全子宫切除术四种术式临床效果对比分析

目的探讨全子宫切除术的最佳术式。方法对362例患者行全子宫切除术,其中行改良经腹全子宫切除术102例（TAH组）、新式经阴全子宫切除术86例（TVH组）、腹腔镜辅助下阴式全子宫切除术98例（LAVH组）、腹腔镜下全子宫切除术76例（LTH组）,比较四组手术效果。结果 TVH组、TAH组手术时间、术中出血量均明显少于另两组（P均〈0.05）;TAH组术后镇痛率明显高于其他三组（P均〈0.01）;术后排气时间、住院时间均明显长于其他三组（P均〈0.05）;LAVH、LTH组住院费用明显高于另两组（P均〈0.05）。结论临床应根据患者的个体情况、术者经验及设备条件合理选择术式,尽量选择微创术式。一般情况下TVH为首选。     

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。     

四种子宫切除术的疗效比较

目的对比全腹腔镜下子宫切除（TLH）、经腹全子宫切除（TAH）、经阴道子宫切除（TVH）及腹腔镜辅助阴式子宫切除（LAVH）4种术式（分别为TLH、TAH、TVH、LAVH组）的临床效果。方法回顾性分析252例采用4种术式切除子宫的手术情况及术后患者恢复情况。结果手术时间：TAH组短于,TVH、LAVH组（P〈0．01）,TVH组长于TLH、LAVH组（P〈0．05、0．01）,TLH组短于LAVH组（P〈0．01）。术中出血量：TAH组多于其他3组（P均〈0．01）;TLH组少于LAVH、TVH组（P均〈0．05）。术后患者排气时间：TAH组长于其他3组（P均〈0．01）。术后体温：TAH组最高（P〈0．01）。术后住院时间：TAH组长于其他3组（P均〈0．01）。结论4种术式各有利弊,应根据患者的具体情况,术者的技术水平,选择适宜术式。对经验丰富的术者而言,TLH更为合适。     

改良腹腔镜辅助阴式全子宫切除联合应用垂体后叶素临床观察

目的探讨改良腹腔镜辅助阴式子宫切除术行大子宫切除(1aparoseope assisted vaginalhysterectomy,LAVH)的临床效果。方法收集2007年9月至2012年3月在我院行子宫切除术的子宫腺肌病或子宫肌瘤(子宫均≥12孕周)患者254例的临床资料,其中传统腹腔镜辅助阴式子宫切除术(LAVH)127例(对照组),改良LAVH 127例(研究组),比较两组术中术后情况及术后疼痛、并发症。结果两组手术均顺利完成,均无严重并发症发生。研究组与对照组比较,术中出血量明显减少(P<0.05),肛门排气时间短(P<0.05)。研究组术后无痛率明显高于、剧烈疼痛率明显低于对照组(P<0.01)。结论改良LAVH作为一种大子宫切除术式,有效、微创、安全、术后恢复快。     

阴式及腹腔镜辅助阴式子宫切除术临床效果观察

目的观察阴式子宫切除术（TVH）与腹腔镜辅助阴式子宫切除术（LAVH）的临床效果。方法TVH患者93例（TVH组）、LAVH患者64例（LAVH组）,比较两组手术时间、出血量、术后排气及住院时间、并发症及直肠膀胱功能状况、有无腰腹痛。结果TVH组手术时间、术后排气时间均较LAVH组短（P〈0.05）;LAVH组并发阴道残端出血及膀胱损伤各1例,TVH组并发阴道残端出血1例。结论TVH、LAVH临床效果相近,与LAVH相比,TVH手术时间短、术后恢复快,LAVH适用于盆腔粘连较重的患者。     

腹腔镜辅助阴式全子宫切除术在巨大子宫肌瘤中的应用

目的分析腹腔镜辅助阴式全子宫切除术在巨大子宫肌瘤中的应用价值。方法回顾性分析,选择2014年1月—2018年1月,湖北省天门市妇幼保健院巨大子宫肌瘤全子宫切除术患者入组,腹腔镜辅助阴式全子宫切除术(LAVH)32例入选LAVH组,腹腔镜全子宫切除术(LTH)45例入选LTH组,对比分析。结果 LAVH组手术时间、术中出血量、术后留置尿管时间、术后下床活动时间高于LTH组,LAVH组手术费用对于LTH组,差异有统计学意义(P0.05);两组对象的住院时间差异无统计学意义(P0.05)。LAVH组放射痛、并发症合计发生率低于LTH组,差异有统计学意义(P0.05)。结论在巨大子宫肌瘤中的应用LAVH术,可以减少手术的费用,降低并发症发生风险,但是会延长尿管留置时间、下床活动时间。     

