腹式横小切口筋膜内子宫切除术62例临床分析

目的 论证横小切口筋膜内子宫切除术的优点。方法 分析62例横小切口筋膜内子宫切除术中、术后情况，并与同期传统腹式纵切口筋膜外子宫全切术比较，观察手术时间、出血量、术后排气时间、术后病率等。结果 改良式手术术后排气时间早，术后疼痛轻，术后病率少。结论 横小切口筋膜内子宫切除术可以在临床推广应用。     

改良筋膜内子宫切除术40例临床分析

目的 :探讨腹式全子宫切除术的方法和效果。方法 :采用改良筋膜内子宫切除术 40例 ,与传统经腹全子宫切除术 30例作为对照。结果 :该术式手术操作简便 ,组织损伤小 ,出血少 ,恢复快 ,对术后性生活影响小。结论 :改良筋膜内子宫切除术优于传统全子宫切除术。     

筋膜内子宫全切术100例分析

目的通过筋膜内子宫全切除术与传统经腹子宫全切除术、次全子宫切除术3种手术方式的比较，探讨筋膜内全子宫切除术的优越性。方法选择同期施行的筋膜内子宫全切除术100例，经腹子宫全切除术120例，次全子宫切除术60例，观察3组手术时间、术中出血量、术后排气时间、术后病率及术后恢复情况（住院天数、术后阴道出血、阴道残端息肉）等并进行比较。结果3组在手术时间、术中出血量、术后排气时间、术后病率及住院天数方面差异无显著性（P〉0．05）。术后阴道出血，传统的经腹子宫全切除术较筋膜内子宫全切除术、次全子宫切除术略多，但差异无显著性（P〉0．05）。筋膜内子宫全切除术残端有小宫颈宴体，无息肉形成，传统的经腹子宫全切除术有9例残端息肉形成。结论筋膜内子宫全切除术取传统经腹子宫全切除术和次全子宫切除术的优点，手术创面小，手术难度降低，不破坏盆底结构，减少术后残端出血及残端肉芽的发生，并且由于切除了宫颈内膜及移行带，消除了次全子宫切除术式发生宫颈残端癌的顾虑。因此，在良性子宫疾病需切除子宫时该术式值得推崇。     

筋膜内子宫切除术的临床探讨

目的 探讨筋膜内子宫切除术的方法和效果。方法 采用筋膜内子宫切除术56例，与传统经腹全子宫切除术42例做对照。结果 筋膜内子宫切除术手术操作简便，组织损伤小，出血少，恢复快，术后病率低，深受患者欢迎。结论 筋膜内子宫切除术优于传统经腹全子宫切除术，值得临床推广应用。     

经腹小切口、半筋膜内全子宫切除术临床探讨

全子宫切除术是治疗子宫良性病变常用的手术，经典的全子宫切除术创伤大，盆底结构变化大，术后一些并发症的出现直接影响患者的生活质量，现有的子宫切除术方式较多，如经腹横切口子宫切除术、阴式子宫切除术、全筋膜内子宫切除术等，均以减少创伤、简便术式以期提高手术质量为宗旨。我们参考相关资料，在吸收各家之长的基础上，自2004年开始探索经腹小切口、半筋膜内子宫切除术术式，取得满意效果，现报告如下。     

腹式小横切口筋膜内子宫切除术的应用

我院自 1999年开展腹式小横切口筋膜内子宫切除术。取得较好效果 ,现总结如下。1　资料与方法1 1　一般资料　 1999年 1月至 2 0 0 0年 6月我们对良性疾病6 5例有子宫切除指征者采用了经腹小横切口筋膜内子宫切除术 ,作为研究组 ,随机选择同期采用传统术式切除子宫的6 5例作为对照组。两组年龄、病种、子宫大小及盆腔粘连等方面差异无显著性 ,术前所有病例都作宫颈细胞学涂片检查 ,40岁以上有阴道不规则出血者分段诊刮排除子宫恶性病变。1 2　手术方法　术前准备和麻醉同传统子宫切除术 ,研究组采用下腹部耻骨联合上 2横指横纹处横形小切口 …     

腹式小横切口筋膜内子宫切除术效果分析

自 2 0 0 1年起我院开展腹式小横切口筋膜内子宫切除术治疗子宫良性病变 6 2例 ,疗效满意 ,报道如下。1　资料与方法1.1　研究对象　 2 0 0 1年 4月至 2 0 0 2年 12月因子宫良性病变需行全子宫切除术者 6 2例 ,子宫如孕 8～ 12周。随机分成研究组和对照组 ,各 31例。两组患者年龄、腹部肥胖程度、子宫大小及疾病程度差异无显著性 (P <0 .0 5 )。1.2　手术方法　两组术前准备与术后处理无差别。1.2 .1　腹式小横切口筋膜内子宫切除术　 ( 1)切口沿Pfan nenstiel皮纹做以腹中线为中心两侧对称切口 6～ 8cm ;( 2 )按传统经腹行全子宫切除术 ,…     

