腹腔镜下手术治疗直肠阴道隔子宫内膜异位症

目的评价腹腔镜下手术治疗直肠阴道隔子宫内膜异位症的疗效。方法2001年1月～2006年5月,手术治疗直肠阴道隔子宫内膜异位症13例,其中开腹手术5例,腹腔镜手术8例。结果开腹手术时间130～200 min,平均187 min,出血量170～280 ml,平均189 ml,术后痛经完全缓解例数1个月5例、3个月4例、6个月3例、12个月2例;腹腔镜手术时间120～185 min,平均155 min,出血量100～190 ml,平均135 ml,术后痛经完全缓解例数1个月8例、3个月8例、6个月7例、12个月5例。结论腹腔镜或腹腔镜辅助下经阴道手术治疗直肠阴道隔子宫内膜异位症效果满意,安全。     

泌尿系子宫内膜异位症的诊断及治疗(附5例报告)

目的:探讨泌尿系子宫内膜异位症的诊断及治疗。方法:回顾性分析2008年~2013年收治的5例泌尿系子宫内膜异位症患者的临床资料,其中膀胱子宫内膜异位症2例,输尿管子宫内膜异位症3例。结果:5例均行手术治疗。腹腔镜膀胱部分切除术1例,经尿道膀胱肿物电切术1例,输尿管部分切除输尿管膀胱吻合术2例,腹腔镜活检+双侧输尿管双J管置入术1例。患者术后均注射戈舍瑞林治疗6个月。5例患者随访6~40个月,经尿道膀胱肿物电切患者停药6个月后复发,行开放膀胱部分切除术,并同时切除双侧卵巢及子宫后治愈。结论:膀胱部分切除术治疗膀胱子宫内膜异位症效果良好,手术治疗输尿管子宫内膜异位症应该个体化,术后辅助药物治疗可预防复发。     

青春期子宫内膜异位症13例临床分析

目的 探讨青春期子宫内膜异位症（endometriosis,EMT）的特点、诊断和治疗.方法 回顾分析2005年6月～2011年4月手术确诊的13例年龄≤20岁青春期EMT的临床资料.手术方法包括腹腔镜或开腹子宫内膜异位囊肿剔除,4例合并生殖道梗阻性畸形同期行整形手术解除梗阻.7例术后辅助药物治疗.结果 8例腹腔镜手术时间35～125min,平均50.6 min;术中出血10 ～120 ml,平均50.9 ml.4例腹腔镜联合宫腔镜手术时间78 ～245 min,平均129.7 min;术中出血10 ～300 ml,平均115.0 ml.1例开腹手术时间120 min,术中出血150 ml.无生殖道畸形9例行腹腔镜手术8例,开腹手术1例.按照美国生育协会修正的标准分期法（r-ASF）进行分期：Ⅰ期2例,Ⅱ期1例,Ⅲ期7例,Ⅳ期3例.10例随访6～72个月,平均48.6月,1例术后1年复发,9例症状缓解.结论 青春期EMT患者常合并生殖道畸形,主要症状为痛经或下腹痛,确诊依赖手术及病理诊断,手术治疗后根据患者情况选择药物辅助治疗.     

腹腔镜子宫内膜异位症粘连分离的临床体会

目的:探讨腹腔镜手术治疗子宫内膜异位症盆腔粘连的优势。方法:为30例患者行开腹手术,54例患者行腹腔镜手术;明确分期后施术,根据患者年龄、分期、有无合并症及生育要求制定个体化手术方案。结果:开腹组术中出血量平均(136.57±83.24)ml,术后平均住院(7.26±0.82)d,术后排气时间平均(31.35±7.27)h,6例复发,复发率20.00%。腹腔镜组术中出血量平均(57.36±33.73)ml,术后平均住院(4.69±0.77)d,术后排气时间平均(21.22±5.45)h,5例复发,复发率9.26%。结论:腹腔镜手术相对开腹手术,患者创伤小、术中出血少、术后康复快,可作为治疗子宫内膜异位症的首选术式。     

腹腔镜下治疗子宫内膜异位症的临床观察

目的评价腹腔镜手术治疗子宫内膜异位症的临床疗效. 方法回顾性分析1998年1月～2003年1月经腹腔镜治疗的102例子宫内膜异位症的临床资料. 结果所有病例无中转开腹和并发症发生.手术时间(80.5±28.3)min,术中出血量(25.2±23.2) ml,术后住院时间(3.0±1.2) d.83例术后随访6～66个月,21例复发;53例内异症合并不孕症中23例正常妊娠. 结论腹腔镜手术治疗子宫内膜异位症效果明显,但仍有术后复发.     

