非脱垂子宫切除术方法的探讨(附260例报告)

目的通过对非脱垂子宫阴式切除术及腹腔镜辅助阴式切除术比较分析，探讨治疗非脱垂子宫的最佳方法。方法回顾性地对我院2004年11月至2008年3月间的260例非脱垂子宫阴式切除术和腹腔镜辅助阴式切除术两种术式的对比分析，比较两种术式在适应证的选择、手术时间的长短、术中出血量、术后住院日和术中术后并发症等方面的差异。结果两种术式在手术时间的长短、术后住院日、术后并发症方面无明显的差异（P〉0．05）；但在手术适应证和术中出血量方面存在着明显的差异（P〈0．05）。结论对于非脱垂子宫，选择腹腔镜辅助阴式切除术较为合适，而只有子宫较小，无盆腹腔粘连者，选择阴式切除术为宜。     

非脱垂子宫阴式切除术548例临床分析

随着微创外科理念的引入,阴式子宫全切术日益受到重视。以往经阴道全子宫切除术(transvaginal hysterectomy,TVH)多限于子宫脱垂的小子宫患者。现总结我院开展的548例非脱垂子宫阴式切除术,旨在探讨非脱垂子宫TVH的方法和临床应用价值。     

阴式全子宫切除术与其它术式比较分析

目的 探讨阴式全子宫切除术与其它术式的优点.方法 取同期手术非脱垂子宫的患者随机分为三组:分别为阴式全子宫切除术组、腹腔镜组、开腹组.分别记录和比较各组的手术时间、术中出血量、术后病率、术后排气时间、术后体温持续时间及平均住院天数.结果 阴式全子宫切除术、腹腔镜手术二者具有术后病率低、并发症少、肛门排气时间早、住院天数少等优点,二者差异无显著性,但阴式全子宫切除术费用低,二者与开腹比较有显著差异.结论 每组手术各有优点,适应阴式全子宫切除术的患者,应首选阴式全子宫切除术,腹腔镜手术是对阴式全子宫切除术的补充.     

23例腹腔镜下阴式全子宫切除术的护理经验体会

目的 总结腹腔镜辅助下阴式全子宫切除术(LAVH)的护理经验.方法 收集我院2013年11月～2014年11月共23例行腹腔镜辅助下阴式全子宫切除术患者的临床及护理资料.结果 本组23例患者均成功行腹腔镜辅助下阴式子宫切除术,其中:子宫肌瘤9例(39.1％),子宫腺肌病9例(39.1％),子宫脱垂2例(8.7％),功能性子宫出血2例(8.7％),宫颈重度不典型增生1例(4.4％);平均年龄47.1岁,手术时间(101.3±45.7)min,术中出血(82.5±57.5)ml,住院时间(12.75±4.83)d,术后低热发生率73.9％,无严重并发症的发生.结论 腹腔镜辅助下阴式全子宫切除术具有手术创伤小,术后恢复快等优点,优质的护理对于手术成功及术后恢复具有重要的意义.     

非脱垂性子宫阴式切除术80例临床分析

探讨改良式非脱垂子宫阴式全子宫切除术(TVH)和腹式全子宫切除术(TAH)的临床效果.经TVH具有无体表瘢痕、创伤小、术中出血少、肠道干扰少、术后疼痛轻、恢复快、住院时间短的优点,是一种安全有效、可行的微创外科手术.     

非脱垂子宫经阴道切除与经腹切除临床对比

目的 比较两种手术方法的临床效果.方法 选择2004年6月至2008年10月在我院行以上两种术式的病例共112例的临床资料,腹式组60例,阴式组52例进行比较分析.结果 TVH术后肛门排气时间、住院时间、术后疼痛时间、镇痛用药及术后恢复正常工作时间均少于TAH组,两组术中出血量、平均手术时间无明显差异(P＞0.05),TVH组术后病率亦低于TAH组.结论 对于子宫体积小于12孕周的非脱垂子宫,TVH具有微创手术的优点,只要技术掌握熟练相对于TAH是一种值得推广的术式.     