改良腹式子宫切除术200例临床分析

经腹子宫切除是妇科常用术式,在以色列医生Stark创立的新式剖宫产术基础上,改良腹式子宫切除使之手术达到微创、简便、快捷、出血少、损伤小和术后恢复快的目的。北京市顺义区妇幼保健院近6年共开展经下腹部改良小切口筋膜内子宫切除术1089例,现总结报道如下。     

腹式筋膜内子宫切除术的临床探讨

目的分析腹式筋膜内子宫切除术的疗效。方法选取我院2013年6月~2015年1月收治的行子宫切除术的患者56例作为研究对象,按照其术式不同分为A组和B组,各28例。A组患者采取腹式筋膜内子宫切除术,B组患者采取常规子宫切除术,对比两组患者手术情况。结果两组患者手术均顺利实施,A组患者切口均甲级愈合,术后未发生并发症;B组患者切口甲级愈合率85.7%,术后并发症发生率21.4%。差异有统计学意义(P0.05)。A组患者手术时间、术中出血量、排气时间及住院时间均短于B组,差异有统计学意义(P0.05)。结论腹式筋膜内子宫切除术操作简单,安全,手术损伤小,疗效显著。     

腹壁横切口筋膜内子宫全切术98例分析

近年 ,因良性病变切除子宫保留宫颈的患者渐多 ,从而筋膜内子宫切除术的应用增多。此术式取筋膜外子宫全切和次全切之优点 ,能预防宫颈残端癌 ,保持盆底组织及阴道的完整性。 1998年 1月至 2 0 0 0年 11月我们共做此手术 98例 ,并与同期筋膜外子宫全切除术 6 0例做对照分析。1　资料和方法1.1　病例选择　患者均为子宫良性病变有子宫切除指征者 ,子宫大小约为妊娠 8～ 12周 ,诊断明确 ,无恶性肿瘤倾向 ,根据术式不同 ,将患者随机分为两组。研究组 98例 ,行筋膜内全子宫切除术 ,对照组 6 0例 ,行传统经腹全子宫切除术。两组年龄 ,子宫大小和…     

Unilateral or bilateral nerve-sparing radical hysterectomy: a surgical technique to preserve the pelvic autonomic nerves while increasing radicality

We performed unilateral or bilateral nerve-sparing (UNS or BNS) radical hysterectomies combined with a parametrial excision in patients with locally advanced cervical cancer. The parametrial excision technique is characterized by a meticulous sharp dissection of the avascular plane outside the visceral fascia of the uterus and vagina under direct vision, providing an en bloc parametria and ensuring that all regional spread of the disease is contained within negative surgical margins. The aim of this study was to describe this surgical technique and to retrospectively evaluate the feasibility and the impact on early bladder function. From February 2005 to November 2006, 32 patients with FIGO stage IB-IIB cervical cancer, who had the tumor of more than 20 mm in diameter, underwent the UNS surgery or BNS surgery. A parametrial excision was performed in all the patients. The surgical procedure was safely completed in all the patients. Though 14 patients had tumor invasion to the parametria, none of the patients had a positive surgical margin in the parametrium. The bladder function of patients in the UNS group immediately after surgery was more damaged than that in the BNS group. However, all the patients in both groups recovered spontaneous voiding with no need of self-catheterization during the perioperative periods. This preliminary study showed that the surgical technique is feasible and safe. For confirmation of the efficacy of this technique, further large prospective studies are needed.     

剖宫产术后子宫瘢痕部位妊娠6例临床分析

目的:是提高子宫瘢痕部位妊娠对早期诊断和早期治疗,提高广大妇产科医生对该病的认识。方法:对我院2010年1月至2010年10月收治的6例子宫瘢痕部位妊娠患者的临床观察进行总结和分析。结果子宫瘢痕部位妊娠病情发展凶险,6例患者中有3例切除子宫,失去生育功能,占50%,3例行子宫动脉栓塞后杀胚治疗,占33.3%。结论子宫瘢痕部位妊娠容易误诊,对有剖宫产史再次妊娠患者常规B超,早期筛查,早期诊断,早治疗极关重要。     

Is diminished pubocervical fascia collagen content a risk factor for failure of surgical management of genuine stress urinary incontinence in women?

