子宫肌瘤剔除术后复发危险因素的分析

目的探讨子宫肌瘤剔除术后复发的危险因素.方法对行子宫肌瘤剔除术的251例患者,进行定期随访并记录检查结果,分析定期随访并资料齐全的234例患者资料.结果①两组患者共54例(23.1%,54/234)复发.腹腔镜组复发44例(24.2%,44/182),经腹手术组复发10例(19.2%,10/52),两组复发率差异无显著性(P＞0.05).②单因素分析显示子宫大小、肌瘤大小和数目是复发的相关因素.Cox回归分析显示复发的3个相关危险因素为肌瘤≥10 cm(P=0.004);多发肌瘤(P=0.001);肌壁间肌瘤(P=0.021).复发患者中3例再次接受手术治疗(5.6%,3/54),2例行全子宫切除术,1例行肌瘤剔除术.结论腹腔镜子宫肌瘤剔除术后不增加复发机会,复发的3个危险因素是肌瘤≥10 cm、多发肌瘤以及肌壁间肌瘤.     

子宫肌瘤剔除术后复发危险因素分析

目的：探讨和分析子宫肌瘤剔除术后复发的后果及其危险的因素,为日后的子宫肌瘤剔除术后可能发生的危险做参考资料。方法：从本院2007年1月至2008年12月这段期间内,选取100例进行子宫肌瘤剔除手术的患者,对她们进行一定时间的追踪和查访,并记录随访后的检查数据和结果,对100例患者的检查数据和结果进行分析和研究。结果：在100例患者中,共有21例患者复发。其中行腹腔镜手术的患者复发了15例,经腹的手术方式患者的复发了6例,两个组的复发程度没有显著差异。各项数据均显示,子宫的大小和肌瘤的大小、数量都与术后的复发有着关联。结论：子宫肌瘤剔除术后复发主要与肌瘤数量、大小及子宫本身形态有关,临床上可针对有以上危险因素的患者强化护理工作。     

子宫肌瘤剔除术后3个月输卵管绒癌1例

患者,40岁,因子宫肌瘤剔除术后3个月,发现盆腔肿物14天于2006年8月30日入院。患者于3个月前因不规则阴道出血5个月在当地医院诊断为"子宫肌瘤",行子宫肌瘤剔除术。术中见子宫前壁肌瘤大小约6cm×5cm×4cm,双侧附件未见异常,病理结果:子宫平滑肌瘤。术后为控制肿瘤复发,口服米非     

子宫肌瘤剔除术对妊娠的影响

子宫肌瘤是女性最常见的盆腔良性肿瘤.随着女性生育年龄的推迟,未生育的合并子宫肌瘤的患者逐渐增多.带瘤妊娠能降低妊娠率、增加产科并发症发生率.然而,子宫肌瘤剔除术形成的盆腔粘连及子宫疤痕对随后的妊娠和分娩都有负面影响.故而,对于未生育的子宫肌瘤患者建议其带瘤妊娠还是剔除子宫肌瘤后妊娠,以及以何种手术方式剔除子宫肌瘤一直是临床的难题.本文对子宫肌瘤剔除术对术后妊娠的影响予以综述.     

阴式子宫肌瘤剔除术45例临床分析

目的探讨阴式子宫肌瘤剔除术的可行性、临床效果和安全性。方法回顾性分析2002年1月至2004年4月间,我院阴式子宫肌瘤剔除术患者45例(阴式组)及同期行腹式子宫肌瘤剔除术的患者45例(对照组)的临床资料,比较手术效果和术后恢复情况。结果平均手术时间、术中平均出血量阴式组为(76±21)min、(414±73)ml,对照组为(72±26)min、(404±68)ml,两组比较,差异均无统计学意义(P>0·05);而阴式组患者术后的平均排气时间[(18±9)h]、术后平均住院时间[(4·8±0·6)d]均明显短于对照组[(31±8)h、(7·8±0·4)d],两组比较,差异有统计学意义(P<0·05)。两组患者术后平均随访6·8个月,因月经过多手术者,症状全部改善;与对照组比较,阴式组患者术后康复快,对手术效果更满意。结论阴式子宫肌瘤剔除术比腹式子宫肌瘤剔除术的手术效果好、创伤小、术后并发症少、康复快,是一种值得推广、应用的微创术式。     

