22例附件扭转保留卵巢手术的临床经验分析

目的 探讨附件扭转患者保留卵巢手术的安全性和可行性.方法 回顾性分析于我院经手术确诊附件扭转行保留卵巢手术的22例患者的临床资料,并分析手术方案及预后情况.结果 患者均成功实施了保留卵巢手术,术后无盆腔炎、肺栓塞等并发症发生;20例患者行腹腔镜手术,2例患者行开腹手术;平均扭转度数(523.64°±235.08°);平...     

腹腔镜下卵巢囊肿蒂扭转保留卵巢术对患者血清FSH水平及卵巢储备功能的影响

研究腹腔镜下卵巢囊肿蒂扭转保留卵巢术对患者血清卵泡刺激素(FSH)水平及卵巢储备功能的影响。选取2014年4月~2016年8月我院治疗卵巢囊肿蒂扭转患者78例,随机数字表法分组,各39例。对照组予以常规开腹手术治疗,观察组予以腹腔镜保留卵巢手术治疗。比较两组治疗前后患者血清FSH水平变化情况及卵巢储备功能。观察组术后FSH水平、雌二醇(E2)、黄体生成素(LH)改善幅度优于对照组,差异有统计学意义(P0.05);术后比较两组卵巢储备功能,观察组AFC、PSV下降幅度均低于对照组,差异均有统计学意义(P0.05)。腹腔镜保留卵巢术治疗卵巢囊肿蒂扭转疗效显著,可改善机体血清FSH水平,并能有效维持患者卵巢储备功能。     

卵巢过度刺激伴附件扭转的超声表现及结局分析

目的探讨卵巢过度刺激（OHSS）患者发生附件扭转的超声诊断要点。 方法回顾性分析2016年1月至2020年4月重庆市妇幼保健院15例超声诊断为OHSS伴附件扭转患者的临床资料及超声图像特征，并随访患者后期结局，分析病例误诊原因。采用两样本配对Wilcoxon检验比较卵巢患侧和对侧的差异。 结果15例患者中，12例手术治疗（1例误诊），3例保守观察。手术治疗者中11例确诊为附件扭转，扭转角度为180°~1080°，均为单侧发病，右侧7例（63.6%），左侧4例（36.4%）；2例（18.2%）为单纯卵巢扭转，9例（81.8%）为输卵管、韧带合并卵巢扭转。3例保守观察者后期症状好转至消失。1例误诊病例为宫内合并宫外复合妊娠。附件扭转手术确诊患者超声表现主要为患侧卵巢较对侧卵巢明显增大［8.5（7.5，10.3）cm vs 5.8（4.3，7.3）cm］，差异具有统计学意义（Z=-2.58，P=0.010）。扭转蒂部结构呈“漩涡征”，血流信号较对侧减少或者消失，存在盆腔积液；扭转蒂部结构的“漩涡征”可作为OHSS患者发生附件扭转的直接且特异性征象。 结论超声特征性图像可帮助OHSS伴附件扭转的诊断，同时对卵巢活性进行初步判定；扫查过程中应结合临床病史及超声特征，避免误诊，为患者争取临床处理时间。     

附件扭转的临床分析

附件扭转是常见的妇科急腹症之一。扭转的原因往往由于卵巢或输卵管肿瘤 ,扭转的内容物包括卵巢或输卵管或两者皆有。由于附件扭转的明确诊断具有特殊性 ,术前诊断比较困难 ,传统手术又需切除扭转的一侧附件 ,故在此回顾性分析我院 10年来附件扭转的诊治。1　临床资料1.1　一般资料　 2 3例中 ,年龄 19～ 77(平均 42 )岁 ,2 0岁以前1例 ,2 0～ 5 0岁 2 0例 ,5 0岁以后 2例 ,孕产次为 1～ 7次 ,其中19例生育 1～ 6次 ,4例未生育。1.2　临床特征　均有下腹部持续性或阵发性腹痛 ,11例伴有恶心、呕吐 ,4例有发热 (3 8～ 40℃ ) ,仅 1例月经异常…     

