腹腔镜手术治疗卵巢囊肿42例临床分析

目的探讨腹腔镜下手术治疗卵巢囊肿的要点及临床使用价值.方法对腹腔镜手术治疗妇科常见卵巢囊肿42 例进行回顾性分析.结果 42例手术均顺利完成,无术中术后并发症.结论腹腔镜手术具有损伤小、疼痛轻、恢复快等优点,是目前妇科治疗卵巢囊肿的较好手术方式.     

腹腔镜手术诊治卵巢囊肿32例

1　资料与方法1.1　临床资料　我院于 1997年 7月—2 0 0 1年 2月行电视腹腔镜诊治卵巢囊肿 32例。年龄 2 1岁～ 48岁 ,平均年龄31岁。临床表现 :无症状经妇检及 B超发现患者 12例 ;痛经者 6例 ;月经紊乱或不规则阴道流血者 4例 ;单纯下腹疼痛者 6例 ;下腹痛伴阴道流血者 2例 ;不孕症 2例。术前 B超 :示单纯性液性包块14例 ,液性包块内有光点及光团 10例 ,混合性包块 8例。包块直径 4.5 cm～ 8cm大小 ,单侧者 2 8例 ,双侧者 4例。1.2　手术方法1.2 .1　麻醉方法 :采用持续硬膜外麻醉 ,于脐下横行切开皮肤 1cm ,放置气腹针 ,形成人工气腹 ,…     

腹腔镜卵巢囊肿剔除术中不同止血方式对卵巢功能的影响

目的比较腹腔镜卵巢囊肿剔除术中不同止血方式对卵巢功能的影响。方法 106例卵巢囊肿患者根据腹腔镜卵巢囊肿剔除术中止血方式分为缝合组(n=56)和电凝组(n=50),术后进行6个月的随访,观察两组患者月经和排卵情况及激素水平,并行彩超检查患者卵巢间质动脉血流收缩期峰值流速(PSV)、窦卵泡数及卵巢大小。结果缝合组患者恢复排卵的比例为82.1%,明显高于对照组的64.0%,差异有统计学意义(P<0.05)。术后6个月,缝合组患者血清促卵泡成熟激素(FSH)、促黄体生成素(LH)、雌二醇(E2)水平与术前比较,差异无统计学意义(P>0.05);但电凝组术后6个月的FSH及LH水平明显高于术前,E2明显低于术前,与缝合组差异均有统计学意义(P<0.05)。电凝组患者窦卵泡数较术前明显减少,且明显低于缝合组,差异有统计学意义(P<0.05)。结论腹腔镜卵巢囊肿剔除术中采用缝合止血比电凝止血法更有利于保护患者的卵巢功能。     

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.     

手术难度评分系统对腹腔镜下子宫肌瘤剔除术后结局的预测价值

目的 分析手术难度评分系统(DDI)对腹腔镜下子宫肌瘤剔除术后结局的预测价值。方法 选取腹腔镜下行子宫肌瘤剔除术的患者100例为研究对象,按照DDI评分将患者分为A组(DDI评分≤4分,47例)、B组(DDI评分为5～7分,43例)、C组(DDI评分≥8分,10例)。比较三组手术时长、术中出血量、术后肛门排气时间、术后血红蛋白下降值,并统计三组并发症发生情况。结果 B、C组手术时长、术中出血量、术后肛门排气时间、术后血红蛋白下降值均显著高于A组(P<0.05),C组上述指标均显著高于B组(P<0.05)。A组并发症总发生率为6.38%,显著低于B、C组的23.26%、40.00%(P<0.05);B组并发症总发生率为23.26%,显著低于C组的40.00%(P<0.05)。结论 DDI评分系统对腹腔镜下子宫肌瘤剔除术后结局具有指导意义。当DDI评分较高时,应适当降低手术难度,以缩短手术时间,改善患者术中情况,减少并发症的发生。     