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。     

非脱垂子宫经阴道切除术128例分析

目的 探讨非脱垂子宫阴道切除术（TVH）的优点、手术要点及适应证。方法 对非脱垂子宫行TVH128例，与同期指征相近的经腹全子宫切除术（TAH）160例进行分析比较。结果THA组手术均成功，无手术、术后并发症，手术时间、肛门排气时间、术后下床时间及住院时间和伤口疼痛程度均〈TAH组，两组差异有显著性（P〈0．05），出血量差异无显著性（P〉0．05）。结论 TVH手术损伤小、恢复快，是一种较好的方法。     

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。     

Nerve-sparing radical hysterectomy for cervical carcinoma

With the concept of the improvement of quality of life in the field of surgical oncology, recent studies have questioned the place of radical hysterectomy (RH) in the treatment of cervical carcinoma due to a high rate of long-term postoperative complications involving the pelvic autonomic nerve system. It has been demonstrated that RH frequently causes bladder dysfunction, anorectal mobility disorders, and sexual dissatisfaction in cervical cancer survivors due to surgical trauma involving the sympathetic and parasympathetic branches of the autonomous innervation of the pelvic organs. Nerve-sparing RH was first pioneered by Takashi Kobayashi in Japan and then other Japanese gynecologic surgeons introduced and improved this concept to Western countries. However, nerve-sparing RH has only become popular among gynecologic surgeons during the last two decades. Recently, European gynecologic surgeons modified this concept. Herein, a review of the evolution of nerve-sparing RH, a quick overview of long-term pelvic organ dysfunctions associated with RH, and the technical details of different authors and their oncological outcomes are presented. Today, the lack of randomized studies comparing the effectiveness and complications of RH with nerve-sparing RH is an important barrier to the widespread use of this concept. Nonetheless, while nerve-sparing RH still awaits prospective randomized trials in order to prove that its effectiveness is equal to or greater than that of conventional treatment modalities, and that is has fewer long-term complications, this surgical approach remains attractive for the patients and gynecologic oncologists based on the published results.     

Changes in bowel function after hysterectomy

PURPOSE: It has been suggested that hysterectomy has a disturbing influence on bowel function. To assess the incidence and nature of these changes, we performed a retrospective study. METHODS: A retrospective study was performed in all 593 women who had undergone hysterectomy between 1989 and 1993. A control group consisted of 100 women who had undergone laparoscopic cholecystectomy. RESULTS: The response rate was 90 percent (n=531; median age, 45 (range, 18–84) years). Of the responding women, 315 patients (59 percent) indicated a normal defecation pattern before hysterectomy. Of these women, severe deterioration in bowel function was reported by 98 patients (31 percent), whereas 36 women (11 percent) mentioned a moderate change after hysterectomy. Most frequent symptoms were severe straining (90 patients), incomplete and/or digital evacuation (83 and 50 patients, respectively). According to most patients, the changes in bowel function were reported to have started within one month after hysterectomy. With advancing age, fewer complaints were recorded ( P =0.008). No significant difference was found in the incidence of disturbed bowel function between the different types of operation (abdominal, vaginal, supravaginal, or radical hysterectomy). In the control group, the response rate was 96 percent. Median age of these women was 46 (range, 25–78) years. Fifty-eight patients (60 percent) reported normal bowel function before laparoscopic cholecystectomy. In this group of patients, disturbed bowel function after surgery was reported by five women (9 percent), which figure is significantly ( P < 0.001) lower compared with that in the corresponding hysterectomy group. CONCLUSION: Hysterectomy seems to play an important role in the pathogenesis of disturbed defecation.     

Tubal pregnancy after total vaginal hysterectomy

We report the case of a 26-year-old woman who presented to our emergency department for evaluation of abdominal pain 24 days after a vaginal hysterectomy. The patient's serum pregnancy test was positive. An ectopic pregnancy of the right adnexa was diagnosed by ultrasound and confirmed by laparotomy. The patient recovered uneventfully. Ectopic pregnancy after a total hysterectomy can occur if the fertilized ovum is in the fallopian tube at the time of the hysterectomy or if a fistulous tract exists between the vagina and the ovaries, enabling fertilization to occur. The diagnosis of ectopic pregnancy after a total hysterectomy is unusual yet must be considered in the presence of intact ovaries to avoid a delay in treatment.     

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。