宫、腹腔镜联合治疗子宫内膜异位症不孕的临床研究

目的:探讨宫腔镜联合腹腔镜手术治疗子宫内膜异位症不孕的临床效果。方法:选取2014年4月至2015年5月收治的86例子宫内膜异位症不孕患者作为研究对象,分为观察组(行宫、腹腔镜联合治疗)与对照组(行腹腔镜手术),每组43例。观察两组患者术中出血量、手术时间、术后住院时间及妊娠情况。结果:两组术中出血量[(69.72±8.59)ml vs.(68.19±8.62)ml]、手术时间[(46.85±6.31)min vs.(45.93±6.29)min]、术后住院时间[(6.97±1.24)d vs.(7.12±1.25)d]差异无统计学意义(P>0.05);观察组术后随访期间总妊娠率为65.12%,显著高于对照组(41.86%),差异有统计学意义(P<0.05)。结论:宫、腹腔镜手术联合治疗子宫内膜异位症不孕安全、有效,可显著提高妊娠率,值得推广应用。     

腹腔镜下骶前神经切断术治疗子宫内膜异位症痛经临床分析

目的探讨腹腔镜下骶前神经切断术治疗子宫内膜异位症痛经的手术方法及临床效果。方法对76例子宫内膜异位症痛经患者施行腹腔镜下骶前神经切断术.回顾性分析患者的临床资料。结果本组76例患者均腹腔镜下成功手术,手术时间75～130 min,术中出血量40～280 mL,术后24 h患者均排气且下床适当活动,未发生严重手术并发症。住院7～12 d后痊愈出院。随访2年,痛经完全缓解64例,部分缓解12例,未见复发患者,无尿频、尿急、便秘及腹泻等发生。结论腹腔镜下骶前神经切断术治疗子宫内膜异位症痛经,效果肯定,值得推广。     

腹腔镜及开腹手术剔除卵巢子宫内膜异位囊肿疗效的比较研究

目的 :比较腹腔镜手术及剖腹手术治疗卵巢子宫内膜异位囊肿的效果。方法 :回顾分析行腹腔镜及开腹手术剔除子宫内膜异位囊肿 332例患者的临床资料 ,包括症状改善情况 ,术后妊娠率及复发率。结果 :腹腔镜组 1 75例 ,平均手术时间 6 2 0 1± 2 0 0 2min ,术后平均住院 3 38± 1 1 6d ;开腹组 1 5 7例 ,平均手术时间 94 73± 2 1 1 0min ;术后平均住院 6 88± 1 30d ,两组差异有高度显著性 (P <0 .0 0 1 )。术后痛经改善率腹腔镜组为 74 8% ,开腹组为 83 1 % ;术后复发率腹腔镜组为 2 8 77% ,开腹组为 34 1 7% ;不孕症患者术后妊娠率腹腔镜组为 5 0 % ,开腹组为 5 4 4 3% ,两组差异无显著性 (P >0 .0 5 ) ,表明两种手术方法治疗子宫内膜异位囊肿的效果相同。结论 :腹腔镜手术剔除卵巢子宫内膜异位囊肿具有与开腹手术相同的疗效 ,且具有微创的特点 ,应作为首选治疗方法     

腹腔镜手术治疗卵巢子宫内膜异位囊肿的疗效观察

目的 :探讨腹腔镜手术治疗卵巢子宫内膜异位囊肿的疗效及可行性。方法 :用腹腔镜手术治疗卵巢子宫内膜异位囊肿 14 0例。结果 :用腹腔镜行囊肿剥除术 118例 ,附件切除术 2 2例。对合并不孕的 90例同时行盆腔粘连分解术及输卵管成形术。不孕组中 5 2例妊娠 ,妊娠率为 5 7 8%。术后 14例子宫内膜异位症复发 ,复发率为 10 %。结论 :应用腹腔镜手术治疗卵巢子宫内膜异位囊肿安全、有效 ,尤其适于不孕症患者。     

卵巢子宫内膜异位囊肿合并不孕33例的腹腔镜手术治疗

目的 探讨腹腔镜手术治疗卵巢子宫内膜异位囊肿合并不孕的临床效果。方法 对33例卵巢子宫内膜异位囊肿合并不孕施行腹腔镜下卵巢子宫内膜异位囊肿剥出术联合盆腔粘连松解术，同时行双侧输卵管通畅度检查，观察其术中术后情况并随访术后受孕率。结果 33例均在腹腔镜下顺利完成手术，无中转开腹，无任何手术并发症。手术时间45min～150min，平均70min，术中出血量10ml～60ml，平均30ml。术后随访3月～42月，复发率9.1%(3/33)，受孕率48.5%(16/33)，术后妊娠中位时间为6个月。结论 腹腔镜手术治疗卵巢子宫内膜异位囊肿合并不孕可达到传统开腹手术治疗的效果，并具有微创手术的优点。     

