腹腔镜子宫肌瘤剔除术与传统手术的比较

目的 探讨腹腔镜子宫肌瘤剔除术的临床效果.方法 对2007年1月至2009年3月行腹腔镜子宫肌瘤剔除术21例与开腹子宫肌瘤剔除术37例患者的手术时间、术中出血量、术后体温恢复正常时间、术后肛门排气时间、住院日及镇痛剂的使用等情况进行回顾性分析比较.结果 腹腔镜组与开腹手术组在术中出血量、胃肠功能恢复时间、住院时间上比较差异有统计学意义(P<0.05);术后镇痛剂使用腹腔镜组2例(9%),开腹组32例(86%),两组比较差异有统计学意义(P<0.05);手术时间比较差异无统计学意义(P>0.05).结论 腹腔镜子宫肌瘤剔除术较传统开腹手术具有创伤小、术后恢复快、住院时间短、并发症少等优点,是目前较为理想的治疗子宫肌瘤的方法之一.     

腹腔镜子宫肌瘤剔除术与传统手术的比较

 目的　探讨腹腔镜子宫肌瘤剔除术的临床效果。方法　对2007年1月至2009年3月行腹腔镜子宫肌瘤剔除术21例与开腹子宫肌瘤剔除术37例患者的手术时间、术中出血量、术后体温恢复正常时间、术后肛门排气时间、住院日及镇痛剂的使用等情况进行回顾性分析比较。结果　腹腔镜组与开腹手术组在术中出血量、胃肠功能恢复时间、住院时间上比较差异有统计学意义（P＜0.05）;术后镇痛剂使用腹腔镜组2例（9 %）,开腹组32例（86 %）,两组比较差异有统计学意义（P＜0.05）;手术时间比较差异无统计学意义（P＞0.05）。结论　腹腔镜子宫肌瘤剔除术较传统开腹手术具有创伤小、术后恢复快、住院时间短、并发症少等优点,是目前较为理想的治疗子宫肌瘤的方法之一。     

腹腔镜子宫肌瘤剔除术与传统手术的比较

目的 探讨腹腔镜子宫肌瘤剔除术的临床效果.方法 对2007年1月至2009年3月行腹腔镜子宫肌瘤剔除术21例与开腹子宫肌瘤剔除术37例患者的手术时间、术中出血量、术后体温恢复正常时间、术后肛门排气时间、住院日及镇痛剂的使用等情况进行回顾性分析比较.结果 腹腔镜组与开腹手术组在术中出血量、胃肠功能恢复时间、住院时间上比较差异有统计学意义(P<0.05);术后镇痛剂使用腹腔镜组2例(9%),开腹组32例(86%),两组比较差异有统计学意义(P<0.05);手术时间比较差异无统计学意义(P>0.05).结论 腹腔镜子宫肌瘤剔除术较传统开腹手术具有创伤小、术后恢复快、住院时间短、并发症少等优点,是目前较为理想的治疗子宫肌瘤的方法之一.     

腹腔镜与开腹子宫肌瘤剔除术的对比分析

目的评价传统开腹式子宫肌瘤剔除术与腹腔镜下子宫肌瘤剔除术的优缺点。方法回顾分析传统开腹式子宫肌瘤剔除术50例(腹式组)和腹腔镜下子宫肌瘤剔除术30例(腹腔镜组)的临床资料,并对两组患者的手术时间、术中出血量和术后复发率等进行比较。结果腹腔镜组手术时间长于腹式组(P0.01),术中出血量与腹式组比较差异无统计学意义(P0.05),术后住院天数及术后病率均少于腹式组(P0.05),但术后复发率腹腔镜组明显高于腹式组(P0.01)。结论开腹式子宫肌瘤剔除术与腹腔镜下子宫肌瘤剔除术各有优缺点,腹腔镜下子宫肌瘤剔除术具有创伤小、恢复快、住院时间短的优势,而对于体积较大且多发性的子宫肌瘤,传统开腹式子宫肌瘤剔除术是较合适的选择。     

