应用腹腔镜行困难子宫全切除术102例临床分析

目的:探讨应用腹腔镜行困难子宫全切除术的方法及手术原则。方法:对102例诊断为子宫内膜异位症、宫颈肌瘤、阔韧带肌瘤及盆腔粘连、剖腹产术后行腹腔镜全子宫切除手术的病例进行临床分析。结果:102例患者全部行腹腔镜下子宫全切除术,平均手术时间(158.3±43.7)m in,术中出血量平均(236.6±87.8)m l,术后平均住院时间(6.4±2.2)d。无1例出现输尿管、膀胱、直肠等脏器损伤。结论:复杂及困难的全子宫切除术也可在腹腔镜下完成。熟悉盆腔解剖、熟练掌握腹腔镜操作技巧、灵活运用各种手术器械是手术成功的重要保证因素。     

腹腔镜子宫肌瘤切除术48例临床分析

目的:探讨腹腔镜子宫肌瘤切除术的手术方法、适应证、手术技巧及临床疗效。方法:选择2011年1月至2011年12月行腹腔镜子宫肌瘤切除术的48例患者,其中多发肌瘤7例,浆膜下肌瘤1例,阔韧带肌瘤1例,肌壁间肌瘤39例(多发13例,前壁单发10例,后壁单发16例)。结果:48例手术均获成功,术中出血量平均(62±37)ml,手术时间平均(102±29)min,术后住院4～7 d。结论:正确把握手术适应证,腹腔镜子宫肌瘤切除术安全、有效,具有安全性高、住院时间短、术后并发症少等优点。     

后腹腔镜及手助腹腔镜肾上腺切除术治疗肾上腺肿瘤(附21例报告)

目的 :探讨腹腔镜微创手术治疗肾上腺肿瘤的适应证及手术方法。方法 :对 18例直径小于 6cm的肾上腺肿瘤患者行后腹腔镜肾上腺切除术 (后腹腔镜组 ) ;对 3例最大直径为 10～ 17cm的肾上腺肿瘤患者行手助腹腔镜肾上腺切除术 (手助腹腔镜组 ) ,并观察手术时间、术中出血量、胃肠功能恢复时间和住院时间。结果 :2 1例患者中 ,2 0例成功。其中后腹腔镜组手术时间 2 5～ 135min ,平均 (82 .8± 31.1)min ,术中出血量 6 5～ 16 0ml,平均 (113.4± 31.8)ml,均未输血。手助腹腔镜组手术时间 180～ 2 10min ,术中出血量 80～ 6 0 0ml。两组患者均于术后 2天排气 ,1～ 3天下床活动 ,术后住院 3～ 7天。结论 :与开放手术相比 ,后腹腔镜肾上腺手术具有创伤小、出血少、恢复快等优点 ;手助腹腔镜为巨大肾上腺肿瘤切除提供了微创手术的新方式。     

非气腹腹腔镜子宫肌瘤切除术18例临床分析

目的:探讨非气腹腹腔镜子宫肌瘤切除术的应用价值。方法:回顾分析2005年6月至2006年5月实施非气腹腹腔镜子宫肌瘤切除术18例患者的临床资料,并在同期施行气腹式腹腔镜子宫肌瘤切除术病例中筛选条件相仿的30例作为对照组。结果:两组病例均用腹腔镜完成手术,无一例中转开腹,最大肌瘤直径和肌瘤数与手术时间及术中出血量呈正相关,非气腹组的平均手术时间较气腹组长,分别为(129±31)min、(109±27)min,两者差异有统计学意义(P<0.05);两组术中平均出血量差异无统计学意义。结论:具有开腹技巧及腹腔镜视野特点的非气腹内窥镜手术有着广阔的应用前景。     

腹腔镜下子宫肌瘤切除术120例临床观察

目的 :探讨腹腔镜下子宫肌瘤切除术的手术方法、适应证、术后疗效及影响因素。方法 :回顾分析腹腔镜下 1 2 0例子宫肌瘤切除术的临床资料 ,其中单发肌瘤 79例 ,多发肌瘤 4 1例 ,单发肌瘤包括肌壁间肌瘤 4 2例 ,浆膜下肌瘤 33例 ,阔韧带肌瘤 4例。结果 :除 1例阔韧带肌瘤靠近子宫动脉中转开腹外 ,余者手术均获成功 ,术中出血 92 2 0± 98 2 1ml ;手术时间 1 0 9 72± 4 5 0 7min ;术后肛门排气时间 1 85± 0 35d ;无术后病率 ;术后住院 4 85± 1 75d ;无严重并发症。结论 :腹腔镜下子宫肌瘤切除术是目前较为理想、安全有效的保留子宫的手术方法。术中出血量和手术时间主要与肌瘤生长部位及其大小有关。     