超声在女性附件扭转诊断中的临床价值

目的探讨彩色多普勒超声在女性附件扭转诊断中的临床价值。方法对41例经手术病理证实的卵巢、输卵管或卵巢肿物蒂扭转患者的声像图表现进行回顾性分析。结果 41例卵巢、输卵管或卵巢肿物蒂扭转中31例声像图均可显示扭转蒂部(血管蒂);超声表现为位于卵巢或肿物一侧的团状不均质中等回声结构;10例未能显示蒂部。结论彩色多普勒超声能及时诊断附件扭转。扭转时血管蒂形成的团状不均质中等回声是其特异性表现,是诊断扭转的有力依据。     

腹腔镜下胆囊及附件同时手术32例

目的探讨腹腔镜下同时行胆囊摘除及附件手术的可行性.方法电视腹腔镜下同时行胆囊摘除及附件手术32例.结果全部手术获得成功,无中转开腹.术中出血平均(18.5±4.32)ml,术后平均输注抗菌素天数为(5.13±2.33),术后发热率为23.5%,术后平均住院日(4.1±1.89)d.与934例单纯胆囊摘除术比较差异无显著性.结论腹腔镜下同时行胆囊摘除及附件手术仍然能够充分体现腹腔镜腹部切口小、术后痛苦少、恢复快的优点,同时能够为患者节约住院时间及费用,值得进一步探索.     

保留卵巢手术治疗卵巢肿瘤蒂扭转14例分析

目的:探讨卵巢肿瘤蒂扭转保留卵巢手术在临床的应用。方法:回顾性分析14例<40岁卵巢良性肿瘤蒂扭转患者、实施蒂扭转复位后肿瘤剥除术的临床诊治过程。结果:14例手术均获成功,无术后栓塞发生。术后超声监测患侧卵巢血液循环正常,且恢复排卵。结论:良性卵巢肿瘤蒂扭转急诊手术治疗时,排除卵巢坏疽后保留卵巢是可行和安全的。     

妊娠期附件扭转MRI表现及其临床特点

目的 探讨妊娠期附件扭转（AT） MRI表现及临床特点。方法 回顾性分析14例经病理证实的妊娠期AT患者的MRI表现及临床资料。结果 14例AT中，原发性2例，继发性12例（卵巢囊肿5例、卵巢畸胎瘤4例、输卵管积水2例、输卵管间皮囊肿1例）；右侧5例，左侧9例；扭转角度180°~1 720°。MRI示，除3例孤立性输卵管扭转外，其余11例均见卵巢增大，12例于盆腔或腹腔内见异常信号肿块，包括8例囊性肿块、4例囊实性肿块；肿块旁见扭转蒂7例，其中6例呈"鸟嘴征"，1例旋涡征，DWI均呈混杂高信号；附件出血6例，盆腔积液8例。6例孕妇分娩足月健康胎儿，8例分娩早产儿。结论 妊娠期AT的MRI表现有一定特征性，结合临床特点有助于诊断。     

腹腔镜附件良性肿瘤手术的临床分析

随着腹腔镜手术在妇科领域普遍应用，大多数附件的良性肿物可以在腹腔镜下得到处理。本文通过对86例附件良性肿瘤行腹腔镜手术治疗，探讨腹腔镜手术的应用前景，并对预防和减少并发症进行讨论。     

腹腔镜微创手术对卵巢良性肿瘤患者卵巢功能影响的临床分析

目的:观察腹腔镜微创手术对卵巢良性肿瘤患者卵巢功能影响的临床疗效。方法:本院2018年11月至2019年11月收治的74例卵巢良性肿瘤患者为本次研究对象,按照是否行腹腔镜微创手术将患者分为对照组(37例:未行腹腔镜微创手术而行开腹手术)与研究组(37例:行腹腔镜微创手术),比较两组患者预后效果。结果:研究组术后3个月雌二醇(E 2)、促黄体生成素(LH)、卵泡刺激素(FSH)等相关卵巢功能指标均优于对照组,数据差异明显(P<0.05)。研究组患者术后并发症总发生率低于对照组,数据差异明显(P<0.05)。结论:卵巢良性肿瘤患者腹腔镜微创手术治疗效果明显优于开腹手术。     

Pediatric ovarian torsion: an uncommon clinical entity

Pediatric ovarian torsion is an infrequent diagnosis and it often mimics acute appendicitis. Most cases are due to underlying ovarian pathology and if left untreated, ovarian torsion may eventually cause peritonitis. Emergency exploratory laparoscopy represents a valuable diagnostic and therapeutic tool in suspected ovarian torsion.     

