新式非脱垂子宫经阴道切除术的临床观察

目的:探讨新式非脱垂子宫经阴道切除术的临床应用价值。方法:分析2000年12月~2005年12月间120例非脱垂子宫阴式子宫全切除术和120例同期指征相近的腹式子宫切除术的手术时间、术中出血量、术后体温、排气时间、下床活动时间、住院天数及术后3~6个月随访情况。结果:新式非脱垂子宫经阴道切除术的120例患者手术均成功,无1例中转开腹,无1例发生严重并发症。新式TVH组与腹式组比较各项指标均有显著差异(P均<0.01)。结论:用特殊的阴式子宫切除器械,通过对术式改进,使该手术变得简单易行。新式TVH组子宫切除较腹式子宫切除组手术时间短、术中出血量少,腹腔干扰少、术后胃肠功能恢复早、术后疼痛轻、住院时间短,腹壁无疤痕,值得临床推广应用。     

Complex one-stop investigation of infertility: transvaginal hydrolaparoscopy

One of the intensively discussed topics recently is investigation of infertile patients. A subject of particular interest is a new technique - transvaginal hydrolaparoscopy (TVHL), which has already found its place amongst other methods of infertility exploration. Transvaginal hydrolaparoscopy allows atraumatic investigation of reproductive organs in physiologic conditions, in ambulatory settings. Significant, for clinical practice, is the possibility of a combination of transvaginal hydrolaparoscopy with other methods of investigation - sonohysterosalpinogography, hysteroscopy and salpingoscopy, which make possible integrated exploration of the reproductive system. Instillation of saline into the pelvic cavity through uterine tubes (or through puncture needle if needed) under ultrasonographic control and exposition of posterior fornix, allows better orientation in the pouch of Douglas, complex assessment of reproductive organs and determination of advisability of pelvioscopy - the relatively invasive technique as well as thorough control of the safe access to the pouch of Douglas.     

经阴道彩超引导穿刺治疗盆腔包裹性积液

目的:观察经阴道彩超引导穿刺治疗妇科盆腔包裹性积液疗效并总结开展该疗法的经验。方法:用该法治疗盆腔包裹性积液68例。尽量抽尽积液后用生理盐水反复冲洗并根据具体情况注入抗生素;其中同时注入抗粘连药物15例。术后1个月～3个月后复查,随访3个月～2a。结果:治疗后3个月复查68例中48例积液消失,20例盆腔包襄性积液均有不同程度缩小,其中直径缩小1/2以上有15例,有效率100%。结论:用该法治疗妇科盆腔包裹性积液简便安全、经济,患者痛苦少,疗效确切。     

子宫内膜超声类型及厚度与妊娠的关系

目的　分析使用促性腺激素诱发排卵的病人子宫内膜的类型及厚度与妊娠关系。方法　回顾性分析 13 5个治疗周期具有均质征子宫内膜、三线征子宫内膜以及子宫内膜厚度≤ 9mm ,≥ 10mm的妊娠结果。结果　 13 5个治疗周期中 ,三线征子宫内膜为 10 7个周期 ( 79% ) ,均质征子宫内膜 2 8个周期 ( 2 1% ) ,在三线征子宫内膜妊娠率为 2 2 % ,均质征子宫内膜妊娠率为 7% ,二者妊娠率有明显差别 (P <0 0 1) ,子宫内膜厚度≥ 10mm时 ,妊娠率明显提高。结论　使用促性腺激素诱发排卵时 ,在hCG注射前 ,子宫内膜呈均质征以及内膜厚度≤ 9mm时 ,妊娠率明显降低     

阴道超声在已婚女性输尿管下段结石诊断中的价值

目的探讨阴道超声检查在诊断已婚女性输尿管下段结石的应用价值。方法回顾性分析我院2008年5月～2011年5月收治的疑为输尿管下段结石的女性患者资料，对其进行阴道超声检查同时与X线检查对照分析。结果80例患者中，阴道超声检查诊断下段结石符合79例，诊断符合率为98．75％，1例漏诊。结论阴道超声检查输尿管下段结石诊断率高，可重复性强，对患者无损伤，无痛苦，操作简便，明显优于x线检查，在临床工作中具有重要的应用价值。     