腹腔镜下子宫肌瘤剔除术和传统开腹手术的效果比较

目的 比较腹腔镜下子宫肌瘤剔除术和传统开腹手术的效果.方法 按照手术方案不同将94例子宫肌瘤患者均分为实验组和对照组,实验组患者采用腹腔镜子宫肌瘤剔除术,对照组采用传统开腹子宫肌瘤剔除术,比较两组治疗效果.结果 实验组患者术手术时间、术中出血量、肛门排气时间、住院时间均显著优于对照组,差异具有显著性(P＜0.05);两组患者肌瘤剔除数目及术后肌瘤残留和复发率比较,差异无统计学意义(P＞0.05);实验组患者切口甲级愈合率显著高于对照组,并发症发生率显著低于对照组,差异具有显著性(P＜0.05);实验组患者术后随访24个月妊娠率显著高于对照组,差异具有显著性(P＜0.05);两组肌瘤数目＜4个患者肌瘤残留和复发率均显著低于同组肌瘤数目≥4个者,差异具有显著性(P＜0.05).结论 腹腔镜下子宫肌瘤剔除术肌瘤剔除数目及术后肌瘤残留和复发率与传统开腹手术相近,但围术期情况优于传统开腹手术,临床应用价值更高.     

开腹与腹腔镜下子宫肌瘤剔除术对多发或巨大子宫肌瘤的疗效对比

目的比较分析开腹剔除术与腹腔镜子宫肌瘤剔除术对多发或巨大子宫肌瘤的疗效。方法选择67例多发或巨大子宫肌瘤患者,随机分为2组,开腹组给予开腹子宫肌瘤剔除术治疗,腹腔镜组给予腹腔镜子宫肌瘤剔除术治疗。比较2组患者的机体免疫功能、一般手术指标、术后疼痛程度、近期疗效和术后并发症发生情况。结果 2组患者的免疫球蛋白A和免疫球蛋白M在术后1 d、2 d均无明显改变(P>0.05);2组患者在术后1 d免疫球蛋白G均明显降低(P<0.05),腹腔镜组在术后2 d恢复到术前水平(P>0.05),而开腹组未恢复到术前水平(P<0.05)。腹腔镜组的术中出血量、手术时间、下床时间、排气时间和住院时间均明显低于开腹组(P<0.05);腹腔镜组术后12 h、2 d、3 d的疼痛评分均明显低于开腹组(P<0.05);腹腔镜组和开腹组的症状缓解率、子宫异常率和子宫肌瘤复发率相比,均无明显差异(P>0.05)。腹腔镜组的并发症发生率为5.88%(2/34),明显低于开腹组的18.18%(6/33)(P<0.05)。结论与开腹子宫肌瘤剔除术相比,腹腔镜剔除术对体液免疫和细胞免疫功能的影响较小,对机体的应激反应小,创伤轻微,有助于术后康复。     

子宫肌瘤剔除术合并子宫动脉阻断治疗多发子宫肌瘤的临床疗效观察

目的评价子宫肌瘤剔除术合并子宫动脉阻断术在治疗子宫多发性平滑肌瘤中的临床意义。方法选取65例患者分为观察组和对照组:观察组行腹腔镜下子宫肌瘤剔除术+子宫动脉阻断术,对照组行腹腔镜下子宫肌瘤剔除术。对两组患者术中出血情况、手术时间、术后肌瘤复发率、复发肌瘤数及术后卵巢功能进行比较。结果 两组患者手术时间、术后内分泌功能比较差异无统计学意义(P>0.05),但观察组患者术中出血量、术后复发率及复发肌瘤数显著降低,差异有统计学意义(P<0.05)。结论 与单纯行腹腔镜下子宫肌瘤剔除术比较,多发性子宫肌瘤患者行腹腔镜下肌瘤剔除术合并子宫动脉阻断术可以减少术中出血量,降低术后肌瘤复发率,减少复发肌瘤数,并且对术后卵巢功能无明显影响,是一项安全、有效、经济的手术方式。     

腹腔镜下26例巨大子宫肌瘤剔除术的临床观察

[目的]探讨腹腔镜下巨大子宫肌瘤剔除术的可行性、安全性。[方法]51例要求保留子宫的巨大子宫肌瘤（肌瘤直径7~11cm）患者纳入研究。腹腔镜手术26例,开腹手术25例,并对其临床资料进行分析,评价两组出血量、手术时间、术后肛门排气恢复时间、术后疼痛、术后住院天数。[结果]两组手术均取得成功,无一例发生并发症。腹腔镜组手术时间长于开腹组,腹腔镜组术后2级以上疼痛发生率、肛门排气恢复时间、住院时间均优于开腹组。[结论]腹腔镜下巨大子宫肌瘤剔除术具有微创手术的优点,安全可行。     

