悬吊式无气腹腹腔镜与气腹腹腔镜在子宫肌瘤切除术中的多中心、随机对照研究

目的：比较悬吊式无气腹腹腔镜与气腹腹腔镜在子宫肌瘤切除术中的可行性、安全性及手术效果。方法：将3家医院收治的474例子宫肌瘤患者随机分为2组,分别采用悬吊式无气腹腹腔镜（239例）和传统气腹腹腔镜（235例）行子宫肌瘤切除术。比较2组患者的手术时间、术中出血量、术中切除肌瘤数、术后腹腔引流量、术后体温持续时间、肛门排气时间等情况。结果：两种手术方式均能完成子宫肌瘤的切除。悬吊式腹腔镜组和气腹腹腔镜组的平均手术时间分别为（65．5±12．5）min和（100．O±10．5）rain,剥除肌瘤数目分别为（6．0±1．4）个和（2．2±1．3）个,术中失血量分别为（110．5±30．5）ml和（250．4±35．3）ml,术后腹腔引流量分别为（120．5±23．0）ml和（260．2±31．5）ml,均差异显著（P〈O．01）;而术后体温持续时间、肛门排气时间和平均住院时间均无显著差异（P〉0．05）。结论：悬吊式无气腹腹腔镜与气腹腹腔镜均能成功地进行子宫肌瘤的切除,但悬吊式无气腹腹腔镜显示出更多的优势。     

改良腹壁悬吊式无气腹腹腔镜技术在子宫肌瘤剔除术中应用研究

目的探讨改良腹壁悬吊式无气腹腹腔镜技术在子宫肌瘤剔除术中应用的可行性及优势。方法选择2017年12月至2018年12月呼和浩特市第一医院妇产科收治的有手术指征的100例子宫肌瘤患者,随机分为两组,分别应用改良腹壁悬吊式无气腹腹腔镜技术剔除子宫肌瘤(改良组,50例)和传统腹壁悬吊式无气腹腹腔镜技术剔除子宫肌瘤(传统组,50例)。对两组患者的手术时间、出血量、肌瘤剔除平均时间、术后肠功能恢复时间和术后住院时间等进行比较。结果改良组手术时间[(72.3±35.6)min]、出血量[(204.9±167.3)mL]均显著短于和小于传统组[(82.7±31.9)min和(266.7±190.5)mL](均P0.05);改良组单个肌瘤剔除时间[(16.5±6.8)min]、直径6.5 cm的肌瘤剔除时间[(17.4±4.7)min]和直径≥6.5 cm的肌瘤剔除时间[(21.6±9.3)min]均短于传统组[(24.4±10.7)min、(23.2±11.4)min和(27.2±13.2)min](均P0.05);两组在术后肠功能恢复时间和术后住院时间方面差异均无统计学意义[分别为(18.4±6.9)h、(4.2±0.8)d和(16.6±7.3)h、(4.0±0.6)d](均P0.05)。结论改良腹壁悬吊装置无需再安装悬吊棒,改善了术者在腹腔外的手术操作空间,方便了手术操作,使悬吊式腹腔镜手术操作更加简单易行、经济实用,具有一定的临床应用价值,有必要进一步探讨和应用。     

腹腔镜与开腹手术施行子宫肌瘤切除术的临床对照分析

目的　探讨腹腔镜下子宫肌瘤切除术的手术方法、适应证、术后疗效及临床应用价值。方法　回顾性分析比较腹腔镜子宫肌瘤切除术 86例 (观察组 )和开腹子宫肌瘤切除术 72例 (对照组 )患者的手术情况和术后情况。结果　观察组中单发肌瘤 72例 ,多发肌瘤 14例 ,剔出肌瘤 10 2个 ,肌瘤直径 1～ 11cm ,平均 (5 16± 1 88)cm。对照组中单发肌瘤 5 6例 ,多发肌瘤 16例 ,剔出肌瘤 94个 ,肌瘤直径 2～ 18cm ,平均 (6 13± 2 92 )cm。观察组手术时间 (82 0 9± 2 3 5 1)min ,对照组手术时间 (84 6 5± 30 4 8)min(P >0 0 5 )。观察组术中出血 (33 14±2 4 0 2 )mL ,对照组术中出血 (85 5 6± 6 5 13)mL(P <0 0 1)。观察组术后平均 (1 2 8± 0 90 )d体温恢复正常 ,对照组术后平均 (2 82± 1 2 5 )d体温恢复正常 (P <0 0 1)。观察组术后住院 (4 2 2± 1 0 0 )d ,对照组术后住院(6 74± 1 6 7)d(P <0 0 1)。结论　腹腔镜子宫切除术具有创伤小、术中出血少、术后恢复快及住院时间短等优点 ,是目前较为理想的微创手术治疗子宫肌瘤的方法之一。     

