腹腔镜与开腹手术治疗卵巢子宫内膜异位囊肿的比较

腹腔镜手术具有创伤小、恢复快、少粘连、易被病人接受等优点。但对于卵巢子宫内膜囊肿，腹腔镜是否能完全取代开腹术，目前尚无定论。为此我们进行了两组术式的比较。一、资料与方法１临床资料：选自１９９５年３月至１９９７年７月珠海市人民医院３０例，及１９９２年...     

应用腹腔镜行卵巢子宫内膜异位囊肿热浴治疗

在腹腔镜下对卵巢子宫内膜异位囊肿的治疗主要采用囊壁剥离或囊肿切除术 ,而当盆腔内有严重致密粘连时 ,囊肿剥离或切除困难 ,我们采用双极电凝钳为加热源在囊腔内加热液体 ,以热效能破坏囊壁病灶 ,减少副损伤的发生 ,达到良好临床效果。现报道如下。一、方法1.腹腔镜置入 :患者在连续硬膜外麻醉成功后取平卧位 ,在脐轮下缘作垂直切口长约 1ｃｍ ,气腹针穿刺 ,注水试验确定进入腹腔后 ,充入二氧化碳气体 3.0～ 3.5Ｌ ,压力为 1.6ｋＰａ ,放置 7ｍｍ套管及腹腔镜 ,改取头低 15～ 2 0°臀高位 ,于两侧下腹相当于麦氏点部位行第 2、3穿刺点 ,分…     

卵巢子宫内膜异位囊肿66例临床分析

子宫内膜异位症近年来发病率呈上升趋势,其中最常发生的部位是卵巢组织,临床上极易误诊。本文收集了６６例卵巢子宫内膜异位囊肿,并与同期卵巢良性肿瘤进行比较,以探讨卵巢子宫内膜异位囊肿的诊治特点。１资料与方法１１一般资料自１９９２年１月至１９９８年４月,...     

腹腔镜手术治疗子宫内膜异位症的前景

本文综述了腹腔镜手术治疗特别是应用激光治疗子宫内膜异位症（内异症）的优点和注意事项及今后的发展趋势，提出腹腔镜手术治疗内异症应该为广大妇科医生熟悉并应用手术前后加用药物治疗可以增加治疗效果及减少病灶的复发率。     

腹腔镜下微波手术治疗子宫内膜异位囊肿68例分析

腹腔镜下微波手术治疗子宫内膜异位囊肿６８例分析朱宪我院于１９９２年１月～１９９５年１２月开展腹腔镜手术近３００例，其中治疗子宫内膜异位囊肿６８例，术后随访４～３６个月，现将结果报告如下。一、资料与方法１．研究对象：年龄为２５～５５岁，４０岁以下者占７...     

子宫内膜异位囊肿合并不孕腹腔镜手术治疗38例分析

应用电视腹腔镜手术治疗卵巢子宫内膜异位囊肿合并不孕症患者38例,所有病例均行子宫内膜异位囊肿剔出术,无一例中转开腹,无严重并发症发生.术后随访6～40个月,术后妊娠率为47.4%.说明电视腹腔镜手术诊治子宫内膜异位囊肿,能完成剖腹手术所能进行的手术操作并达到相应疗效,且具有损伤小、术后病人恢复快的优点,对于不孕患者可达到与剖腹手术相同的治疗效果.     

卵巢子宫内膜异位囊肿手术对卵巢储备功能的影响

子宫内膜异位症(endometriosis,内异症)是生育年龄妇女的常见病,病变分布广泛、形态多样、具有侵袭性和复发性,是难治之症。盆腔内异症可分为腹膜型、卵巢型以及深部浸润型,其中卵巢内膜异位囊肿是常见的类型,保守性腹腔镜手术是其首选治疗方法。但由于内膜异位囊肿本身的特性和内异症造成的盆腔血管增生、粘连形成、解剖变异等原因,手术比较困难,易发生术中出血和脏器损伤。而且囊肿剔除术后,有卵巢储备功能下降(diminished ovarian re-serve,DOR)甚至卵巢功能早衰(premature ovarian failure,POF)的风险,成为近年来受到关注的问题[1]。…     