300例子宫肌瘤患者剔除术后复发危险因素分析

目的：探讨与分析子宫肌瘤患者剔除术后复发危险因素。方法：回顾性总结在我院施行子宫肌瘤剔除手术治疗的患者300例资料。结果：300例子宫肌瘤患者手术治疗半年后开始随访调查,确诊复发例数为38例,复发率为12.7%。其中,40岁患者;单发性肌瘤患者复发率为5.6%,明显低于多发性肌瘤患者;肌瘤直径〉5cm患者复发率6.6%,显著小于肌瘤直径〈5cm患者,而肌瘤位置的不同使患者手术后复发率差异也具有统计学意义（P〈0.05）。结论：子宫肌瘤患者剔除术后复发危险因素包括子宫肌瘤大小、位置、年龄和肌瘤数量,而病程因素和体重等因素并不是子宫肌瘤术后复发的主要原因。     

妊娠期子宫破裂修补术（附38例临床分析）

妊娠期子宫破裂修补术（附３８例临床分析）李素洁（上海市第六人民医院妇产科）现将我们自１９８７年４月至１９８９年３月于摩洛哥塔扎省医院工作期间对３８例子宫破裂患者的诊治情况报告如下。１临床资料３８例从子宫破裂到急诊手术最短约３ｈ，最长３８ｈ，超过２４ｈ...     

妊娠期子宫肌瘤剔除术86例Meta分析

目的 探讨妊娠期子宫肌瘤剔除术的手术指征、并发症、妊娠结局以及影响手术成功的因素。方法 检索Pubmed（1989年1月～2004年4月）有关妊娠期行子宫肌瘤剔除术文献资料，对文献质量进行评价并提取相关信息．总结妊娠期行子宫肌瘤剔除术者的肌瘤特点、手术指征、并发症、妊娠结局等。结果 妊娠期行子宫肌瘤剔除术的86例中绝大部分在孕中期进行（12～26周），主要手术指征为腹痛（64％，35／55）和肌瘤过大或生长过快（20％．11／55）．术中无出血过多、子宫切除的并发症，术后自然流产4例．活产率达92％．分娩方式以剖宫产为主，占75％（53／71）。结论 在严格掌握适应证的基础上，妊娠期仍可安全地行子宫肌瘤剔除术。     

腹腔镜下多发性子宫肌瘤剔除76例临床分析

子宫肌瘤是女性生殖器官最常见的良性肿瘤,发病率高达20～30%,现代女性更为重视生殖器官的完整性和子宫的生理功能,且更多妇女要求晚育,在患妇科疾病时她们总是希望尽量将子宫保留与减少创伤,所以,子宫肌瘤患者都会首选腹腔镜下子宫肌瘤剔除术,而多发性子宫肌瘤的剥除,因为其复发率高、术中出血多既往常常是腹腔镜手术的禁忌症。我院自2008年12月至2010年12月间腹腔镜下子宫肌瘤剔除术157例,术前都是通过彩色超声检查以基本明确的,门诊检查     

妊娠合并子宫肌瘤行剖宫产术中剔除的效果观察

目的:观察妊娠合并子宫肌瘤行剖宫产术中剔除的效果。方法:选择我院2009年6月—2010年12月56例妊娠合并子宫肌瘤的孕晚期孕妇在行剖宫产术时同时行子宫肌瘤剔除术,本组患者设为观察组;与同期行单纯剖宫产术的患者56例作为对照组,对手术时间、术中出血量、术后恢复情况等进行对比分析。结果:观察组平均手术时间较对照组长,其差异具有显著性,有统计学意义P<0.05;二组术中平均出血量与平均住院时间差异不明显,其差异无显著性,无统计学意义P>0.05。结论:术前根据肌瘤的大小及生长部位选择合适的手术切口位置及手术方式,在行剖宫产手术的同时行子宫肌瘤剔除是安全可行的,值得临床推广。     

Risk Factors for Uterine Rupture after Laparoscopic Myomectomy

Case reports for uterine rupture subsequent to laparoscopic myomectomy were reviewed to determine whether common causal factors could be identified. Published cases were identified via electronic searches of PubMed, Google Scholar, and hand searches of references, and unpublished cases were obtained via E-mail queries to the AAGL membership and AAGL Listserve participants. Nineteen cases of uterine rupture after laparoscopic myomectomy were identified. The removed myomas ranged in size from 1 through 11 cm (mean, 4.5 cm). Only 3 cases involved multilayered closure of uterine defects. Electrosurgery was used for hemostasis in all but 2 cases. No plausible contributing factor could be found in 1 case. It seems reasonable for surgeons to adhere to techniques developed for abdominal myomectomy including limited use of electrosurgery and multilayered closure of the myometrium. Nevertheless, individual wound healing characteristics may predispose to uterine rupture.     

