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。     

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1560例临床分析

目的：探讨腹腔镜手术在妇科的临床应用价值。方法：1997～2002年对1560例腹腔镜手术者均采用全麻；异位妊娠术式为输卵管切除术、输卵管伞端取胚术及输卵管造口术；卵巢囊肿手术采用剔除术、剥除术及患侧附件切除术；子宫手术采用改良式CISH术、子宫次全切除术、子宫全切术及LAVH术；主要器械为单双极电凝及超声刀。结果：腹腔镜手术占同期妇科手术的45．28％，手术成功率99．55％，发生并发症7例(0．45％)。结论：适应证掌握得当。妇科大部分手术可在腹腔镜下完成。     

子宫血管缝扎术在腹腔镜下全子宫切除术中应用的临床分析

目的 探讨腹腔镜下全子宫切除术中子宫血管处理方法。方法 回顾性分析89例腹腔镜下全子宫切除术中子官动静脉处理方法。分析宫旁缝扎组的手术时间、术中出血量及术后病率，并与子宫动脉游离结扎组及腹腔镜联合阴式子宫切除术组进行比较。结果 子宫血管缝扎组与血管游离后处理组患者的手术时间、术后出血量及术后病率比较差异无显著性（P〉0．05）；子宫血管缝扎组与腹腔镜联合阴式子宫切除术组的手术时间及术后病率比较差异无显著性（P〉0．05），但子宫血管缝扎组出血量明显减少（P〈0．05）。结论 宫旁缝扎子宫动静脉后电凝切断子宫血管及主韧带，需要的器械简单，操作简便，手术野清晰，容易推广，在腹腔镜子官切除术中有较大的临床应用价值。     

常规器械经脐单孔腹腔镜输卵管切除术41例分析

目的 探讨常规器械经脐单孔腹腔镜输卵管切除术的临床疗效、安全性及其优点。方法 对嘉兴学院附属第一医院2011年8月至2012年8月41例输卵管妊娠患者行常规器械经脐单孔腹腔镜输卵管切除术,并与同期45例常规腹腔镜下输卵管切除术比较。结果　两组相比,单孔腹腔镜组术后切口美观优于传统腹腔镜组,单孔腹腔镜组手术时间（30.43±5.83） min,术中出血量（8.63±3.79 ）mL,术后排气时间（28.35±7.41） h,住院时间（5.03±0.72） d。传统腹腔镜组手术时间（21.09±3.82 ）min,术中出血量（8.23±3.31） mL,术后排气时间（29.85±6.24） h,住院时间（5.24±0.63） d。单孔腹腔镜组手术时间略长于传统腹腔镜组,差异有统计学意义（P<0.05）,术中出血量、术后排气时间及住院时间两组差异无统计学意义（P>0.05）。结论　经脐单孔腹腔镜输卵管切除术在常规腹腔镜器械下可以安全、可靠地完成,术后腹壁瘢痕不明显,易被患者接受。     

多种腹腔镜电凝器械对卵巢组织热损伤的研究

目的:研究腹腔镜手术中单极电凝、双极电凝、等离子电切刀(PK 刀)和结扎速血管闭合钳(LigaSure)对卵巢组织的热损伤效应,以助于临床合理选择电外科手术器械.方法:取手术中切除的人类正常卵巢组织,分别用上述电外科器械电凝,然后将组织块包埋、切片,HE染色后在光学显微镜下观察,并测量热损伤的宽度和深度.结果:电凝后卵巢组织均有不同程度的凝固性坏死,4种器械的热损伤坏死带范围宽度和深度之间比较,差异均有高度统计学意义(P=0.000).其中两两比较中,LigaSure组的热损伤坏死深度小于单极电凝组(P=0.044),PK刀组的热损伤坏死宽度小于LigaSure组(P=0.002)、单极电凝组(P=0.024)和双极电凝组(P=0.045).结论:各种腹腔镜电凝止血均会对卵巢组织造成一定的热损伤,在行腹腔镜卵巢手术时,应尽量减少电凝止血的操作,并尽量选用热损伤范围小的智能双极系统如PK刀等.     

