保留子宫的经阴道卵巢良性肿瘤切除术62例报告

目的 探讨经阴道卵巢肿瘤切除术的可行性及优点。方法 对62例要求保留子宫的卵巢良性肿瘤患者在全麻或硬膜外麻醉下实施了经阴道肿瘤切除或剥除术。同时对手术适应证、手术方法、术中并发症、手术时间、术中出血量、术后病率与并发症及住院时间进行探讨。结果 62例患者均成功地完成了手术,无需腹腔镜辅助及中转开腹,亦未出现肿瘤破裂内容物漏入腹腔的情况。平均手术时间39．4min,平均出血量37．5ml。术后病率：无。无术后并发症,平均体温正常时间1．3天,平均排气时间20．1h,平均住院时间4．2天。术后随诊无盆腔疼痛,阴道切口愈合正常。结论 对于欲保留子宫的卵巢良性肿瘤患者实施经阴道肿瘤切除或剥除术是安全可行的。该术式的优点为创伤小、易掌握、设备简便、节省时间、费用较低、腹壁不留瘢痕,与经腹及腹腔镜手术相比,患者容易接受。     

结扎速血管闭合系统在经阴道子宫切除术中的应用

目的探讨结扎速(LigaSure)在经阴道子宫切除术中的应用。方法应用LigaSure对161例患者实施经阴道子宫切除术,部分患者同时切除一侧或双侧附件,同期对比传统缝线组62例。观察手术时间、术中出血量、术后恢复情况。结果LigaSure组平均手术时间43．16min;平均术中出血量52．35ml;术后平均发热时间1．3天;术后平均排气时间19．46h;术后平均住院天数5．1天;均明显优于传统缝线组。无术中副损伤及术后并发症。结论LigaSure具有操作简便、安全可靠、省时省力等优越性,在妇科手术中具有广泛的应用价值,尤其适合于经阴道困难大子宫及附件切除等深部手术的临床应用。     

经阴道全子宫切除术临床效果评估

目的：评估经阴道全子宫切除术（transvaginal hysterectomy,TVH）的临床价值。方法：2007-05~2008-05选择河南省安阳地区医院子宫肌瘤患者84例,分为经阴道全子宫切除术组32例和开腹手术组52例。观察两组手术时间、术中出血量、术后排气时间、术后住院时间、术后镇痛、术后病率及术后并发症等。结果：84例均获得成功,两组手术时间、术中出血量差异无显著性意义（P〉0.05）。经阴道手术组术后排气早（21.13±5.54）h、住院时间短（4.85±0.82）d、术后镇痛药使用率8.40%及术后病率（1.68%）低与开腹比较差异有显著性意义（P〈0.05）。结论：TVH是一种安全、可行、临床效果好的微创术式,值得临床推广和应用。     

腹腔镜子宫肌瘤剔除术52例临床分析

目的探讨腹腔镜治疗特殊部位子宫肌瘤的临床价值。方法选择2007年6月到2008年9月在我院妇产科行腹腔镜下子宫肌瘤剔除术且无合并其他部位子宫肌瘤、无其它联合手术、无内外科合并症者共52例,观察手术时间、术巾出血量、术中术后并发症、术后住院日。结果52例手术均获成功,术中出血量20～320ml,平均85．00±65．23ml;手术时间（110．56-41．35）min;术后肛门排气（1．79±0．25）d;术后住院天数（6．81±1．32）d,无1例子宫肌层血肿形成;无严重并发症。结论腹腔镜下特殊部位子宫肌瘤剔除术是可行的、安全的。     

696例阴式非脱垂、大子宫切除术临床研究

目的　探讨阴式非脱垂大子宫切除术的可行性及优越性。方法　对 6 96例非脱垂、大子宫患者实施阴式子宫切除术(TVH) ,观察手术时间、术中出血量、术后排气时间、病死率、并发症、术后住院时间。结果　6 93例成功 ,3例术中行开腹或阴腹联合手术 ,成功率 99 6 %。平均术时 4 9 3min ,术中平均出血 6 9 7ml,术中副损伤 3例 ,术后并发症 6例 ,术后平均排气时间 2 2 6h ;体温恢复正常时间 1 2天 ,术后平均住院时间 5 3天。结论　经过详细的术前检查、正确的评估及充分的准备 ,大多数非脱垂、大子宫切除均可安全地经阴道完成。     