78例阴式非脱垂子宫切除术临床疗效分析

目的探讨非脱垂子宫阴式切除术（TVH）在妇科疾病中的临床应用价值及可行性。方法回顾性分析2009年5月至2010年10月78例实施非脱垂子宫阴式切除术患者的病例资料,观察手术时间、出血量、并发症等。结果 76例成功经阴道完成手术,成功率97.4%,手术平均时间57 min,术中出血量50～100 mL。结论非脱垂子宫阴式切除手术具有创伤小、恢复快、住院时间短、腹部不留瘢痕等优点,符合现代微创观念,有临床使用价值,值得推广。     

腹腔镜筋膜内子宫切除与经腹子宫切除比较

随着妇科腹腔镜技术的发展，腹腔镜子宫切除（CASH）技术也发展越来越成熟。我院自2005年1月-2007年12月间行腹腔镜子宫切除76例，同期行经腹子宫切除62例，现将相关资料报告如下。     

非脱垂子宫经阴道切除术的临床应用及护理

近年来,子宫良性病变行子宫切除术已成为妇科最常施行的手术之一.我科在2006年9月～2007年9月间对50例子宫良性疾病行TVH,证实该手术方较传统经腹子宫切除术有诸多优点.现总结体会如下.     

Total laparoscopic hysterectomy versus total abdominal hysterectomy: an assessment of the learning curve in a prospective randomized study

The present randomized study was undertaken in order to compare the short-term results between total laparoscopic hysterectomy and abdominal hysterectomy in a centre with experience in laparoscopic surgery. From January 1997 to September 1998 inclusive, 102 women aged 44-71 years were randomly assigned to either total laparoscopic hysterectomy (n = 51 patients) or abdominal hysterectomy (n = 51 patients). The patients' demographic characteristics were similar in both groups. Average intra-operative blood loss was lower in laparoscopic hysterectomy than in abdominal hysterectomy (P 相似文献   

Ureteral complications from laparoscopic hysterectomy indicated for benign uterine pathologies: a 13-year experience in a continuous series of 1300 patients

BACKGROUND: The aim of this study was to evaluate the risk of ureteral injuries and to discuss how to avoid their occurence after laparoscopic hysterectomy indicated for benign uterine pathologies. METHODS: This observational study covers the period from January 1993 to December 2005 (retrospective study from 1993 to 2000 and prospective from 2001). We reviewed incidence, methods of diagnosis and management of ureteral injuries. RESULTS: The rate of ureteral injuries was 0.3% (four patients). Three patients presented a ureteral fistula diagnosed secondarily some time after the operation. The fourth patient presented a ureteral injury that was diagnosed peroperatively. Three out of four of the lesions were observed on the right side. In every case, there were preoperative risk factors connected with a past history of surgery, or the lateral location of uterine myomas. All four patients needed ureterovesical reimplantation. The outcome was good in all four cases. CONCLUSIONS: The rate of ureter complications after laparoscopic hysterectomy is low and comparable to that observed after hysterectomy by laparotomy. The risk should not prevent laparoscopic hysterectomy being used more widely. Prevention depends on training in the technique and the surgeon's experience.     

Surgical routes and complications of hysterectomy for benign disorders: a prospective observational study in French university hospitals

BACKGROUND: Despite the advantages of the vaginal and laparoscopic approaches, most hysterectomies carried out involve laparotomy. The objective of this prospective observational multicentre study was to examine the routes and complications of hysterectomy for benign disorders. METHODS: Of the 15 university hospitals belonging to Collégiale de Gynécologie-Obstétrique de Paris-Ile de France, 12 participated in this study that took place between June and December 2004. We analysed the characteristics of the patients, the indications for hysterectomy and intra- and post-operative complications (and their determinants) according to the surgical approach. RESULTS: In total, 634 women underwent hysterectomy for benign disorders during the study period. The patients' mean age (+/-SD), BMI, parity and previous Caesarean sections were 51.4 +/- 10.3 years, 25 +/- 5.7 kg/m(2), 2 +/- 1.6 children and 0.2 +/- 0.6, respectively. Hysterectomy was performed by the laparoscopic, laparoscopically assisted vaginal hysterectomy (LAVH), laparotomic and vaginal routes in 19.1, 8.2, 24.4 and 48.3% of cases, respectively. The operating time was shorter with the vaginal route than with laparoscopy, laparotomy and LAVH (P < 0.0001). Intra- and post-operative complications were significantly more frequent in the laparotomic group (18%) compared with the vaginal group (8.2%), the laparoscopic group (5.8%) and the LAVH group (8.2%) (P < 0.0001). In a multivariate logistic regression model, obesity [odds ratio (OR): 2.84, 95% confidence interval (CI): 1.53-5.27, P = 0.001], history of pelvic surgery (OR: 2.47, 95% CI: 1.39-4.39, P = 0.002) and history of Caesarean section (OR: 2.04, 95% CI: 1.01-4.1, P = 0.046) were significantly associated with intra- and post-operative complications. Laparoconversion was necessary in 36 cases (7.5%) overall and was more frequent with laparoscopy and LAVH than with the vaginal route (P < 0.0001). CONCLUSIONS: This study confirms that the vaginal route is increasingly used for hysterectomy in France and that it is the route of choice for benign disorders.     