手术治疗卵巢子宫内膜异位囊肿伴不孕的疗效分析

子宫内膜异位症（内异症）是妇科常见病,卵巢是最容易被异位子宫内膜侵犯的器官,可累及卵巢表层和深层而影响其排卵和内分泌功能;同时还常合并存在盆腔腹膜及其他脏器内异症病灶,引起局部微环境变化而阻止受孕.为了解手术对内异症所致不孕的治疗效果,我们对因单纯卵巢子宫内膜异位囊肿或合并盆腔其他脏器异位病灶不孕妇女105例的临床资料进行了分析,旨在为临床处理提供参考.     

卵巢子宫内膜异位囊肿相关性不孕研究进展

卵巢子宫内膜异位囊肿(varian endometrial cyst,OEC)是最常见的子宫内膜异位症(endometriosis,EMs),可引起疼痛和不孕.由于其具有增生、侵润等破坏卵巢功能及治疗后复发等恶性肿瘤样特征,OEC合并不孕的治疗越来越受到临床医师的重视.目前主要的治疗方法包括手术治疗、药物治疗及辅助生殖...     

卵巢子宫内膜异位囊肿手术方式探讨

目的　通过对开腹和腹腔镜下卵巢子宫内膜异位囊肿剥除术的比较 ,探讨腹腔镜在临床应用中的价值。方法　回顾性分析了 1 994年 1月～ 2 0 0 1年 8月于我院妇科施行的开腹和腹腔镜下卵巢子宫内膜异位囊肿剥除术的手术经验。两组病人术后随访 1 2～ 36个月。并对两组患者围手术期情况 ,术后症状缓解 ,复发率及妊娠率进行比较。结果　 92例腹腔镜手术患者术中出血量 (1 1 0 5± 82 8)ml明显小于开腹组 (1 89 5± 96 8)ml,P <0 0 5。手术时间腹腔镜组 (1 36 5± 80 4 )min与开腹组 (1 4 8 5± 86 8)min相近 ,P >0 0 5。术后病率腹腔镜组 (4 92 ,4 3% )明显低于开腹组 (1 2 96 ,1 2 5 % ) ,P <0 0 5。术后下床活动及肛门排气时间腹腔镜组比开腹组明显缩短 ,P <0 0 5。随访术后妊娠率两组间差异有显著性 (P <0 0 5 )。结论　腹腔镜在子宫内膜异位囊肿诊断及治疗中具有安全、有效、微创的特点 ,适合于广泛开展     

腹腔镜在盆腔炎诊断和治疗中的价值

目的　探讨腹腔镜手术在盆腔炎 (plevicinflammatorydisease ,PID)治疗中的价值。 方法　复旦大学附属妇产科医院于 1998年 1月至 2 0 0 3年 3月对临床诊断为急性PID患者 86例 ,分别行单纯药物治疗 ,超声下穿刺 ,药物控制感染后经腹或腹腔镜手术治疗PID。治疗后随访 6～ 12个月。结果　药物治疗及超声下穿刺者 ,与手术治疗组治疗后盆腔炎性包块和盆腔痛发生率相比差异有显著性意义 (P <0 0 1)。经腹手术与腹腔镜手术 ,手术时间差异无显著性意义 (P >0 0 5 ) ,住院天数腹腔镜手术组明显缩短 (P <0 0 5 )。所有手术病例 ,行全子宫双附件切除 (TAH BSO) 6例 ,患侧附件切除 (USO) 19例 ,保守性手术 2 7例 ,术后盆腔炎性包块分别为 0、0和 5例 (P >0 0 5 ) ;盆腔痛分别有 1、1和 6例 (P >0 0 5 ) ;但同时出现盆腔炎性包块和盆腔痛的患者TAH BSO组 1例 ,USO组 1例 (P >0 0 5 ) ,保守性手术患者 11例 ,保守性手术患者与USO组相比差异有显著性意义 (P <0 0 1)。PID病程在 1周以内者 ,腹腔镜手术时间明显短于经腹手术组 (P <0 0 5 ) ;病程超过 1周时两组手术时间差异无显著性意义 (P >0 0 5 )。结论　腹腔镜检查是诊断急性PID诊断的金标准。保守性手术术后并发症较多 ,但对女性生殖内分泌功能及生育能力     