腹腔镜下复杂子宫肌瘤剔除术的可行性分析

目的探讨腹腔镜下进行复杂子宫肌瘤剔除术的可行性。方法对67例多发、多部位的子宫肌瘤(即复杂子宫肌瘤)患者在腹腔镜下,使用输尿管红外线显示系统和(或)自制肌瘤分离棒,行子宫肌瘤剔除术,观察手术并发症、手术时间、术中出血量及术后恢复情况。其中多发子宫肌瘤(肌瘤≥5个)者29例,单发子宫肌瘤直径≥7 cm者23例(子宫肌壁间肌瘤19例,子宫浆膜下肌瘤4例),子宫阔韧带肌瘤6例,子宫颈肌瘤9例。剔除子宫肌瘤最多达17个,子宫肌瘤直径≥10 cm者11例,其中直径最大的达15 cm(为阔韧带肌瘤,重2100g)。结果所有病例手术均获成功,无一例中转开腹,无手术并发症发生。平均手术时间(114±32)min,平均术中出血量(114+78)ml,术后平均住院时间5．1d。子宫多发肌瘤、肌壁间肌瘤及宫颈肌瘤术中出血量及手术时间明显多于子宫阔韧带肌瘤及子宫浆膜下肌瘤,差异有统计学意义(P＜0．05)。结论复杂子宫肌瘤剔除术可在腹腔镜下完成,输尿管红外线显示系统的应用,扩大了腹腔镜子宫肌瘤剔除术的手术指征,手术器械的不断创新及熟练的手术技巧是手术成功的关键。     

悬吊式腹腔镜在子宫肌瘤剥除术中的临床应用

目的:比较以悬吊式腹腔镜与开腹行子宫肌瘤剥除术的疗效及应用价值。方法:对52例子宫肌瘤患者行悬吊式腹腔镜子宫肌瘤剥除术(悬吊组),与40例行开腹子宫肌瘤剥除术(开腹组)比较手术时间、术中出血量、术后排气时间、术后疼痛情况、术后并发症等相关指标。结果:悬吊组的手术时间长于开腹组(P<0.05),悬吊组的术中出血量、术后并发症与开腹组无差异(P>0.05),术后排气时间、术后疼痛时间、住院时间均低于开腹组(P<0.05),悬吊组住院费用高于开腹组(P<0.05)。结论:悬吊式腹腔镜下行子宫肌瘤剥除术具有疼痛轻、恢复快、住院时间短的优点,在妇科手术中值得推广。     

悬吊式腹腔镜辅助经阴道子宫切除术20例临床分析

目的探讨悬吊式腹腔镜辅助经阴道子宫切除术的临床应用价值。方法对悬吊式腹腔镜辅助经阴道全子宫切除术20例（腹腔镜组）和经阴道全子宫切除术22例（经阴组）进行分析，比较两组的手术时间、出血量、子宫重量及术后病率、术后肠功能恢复时间、术后住院时间和抗生素应用时间。结果两组的手术时间、出血量、子宫重量及术后病率差异均无显著性（P〉0．05）。术后腹腔镜组的肠功能恢复时间、术后住院时间和抗生素应用时间均显著小于经阴组（P均〈0．05）。结论悬吊式腹腔镜辅助经阴道全子宫切除术具有创伤小、术后恢复快及住院时间短等优点，是一种较好的微创手术切除子宫的方法。     

腹腔镜下与开腹下子宫肌瘤剔除术的比较分析

目的 通过与开腹下子宫肌瘤剔除术的比较，得出腹腔镜下子宫肌瘤剔除术(LM)的优点。方法 选择1998年4月～2004年10月我院单发子宫壁间肌瘤39例行肌瘤剔除术的患者，其中腹腔镜下手术20例，开腹下19例．对两组患者手术中出血量、手术时间、住院时间等进行比较。结果 LM较开腹子宫肌瘤剔除术具有出血量少、手术时间短、住院时间短、美观等优点。结论 LM具有微创、恢复快、出血少等优点，是一种理想的保留器宫的术式。     