Loss of ovarian reserve after uterine artery embolization: a randomized comparison with hysterectomy

BACKGROUND: Ovarian failure as a complication of uterine artery embolization (UAE) for symptomatic uterine fibroids has raised concerns about this new treatment modality. METHODS: We investigated the occurrence of ovarian reserve reduction in a randomized trial comparing UAE and hysterectomy by measuring follicle stimulating hormone (FSH) and anti-Mullerian hormone (AMH). A total of 177 pre-menopausal women with menorrhagia due to uterine fibroids were included (UAE:n=88; hysterectomy:n=89). FSH and AMH were measured at baseline and at several time-points during the 24 months follow-up period. Follow-up AMH levels were also compared to the expected decrease due to ovarian ageing during the observational period. RESULTS: FSH increased significantly compared to baseline in both groups after 24 months follow-up (within group analysis: UAE:+12.1; P=0.001; hysterectomy:+16.3; P<0.0001). No differences in FSH values between the groups were found (P=0.32). At 24 months after treatment the number of patients with FSH levels>40 IU/l was 14/80 in the UAE group and 17/73 in the hysterectomy group (relative risk=0.75; P=0.37). AMH was measured in 63 patients (UAE: n=30; hysterectomy: n=33). After treatment AMH levels remained significantly decreased during the entire follow-up period only in the UAE group compared to the expected AMH decrease due to ageing. No differences were observed between the groups. CONCLUSIONS: This study shows that both UAE and hysterectomy affect ovarian reserve. This results in older women becoming menopausal after the intervention. Therefore, the application of UAE in women who still wish to conceive should only be considered after appropriate counselling.     

腹腔镜手术与开腹手术治疗子宫肌瘤的比较分析

目的　探讨腹腔镜手术对子宫肌瘤的治疗价值。方法　 12 0例子宫肌瘤患者随机分为腹腔镜手术组和剖腹手术治疗组 ,对两组手术时间、术中出血量、手术并发症、术后恢复情况及疾病复发进行比较分析。结果　 60例腹腔镜手术时间平均 12 8.6min ,术中出血平均 92 .4ml ,剖腹手术组手术时间平均 10 4.3min ,术中出血平均 88.2ml。腹腔镜和剖腹手术组术后并发症发生率分别为 7.7%和 15 %。腹腔镜组手术时间明显长于剖腹手术组 (P <0 .0 1)。结论　腹腔镜下子宫肌瘤切除术用于治疗子宫肌瘤具有创伤小、并发症发生率低的优点     

Surgery: Hysterectomy for patients without previous vaginal delivery: results and modalities of laparoscopic surgery

The great majority of hysterectomies in nulliparous patientshave been carried out via laparotomy. The purpose of this studywas to establish whether laparoscopic surgery can be of usein an attempt to reduce the number of iaparotomies when hysterectomyis indicated in patients without previous vaginal delivery.A retrospective study was carried out on 66 women who had nothad a previous vaginal delivery who underwent hysterectomy fromJanuary 1993 to May 1995. Laparotomy was required for only 19.7%of cases (13 patients). For the 53 patients (80.3%) who underwentlaparoscopic hysterectomy, the average duration of the operationwas 152.24±45.7 min, and the average weight of the uteruswas 2383±154.1 g. The duration of the laparoscopic operationwas correlated in a statistically significant fashion with theweight of the uterus (P=0.0005), the necessity of associatedprocedures during the hysterectomy (P=0.01) and the surgeon'sexperience (P=0.01). These results demonstrate that laparoscopicsurgery decreases the number of laparotomies necessary for patientswith no previous vaginal delivery who require hysterectomy.When vaginal access is poor, simple laparoscopic preparationis inadequate and the only possibility of avoiding laparotomyis to carry out the hysterectomy entirely via the laparoscopicroute.     

