经阴道子宫肌瘤剔除术治疗子宫肌瘤63例效果观察

目的观察经阴道子宫肌瘤剔除术治疗子宫肌瘤的效果。方法将127例子宫肌瘤患者随机分为对照组和观察组2组,对照组(n=64例)行经腹子宫肌瘤剔除术,观察组(n=63例)行经阴道子宫肌瘤剔除术,比较2组患者手术时间、手术出血量、术后肛门排气时间、住院时间、术后应用止痛剂例数等指标。结果 2组患者的手术时间组间比较差异无统计学意义(P>0.05)。观察组患者手术出血量、术后肛门排气时间、住院时间和术后应用止痛剂例数均少于对照组(P<0.05)。结论经阴道子宫肌瘤剔除术创伤小、恢复快、术后痛苦轻、腹部无疤痕,安全性高,临床治疗效果显著。     

经阴道和经腹子宫肌瘤剔除治疗子宫肌瘤疗效观察

目的观察比较经阴道和经腹子宫肌瘤剔除术治疗子宫肌瘤的效果。方法将127例择期行子宫肌瘤患者,按不同手术方式分为对照组(n=64)观察组(n=63)2组。对照组实施经腹子宫肌瘤剔除术,观察组实施经阴道子宫肌瘤剔除术,比较2组手术时间、手术出血量、术后肛门排气时间、住院时间等指标。结果 2组患者手术时间、手术出血量比较差异无统计学意义(P>0.05)。观察组患者肛门排气时间、住院时间和术后切口感染率均少于对照组,2组比较,差异有统计学意义(P<0.05)。结论在正确掌握适应证前提下,规范实施阴式子宫肌瘤剔除术具有创伤小、恢复快、安全性高,对子宫的正常生理功能影响小,效果肯定。     

经阴道子宫肌瘤剔除术与经腹子宫肌瘤剔除术疗效观察

目的总结经阴道子宫肌瘤剔除的临床疗效。方法将127例子宫肌瘤患者分为对照组和观察组,对照组行经腹子宫肌瘤剔除术,观察组行经阴道子宫肌瘤剔除术,比较两组患者手术时间、术中出血量、术后住院时间以及术后镇疼率等。结果两组手术时间、术中出血量比较,差异无统计学意义(P0.05);观察组术后肛门排气时间及住院时间均少于对照组;术后疼痛感低于对照组,两组差异均有统计学意义(P0.05)。结论正确掌握手术适应证并规范实施经阴道子宫肌瘤剔除术,具有创伤小,术后恢复快,并发症少,效果肯定。     

经阴道子宫肌瘤剔除术治疗子宫肌瘤的临床效果观察

目的分析经阴道子宫肌瘤剔除术的临床应用效果。方法将在濮阳市妇幼保健院行肌瘤剔除术的72例患者随机分为对照组和观察组,每组36例。对照组实施经腹子宫肌瘤剔除术,观察组实施经阴道子宫肌瘤剔除术。比较2组临床治疗效果。结果 2组患者均成功完成手术,观察组中无中转开腹病例。2组患者手术时间、术中出血量、肌瘤剔除个数比较,差异无统计学意义(P0.05),观察组术后肛门恢复排气时间、并发症发生率和住院时间均优于对照组,差异有统计学意义(P0.05)。结论与经腹子宫肌瘤剔除术比较,经阴道子宫肌瘤剔除术创伤小、术后并发症少、恢复时间短且治疗效果肯定。     

经阴道与腹腔镜下子宫肌瘤剔除术的对照研究

目的探讨经阴道与腹腔镜下子宫肌瘤剔除术的疗效及临床应用价值。方法回顾分析2007年3月～2008年10月58例经阴道子宫肌瘤剔除术(阴道组)和55例腹腔镜下子宫肌瘤剔除术(腹腔镜组)的临床资料,对2组患者的手术时间、术中出血量、剔除肌瘤重量、术后病率、肛门排气时间、住院时间、住院费用等进行对照分析。结果 2组术后肛门排气时间、住院时间均无统计学差异(P=0.056,P=0.067),但经阴道组手术时间(62±13)min显著短于腹腔镜组(97±18)min(t=-11.895,P=0.000),术中出血量(105±30)ml显著少于腹腔镜组(180±25)ml(t=-14.396,P=0.000),术后病率(48.3%)显著高于腹腔镜组(23.6%)(χ2=7.410,P=0.006),住院费用(5216.4±28.5)元显著低于腹腔镜组(7421.6±31.2)元(t=-392.597,P=0.000)。结论 2种术式各有适应证而不可完全互相替代,但从卫生经济学角度而言,经阴道手术可作为治疗的首选术式,并值得在临床推广应用。     