阴式子宫切除术安全性可行性研究

目的探讨拓展经阴道子宫切除适应证的安全性及可行性。方法选择解放军总医院1998年12月至2001年12月期间417例阴式子宫切除的病例(腹式子宫切除术200例为对照组),对阴式子宫切除手术指征、手术时间、出血量、术时副损伤、术后病率及并发症进行回顾性分析。结果单纯阴式子宫切除术242例;同时行双侧附件切除36例;单侧附件切除22例,输卵管切除12例,卵巢囊肿剥除术25例;阴道前后壁修补术73例;子宫内膜异位症14例,其中3例因子宫内膜异位侵及直肠肌层,行直肠前壁病灶切除及直肠前壁修补术。术时副损伤1例,系子宫内膜异位症重度粘连,缝线穿过右侧输尿管致输尿管瘘,术后发现行输尿管膀胱移植术。同时行阴腹联合手术切除子宫附件4例。其中切除残余宫颈附件1例。术后并发症2例,1例为部分阴道壁粘连,1例为下肢静脉血栓。手术时间12～135min,平均51.74±30.62min,术中出血量20～500ml,平均97.77±88.37ml,术前血红蛋白118.63g/L,术后血红蛋白116.28g/IL(P=0.10997≥0.05),术后住院天数4～28d,平均6.6d,术后病率4.83%,均优于腹式子宫切除术组。术后三个月定期随诊,无远期并发症发生。结论经阴道切除无脱垂子宫是有效可行及安全的,但手术的成功率与子宫大小、形态、活动度、盆腔粘连程度及术者技术经验等有关。     

腹腔镜子宫肌瘤剔除术42例临床分析

目的：探讨腹腔镜行子宫肌瘤剔除术的临床应用价值。方法对有手术指征要求保留子宫仅行子宫肌瘤剔除术的42例患者采用腹腔镜下子宫肌瘤剔除术,并准确记录手术时间、术中出血量、术后排气时间、术后疼痛情况、术后住院天数、观察手术效果等。结果42例患者手术时间短、术中出血少、术后排气早、术后疼痛轻、恢复快、住院时间短,除2例改行腹腔镜下子宫次全切除术,1例因止血困难中转开腹术外。结论腹腔镜下子宫肌瘤剔除微创、可行、效果好、恢复快,值得临床推广和应用。     

经阴道子宫肌瘤剥除术220例临床分析

目的:探讨经阴道行子宫肌瘤剥除术的临床价值.方法:对有手术指征、要求保留子宫的220例子宫肌瘤患者实施经阴道剥除手术,观察手术效果、手术时间、术中出血量、术后排气时间、术后疼痛情况、术后住院天数等.结果:220例中,有2例改行经阴道次全子宫切除术,有1例术后出血,1例膀胱损伤,无中转开腹病例,手术时间短,术中出血少,术后排气早,疼痛轻,恢复快,住院时间短.结论:经阴道行子宫肌瘤剥除术微创可行、效果好、恢复快,值得推广应用,但要严格把握适应证,掌握一定的手术技巧.     

非脱垂大子宫经阴道切除98例临床研究

采用子宫劈开、肌瘤剜除、碎去核等缩小子宫体积的方法，对98例非脱垂子宫增大如6-18孕击、重138-741g的子宫肌瘤、子宫肌腺病患者行经阴道子宫切除术，结果93例经阴道切除，成功率95%，子宫平均重量376g(138-741g)，平均手术时间99min(40-135min)，估计平均失血量245ml(50-600ml)。术后住院时间平衡5.4天（4-9天），术后病率3.1%，表明非脱垂大子宫经过有效的缩小子宫体积多可经阴道安全切除，选择手术时不仅要注意子宫的绝对大小，还需充分注意子宫的形态及活动度。手术的成功与术者经验和技术密切相关。     

两种不同手术方在子宫肌瘤剔除术中的应用效果分析

目的探讨经阴道和开腹手术实施子宫肌瘤剔除术的临床效果。方法所选80例患者均为子宫肌瘤患者．上述患者均为2010年7月～2013年7月期间收治的患者,上述患者均经病理组织学检查证实为子宫肌瘤,随机分为观察组和对照组。观察组患者实施经阴道子宫肌瘤剔除术,对照组患者实施传统的经腹子宫肌瘤剔除术。记录两组患者是手术时间;观察两组患者手术过中的出血情况;记录两组患者中单个肌瘤的具体重量;记录两组患者术后肛门排气时间;观察术后盆腔感染发生情况。结果两组患者手术情况比较：观察组患者手术时间低于对照组,观察组患者术中出血量低于对照组,观察组患者中的单个肌瘤重量低于对照组,观察组术后排气时间早于对照组,观察组术后盆腔感染发生率低于对照组,差异有统计学意义（P〈0．05）。结论经阴道子宫肌瘤剔除术较开腹子宫肌瘤剔除术优点多,前者创伤小,术后恢复快,减少术后并发症,具有显著优势。     

Is uterine artery embolization prior to myomectomy for giant fibroids helpful?

