子宫腺肌症病灶切除术治疗子宫腺肌症66例临床观察

目的分析探讨子宫腺肌症病灶切除术后患者痛经改善情况以及妊娠情况。方法：选取2004年5月至2013年9月在我院接受子宫腺肌症病灶切除术治疗的患者66例,对其临床资料进行回顾性分析,66例患者有40例患者实行保留生育能力的开腹子宫腺肌症病灶切除术,另26例患者采用腹腔镜子宫腺肌症病灶切除术,分析其治疗效果。结果：66例患者手术均获得成功,实行不同手术方式的患者手术时间无明显差异,不具有统计学意义,但采用腹腔镜子宫腺肌症病灶切除术患者治疗过程中出血量少,有58例痛经患者经治疗后52例患者痛经症状明显改善,42例不孕患者经手术后17例患者妊娠成功。结论：子宫腺肌症病灶切除术对治疗子宫腺肌症效果明显,能够明显改善患者的痛经情况,提高其术后妊娠率,值得在临床推广应用。     

子宫肌腺症的临床病理特点及手术指征的探讨

目的:探讨子宫肌腺症的临床病理特点及手术指征。方法:2004年1月至12月手术治疗且病理证实为子宫肌腺症340例,其中全子宫切除284例,保守手术(子宫肌腺症病灶切除术)56例,回顾分析其临床病理特点并探讨手术方式及指征。结果:340例子宫肌腺症中合并子宫内膜异位囊肿95例(27.94%),合并子宫肌瘤148例(43·5%),合并贫血95例(27.9%),合并子宫内膜息肉20例(5.9%)。痛经组与无痛经组患者合并不孕症差异无统计学意义(P>0.05),两组合并内膜息肉有显著的统计学差异(P<0.01),痛经者合并内膜息肉是非痛经组的5倍,95%CI为0.079~0.509。两组合并子宫内膜异位囊肿有显著的统计学差异(P<0.01)。痛经患者合并卵巢子宫内膜异位症的风险是无痛经患者的3.369倍,95%CI为1.699~6.681。多因素Logistic回归分析表明,绝经前、月经量多和子宫大的患者易并发卵巢子宫内膜异位囊肿;年轻、分娩次数多和痛经重的患者易并发子宫内膜息肉;绝经前年轻女性和子宫体积大的患者易并发子宫肌瘤。分析不同手术途径表明:腹腔镜组年龄偏低,贫血、不孕比例明显增高。结论:对年轻合并性交痛、肛门坠痛等症状,伴有贫血或不孕患者首选腹腔镜检查/手术;子宫较大、B超提示合并肌瘤或既往有剖宫产史,估计盆腔粘连重者选择开腹手术;合并子宫脱垂、尿失禁等盆底组织缺陷性疾病选择阴式途径完成。保留子宫的手术可以根据患者主要症状、手术医师的技能和仪器来选择术式。对年龄大且无生育要求,合并贫血、子宫肌瘤,服药有严重副作用或无明显疗效的可行全子宫切除术。     

腹腔镜下子宫腺肌病病灶切除术治疗子宫腺肌病

目的:探讨腹腔镜下子宫腺肌病病灶切除术治疗子宫腺肌病的临床疗效.方法:对18例子宫腺肌病患者行腹腔镜下子宫腺肌病病灶切除术治疗,术后观察患者痛经程度、月经周期、经量、经期和贫血情况的变化.结果:术后3月共有16例(88.89%)的患者症状消失或明显缓解;术后6月随访16例,有4例症状完全缓解,8例症状明显缓解;术后12月随访9例,有6例症状明显缓解.8例月经过多患者7例术后月经量明显减少(P<0.05),月经周期和经期无明显改变(P>0.05),8例贫血患者术后3月血红蛋白较术前明显升高(P<0.05).结论:腹腔镜下子宫腺肌病病灶切除术治疗子宫腺肌病近期疗效确切,对于年轻、希望保留子宫的患者是一种可选择的手术方式.     