子宫阔韧带肌瘤行腹腔镜下肌瘤剔除术的疗效分析

目的分析子宫阔韧带单发肌瘤行腹腔镜下肌瘤剔除术的安全性及疗效。方法将86例单发子宫阔韧带肌瘤患者分为两组,研究组(46例)行腹腔镜下肌瘤剔除术,对照组(40例)行开腹肌瘤剔除术。对比分析两组手术疗效。结果研究组术中出血量明显低于对照组,手术时间、术后肛门排气时间、住院时间均明显短于对照组,镇痛药物应用率明显低于对照组,术后并发症发生率明显低于常规组。差异均有统计学意义(P0.05)。结论腹腔镜下子宫阔韧带单发肌瘤剔除术具有损伤小、恢复快、安全有效等优点,是子宫阔韧带单发肌瘤首选的术式。     

经阴道子宫肌瘤剔除术88例临床分析

目的探讨经阴道子宫肌瘤剔除术的临床特点及临床价值。方法将近3年我院收治的176例子宫肌瘤患者随机分为经阴道组(观察组)和经腹手术组(对照组)各88例,观察手术时间、术中出血量、剔除肌瘤数目、剔除肌瘤重量、术后疼痛程度和住院时间。结果观察组与同期对照组比较:两组患者的手术时间、术中出血量、剔除肌瘤数目及重量无明显差异,观察组有对腹腔侵扰少、恢复快、痛苦小、住院时间短等优点。结论阴道子宫肌瘤剔除术为微创手术,安全可靠。而对多发(≥5个)、巨大或盆腔有严重粘连的肌瘤首选开腹肌瘤剔除术。     

腹腔镜与开腹肌瘤剔除术治疗子宫肌瘤效果分析

目的探讨腹腔镜与开腹手术治疗子宫肌瘤的效果。方法随机将102例子宫肌瘤的患者分为2组,各51例。对照组用开腹镜肌瘤剔除术,观察组给予腹腔镜肌瘤剔除术。比较2组治疗效果。结果观察组手术时间、术中出血量、术后排气时间、住院时间及术后疼痛评分,均优于对照组,差异均有统计学意义(P0.05)。结论腹腔镜肌瘤剔除术治疗子宫肌瘤效果显著。     

剖宫产同时行肌瘤剔除术临床分析

目的探讨剖宫产术中同时行子宫肌瘤剔除术的疗效。方法对26例妊娠合并子宫肌瘤患者,在行子宫下段剖宫产时,行肌瘤剔除术。并与同期单纯性剖宫产26例产妇比较术后出血、并发症及住院时间等情况。结果剖宫产同时行肌瘤剔除术时,手术时间延长,但2组术中及术后24 h出血量、肛门排气及住院时间等,差异无统计学意义。结论对妊娠合并子宫肌瘤患者在剖宫产术同时行肌瘤剔除术,可减少患者痛苦和再次手术治疗率。     

不同手术方式治疗子宫肌瘤的临床效果分析

目的探讨经阴道与经腹子宫肌瘤剔除术治疗子宫肌瘤的效果。方法选取2014-02—2018-02间在睢县人民医院接受肌瘤剔除术的80例子宫肌瘤患者。将2014-02—2015-12间行经腹手术的患者作为对照组,将2016-01—2018-02间行经阴道手术的患者作为观察组,各40例。回顾性分析患者的临床资料。结果 2组患者均顺利完成手术。2组手术时间差异无统计学意义(P0.05)。观察组术中肌瘤剔除数少于对照组;术中出血量及术后疼痛程度、抗生素应用时间、胃肠功能恢复时间、住院时间均小(短)于对照组。差异均有统计学意义(P0.05)。结论经阴道与经腹子宫肌瘤剔除术治疗子宫肌瘤均有良好的效果。经阴道子宫肌瘤剔除术创伤小、术后疼痛轻、恢复快。在合理把握手术指征的基础上,可作为首选手术方式。     