阴式子宫肌瘤剔除术与腹腔镜子宫肌瘤剔除术的对比观察

目的评估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疗效。方法选取2013年1月~2015年4月我院收治的子宫肌瘤患者90例,随机分为阴式组和腹腔镜组,各45例。阴式组患者采用阴式子宫肌瘤剔除术,腹腔镜组患者采用腹腔镜子宫肌瘤剔除术,观察记录两组患者的术中(手术时间、术中出血量、剔除肌瘤数)、术后(术后肛门排气时间、平均住院时间)指标及术后复发率情况。结果阴式组术中的手术时间、术中出血量和剔除肌瘤数均显著优于腹腔镜组,差异有统计学意义(P0.05);两组患者术后指标及术后复发率对比,差异无统计学意义(P0.05)。结论阴式子宫肌瘤剔除术在手术时间、术中出血量和剔除肌瘤数上均显著优于腹腔镜子宫肌瘤剔除术,具有一定的推广价值。     

开腹和腹腔镜下子宫肌瘤切除术后患者妊娠结局临床分析

目的探讨不同手术方式子宫肌瘤切除术对妊娠结局的影响。方法回顾性分析2009年1月至2014年10月北京大学人民医院妇产科收治的有开腹或腹腔镜下子宫肌瘤切除史101例孕妇的临床资料。根据手术方式将其分为腹腔镜组(50例)和开腹组(51例)。比较两组孕妇子宫肌瘤切除术中肌瘤的位置、大小、数目、术后感染、妊娠距手术时间及妊娠后母儿结局。结果腹腔镜组和开腹组孕妇的年龄、手术中肌瘤大小、类型、部位和个数比较,差异均无统计学意义(P0.05)。腹腔镜组手术后妊娠时间[(2.7±1.2)年]与开腹组[(4.3±2.5)年]比较,差异有统计学意义(P0.05)。两组孕妇的分娩孕周、阴道分娩、产后出血量、早产、新生儿体质量2 500g比例比较,差异均无统计学意义(P0.05)。两组孕妇均无前置胎盘、胎盘早剥及胎盘植入发生。腹腔镜组发生1例子宫破裂。结论开腹或腹腔镜下子宫肌瘤切除术对有生育要求的子宫肌瘤患者均安全可行,可获得较满意的母儿结局。     

腹腔镜子宫肌瘤剔除手术的相关因素分析

目的探讨腹腔镜子宫肌瘤剔除的指征、局限、技巧和影响手术疗效的因素.方法对2001年1月～2003年8月167例腹腔镜子宫肌瘤剔除术患者的临床资料进行回顾性分析.结果 167例患者共剔除肌瘤293个,每例患者剔除肌瘤数目1～9个不等;其中单发肌瘤102例,多发肌瘤65例;肌壁间肌瘤92例,浆膜下肌瘤50例,25例子宫肌壁间与浆膜下肌瘤同时存在;平均肌瘤三径分别为:(6.30±1.49)cm、(5.62±1.41)cm、(5.49±1.30)cm.最大肌瘤体积为11.3 cm×10.0 cm×8.7 cm.腹腔镜下完成手术操作157例,10例小切口辅助或中转开腹手术,包括1例肠管损伤,2例腺肌瘤无明确肌瘤包膜,开腹行腺肌瘤挖除及子宫体重建术.平均手术时间114.80 min,平均术中出血量87.28 ml.肌瘤直径大于等于6 cm时手术时间和术中出血量明显延长和增加(P<0.05);肌壁间肌瘤的手术时间和术中出血量明显高于浆膜下肌瘤(P=0.001);手术并发症1.19%.结论腹腔镜子宫肌瘤剔除是一种微创伤、安全、有效的手术方法,合适的指征选择和镜下缝合技术是保证手术成功的关键.     

The treatment of failed laparoscopy using open laparoscopy

There are over 300,000 laparoscopies done each year in the United States, and about 60,000 in England. “Failed laparoscopies” in which the procedure cannot be accomplished, has variously been reported in 0.043–4.3/1000 cases. A reasonable estimate of failed laparoscopy of 0.75% suggest that up to 2250 cases of “failed laparoscopy” occurs each year in the USA and 450 in UK. The translation of such failures into the personal experience of patients and the overall cost is staggering despite the fact that failures are not common. Three cases of “failed laparoscopy” in which the procedure was easily completed by open laparoscopy are reported and discussed. Familiarity with the techniques of open laparoscopy could virtually eliminate the incidence of failed laparoscopies.     