地诺孕素、亮丙瑞林辅助治疗卵巢子宫内膜异位囊肿的临床效果比较#br#

Objective?To compare the efficacy of different drugs in adjuvant treatment of ovarian endometrioma. Methods?A total of 170 patients with ovarian endometriosis cysts were randomly divided into dienogest group (dienogest treatment) and leuprolide group (leuprolide treatment), 85 cases in each group. The curative effects of the two groups were compared, and the follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), carbohydrate antigen 125 (CA125), endometrial thickness, uterine volume, and antral follicle count (AFC) were observed in the two groups, ovarian stromal blood flow resistance index (RI), pulsatility index (PI) changes. Results?There was no significant difference in the total effective rate, endometrial thickness, uterine volume, CA125 level and AFC between the two groups (P>0.05); the levels of FSH, E2, LH, RI, and PI in the leuprolide group were lower than those in the dinoflagellate group. There was no significant difference in endometrial thickness, uterine volume, CA125 or AFC between the two groups after treatment (P＞0.05). After treatment, RI in leuprolide group was lower than that in dienogest group (P<0.05). Conclusion?The effects of dienogest and leuprolide on ovarian endometrioma cysts are similar, but adjuvant leuprolide therapy can be more beneficial to improve ovarian blood supply.     

腹腔镜手术和开腹手术治疗良性卵巢囊肿的比较研究

目的探讨腹腔镜手术治疗良性卵巢囊肿的临床应用价值。方法 回顾性分析1999年1月至2001年8月间80例腹腔镜手术治疗的卵巢囊肿病例(其中完成腹腔镜手术者为腹腔镜组),选择同期54例开腹手术治疗的良性卵巢囊肿病例作为对照组。结果80例腹腔镜手术有4例术中转开腹,其中1例为卵巢恶性肿瘤;76例卵巢囊肿为良性,以子宫内膜异位囊肿和成熟性畸胎瘤最多见。囊肿切除术腹腔镜组占88.2％,开腹手术组占64.8％。两组手术时间差异无显著性。腹腔镜手术组术中出血、术后住院及恢复时间短于开腹手术组,差异有显著性。结论腹腔镜手术治疗良性卵巢囊肿比开腹手术更具优越性。     

Monoclonal origin of endometriotic cysts

Endometriosis—endometrial tissue in an ectopic site outside the uterus—is one of the most common gynecologic disorders. The pathogenesis of this disease is controversial; the two major theories implicate either metaplasia or metastatic spread. In the ovary, endometriosis sometimes appears as endometriotic cysts. Occasionally, malignant tumors develop within these cysts, which therefore have been suggested to carry a neoplastic potential. We have investigated the clonal origin of five such ovarian cysts by a recombinant DNA X-chromosome inactivation technique. Three of the endometriotic cysts showed a monoclonal X-chromosome inactivation pattern, ie the cell populations of those cysts were each derived from one cell, whereas the remaining two cysts had polyclonal inactivation patterns. These findings suggest that endometriotic cysts can, in at least some cases, be regarded as neoplasic.     

长效达菲林联合阴道超声引导下穿刺治疗卵巢子宫内膜异位囊肿及对辅助生殖技术结局的影响

目的:探讨长效达菲林联合阴道超声引导下穿刺治疗卵巢子宫内膜异位囊肿及对辅助生殖技术(ART)结局的影响。方法:回顾分析因不孕要求实施IVF-ET的子宫内膜异位症患者126例,比较卵巢子宫内膜异位囊肿行长效达菲林联合囊肿穿刺组(实验组)与单用长效达菲林组(对照组)囊肿大小变化、早卵泡期(基础)FSH、LH、E2水平、Gn启动日FSH、LH、E2水平、取卵日E2水平、获卵数、受精率、卵裂率、优质胚胎数及IVF-ET结局的差异。结果:实验组与对照组相比,卵巢大小、基础内分泌及启动日LH、E2、受精率、卵裂率、临床妊娠率均无统计学差异。穿刺组囊肿全部消失,未穿刺组96个囊肿31个消失。实验组启动日FSH低于对照组,取卵日E2明显高于对照组(P<0.05),优质胚胎数、成熟卵泡数明显多于对照组(P<0.05)。结论:因子宫内膜异位症导致不孕而要求行辅助生殖技术的患者,尤其不愿手术的患者,可以先行囊肿穿刺术,同时使用超长方案ART治疗可获得更多优质胚胎数,因而可能有助于提高累积妊娠率。     