腹腔镜子宫肌瘤切除术术中先缝合子宫肌壁的应用价值

目的:探讨腹腔镜子宫肌瘤切除术的手术技巧及临床疗效。方法:回顾分析41例患者(观察组)腹腔镜子宫肌瘤切除术术中先缝合子宫肌壁的临床资料,并与常规腹腔镜子宫肌瘤切除术40例对照。结果:81例均顺利完成手术,无中转开腹及手术并发症发生。平均手术时间观察组(73.5±25.7)min,对照组(99.3±26.9)min(P<0.05);术中平均出血量观察组(40.7±21.3)ml,对照组(93.5±34.2)ml(P<0.05)。术后2组病率、肛门排气时间差异无统计学意义(P>0.05)。术后随访6～20个月,平均13个月,影像学检查示局部无肿瘤组织残留或肌瘤复发,无远期并发症发生。结论:先缝合子宫肌壁在腹腔镜子宫肌瘤切除术中具有手术时间短、术中出血少、易于掌握等优点,适于临床应用。     

腹腔镜下子宫肌瘤切除术120例临床分析

目的:探讨腹腔镜下子宫肌瘤切除术的可行性及临床效果。方法:回顾分析腹腔镜子宫肌瘤切除术120例(腹腔镜组)及同期开腹子宫肌瘤切除术120例(对照组)患者的临床资料,比较两组手术效果和术后康复情况。结果:(1)腹腔镜下切除浆膜下肌瘤和最大直径<6 cm肌瘤的平均手术时间短于对照组,术中出血量少于对照组(P<0.05);(2)腹腔镜下切除最大直径≥6 cm肌瘤的手术时间长于对照组,术中出血量多于对照组(P<0.05);(3)腹腔镜下切除肌壁间肌瘤的手术时间和术中出血量与对照组差异无显著性(P>0.05);(4)腹腔镜组患者术后的平均排气时间、住院时间短于对照组,术后使用镇痛剂的比例低于对照组(P<0.05),而术后病率、使用抗生素时间、住院费用及术后并发症发生率两组差异无统计学意义(P>0.05)。结论:腹腔镜下切除中等大小的子宫肌瘤,尤其是浆膜下肌瘤的手术时间短,患者出血少,术后康复快。     

腹腔镜下子宫切除128例体会

目的:讨论腹腔镜下子宫切除术式选择及临床应用体会。方法:我院自2002年5月至2005年5月对128例子宫良性疾病需子宫切除术的患者分别施行了鞘膜内子宫切除术、子宫次全切除术及腹腔镜辅助下阴式子宫切除术。结果:手术均获成功,平均手术时间为118m in,平均出血量为(60±10)m l,平均住院5d,无中转开腹,无副损伤。结论:腹腔镜下子宫切除术损伤小、出血少,恢复快,明显优于开腹手术。若正确选择术式,腹腔镜手术适应证明显扩大。     

腹腔镜下改良子宫肌瘤切除术91例临床分析

目的　探讨腹腔镜下改良子宫肌瘤切除术的手术技巧和疗效。　方法　通过对子宫切口设计、组织分离 剥离器使用、肌瘤营养血管处理等手术技巧和手术器械的改进 ,行腹腔镜下子宫肌瘤切除术 91例。根据术前B超检测 ,分成肌瘤径线≥ 70mm组和 <70mm组。　结果　术中共发现肌瘤 10 2个 ,其中肌壁间肌瘤 73个 (71 6 % )。手术时间为 (116 1± 4 5 7)min ,出血量 (81 7± 4 1 7)ml,术后住院时间 (8 0± 2 8)天 ,术后最高体温 (37 9± 0 5 )℃。肌瘤径线≥ 70mm组术中出血量 (95 2± 4 2 0 )ml ,<70mm组 (6 5 6± 31 7)ml(t=2 35 ,P <0 0 5 ) ;两组手术时间分别为 (119 1± 4 4 2 )min和 (112 9± 33 4 )min ,(t=0 6 9,P >0 0 5 )。　结论　腹腔镜改良子宫肌瘤切除术可缩短手术时间、减少术中出血 ,即使较大径线的子宫肌瘤也能达到较好的疗效。     

联合LigaSure TM血管闭合系统与微波刀行腹腔镜肝切除术的临床体会

目的:探讨联合应用LigaSure TM血管闭合系统与微波刀行腹腔镜肝切除术的临床价值。方法:回顾分析2005年8月至2012年3月应用LigaSure TM血管闭合系统与微波刀为36例患者行腹腔镜肝切除术的临床资料。结果:36例手术均顺利完成,无一例中转开腹、手术死亡及并发症发生,手术时间平均(95±22)min,术中出血量平均(314±136)ml,患者均于术后第1天开始进食,平均住院(8.5±1.2)d。结论:腹腔镜肝切除术中联合应用LigaSure TM血管闭合系统与微波刀处理肝断面及胆管安全、可靠,可明显缩短手术时间,减少术中出血,提高手术安全性。     

