手术治疗老年妇女盆腔脏器脱垂60例

盆腔脏器脱垂是老年妇女常见疾病,子宫从阴道及阴道前后壁膨出,造成局部黏膜溃疡,甚至引起排尿困难,严重影响患者的生活质量〔1〕。老年妇女盆腔脏器脱垂的手术治疗方式有多种,临床上最常用的为经阴子宫全切加阴道前后壁修补术,创伤大,并发症多〔2〕。而子宫颈部分切除加部分阴道封闭     

妇科单孔腹腔镜手术的应用现状和未来的发展趋势

单孔腹腔镜是近年的手术热点,也是妇科手术发展的必然趋势。单孔腹腔镜手术根据入路不同,分为经脐单孔腹腔镜手术和经阴道单孔腹腔镜手术,还可以根据操作方式的不同,分为常规单孔腹腔镜手术和机器人辅助单孔腹腔镜手术。目前单孔腹腔镜在妇科良性疾病手术中应用广泛,其微创的理念得到一致认可,在妇科恶性肿瘤手术中的应用仍处于探索讨论阶段。我国单孔腹腔镜手术起步稍晚,但在我国广大医务工作者的不懈努力和部分先行者的引领下也迅速发展起来,无论是单孔腹腔镜手术的数量、术式,还是质量和创新方面,都已处于世界的先进水平。该文就妇科单孔腹腔镜手术的应用现状和未来的发展趋势作一阐述。     

国产机器人在妇科单孔腹腔镜手术中的应用

［摘要］　在科技迅猛发展的当下,机器人单孔腹腔镜手术系统正在蓬勃发展,我国也出台了政策鼓励国产机器人系统发展。目前我国获批上市的两款单孔机器人系统的效果和安全性已在妇科常见良恶性疾病手术中得以验证,有很好的发展前景。该文简要回顾国产手术机器人的发展背景及其在妇科中的应用情况,并展望其未来发展前景。     

四维超声诊断老年盆腔脏器脱垂及手术效果评估

目的探讨盆底四维超声对盆腔脏器脱垂(POP)的诊断价值以及对盆底手术后效果的评估。方法测量90例POP患者术前和术后及100例阴性对照组盆底结构二维、三维及四维超声数据指标,评估术前及术后的膀胱最低点、子宫宫颈前后唇、直肠壶腹部与耻骨联合后下缘的距离,肛提肌裂孔面积,并观察两组肛提肌形态结构。结果盆底手术前,Valsalva动作下POP组膀胱颈移动度较对照组增大(P<0.05);子宫宫颈前后唇距离耻骨联合后下缘水平线距离小于15 mm、膀胱最低点及直肠壶腹部位于耻骨联合后下缘水平线以下;术后,Valsalva动作下POP组膀胱颈移动度较术前减小(P<0.05);阴道残端位于耻骨联合后下缘水平线以上且距离大于15 mm、膀胱最低点及直肠壶腹部均位于耻骨联合后下缘水平线以上。结论盆底四维超声能很好地评估老年女性盆底结构,是有效诊断POP的辅助手段。同时,盆底四维超声还可以用来对盆底手术后效果的评估提供有效的依据,预防术后POP的复发。     

妇科经自然腔道单孔手术发展现状与未来方向

［摘要］　经自然腔道单孔内镜手术创伤小,美容效果好,术后康复快,并发症发生率低,符合现代无瘢痕、无痛的微创理念,是妇科微创外科的发展方向。妇科经自然腔道单孔内镜手术主要分为经脐入路与经阴道入路。经阴道入路腹部无瘢痕,切口愈合快,术后疼痛程度低,并发症发生率低,是目前妇科微创手术的研究热点。近年来,机器人手术系统快速发展,与经自然腔道单孔内镜手术结合可实现三维成像放大术野,灵活的机械臂实现复杂手术操作,拓宽了手术适应证,提高了手术精准度,被认为是微创手术的革命性突破。该文就妇科经自然腔道单孔手术发展现状与未来方向进行阐述。     

经脐单孔腹腔镜技术在妇科手术中的应用进展

更小的创伤、更佳的美容效果是外科技术发展的趋势.与此应运而生的经脐单孔腹腔镜手术在全球引起普遍关注和兴趣.对该项技术在妇科手术中的应用进展进行综述.     