PURPOSE: To determine whether uterine artery embolization (UAE) prior to myomectomy is more effective than myomectomy alone. MATERIALS AND METHODS: The study included 15 consecutive infertile women with uterine fibroids > 10 cm (Group I) that underwent UAE with spherical particles using a microcatheter technique and a unilateral femoral approach between March 2005 and January 2007. The day after embolization all cases underwent myomectomy since the protocol for large fibroids in our hospital is myomectomy only. The control group was composed of 15 patients who underwent myomectomy only (Group II). Group II was established based on fibroid size (14 +/- 3 cm). Operating time, estimated blood loss and transfusion, complications, and hospital stay were calculated by retrospective chart reviews, and comparisons were made between the groups with Student's t-test. RESULTS: Mean operating time was 138 min in Group I and 240 minutes in Group II (P < 0.01). Mean estimated blood loss was 250 ml in Group I and 690 ml in Group II (P < 0.01). There was no need for transfusion in Group I, while transfusion was needed in 2 cases (13%) in Group II. Mean hospital stay in Group I was 5 days versus 8 days in Group II. Complications, including subsequent hysterectomy, were seen in 2 cases and bowel-bladder injuries in 1 case in Group II (a total of 20%), while no complications were observed in Group I. One of the cases in Group I later conceived and gave birth to a healthy child. CONCLUSION: UAE prior to myomectomy is more effective than myomectomy alone.     

腹腔镜下与经腹子宫肌瘤核除术的临床对比分析

目的：观察分别用腹腔镜与经腹子宫肌瘤核除术治疗妇科子宫肌瘤的临床疗效,并比较两者差异。方法选择2014年1月～2015年6月收治的80例子宫肌瘤患者作为研究对象,按照随机数字表法将研究对象分为实验组和对照组,每组各40例,实验组患者实施腹腔镜下子宫肌瘤核除术,对照组患者实施经腹子宫肌瘤核除术,对两组患者手术情况及术后情况进行对比分析。结果对照组患者的手术时间、术中出血量及住院时间分别为（76.5±13.5）min、（104.1±2.4）L、（10.5±3.2）d,实验组患者的手术时间、术中出血量和住院时间分别为（70.5±10.5）min、（76.1±2.1）L、（6.2±2）d,与对照组相比,实验组患者的手术时间、术中出血量及住院时间均明显减少。对照组患者的发热情况、镇痛药物应用、肛门排气时间及下床时间分别为18（45％）、19（47.5％）、（31±13）h、（4.3±2.1）d,实验组患者的发热情况、镇痛药物应用、肛门排气时间及下床时间分别为14（35％）、5（12.5％）,（21±6）h、（2.7±0.5）d,实验组的发热情况、镇痛药物应用、肛门排气时间及下床时间等均优于对照组。结论与经腹子宫肌瘤剔除术相比,应用腹腔镜进行子宫肌瘤核除术具有手术时间短、出血量少、发热概率低、恢复快等优势,治疗子宫肌瘤安全有效,值得在临床推广应用。     