腹腔镜手术治疗卵巢内异囊肿60例分析

目的:探讨腹腔镜手术治疗卵巢内异囊肿的应用价值。方法:回顾分析腹腔镜手术及开腹手术治疗卵巢内异囊肿的临床资料,分析比较两种术式围手术期症状的改善状况。结果:腹腔镜组平均手术时间、术中出血量、肛门排气时间和术后住院天数均少于开腹组,结果有显著差异(P<0.01),术后痛经症状缓解及复发率两组无显著差异(P>0.05)。结论:腹腔镜应作为卵巢内异囊肿手术的首选之一。     

腹腔镜子宫悬吊术治疗不孕症的临床研究

目的:探讨腹腔镜子宫悬吊术治疗不孕症的临床效果。方法:2001年1月至2002年7月为不孕症合并子宫后倾后屈的10例患者施腹腔镜下子宫悬吊术。结果:1例盆腔正常;9例盆腔粘连(慢性盆腔炎引起7例,手术引起1例,子宫内膜异位引起1例),其中3例子宫后壁与直肠广泛粘连,直肠窝消失;1例盆腔炎症包块;4例子宫内膜异位,其中1例双侧卵巢小巧克力囊肿合并双侧卵巢小畸胎瘤。镜下行盆腔粘连松解,输卵管成形、造口术,内膜异位病灶烧灼、卵巢囊肿剔除、子宫悬吊术。术后腹痛、性交痛、腰酸,肛门坠胀感消失。术后随访1月~1年,3例怀孕。结论:腹腔镜下子宫悬吊术治疗不孕症可完全替代剖腹的子宫悬吊术,减少了患者术后不适,提高了患者的生育功能及生活质量。     

应用腹腔镜诊治不孕症135例疗效分析

目的 :探讨应用腹腔镜手术诊断治疗不孕症的临床价值。方法 :回顾分析 1 35例不孕症腹腔镜手术诊断、治疗和术后的妊娠情况。结果 :1 35例腹腔镜手术均获成功 ,子宫内膜异位症 2 9例 ,术后妊娠率6 9 % ,输卵管伞端闭锁 2 8例 ,术后妊娠率 4 4 5 % ,多囊卵巢综合征 1 7例 ,术后妊娠率 5 3 9% ,盆腔粘连 38例 ,术后妊娠率 5 0 % ,其它 2 3例 ,术后妊娠率 30 4 %。结论 :腹腔镜对各种疾病引起的不孕症均有一定的疗效 ,有效者多在术后 1年内妊娠     

宫腔镜、腹腔镜联合诊治不孕症的价值

目的:探讨宫腔镜、腹腔镜联合诊治不孕症的价值。方法:联合应用宫腔镜、腹腔镜诊治109例不孕症患者。结果:109例患者中盆腔粘连38例(28.4%)、输卵管积水阻塞24例(17.9%)、盆腔子宫内膜异位症20例(14.9%),三者系不孕症的主要病因。82例患者获随访,妊娠率为47.6%。结论:宫腔镜、腹腔镜联合手术可明确不孕症病因,在诊断的同时进行治疗,其创伤小、并发症少、安全有效,具有重要的临床应用价值。     

Successful laparoscopic treatment of ileocecal-appendicular endometriosis

Intestinal endometriosis is an uncommon clinical entity that is rarely seen by general surgeons. It traditionally requires laparoscopy for diagnosis and an open laparotomy procedure for the treatment. Herein, we report a rare case of colonic endometriosis involving the ileocecal region and left adnexal region. The management was totally laparoscopic: an ileocecal resection of the lesions was successfully performed. Endometriosis was not suspected preoperatively; however, it became a differential diagnosis during the operation and then confirmed by the histopathologic examination. We discuss the investigation process, surgical management, and prognosis related to ectopic endometriosis.     

The success of laser laparoscopy in the treatment of endometriosis: a two-step analysis.

