腹腔镜双极电凝全子宫切除术133例临床分析

目的 探讨双极电凝在腹腔镜全子宫切除术中的可行性和安全性.方法 2005年1月至2007年6月在中山大学附属佛山医院将有腹腔镜全子宫切除术指征的患者133例随机分为双极电凝组和超声刀组,观察两组患者的手术时间、术中出血量、并发症、住院时间以及预后等.结果 手术时间双极电凝组(90.64±10.72)min,超声刀组(89.11±10.23)min.两组无统计学意义(P=0.213);术中出血量双极电凝组(78.72±25.27)mL,超声刀组(99.23±28.89)mL,双极电凝组的术中出血量明显少于超声刀组(P=0.000);两纽术中并发症、住院天数、预后均无统计学意义.结论 双极电凝应用于腹腔镜全子宫切除术是安全、可行的.只要掌握双极电凝的操作技巧,双极电凝不失为一种简便、经济的能源器械.     

妇科腹腔镜手术中结扎束血管闭合系统与双极电凝止血的对比研究

目的：比较结扎束血管闭合系统（简称结扎束）与双极电凝在妇科腹腔镜手术中应用的效果及安全性。方法：对180例妇科腹腔镜手术的患者进行回顾性分析（包括输卵管切除术、输卵管及卵巢切除术、子宫全切术）,90例使用结扎束血管闭合系统（LigaSure血管闭合系统）闭合卵巢和子宫血管,另90例使用普通双极电凝钳凝固闭合卵巢和子宫血管,比较2组手术时间、术中出血量、术后恢复情况及近期术后并发症的发生情况。结果：2组术后住院时间及排气时间差异无统计学意义（P＞0.05）,手术时间及术中出血量差异有统计学意义,结扎束组少（短）于双极电凝组（均P＜0.05）;术后最高体温结扎束组低于双极电凝组（P＜0.05）。结论：结扎束血管闭合系统较双极电凝更安全,更有效地闭合血管,减少出血量及缩短手术时间,减少术后发热。     

不同子宫切除术式的临床疗效分析

目的探讨腹腔镜下不同子宫切除术的临床疗效。方法回顾性分析2000～2004年78例患者分别行腹腔镜下子宫次全切除术（LSH）、改良筋膜内子宫全切术（MCISH）或腹腔镜辅助的阴式子宫切除术（LAVH），比较三组患者术中、术后情况。结果三组患者的手术时间、术后疼痛发生率、术后使用抗生素时间、体温升高、肛门排气时间、术后下床活动时间和术后住院时间差异均无显著性，手术时间、术中出血量LAVH组较LSH、MCISH组显著增加，LAVH、MCISH组术后性生活恢复时间均较LSH组延长。三组均无手术并发症发生。结论腹腔镜子宫全切术具有创伤小，腹腔内环境干扰小，恢复快等优点。腹腔镜下子宫次全切除术、筋膜内子宫切除术和腹腔镜辅助阴式子宫切除术都是安全可行的，三种手术方式各有其优缺点，术式选择应根据设备的情况、患者情况及术者对手术方式的掌握程度来定。     

宫腔镜双、单极电切割粘膜下子宫肌瘤的对照研究

目的:探讨宫腔镜下双极汽化切割粘膜下子宫肌瘤的临床价值。方法:双极汽化切割粘膜下子宫肌瘤61例与单极电切割粘膜下子宫肌瘤65例,就两组患者临床特征、手术时间、术中出血量、膨宫液量和并发症进行对比分析。结果:两组患者年龄、术前血红蛋白(HGB)、肌瘤大小、宫腔深度差异无显著性(P>0.05),手术时间、术中出血量、膨宫液量和术中并发症差异有显著性(P<0.01)。结论:宫腔镜双极汽化切割术与单极电切割术相比,具有手术时间短、术中出血少、膨宫液量少、并发症少等优点,宫腔镜双极汽化切割术可替代单极电切割术。     