早期子宫颈癌腹腔镜与开腹下广泛性子宫切除术及淋巴清扫术的疗效研究

目的探讨腹腔镜及开腹下广泛性子宫切除术及淋巴结清扫术对早期子宫颈癌的疗效。方法回顾性分析83例确诊为早期宫颈癌并分别行腹腔镜及开腹下广泛性子宫切除及淋巴清扫术患者的临床资料,37例采用腹腔镜下手术为腹腔镜组,46例采用开腹手术为开腹组。比较2组患者的手术时间、术中出血量、宫旁及阴道切除长度、淋巴结切除数目、肛门排气时间、尿管拔除时间、住院时间、并发症发生率等指标。结果相比开腹组,腹腔镜组手术时间长、术中出血量少、术后肛门排气时间快及住院时间短,差异均有统计学意义（P值分别为0.000、0.003、0.000、0.037,P均〈0.05）;而淋巴结切除数、切除范围（宫旁、阴道）、盆腔引流量、术后尿管拔除时间这几个指标的比较,差异均无统计学意义（P值分别为0.178、0.105、0.097、0.551、0.74,P均〉0.05）。较开腹组,腹腔镜组术后尿潴留发生率明显低于开腹组,分别为37.0%和16.2%,差异有统计学意义（P=0.036〈0.05）。而脏器损伤、大出血、淋巴囊肿无统计学意义（P值分别为0.582、0.453、0.332,P均〉0.05）。结论腹腔镜下广泛性子宫切除及淋巴清扫术可以达到与开腹手术治疗早期宫颈癌的疗效,并具备了术中出血量少、术后恢复快、并发症少的优点。因此,腹腔镜下广泛性子宫切除及淋巴清扫术是一种理想术式。     

Abdominal myomectomy versus uterine fibroid embolization in the treatment of symptomatic uterine leiomyomas

OBJECTIVE: The purpose of this study was to compare treatment efficacy and complications of abdominal myomectomy with those of uterine fibroid embolization in women with symptomatic uterine fibroids. MATERIALS AND METHODS: We analyzed the outcomes of 111 consecutive patients who underwent abdominal myomectomy (n = 44) or fibroid embolization (n = 67) over a 30-month period. The mean ages of the two groups were 37.7 years (range, 28-48 years) and 44.2 years (range, 31-56 years), respectively. A questionnaire and review of medical records assessed all procedure-related complications and changes in symptoms. Length of hospital stay, time until resumption of daily activities, and pain medication requirements after the procedure were also analyzed. RESULTS: Follow-up times for the myomectomy and embolization groups were 14.6 and 14.3 months, respectively. The respective observed success rates in abdominal myomectomy and uterine fibroid embolization patients were 64% versus 92% for menorrhagia (p < 0.05), 54% versus 74% for pain (not significant), and 91% versus 76% for mass effect (p < 0.05). The complication rates were 25% (abdominal myomectomy) and 11% (uterine fibroid embolization) (p < 0.05). The respective secondary end points for the two procedures were 2.9 versus 0 days mean hospital stay, 8.7 versus 5.1 days of narcotics use, and 36 versus 8 days until resumption of normal activities. These differences were all statistically significant. CONCLUSION: Uterine fibroid embolization is a less invasive and safer treatment option in women with symptomatic leiomyomas than myomectomy. Menorrhagia may be better controlled with embolization, and myomectomy may be a better option in patients with mass effect. Both procedures were equally effective in controlling pain.     

不同术式子宫动脉阻断后行子宫肌瘤剔除治疗子宫肌瘤的临床研究

目的探讨子宫肌瘤剔除合并子宫动脉阻断治疗子宫肌瘤的临床效果及可行性,比较腹腔镜手术与剖腹手术的优势。方法对2002年10月至2007年9月收住我院要求保留子宫的子宫肌瘤手术患者共221例,随机分为腹腔镜组和剖腹组,采用子宫肌瘤剔除术中先阻断双侧子宫动脉的方法治疗子宫肌瘤。其中腔镜组89例、剖腹组132例。两组肌瘤数目、大小、发病年龄两组间差异无显著性。通过统计手术时间、术中出血量、住院天数等,以及观察术后定期随访1年,观察月经症状的改变、B超监测子宫大小及肌瘤复发情况,并将两组进行对照比较。结果腔镜组和剖腹组手术时间两组统计学无显著差异（90.6vs103.8min P〉0.05） 但寻找子宫动脉时间腔镜组较剖腹组短（21.4vs30.6min P〈0.05） 术中出血量剖腹组较腔镜组有所增加（87.5vs101.2ml P〈0.05） 住院天数腔镜组明显少于剖腹组（7.28vs11.13d P〈0.05）。术后随访1年,腔镜组失访12例,剖腹组失访17例,以腔镜组77例、剖腹组115例进行统计。腔镜组和剖腹组月经症状缓解率为92.64%和97.97% 腔镜组与剖腹组两组肌瘤复发率分别为3.89%和3.47%,两组统计学无显著差异,P〉0.05。结论子宫肌瘤剔除前先阻断子宫动脉,能明显减少术中出血,更好地缓解月经过多等症状,延缓了肌瘤的复发,在腔镜下行此手术较剖腹手术更有优势,是一种安全、有效的治疗子宫肌瘤并能保留子宫的新方法。     

