differences in the expression of the high mobility group protein HMGA2 seen when comparing fibroids of different genetic subtypes are surprisingly not reflected by significant differences in their growth potential in vitro. We aimed to evaluate possible changes of the HMGA2 expression level between the native tissue and cell cultures, so we performed quantitative real-time polymerase chain reaction studies that revealed a marked decrease of the HMGA2 mRNA in culture in those cases with overexpression of HMGA2. In the two cases initially showing the highest expression, it decreased by approximately 97%. Associated with the decrease of HMGA2 was a clearly increased expression of the senescence-associated p19^Arf. Together, these findings explain the similar behavior of cell cultures from fibroids of different genetic subgroups and may also offer an explanation for the early onset of in vitro senescence in these cell cultures.     

中西医结合护理对育龄期腹腔镜子宫肌瘤剔除术患者焦虑情绪及胃肠功能恢复的影响

目的:观察中西医结合护理对育龄期腹腔镜子宫肌瘤剔除术患者的效果以及对焦虑情绪及胃肠功能恢复的影响.方法:选择2020年3月至2021年3月于达州市中西医结合医院行子宫肌瘤剔除术的90例患者,按照随机数表法分为观察组与对照组,每组45例.对照组采用常规护理方案,观察组采用中西医结合护理,均持续护理至患者出院.比较两组围手...