Laparoscopic blockage of uterine artery and myomectomy

Background The goal of this study was to evaluate the effects of laparoscopic coagulation or blockage of the uterine arteries and myomectomy in treating symptomatic myomas. Methods A total of 142 women with symptomatic fibroids warranting surgical treatment and wanting to retain their uteri were treated by laparoscopic coagulation or blocking of the uterine arteries and myomectomy. Results Most of the 142 patients had multi-myomas of the uterus, as intramural myomas (54), subserous myomas (65), and submucosal myomas (25). The number of myomas in each patient varied from 1 to 4. The size of the myomas in all patients ranged from 2 to 12 cm. In 86 cases (60.4%) the uterine wall was sutured in one layer. Average operating time was 124.2 ± 33.1 min, and average blood loss was 117.8 ± 48.6 ml. Mean postoperative hospital stay was 4.8 ± 1.2 days. All patients underwent technically successful laparoscopic coagulation or blocking of uterine arteries and myomectomy without intraoperative complications. The mean follow-up time was 16.2 months (16–26). Symptomatic improvement was achieved in all patients. Five patients experienced recurrence of myomas. Conclusions Laparoscopic coagulation or block of the uterine arteries and myomectomy appears to be a safe, effective, and promising new method for treating symptomatic uterine myomas.     

子宫动脉阻断在腹腔镜子宫肌瘤切除术中的应用体会

目的:探讨子宫动脉阻断在腹腔镜子宫肌瘤切除术中的应用价值。方法:回顾分析2007年3月至2009年3月为148例患者行腹腔镜子宫肌瘤切除术的临床资料,其中62例行传统腹腔镜子宫切除术(常规组),86例先行子宫动脉阻断后再行子宫肌瘤切除术(子宫动脉阻断组)。结果:常规组手术时间平均(84.27±29.52)min,术中出血量平均(148.38±31.5)ml;子宫动脉阻断组手术时间平均(68.32±21.36)min,术中出血量平均(69.11±27.52)ml;子宫动脉阻断组手术时间及术中出血量明显优于常规组(P<0.01)。结论:子宫动脉阻断后行腹腔镜子宫肌瘤切除术可明显减少术中出血,缩短手术时间,术野暴露清晰,具有较好的发展优势。     

Isobaric gasless laparoscopic myomectomy for removal of large uterine leiomyomas

Background This study aimed to evaluate the feasibility and safety of isobaric laparoscopic removal of large myomas (≥8 cm) using the Laparotenser, a subcutaneous abdominal wall-lifting system. Methods A series of 63 consecutive patients with at least one large symptomatic subserosal or intramural uterine myoma (≥8 cm) underwent an isobaric gasless laparoscopic myomectomy. Conventional laparotomy instruments were used. Results The procedure was successfully completed for all 63 consecutive patients. The average size of the dominant myoma was 11 cm. The mean number of myomas removed from each patient was 3.6. The mean blood loss was 143 ml, and the mean operating time was 72 min. No intraoperative complication occurred. Conclusions Gasless laparoscopic myomectomy for the removal of large myomas using the Laparotenser is feasible and safe. It offers several advantages over laparoscopy with pneumoperitoneum.     

腹腔镜下多发性子宫肌瘤切除术的手术体会

目的:探讨腹腔镜多发性子宫肌瘤切除术术中止血及残存肌瘤的处理方法。方法:66例患者中30例行开腹子宫肌瘤切除术,36例行腹腔镜手术。肌瘤最多12个,最少2个。腹腔镜组中18例行单纯腹腔镜子宫肌瘤切除术,18例行腹腔镜子宫肌瘤切除术加子宫动脉阻断术。腹腔镜子宫肌瘤切除术中结合B超监测。结果:开腹手术后平均住院(7.21±0.85)d,术后排气时间(31.15±7.26)h,腹腔镜术后平均住院(4.72±0.81)d,术后排气时间(21.13±5.36)h。单纯腹腔镜手术:平均手术时间(98±24)min,术中出血(129.7±58.6)ml,术后复发率26.3%。腹腔镜联合子宫动脉阻断术:平均手术时间(105.6±27.6)min,术中平均出血(87.52±18.35)ml,术后复发3.1%。结论:患者行腹腔镜多发性子宫肌瘤切除术后康复快。由于腹腔镜手术的进展,选择病例的范围更广泛,联合子宫动脉阻断术比单纯腹腔镜手术电切、分离、缝扎等安全可靠,且出血少,复发率低,术中B超监测降低了肌瘤切除术的漏切率。     