阴式辅助腹腔镜在特殊情况子宫肌瘤剔除术中的应用

目的探讨在特殊情况下施行阴式辅助腹腔镜子宫肌瘤剔除术（transvaginal-assisted laparoscopic myomectomy,VALM）的可行性、安全性。方法 2006年3月～2010年5月,行腹腔镜子宫肌瘤剔除术148例,其中24例行阴式辅助腹腔镜子宫肌瘤剔除术,包括较大子宫肌壁间（6～8 cm）近黏膜下肌瘤8例、子宫下段肌瘤3例、子宫腺肌瘤术前彩超误诊为子宫肌瘤4例、对于子宫肌瘤粉碎后取出有顾虑强烈要求完整取出肌瘤者5例、子宫肌瘤囊性变4例。结果所有病例均经阴式辅助顺利完成手术。2例术中触诊发现术前超声未提示肌壁间直径约1 cm肌瘤结节3枚,行剔除术。无中转开腹、临近脏器损伤。术中出血量50～120 ml,（75.4±22.1）ml,手术时间40～90 min,（63.5±14.7）min。无术后发热、感染等并发症。术后专人定期电话随访2～51个月,（38.1±12.9）月,均无复发。结论 VALM安全可行,可以拓展腹腔镜及阴式子宫肌瘤剔除术的适应证,并作为困难腹腔镜手术的一种补救措施,避免中转开腹。     

Postoperative Outcomes After Robotic Versus Abdominal Myomectomy

Background and Objectives:

Differences in postoperative outcomes comparing robotic-assisted laparoscopic myomectomy (RALM) with abdominal myomectomy (AM) have rarely been reported. The objective of this study was to compare surgical, quality-of-life, and residual fibroid outcomes after RALM and AM.

Methods:

Consecutive patients who underwent RALM (n = 16) were compared with AM patients (n = 23) presenting with a uterine size of <20 weeks. Study patients participated in a telephone interview at 6 weeks and underwent a no-cost ultrasonographic examination at 12 weeks after surgery to obtain quality-of-life and residual fibroid outcomes. Medical records were reviewed to obtain surgical outcomes.

Results:

Longer operative times (261.1 minutes vs 124.8 minutes, P < .001) and a 3-fold unfavorable difference in operative efficiency (73.7 g vs 253.0 g of specimen removed per hour, P < .05) were observed with RALM compared with AM. Patients undergoing RALM had shorter lengths of hospital stay (1.5 days vs 2.7 days, P < .001). Reduction of patient symptoms and overall satisfaction were equal. RALM patients were more likely to be back to work within 1 month (85.7% vs 45.0%, P < .05). Residual fibroid volume in the RALM group was 5 times greater than that in the AM group (17.3 cm³ vs 3.4 cm³, P < .05).

Conclusion:

RALM and AM were equally efficacious in improving patient symptoms. Although operative times were significantly longer with RALM, patients had a quicker recovery, demonstrated by shortened lengths of stay and less time before returning to work. However, greater residual fibroid burden was observed with RALM when measured 12 weeks after surgery.     

Bidirectional Barbed Suture: An Evaluation of Safety and Clinical Outcomes

Objective:

To evaluate the safety and efficacy of using bidirectional barbed suture in laparoscopic myomectomy (LM) and total laparoscopic hysterectomy (TLH).

Methods:

This was a case series of clinical outcomes following 172 consecutive LM and TLH cases over a 1-year period conducted at a university teaching hospital. It included 172 women (ages 17 to 81), requiring a myomectomy or hysterectomy for symptomatic uterine fibroids, pelvic pain, or abnormal uterine bleeding; 117 women underwent TLH and 55 women underwent LM. Patients were contacted over the phone 6 months after surgery to inquire about number of days of postoperative vaginal bleeding, visits to the hospital due to bleeding, dyspareunia, and other potential complications.

Results:

For TLH, the average duration of surgery was 109 minutes, average uterine weight was 256 grams (range, 18 to 1242), and average blood loss was 71mL. In LM, average duration of surgery was 125 minutes, average weight of fibroids was 252g, average number of fibroids removed was 4.0, and average blood loss was 159mL. Seven percent of patients and 8% of their partners had persistent dyspareunia after surgery. There were no conversions to laparotomy.

Conclusions:

The use of bidirectional barbed suture appears to be safe for closing the vaginal cuff in a TLH and for closing the hysterotomy site during a laparoscopic myomectomy.     