两种改良腹腔镜术式行大子宫切除的比较

目的：比较改良腹腔镜大子宫切除术（TLH）与改良腹腔镜辅助阴式大子宫切除术（LAVH）的临床效果。方法：回顾分析2007年1月~2012年12月我院收治的127例大子宫（子宫大小≥孕12周）切除术患者的临床资料,其中改良TLH组65例,改良LAVH组62例。比较两组的手术时间、术中出血量、子宫重量、术后排气时间、术后住院时间及围术期并发症的发生率。结果：127例患者手术均能顺利完成,改良TLH组2例术中转LAVH完成,无一例中转开腹。改良TLH组的手术时间[（116.0±30.4）min]、出血量[（98.3±45.8）ml]均显著低于改良LAVH组[（147.0±40.4）min,（133±41.7）ml]（P〈0.05）。两组的子宫重量、术后排气时间、术后住院时间及围术期并发症发生率均无显著差异（P〉0.05）。结论：两种术式均为微创、安全、有效,改良TLH比改良LAVH手术时间短,出血少。应综合考虑患者的具体情况、术者手术经验和技术及手术设备和器械因素选择安全、有效术式。     

腹腔镜下电凝和缝合止血对残留卵巢储备功能影响的对比研究

目的:对比研究腹腔镜下卵巢囊肿剥除术中残留卵巢创面采用双极电凝和缝合止血方法对卵巢储备功能的影响。方法:双侧卵巢囊肿患者90例,卵巢囊肿均位于卵巢门部位以外。随机分为电凝组(45例)和缝合组(45例)。比较两组患者术后的血清E2、FSH、LH以及窦卵泡计数(AFC)的变化情况。结果:全部患者均顺利完成手术,术中未发生任何并发症。两组患者术后与术前比较,E2和AFC均显著下降,FSH显著升高,差异均有统计学意义(P<0.05),而LH差异无统计学意义(P>0.05)。两组患者术后组间比较,E2、FSH以及AFC差异无统计学意义(P>0.05)。两组术后均有1例患者新发生卵巢储备功能下降,均无卵巢功能衰竭病例发生。结论:对囊肿位于卵巢门部位外的卵巢囊肿患者,腹腔镜下卵巢囊肿剥除术中,残留卵巢创面采用双极电凝和缝合止血方法对卵巢功能影响无明显差异。     

宫腔镜双极汽化切割手术42例分析

目的 :探讨宫腔镜双极汽化切割手术的安全性和疗效。方法 :术前宫腔镜诊断均为粘膜下或肌壁间突向宫腔肌瘤 42例 ,在宫腔镜下施行双极汽化切割手术。结果 :手术成功率 10 0 %,手术时间 2 8 71± 13 83分钟 ,出血量 16 0 7± 12 17ml,标本组织重量 32 2 4± 7 4 6g,术中、术后无并发症 ,术后 3、6、12和 2 4个月随访有效率分别达 97 1%、97 1%、94 3%和 91 4 %。结论 :宫腔镜双极汽化切割手术具有手术时间短、出血少、无并发症等优点 ,疗效满意 ,可替代单极电切割术。     

LEEP刀宫颈环切诊治宫颈疾病临床分析

目的：探讨LEEP刀宫颈环切术诊治宫颈疾病的临床应用和疗效。方法：选取我院在2012年1月至2013年1月收治的宫颈疾病患者115例，对所有患者均行LEEP刀宫颈环切术。结果：115例患者手术均成功，手术平均时间为13．5min，术中平均出血量16．9ml，对所有患者进行3个月的随访，总体治愈率为95．6％（110／115）。结论：应用LEEP刀治疗宫颈疾病患者疗效确切，且具有手术时间短，术中出血量少，对周围组织伤害小、疼痛轻、操作简单等绝对优势，值得临床推广。     

腹腔镜辅助阴式子宫切除术与阴式子宫切除术适应证的探讨

目的通过比较腹腔镜辅助阴式子宫切除术(LAVH)与阴式子宫切除术(VH)的不同手术适应证及效果,探讨LAVH与VH手术病人的最佳选择。方法回顾性分析上海瑞金医院1999年6月至2002年12月间LAVH与VH手术病例381例,比较两种手术在手术时间、出血量、术后住院日、术中术后并发症及两者的手术适应证,尤其是子宫大小、盆腔粘连等的不同。结果两组手术在术中出血、手术并发症等方面差异无显著性意义,LAVH手术时间较长与患者子宫大、盆腔粘连者多、手术难度大有关。VH组患者均为正常或小于正常大小的子宫、无盆腔粘连、不伴有附件疾病者,手术适应证明显受限制。结论VH与LAVH均为创伤小、恢复快的微创手术,但VH适合于子宫小、无粘连并伴下垂者,而LAVH扩大了VH的适应证,是值得推广的手术。     

