阴式手术与腹腔镜手术治疗输卵管妊娠的对照研究

目的:比较阴式手术与腹腔镜手术治疗输卵管妊娠的疗效及优缺点。方法:通过对60例输卵管妊娠患者分别行阴式手术(30例)与腹腔镜手术(30例),比较两组的疗效和术中、术后情况。结果:两组术后血β-HCG下降情况比较,差异无统计学意义(P>0.05),术后复诊均未发现盆腔包块。两组的手术时间、术中出血量、最高体温、术后白细胞计数(WBC)、术后住院时间比较,差异均无统计学意义(P>0.05),阴式手术组术后肛门排气时间较腹腔镜手术组短、住院费用较腹腔镜手术组少(P<0.05)。结论:阴式手术与腹腔镜手术治疗输卵管妊娠的疗效相同,但在术后肛门排气时间、住院费用方面明显优于腹腔镜手术,可为临床治疗输卵管妊娠提供一种有效、微创、安全、费用低的方法。     

阴式子宫肌瘤剔除术的可行性分析

目的:通过比较阴式、腹式和腹腔镜下子宫肌瘤剔除术的优缺点,评价阴式子宫肌瘤剔除术的可行性.方法:回顾性分析阴式子宫肌瘤剔除术38例(阴式组)、腹式子宫肌瘤剔除术31例(腹式组)和腹腔镜下子宫肌瘤剔除术29例(腹腔镜组)的临床资料,并对3组围手术期情况进行比较分析.结果:阴式组术中出血量、术后排气时间和术后住院天数均明显低于腹式组(P＜0.05),与腹腔镜组相当(P＞0.05);手术时间长于腹式组(P＜0.05)而短于腹腔镜组;住院费用和手术费用明显低于腹腔镜组(P＜0.01),与腹式组相当(P＞0.05).结论:阴式子宫肌瘤剔除术具有创伤小、恢复快、术后并发症少、腹部无切口等优点,安全可行,值得推广.     

改良腹腔镜大子宫全切除术与开腹手术的比较

目的:比较改良腹腔镜大子宫全切除术与开腹大子宫切除术的临床疗效,探讨改良方法的可行性。方法:选择2006年1月至2010年3月我院收治的因子宫肌瘤、子宫体积如孕13～22周的患者230例,按照患者的经济情况分为改良腹腔镜组(146例)和开腹组(84例),比较两组术后子宫重量、手术时间、术中出血量、术后病率、住院时间以及围手术期并发症的发生率。结果:改良腹腔镜组143例完全在腹腔镜下完成手术,3例经腹腔镜辅助腹部小切口完成。改良腹腔镜组术中出血量[(136.9±53.6)ml vs(199.5±66.0)ml],排气时间[(23.8±6.1)hvs(30.2±7.7)h],术后24h中、重度疼痛发生率(8.2%vs 56.0%),术后病率(4.8%vs 19.0%)以及住院时间[(5.5±1.3)天vs(8.0±1.4)天]均显著低于开腹组(P<0.01)。两组手术时间、子宫重量、围手术期并发症无统计学差异(P>0.05)。结论:改良腹腔镜大子宫切除术安全、可行,但需要加强术前病情评估、掌握针对大子宫特点的手术方法和技巧。     

腹腔镜手术和开腹手术治疗盆腔炎性包块的比较

目的:探讨腹腔镜手术治疗盆腔炎性包块的可行性及其价值。方法:收集1999年6月至2004年7月间,41例腹腔镜手术治疗的盆腔炎性包块及13例开腹手术病例,比较其住院天数、费用、疾病种类、手术和术后恢复情况。结果:腹腔镜手术和开腹手术相比较,两组手术时间、住院费用及手术费用差异无显著性(P>0.05),腹腔镜组手术并发症、术中出血量少于开腹手术组,术后排气时间、体温恢复到正常时间、血象恢复时间、术后拆线时间、住院时间均短于开腹手术组,差异有显著性(P<0.05)。结论:腹腔镜手术治疗盆腔炎性包块是可行的,具有较好的临床应用价值。     