非脱垂大子宫经阴道切除术120例分析

目的探讨非脱垂大子宫经阴道切除术的临床价值。方法选择2007年2月至2009年2月在广东省博罗县人民医院行经阴道子宫切除(TVH)120例作为观察组,经腹子宫切除(TAH)136例作为对照组,观察术中、术后情况。结果TVH组手术成功率98.33%,膀胱副损伤发生率0.008%。观察组与对照组比较,手术时间分别为(93.1±21.6)min,(88.3±14.8)min;出血量分别为(90.0±25.5)mL,(98.7±30.6)mL,差异无显著性,P>0.05。术后肠功能恢复时间分别为(24.9±7.8)h,(50.3±8.6)h;术后平均住院日分别为(5.3±1.2)d,(8.7±1.6)d;术后镇痛率分别为30.5%、97.1%;术后阴道残端息肉发生率分别为9.3%、1.5%,均P<0.05。结论非脱垂大子宫阴式切除术创伤小,术后康复快,手术安全可行。     

Transvaginal Bladder Neck Suspension to Cooper’s Ligament: A Review of the Literature

The aim of this paper was to review the surgical technique and clinical experience of transvaginal bladder neck suspension to Cooper’s ligament. A computerized MEDLINE search identified five English-language articles published between January 1990 and December 1998. The success rate obtained with this procedure is comparable to that obtained with the traditional Burch procedure and ranges between 86.4% and 100%. Postoperative de novo detrusor instability occurs infrequently, with an incidence ranging between 0% and 20%. Complications occur infrequently and postoperative voiding dysfunction is rare. Limited postoperative urodynamic data are available. Transvaginal suspension of the bladder neck to Cooper’s ligament combines the technique of a needle suspension with the anatomic effect of the Burch procedure.     

Laparoscopic management of ovarian pregnancy.

BACKGROUND: Ovarian pregnancy (OP) comprises 0.15% of all pregnancies and 1% to 3% of ectopic gestations. CASE REPORT: Two cases of OP detected and treated during laparoscopy for suspected ectopic pregnancy are described. We used clinical examination, serum beta-hCG levels, and transvaginal ultrasonography (TVS) preoperatively to confirm the suspected diagnosis of extrauterine pregnancy. In the first patient, oophorectomy was performed, whereas the second patient was treated by an ovarian wedge resection to restore and preserve ovarian integrity. Postoperative recovery periods were normal in both patients, with no further therapeutic intervention in the follow-up course. CONCLUSION: Primary OP may occasionally occur in patients with a suspected ectopic pregnancy. Signs and symptoms suggestive of extrauterine pregnancy, TVS, and serum beta-hCG dynamics can be a useful adjunct to allow the preoperative diagnosis of OP prior to the use of the diagnostic gold standard, diagnostic laparoscopy. Preservation of ovarian tissue should be the therapeutic goal to maintain ovarian reserve and preserve fertility in young women with OP.     

Transvaginal vs transobturator approach for synthetic sling placement in patients with stress urinary incontinence

We present comparative short-term experience with the transvaginal (TVT) and the transobturator (TVT-O) approaches for the treatment of stress urinary incontinence (SUI). We studied 315 women with SUI, treated with a tension-free tape placement. The TVT approach was applied in 265 women, while 50 women were treated by the TVT-O approach. The mean operation time was 25 and 17 min in the TVT and TVT-O group, respectively (p < 0.001). In the TVT group, continence rates were 87% after 1 year, while in the TVT-O group, the continence rate was 94%. Postoperative pain was reported in 14.4 and 28% of the TVT and TVT-O patients, respectively (p = 0.02). Complications such as bladder perforation, retropubic hematoma, and urinary retention took place only in the TVT group. Urinary tract infections were recorded in 20 and 8% of the TVT and TVT-O patients, respectively (p = 0.04), while vaginal erosion took place in 1.5 and 2% and de novo urgency in 14 and 8%. Both approaches show high rates of cure at the first postoperative year, while complications are less with the TVT-O procedure.     

经腹和经阴超声诊断卵巢囊性肿块的比较研究

目的探讨腹部超声和阴道超声对卵巢囊性肿块的诊断及鉴别诊断的临床价值。方法对186例门诊拟诊为卵巢囊肿患者的临床资料进行回顾性分析，比较其经腹部及经阴道超声的诊断符合率。结果经腹部超声检查阳性患者88例，误诊17例，临床诊断符合率为80．68％。经阴道超声检查阳性患者98例，误诊8例，临床诊断符合率为91．83％。经x2检验，两组临床诊断符合率比较差异有统计学意义（P〈0．05）。结论高分辨率的阴道超声检查在诊断卵巢囊性肿块中具有明显的优势，较腹部超声检查具有更高的准确性，必要时可联合应用经阴超声和经腹超声，正确识别声像图特征，提高诊断的准确性。