微创腹腔镜与传统开腹肝切除术治疗肝癌的近期疗效观察

目的探讨微创腹腔镜与传统开腹肝切除术治疗肝癌的近期效果。方法选取2013年2月至2015年2月间武汉大学人民医院收治的40例肝癌手术患者,采用自愿原则分为研究组与对照组,每组20例。研究组患者采用微创腹腔镜治疗,对照组患者采用传统开腹肝切除术治疗,对比两组患者术中情况、术后恢复情况、手术前后血清指标、1年内生存率和局部复发率及转移率。结果研究组患者手术出血量低于对照组,术后排气时间、下床活动时间、引流管留置时间、进食时间及住院时间均低于对照组,两组比较,差异均有统计学意义(均P<0.05)。研究组患者术后血清白细胞介素-6、降钙素原、人基质金属蛋白酶-13和细胞间黏附分子-1水平均优于对照组,两组比较,差异均有统计学意义(均P<0.05)。2组患者手术时间、1年内生存率、局部复发率及转移率对比,差异均无统计学意义(均P>0.05)。结论微创腹腔镜肝切除术与传统开腹肝切除术后的复发率、转移率与生存率无明显差异,且出血少、恢复快,住院时间短,值得临床推广。     

腹腔镜在子宫肌瘤剔除术中的临床应用价值

[目的]探讨腹腔镜子宫肌瘤剔除术的临床应用价值。[方法]选择腹腔镜下子宫肌瘤剔除术112例患者作为观察组（腔镜组），取同期具有可比性的开腹子宫肌瘤剔除术患者75例为对照组（开腹组），比较两组病人术中、术后情况。[结果]腔镜组平均手术时间比开腹组长（P=0．001），腔镜组术中平均出血量与开腹组相比无明显差异（P=0．261），腔镜组术后使用镇痛剂、肠功能恢复时间、住院天数、恢复生活自理时间、恢复工作时间及术后病率均低于开腹组，差异有统计学意义（P〈0．05）。无严重手术并发症发生。[结论]腹腔镜子宫肌瘤剔除术是一种微创、安全、有效的手术方法，合理选择适应证和熟练掌握镜下缝合技术是保证手术成功的关键。     

超选择子宫动脉栓塞治疗子宫肌瘤的临床研究

目的　研究超选择子宫动脉栓塞治疗子宫肌瘤的临床研究。方法　于 2 0 0 0年 1月～ 2 0 0 1年 6月对 5 6例子宫肌瘤患者进行双侧子宫肌瘤供血动脉的栓塞治疗。结果　插管栓塞成功率 10 0 % ,随访 1～ 6个月。B超随访 1个月肌瘤体积平均缩小 2 5 %。随访 6个月 ,16例肌瘤消失 ,40例肌瘤体积平均缩小 66% ,并均有月经量的明显减少。结论　子宫肌瘤的介入治疗疗效肯定 ,对黏膜下肌瘤尤为适宜。     

CT-Monitored Percutaneous Cryoablation of Uterine Fibroids after Uterine Artery Embolization

OBJECTIVE To investigate the effects of percutaneous cryoablation on uterine fibroids using computed tomographic (CT) guidance after uterine artery embolization. METHODS Twelve patients who failed to respond to uterine artery em- bolization were treated using percutaneous cryoablation. All patients had undergone previous uterine artery embolization an average of 1.2 years (0.7~1.6 years) ago. Two cases had abnormal bleeding, and the other 10 suf- fered from pressure and/or pelvic pain. Myoma diameters were 4 cm to 16.5 cm. By using CT guidance, 2.0, 2.4, 3.0 or 3.8 mm cryoprobes were placed into the fibroid, and two 15~20 min freezing processes were performed. He- mostasis was achieved only by pressing the incisions for several minutes. MR-imaging was performed before the procedure to measure the size and number of fibroid tumors, and follow- up MR-imaging determined the reduc- tion of the lesions. RESULTS All patients were discharged within 48 h of treatment. Almost no hemorrhage was found in all of the cases. No bladder or bowel injury or significant postsurgery pain was reported. Ice spheres were readily visual- ized at CT. Beam-hardening artifact from the metal probes was present, but did not interfere with the procedure. Myomas regressed up to 76.3% after 12 months of treatment, and the primary symptoms improved in all treated women. CONCLUSION CT-monitored percutaneous cryoablation is an effective and minimally invasive therapy for symptom relief and fibroid shrinkage after the failure of uterine artery embolization.     

