改良腹腔镜辅助阴式切除巨大子宫临床疗效探究

目的评估改良腹腔镜辅助阴式子宫切除术(LAVH)切除巨大子宫的临床疗效,探讨其价值和意义。 方法回顾性分析180例接受LAVH患者的临床资料,平均年龄(49.4±8.5)岁,分为观察组(子宫体积 ≥ 12孕周)和对照组(子宫体积 < 12孕周),比较两组的一般资料、手术时间、术中出血量、输血率、平均住院时间、并发症发生率、中转开腹率等指标。 结果两组的平均年龄、体质量指数符合正态分布且差异无统计学意义;观察组子宫体积较对照组大[(15.4±3.6)孕周 vs (7.6±2.2)孕周],两组疾病构成亦有区异 (P<0.001);观察组的平均手术时间[(83.9±32.9)min vs(50.6±20.8)min(P<0.001)]、术中出血量[(259.4±122.6)ml vs (150.9±95.1)ml(P<0.001)]和输血率[8例(10.3%)vs 2例(2.0%)(P＝0.016)]均多于对照组,差异有统计学意义;两组手术并发症发生率、平均住院时间和中转开腹率差异无统计学意义。 结论改良LAVH切除巨大子宫是安全、可靠的,尽管观察组术中出血量和手术时间高于对照组,但并不增加手术并发症发生率和平均住院时间,需注意适应证的选择和术者手术技巧的掌握。     

腹腔镜大子宫全切术的临床体会

目的：探讨改良式腹腔镜大子宫全切术的安全性。方法：将2009年1月至2012年7月因妇科良性病变行腹腔镜全子宫切除术的267例患者分为对照组与研究组,对照组（子宫萎小至如孕11周）189例患者行常规术式;研究组（子宫如孕12～22周）78例行改良术式。比较两组患者手术情况、术后恢复、住院时间、并发症及随访情况。结果：研究组2例中转开腹,中转率明显低于对照组（P〈0.05）,术中出血量、术后恢复、住院时间、并发症发生率两组差异无统计学意义（P〉0.05）。结论：改良式腹腔镜大子宫全切术安全可行,术者操作技巧熟练、适应证选择合理、围手术期管理严格,并不增加术后病率,适于临床应用。     

改良子宫腹腔镜辅助阴式全子宫切除术的临床应用

目的:比较常规腹腔镜辅助阴式子宫切除本( LAVH)与改良LAVH在较大子宫切除中的临床效果.方法:收集我院2006年5月～2012年4月接受以上不同术式大子宫切除术326病例的临床资料,其中常规LAVH 157例(对照组),改良LAVH 169例(研究组),比较两组的间隙分离时间、手术时间、术中出血量及排气时间等.结果:研究组与对照组相比,间隙分离时间及手术时间缩短(P＜0.05),出血量减少(P＜0.05),但排气时间接近(P＞0.05).所有手术均在镜下完成,无中转开腹,近期随访均无严重并发症发生.结论:改良LAVH在较大子宫切除方面优于常规LAVH.     

腹腔镜全子宫切除两种术式的临床比较

目的比较腹腔镜辅助阴式子宫切除术(laparoscopic-assisted vaginal hysterectomy,LAVH)及全腹腔镜子宫切除术(total laparoscopic hysterectomy,TLH)的临床价值. 方法 2004年1月～2006年8月,因子宫良性疾病行LAVH 128例和TLH 42例,从手术时间、术中出血量、术后住院时间、术后并发症发生率等方面进行对比分析. 结果所有病例均在镜下完成,无一例中转开腹.2组肛门恢复排气时间、术后住院时间、术后并发症发生率差异均无显著性(P＞0.05).手术时间LAVH组短于TLH组[(95.6±18.2)min对(112.9±24.5)min,t=-4.883, P=0.000],但术中出血量以LAVH组为多[(73.8±50.8)ml对(49.8±26.9)ml, t=2.926, P=0.004]. 结论应用腹腔镜行全子宫切除是安全可行的,LAVH和TLH各有优势,但对经验丰富的术者而言,TLH更为合适.     

腹腔镜辅助阴式子宫切除术86例临床分析

目的 探讨腹腔镜辅助阴式子宫全切术(LAVH)的临床应用价值.方法 收集子宫良性病变269例,其中LAVH 86例,开腹子宫全切术(TAH)183例,对比2组手术时间、术中出血量、术后恢复情况、术后并发症及平均住院时间.结果 与TAH相比,LAVH术后病率、肛门排气时间、住院时间、术后疼痛情况均明显低于TAH(P<0....     