Co-Existence of Uterine Myomas and Endometriosis in Women Undergoing Laparoscopic Myomectomy: Risk Factors and Surgical Implications

Study ObjectiveTo investigate the prevalence of and explore risk factors for the coexistence of uterine myomas and endometriosis and to assess operative outcomes during laparoscopic myomectomy.DesignRetrospective cohort study (Canadian Task Force classification II-2).SettingTertiary referral center in London, England.PatientsTwo hundred twelve women undergoing laparoscopic myomectomy to treat symptomatic uterine myomas.InterventionLaparoscopic myomectomy.Measurements and Main ResultsCoexisting myomas and endometriosis were identified in 21.2% of patients. Endometriosis was more common in those with subfertility (44% vs 25.7%; p = .02) and less common in those with bleeding disorders (20% vs 45%; p = .003). Parity, location of myoma, and race/ethnicity affected risk of endometriosis, whereas size and number of myomas did not. Of patients with endometriosis, 42% underwent surgical treatment of endometriosis during myomectomy. Significantly more patients with endometriosis also underwent ovarian cystectomy than did those without endometriosis (15.6% vs 3%; p = .004). Operative time was similar in both groups (109.6 minutes vs 116.4 minutes; p = .83), as was estimated blood loss (271 mL vs 327 mL; p = .16).ConclusionsA diagnosis of concomitant endometriosis should be considered, in particular in patients with subfertility and pain. This enables optimal preoperative counseling and consent for potential additional procedures such as treatment of endometriosis or ovarian cystectomy.     

9例完全性子宫破裂病例病因分析与探讨

目的：探讨完全性子宫破裂的病因、临床特点及结局。方法：回顾性分析2016年1月—2018年12月南京医科大学附属淮安第一医院收治的9例完全性子宫破裂患者的病例资料,对患者一般资料及发病、治疗过程进行归纳总结。结果：9例完全性子宫破裂患者中,引产导致子宫破裂4例（2例位于子宫体部、2例位于子宫下段原切口瘢痕）,胎盘植入导致子宫破裂1例（子宫下段原切口瘢痕处）,不明原因子宫破裂1例（有人工流产病史,位于子宫底部）,腹腔镜宫角部手术后瘢痕破裂1例（位于子宫角部）,宫缩发动后前次剖宫产瘢痕切口破裂2例（子宫下段原切口瘢痕处）。临床表现为持续性下腹痛2例,不规则下腹痛4例,持续性脐周痛1例,无明显腹痛2例。6例伴阴道出血,3例无阴道出血表现。7例行子宫破裂修补术,2例行次全子宫切除术。非引产的5例病例中,胎死宫内1例,其余4例新生儿结局良好。结论：瘢痕子宫再次妊娠是子宫破裂的高发人群,对于具有前置胎盘、多次剖宫产和人工流产、子宫手术等宫腔操作史的孕妇应警惕子宫破裂的风险。     

Pregnancy outcomes after transvaginal myomectomy by colpotomy

Objective

To examine long-term effects of transvaginal myomectomy by colpotomy on uterine ruptures, fertility and pregnancy outcome.

Study design

Transvaginal myomectomy by colpotomy was performed for sixteen patients who had symptomatic uterine leiomyomas and wished to preserve their fertility. Data on possible pregnancies, infertility treatments, hysterectomies and other reoperations during a follow-up period of ten years were retrospectively collected from the hospital records. Those who had no outpatient contacts in the hospital records were interviewed by telephone.

Results

Eight (50%) of the 16 patients tried actively to conceive and they produced 14 pregnancies: six of them had two pregnancies and two had one. The median interval between the transvaginal myomectomy and the first pregnancy was 17 months (range 14–68 months). All pregnancies were uneventful and ended in full-term delivery of a healthy infant. Uncomplicated vaginal delivery was recorded in 10 (71%), vacuum extraction in one (7%) and cesarean section in three (21%) out of 14 cases. Uterine rupture or heavy postpartal bleeding was not reported.