双极汽化电切技术在绝经后妇女宫腔内病变的应用

目的　探讨双极汽化电切技术在绝经后妇女的良性宫腔病变的应用。方法　患者为 2 0 0 1年 1 0月～ 2 0 0 3年 4月于我院妇科病房收治的接受宫腔镜手术治疗的绝经后妇女。术后病理诊断为子宫内膜息肉或粘膜下子宫肌瘤的患者共 1 0 4例。患者分为A、B两组。A组 5 4例 ,给予双极系统电切除手术 (TCRP或TCRM) ;B组 5 0例 ,给予单极系统切除手术。手术在连续硬膜外麻醉下进行 ,应用Versapoint系统 (Gynecare)和单极电切(Olympus)系统。所得组织均送病理检查 ,证实诊断。结果　患者平均年龄 6 3 0± 6 2岁 (4 8～ 74岁 ) ,平均绝经时间 1 2 4± 7 4年 ,阴道分娩次数 2 0± 1 2次 (0～ 4次 ) ,1 5 38% (1 6 / 1 0 4例 )无阴道分娩史 ,4 0 38% (4 2 / 1 0 4例 )单独合并高血压等心血管疾病 ,5 77% (6 / 1 0 4例 )单独合并糖尿病 ,另 5 77% (6 / 1 0 4例 )同时合并高血压和糖尿病。A、B两组患者在平均年龄、绝经时间和阴道分娩次数相匹配。比较两组的手术结果 :术后均未见复发 ;B组 1例患者手术中发现子宫穿孔。A组平均手术时间较B组缩短 (P <0 0 5 ) ,差异有显著性。结论　在绝经后妇女的宫腔镜手术中 ,双极系统可以节省手术时间而且是比较安全 ,有效的。因此它在此类手术中有一定的发展前景     

腹腔镜子宫次全切除术中超声刀的应用

目的　探讨超声刀在腹腔镜子宫次全切除术中的应用价值。方法　 2 0 0 2年 1～ 12月在腹腔镜下分别应用超声刀和双极电凝及剪刀进行子宫次全切除术 ,比较术中出血量、手术时间、术后平均住院日及肛门排气时间。结果　超声刀组的平均手术时间、术中平均出血量显著少于双极电凝组 (P <0 0 1) ,术后平均住院日及肛门排气时间在两组间差异无显著性 (P >0 0 5 )。结论　超声刀可应用于妇科腹腔镜子宫次全切除术 ,由于其操作简单、安全可靠 ,值得推广。     

Comparison of the use of electrothermal bipolar vessel sealer with harmonic scalpel in total laparoscopic hysterectomy

AIM: The aim of the present study was to compare the use of electrothermal bipolar vessel sealer (EBVS) with harmonic scalpel (HS) during total laparoscopic hysterectomy with respect to operation time, estimated blood loss and related complications. METHODS: A retrospective study was conducted in the university hospital. Forty patients who underwent total laparoscopic hysterectomy and bilateral salpingo-oophorectomy were enrolled. Nineteen hysterectomies were performed with HS and in 21 patients the same surgeons used EBVS. Data about the characteristics of the patients, operation time, estimated blood loss, uterine weights, related complications and length of hospital stay were registered and compared. RESULTS: Mean procedure time and estimated blood loss were significantly less in the EBVS arm (59.57 +/- 3.71 vs 90.95 +/- 5.73 min, P < 0.001; 87.76 +/- 25.48 vs 152.63 +/- 60.90 mL; P < 0.001, respectively). The change in hemoglobin and hematocrit values was found to be more significant in the HS group. CONCLUSION: EBVS was found to be less time-consuming and caused less bleeding when compared with HS.     

