腹腔镜子宫切除术

腹腔镜子宫切除术是指在腹腔镜下或在腹腔镜辅助下进行的子宫切除术。分为腹腔镜辅助阴式子宫切除术 (L AVH)、腹腔镜全子宫切除术 (TL H)、腹腔镜次全子宫切除术 (L SH)和腹腔镜筋膜内子宫切除术 (CISH)等。1　 L AVH是以腹腔镜手术开始 ,阴道手术结束 ,至少在腹腔镜下处理附件的子宫切除术。其适应证有子宫肌瘤或腺肌病 ,功血 ,盆腔子宫内膜异位症 ,子宫内膜异常增生 ,早期子宫内膜癌 ,适于经阴子宫切除但切除附件困难者等。禁忌证有子宫超过14周妊娠大小 ,阴道狭窄 ,盆腔严重粘连 ,手术者阴道手术不熟练等。并发症有输尿管、膀胱…     

腹腔镜联合阴式全子宫切除术与经腹全子宫切除术的临床效果比较

目的比较腹腔镜联合阴式全子宫切除术与经腹全子宫切除术的临床效果。方法分析43例采用腹腔镜联合阴式全子宫切除术(LAVH)患者的临床资料,并与同期抽取的50例经腹全子宫切除术(TAH)患者进行比较。结果两组手术均顺利,未出现手术并发症,在术中出血量、肛门排气时间、住院时间,LAVH组均少于TAH组(P<0.01);而手术时间LAVH组长于TAH组(P<0.01)。结论 LAVH术后恢复快、伤口美观、愈合好,值得临床推广应用。     

改良腹腔镜下子宫次全切除术治疗子宫良性病变40例效果观察

目的探讨改良腹腔镜下子宫次全切除术(LSH)治疗子宫良性病变的临床效果。方法将80例拟行手术治疗的子宫良性病变患者随机分为观察组和对照组各40例,分别行改良LSH和传统腹腔镜下子宫次全切除术,观察两组术中出血量、手术时间及术后恢复情况。结果两组术后下床时间、住院时间、住院费用无明显差异,但观察组术中出血量、手术时间、肛门排气时间明显少于对照组(P均<0.01)。改良腹腔镜下子宫次全切除术的临床疗效明显优于传统腹腔镜下子宫次全切除术。结论改良LSH治疗子宫良性病变可明显缩短手术时间,减少术中出血、缩短术后康复时间,且不增加手术费用。     

腹腔镜辅助经阴子宫切除术146例治疗体会

2002年8月～2006年8月,我院行腹腔镜下经阴子宫全切除术146例,效果满意.现报告如下.     

腹腔镜下行阴式子宫全切术与开腹子宫全切除术的临床效果比较

目的探讨腹腔镜辅助下阴式子宫全切术的临床应用及疗效。方法选取2012-06~2015-06该院收治的子宫良性病变患者86例,其中行腹腔镜辅助下行阴式子宫全切术43例(观察组),行传统开腹子宫全切除术43例(对照组),分析比较两组手术出血量、手术时间、下床活动时间、住院时间及术后并发症等。结果 86例患者均顺利完成手术,观察组术中出血量少于对照组(P0.01),下床活动时间、住院时间短于对照组(P0.01),观察组手术时间长于对照组(P0.01),术后并发症发生率低于对照组(P0.01),两组均无输尿管损伤及膀胱损伤发生。结论腹腔镜辅助下阴式子宫全切术有创伤小、安全系数高、住院时间短等优点,且术后并发症少,值得推广应用。     

腹腔镜全子宫切除术中转开腹原因分析

目的 探讨腹腔镜全子宫切除术(TLH)中转开腹的原因.方法 对587例接受TLH患者的临床资料进行回顾性分析.结果 本组TLH中转开腹率为5.79％(34/587).TLH中转开腹主要原因为子宫肌瘤位置特殊(13例,38.24％)及严重盆腔粘连(12例,35.29％),其次是术中出血(5例,14.71％)及副损伤(4例,11.76％).结论 子宫肌瘤位置特殊及严重盆腔粘连是TLH中转开腹的主要原因,不断提高腹腔镜手术技术,术前充分评估病情,严格掌握腹腔镜手术指征,可降低TLH的中转开腹率.     