自制入路系统在单孔腹腔镜妇科手术中的应用效果观察

目的 评价采用胸科手术皮肤切口保护套50/40及橡胶手套制作的入路系统在单孔腹腔镜妇科手术中的应用效果。方法 腹腔镜妇科手术患者100例,采用自制入路系统单孔腹腔镜手术治疗的50例为观察组,采用传统腹腔镜手术治疗的50例为对照组。比较两组患者的手术情况,采用视觉模拟评分（VAS）评估疼痛程度,采用ELISA法检测血清炎症因子指标[C反应蛋白（CRP）、白细胞介素6(IL-6)、肿瘤坏死因子α(TNF-α)]及应激反应指标[皮质醇（Cor）、丙二醛（MDA）、超氧化物歧化酶（SOD）],记录并比较并发症发生情况,采用世界卫生组织生存质量测定量表简表（WHOQOL-BREF）评价生活质量。结果 观察组首次下床时间、住院时间均短于对照组,住院费用少于对照组,术后72 h的VAS低于对照组（P均<0.05）。两组术后24 h血清CRP、IL-6、TNF-α、COR、MDA升高,SOD水平降低（P均<0.05）;观察组术后24 h血清COR、MDA水平低于对照组,SOD水平高于对照组（P均<0.05）。两组并发症发生率差异无统计学意义（P>0.05）。观察组WHOQOL-...     

中国大陆妇科单孔腹腔镜手术的现状和展望

近年来,妇科单孔腹腔镜手术已在临床广泛应用。该文从术式发展历史、学术探索与创新、中国特色的人才培养与技术推广、国家级学会的支持和专业学术组织的建立、器械研发与创新等方面对中国大陆妇科单孔腹腔镜手术的发展进行了回顾总结,并予以展望。     

柳州地区女性盆腔脏器脱垂与压力性尿失禁之间的关系

目的研究柳州地区成年女性盆腔脏器脱垂(POP)与压力性尿失禁(SUI)之间的关系。方法采取整群抽样的方法选择在柳州市和下辖7个县的妇幼保健院就诊或住院的1 807例20周岁以上女性为研究对象,对其进行问卷调查以及妇科检查(POP-Q分期法),分析POP与SUI之间的关系。结果 1 807人中阴道前壁膨出者为1 424人,子宫脱垂者为1 144人,阴道后壁膨出者281人,POP患者中SUI患病率为51.3%,其中SUI在阴道前壁膨出、子宫脱垂和阴道后壁膨出的患者中患病率分别为18.2%、18.5%和22.1%。SUI患病率在四种阴道前壁膨出程度间差异有统计学意义(P0.01),且患病率随阴道前壁膨出程度增加而升高(P0.01)。不同子宫脱垂程度间SUI患病率差异有统计学意义(P0.01),且患病率随子宫脱垂程度增加而升高(P0.01)。但各组阴道后壁膨出间SUI患病率差异无统计学意义(P0.05)。结论阴道后壁膨出、阴道前壁膨出和子宫脱垂的病情越严重,并发SUI的危险性越大。     

Uterus preservation in pelvic organ prolapse surgery

Attitudes to sexuality and the psychological value of reproductive organs have changed in Western countries over the last few decades. Nevertheless, repair of pelvic support defects with concomitant hysterectomy is still considered the standard treatment for pelvic organ prolapse. Over the last 10 years, however, interest has been growing in uterus-sparing surgery, which can be divided into vaginal, abdominal, and laparoscopic procedures. The majority of studies on uterus-sparing surgery, with the exception of abdominal techniques, report few cases with short follow-up. Sacrospinous hysteropexy is the most studied vaginal technique for uterus preservation and favorable results have been demonstrated, although the majority of studies are flawed by selection and information bias, short follow-up and lack of adequate control groups. Abdominal and laparoscopic procedures are promising, providing similar functional and anatomical results to hysterectomy and sacrocolpopexy. Consensus is growing that the uterus can be preserved at the time of pelvic reconstructive surgery in appropriately selected women who desire it. The results of comparison trials and prospective studies confirm that uterus-sparing surgery is feasible and is associated with similar outcomes to hysterectomy, as well as shorter operating times. Surgeons should be ready to respond to the wishes of female patients who want to preserve vaginal function and the uterus.     