OBJECTIVE: The assessment of relationship between pubocervical collagen content and clinical results of surgical treatment of genuine stress urinary incontinence (GSUI) in women. METHODS: Twenty-four women treated for genuine stress urinary incontinence were included into the study. All women underwent the same surgical procedure. The samples of pubocervical fascia were taken at the time of surgery. The contents of acid soluble, pepsin soluble, insoluble fraction of collagen, total collagen and collagen crosslinks were measured. The study of pubocervical fascia collagen metabolism included also estimation of collagenase activity. At follow-up done 5 years following surgery, 20 patients reported symptoms of GSUI (study group). Four women were still without symptoms of urine leakage (control group). RESULTS: The biochemical parameters of pubocervical fascia did not show, statistically significant differences between compared groups. CONCLUSION: The pubocervical fascia collagen metabolism does not have impact on the results of anti-incontinence surgery.     

Robot-assisted Nerve Plane–sparing Eradication of Deep Endometriosis with Double-bipolar Method

ObjectiveTo demonstrate anatomic and technical highlights of a robot-assisted nerve plane–sparing eradication of deep endometriosis (DE).DesignStepwise demonstration of the technique with narrated video footage.SettingAn urban general hospital.InterventionsLaparoscopic nerve-sparing techniques as represented by the Negrar method reportedly result in lower rates of postoperative bladder, rectal, and sexual dysfunctions than classical approaches [1]. In addition, robotic surgery has become available, and 2 meta-analyses have confirmed that robotic surgery is safe and feasible for the treatment of endometriosis, especially in advanced cases [2,3]. However, few papers have shown the surgical techniques for a nerve-sparing procedure using a robotic approach.The patient was a 45-year-old woman who presented with severe chronic pelvic pain and dysmenorrhea resistant to medication therapy. She had no nerve-specific complaints such as pain in the pudendal distribution or a voiding dysfunction. Magnetic resonance imaging revealed multiple uterine fibromas and adenomyosis with DE, involving the uterosacral ligament and surface of the rectum, with cul-de-sac obliteration. The parametrium was not involved in the DE. Robot-assisted nerve plane–sparing excision of DE with a double-bipolar method was performed using the following 8 steps: step 1, adhesiolysis and adnexal surgery; step 2, checking the ureteral course; step 3, separation of the nerve plane (step 3.1, dissection of the avascular layer below the hypogastric nerve, between the prehypogastric nerve fascia and presacral fascia; and step 3.2, dissection of the avascular layer above the hypogastric nerve, between the prehypogastric nerve fascia and fascia propria of the rectum) [4,5]; step 4, reopening of the pouch of Douglas; step 5, complete removal of DE lesions while avoiding injury to the nerve plane; step 6, hysterectomy (if the patient desires non–fertility-sparing surgery); step 7, checking for rectal injury using an air leakage test; and step 8, barrier agents for adhesion prevention.With regard to step 3, as a result of sharp dissection between avascular layers both above and below the hypogastric nerve, autonomic nerves in the pelvis were separated like a sheet with the surrounding fascia (the nerve plane). We then performed steps 4 to 6 in a step-by-step manner while avoiding injury to the nerve plane. The urinary catheter was removed within 24 hours after the surgery, and no residual urine was seen. The patient developed no perioperative complications; in particular, no postoperative bladder or rectal dysfunctions. The precise sharp dissection of the right embryo-anatomic planes on the basis of the detailed mesoanatomy seems important for improving functional outcomes in nerve-sparing surgery [5].ConclusionRobot-assisted nerve plane–sparing eradication of DE is as technically feasible as the conventional laparoscopic approach. The step-by-step technique should help surgeons perform each part of the surgery in a logical sequence, making the procedure easier and safer to complete. However, the latent benefits of robot-assisted nerve-sparing surgery in the treatment of DE remain uncertain.     

Piver's radical hysterectomy (type III): Endo-Gia 30 stapler versus traditional forcipressure for resection of the cardinal ligament

OBJECTIVE: Morbidity and costs associated with Piver's radical hysterectomy (type III) are noteworthy. The Endo-Gia stapler method for resection of cardinal ligaments can reduce duration of surgery and hospitalization, blood loss, costs and postoperative infection rates. METHOD: Two groups of patients (homogeneous for age, weight and medical condition) were studied: one group was operated on using the Endo-Gia stapler method (n=52) and the other with the traditional forcipressure (n=13). The size of parametrial tissue removed, blood loss, duration of surgery, duration of hospitalization, cost of materials and postoperative fever were compared in the two groups. RESULT: Mean operative times were lower in the Endo-Stapler group than in the controls (mean 180 min versus 220 min). Mean blood loss was 300 cc in the stapler group versus 450 cc in the forcipressure group. Mean cost of surgery (considering costs of materials, hospital stay. duration of surgery), was lower in the stapler group (3,095 euros) than in the group who underwent traditional surgery (3,434 euros). CONCLUSION: Our data suggest the Endo-Gia stapler method significantly reduces blood loss, operative time and cost.     