腹腔镜下子宫血管阻断治疗子宫肌瘤的最初经验及与子宫动脉栓塞治疗的比较

为了解腹腔镜下子宫血管阻断治疗有症状子宫肌瘤的价值．选择46例绝经期前，平均年龄43（34～51）岁，有临床症状的子宫肌瘤患者纳入研究。组其中（24例）采用放射介导子宫动脉栓塞治疗．组2（22例）采用腹腔镜下子宫血管阻断治疗．组2操作要点为近髂内动脉水平以腹腔镜内铗阻断子宫动脉．同时双极电凝处理卵巢固有韧带以阻断卵巢与子宫的交通血供。对两组术后子宫出血的改变情况．子宫及子宫肌瘤的体积变化情况及术后疼痛及镇痛药的使用情况进行评估分析。     

腹腔镜输卵管妊娠挤压取胚术中垂体后叶素的应用

目的：探讨腹腔镜输卵管妊娠挤压取胚保守性手术中垂体后叶素的应用效果。方法：2010年1月—2011年12月广西钦州市妇幼保健院妇科确诊为未破裂型输卵管妊娠（除外输卵管间质部妊娠）、有生育要求、具有保留输卵管条件的100例患者,行腹腔镜输卵管妊娠保守性手术。随机分为2组,在输卵管妊娠挤压取胚保守性手术中应用垂体后叶素者为观察组（５０例）,未使用垂体后叶素者为对照组（５０例）。比较２组手术时间、术中出血量、输卵管保留成功率、术后输卵管通畅率及持续性异位妊娠发生率情况。结果：观察组手术时间、术中出血量少于对照组（P＜0.01）,输卵管保留成功率及术后输卵管通畅率高于对照组（P＜0.01）。2组术后持续性异位妊娠发生率比较差异无统计学意义（P＞0.05）。结论：输卵管妊娠挤压取胚保守性手术中,使用垂体后叶素能减少术中出血量、缩短手术时间、提高输卵管保留成功率及术后输卵管通畅率,手术安全可靠,不良反应少,值得推广。     

PK刀在腹腔镜辅助阴式子宫切除术中的应用

目的 探讨五合一双极PK等离子刀（Plasmakinetic^TM Tissue Management System，PK刀）在腹腔镜辅助阴式子宫切除术（LAVH）中的应用价值。方法 回顾性分析北京大学人民医院妇科2003年1月-2004年11月问，住院行LAVH的135例患者的临床资料结果，比较PK刀与五合一双极电凝切刀钳（双极）在LAVH中的手术时间、术中腹腔出血量、术中术后并发症和术后患者恢复情况。结果 与双极相比，PK刀明显减少术中出血量、显著缩短手术时间。结论 PK刀在LAVH中具有一定的优势，改变了双极凭经验掌握电凝程度的不足，避免了组织凝固不均、组织凝固过度炭化和凝固不全出血等缺点，并具有止血效果佳、热辐射损伤范围小、操纵简单等优点，值得推广使用。     

腹腔镜下子宫三角形切除术中3种方法阻断子宫动脉的比较研究

目的:探讨腹腔镜下子宫三角形切除术中采用丝线或钛夹结扎、双极碳化、红尿管捆扎3种方法阻断子宫动脉的临床应用效果.方法:对997例患者行腹腔镜下子宫三角形切除术,术中采用3种不同方式阻断子宫动脉,比较3组患者术中、术后情况.结果:3组患者术后疼痛发生率及术后使用抗生素、体温升高、肛门排气、术后下床活动和术后住院时间比较,差异均无统计学意义(P＞0.05).手术时间、术中出血量红尿管捆扎组较丝线或钛夹结扎组、双极碳化组高(分别为80.2±29.0分钟、79.3±31.0分钟、71.2 ±28.0分钟,212.0±38.0 ml、121.0±52.0ml、109.0±21.0 ml),差异有统计学意义(P ＜0.05,P＜0.01);丝线或钛夹结扎组、双极碳化组术后性生活恢复时间均较红尿管捆扎组长(33.0±3.6天、51.0±4.6天VS 21.0±4.7天),差异有统计学意义(P＜0.05).3组均无手术并发症发生.结论:丝线或钛夹结扎、双极碳化法操作容易,手术时间短,术中出血少;红尿管捆扎法能较好保护患者术后血供,术后性生活恢复时间较短.应根据医院手术器械和手术医生技术及患者的具体情况选择子宫动脉阻断方式.     

Laparoscopic tubal coagulation--technic and follow-up results

This report presents 155 cases of laparoscopic electrocoagulation of the fallopian tubes. 53 coagulations were performed with unipolar devices, 102 ones with bipolar technique.--The patency of tubal obliteration was tested 12 weeks after the operation hysterosalpingographically.--In 4 cases the contrast medium was forced through the obliterated part of the fallopian tube, but controlled a half year later the tubes are completely closed. Hysterosalpingographic studies are not suited to criticize the reliability of laparoscopic sterilization. Severe operative and early postoperative complications were not to be seen.--The laparoscopic bipolar coagulation of the fallopian tubes is a method without the high of electric accidents. There is a great efficacy in producing sterility.     