加速康复外科理念在腹腔镜下子宫肌瘤剔除术患者围手术期的应用

目的探讨加速康复外科理念对腹腔镜下子宫肌瘤剔除术患者围手术期的效果。方法选取2014年5月至2016年5月间湖北省咸丰县人民医院收治的80例腹腔镜下子宫肌瘤剔除术患者,依据治疗方法分为加速康复外科理念治疗组(简称FTS理念治疗组)和传统治疗组,每组40例。对两组患者临床疗效、术后并发症发生情况、手术时间、术中出血量、术后排气时间、住院时间及治疗费用进行比较分析。结果 FTS理念治疗组患者的痊愈率为90.0%,高于传统治疗组患者的70.0%,FTS理念治疗组患者的术后并发症发生率为5.0%,低于传统治疗组的20.0%,两组组间比较,差异均有统计学意义(均P<0.05)。FTS理念治疗组患者的术后排气时间(13.6±3.8)h和住院时间(4.2±0.5)d,均短于传统治疗组的(17.7±3.9)h和(5.6±0.8)d。FTS理念治疗组患者的治疗费用(6751.9±179.8)元,低于传统治疗组的(7439.1±285.8)元,两组组间比较,差异均有统计学意义(均P<0.05)。结论加速康复外科理念治疗腹腔镜下子宫肌瘤剔除术患者围手术期有较高的治疗效果,患者住院时间短,治疗费用较少,值得临床推广应用。     

腹腔镜下子宫肌瘤剔除术疗效分析

子宫肌瘤是女性生殖系统常见良性肿瘤,子宫肌瘤较大时通常采用手术切除的方法,但是以往的手术方式损伤较大,且大多会影响患者的生育功能,而目前常用的非手术治疗手段不能根治子宫肌瘤,复发率较高[1]。因此,创伤小、切除彻底的微创手术成为了研究的热点。作者分析商丘市第一人民医院2007年至     

腹腔镜下子宫肌瘤剔除术中转开腹89例

 目的　探讨腹腔镜下子宫肌瘤剔除术中转开腹的相关因素。方法　分析89例腹腔镜下子宫肌瘤剔除术中转开腹患者的临床资料。结果　中转开腹的89例中,29例因盆腔致密粘连、24例因术中止血困难、3例术中发现子宫恶性病变、5例术中发生脏器损伤、5例为子宫腺肌瘤、2例为腹茧症、2例为复发性子宫肌瘤。16例多发性子宫肌瘤中6例为5个以上的子宫肌瘤、10例为5个以下的肌瘤,共有5例巨大子宫肌瘤,其中2例直径>10 cm,3例直径＜10 cm。结论　腹腔镜下子宫肌瘤剔除术中转开腹的主要原因为盆腔粘连和术中止血困难;术前应当加强对患者的评估,选择合适患者;对于多发性子宫肌瘤（≥5个）特殊部位或巨大子宫肌瘤,腹腔镜下子宫肌瘤剔除术并非首选;适时主动中转开腹是减少和避免并发症的有效措施。     

术前给予醋酸亮丙瑞林对子宫肌瘤腹腔镜剔除术手术效果研究

目的:研究术前给予醋酸亮丙瑞林对子宫肌瘤腹腔镜剔除术手术效果影响。方法:研究对象选取我院2012年10月到2017年10月间行子宫肌瘤腹腔镜剔除术患者120例,采用随机数字法将其分为对照组和观察组,每组各60例。对照组患者仅行子宫肌瘤腹腔镜剔除术治疗,观察组患者子宫肌瘤腹腔镜剔除术前,皮下注射醋酸亮丙瑞林预处理。比较两组患者的手术和术后效果指标,同时比较观察组患者治疗前后的血清黄体生成素、卵泡刺激素、雌二醇水平和月经量、子宫体积、肌瘤体积等。结果:观察组患者的术中出血量、盆腔引流量、首次下床活动时间、住院时间均明显低于对照组(P<0.01),观察组患者治疗后的血清黄体生成素、卵泡刺激素、雌二醇水平均明显低于治疗前(P<0.01),月经量、子宫体积、肌瘤体积均明显低于治疗前(P<0.01)。结论:子宫肌瘤腹腔镜剔除术术前给予醋酸亮丙瑞林治疗,能够有效调节患者激素水平和月经量,缩小子宫肌瘤体积,提高术前准备质量,有助于患者手术开展和术后恢复,值得在临床推广。     

