腹腔镜诊治妇科急腹症的临床应用

目的:探讨腹腔镜诊断和治疗妇科急腹症的价值。方法:回顾分析应用腹腔镜诊断和治疗妇科急腹症41例的临床资料。结果:腹腔镜诊断并对36例异位妊娠、3例黄体破裂、2例卵巢肿瘤扭转成功进行手术治疗,其中输卵管切除术34例,附件切除术2例,保守性手术如输卵管开窗清除胚胎病灶和卵巢电凝止血术5例。术后3～5d痊愈出院。结论:应用腹腔镜诊断和治疗妇科急腹症有效、实用、微创。     

腹腔镜手术治疗妊娠合并卵巢囊肿蒂扭转26例报告

目的探讨腹腔镜手术治疗妊娠合并卵巢囊肿蒂扭转的经验。方法 2009年1月~2016年12月对26例妊娠合并卵巢囊肿蒂扭转急诊行腹腔镜手术,根据术中情况,腹腔镜下行囊肿剥除术或患侧附件切除术。术后早期妊娠患者黄体酮20~40 mg肌肉内注射,1次/d,连续3 d;中晚期妊娠患者硫酸镁静脉滴注,5 g/d,连续3 d。通过患者再次入院记录、门诊或电话随访妊娠结局。结果 26例均完成腹腔镜手术。术中发现11例卵巢坏死行患侧附件切除术,其余15例行患侧卵巢肿物剥除术。手术时间20~60 min,平均47.8 min。术中出血10~400 ml,平均88.8 ml。住院时间2~16 d,平均5.8 d。术后21例(80.8%)保胎治疗。术后26例均未出现流产、早产症状,继续妊娠至足月分娩,13例顺产,13例剖腹产;新生儿出生后1、5 min Apgar评分8~10分。结论腹腔镜手术治疗妊娠合并卵巢囊肿蒂扭转对妊娠是安全的,但对于大囊肿、妊娠晚期患者手术困难。     

腹腔镜诊治妇科急腹症的临床应用

目的 :探讨腹腔镜诊断和治疗妇科急腹症的价值。方法 :回顾分析应用腹腔镜诊断和治疗妇科急腹症 5 2例的临床资料。结果 :腹腔镜诊断并对 36例异位任娠、8例黄体破裂、8例卵巢肿瘤蒂扭转成功进行手术治疗 ,其中输卵管切除术 2 6例、附件切除术 5例、卵巢囊肿剥除术 3例 ,保守性手术如输卵管开窗清除胚胎和卵巢电凝止血术 1 8例。术后 3～ 5d均痊愈出院。结论 :运用腹腔镜诊断和治疗妇科急腹症有效、实用。     

腹腔镜下268例异位妊娠手术方式的探讨

<正> 我院97年8月至99年2月共行腹腔镜手术512例,其中行异位妊娠手术268例,占52.34％,根据术中的情况采取不同的手术方式,现介绍如下。 临床资料 1 一般资料 年龄19～43岁,平均31岁。268例妊娠中,壶腹部妊娠175例,峡部妊娠73例,伞部妊娠12例,卵巢妊娠2例,有6例患者未见妊娠部位;其中破裂型24例;腹腔内积血50—1800ml,平均925ml。 2 手术方式 根据有无生育要求及术中的情况主要采取以下几种方式:输卵管线状切开取胚术92例,输卵管切除术141例,输卵管部分切除术21例,病灶清除术8例,6例患者于术中见子宫及附件均无异常,仅见腹腔内积血300—500ml不等,将积血清理干净后,取部分组织送病理,后术毕。除输卵管切除术外,其余患者术后腹腔内均放置5-FU 750mg。同时有26例患者同时行另侧输卵管绝育术。     

妇科急症腹腔镜手术360例临床分析

目的:探讨妇科急症腹腔镜手术的可行性、安全性及治疗效果。方法:在全麻下采取常规三孔法置入腹腔镜器械,根据疾病不同采取相应的手术方法,如输卵管切除术、输卵管开窗术、卵巢部分切除术、一侧附件切除术、脓肿切开引流术。结果:所有手术均用腹腔镜顺利完成,平均手术时间(50.2±21.3)min,术后无一例发生并发症。结论:腹腔镜手术治疗妇科急症快速、安全、有效,可作为一种常规手术加以推广。     

电视腹腔镜手术在妇科的应用（附64例报告）

应用电视腹腔镜施行妇科手术64例,包括输卵管切除术、输卵管造口术、输卵管伞端扩张术、输卵管扎管术、卵巢或附件切除术、卵巢囊肿剥出成形术、卵巢穿刺术、卵巢冠囊肿切除术、子宫肌瘤挖除术及盆腔粘连分解术等。结果表明:利用电视腹腔镜施行妇科手术,具有手术时间短、损伤小、采后恢复快、并发症少等优点,值得推广应用。     