Women’s Pain Experience Predicts Future Surgery for Pain Associated With Endometriosis

ObjectivesA previous randomized controlled trial from 1991 to 1993 comparing excision of endometriosis with sham surgery demonstrated no difference in reported pain after blinding between the excision and sham groups for one year. Overall, when both groups were considered, there was a significant reduction in pain one year postoperatively. This trial was done to determine the predictors of subsequent surgery.MethodsThe time to repeat surgery was the outcome of interest as a marker for significant pain. Survival analysis and log rank tests were performed to determine if the time to repeat surgery differed by group or by age, parity, original level of pain pre-operatively and stage of the disease.ResultsOnly the reported measurement of pain prior to the initial trial was a significant covariate in the overall prediction of repeat surgery among all subjects. The overall repeat surgical operation rate was 48.3% in the sham surgery group and 51.7% in the excision group. The estimated relative risk for repeat surgery (excision vs. sham) was 1.42 (95% confidence intervals 0.539–3.75).ConclusionPain experience preoperatively was found to be an important predictor of subsequent surgical need. In this study, age, stage of disease, and excision of endometriosis were not associated with improvement in pain as measured by the time to repeat surgery.     

Surgical treatment of endometriosis: a 7-year follow-up on the requirement for further surgery

OBJECTIVE: To investigate the need for further surgery after laparoscopic excision of endometriosis or hysterectomy. METHODS: In this retrospective study, women who had surgery for endometriosis-associated pain at the Cleveland Clinic were assessed for requirement for subsequent surgery. One hundred twenty patients who underwent hysterectomy with or without oophorectomy for endometriosis and 120 patients who had laparoscopic excision of their endometriotic lesions only (local excision group) formed the study population. Estimates of reoperation-free survival at 2, 5, and 7 years were calculated using Kaplan-Meier methods, and estimates of risk (hazard ratios) were computed using Cox proportional hazards models. A significance level of .05 was assumed for all tests. RESULTS: In women who underwent local excision with ovarian preservation, the surgery-free percentages were 79.4%, 53.3%, and 44.6%, respectively, at 2, 5, and 7 years. In women who underwent hysterectomy with ovarian preservation, the 2-, 5-, and 7-year reoperation-free percentages were 95.7%, 86.6%, and 77.0%, respectively. In women who underwent hysterectomy without ovarian preservation, the percentages were 96.0%, 91.7%, and 91.7%, respectively. However, in women between 30 and 39 years of age, removal of the ovaries did not significantly improve the surgery-free time. CONCLUSION: Local excision of endometriosis is associated with good short-term outcomes but, on long-term follow-up, has a high reoperation rate. Hysterectomy is associated with a low reoperation rate. Preservation of the ovaries at the time of hysterectomy remains a viable option. LEVEL OF EVIDENCE: II.     

Preservation of Endopelvic Fascia: Effects on Postoperative Incontinence and Sexual Function – A Randomized Clinical Trial

BackgroundUrinary incontinence and sexual dysfunction are common after robot-assisted radical prostatectomy (RALP). New surgical techniques to improve these functions after the operation are under evaluation for example, preservation of endopelvic fascia during RALP. However, the benefits of this technique have not been critically scrutinized in a randomized setting.AimIn this study, we compared endopelvic fascia preserving operation with the standard surgical procedure in a randomized trial at the Tampere University Hospital, Finland.MethodsA total of 158 men with localized prostate cancer and scheduled for RALP were randomized 1:1 into endopelvic fascia–preserving RALP or a control group that is, standard operation. All operations were performed by a single surgeon.OutcomesUrinary and sexual function were evaluated by the Expanded Prostate Cancer Index Composite-26 questionnaire at baseline and 3, 6, and 12 months after the surgery.ResultsThere was no difference in urinary incontinence or sexual function between the groups at any time point (urinary incontinence domain at 12 months after RALP for fascia preserving and control group 73.6 ± 3 vs 78.9 ± 2.5 and sexual domain 43 ± 3.2 vs 40.3 ± 3, respectively). Clinical and pathologic tumor characteristics, duration of surgery, blood loss, rate of complications, and time to hospital discharge were similar between the study arms. Compliance of filling out the Expanded Prostate Cancer Index Composite-26 questionnaire varied from 91% to 98%, with no difference between study arms.Clinical ImplicationsBased on our results, endopelvic fascia preservation alone during RALP is not recommended over the standard surgical method.Strengths & LimitationsThis is a randomized clinical study with sufficient statistical power. As a limitation, only a minority of participants underwent magnetic resonance imaging before the operation, thus we could not evaluate the role of urethral length or shape of the prostate. Urinary and sexual function results are based on questionnaires filled out by the patients, however, participants completed the surveys independently unassisted by health care personnel.ConclusionEndopelvic fascia–preserving RALP does not improve urinary continence or sexual function as compared with the standard surgical technique. Future studies aiming to improve functional outcomes after RALP should focus on evaluating other technique modifications.Siltari A, Riikonen J, Murtola TJ. Preservation of Endopelvic Fascia: Effects on Postoperative Incontinence and Sexual Function – A Randomized Clinical Trial. J Sex Med 2021;18:327–338.     