Laparoscopic surgical staging for uterine malignancies using harmonic shears (UltraCision) in comparison to electrosurgery: operative technique, feasibility and complications

This retrospective study assesses and compares perioperative parameters in two groups of patients treated by different operative techniques of laparoscopic surgical staging (LASS) for uterine cancer. Between April 1996 and May 2005, 119 consecutively selected women with cervical cancer (n=30) or clinical stage I endometrial cancer (n=89) underwent laparoscopic assisted vaginal hysterectomy (LAVH), total laparoscopic hysterectomy (TLH) or radical laparoscopic assisted vaginal hysterectomy (RALVH) plus bilateral salpingo-oophorectomy (BSO) and/or lymph node dissection (LND) during a primary surgical procedure using an electrosurgery (ELC, n=37) or ultrasonic (US, n=82) operative technique (harmonic shears, UltraCision). The UltraCision was used as a primary method of dissection and hemostasis from 1999. We were unable to perform prompt and thorough hemostasis in 2 patients from the US group (successful procedure rate 97.5%) because of ineffective post-ultrasonic coagulation of venous paravaginal varices (RALVH procedure) and of vena ovarica varices (LAVH, BSO procedure). The UltraCision was effective in all cases of lymphadenectomy. Successful procedure rate of the ELC operative technique was 100%. There were no statistically significant differences between the groups with regard to operation time, blood loss, hospital stay, and complications. There was a significant difference (P<0.001) in the number of lymph nodes harvested: a mean of 18.1 in the US group and 13.7 in the ELC group. We think that the difference was influenced by an increase in experience with laparoscopic lymph node dissection. The UltraCision operative technique ensures efficient dissection, coagulation, cutting, and grasping for LASS in women with cervical and endometrial cancer.     

妇科肿瘤腹腔镜手术中超声刀应用技巧及副损伤防治

超声刀是一种把电能转换为机械能的手术器械,主要工作原理是通过刀头的振荡摩擦产生热能作用在组织上,具有凝血和切割同时完成、刀头温度低、侧向热传导小、无电流刺激等特点。在妇科恶性肿瘤手术的一些关键技术操作上有独特优势,提高了腹腔镜手术的安全性和减少了术后的一些并发症。超声刀引起的输尿管或肠管的损伤,仍然按照热损伤的原则进行防治和处理。     

卵巢肿物剥除术不同止血方式对卵巢功能的影响

目的探讨卵巢肿物剥除术中使用可吸收线缝合、单、双极电凝及超声刀四种方式止血对卵巢功能的影响。方法共200例单侧卵巢良性肿瘤患者均行卵巢肿物剥除术,按不同止血方式分为超声刀组、单极电凝组、双极电凝组、可吸收线缝合组每组50例,分别于术前、术后1个月、术后3个月及术后6个月的月经周期第2~3天化验卵泡刺激素（FSH）、促黄体生成素（LH）、雌二醇（E2）,并行阴道彩超监测卵巢窦卵泡数（AFC）,同时随访术后6个月期间的月经变化。结果四组患者术前性激素、窦卵泡数及月经改变比较差异无统计学意义（P〉0.05）。术后1个月较术前均出现E2下降和FSH、LH增高及窦卵泡数减少,与术前比较差异均有统计学意义（P〈0.05）;术后3个月可吸收线缝合组激素水平基本恢复术前水平,其余三组较术前比较差异均有统计学意义（P〈0.05）,超声刀组E2水平偏高,FSH、LH水平偏低,与其余两组比较差异有统计学意义（P〈0.05）,可吸收线缝合组及超声刀组窦卵泡数恢复正常范围;术后6个月超声刀组激素水平基本恢复,但单极组、双极组E2、FSH、LH较术前比较差异仍有统计学意义（P〈0.05）,但较之术后1个月比较,E2有所升高,FSH、LH有所降低,差异有统计学意义（P〈0.05）。窦卵泡数较术前比较差异均无统计学意义（P〉0.05）。月经的改变主要表现为月经周期延长、月经量减少,偶有经期延长及轻微潮热出汗,情绪烦躁的表现,但在术后3~6个月间症状基本消失,并没有出现闭经及严重围绝经期症状的患者。结论卵巢肿物剥除术中可吸收线缝合对卵巢功能影响最小而恢复最快的。超声刀组较高频电刀组（单极、双极）恢复快,影响小。     

Laparoscopic assisted vaginal hysterectomy: one group's experience

Laparoscopic assisted vaginal hysterectomy (LAVH) has been reported worldwide. We report our experience with LAVH in 51 patients, 23 with the laparoscopic stapling device, 12 with a combination of stapler and bipolar coagulation, and 16 by bipolar coagulation exclusively. No operations were converted to laparotomy, and there were few minor complications. Average operating time was 1 h and 38 min. Hospital stay averaged 2.2 days. Average hospital costs were greater for the stapling devices ($7815.00) compared with bipolar coagulation ($7150.00). Postoperative patient satisfaction was high (96%), with high resolution of the symptoms (94%). We conclude that LAVH is a safe, effective operation in selected cases and may be a valid alternative to abdominal hysterectomy.     