妇科腹腔镜手术271例临床分析

目的:探讨腹腔镜手术用于治疗妇科疾病的临床价值。方法:回顾分析为271例患者行腹腔镜妇科手术的临床资料,评价平均手术时间、术中出血量等指标。结果:271例均在腹腔镜下完成手术,包括腹腔镜全子宫切除术83例,次全切除术80例,子宫肌瘤切除术42例,附件切除术33例,附件囊肿剥除术28例,输卵管妊娠取胚术5例。2例(0.74%)发生并发症。结论:腹腔镜妇科手术患者创伤小,康复快,只要严格掌握手术适应证,大部分妇科良性疾病可用腹腔镜手术治疗。     

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。     

腹腔镜下治疗输卵管妊娠112例分析

目的:探讨腹腔镜治疗输卵管妊娠的价值及术式。方法:回顾分析了112例输卵管妊娠腹腔镜治疗的效果。结果:112例中,除2例输卵管间质妊娠和2例输卵管妊娠保守治疗失败外,均在腹腔镜下手术成功。其中,镜下输卵管局部注药保守治疗10例,输卵管开窗取胚15例,81例行输卵管切除术,行清除术4例。出血量最少为0ml,最多为2500ml。结论:只要病情允许,应首选腹腔镜手术,应根据输卵管的病变情况,患者年龄及有无生育要求,采用输卵管妊娠局部注药术,输卵管开窗术,输卵管切除术和清除积血及流产物等术式。     

腹腔镜在异位妊娠诊治中的价值

目的 探讨腹腔镜手术在异位妊娠诊断和治疗中的价值。方法 2003年1月～2005年1月，我院对342例临床拟诊异位妊娠行腹腔镜检查。诊断明确335例，行单侧输卵管切除术、输卵管开窗术、部分卵巢切除术或宫角切除术等：诊断不明确7例，进一步行诊断性刮宫术。结果 335例腹腔镜确诊异位妊娠，333例成功行腹腔镜手术（包括3例卵巢妊娠、3例输卵管间质部妊娠），2例中转开腹。7例腹腔镜未见明显妊娠部位行诊断性刮宫术，其中1例子宫畸形（残角子宫）合并宫内妊娠行残角子宫及同侧输卵管切除术，1例卵巢黄体囊肿破裂合并宫内妊娠行黄体囊肿剥出术，5例宫内外均未发现妊娠部位，MTX治疗成功。340例腹腔镜术后8～24h肛门排气，除5例MTX保守治疗外，335例术后2～4d出院；2例中转开腹术后24～36h肛门排气，术后6d出院。结论 腹腔镜检查有利于异位妊娠的早期诊断；腹腔镜手术治疗异位妊娠安全有效、恢复快。     

电视腹腔镜妇科手术18例报告

目的:探讨腹腔镜治疗妇科疾病的效果。方法:应用腹腔镜治疗妇科疾病18例,其中腹腔镜辅助阴式子宫切除1例,卵巢囊肿剥除术4例,附件切除术9例,输卵管切除术4例。结果:18例手术均在腹腔镜下完成,术中无并发症发生。无1例术后切口感染,术后平均住院2.8d。结论:腹腔镜手术治疗妇科疾病安全有效,患者术后恢复快,疤痕小,并发症低。     

腹腔镜诊治卵巢囊肿蒂扭转

目的:探讨腹腔镜在诊断和治疗卵巢囊肿蒂扭转方面的应用价值。方法:对1994年1月至2006年2月14例经腹腔镜诊断和治疗的卵巢囊肿蒂扭转患者的临床资料进行回顾性分析。结果:14例中12例(85.7%)临床表现为急性腹痛,8例(57.14%)伴有恶心呕吐;仅6例术前诊断为卵巢囊肿蒂扭转;14例均经腹腔镜确诊并于镜下完成治疗,行患侧附件切除术9例,蒂扭转复位后行卵巢囊肿剥出术5例,平均手术时间114.3m in,平均出血24.3m l,无手术并发症发生;术后病理诊断卵巢成熟囊性畸胎瘤10例,浆液性囊腺瘤3例,卵巢单纯性囊肿1例。结论:腹腔镜对早期诊断卵巢囊肿蒂扭转有重要价值,在诊断的同时治疗卵巢囊肿蒂扭转安全有效。     

Salpingectomy via laparoscopy: a new surgical approach.

This study presents 100 consecutive cases of total salpingectomy performed via laparoscopy for indications of ruptured or recurrent ectopic pregnancy, hydrosalpinges, torsion of the fallopian tube, hematosalpinges, or extensive adhesions. A multiple abdominal puncture approach was used, and salpingectomy was accomplished by electrosurgical coagulation and laser transection of the isthmus, mesosalpinx, and tubo-ovarian ligaments using the CO2 laser. The fallopian tubes were removed from the pelvic cavity through one of the suprapubic punctures. The mean duration of the procedure was 22 minutes, and the mean duration of hospitalization after surgery 7.4 hours. No major intraoperative or postoperative complications were encountered. Laparoscopic salpingectomy appears to be a safe and relatively simple procedure associated with the advantages of outpatient surgery.     