阴式与腹腔镜子宫全切除术的临床效果比较

目的比较阴式子宫全切除术和腹腔镜子宫全切除术的临床效果。方法收集我院2002年1月至2004年6月接受以上不同途径子宫切除术的病例共301例的临床资料,其中阴式子宫全切除术197例(阴式组),腹腔镜子宫全切除术104例(腹腔镜组),比较两组疾病种类、手术时间、术中出血量、住院时间、医疗费用及术后恢复情况等。结果(1)疾病种类:宫颈非典型增生阴式组19例、腹腔镜组3例;子宫腺肌病、合并附件疾病或盆腔子宫内膜异位症,阴式组分别为58例、9例、8例,腹腔镜组分别为45例、33例、13例;(2)手术时间:阴式组(76±28)min、腹腔镜组(139±52)min;(3)术中出血量:阴式组(170±125)ml、腹腔镜组(206±153)ml;(4)肌瘤或腺肌瘤最大直径:阴式组(49±17)mm、腹腔镜组(57±22)mm;(5)手术费用:阴式组(1073±203)元、腹腔镜组(1526±676)元。以上各指标两组比较,差异均有统计学意义(P<0·05);(6)住院时间:阴式组(5·6±1·2)d、腹腔镜组(5·7±2·4)d;(7)子宫重量:阴式组(235±115)g、腹腔镜组(256±158)g;(8)手术并发症发生率:阴式组为2·54%、腹腔镜组为2·88%。住院时间、切除子宫重量及手术并发症发生率等两组比较,差异均无统计学意义(P>0·05)。结论无明显盆腔粘连和附件疾病的子宫全切除术可选择阴式途径,子宫大小并非选择术式的决定因素。     

阴式与腹腔镜下剔除子宫肌瘤的效果比较

目的:比较阴式子宫肌瘤剔除术与腹腔镜下子宫肌瘤剔除术治疗子宫肌瘤的临床效果。方法:选择2009年2月—2011年2月收治的80例子宫肌瘤患者,按照随机数字表法分为阴式组(40例)和腹腔镜组(40例)。对2组患者的手术创伤、术后疼痛率及术后病率进行比较分析。结果:2组患者的手术时间、术中出血量、术后肛门排气时间、术后疼痛率及术后病率比较,阴式组均优于腹腔镜组,差异均有统计学意义(P0.05)。结论:在选择正确的适应证条件下,阴式子宫肌瘤剔除术与腹腔镜下子宫肌瘤剔除术均是临床上安全有效的微创手术方式,但阴式子宫肌瘤剔除术具有创伤更小、术后疼痛轻且体表无瘢痕等优点。     

开腹与微创子宫肌瘤剔除术临床结局分析

目的 评价开腹、腹腔镜下及阴式子宫肌瘤剔除术的优缺点和手术适应证.方法 回顾分析北京协和医院2005年1月至2006年6月同期行开腹子宫肌瘤剔除术81例、腹腔镜下子宫肌瘤剔除术148例和阴式子宫肌瘤剔除术10例的临床资料,选出相匹配的组别分别进行比较,分析其一般临床资料及围手术期资料特点.结果 阴式组与相匹配的腹腔镜组比较:住院费用阴式组明显少于腹腔镜组[(4 669±1 050)元对(6 187±945)元],术后肛门排气时间阴式组明显短于腹腔镜组[(14.8±2.6)h对(18.8±3.1)h],差异有统计学意义(P<0.05).术后住院时间阴式组长于腹腔镜组[(4.1±1.9)d对(2.6±O.9)d,P<0.05);单发肌壁间肌瘤腹腔镜组与相匹配的开腹组相比,术后住院时间腹腔镜组明显短于开腹组[(3.2±0.9)d对(6.0±0.94)d],术后病率和术后镇痛药使用率腹腔镜组亦明显少于开腹组(5.88%对41.18%,8.82%对35.29%).手术时间腹腔镜组明显长于开腹组[(106.9±42.0)min时(74.8±27.1)min),均P<0.05.结论 腹腔镜下及阴式肌瘤剔除术均为微创术式,两种术式均安全可靠;阴式肌瘤剔除术住院费用更少,对腹腔干扰更小,而多发(≥5个)、巨大或剔除术后复发的肌瘤首选开腹肌瘤剔除术.     