Improved hemostasis with plasma kinetic bipolar sealing device in the vaginal steps of laparoscopic-assisted vaginal hysterectomy

Objective

During the vaginal steps of laparoscopic-assisted vaginal hysterectomy (LAVH), excessive bleeding occurs if the vascular pedicles are not securely clamped. Accordingly, this study investigates if an advanced bipolar sealing device (PlasmaKinetics [PK] Sealer), compared to conventional sutures, could improve the efficacy and safety in the vaginal steps of LAVH.

The study of laparoscopic electrosurgical instruments on thermal effect of uterine tissues

Purpose

It is to compare the thermal damage on myometrium tissue caused by five electrosurgical instruments, including monopolar forceps, bipolar forceps, PK scalpel, Ligasure and BiClamp.

Methods

Normal myometrium in vitro was collected and electric coagulation was conducted with five electrosurgical instruments under corresponding powers. The zones of thermal injury (ZTI) in each coagulation sites were examined histologically, while the width and depth of thermal damage were measured.

Results

1. There were significant differences among various groups’ widths of ZTI of myometrium (P?P?P?>?0.05). 2. The depths of ZTI in different groups were of significant differences (P?P?P?>?0.05).

Conclusions

As for myometrium, the thermal damage is rather small in the horizontal and vertical directions when using BiClamp and PK scalpel. Ligasure places larger range of thermal damage in horizontal direction with little depth in vertical direction, which is rather safe when acting on uterine surface. Electrocoagulation was conducted with monopolar (the power is 55?W) and bipolar forceps (the power is 40?W) continuously for 3?s, whose thermal damage range is fairly safe to corpus uteri wall and fundus uteri.     

盆腔淋巴结清扫术后盆腔淋巴囊肿预防探讨

目的：探讨超声刀和百克钳在妇科恶性肿瘤腹式根治术中的应用。方法：回顾分析2009年1月—2010年10月郑州大学第一附属医院58例应用超声刀或百克钳的腹式盆腔淋巴结清扫术患者及100例未应用超声刀或百克钳的腹式盆腔淋巴结清扫术患者临床资料,比较手术时间、术中出血量、清扫淋巴结个数、引流液量、尿管留置时间、淋巴囊肿发生例数,住院时间及术后盆腔淋巴囊肿的发生率。结果：治疗组手术时间、术中出血量、引流液量低于对照组,术后淋巴囊肿发生率明显低于对照组,差异有统计学意义（P＜0.05）。结论：腹式盆腔淋巴结清扫术中使用超声刀或百科钳能有效地缩短手术时间、减少术中出血量、降低术后淋巴囊肿的发生率,在妇科肿瘤根治术中值得推广。     

Harmonic scalpel versus conventional electrosurgery in the treatment of vulvar cancer

OBJECTIVE: To compare differences in blood loss, operative time, and intra- and postoperative complications with the harmonic scalpel or conventional electrosurgery in the treatment of vulvar cancer. METHODS: Consecutive patients who underwent radical vulvectomy with inguinal lymphadenectomy using the harmonic scalpel (HS) or conventional electrosurgery (CE) were compared. RESULTS: A total of 42 patients were included, 22 in the HS group and 20 in the CE group. Mean blood loss was significantly less in the HS group compared with the CE group (127 mL vs 210 mL; P<0.05) and mean operative time was significantly shorter with the HS compared with CE (117 minutes vs 142 minutes; P<0.05). There were no significant differences between the 2 groups in postoperative complications. CONCLUSION: Use of the harmonic scalpel for surgical treatment of vulvar cancer is safe and has several advantages, including decreased operative time and blood loss, improved visibility in the operative field, and good postoperative outcome.