BACKGROUND AND OBJECTIVES: The most advantageous treatment for nonextensive endometriosis has long been the subject of debate. In recent years, the ability to detect atypical presentations has allowed the gynecological surgeon to treat this disease more readily. The treatment in the past has only been concerned with the singular treatment being applied at the time, not on the effects that previous treatments have had. The purpose of the current study was to see whether previous unsuccessful treatment modalities affected subsequent laser laparoscopy treatment of endometriosis. METHODS: Patients who were previously treated for their endometriosis (minimal and mild) underwent treatment of their disease by laser laparoscopy and the results were analyzed by chi2 (chi-square) analysis. RESULTS: Those patients previously treated with laser laparoscopy and laparotomy demonstrated poorer results than those previously treated with expectant, medical, or cautery. The sum of the original treatments plus the second treatment of laser laparoscopy was equal in all groups. CONCLUSIONS: If endometriosis is diagnosed at the time of laparoscopy and is easily amenable to treatment, it behooves the physician to treat it at the time of surgery.     

Long-term follow-up of a controlled trial of laser laparoscopy for pelvic pain.

BACKGROUND AND OBJECTIVES: The purpose of this study was to assess the long-term efficacy of laparoscopic laser surgery in the treatment of painful pelvic endometriosis. METHODS: We conducted a long-term follow-up of 56 patients who had participated in a randomized, double-blind controlled study at a tertiary referral center for the laparoscopic treatment of endometriosis. The patients had pelvic pain, minimal-to-moderate endometriosis, and underwent laser laparoscopy. We asked patients whether they had now achieved satisfactory symptom relief or whether they had received any further medical intervention for their endometriosis. The main outcome measure was continued symptom relief after treatment and subsequent medical history. RESULTS: Of the original 56 patients, we were able to contact 38 (67.9%). The mean (range) time since operation was 73 months. Painful symptoms had recurred in 28/38 (73.7%) patients at some point since their operation. The median (range) time for recurrence was 19.7 (5-60) months. At the time of follow-up, satisfactory symptom relief was reported in 21/38 (55.3%) patients. The remaining 17/38 (44.7%) patients continued to experience painful symptoms, and eight eventually had a hysterectomy. CONCLUSIONS: This study suggests that operative laparoscopy can have long-term benefits for the majority of women with pelvic pain due to endometriosis, but because of the small numbers, this study lacks the power to demonstrate this conclusively.     

宫、腹腔镜联合手术诊治不孕症的临床分析

目的:探讨宫、腹腔镜联合手术诊治不孕症的价值。方法:为160例不孕症患者行宫、腹腔镜联合手术,对其病因做出诊断,并予以针对性的治疗。结果:盆腔粘连和输卵管阻塞是不孕症的主要原因,子宫内膜异位症是次要原因,160例患者经宫、腹腔镜联合手术后受孕率达45.5%。结论:宫、腹腔镜联合手术诊治不孕症创伤小、效果好、康复快,可替代开腹手术。     

Multidisciplinary Treatment for Thoracic and Abdominopelvic Endometriosis

Background and Objectives:

Thoracic endometriosis is a rare form of extragenital endometriosis with important clinical ramifications. Up to 80% of women with thoracic endometriosis have concomitant abdominopelvic endometriosis, yet the surgical treatment is usually performed with separate procedures. This is the largest published series of the combination of video-assisted thoracoscopic surgery and traditional laparoscopy for the treatment of abdominopelvic and thoracic endometriosis. The objectives of this series are to further evaluate the manifestations of thoracic endometriosis, assess the multidisciplinary surgical approach, and discuss our institution''s protocols.

Methods:

This is a retrospective, institutional review board–approved case series of 25 consecutive women who underwent combined video-assisted thoracoscopic surgery and traditional laparoscopy for the treatment of abdominopelvic, diaphragmatic, and thoracic endometriosis from January 1, 2008, to September 30, 2013. All surgeries were performed at a tertiary referral center by the same primary surgeons. Data were collected by chart review.

Results:

Twenty-five patients were included, with a mean age of 37.7 years. Eighty percent of patients had catamenial chest pain, and in 40% this was their only chest complaint. Shoulder pain was noted in 40% of patients, catamenial pneumothorax in 24%, and hemoptysis in 12%. One hundred percent of patients were found to have endometriosis in the pelvis, 100% in the diaphragm, 64% in the chest wall, and 40% in the parenchyma. There were 2 major postoperative complications: 1 diaphragmatic hernia and 1 vaginal cuff hematoma.

Conclusion:

Clinical suspicion and preoperative assessment are crucial in the diagnosis of thoracic endometriosis and allow for a multidisciplinary approach. The combination of video-assisted thoracoscopic surgery and traditional laparoscopy for the treatment of endometriosis optimally addresses the pelvis, diaphragm, and thoracic cavity in a single operation.