Management of pelvic organ prolapse

Symptomatic pelvic organ prolapse can afflict up to 10% of women. Urinary incontinence, voiding dysfunction or difficulty possibly related to bladder outlet obstruction are common symptoms. Infrequently hydronephrosis or defecatory dysfunction can be seen. The management of pelvic organ prolapse (POP) should start with adequate assessment of all pelvic floor complaints. If a patient is not symptomatic, surgical intervention is usually not indicated. While the use of a variety of graft materials are available today including porcine, dermal and synthetic grafts, that are used in some surgical approaches to pelvic organ prolapse, other more conservative approaches may prove beneficial to many patients. This article describes our approach to the patient with pelvic organ prolapse.     

单孔腹腔镜下子宫内膜癌分期手术的研究进展

循证医学已证明腹腔镜全面分期手术可作为治疗子宫内膜癌的理想术式。经脐单孔腹腔镜成功完成子宫内膜癌分期手术的例数逐渐增多,虽然该术式与传统腹腔镜手术在术中及术后并发症、远期疗效方面差异并不明显,但单孔腹腔镜以美观程度更高、术后恢复更快的优点逐渐应用于子宫内膜癌分期手术中。由于手术难度大、学习曲线长和远期疗效缺乏大样本研究等原因,单孔腹腔镜在子宫内膜癌分期手术上尚未广泛应用。但随着医学的发展,该术式将在子宫内膜癌分期手术中占据越来越重要的地位,使更多女性从中获益。     

Assessing and treating pelvic organ prolapse

At least half of all women who have given birth experience pelvic organ prolapse, a condition where pelvic organs protrude through the vagina. Because of the presentation of the different aspects of prolapse, treatment had become compartmentalized in line with pelvic involvement, with urologists, gynecologists, colorectal surgeons, and gastroenterologists each addressing their field of expertise. In addition, urinary or fecal incontinence, urinary retention, and urinary tract infections often are associated with pelvic organ prolapse. Both pelvic organ prolapse and incontinence have a significant impact on the quality of life. New training programs in urogynecology and reconstructive pelvic surgery are producing clinicians who are better equipped to treat pelvic organ prolapse, as well as related urinary and fecal incontinence. This article provides an overview of the various aspects of pelvic organ prolapse for all clinicians involved in assessment, treatment, and potential prevention of this condition.     

Outcome of sphincteroplasty combined with surgery for urinary incontinence and pelvic organ prolapse

PURPOSE: This is the first reported prospective study comparing outcome and cost in patients undergoing sphincteroplasty for anal incontinence vs. sphincteroplasty performed in combination with one or more procedures for urinary incontinence and/or pelvic organ prolapse. METHODS: We analyzed 44 patients with fecal incontinence who underwent anal sphincter repair alone (20 patients) or in combination with procedures for urinary incontinence or pelvic organ prolapse (24 patients). Information regarding risk factors for fecal incontinence, the degree of incontinence, and the extent that incontinence limited social, physical, and sexual activity was prospectively obtained from questionnaires. Clinic chart reviews and follow-up telephone interviews provided additional data. A cohort of case-matched patients who underwent only urogynecologic procedures was compared retrospectively for operative time, hospital cost, length of stay, and postoperative complications. RESULTS: There were no major complications in any group. The functional outcomes, physical, social, and sexual activity were similar in all three groups. Twenty-two of 24 patients who underwent the combined procedures were glad that they had both procedures concomitantly. CONCLUSION: Combination pelvic floor surgery provides good outcomes and is cost effective. This approach should be offered to women with concurrent problems of fecal and urinary incontinence and/or pelvic organ prolapse.