腹腔镜筋膜内全子宫切除术的临床观察

目的探讨腹腔镜筋膜内全子宫切除术与开腹全子宫切除术的临床应用价值。方法对腹腔镜全子宫切除和开腹全子宫切除术两组疗效进行比较。结果两组手术时间无统计学差异(P0.05),术中估计出血量及术后恢复情况相比,差异有统计学意义(P0.05或P0.01)。结论腹腔镜全子宫切除术可以取代大部分经典的开腹手术。     

单孔腹腔镜与传统腹腔镜行全子宫切除术的效果对比研究

目的探讨单孔腹腔镜下全子宫切除术(LESS-TH)的应用价值。方法将120例因妇科非恶性疾病行全子宫切除术的患者,随机分为实验组和对照组,实验组(60例)实施单孔腹腔镜下全子宫切除术;对照组(60例)实施传统腹腔镜下全子宫切除术。比较两组的手术时间、术中出血量、住院时间、术后病率、术后肛门排气时间、患者满意度等。结果实验组和对照组的手术时间、术中出血量及住院时间比较差异均无统计学意义(P0.05)。实验组和对照组的术后疼痛评分、术后肛门排气时间及腹部伤口美容满意度比较,实验组明显优于对照组,差异有统计学意义(P0.05)。两组手术均顺利完成,且均无术中、术后严重并发症、无手术死亡病例,无一例中转开腹手术。结论单孔腹腔镜手术是一种安全、可行的手术方式,因其较其他手术方式术后疼痛减少,术后恢复更快,具有更佳的美容效果,故更容易被患者接受。     

腹腔镜下和腹式子宫次全切除术临床效果分析

目的比较腹腔镜下及腹式子宫次全切除术的临床效果。方法将同期收治的351例拟行子宫次全切除术的子宫疾病患者随机分为腹腔镜组87例和开腹组264例,分别行腹腔镜下和腹式子宫次全切除术,观察两组术中、术后一般情况及并发症发生率。结果腹腔镜组患者无中转开腹及严重并发症发生,手术时间长于开腹组,出血量、术后肛门排气时间、镇痛剂使用率、下床活动时间、术后并发症及住院时间方面均显著优于开腹组,P均〈0.05。结论经腹腔镜和腹式子宫次全切除术各有优缺点,但前者具有创伤小、住院时间短、并发症少、患者恢复快等优点;临床医师应于术前综合评估病情,选择个体化治疗方案。     

改良腹腔镜筋膜内子宫切除术与腹腔镜子宫全切术的临床应用效果比较

［摘要］　目的　探讨改良腹腔镜筋膜内子宫切除术与腹腔镜子宫全切术的临床应用效果。方法　选择2010-05～2013-03该院行腹腔镜筋膜内子宫全切术及腹腔镜子宫全切病例162例,根据手术方法不同分为观察组（腹腔镜筋膜内子宫切除术）及对照组（腹腔镜子宫全切术）各81例,对两组手术时间、术中出血量、术后病率、住院费用、住院床日、术后性生活恢复、息肉、残端感染、副损伤进行比较。结果　两组手术时间,术中出血量、术后病率、住院费用、住院床日、术后性生活时间、息肉、残端感染、副损伤比较差异均有统计学意义（P<0.05）。结论　改良腹腔镜筋膜内子宫切除术副损伤少,术中出血量少,值得临床推广。     

产科急症子宫切除术11例临床分析

目的探讨产科急症子宫切除术在抢救产后大出血中的应用价值。方法对该院产科2007-01～2012-01收治的11例因产科急症行子宫切除术患者的临床资料进行回顾性分析及文献复习。结果 11例中,行次全子宫切除8例,全子宫切除3例,均痊愈出院。急症子宫切除术率,经产妇（0.152%）高于初产妇（0.011%）（P=0.000）;剖宫产手术者（0.126%）高于阴道分娩者（0.012%）（P=0.000）。结论产科急症子宫切除术是治疗急性产后大出血的有效手段之一。     

基层医院行腔镜胆囊切除术66例体会

目的：总结基层医院行腹腔镜胆囊切除术（ LC）的体会。方法对2010-10～2013-09在该院因复杂胆囊病变施行LC手术的66例患者的临床资料进行回顾性分析。结果本组64例在腹腔镜下完成手术,2例患者中转开腹,术后胆漏1例,再次手术。66例患者均顺利康复出院。结论基层医院行LC手术初期必须加强基本功训练,严格选择病例及适应证;术中精心操作,处理好胆囊动脉及胆囊管,遇到困难可采取及时中转开腹手术等措施,确保手术安全;术后严密观察,发现问题及时处理。     

腹腔镜联合纤维胆道镜保胆取石82例临床分析

目的探讨腹腔镜联合纤维胆道镜保胆取石术的应用价值。方法回顾性分析该院82例胆囊结石患者行腹腔镜联合纤维胆道镜保胆取石治疗的临床资料。结果 82例手术均获成功,术后无胆瘘、急性胆囊炎、胰腺炎、继发性胆总管结石等并发症发生,无死亡病例;随访6～12个月,无复发病例。结论腹腔镜联合纤维胆道镜保胆取石术具有创伤小、安全可靠、并发症少等优点,同时保留了有功能的胆囊,提高患者的生存质量,值得推广应用。     

