子宫全切除术后发生输卵管脱垂的临床分析

目的探讨子宫全切除术后输卵管脱垂的诊断、处理及预防措施。方法收集1983年1月至2005年8月行各类子宫全切除术7949例患者的资料,其中行开腹子宫全切除术6229例,行阴式子宫全切除术780例,行腹腔镜辅助阴式子宫全切除术940例。结果手术后共发生阴道残端输卵管脱垂9例,发生率为0．11％（9／7949）。其中开腹子宫全切除术后发生5例,发生率为0．08％（5／6229）;阴式子宫全切除术后发生4例,发生率为0．51％（4／780）;腹腔镜辅助阴式子宫全切除术后无一例发生输卵管脱垂。9例患者子宫全切除术后均放置了阴道引流管,其中5例子宫切除后未行阴道残端腹膜化处理。9例患者中,3例无任何症状;6例有症状的患者中,1例出现左侧腰背部痛,5例出现阴道排液。妇科检查,3例阴道残端发现输卵管伞端,6例阴道残端可见类似肉芽样组织。9例患者均经阴道切除,局部烧灼脱垂的输卵管,切除组织经病理检查证实均为输卵管组织。之后随诊1-59个月无异常发现。结论输卵管脱垂是子宫全切除术后的一种少见并发症,输卵管脱垂一般发生于子宫全切除术后放置阴道引流管的患者,经正确的诊断和治疗预后良好。行子宫全切除术时,应将附件固定在骨盆侧壁或行输卵管切除。     

全子宫切除术后输卵管脱垂的病例分析

患者 36岁 ,住院号Ｐ6 2 72 1。因子宫肌瘤在硬脊膜外麻醉下 ,于 2 0 0 0年 7月 4日行腹式全子宫切除术。术后第3天出现高热 ,达 39℃。术后第 6天起出现阴道出血 ,量多伴头晕 ,经对症治疗后阴道出血停止 ,术后第 12天痊愈出院。患者出院后不久即出现阵发性的阴道排液 ,带有血丝 ,伴有臭味及下腹隐痛。于术后 3个月回院进一步检查 ,膀胱注入美蓝液后检查阴道残端无蓝色液体流出 ;行阴道镜检查见阴道残端左侧角有一束潮红菜花样组织突出 ,活检送病理检查 ,结果是“息肉组织”。静脉肾盂造影 (ＩＶＰ)检查示“双侧输尿管行程未见异常”。根据…     

子宫切除术后输卵管脱垂的临床分析

输卵管脱垂(fallopian tube prolapse,FTP)是子宫全切除术后在腹腔与阴道之间相通时发生的一种并发症,较少见,是疝的一种类型.本研究回顾性分析了我院2000年1月至2007年12月收治的子宫全切除术后发生FTP6例的临床资料,对其临床表现、诊断、治疗方法以及预防措施进行探讨,以提高临床医师对FTP的认识.     

输卵管脱垂2例

例1,49岁。2年前因多发性子宫肌瘤行全子宫切除术。术后2月常规随访主诉右下腹偶感隐痛,妇科检查示阴道残端愈合,无异常分泌物,建议门诊随访以除外子宫内膜异位症。术后2年患者仍偶感右下腹隐痛,且渐有坠胀感,近期加重,遂来院就诊。患者术后无接触性出血史。妇科检查示阴道粘膜充血,淡黄色分泌物较多,阴道顶端右侧见肉芽组织直径约2cm,盆腔右侧扪及囊肿约4cm。B超示右侧盆腔有一液性区4cm×3cm×3cm,疑为右卵巢。拟诊为1.右附件囊肿;2.阴道残端肉芽。行肉芽摘除术。术时患者感右下腹有剧烈牵拉痛,肉芽摘除后在阴道残端见一小破口,并见未吸…     

全子宫切除术后输卵管脱垂四例

一、病例摘要 病例1：患者43岁,于2005年3月因多发性子宫肌瘤于外院行开腹全子宫切除术,手术顺利,术后给予抗炎治疗,患者术后体温正常。术后1个月逐渐出现阴道分泌物增多,粉色,就诊于北京大学人民医院,妇科检查：阴道断端可见肉芽样组织。于2005年5月在腰麻下行阴道断端肿物切除术＋阴道残端修补术,术中探查肿物为输卵管,完整切除后可见输卵管组织充血水肿。     

输卵管妊娠发生的危险因素

输卵管妊娠发生的危险因素宋殿荣钱丽娟翟瞻粲异位妊娠是妇产科领域常见的急腹症，也是引起孕产妇死亡的主要原因之一。近年来，各国异位妊娠的发病率均不断增加，与异位妊娠发生相关的各种危险因素越来越多地受到人们的重视。本文就近年来探讨较多的输卵管异位妊娠发生的...     