腹腔镜与开腹低位直肠癌保肛术安全性的Meta分析

目的 分析腹腔镜与传统开腹手术在低位直肠癌保肛术中的安全性。方法 按照拟定的标准,筛选出13篇比较腹腔镜与开腹术式在低位直肠癌保肛治疗中安全性的文献,运用Meta分析对相关临床指标进行综合分析。结果 开腹组（OS组）的手术时间较腹腔镜组（LS组）少16.86 min（MD = 16.86,95%CI：9.74～23.98,P = 0.000）、术中出血量较LS组多115.16 mL（MD = -115.16,95%CI：-141.90～-88.42,P = 0.000）。两组术中清扫的淋巴结数目比较,差异无统计学意义（MD = 0.03,95%CI：-0.66～0.72,P = 0.930）。LS组环周切缘（CRM）癌肿的阳性率较OS组高（O = 2.67,95%CI：1.07～6.68,P = 0.040）。LS组术后切口并发症发生率比OS组低（O = 0.20,95%CI：0.08～0.50,P = 0.001）。两组术后吻合口瘘、肠梗阻和泌尿系并发症发生率比较,差异无统计学意义（均P > 0.05）。LS组术后肛门首次排气时间较OS组早（SMD = -1.61,95%CI：-2.20～-1.01,P = 0.000）、住院时间较OS组短2.78 d（MD = -2.78,95%CI：-3.84～-1.71,P = 0.000）。两组术后肿瘤局部复发率和远处转移率比较,差异无统计学意义（均P > 0.05）。结论 与OS比较,LS在低位直肠癌保肛术中对患者损伤小、术后恢复快。两种术式在肿瘤的安全性上无明显区别。     

A normal ovary in an abnormal location: A case of torsion

The clinical and radiologic diagnosis of adnexal torsion is challenging. The patient's history, physical examination, and laboratory evaluation may overlap significantly with other causes of abdominal pain. Ultrasound is the most common radiologic tool to assess for torsion, and the imaging findings can be equally equivocal. We present a case of adnexal torsion in an 18‐year‐old emergency room patient with abdominal pain, diagnosed by ultrasound based solely on an abnormal medial position of the ovary–a finding that has been only rarely mentioned in the literature, and never in isolation. © 2014 Wiley Periodicals, Inc. J Clin Ultrasound 43 :578–580, 2015     

87例腹腔镜下卵巢囊肿剥出术的临床分析

目的探讨腹腔镜下卵巢囊肿剥出术的操作要领及其临床应用价值。方法对87例卵巢囊肿进行腹腔镜下剥出手术,严格把握操作要领。根据囊肿或肿瘤的性质、大小不同而采取不尽相同的操作方法,单侧剥出者68例,双侧剥出者19例。结果87例患者均未发生明显并发症,无一例中转开腹。结论腹腔镜下卵巢囊肿剥出术创伤小,术后恢复快并发症少,集诊断与治疗为一体,临床应用价值比较肯定。     

Preoperative sonographic and clinical characteristics as predictors of ovarian torsion.

OBJECTIVE: The purpose of this study was to determine the most closely associated sonographic and clinical characteristics of ovarian torsion. METHODS: The medical records and sonographic studies of 39 patients with pathologically proven ovarian torsion diagnosed at our institution from July 1, 2000, through December 31, 2005, were retrospectively reviewed. The volumes of the affected ovaries and ovary/mass complexes were compared with an age-appropriate standard. Statistical significance of the data was assessed by a likelihood ratio chi(2) analysis. RESULTS: All patients (100%) had a chief symptom of abdominal pain. Thirty-three (85%) reported vomiting; 22 (56%) had leukocytosis; and 7 (18%) had a documented elevated temperature. All affected ovaries and ovary/mass complexes were enlarged. Twenty-one (54%) had arterial flow on Doppler interrogation, and 18 (46%) had no arterial flow. Thirteen (33%) had venous flow, and 26 (67%) had no venous flow. Differences in the arterial and venous flow patterns between the premenarchal and reproductive age groups were not statistically significant. CONCLUSIONS: Abdominal pain, vomiting, ovarian enlargement, and absence of ovarian venous Doppler flow are the most frequently shown clinical and sonographic indicators of ovarian torsion. However, ovarian enlargement, even in the presence of arterial and venous Doppler flow, is the most commonly associated sonographic finding. Suspicion of ovarian torsion should be high in the setting of clinical symptoms and ovarian enlargement regardless of the presence or absence of an ovarian Doppler signal.     