Sparing of saphenous vein during inguinal lymphadenectomy for vulval malignancies

OBJECTIVE: This work was set out to investigate the effect of saphenous vein preservation during inguinal lymphadenectomy for patients with vulval malignancies. METHODS: 64 patients with vulval malignancies were allocated into two groups depending on their clinical stages, with one of them (31 patients included) being subjected to sparing of saphenous vein and the other to saphenous vein ligated surgery while treated with inguinal lymphadenectomy. The operative time, blood loss, 5-year survival rate, short- and long-term postoperative complications, 5-year survival rate and groin recurrence were selected as the monitored parameters, through which the above two groups were compared with each other using t test, chi2 and life table analysis. RESULTS: (1) The median operative time for bilateral inguinal lymphadenectomy was 155 min (130-170 min) in the sparing group, compared to 140 min (120-170 min) in the excision group (P>0.05). The median intraoperative blood loss was 295 mL (100-450 mL) in the sparing group, and 270 mL (150-390 mL) in the excision group (P>0.05). (2) Short-term lower extremity lymphedema occurred with 27 patients (43.5%) in the sparing group and 44 patients (66.7%) in the excision group (P<0.01). Still, short-term lower extremity phlebitis was observed with 7 patients (11.3%) in the sparing group while 17 developed phlebitis (25.8%) in the excision group (P<0.05). However, there was no statistical difference in postoperative fever, acute cellulites, seroma, or lymphocyst formation. (3) Long-term complication occurrence rate decreased by about 50% in patients subjected to saphenous vein sparing surgery compared with those to ligated surgery, while there was no remarkable difference between two groups in the occurrence rates of phlebitis and deep venous thrombosis (P>0.05). (4) The overall 5-year survival rate was 67.3%, with 66.7% and 68.0% for the excision group and the sparing group, respectively (P>0.05). CONCLUSION: The application of saphenous vein preservation technique during inguinal lymphadenectomy for patients with vulval malignancies could significantly decrease the occurrence rate of postoperative complications without compromising outcomes and should be widely put into clinical practice.     

A prospective randomized trial using solvent dehydrated fascia lata for the prevention of recurrent anterior vaginal wall prolapse

OBJECTIVE: This study was undertaken to compare outcomes after anterior colporrhaphy with and without a solvent dehydrated cadaveric fascia lata graft. STUDY DESIGN: A total of 162 women were enrolled in a prospective, randomized trial that evaluated the impact of a solvent dehydrated cadaveric fascia lata patch on recurrent anterior vaginal prolapse. Subjects were randomly assigned to standard colporrhaphy with or without a patch. Before and after surgery, subjects were evaluated by both the Baden-Walker and pelvic organ prolapse quantification systems. "Failure" was defined as stage II anterior wall prolapse or worse. RESULTS: Of 154 women randomly assigned (76 patch: 78 no patch), all underwent surgery and 153 (99%) returned for follow-up. Sixteen women (21%) in the patch group and 23 (29%) in the control group experienced recurrent anterior vaginal wall prolapse (P = .229). Only 26% of all recurrences were symptomatic. Concomitant transvaginal Cooper's ligament sling procedures were associated with a dramatic decrease in recurrent prolapse (odds ratio [OR] 0.105 , P < .0001). CONCLUSION: Solvent dehydrated fascia lata as a barrier does not decrease recurrent prolapse after anterior colporrhaphy. Transvaginal bladder neck slings were associated with a significant reduction in the risk of recurrent anterior wall prolapse.