Conclusions

Pregnancies after transvaginal myomectomy by colpotomy were uneventful and no uterine ruptures were detected during a long-term follow-up. Pregnancy rates after the procedure appear to be similar to results after abdominal or laparoscopic myomectomy. Transvaginal myomectomy by colpotomy is a safe and feasible treatment option for selected patients wishing to preserve their ability to conceive.     

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。     

关于分碎术对未预料子宫肉瘤影响的55例病例对照研究

目的：对腹腔镜及开腹手术中发现的未预料子宫肉瘤病例进行病例对照研究,以探讨分碎术对该病的影响,并分析患者的病例资料探讨该病的早期诊断。方法：选取2008年11月—2014年11月术后病理为子宫肉瘤而手术指征为子宫肌瘤的病例,其中腹腔镜组8例,开腹组47例,腹腔镜组使用分碎器而开腹组未使用,行对照研究并分析患者临床特点。结果：55例未预料子宫肉瘤患者中16例（腹腔镜组7例,开腹组9例）行二次手术;腹腔镜组二次手术率高于开腹组（87.5% vs. 19.1%,P=0.000）,二次手术中发现盆腔种植转移病例数多于开腹组（2 vs. 0）,术中病理确诊率低于开腹组（37.5% vs. 76.6%,P=0.038）。结论：腹腔镜下分碎术可能增加了未预料子宫肉瘤的盆腔种植转移以及二次手术的概率,并降低了术中病理明确诊断率,这应该引起临床医师的注意并采取相应的措施规避此风险的发生。     

妊娠期子宫破裂8例报告及文献复习

目的:探讨妊娠期子宫破裂的可能原因、临床表现及预防措施。方法:回顾2013—2016年首都医科大学附属北京安贞医院妇产科收治的8例子宫破裂患者的临床特点、治疗情况及预后,并结合相关文献进行分析。结果:8例妊娠期子宫破裂患者中有7例是瘢痕子宫破裂,1例是非瘢痕子宫破裂,临床表现多样。妊娠期瘢痕子宫发生破裂的概率较非瘢痕子宫高,而剖宫产术是造成瘢痕子宫及再次妊娠子宫破裂的高危因素。结论:剖宫产术后再次妊娠的时机及分娩方式的选择对预防妊娠期子宫破裂的发生至关重要。     

Laparoscopic Myomectomy of a Symptomatic Uterine Leiomyoma in a 15-Year-Old Adolescent

BackgroundAlthough adnexal masses and ovarian torsion are common causes of acute pain in the female adolescent, fibroids are an uncommon etiology and little is reported in the literature. Because of the rarity of adolescent leiomyomas, the best surgical management is still unknown.CaseTo our knowledge, this is the first case report of a laparoscopic myomectomy in the adolescent population. The removed fibroid is one of the largest documented cases of uterine leiomyoma in adolescents.Summary and ConclusionDegenerative fibroids, albeit less common, should be kept on the differential diagnosis, as a possible cause of pelvic mass and pain in the adolescent population. Fibroids in the adolescent patient, like the adult, can be managed with minimally invasive surgery with excellent clinical outcomes.     

Multidisciplinary Approach in Large-sized Submucosal Myoma: Hysteroscopic Myomectomy after Uterine Artery Embolization

Study Objective

To evaluate the safety and effectiveness of hysteroscopic myomectomy after uterine artery embolization (UAE) for the treatment of large-sized submucosal myomas with deep intramural invasion that are difficult to treat with 1-step hysteroscopy.

腹腔镜下子宫动脉阻断术治疗子宫肌瘤的研究进展

近年来,随着妇科微创技术的不断发展,腹腔镜下子宫动脉阻断术逐渐被应用于治疗子宫肌瘤。国内外文献报道,用该术式治疗子宫肌瘤可达到满意的临床疗效,术后能明显缓解月经异常症状,缩小子宫体积,有效降低子宫肌瘤的复发率。另外,该技术治疗子宫肌瘤的机制尚不完全明确,目前认为可能与子宫的血供特点、子宫肌瘤与平滑肌组织的凝血-纤溶激活系统差异有关。现对近年来该技术的临床应用情况以及相关机制研究进行综述。