Laparoscopy in gynecologic emergencies

Laparoscopy is ideal for the diagnosis of acute pelvic pain and the treatment of gynecologic emergencies. It is as safe and effective as laparotomy for the treatment of ectopic pregnancy, ovarian cysts, dermoid cysts, and adnexal torsion. Treatment with laparoscopy results in shorter hospital stay and faster recovery. Future fertility is not compromised and in some cases may be improved with laparoscopic treatment. There are also studies suggesting that laparoscopy can be used safely for the diagnosis and treatment of gynecologic emergencies in the first and second trimester of pregnancy.     

探讨腹腔镜手术诊治异位妊娠的价值

目的:探讨腹腔镜手术诊断和治疗异位妊娠的应用价值。方法:2004年1月至2008年12月我院为226例拟诊为异位妊娠的患者行腹腔镜探查,明确诊断223例,同时行单侧输卵管切除术,输卵管开窗术及宫角切除术;诊断不明确3例,进一步行诊刮术。结果:223例经腹腔镜探查确诊为异位妊娠,221例成功行腹腔镜手术,2例中转开腹。3例腹腔镜下未见明显妊娠部位而行诊刮术,其中1例卵巢黄体破裂合并宫内妊娠行黄体囊肿剥除术,2例宫内宫外未见妊娠部位,注射MTX治疗成功。224例腹腔镜术后6～24h肛门排气,除2例用MTX保守治疗外,222例术后4d出院,2例中转开腹者术后24～36h肛门排气,术后5～6d出院。结论:腹腔镜探查有利于异位妊娠的早期诊断,腹腔镜手术治疗异位妊娠安全、有效、康复快。     

初期开展腹腔镜技术诊治妇科疾病142例临床分析

目的:探讨腹腔镜手术用于诊治妇科疾病的价值,总结初期开展妇科腹腔镜手术的体会。方法:回顾分析初期开展142例妇科腹腔镜手术的临床资料,主要包括输卵管切开取胚术、输卵管切除术、卵巢囊肿剥除术、附件切除术、输卵管结扎术、子宫肌瘤切除术、盆腔粘连松解术、输卵管造口术、腹腔镜辅助阴式子宫切除术等13种手术。结果:142例中136例(95.8%)成功完成腹腔镜手术,6例中转开腹(4.2%),6例(4.2%)发生并发症,平均手术时间(102.43±42.85)min,平均术中出血20ml。结论:腹腔镜手术具有患者创伤小、术中出血少、术后康复快、住院时间短、腹壁切口美观且诊断和治疗同步完成等优点,但初期开展此手术须严格掌握适应证并熟悉各种并发症的防治,从而使腹腔镜技术诊治妇科疾病有更广阔的应用前景。     

The laparoscopic approach in abdominal emergencies: a single-center 10-year experience.

INTRODUCTION: Laparoscopy has rapidly emerged as the preferred surgical approach to a number of different diseases because it allows for a correct diagnosis and proper treatment. In abdominal emergencies, both components of treatment--exploration and surgery--can be accomplished via laparoscopy. The aim of the present work is to illustrate retrospectively the results of a case-control experience with laparoscopic versus open surgery for abdominal emergencies performed at our institution. METHODS: From January 1992 to January 2002, 935 patients (mean age, 42.3+/-17.2 years) underwent emergent or urgent surgery, or both. Of these, 602 (64.3%) were operated on laparoscopically (small bowel obstruction, 28; gastroduodenal ulcer disease, 25; biliary disease, 165; pelvic disease, 370 cases; colonic perforations, 14) based on the availability of a surgical team trained in laparoscopy. Patients with a history of malignancy, more than 2 previous major abdominal surgeries, or massive bowel distension were not treated laparoscopically. Peritonitis was not deemed a contraindication to laparoscopy. RESULTS: The conversion rate was 5.8% and was mainly due to the presence of dense intraabdominal adhesions. Major complications ranged as high as 2.1% with a postoperative mortality of 0.6%. A definitive diagnosis was accomplished in 96.3% of cases, and 94.1% of these patients were treated successfully with laparoscopy. CONCLUSIONS: Even if limited by its retrospective nature, the present experience shows that the laparoscopic approach to abdominal emergencies is as safe and effective as conventional surgery, has a higher diagnostic yield, and results in less trauma and a more rapid postoperative recovery. Such features make laparoscopy an attractive alternative to open surgery in the management algorithm for abdominal emergencies.