子宫内膜切除术治疗子宫腺肌病28例分析

子宫内膜切除术是通过去除子宫内膜，达到减少经血量目的的腔内手术，主要适应症为功血，可同时切除突向宫腔的肌瘤。腺肌病因有进一步手术的指征，故非适应症。在１９９０年５月至１９９３年４月所施２０８例子宫内膜切除术中，经术中镜下所见，Ｂ超监视示灌流液进入肌层及病理证实，发现子宫腺肌病２８例。经术后３～３４个月随访，２例子宫切除，２６例疗效满意，成功率９２．８６％，月经均有改善，贫血治愈，１８例术前痛经者７７．８％术后痛经消失，２２．２％减轻。文中就子宫内膜切除术能治疗子宫腺肌病的机制进行了探讨，提出子宫腺肌病多发生于育龄妇女，子宫切除的治疗原则常使患者望而却步，若术前能对此病正确诊断，选择轻症患者行子宫内膜切除术，有可能成为代替子宫切除治疗子宫腺肌病的全新方法。     

子宫腺肌症206例临床分析

近年来，国内外文献报道子宫腺肌症的发病率有明显上升趋势［１，２］，但其临床漏诊率甚高。本研究回顾性分析２０６例子宫腺肌症的临床病理资料，以提高子宫腺肌症的临床诊断准确率。一、资料与方法收集我院１９９６年３月至１９９７年３月，因各种妇科疾病行子宫切除的...     

子宫内膜切除术治疗子宫腺肌病32例分析

子宫腺肌病是妇科临床较常见的疾病，治愈的主要手段是全子宫切除术。近年来有报道子宫内膜切除术可用于治疗子宫腺肌病及超过6个月以上的月经过多的患者。我院行子宫内膜切除术（TCRE）治疗超过6个月以上的月经过多、术后病理证实子宫腺肌病患者32例。现将治疗及随访情况报告如下。     

子宫腺肌症病因和发病机理的研究进展

子宫腺肌病的发病机制尚不十分清楚。现将近年来有关孕产次数、体内性激素水平、免疫机制以及间质成分的变化与子宫腺肌病发生发展关系的研究进展作一综述。     

腹腔镜下子宫腺肌病病灶切除术治疗子宫腺肌病的临床分析

目的:观察腹腔镜下子宫腺肌病病灶切除术治疗子宫腺肌病的临床疗效。方法:2008年1月至2010年6月对74例子宫腺肌病患者行腹腔镜下子宫腺肌病病灶切除术。术后定期随访患者,观察临床疗效,包括痛经程度、月经情况(周期、经期、经量)、贫血及子宫体积的变化。结果:术后1、3、6、12、24个月痛经消失和明显缓解的患者分别为64例(86.5%)、68例(91.9%)、60例(81.1%)、51例(68.9%)和31例(41.9%);术前53例月经过多患者中45例术后月经量明显减少(P0.05);术前45例贫血患者,术后血红蛋白明显升高(P0.05);术后患者子宫体积较术前明显缩小(P0.05);术后患者月经周期和经期无明显改变(P0.05)。结论:腹腔镜下行子宫腺肌病病灶切除术治疗子宫腺肌病的近期疗效明确,对年轻希望生育或要求保留子宫的子宫腺肌病患者可作为一种可选择的微创手术方式。     

子宫腺肌症保守治疗的研究进展

随着剖宫产、人工流产等相关宫腔手术操作的增加,子宫腺肌症的发病率也在不断上升,逐渐演变为困扰育龄期女性的主要问题。目前,临床上对无生育要求的子宫腺肌症患者,可通过子宫全切术以缓解其临床症状,避免疾病反复,但对有保留子宫欲望及生育要求的患者,采取保守治疗显得尤为重要。基于此,本研究将对子宫腺肌症的保守治疗进展进行综述,以期为临床治疗子宫腺肌症患者提供参考。     

Total and supracervical hysterectomy

Despite a long history of success with laparoscopic approach to hysterectomy, the majority of hysterectomies in the United States are currently performed via laparotomy.48–51 Barriers to the integration of laparoscopic hysterectomy include technological difficulties, inadequate training, low levels of peer support, potential for decreased reimbursement and misconceptions about laparoscopic safety, cost, and technical feasibility.52–54 With the continual evolution of minimally invasive hysterectomy techniques, now including robotic, single-port, and natural-orifice surgery, it is vital to critically evaluate the literature in an effort to offer patients the most safe and effective treatments. This report aims to summarize the available data surrounding both the total and supracervical laparoscopic hysterectomy and to provide concrete suggestions for maximizing success with these procedures.     