腹腔镜辅助阴式全子宫切除术与开腹全子宫切除术的临床效果比较

目的对比分析腹腔镜辅助阴式全子宫切除术(LAVH)与开腹全子宫切除术(TAH)的临床效果及安全性。方法分析2013-01~2016-01该院收治的68例接受全子宫切除患者的临床资料,随机分为观察组和对照组各34例,观察组接受LAVH治疗,对照组接受TAH治疗,对比两组治疗效果及住院费用。结果观察组在切口长度、术中出血量、排气时间、术后疼痛率、住院时间及并发症发生率显著低于或短于对照组,手术时间和住院费用高于对照组(P均0.05)。结论 LAVH与TAH各具优势,前者有创伤小、安全性高、恢复快、住院时间短的优点,但是费用高,临床上应合理选择。     

Increased frequencies of hysterectomy and early menopause in fibromyalgia patients: a comparative study

The objective was to determine the relationship between symptoms of fibromyalgia (FM) and early menopause and hysterectomy. We included 115 postmenopausal patients with FM (mean age 54.6 ± 7.6) and 67 rheumatoid arthritis (RA) patients (mean age 55.5 ± 9) into our study. All patients were questioned about the severity of their symptoms of FM, anxiety, and depression by using a visual analog scale and FM impact questionnaire. Patients’ history of menopause and hysterectomy were recorded. Menopause (≤45 years) was accepted to be early. The frequencies of early menopause (38.3% vs. 13.4%, p = 0.001) and hysterectomy (16.5% vs. 6%, p = 0.039) in FM patients were significantly higher than in RA patients. While chronic widespread pain and other FM-related symptoms started after menopause in 58.3% of FM patients, the disease started after menopause in 64.2% of RA patients (p > 0.05). FM-related symptoms started in 30 patients (26.1%) with FM with menopause or within the first postmenopausal year. When the clinical features of FM patients whose symptoms started within the first menopausal year were compared to other FM patients; it was observed that the frequency of early menopause was higher in the former group (p = 0.048). Duke anxiety and depression score was higher in patients with hysterectomy whose FM symptoms started within the first year of post-hysterectomy than other FM patients (9.1 ± 2.7 vs. 6.7 ± 2.7, p = 0.022). Early menopause and hysterectomy may be one of the factors contributing to the development of FM.     

Effect of hysterectomy on bowel function

PURPOSE Hysterectomy is the most common major gynecologic procedure. Unwanted postoperative effects on bowel function are a topic of recent debate. The aim of the present study was to prospectively evaluate the influence of hysterectomy on bowel function.METHODS One hundred and twenty consecutive patients undergoing hysterectomy for benign conditions answered a questionnaire covering bowel habits and symptoms preoperatively and at 6 and 12 months postoperatively. Forty-four patients underwent vaginal hysterectomy and 76 underwent abdominal hysterectomy. Concomitant bilateral salpingo-oopherectomy was performed in 17 patients.RESULTS After abdominal hysterectomy, patients reported increased symptoms of gas incontinence, urge to defecate, and inability to distinguish between gas and feces (P < 0.05). There was a tendency of increased fecal incontinence. Subgroup analysis indicated that concomitant bilateral salpingo-oopherectomy resulted in an increased risk of fecal incontinence. No significant changes were detected in symptoms associated with constipation. Mean defecation frequency increased and the frequency of pelvic heaviness symptoms was reduced. After vaginal hysterectomy, there was no increased frequency of incontinence or constipation symptoms. The frequency of pelvic heaviness symptoms was reduced.CONCLUSIONS Patients undergoing abdominal hysterectomy may run an increased risk for developing mild to moderate anal incontinence postoperatively and this risk is increased by simultaneous bilateral salpingo-oopherectomy. An increased risk of anal incontience symptoms could not be identified in patients undergoing vaginal hysterectomy. Our study does not support the assumption that hysterectomy is associated with de novo or deteriorating constipation.     

产科急症子宫切除13例临床分析

目的 探讨产科急症子宫切除的临床情况.方法 对我院2004-01～2008-12 5年间13例产科急症子宫切除病例进行回顾性分析.结果 13例产科子宫切除术指征为前置胎盘并胎盘植入、子宫收缩乏力致产后出血、DIC、羊水栓塞、子宫动脉瘤破裂;出血量为1000～17000 ml,平均出血量约为5800 ml.术后严重并发症包括DIC、急性肾衰、多器官功能障碍综合征(MODS),无孕产妇死亡;围产儿13例中死亡1例.结论 子宫切除是治疗产科急性出血的有效措施之一,加强高危孕产妇的筛查管理,预防产科严重并发症发生,降低剖宫产率可减少产科子宫切除的发生.