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。     

Electrosurgical bipolar vessel sealing for radical abdominal hysterectomy

OBJECTIVE: We analyzed the use of an electrosurgical bipolar vessel sealing system for radical abdominal hysterectomy. METHODS: We compared operating time, transfusion requirements and other surgical parameters in 52 patients undergoing radical abdominal hysterectomy with systematic pelvic +/- paraaortic lymphadenectomy for stage IB1-IIB cervical cancer between January 2001 and June 2004. At 21 operations between January 2001 and March 2002, the parametrium, paracolpos and vaginal cuff were resected with clamps and the pedicles suture ligated; 31 operations between November 2001 and June 2004 were done with a bipolar vessel sealing system (LigaSure Vessel Sealing System, Valleylab, Boulder, CO). Four surgeons did all operations. Data were compared with the t test. RESULTS: Patients operated with the LigaSure system received fewer packed RBC transfusions than those operated with clamps (mean, 0.61 +/- 1.1 vs. 2.14 +/- 2.6 units, respectively; P = 0.01), even when looking at patients who underwent only pelvic (without paraaortic) lymphadenectomy (mean, 0.52 +/- 1.1 vs. 1.29 +/- 1.2 units, respectively; P = 0.02). The transfusion rate in the two groups was 26% (8/31) and 67% (14/21), respectively (P < 0.05). Operating time did not differ significantly (199 +/- 33 vs. 213 +/- 45 min, respectively). There were no significant differences between the groups in number of pelvic nodes removed, febrile morbidity, postoperative stay, or days until residual urine <100 ml. One patient in the LigaSure group developed a ureterovaginal fistula that resolved with stenting. CONCLUSION: The LigaSure system appears useful to reduce blood loss at radical abdominal hysterectomy.     

Laparoscopic total radical hysterectomy by the Pune technique: our experience of 248 cases

STUDY OBJECTIVE: To describe our experience and technique of total laparoscopic radical hysterectomy with pelvic lymphadenectomy, which is the largest single- institution study. DESIGN: Retrospective, nonrandomized study (Canadian Task Force classification II-2). SETTING: Private hospital. PATIENTS: Two hundred forty-eight patients with International Federation of Gynecology and Obstetrics stage IA2 (n = 32) and IB1 (n = 216) of cancer of the cervix. INTERVENTION: Total laparoscopic type III radical hysterectomy with bilateral pelvic lymphadenectomy was done. Simple repetitive steps were used to perform this surgery and develop an easily replicable technique. Harmonic Shears, bipolar coagulation, and vascular clips were used. Resection of the cardinal and uterosacral ligaments was performed with LigaSure (LigaSure Vessel Sealing System; Valleylab, Tyco Healthcare, Boulder, CO) or the Harmonic Shears (Ethicon Endo-Surgery, Inc., Cincinnati, OH). Pelvic lymph node dissection was done. MEASUREMENTS AND MAIN RESULTS: Histopathologically, there were 183 (73%) cases of squamous carcinoma, 52 (20%) adenocarcinomas, and 13 (5%) adenosquamous carcinomas. Four patients needing anterior exenteration because of bladder involvement were excluded from data analyses. The operation was performed entirely by laparoscopy in all patients and by the same surgical team. The patients' median age was 61 years. The median operative time was 92 minutes (range 65-120 minutes). The median number of resected pelvic nodes was 18. The median blood loss was 165 mL. The median length of stay was 3 days. All 15 intraoperative complications were tackled laparoscopically. No patients were converted to the open technique. There were no deaths in our series. Seventeen patients had complications within 2 months of surgery. Seven patients had recurrences after a median follow-up of 36 months. CONCLUSION: Our technique of total laparoscopic radical hysterectomy, developed over 248 cases, can be performed safely. It is an easily replicable technique. This procedure reduces the morbidity associated with abdominal radical hysterectomy. All of the complications can also be tackled laparoscopically, which does not further add to the morbidity.     