腹腔镜及开腹术式对慢性阑尾炎患者疼痛及腹腔粘连的影响

目的：结合临床实践经验,探讨腹腔镜及开腹术式对慢性阑尾炎患者疼痛及腹腔粘连的影响。方法：按照手术方式的不同,将患者分为开腹手术组（67例）和腹腔镜手术组（65例）。两组患者在性别、年龄、病情等一般资料方面差别无统计学意义（P〉0.05）,具有可比性。通过对比两组患者在术中、术后的情况及处理,并随访患者慢性腹痛以及肠粘连的情况,探讨其临床应用价值。结果：术中出血、住院时间、术中粘连以及术后疼痛比较中,开腹手术组和腹腔镜组两组差异有统计学意义。手术时间比较中两组差异无统计学意义。结论：腹腔镜组术中出血与住院时间明显少于开腹手术组,提示腹腔镜手术术中出血少、住院时间短的优点。腹腔镜能对腹腔内进行彻底的探查,更多的发现患者腹腔内粘连并治疗,术后慢性疼痛少于开腹手术组,具有明显的优势,值得临床推广。     

Cost and Reimbursement for Three Fibroid Treatments: Abdominal Hysterectomy,Abdominal Myomectomy,and Uterine Fibroid Embolization

Purpose To compare costs and reimbursements for three different treatments for uterine fibroids. Methods Costs and reimbursements were collected and analyzed from the Thomas Jefferson University Hospital decision support database from 540 women who underwent abdominal hysterectomy (n = 299), abdominal myomectomy (n = 105), or uterine fibroid embolization (UFE) (n = 136) for uterine fibroids during 2000–2002. We used the chi-square test and ANOVA, followed by Fisher’s Least Significant Difference test, for statistical analysis. Results The mean total hospital cost (US$) for UFE was $2,707, which was significantly less than for hysterectomy ($5,707) or myomectomy ($5,676) (p < 0.05). The mean hospital net income (hospital net reimbursement minus total hospital cost) for UFE was $57, which was significantly greater than for hysterectomy (−$572) or myomectomy (-$715) (p < 0.05). The mean professional (physician) reimbursements for UFE, hysterectomy, and myomectomy were $1,306, $979, and $1,078, respectively. Conclusion UFE has lower hospital costs and greater hospital net income than abdominal hysterectomy or abdominal myomectomy for treating uterine fibroids. UFE may be more financially advantageous than hysterectomy or myomectomy for the insurer, hospital, and health care system. Costs and reimbursements may vary amongst different hospitals and regions.     

Interest of uterine artery embolization with gelatin sponge particles prior to myomectomy for large and/or multiple fibroids

Purpose

To evaluate the efficacy of pre-myomectomy uterine artery embolization with gelatin sponge particles to reduce operative blood loss and facilitate removal of fibroids.

Materials and methods

This retrospective study included 33 women (mean age, 36 years; range, 24-45 years), of whom at least 18 wished to preserve fertility. They presented with at least one large myoma (mean diameter, 90 mm; range, 50-150 mm) and had undergone preoperative uterine artery embolization with resorbable gelatin sponge by unilateral femoral approach between December 2001 and November 2008. Clinical, radiological and surgical data were available for all patients. Mean haemoglobin levels before and after surgery were compared with Student's t-test.

Results

No complication or technical failure of embolization occurred. The myomectomies were performed during laparotomy (25 cases) or laparoscopy (8 cases). Dissection of fibroids was easier (mean, 3 per patient; range, 1-11), with a mean operating time of 108 ± 50 min (range, 30-260 min). Bloodless surgery was the rule with a mean estimated peroperative blood loss of 147 ± 249 mL (range, 0-800 mL). Mean pre-(12.9 ± 1.3 g/dL) and post-therapeutic (11.4 ± 1.2 g/dL) haemoglobin levels were not statistically different (p > 0.05). There was no need for blood transfusion. None of the patients required hysterectomy. The mean duration of hospital stay was 7.5 ± 1.3 days (range, 3-12 days).

Conclusion

Preoperative uterine artery embolization is effective in reducing intraoperative blood loss and improves the chances of performing conservative surgery. It should be considered a useful adjunct to myomectomy in women at high hemorrhagic risk or who refuse blood transfusion.