Comparison of complications of vaginal hysterectomy in patients with leiomyomas and in patients with adenomyosis

We reviewed 1246 vaginal hysterectomies performed at Handa City Hospital between January 1984 and December 1996. We divided the patients into 2 groups: those with leiomyomas (n=893) and those with adenomyosis (n=353). There was no difference in operative time and estimated blood loss between the 2 groups when analyzed by uterine weight. However, adenomyosis was associated with an increased risk of bladder injury. Accepted: 7 April 1998     

Sexual response in the patient after hysterectomy: total abdominal versus supracervical versus vaginal procedure

OBJECTIVE: The present study examines the patient's own appraisal of her sexual responsiveness after hysterectomy. STUDY DESIGN: Four hundred women who had undergone hysterectomy within a 3-year period were selected randomly and asked to respond to a questionnaire that was devised to ascertain the patient's own objective evaluation of self-image, sexuality, and sexual response before and after hysterectomy. The confidential responses were analyzed, noting the presence of any significant divergence between demographic and procedural cohorts. RESULTS: Of 126 respondents, 48.4% underwent total abdominal hysterectomy; 34.1% underwent vaginal hysterectomy, and 17.4% underwent supracervical hysterectomy. The mean patient age was 49.7+/-8.7 years. No direct correlation was found between hysterectomy type and age. Most women did not report any significant deterioration in mental attitude after the procedure (P =.788). Self and body image also remained consistent, with only 25.3% indicating a change for the worse. Only 10.3% of respondents felt less feminine after hysterectomy; nearly 70% of the respondents did not feel less feminine. Responses that pertained to libido, sexual activity, or feelings of femininity did not reveal significant changes (P >.05). Satisfaction with procedural choice was positive (54.8%), with only 7.1% responding unfavorably. CONCLUSION: The responses suggest that neither self-image nor sexuality need diminish after hysterectomy. The type of hysterectomy that was performed did not appear to affect the attitudes of the respondents.     

Retained myoma after laparoscopic supracervical hysterectomy with morcellation

Laparoscopic myomectomy and, more recently, laparoscopic supracervical hysterectomy are practical alternatives to traditional surgical management of uterine fibroids. With the advent of mechanical morcellation these procedures are now much more feasible. A 6-cm fibroid was lost at the time of laparoscopic-assisted supracervical hysterectomy and caused persistent, severe abdominal pain over the next 3 weeks. The fibroid was lodged in the region of the liver and gallbladder and required removal by laparotomy. Although retention of fibroids after operative laparoscopy has been reported, it has not been associated with complications. Technical alternatives at the time of operative laparoscopy involving morcellation should be considered to prevent this event.     

Radical vaginal trachelectomy after supracervical hysterectomy

BACKGROUND: Radical vaginal trachelectomy (RVT) is an acceptable approach when applied toward a select group of patients with early stage cervical carcinoma. It is less invasive, can maintain fertility, and can be ideal in patients with significant comorbid factors compared to abdominal approaches. A small subset of patients with a previous supracervical hysterectomy can pose a surgical dilemma. CASE: An 81-year-old woman with a history of severe cardiac disease on routine gynecological examination was found to have adenocarcinoma in situ with a focus suspicious for invasion of the cervical stump diagnosed by cone biopsy. She previously had a supracervical hysterectomy for benign disease of the uterus. A RVT was performed as definitive treatment and the patient recovered without complications. CONCLUSION: In the rare case that presents with a history of supracervical hysterectomy, RVT with some technical modifications can still be considered as a therapeutic option for early stage cervical carcinoma.     

Hormone levels in women after hysterectomy

Summary The serum levels of FSH, LH and estradiol-17 (E₂) were determined in 110 women aged between 38–48 years who had been hysterectomized 2–10 years previously and were compared with a control group (n=112). In hysterectomized women both FSH and LH levels were higher than in controls during the whole 12 year period. These differences were significant up to 43 years of age. The hypergonadotropism in hysterectomized women correlates with the higher incidence of climacteric symptoms reported in the literature.     

结合珠蛋白在子宫腺肌病表达及与痛经的关系

目的:探讨结合珠蛋白(Hp)在子宫腺肌病组织中的表达及与痛经的关系。方法:选择子宫腺肌病组织37例(研究组)和正常子宫内膜18例(对照组),研究组按痛经程度分为:无痛经组(15例),轻度痛经组(9例),中度痛经组(5例),重度痛经组(8例)。采用免疫组化技术检测各组Hp的表达。结果:研究组在位内膜及病灶组织中Hp表达高于对照组在位内膜及正常肌层;研究组卵泡期病灶组织中Hp表达高于黄体期。无痛经组病灶组织中Hp表达高于痛经组;研究组病灶组织中Hp表达的整体趋势是随着疼痛加重而逐渐下降。结论:Hp表达与子宫腺肌病的发生发展及痛经密切相关。