机器人手术系统在盆腔腹膜后肿瘤切除术中的应用

目的探讨机器人手术系统在盆腔腹膜后肿瘤(PRT)切除术中应用的可行性和安全性。方法收集2017年10月至2020年4月在郑州大学第一附属医院接受手术治疗的PRT患者47例,其中接受达芬奇机器人手术患者16例(机器人组)、传统腹腔镜手术患者31例(腹腔镜组)。对比两组患者的手术相关指标、手术并发症及分级(Clavein-Dindo并发症分级)、术后肿瘤性质(良、恶性)以及预后。结果与腹腔镜组比较,机器人组患者的手术时间延长(中位数分别为147、275 min)、住院费用增加(中位数分别为29375、61088元),分别比较,差异均有统计学意义(P<0.05);而两组患者的术中出血量、术后住院时间、肛门排气时间、肿瘤切除是否完整、与周围组织分界是否清楚、距离骶前静脉丛及大血管的距离,分别比较,差异均无统计学意义(P>0.05)。机器人组患者手术并发症发生率(2/16)与腹腔镜组[13%(4/31)]比较,差异无统计学意义(χ²=0.000,P=1.000);Clavein-Dindo并发症分级,机器人组Ⅰ级、Ⅲ级各1例,腹腔镜组Ⅰ级、Ⅱ级、Ⅳ级分别为1、2、1例。术后病理检查,机器人组恶性肿瘤4例(4/16),腹腔镜组4例(13%,4/31),两组患者恶性肿瘤比例比较,差异无统计学意义(χ²=0.405,P=0.525)。机器人组肿瘤均完整切除,术后无复发患者;腹腔镜组3例未完整切除,2例术后复发。机器人组复发率(0/16)与腹腔镜组(6%,2/31)比较,差异无统计学意义(P=0.541)。结论与传统腹腔镜手术相比,机器人手术系统治疗PRT的手术时间延长、住院费用增加,但手术野图像更清晰,可增加肿瘤切净率,减少术后复发,且不增加手术并发症,可作为治疗PRT的选择之一。     

机器人辅助腹腔镜与传统腹腔镜在巨大子宫切除术的疗效比较

目的:比较达芬奇机器人子宫切除术(RH)与传统腹腔镜子宫切除术(TLH)在巨大子宫切除中的临床疗效，以探讨相关临床经验和机器人手术优势。方法:回顾性分析郑州大学第一附属医院2014年11月至2021年11月完成的因良性疾病导致的巨大子宫并接受RH或TLH共813例患者的临床资料。其中RH组374例、TLH组439例。对两组患者的一般资料、围手术期相关指标、近远期并发症情况进行比较，及其在大子宫人群(子宫体积为孕12～16周)和超大子宫人群(子宫体积大于孕16周)中相关指标的比较。结果:(1)与TLH组相比，虽然RH组子宫体积较大、腹部手术史发生率较高、手术时间较长；但术中出血量减少、术中输血率降低、术后肛门排气时间缩短、术后住院时间缩短，差异均有统计学意义(P<0.05)。两组均无术中转变手术方式的病例。近期术后并发症中，下肢静脉血栓形成发生率最高(3.20%,26/813),远期术后并发症中，淋巴潴留囊肿发生率最高(1.11%,9/813)。(2)在大子宫人群中，与TLH组相比，虽然RH组手术时间较长，但术中输血率降低、术后肛门排气时间缩短、术后住院时间缩短，差异有统计学意义(P<0.05)。(3)在超大子宫人群，与TLH组相比，RH组术后住院时间缩短(P<0.05),余各项围手术期指标比较差异均无统计学意义(P>0.05)。结论:机器人巨大子宫切除术是安全可行的，与传统腹腔镜相比，机器人辅助腹腔镜有术中出血量更少、术后肠道功能恢复更快等优势。此外，子宫体积的增大并未对手术并发症造成显著影响。     