Sonohysterographic Predictors of Successful Hysteroscopic Myomectomies

Methods:Charts from all hysteroscopic myomectomies performed by a single surgeon between 2003 and 2011 were reviewed for preoperative, intraoperative, and postoperative sonohysterographic findings. Predictors included myoma number, diameter and percent extension into the cavity of the largest fibroid, and percent surgically resected. These predictors were assessed with postoperative sonohysterography. Statistics included t test, logistic regression, χ² test, and Fisher exact test.Results:Among the 79 cases with postoperative sonohysterograms, 17 (21.5%) had persistent submucosal myoma, and 9 (11.4%) had intrauterine scarring on postoperative sonohysterogram. Repeat hysteroscopic myomectomy was required in 11 (13.9%), but none required lysis of adhesions. The myoma number was not a significant predictor. A higher percentage of myoma within the cavity (63.35% vs 44.89%, P < .05) and smaller myoma size (2.22 cm vs 3.31 cm, P < .01) were significant predictors of a complete resection, a normal postoperative sonohysterogram, and avoidance of repeat surgery. On regression analysis, the percent of the myoma resected was the most significant outcome predictor (P < .001).Conclusion:Larger myomas with a lower percent found within the uterine cavity are less likely to be completely resected. Percent resection at the time of surgery is the most significant predictor of a normal postoperative sonohysterogram, as well as the best predictor of the need for repeat surgery.     

腹腔镜开窗式子宫肌瘤剔除术69例临床分析

目的 探讨腹腔镜开窗式子宫肌瘤剔除术的临床价值.方法 对2010年2月～2012年5月136例子宫肌瘤行腹腔镜下子宫肌瘤剔除术,其中切开式67例（切开组）,开窗式69例（开窗组）,比较2组手术时间、术中出血量、术后排气时间、术后病率、住院费用、术后复发率等.结果 开窗组手术时间（62.5±12.5） min显著少于切开组（82.4±25.5） min（=5.804,P=0.000）;开窗组术中出血量（77.3±17.8）ml显著少于切开组（119.5±38.5） ml（t=8.243,P=0.000）;开窗组术后病率2.9％ （2/69）,显著低于切开组13.4％（9/67）（Х^2=5.074,P=0.024）;开窗组住院费用（5803.38±317.04）元,明显少于切开组（6147.97±319.86）元（t=6.309,P=0.000）;开窗组术后排气时间（22.4±2.6）h,显著短于切开组（24.8 ±3.9）h（t=4.234,P=0.000）;2组术后复发率比较无差异[11.6％（8/69） vs.10.4％（7/67）,Х^2=0.046,P=0.831].结论 腹腔镜开窗式子宫肌瘤剔除术操作简单,易于掌握,手术时间短、术中出血量少、术后病率低,值得临床推广.     

腹腔镜用于较大子宫肌瘤手术中的技巧

目的探讨腹腔镜下较大子宫肌瘤核除术的各种手术技巧。方法 2007年9月至2010年12月,完成腹腔镜下子宫肌瘤核除术756例,其中核除较大子宫肌瘤（直径6～13cm,至少1个肌瘤直径≥6cm）229例。结果 229例腹腔镜下较大子宫肌瘤核除术无术中、术后并发症发生,仅1例由于腹腔粘连严重中转开腹。结论腹腔镜下较大子宫肌瘤核除术是安全可行的,提高手术技巧有利于降低中转开腹率和并发症的发生率。     

The indications, surgical techniques, and limitations of laparoscopic myomectomy.

OBJECTIVE: To assess the indications and limits of laparoscopic myomectomies (LM). METHODS: We conducted a retrospective analysis of 89 consecutive cases of LM. Our LM procedures were as follows: Diluted vasopressin was injected into the myoma capsule, and a transverse incision was made by fine monopolar electrode. Traction was applied to the myoma with a myoma screw. The uterine wall was sutured with a curved needle. Fibrin glue spray was applied to prevent adhesion formation. Enucleated myomas were removed via trocar by using an electric morcellator. RESULTS: We enucleated 195 nodules with diameters > 2 cm; the mean size of the dominant myomas was 5.3 cm. The mean number of myomas removed from each patient was 2. The uterine wall was sutured in all cases with a mean of 9 sutures. The mean blood loss was 102 mL, and the mean operating time was 111 minutes. No patients were converted to laparotomy. The average hospital stay was 2.4 days. When the myomas were larger than 10 cm, the blood loss and operating time were increased. However, the number of myomas did not correlate with blood loss. CONCLUSION: LM appears to offer a number of advantages if the myoma is not larger than 10 cm.