非脱垂子宫阴式切除术31例临床分析

以往行经阴道全子宫切除术 (transvaginalhysterecto my,TVH)多限于子宫脱垂的小子宫患者。现总结我院开展的 31例非脱垂子宫阴式切除术,旨在探讨非脱垂子宫TVH的方法和临床应用价值。1　资料与方法1. 1　研究对象　1990年 1月至 2002年 4月我院妇科共施行阴式非脱垂子宫切     

严重产后出血及与其相关的子宫切除危险因素分析

目的探讨严重产后出血(severe postpartum hemorrhage，SPPH)的独立危险因素及导致子宫切除不良事件发生的危险因素。 方法回顾分析2015年7月至2017年12月于广州医科大学附属第一医院分娩的157例产后出血患者的临床资料，并根据失血程度将其分为SPPH组(39例)和非SPPH组(118例)，比较两组患者产前及产时出血原因和相关因素，同时分析SPPH组患者子宫切除的相关因素。 结果SPPH组患者产前纤维蛋白原水平(4.18±1.01)g/L，非SPPH组(4.61±0.79)g/L，两组间存在显著性差异(t＝-2.689，P<0.05)，两组合并子宫肌瘤发生率分别为10.3%和0.8%，差异有统计学意义(χ²＝5.641，P<0.05)。多因素分析结果显示，SPPH与产前纤维蛋白原水平以及是否子宫肌瘤合并妊娠有关(P<0.05)。SPPH患者中，子宫切除组胎盘植入发生率为50%，非子宫切除组为3.4%，两组间差异有统计学意义(P＝0.002)。 结论产前纤维蛋白原水平偏低、子宫肌瘤合并妊娠是导致SPPH的独立危险因素。胎盘植入、凝血功能障碍、产后出血量是导致围产期子宫切除的危险因素。     

北京协和医院健康体检妇女盆腔器官脱垂程度及其危险因素分析

目的 研究北京协和医院常规体检妇女的盆腔器官脱垂(POP)情况及其临床特征,探讨其发病相关因素.方法 对2008年1月-2009年8月在本院行常规健康体检的972名成年妇女进行现场问卷调查以及妇科检杳,由专人采用POP定量分度(POP-Q)法九格表进行测量,并记录各项指标的测量值.结果 (1)观察对象的平均年龄为(42±10)岁(22～78岁),平均身高(162±5)cm(142～180 cm),平均体质量(59±8)kg(42～91 kg);83.8%(815/972)为已分娩妇女.972名妇女的平均阴道长度(TVL)为(8.20±0.35)cm.所有观察对象均未达到POP的诊断标准,其中35.5%(345/972)存在阴道后壁轻度膨出,96.7%(940/972)存在阴道前壁轻度膨出,但均无自觉症状.(2)972名妇女中,未分娩者的生殖道缝隙(gh)、TVL测量值及C、D点距处女膜缘的罡巨离分别为(2.26±0.32)、(8.08±0.30)、(-7.08±0.24)和(-8.08±0.30)cm,均小于已分娩者[分别为(2.33±0.39)、(8.22 ±0.35)、(-7.14±0.28)和(-8.22±0.35)cm],Ap、Bp点距处女膜缘的距离分别为(-2.87±0.22)、(-2.87±0.22)cm,均大于已分娩者[分别为(-2.81±0.25)、(-2.81±0.25)cm],以上各项两者间比较,差异均有统计学意义(P<0.05).与未分娩妇女比较,已分娩妇女阴道后壁膨出的风险增加(OR=1.819).(3)22～34岁、35～49岁及≥50岁者的POP-Q各项指标测量值比较,差异均有统计学意义(P<0.05);22～34岁者与35～49岁者之间比较,差异无统计学意义(P>0.05);22～34岁、35～49岁者分别与≥150岁者比较,差异均有统计学意义(P<0.05).与22～34岁者比较,35～49岁及≥50岁者发生阴道后壁膨出的风险增高(OR=1.713、3.765).(4)绝经后妇女的POP-Q各项指标测馈值均小于未绝经妇女,差异也均有统计学意义(P<0.05);与未绝经妇女比较,绝经后妇女阴道后壁膨出的风险增加(OR=3.354).结论 在我国健康体检的成年妇女中,以POP-Q法作为评价POP程度的指标时,轻度的阴道前、后壁膨出很常见,阴道前壁膨出较后壁膨出的检出率高,但通常并无症状,临床上不需干预.分娩史和年龄是影响阴道壁膨出严重程度及检出率的重要危险因素.     

女性盆腔脏器脱垂患病危险因素分析

目的:对我院妇科近5年盆腔脏器脱垂(POP)手术患者进行调查分析,探讨POP患病危险因素及其特点.方法:采用非条件Logistic回归分析方法确定与POP有关的危险因素;χ2或t检验进行维汉不同民族患病危险因素的比较.结果:256例POP手术患者经单因素及多因素分析,得出患者年龄、民族、体重指数(BMI)、产次、阴道分娩、绝经、便秘以及子宫切除术后8项为POP发生的相关危险因素(P<0.05);维吾尔族与汉族POP患者各危险因素比较,患者年龄、BMI、初产、产次4项因素差异有统计学意义(P<0.05).结论:POP患病原因除了与不同民族及区域有关外,同时与衰老、绝经、阴道分娩、长时间腹内压增加及医源性损伤等因素也有关.     