宫腹腔镜联合手术治疗子宫切口憩室的效果

目的 探讨宫腹腔镜联合手术治疗子宫切口憩室的效果。方法 选取70例子宫切口憩室患者为研究对象,根据随机数字表法分为两组,各35例。对照组采用宫腔镜电切术治疗,试验组采用宫腹腔镜联合手术治疗,比较两组的手术相关指标、憩室恢复情况、并发症发生情况及治疗效果。结果 试验组手术时间长于对照组,术后肛门排气时间、术后阴道出血时间、住院时间短于对照组,术中出血量多于对照组（P<0.05）;术后,试验组憩室深度、憩室宽度均低于对照组（P<0.05）;试验组并发症发生率和复发率分别为2.86%、5.71%,均低于对照组的20.00%、22.86%,(P<0.05);试验组治疗总有效率为94.29%,显著高于对照组的74.29%(P<0.05)。结论 宫腹腔镜联合手术治疗子宫切口憩室,效果显著,能改善手术相关指标,降低并发症发生率和复发率,值得临床推广和使用。     

腹腔镜手术治疗卵巢囊肿蒂扭转43例临床分析

目的:探讨腹腔镜手术治疗卵巢囊肿蒂扭转的临床价值.方法:回顾性分析我院2001年2月至2008年10月间接受腹腔镜诊治的43例卵巢囊肿蒂扭转患者的临床资料.结果:43例患者平均年龄26.6岁,有腹痛病史41例,其中急性腹痛27例,伴恶心、呕吐21例.34例行腹腔镜下患侧附件切除术,9例行腹腔镜下患侧卵巢囊肿剥出术.所有病例均在腹腔镜下顺利完成手术治疗,平均手术时间65.0±16.5分钟,术中出血2-150 ml,中位出血量10 ml,无术时术后并发症发生.术后病理诊断卵巢成熟性畸胎瘤34例(79.1%),卵巢单纯囊肿3例(7.0%),卵巢粘液性囊腺瘤2例(4.7%),卵巢甲状腺肿1例(2.3%),卵巢巧克力囊肿1例(2.3%),副中肾管源性囊肿(卵巢冠囊肿)1例(2.3%),组织出血梗死不能辨认1例(2.3%).术后平均肛门排气时间27.3±11.4小时,术后平均放置尿管时间11.2±9.5小时,术后平均住院时间4.2±1.3天.结论:腹腔镜诊治卵巢囊肿蒂扭转具有及时准确、创伤小、出血少、术后恢复快等优点.     

Laparoscopic adnexectomy in postmenopausal women.

Postmenopausal palpable ovaries and pelvic masses require histologic examination to preclude missing ovarian carcinomas. However, the majority of such lesions are benign. Of 44 such patients, 42 (95.4%) underwent successful management with laparoscopic adnexectomy. The average operating time was 115.8 minutes, and 40 patients were discharged the day of surgery. Thirty-eight patients had a blood loss of less than or equal to 50 mL. The laparoscopic procedures were well tolerated and allowed the patients to return rapidly to normal activity.     

腹腔镜下卵巢囊肿剥除术治疗卵巢囊肿的效果与安全性观察

目的 研究卵巢囊肿患者应用腹腔镜下卵巢囊肿剥除术治疗的效果及安全性.方法 选取20例行手术治疗的卵巢囊肿患者,采用抽签法分为对照组(8例)与研究组(12例).对照组应用开腹卵巢囊肿剥除术治疗,研究组应用腹腔镜下卵巢囊肿剥除术治疗.对比两组手术相关指标、治疗前后雌二醇(E2)、卵泡刺激素(FSH)水平、并发症发生情况及临...     

Surgical treatment of ovarian dermoid cysts: a comparison between laparoscopic and vaginal removal

BACKGROUND: In the last years transvaginal ultrasonographic diagnosis of ovarian dermoid cyst together with laparoscopic approach have greatly improved the treatment of this benign lesion. Vaginal approach with laparoscopic assistance has been proposed as an alternative to total laparoscopic removal. METHODS: A retrospective comparison between total laparoscopic (56 patients) and direct vaginal removal (30 patients) of ovarian dermoids. RESULTS: There were few, but significant, advantages of vaginal removal, especially regarding operating time, intraperitoneal spillage of dermoid tissue and post-operative outcome. CONCLUSION: Vaginal approach to the removal of dermoid cysts can be considered a safe alternative procedure to laparoscopy.     