腹腔镜下卵巢畸胎瘤剔除术80例

目的分析腹腔镜下卵巢良性畸胎瘤剔除术的效果。方法对80例卵巢良性畸胎瘤患者进行腹腔镜手术,以同期20例采用开腹手术的卵巢良性畸胎瘤患者为对照组,就其手术时间、出血量、术后镇痛率、肛门排气时间、术后病率及囊肿破裂率、复发率进行回顾性分析。结果2种手术方法平均手术时间、术中出血量相仿,腹腔镜手术组平均肛门排气时间及术后住院时间明显早于对照组,腹腔镜手术组患者术后病率及术后住院时间明显少于对照组,术中囊肿破裂及术后复发率机会无明显增加。结论腹臃镜下卵巢良性畸胎瘤手术具有损伤小、恢复快、并发症少等优点。     

抑那通对腹腔镜术后巧克力囊肿的辅助治疗作用

目的 探讨抑那通联合腹腔镜术治疗卵巢巧克力囊肿的疗效。方法 将76例巧克力囊肿患者分为研究组（50例，腹腔镜术后加用抑那通）和对照组（26例，仅行腹腔镜手术），分析其术后复发率和妊娠率。结果 腹腔镜联合抑那通治疗组的术后复发率明显低于单纯腹腔镜手术组（P〈0．01）。合并不孕的48例巧克力囊肿患者中，腹腔镜联合抑那通治疗组的术后妊娠率高于单纯手术组（P〈0．05）。结论 抑那通联合腹腔镜术治疗卵巢巧克力囊肿，复发率低，受孕率高，取得满意的疗效。     

腹腔镜手术治疗卵巢成熟型畸胎瘤的临床分析

目的探讨腹腔镜手术(LS)治疗卵巢成熟型畸胎瘤(MOCT)的临床疗效。方法2011年9月至2013年4月确诊的MOCT患者86例,分为LS组和开腹手术(OS)组,各43例。比较两组术中失血量、手术时间、术后住院时间、总费用、肛门排气时间、抗生素应用时间、止痛药应用情况和禁食时间,以及术后患者的月经和复发情况。结果 LS组患者的失血量、术后住院时间、肛门排气时间、抗生素应用时间、止痛药应用例数及禁食时间均明显少于OS组,两组手术时间无显著差异,LS组总费用明显高于OS组。随访结果显示,LS组月经异常3例,下腹痛5例,而OS组分别为9例和13例,差异有统计学意义(P<0.05)。结论 LS治疗MOCT,住院时间短,出血量更少,且疗效显著,值得进一步推广。     

妊娠合并卵巢囊肿患者手术治疗期间护理和疗效的相关性分析

目的探讨妊娠合并卵巢囊肿患者综合护理管理的疗效。方法回顾性分析2011年1月至2013年1月收治的80例妊娠合并卵巢囊肿患者在常规护理基础上应用综合护理措施的效果。结果 80例患者手术顺利,切口愈合良好,无并发症及孕妇死亡发生,无一例发生流产及死胎,治愈率为100%。平均住院时间为（5.07±0.65）d。出院时焦虑自评量表（SAS）和抑郁自评量表（SDS）分别为（43.85±4.37）分和（36.26±4.93）分,入院时分别为（55.41±4.90）分和（57.33±5.06）分,出院时患者SAS和SDS评分分值均低于入院时,差异有统计学意义（P〈0.05）。出院时护理服务很满意为85.0%（68/80）,高于入院时的48.8%（39/80,P〈0.05）。对疾病的治疗信心出院时为86.3%（69/80）,高于入院时的7.50%（6/80,P〈0.05）。结论精心的围手术期护理是减少并发症发生的关键,对减轻患者痛苦,保证母婴健康有着积极的意义。     