Comparison of single-incision and conventional laparoscopic surgery for benign adnexal masses

Background: Our aim was to compare single incision and conventional laparoscopic surgeries performed for benign adnexal masses with regard to their intraoperative characteristics and postoperative pain levels.

Material and methods: The main outcome measures were laparoscopic entry time, total operation time, amount of bleeding, intraoperative complications, post-operative pain scores, additional analgesic requirements, and length of hospital stay.

Results: A total of 71 women, 39 in the conventional laparoscopy group and 32 in the SILS group, participated in the study. Demographic findings did not differ between the two groups. Similarly, rates of intraoperative complications, rates of conversion to laparotomy, pre- and postoperative hematocrit levels were not significantly different between the groups. Laparoscopic entry time was shorter in the SILS group (10.4?±?5.9?min. vs. 5.28?±?1.7?min.). However, total operation time was similar in the two groups. The groups did not show significant differences regarding additional analgesic requirements, or postoperative pain scores after 24?h. However, pain scores in the recovery room and after six and 12?h were lower in the SILS group.

Conclusion: SILS seems to be effective and safe for the treatment of benign adnexal masses. SILS appears to be advantageous regarding postoperative pain especially in the early period.     

腹腔镜下卵巢良性肿瘤剥除术135例临床分析

目的探讨腹腔镜下卵巢肿瘤的手术技巧。方法回顾分析135例良性卵巢肿瘤包括巨大卵巢肿瘤、卵巢巧克力囊肿、合并严重盆腔粘连以及不育症等并发症的腹腔镜下手术技巧。结果134例在腹腔镜下顺利完成,手术时间最长90min,最短15min,瘤体直径最大者26cm,最小约2cm,1例双侧巧克力囊肿,盆腔粘连较重改中转开腹。全部患者术后疼痛轻微,常规应用抗生素3d;术后体温第3天全部正常,住院4～6d,134例腹腔镜下手术病例随访最长3a无复发。10例合并不育患者术后2a内妊娠者8例。结论腹腔镜下卵巢良性肿瘤剥除术具有微创、恢复快、疼痛轻及美观等优点,是治疗卵巢良性肿瘤的最佳方法。     

腹腔镜下巨大卵巢囊肿手术方式改进应用价值

目的:探讨腹腔镜下巨大良性卵巢肿瘤手术方式改进的应用价值。方法:58例巨大卵巢囊肿患者,其中囊肿直径≥14 cm 37例,≥20 cm 15例,≥28 cm 6例,均改进手术穿刺方式应用腹腔镜治疗,观察患者手术时间、出血量、并发症及术后恢复情况。结果:手术时间(78.54±28.31)min,出血量(46.0±23.5)mL,患者术后下地活动时间(8.41±2.49)h,肛门排气时间(6.21±3.50)h,住院时间(4.2+1.5)d。结论:严格排除恶性肿瘤及手术禁忌证,改进手术方式,应用腹腔镜治疗巨大良性卵巢肿瘤手术出血量少,术后并发症少,恢复快,住院时间短,安全、有效。     

腹腔镜微创手术对卵巢良性肿瘤患者免疫指标和炎性因子的影响

目的探讨腹腔镜微创手术对卵巢良性肿瘤患者免疫指标和炎性因子的影响。方法随机选取我院收治的120例卵巢良性肿瘤患者的临床资料进行回顾性分析,根据治疗方式不同将其分为对照组和观察组,每组60例。对照组行传统开腹手术治疗,观察组行腹腔镜微创手术治疗。比较两组的临床治疗效果。结果术后24 h,两组IgA、IgG、IgM水平均下降,但观察组高于对照组(P<0.05)。术后24 h,两组TNF-α、IL-6、CRP水平均升高,但观察组低于对照组(P<0.05)。术后第3天,两组FSH、LH水平均升高,但观察组低于对照组(P<0.05);两组E2、AMH水平均降低,但观察组高于对照组(P<0.05)。术后1个月,两组QLICP-OV各项评分均升高,且观察组高于对照组(P<0.05)。结论相比于传统开腹手术,腹腔镜微创手术治疗卵巢良性肿瘤对患者免疫指标和炎性因子水平影响较小,安全性较高,对患者疾病预后有积极的影响作用。