腹腔镜手术治疗良性卵巢肿瘤115例疗效分析

目的　探讨应用腹腔镜手术治疗良性卵巢肿瘤的疗效。方法　广东省中山市人民医院将 2 0 0 1年 6月至 2 0 0 3年 12月间住院治疗的 196例卵巢良性肿瘤患者 ,分为腹腔镜手术组和剖腹手术组 ,对比观察两组手术效果及手术并发症等。结果　腹腔镜手术组手术时间与剖腹手术组比较差异无显著性意义 (P >0 0 5 ) ,腹腔镜手术组术中出血量、肛门排气时间、术后平均住院日及术后发热、镇痛剂使用例数均明显少于剖腹手术组 (P <0 0 1)。结论　腹腔镜对机体内外环境干扰少。腹腔镜手术组术中出血量少 ,术后恢复快 ,适于临床应用。     

Giant ovarian cyst in a woman in rural Africa

A 42-year-old woman presented to the open access surgical outpatients clinic run by an international Non-Governmental Organisation in the south western region of Chad in central Africa. She gave a 2-year history of increasing abdominal girth, which had recently been associated with breathlessness and lower back pain. This had forced her to stop work, culminating in her self-referral to the clinic. In the absence of access to helpful investigatory modality, we performed an exploratory laparotomy, during which a large cyst (15.1 kg, 12.5 l) in the left ovary was excised and abdominoplasty was performed. She made a good recovery with no complications and was discharged 5 days postoperatively.     

腹腔镜术对女性绝育术后盆腔静脉淤血症诊断的价值

１９９０年６月至１９９５年５月，对女性绝育术后慢性腹痛患者经腹腔镜诊断为盆腔静脉淤血症４６例，检查后施行盆腔静脉造影３２例。手术３７例次，其中经盆腔静脉造影２４例，腹腔镜检查后直接手术１３例。通过腹腔镜检查，观察盆腔静脉血管显露、曲张或怒张等形态学改变及其范围，并且根据患者由平卧位改变成头低臀高６０°位，拨动举宫器使子宫变成前屈位，计算盆腔静脉血流消失时间，拟订了女性绝育术后盆腔静脉淤血症腹腔镜下诊断标准。按此标准与盆腔静脉造影诊断标准作比较，两者无显著性差异（Ｐ＞００５），与手术中盆腔静脉血管表现和术后病理检查均相符合，证明腹腔镜术是可以作为诊断盆腔静脉淤血症的客观依据之一。     

Laparoscopic management of a 20-cm ovarian cyst in a patient with a BMI of 70: a case report

A woman in her mid-40s with a body mass index (BMI) of 70 presented with lower abdominal pain of 24-h duration. The trans-abdominal scan revealed a large cystic ovarian mass. Laparoscopic salpingo-oophrectomy was performed by placing six ports in the upper abdomen; initial Verres needle entry and pneumoperitoneum were established through the left upper quadrant. A low CA-125 and the benign appearance of the ovary allowed the operation to continue laparoscopically with fewer perioperative complications. The histology of the specimen demonstrated a benign epithelial serous cystadenoma of the ovary with torsion.     

Torsion of a giant para-ovarian cyst. Conservative laparoscopic treatment

Adnexal torsion is a condition that may result in serious consequences, including adnexa removal. Recently, de-torsion has replaced salpingo-oophorectomy as the treatment for a twisted ischaemic adnexum, and the best way to do it seems to be laparoscopic surgery. A case of adnexal torsion caused by a giant para-ovarian cyst treated, with good results, by a conservative laparoscopic approach is reported.