腹腔镜阴式与开腹全子宫切除术治疗子宫良性疾病效果观察

目的比较腹腔镜辅助阴式子宫全切除术与开腹子宫切除术治疗子宫良性疾病的效果。方法随机将在许昌市人民医院接受择期子宫切除术的84例子宫良性疾病患者分为2组,各42例。开腹组行开腹手术,腹腔镜组行腹腔镜辅助阴式手术。比较2组的疗效。结果腹腔镜组手术时间长于开腹组,差异有统计学意义(P0.05)。腹腔镜组术中出血量、术后止痛药使用率、并发症发生率、术后肠道功能恢复时间、下床活动时间、住院时间均优于开腹组,差异均有统计学意义(P0.05)。结论腹腔镜辅助阴式子宫切除术治疗子宫良性疾病,创伤小、并发症发生率低、患者术后恢复快。     

腹腔镜辅助阴式子宫切除术38例分析

目的 :通过对 38例患者行腹腔镜辅助阴式子宫切除术 (LAVH)后分析LAVH的适应证、手术要点和并发症的预防。方法 :38例因各种妇科良性疾病需行子宫全切除术的患者 ,采用LAVH术式。患者平均年龄 5 3岁 (36～ 6 5岁 ) ,术前子宫正常大小者 2例 ,子宫增大≤ 12孕周者 2 3例 ,>12孕周 13例。有下腹部手术史 4例。结果 :38例LAVH中有 37例顺利完成 ,1例因膀胱损伤行开腹膀胱修补术。平均手术时间 112(6 8～ 2 2 0 )min ,术中出血量 110 (4 0～ 2 30 )ml。平均住院 4d。结论 :LAVH拓宽了阴式子宫切除的适应证 ,可避免开腹 ,减少手术创伤     

腹腔镜辅助阴式全子宫切除术112报告

目的:探讨腹腔镜辅助阴式全子宫切除术(laparoscopiclly assisted vaginal hysterectomy,LAVH)的临床疗效及安全性。方法:回顾分析为112例有子宫切除指征的患者行LAVH的临床资料,术后应用抗生素规范治疗。观察术中、术后患者一般情况、手术时间、出血量、住院时间、并发症及术后随访等。结果:112例均顺利完成手术,无一例中转开腹,术后患者临床症状完全消失。6例术后阴道残端出血,经再缝扎宫颈残端后治愈;无一例发生术后腹壁切口感染、泌尿系感染、膀胱及直肠破裂、尿路刺激症状、尿潴留、术后阴道膀胱瘘等并发症。远期随访效果均满意。结论:LAVH治疗妇科良性疾病临床疗效显著,安全性高,是目前较理想的治疗方法,值得推广应用。     

两种腹腔镜子宫切除术式探讨

目的:探讨腹腔镜子宫切除的临床应用价值。方法:收集我院腹腔镜筋膜内子宫切除术(C ISH组)96例和腹腔镜辅助下阴式子宫切除术(LAVH组)45例患者的临床资料,就术式的选择、并发症和中转开腹的原因进行回顾性分析。结果:C ISH组手术成功率88.5%,11例中转开腹者既往有盆腹腔手术史8例,并发症发生率16.5%,多发生于开展腹腔镜初期。LAVH组手术成功率95.6%,6例有盆腹腔手术史,均非子宫手术,无1例发生并发症。结论:腹腔镜子宫切除术具有微创、效优的特点,值得临床推广。根据不同的病情选择合适的手术方式是减少并发症,提高手术安全性的关键。     

腹腔镜辅助与阴式大子宫切除的比较性研究

目的 探讨腹腔镜辅助阴式大子宫切除的临床应用价值. 方法 2005年1月～2007年3月,我院行大子宫（子宫如孕10～18周）切除94例,其中腹腔镜辅助阴式全子宫切除（laparoscopic-assisted vaginal hysterectomy,LAVH）56例,阴式子宫切除术（vaginal hysterectomy,VH）38例,比较两种方式手术时间、出血量、术后住院天数、并发症的发生率. 结果与VH组相比,LAVH组中转开腹率低（0/56 vs 5/38, χ^2=5.389,P=0.020）,手术时间短[（149±11） min vs （179±14） min,t=-11.610,P=0.000],术后住院时间短[（5.8±1.4）d vs （7.3±3.6） d,t=-2.825,P=0.006].两组术中出血量、术后病率、术后排气时间差异无显著性（P＞0.05）. 结论 LAVH扩大VH的适应证,使大于孕10周子宫切除能在微创手术下顺利完成,是值得推广的手术方法.     