Management of ovarian dermoids without laparoscopy or laparotomy

OBJECTIVE: To report experience of managing ovarian dermoids via the vaginal route. STUDY DESIGN: A series of 26 cases managed this way either with or without hysterectomy and for comparison 10 women managed by laparotomy and 6 who underwent laparoscopic ovarian cystectomy or oophorectomy were considered. RESULTS: The vaginal approach was successful in all patients, without need for laparoscopic assistance or a switch over to laparotomy. Spill was minimal or absent in the vaginal group and recovery significantly faster in the vaginal and laparoscopic groups compared to the laparotomy group. Hospital stay was slightly shorter in the vaginal than the laparoscopic group. No disposable material or equipment was used in the vaginal or laparotomy group. CONCLUSION: For mobile, benign ovarian teratoma, the vaginal route should be strongly considered to minimise invasive surgery, particularly when the operator is an experienced vaginal surgeon or laparoscopic equipment or laparoscopic surgeons are not easily available. Reduced spillage and speedier recovery are important advantages.     

Use of laparoscopic support to avoid laparotomy in vaginal ovarian cystectomy

The objective of our study was to evaluate the use of a procedure for vaginal ovarian cystectomy that is supported by the option to convert to laparoscopy. The ovarian cystectomy was initially approached transvaginally, and then if impossible, completed laparoscopically. We applied this operation system to 38 patients with benign ovarian cysts. Preoperative characteristics of patients, outcomes of colpotomy and vaginal ovarian cystectomy, conversion rate from a vaginal approach to a laparoscopic procedure or a laparotomy, completion rate, operating time, blood loss, complications, and postoperative outcomes were examined. Colpotomy was successfully performed in 37 (97%) of 38 cases and vaginal ovarian cystectomy was accomplished in 35 (92%) cases. Three (8%) cases, including 1 case of failed posterior colpotomy and 2 cases of intrapelvic adhesions, were converted from a vaginal approach to a laparoscopic procedure. In all (100%) cases, cystectomy was successful without laparotomy. Support by laparoscopy preserves the minimal invasiveness of vaginal ovarian cystectomy in cases that would normally require conversion to laparotomy. Thus, this operation system is an alternative procedure to an exclusively vaginal ovarian cystectomy.     

非脱垂子宫阴式子宫全切除术的适应证和禁忌证探讨

目的探讨非脱垂子宫阴式子宫全切除术(TVH)的适应证和禁忌证。方法回顾性分析我院1992年6月至2003年6月间2086例非脱垂子宫TVH的临床资料,按子宫体积、既往有无盆腹腔手术史、有无阴道分娩史、是否同时处理附件等分别进行统计,比较手术并发症的发生情况。结果(1)不同体积子宫比较:子宫体积>16孕周患者的非脱垂子宫TVH手术时间、术中出血量及术后盆腔感染率分别为(73±25)min、(237±86)ml、1.69%(7/413);子宫体积≤16孕周患者的非脱垂子宫TVH手术时间、术中出血量及术后盆腔感染率分别为(42±16)min、(101±58)ml、0.78%(13/1673),不同体积子宫上述各项指标比较,差异有统计学意义(P<0.01)。(2)既往有无盆腹腔手术史比较:既往有无盆腹腔手术史患者的非脱垂子宫TVH手术时间和术中出血量比较,差异无统计学意义(P>0.05),但有盆腹腔手术史患者非脱垂子宫TVH的术中并发症发生率升高;(3)有无阴道分娩史患者非脱垂子宫TVH的手术时间和术中出血量比较,差异也无统计学意义(P>0.05);119例合并卵巢囊肿患者均成功行非脱垂子宫TVH。结论子宫体积≤16孕周患者的非脱垂子宫TVH是安全、可行的,子宫体积>16孕周患者的非脱垂子宫TVH手术难度较大,是否行TVH,需根据术者的经验及患者的情况进行选择;既往有盆腹腔手术史,可增加非脱垂子宫TVH并发症的发生率;对于子宫体积≤16孕周的患者,有无阴道分娩史均不影响TVH的成功率;TVH同时处理直径≤6cm的卵巢单纯性囊肿是可行的。     