Operative laparoscopy

Operative laparoscopy has almost replaced laparotomy as the approach for treating ectopic pregnancy, adhesiolysis, distal tube disease, and other gynecologic problems. Required and/or suggested operating room equipment for operative laparoscopy include insufflator, video equipment, irrigator, coagulator, TV monitor, 2 Mayo stands, laser, an operating table, and Allen stirrups. The surgeon also needs the following surgical instruments: graspers, various scissors, hemostatic instruments, irrigation and suction instruments, and suturing instruments such as staplers and clip appliers. He/she must confirm that the patient has undergone a routine medical history, physical, and laboratory tests (e.g., CBC and urinalysis) and has been well informed about the surgery. The surgeon should perform operative laparoscopy under general anesthesia with endotracheal intubation. Operative laparoscopy results in decreased hospitalization, rapid return to activity, and likely economic benefits. In ectopic pregnancy cases where the patient wishes to bear future children, salpingostomy is the best procedure. Traditional treatment for distal tubular disease tends not to be very effective. Even if the results from operative laparoscopy were not much better, operative laparoscopy is the best surgical procedure choice for distal tubular disease since it leads to reduced morbidity and rapid return to normal activity. The 3 recommended techniques for distal tubal surgery include simple eversion salpingostomy, incisional salpingostomy suture, and the Bruhat technique. Surgeons can also use operative laparoscopy for removing an ovary, ovarian cysts, and uterine tumors.     

Open laparoscopy. Contribution to safe gynecologic laparoscopy

A modified form of "open" laparoscopy is proposed starting from the different estimation of the risk of "closed" laparoscopy, the differently manipulated technical procedure, the considerable possibilities of complications and their control especially at smaller gynaecologic departments. Safety and easy manipulation are underlined, first of all in extremely obese patients. Usage of this method is recommended even at smaller departments.     

Operative laparoscopy

The single-puncture laparoscope offers the advantages of 1 puncture, 1 closure, and less chance of bleeding. The double-puncture, which is the more popular, allows a multiplicity of instruments to be inserted via the 2nd hole, a good working angle, and a 180-degree angle of vision which is almost equal to that of laparotomy. This technique requires more time and there is the possibility of bleeding at the 2nd site. However, if the trocar is introduced under direct vision, there is little likelihood of the mishap. Large amounts of peritoneal fluid and ovarian cysts may be aspirated through this technique. It has been used successfully for lysis of adhesions through the traction and countertraction technique and for tubal sterilization. Techniques are discussed for cauterization of endometrial implants, uterine suspension, recovery of foreign bodies (generally IUDs) and recovery of ova (which has been restricted to laboratory animals so far). Its use in biopsies is also discussed. Great care must be taken when using the laparoscope, but used expertly is it a great tool.     

Transvaginal laparoscopy

Transvaginal laparoscopy (TvL) offers an alternative to standard diagnostic laparoscopy in subfertile patients without obvious pelvic pathology. With a specially developed needle-trocar system, access to the pouch of Douglas is gained through a needle puncture of the posterior fornix. Performed under local anaesthesia or sedation with the patient in a dorsal decubitus position and using prewarmed Ringer lactate as a distension medium, TvL allows complete exploration of the tubo-ovarian structures without supplementary manipulation. The combination of transvaginal sonography and transvaginal endoscopy, including minihysteroscopy, TvL, salpingoscopy and chromopertubation test, permits the most complete exploration of the reproductive tract and can be used as a first-line investigation of female fertility in a one-stop infertility clinic. As the transvaginal route offers easy access to the tubes, ovaries and fossa ovarica, some operative procedures are possible. However, in the absence of a panoramic view, these will be limited to minor interventions.     

Mouse laparoscopy

STUDY OBJECTIVE: To develop a technique for performing laparoscopy in the mouse. DESIGN: Controlled animal study (Canadian Task Force classification II-1). SETTING: University research laboratory. SUBJECTS: Twenty-eight CD-1 pregnant mice. INTERVENTION: Eight mice underwent anesthesia only and 20 had anesthesia plus laparoscopy at 5.5 and at 10.5 days' gestation (implantation occurs on day 4.5 and delivery on days 19-20). MEASUREMENTS AND MAIN RESULTS: Four mice in the laparoscopy group died early in the series, three due to hemorrhage and one due to anesthetic overdose. Among survivors, there were no differences between operated and control groups in number of pups delivered at term (8.7 +/- 5.1 and 8.9 +/- 3.8, respectively), frequency of pregnancy failure (18.8% and 12.5%), and presence of intraabdominal adhesions on autopsy after delivery (12. 5% and 12.5%). Intraabdominal contents could be manipulated to visualize both uterine horns in their entirety. The number of gestations could be counted accurately as early as 1 day after implantation. CONCLUSION: Given the fact that laparoscopy is not accompanied by the immunosuppression characteristic of laparotomy, this technique could prove useful for investigations requiring intraabdominal manipulations in mice when preservation of immune function is critical. The technique can be performed safely and repeatedly after an initial learning period. (J Am Assoc Gynecol Laparosc 6(2):173-177, 1999)