Vaginoperitoneal fistula and fallopian tube prolapse after total laparoscopic hysterectomy

Vaginoperitoneal fistula and fallopian tube prolapse are uncommon after hysterectomy, whether vaginal or abdominal. The main symptoms are leukorrhea and discharge that mimic urinary incontinence. A case report with a complex history of endometriosis, several surgical procedures, and total laparoscopic hysterectomy (TLH) is presented, and the diagnostic procedures and laparoscopic repair are discussed.     

Post-hysterectomy fallopian tube prolapse

Post-hysterectomy fallopian tube prolapse is a rare complication with only 80 cases described since 1902. Symptoms are non-specific and often of delayed onset. Final diagnosis is confirmed by vaginal biopsy with salpingectomy being the treatment of choice, preferably performed laparoscopically. Following surgery, complete symptom resolution is usually observed and no recurrence has been reported.     

Risk factors for vaginal prolapse after hysterectomy

Objective

To identify risk factors for pelvic organ prolapse (POP) and their influence on the occurrence of vaginal prolapse after hysterectomy.

Methods

Medical records from 2 groups of women who had undergone hysterectomy were reviewed retrospectively. The study group was 82 women who had undergone surgery for vaginal prolapse after hysterectomy; the control group was 124 women who had undergone hysterectomy with no diagnosis of vaginal prolapse by the time of the study. All hysterectomy procedures had been performed for benign gynecological disease, including POP. Both groups of women completed a self-administered questionnaire to obtain additional information on the occurrence of POP.

Results

The incidence of vaginal prolapse after hysterectomy was significantly higher in women with a higher number of vaginal deliveries, more difficult deliveries, fewer cesareans, complications after hysterectomy, heavy physical work, neurological disease, hysterectomy for pelvic organ prolapse, and/or a family history of pelvic organ prolapse. Premenopausal women had vaginal prolapse corrected an average of 16 years after hysterectomy, and postmenopausal women 7 years post hysterectomy.

Conclusion

Before deciding on hysterectomy as the approach to treat a woman with pelvic floor dysfunction, the surgeon should evaluate these risk factors and discuss them with the patient.     

Fallopian tube prolapse after hysterectomy. A report of two cases

Two patients were treated for fallopian tube prolapse after abdominal hysterectomy. This rare complication is usually seen after vaginal hysterectomy. Our patients presented with a profuse, blood-tinged vaginal discharge and lower abdominal pain two and three months after hysterectomy. The tender, fimbriated end of the fallopian tube must be distinguished from common cuff granulation tissue, one patient underwent painful cautery treatments for over a year before the correct diagnosis was made. Biopsy of the prolapsed tissue in both cases failed to provide the correct diagnosis. In cases reported on previously, repair of the prolapsed tube usually was accomplished transvaginally, but in one of our patients laparotomy was required to control bleeding from the retracted proximal tube. The other patient had her prolapsed tube diagnosed and resected laparoscopically. This technique, described in detail, has the advantage of avoiding more-extensive surgery in selected cases.     

Risk factors for pelvic organ prolapse repair after hysterectomy

OBJECTIVE: To estimate the incidence and identify the risk factors for pelvic organ prolapse repair after hysterectomy. METHODS: We conducted a case-control study. We identified 6,214 women who underwent hysterectomy in our gynecology department from 1982 to 2002. Cases (n=114) were women who required pelvic organ prolapse surgery after hysterectomy from January 1982 through December 2005. Controls (n=236) were women randomly selected from the same cohort who did not require pelvic organ surgery during the same period. We performed a univariable and a multivariable analysis among 104 cases and 190 controls to identify the variables associated with prolapse repair after hysterectomy. RESULTS: The incidence of pelvic organ prolapse that required surgical correction after hysterectomy was 1.3 per 1,000 women-years. The risk of prolapse repair was 4.7 times higher in women whose initial hysterectomy was indicated by prolapse and 8.0 times higher if preoperative prolapse grade 2 or more was present. Risk factors included preoperative prolapse grade 2 or more (adjusted odds ratio [OR] 12.6, 95% confidence interval [CI] 4.6-34.7), previous pelvic organ prolapse or urinary incontinence surgery (adjusted OR 7.9, 95% CI 1.3-48.2), history of vaginal delivery (adjusted OR 5.0, 95% CI 1.3-19.7), and sexual activity (adjusted OR 6.2, 95% CI 2.7-14.5). Vaginal hysterectomy was not a risk factor when preoperative prolapse was taken into account (adjusted OR 0.7, 95% CI 0.4-1.1). CONCLUSION: Preoperative pelvic organ prolapse and other factors related to pelvic floor weakness were significantly associated with subsequent pelvic floor repair after hysterectomy. Vaginal hysterectomy was not a risk factor. LEVEL OF EVIDENCE: II.