Chronic ovarian torsion after vaginal hysterectomy: a case with metastatic serous ovarian cancer

Ovarian torsion refers to partial or complete rotation of the ovary on its ligamentous support, often resulting in partial or complete obstruction of its blood supply. It is one of the most common gynecologic surgical emergencies and may affect females of all ages, but it is relatively rare in postmenopausal women. Chronic adnexal torsion with complete occlusion of the ovarian blood supply results in necrosis and loss of ovarian function. Clinical symptoms and signs are not specific and definitive diagnosis is often challenging. In this case report, we present a 65-year-old woman with chronic ovarian torsion that was detected 7 years after vaginal hysterectomy. Approximately 3% of postmenopausal cases with adnexal torsion are associated with malignancy. Ovarian torsion incidence is low in postmenopausal ovarian cancer due to the progression of accompanying inflammation, which causes immobility of the ovarian mass.     

碳酸利多卡因复合吗啡硬膜外麻醉在子宫全切术中的应用研究

目的观察碳酸利多卡因复合吗啡硬膜外麻醉对全子宫切除术中牵拉反应和术后镇痛的影响。方法70例在硬膜外麻醉下行全子宫切除术的病人,随机分为两组,观察组用碳酸利多卡因复合吗啡,并用碳酸利多卡因作对照组。观察术中牵拉腹膜、缝合残端、探查腹腔等主要手术操作步骤时的牵拉反应,并记录两组病人的镇静评分和术后24h的镇痛效果。结果观察组和对照组在牵拉腹膜、缝合残端、探查腹腔时,出现牵拉反应Ⅰ、Ⅱ级的机率分别为16.6%、66.6%;0%、66.6%;33.3%、83.3%。观察组显著低于对照组(P<0.05);两组病人的镇静评分分别为1.0±0.1、3.4±0.2,有显著性差异(P<0.05);观察组较对照组术后止痛剂的需求量明显减少、开始止痛的时间明显延长,分别为:(48.57±18.66)mg、(85.67±24.30)mg;(18.0±3.97)h、(10.0±4.18)h;有显著性差异(P<0.05)。结论碳酸利多卡因复合吗啡用于全子宫切除术可明显减轻术中牵拉反应,延长术后的镇痛时间。     

Hysterectomy techniques used for benign pathologies: results of a French multicentre study.

The objective of this study was to assess the techniques by which hysterectomies are carried out and to determine the rate of total laparoscopic hysterectomy (TLH). A transversal multicentre study was conducted in 23 gynaecology and obstetrics departments of French University Hospital Centres. The study population comprised only those patients for whom hysterectomy was indicated for benign disease without genital prolapse or urinary stress incontinence. Whereas the rates of performance of hysterectomy by laparotomy and by the vaginal route are comparable [respectively 40.0% (94 patients) and 46.8% (110 patients)], the rate of performance of TLH is only 13.2% (31 patients). All 23 centres (100%) carried out hysterectomy by laparotomy and 21 centres (91.3%) carried out vaginal hysterectomy; however, only nine centres (39.1%) carried out TLH. Only seven centres (30.4%) performed all three types of operation. Of the eight centres whose rate of vaginal hysterectomy was >60%, six (75%) did not carry out TLH. The study suggests that the usage of the TLH technique appears to be limited. The extent of surgical training is a major factor in the choice of technique for hysterectomy.     

Surgery: Adenomyosis at hysterectomy: a study on frequency distribution and patient characteristics

To evaluate the prevalence and risk factors for adenomyosis,the clinical records of consecutive women undergoing hysterectomyduring a 3 year period were retrieved. Data were collected onindication for the intervention, general sociodemographic characteristicsof the patients, age at menarche, parity, abortions, and menopausalstatus at surgery. Adenomyosis was diagnosed in 332 of the 1334cases (24.9%). The condition was present in 146 of the 627 patients(23.3%) with fibroids and menorrhagia, 68 of the 265 (25.7%)with prolapse, 21 of the 98 (21.4%) with ovarian cysts, 19 ofthe 100 (19%) with cervical cancer, 31 of the 110 (28.2%) withendometrial cancer, 16 of the 57 (28.1%) with ovarian cancer,and 19 of the 77 (24.7%) with miscellaneous indications. Thesedifferences were not statistically significant (x²₆ = 11.14).In comparison with nulliparous women, the odds ratio was 1.3and 1.5 respectively in women with one and two births (x²₁ trend= 5.76, P < 0.05). No relationship was found between ageat surgery, age at menarche, indications for surgery, menopausalstatus at intervention, and presence of endometriosis. Our findingsdo not support the notion that adenomyosis is more frequentlyrelated to particular clinical conditions, and suggest thatparity may be associated with an increased frequency of adenomyosis.