Laparoscopic management of a large ovarian cyst in an adolescent. A case report

BACKGROUND: The safety of laparoscopic management of benign ovarian cysts has been demonstrated. The size of the benign ovarian cyst continues to be a limiting factor for laparoscopic surgery, with most surgeons choosing laparotomy for large cysts. CASE: A 15-year-old woman had a 22-cm, benign ovarian cyst extending above the umbilicus that was managed successfully with laparoscopy. We performed prelaparoscopy cyst drainage with a suprapubic Bonanno catheter (Becton Dickinson, Rutherford, New Jersey) followed by laparoscopic cystectomy. Because of its coiled end, the Bonanno catheter is less likely to result in cyst leakage around the aspiration site. CONCLUSION: With proper patient selection, laparoscopic surgery can be safely applied in a select group of patients with large, benign ovarian cysts.     

Laparoscopic treatment of benign ovarian tumors

BACKGROUND: laparoscopic surgery is one of the most common procedures performed in the presence of benign ovarian tumor. THE AIM OF THE STUDY: The purpose of our study was to analyze clinical findings, operative procedures, size and histopathologic type of tumors, time of hospitalization and surgical complications. MATERIAL AND METHODS: 102 female patients operated for benign adnexal masses by laparoscopic approach, in 3rd Department of Gynecology and Obstetrics, University of Medicine, Lód?, between 2001-2004. RESULTS: the most frequent laparoscopic procedure was excision of the tumor (59.8%), and the most common histopathologic type was teratoma adultum (25%), endometroid cyst (21.1%) and serous cyst (20.2%), of 5-7 cm median size. The majority of operated women (75.5%) were under 40 years of age. No intraoperative complications were noted. Postoperatively 1 patient presented with bleeding and was re-operated, 1 had hernia in the place of trocar installation, 5 had rised temperature (complication rate 6.9%). CONCLUSIONS: in the case of benign ovarian tumor laparoscopy is recommended procedure due to sparing ovarian function by small tissue traumatisation, shorter time of hospitalization, faster return to the health and low risk of complications. Because of the possibility of encountering an unexpected ovarian malignancy, the laparoscopy should be executed only in the centers where the intraoperative histopathologic examination is a routine procedure.     

阴式广泛全子宫切除加腹腔镜下淋巴结切除术与开腹手术治疗早期宫颈癌疗效比较

目的探讨阴式广泛全子宫切除加腹腔镜下淋巴结切除术治疗早期宫颈癌的临床价值。方法 2004年11月至2011年4月于佛山市妇幼保健院,回顾性分析行阴式广泛全子宫切除加腹腔镜下淋巴结切除术的90例早期宫颈癌患者(阴式组)的病例资料,抽取同期行开腹广泛全子宫切除加盆腔淋巴结切除术42例(开腹组)作为对照。结果两组手术时间差异无统计学意义(P>0.05)。阴式组术中出血量[(348±114)mL]、肠道功能恢复时间[(36.76±4.9)h]、住院天数[(10.56±2.10)d]均少于开腹组的[(398±127)mL]、[(40.09±6.5)h]、[(11.79±2.45)d],差异有统计学意义(P<0.05)。阴式组切除阴道长度[(3.12±0.17)cm]大于开腹组的[(3.05±0.21)cm](P<0.05)。阴式组尿潴留发生率(30.0%)较开腹组(11.9%)高(P<0.05)。阴式组术后5年内复发率(14.6%)低于开腹组(31.5%)(P<0.05)。结论阴式广泛全子宫切除加腹腔镜下淋巴结切除术式创伤小,术后恢复快,手术彻底,有临床应用价值。