综合评分诊断卵巢子宫内膜异位囊肿的临床研究

目的 探讨卵巢子宫内膜异位囊肿(巧克力囊肿)临床诊断标准.方法 对218例因附件包块住院治疗的患者,进行临床症状、体征、超声、血清CA125四项指标分析,通过临床综合评分进行诊断及分期(轻、中、重三型)再行腹腔镜手术并与术中诊断及分期相比较.其中经腹腔镜诊治及病理确诊为卵巢子宫内膜异位囊肿172例,经腹腔镜手术治疗的卵巢良性肿瘤及输卵管积液共46例.结果 临床评分法诊断卵巢子宫内膜异位囊肿,诊断敏感性96.4%;特异性79.6%;阳性预测值93.0%;阴性预测值90.0%,诊断符合率91.7%,诊断指数73.4%.与对照组比较差异有统计学意义(χ2=127.818,P＜0.001).临床综合评分法诊断卵巢子宫内膜异位囊肿分期的符合率,轻型与Ⅰ～Ⅱ期诊断符合率95.6%;中型与Ⅲ期诊断符合率95.6%;重型与Ⅳ期诊断符合率83.0%.轻型、中型间诊断符合率比较差异无统计学意义(χ2=0,P＞0.05);轻型、中型和重型间诊断符合率比较差异有统计学意义(χ2=4.472,P＜0.05).结论 临床综合评分法可试用于临床对卵巢子宫内膜异位囊肿的诊断及分期.     

Causes of postoperative mortality after surgery for ovarian cancer

Residual disease after cytoreductive surgery is an important prognostic factor in patients with advanced stage epithelial ovarian cancer (EOC). Aggressive surgical procedures necessary to achieve maximal cytoreduction are inevitably associated with postoperative morbidity and mortality.To determine causes of postoperative mortality (POM) after surgery for EOC all postoperative deaths in the southwestern part of the Netherlands over a 17-year period were identified and analysed by reviewing medical notes.Between 1989 and 2005, 2434 patients underwent cytoreductive surgery for EOC. Sixty-seven patients (3.1%) died within 30 days after surgery. Postoperative mortality increased with age from 1.5% (26/1765) for the age group 20–69 to 6.6% (32/486) for the age group 70–79 and 9.8% (18/183) for patients aged 80 years or older. Pulmonary failure (18%) and surgical site infection (15%) were the most common causes of death. Only a quarter of deaths resulted from surgical site complications.Our results suggest that causes of postoperative mortality after surgery for EOC are very heterogeneous. Given the impact of general complications, progress in preoperative risk assessment, preoperative preparation and postoperative care seem essential to reduce the occurrence of fatal complications.     

单孔腹腔镜行囊肿剔除术治疗卵巢巨大囊肿的临床分析

目的:探讨应用单孔腹腔镜行囊肿剔除术治疗卵巢巨大囊肿的安全性及可行性。方法:回顾性分析我院2017年6月至2018 年6月收治的卵巢巨大囊肿患者71例（直径≥12 cm）,按手术途径分为研究组34例（应用单孔腹腔镜行囊肿剔除术）和对照组37例（应用传统腹腔镜行囊肿剔除术）。比较两组患者手术时间、术中出血量、术中囊液外漏率、术后24 h疼痛评分、术后排气时间、首次离床时间、术后并发症发生率、术后住院时间及住院费用等临床指标。结果:研究组和对照组患者术中囊液外漏率分别为2.9%和18.9%;在巧囊组患者中,手术时间及术中出血量两组比较差异无统计学意义;在非巧囊组患者中,研究组手术时间及术中出血量较对照组明显减少,差异有统计学意义（P＜0.05）;两组患者均无并发症发生;研究组术后排气时间、首次离床时间明显早于对照组,且术后24 h疼痛评分低,术后住院时间短,住院费用低,差异有统计学意义（P＜0.05）。结论:在严格选择病例的前提条件下,单孔腹腔镜治疗卵巢巨大囊肿能减少囊液外漏率,减轻患者术后疼痛,促进肠道功能恢复,缩短住院时间,不增加并发症发生率及住院费用,是安全有效的。     