Laparoscopic hysterectomy with retroperitoneal uterine artery sealing using LigaSure™: Gazi hospital experience

OBJECTIVE: The aim of this study was to evaluate the efficacy and safety of laparoscopic hysterectomy by retroperitoneal sealing of the uterine arteries with LigaSure. METHODS: Laparoscopic hysterectomy by retroperitoneal uterine artery sealing with LigaSure was performed by four-puncture laparoscopy in 50 women with various indications for hysterectomy. The mean operation time, amount of intraoperative bleeding, drop in hemoglobin concentration, weight of removed uterus, major and minor per-post operative complications, and the rate of conversion to classical abdominal approach were analyzed prospectively. RESULTS: The mean operation time was 85 min (range 60-125 min). The mean weight of removed uterus was 180 g (range 60-650 g). There was one major complication; one patient had cystotomy due to difficulty in dissecting severe adhesions because of two previous cesarean sections that were repaired laparoscopically. Only one patient converted to laparotomy because of severe bowel adhesions due to rectovaginal endometriosis. All patients were discharged on the first postoperative day. No minor complications occurred. Hemoglobin decreased a mean of 0.4 g/dl (range 0.2-1.4 g/dl) by postoperative day 1. CONCLUSION: Laparoscopic hysterectomy by retroperitoneal uterine artery sealing with LigaSure is an effective, safe, and fast procedure with less intra operative bleeding, short operation time and hospital stay.     

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。     

腹腔镜手术在妇科的临床应用价值

目的探讨腹腔镜手术在妇科的临床应用价值.方法腹腔镜下行妇科输卵管手术、卵巢肿物手术、子宫(包括肌瘤剔除及子宫切除)手术229例,选择同期同样手术指征的腹腔镜和开腹手术各50例,进行手术时间、术中出血、术后镇痛用药率、术后输液日、住院日和术后发热率的比较.结果腹腔镜下绝大部分妇科良性疾病的手术获得成功.与开腹手术比,腹腔镜组术中出血少、术后用药少、痛苦小、住院日短、术后发热率低.结论腹腔镜手术创伤小、恢复快、术后并发症少,可施行于大部分妇科良性疾病.     

Safety and efficacy of using the LigaSure vessel sealing system for securing the pedicles in vaginal hysterectomy: randomised controlled trial

OBJECTIVE: To assess the safety and efficacy of using the LigaSure vessel sealing system for securing the pedicles during vaginal hysterectomy in comparison with the conventional method of securing the pedicles by suture ligation. DESIGN: Randomised controlled trial. SETTING: Gynaecology Department, Benenden Hospital, Kent. POPULATION: One hundred and sixteen women undergoing vaginal hysterectomy were prospectively randomised to either LigaSure (Group I) or suture ligation (Group II) for securing the pedicles. METHODS: Data of patients were collected prospectively. Statistical analysis was performed using the Mann-Whitney U test, chi(2) and Fisher's exact test as appropriate. MAIN OUTCOME MEASURES: Operating time, operative blood loss and peri-operative complications. RESULTS: The operating time was significantly shorter in the LigaSure group compared with the control group (P < 0.04). There was no statistical significant difference between the two groups in operative blood loss (P= 0.433), but peri-operative haemorrhagic complications were less frequent in the LigaSure group (0%vs 6.8%, P= 0.057). Four patients in the control group required either conversion to laparotomy because of bleeding, return to theatre for immediate post-operative haemorrhage or readmission for vault haematoma, whereas none in the LigaSure group had bleeding from unsecured pedicles. CONCLUSION: The LigaSure vessel sealing system is a safe alternative for securing pedicles in vaginal hysterectomy when compared with conventional suture ligation. Larger studies are required to determine its place in gynaecological surgery.     

腹腔镜联合阴式手术治疗早期子宫恶性肿瘤的临床价值

目的探讨腹腔镜盆腔淋巴切除 阴式广泛全子宫切除术(LPL VRH)治疗早期子宫恶性肿瘤的临床价值。方法2003年8月至2007年12月,选择11例早期子宫颈癌和8例子宫内膜癌的患者行LPL VRH治疗(研究组),选取同时入院接受开腹子宫广泛切除 淋巴切除术治疗早期子宫颈癌11例、子宫内膜癌8例为对照组,对其手术情况、手术时间、术后并发症、术中出血量、淋巴结切除数目、术后病率进行比较。结果研究组19例中18例成功手术,1例因淋巴结切除困难中转开腹。研究组与对照组在术中出血[(321.08±284.36)mL,(513.62±237.23)mL]、术后胃肠恢复时间(1.5d,4.5d)、术后下床活动时间(2d,7d),两组间比较差异有统计学意义(P<0.05)。而两组在手术时间、术中清除淋巴结数、术后尿潴留、尿失禁、淋巴囊肿及术后复发等指标上差异无统计学意义(P>0.05)。结论LPL VRH可作为早期子宫恶性肿瘤手术治疗方法之一,近期效果良好,远期疗效有待进一步观察。