经导管子宫动脉栓塞术治疗子宫肌瘤的临床应用

目的探讨经导管子宫动脉栓塞术(TUAE)治疗子宫肌瘤的疗效及安全性。方法对69例子宫肌瘤患者采用Seldinger's技术经导管子宫动脉注射碘海醇-真丝线段或聚乙烯醇-抗生素乳剂行TUAE治疗,随访6~24个月,观察术后临床症状改善情况、肌瘤和子宫变化情况。结果行TUAE治疗后,69例患者临床症状缓解,月经量减少至术前的(56.3±14.4)%,合并继发性贫血的子宫肌瘤患者,血红蛋白由术前的(81.2±17.1)g/l恢复至(112.7±15.3)g/l。治疗后6个月、12个月、18个月、24个月肌瘤体积分别缩小62.7%、82.9%、90.6%、94.0%,子宫体积分别缩小53.2%、65.8%、67.9%、69.0%。结论TUAE是治疗子宫肌瘤的一种新方法,疗效显著、安全性好。     

经皮子宫动脉栓塞治疗子宫肌瘤临床应用

目的探讨经皮子宫动脉栓塞治疗子宫肌瘤的方法、疗效及并发症.方法本组56例、平均年龄36岁,年龄范围24～5 1岁,单发41例,多发15例,均行超选择双侧子宫动脉插管,应用PVA栓塞.结果成功率100%.随访4～23个月,B超缩小40%～80%.7例粘膜下肌瘤,经阴道排出部分坏死肌瘤组织并经病理证实.全部患者症状消失或改善.结论子宫肌瘤栓塞治疗子宫肌瘤,创伤小、疗效确切、并发症少,是有效的治疗方法之一.     

Genetics of uterine leiomyomata

Uterine leiomyomata, or fibroids, represent the most common tumor in women of reproductive age. Although benign, leiomyomata constitute a major health problem, and are the most frequent indication for hysterectomy. The pathobiology of these tumors is still poorly understood. Cytogenetic and genetic studies have, in recent years, advanced our understanding of the etiology of these tumors. Specifically, cytogenetic aberrations involving chromosomes 6, 7, 12 and 14 have been shown to constitute the major chromosomal abnormalities seen in leiomyomata and have led to the discovery that HMGIC and HMGIY, two members of the non-histone high mobility group of genes, are involved in fibroid development. HMGIC and HMGIY map to 12q15 and 6p21, and their disruption or dysregulation has been shown to contribute to leiomyomata formation. Given the observation of several additional, but consistent, chromosomal aberrations, it is likely that other genes with fundamental roles in the pathobiology of uterine leiomyomata await identification. Furthermore, twin studies and the discovery of both ethnic and familial predispositions have suggested a genetic liability to develop uterine leiomyomata.     

Treatment of uterine sarcomas

During a 21-year period, 66 patients with uterine sarcomas were treated at California Medical Center. Histological diagnoses were mixed mesodermal sarcoma in 32 patients (48%), leiomyosarcoma in 24 (36%), and endometrial stromal sarcoma in 10 (15%) patients. The majority of patients (73%) had Stage I tumors. The treatment consisted of surgery alone in 27 (41%), surgery in combination with radiation therapy in 36 (55%), and radiation therapy alone in three (4%) patients. The overall 1-, 2-, and 5-year actuarial survival was 74%, 57%, and 38%, respectively. The 1-, 2-, and 5-year actuarial survival for the 27 surgery alone patients was 73%, 50%, and 25%, which compared with 75%, 61%, and 44% for the 36 surgery plus radiation therapy patients (P = 0.12). The disease-free survival was better for the surgery plus radiation therapy patients, as compared with the surgery alone group (38% vs. 18% at 5 years, P = 0.081). The 5-year survival by histology was 70% for the 10 endometrial stromal sarcoma patients, 40% for the 24 leiomyosarcoma patients, and 23% for the 32 mesodermal sarcoma patients (P = 0.064). As expected, survival depended on the stage of disease (P less than 0.0001). Treatment failure was observed in 35 (53%) patients, which included 9 (14%) with failure in the pelvis. There was no difference in the incidence of failure among patients in the three treatment groups and also in the three histologic groups. There was, however, a significant difference in the incidence of pelvic failure between surgery alone and surgery plus radiation therapy patients. In the 27 surgery alone patients, nine (33%) relapsed in the pelvis, whereas none of the 36 surgery plus radiation therapy patients had locoregional failure, P less than 0.0001. Adjuvant radiation therapy is an important treatment in the management of patients with sarcoma of the uterus.     

Lymphoma of uterine cervix

Two patients with malignant lymphoma of the cervix treated with radiotherapy and chemotherapy are reported. Both are alive and disease-free 8 years later. The literature is reviewed to define the role of the different treatment modalities.