子宫动脉栓塞术治疗子宫肌瘤的相关进展

子宫肌瘤是育龄期女性最常见的良性肿瘤。其治疗方式有药物治疗、手术治疗和微创治疗等。随着社会的发展,患者对器官完整性的要求越来越高。子宫动脉栓塞(uterine a rtery embolization,UAE)术不仅可以保留子宫,而且具有操作简便、创伤小、病人易耐受、手术效果佳以及住院时间短等优点,临床上有着较广泛的应用前景。本文就UAE术治疗子宫肌瘤的相关进展进行讨论。     

Recurrent uterine rupture after hysterescopic resection of the uterine septum

INTRODUCTIONUterine rupture after hysteroscopic septum resection is a rare complication, and its frequency is reported to be approximately 1–2.7%. Uterine perforation and monopolar resection during hysteroscopy are well-known risk factors for subsequent uterine rupture during pregnancy.PRESENTATION OF CASEWe present a case of recurrent uterine ruptures during consecutive pregnancies in a patient who had undergone hysteroscopic septum resection for recurrent pregnancy loss.DISCUSSIONRecurrent uterine rupture due to hysteroscopic septum resection in pregnancy is a very rare condition. In the present case we noted that the first two uterine ruptures resulted from uterine contractions; however, the third rupture occurred spontaneously and earlier in gestation. As each uterine rupture occurred earlier than the rupture in the previous gestation, a history of uterine rupture during pregnancy should raise provider suspicion about the possibility of earlier uterine rupture recurrence.CONCLUSIONUterine rupture may occur in pregnancies after hysteroscopic resection of the uterine septum. However, if a patient has a history of uterine rupture during previous pregnancies, the risk of uterine rupture may increase for earlier gestational ages in subsequent pregnancies. The patient must be informed about both the risks of uterine rupture during pregnancy after hysteroscopic septum resection and that recurrent ruptures may occur at earlier gestational weeks than during previous pregnancies.     

子宫动脉栓塞治疗术治疗子宫肌瘤的临床应用

目的探讨子宫动脉栓塞治疗术(UAE)治疗子宫肌瘤的临床应用。方法对46例子宫肌瘤患者进行子宫动脉栓塞治疗,观察术后反应和症状变化,术后3、6、12个月进行随访分析疗效。结果造影显示双侧子宫动脉供血17例(占37%),一侧供血为主24例(占52%),单纯一侧供血5例(占11%)。肿瘤平均缩小率:3个月34%,6个月48%,12个月56%,其中5例肌瘤消失。46例患者临床症状均有不同程度改善,无严重并发症。结论子宫动脉栓塞术治疗子宫肌瘤是一种安全有效的微创治疗方法。     

Tuberculosis of uterine cervix

Tuberculosis of the cervix uteri is generally considered to be an unusual condition but is probably more common than suspected.     

Management of uterine hemorrhages

One hundred and three cases of uterine hemorrhages have been analyzed as to causation and treatment.A proper understanding of the symptom of uterine hemorrhage is essential in the handling of many gynecological disorders.The rare and less frequent causes of bleeding have not been included in this study because I have had no experience with them.The measures used in treating these cases have been presented, and they have been satisfactory in my hands.     

Pelvic organ prolapse after uterine artery embolization for uterine myoma

Uterine artery embolization (UAE) is gaining popularity as a treatment modality in patients with symptomatic uterine fibroids who do not desire fertility. Complications of this procedure can be serious and disabling. A 50-year-old woman presented with stage II uterovaginal prolapse after UAE for symptomatic uterine fibroids. Pelvic organ prolapse developed 16 months after the initial procedure. Surgical correction was performed. This is the first case report of pelvic organ prolapse after UAE. Normal prior gynecological examinations, and absence of pelvic pressure symptoms, indicate that pelvic organ prolapse had occurred subsequent to UAE.