复发性卵巢上皮癌二次细胞减灭术的临床意义

目的 探讨复发性卵巢上皮癌二次细胞减灭术（SCR）的作用及其影响因素。方法 60例晚期卵巢上皮癌因肿瘤复发行SCR治疗。采用Cox逐步回归分析预后的影响因素;采用Logistic回归分析影响SCR的危险因素。结果 SCR术后残癌≤1cm组与＞1cm组的中位生存期分别为19个月和8个月,差异有显著性（P＝0.0000)。缓解期＞12个月与≤12个月者,再手术后中位生存期分别为12个月和8个月,差异有显著性（P＝0.0224)。肿瘤复发伴有腹水是预后的影响因素,同时也是影响SCR的主要危险因素。复发伴腹水者,SCR切净的可能减少了20．36倍。第1次手术后残癌＞1cm是影响SCR的危险因素（RR＝5．16）。本组手术死亡率1．7％,术后并发症发生率8．3％。结论 在有效二线化疗的配合下,SCR对首次行满意细胞减灭术、缓解期达12个月以上、无腹水的复发性卵巢上皮癌患者有肯定的临床疗效。     

Present laparoscopic surgery for colorectal cancer in Japan

In many clinical studies, laparoscopic surgery (LS) for colon cancer has been shown to be less invasive than open surgery (OS) while maintaining similar safety. Furthermore, there are no significant differences between LS and OS in long-term outcomes. Thus, LS has been accepted as one of the standard treatments for colon cancer. In the treatments of rectal cancer as well, LS has achieved favorable outcomes, with many reports showing long-term outcomes comparable to those of OS. Furthermore, the magnification in laparoscopy improves visualization in the pelvic cavity and facilitates precise manipulation, as well as providing excellent educational effects. For these reasons, rectal cancer has seemed to be well indicated for LS, as has been colon cancer. The indication for LS in the treatment of locally advanced rectal cancer, which is relatively unresectable (e.g., cancer invading other organs), remains an open issue. In recent years, new techniques such as single-port and robotic surgery have begun to be introduced for LS. Presently, various clinical studies in our country as well as in most Western countries have demonstrated that LS, with these new techniques, are gradually showing long-term outcomes.     

Conservative surgery for malignant ovarian tumor in women of childbearing age

Background. The traditional operative procedures for the treatment of ovarian cancer have been simple total hysterectomy, bilateral salpingo-oophorectomy, and omentectomy. However, young patients who want to preserve fertility are occasionally encountered. This study was designed to assess the results of conservative surgical management for young women with stage I epithelial ovarian carcinoma or malignant germ cell tumor and to explore the indications for such surgical treatment. Methods. Fifty-eight patients aged under 35 years were treated for malignant ovarian tumors (germ cell tumor, n = 20; epithelial tumors, n = 38) between 1971 and 1996. We studied all 20 patients with germ cell tumors and 22 pa-tients with stage I epithelial tumors; we excluded the 12 patients with stage II and more advanced disease and the 4 patients with stage I clear cell carcinoma, because these patients had poor prognoses. Eleven of the 22 patients with stage I epithelial tumors and 8 of the 20 patients with germ cell tumors received conservative surgery (conservative surgery group); the remaining 23 patients underwent radical surgery, including hysterectomy and bilateral salpingo-oophorectomy (radical surgery group). The overall survival rates of the two groups were compared, and ovarian function and pregnancy outcome were evaluated in the conservative surgery group. Results. Of the patients with malignant epithelial tumor who were treated with conservative surgery, 3 patients with stage Ic mucinous adenocarcinoma died 1 year and 8 months, 7 years and 6 months, and 8 years, respectively, after the initial surgery. The 10-year survival rate was 65% for the conservative surgery group and 91% for the radical surgery group. All patients with stage Ia epithelial tumors in both groups survived, and there were no differences in survival curves between the two groups among the patients with stage Ic epithelial tumors. All patients with germ cell tumors in the conservative surgery group survived. Their survival rate, however, was not significantly better than that in the radical surgery group. All patients with germ cell tumors who received platinum-based chemotherapy survived and had a significantly better survival rate than those who received non-platinum-based regimens (P < 0.05). All the patients in the conservative surgery group received postoperative chemotherapy; 10 of these patients had transient ovulation failure after the completion of chemotherapy, although a normal menstrual cycle was restored within 1 year. Of the 10 patients who wished to have babies, 6 became pregnant, and they have had a total of 11 children. Conclusion. Conservative surgery is feasible in patients with stage Ia epithelial carcinoma and germ cell tumor. Postoperative chemotherapy suppressed ovarian function in these patients, but only for a brief period. Received: January 5, 1999 / Accepted: October 27, 1999