子宫动脉上行支结扎用于腹腔镜子宫肌瘤切除术的临床研究

目的:评估子宫动脉上行支结扎用于腹腔镜子宫肌瘤切除术的效果。方法:为74例患有症状性子宫肌瘤要求保留生育功能的患者行腹腔镜子宫肌瘤切除术。30例先结扎子宫动脉再切除肌瘤(结扎组);44例直接行肌瘤切除术(对照组)。结果:结扎组术中平均出血(152±90)ml,输血率3.3%,明显低于对照组(P0.01);平均手术时间[(95±15)min]及术后发热率(16.7%)与对照组差异无统计学意义(P0.05)。随访2~24个月,结扎组症状改善率93.3%,复发率10.0%,与对照组相比差异有统计学意义(P0.05)。结论:腹腔镜子宫动脉结扎用于肌瘤切除术安全、可行,可有效减少术中出血,降低复发率。     

Laparoscopic myomectomy with lateral dissection of the uterine artery.

BACKGROUND: We assessed the results and impact of lateral uterine artery dissection on clinical outcome following laparoscopic myomectomy. METHODS: We retrospectively analyzed the clinical data for 27 laparoscopic myomectomy cases (Group I) and 54 laparoscopic myomectomy cases combined with lateral uterine artery dissection (Group II) between January 2001 and August 2004 in one center. Only 81 patients who had dominant fibroids between 4 cm and 10 cm in diameter were included in the study. We assessed the clinical outcomes: perioperative blood loss, operating time, hospital stay, complications, hemoglobin decrease, inflammatory response, and tissue markers (C-reactive protein, white blood cells, creatinine kinase) changes. RESULTS: The mean operating time was 70.37 minutes in group I and 78.61 minutes in group II. The mean length of hospital stay was 2.7 days versus 2.2 days, respectively (P>0.05). The difference in intraoperative blood loss was 70.1 mL (147.7 mL vs 77.3 mL, Group I) and 33.9 mL (105 mL vs 71.1 mL, Group II); estimated postoperative blood loss was statistically significant (P<0.001, P<0.05, respectively). Group 2 demonstrated a less intense stress response in C-reactive protein (P<0.001) and white blood cell count (P<0.05). CONCLUSION: The dissection of the uterine artery in laparoscopic myomectomy is a feasible operative procedure with a low rate of complications. The procedure reduced perioperative blood loss and resulted in significant improvement in fibroid-related symptoms.     

经阴道与腹腔镜下子宫肌瘤剔除术的对照研究

目的探讨经阴道与腹腔镜下子宫肌瘤剔除术的疗效及临床应用价值。方法回顾分析2007年3月～2008年10月58例经阴道子宫肌瘤剔除术(阴道组)和55例腹腔镜下子宫肌瘤剔除术(腹腔镜组)的临床资料,对2组患者的手术时间、术中出血量、剔除肌瘤重量、术后病率、肛门排气时间、住院时间、住院费用等进行对照分析。结果 2组术后肛门排气时间、住院时间均无统计学差异(P=0.056,P=0.067),但经阴道组手术时间(62±13)min显著短于腹腔镜组(97±18)min(t=-11.895,P=0.000),术中出血量(105±30)ml显著少于腹腔镜组(180±25)ml(t=-14.396,P=0.000),术后病率(48.3%)显著高于腹腔镜组(23.6%)(χ2=7.410,P=0.006),住院费用(5216.4±28.5)元显著低于腹腔镜组(7421.6±31.2)元(t=-392.597,P=0.000)。结论 2种术式各有适应证而不可完全互相替代,但从卫生经济学角度而言,经阴道手术可作为治疗的首选术式,并值得在临床推广应用。     

Developments in techniques for laparoscopic myomectomy.

OBJECTIVES: Conflicting opinions about laparoscopic myomectomy (LM) are still present regarding indications and risks related to reproductive outcome. We reviewed our 13-year experience (1) to identify risk factors or changes in methods that have improved our myomectomy technique and (2) to evaluate how the learning curve and improved surgical devices influenced our procedures, and (3) to study the myomectomy scar with a power color Doppler ultrasound (US). METHODS: From January 1991 to December 2003, we studied 332 patients who underwent laparoscopic myomectomy. We analyzed, as the learning curve, how the introduction of the Steiner morcellator, the use of vasoconstrictive agents, and different techniques of suturing have influenced parameters such as operating time and blood loss. RESULTS: We performed 332 single or multiple myomectomies for symptomatic myomas. Most patients (47%) had more than one myoma, with a maximum of 8 per patient (average myomas removed for patients: 2.23, range 1 to 8). Myoma size ranged from 1cm to 20 cm (mean, 60.20+/-SD27.1 mm). Myomas <4cm were removed during myomectomy for larger ones. The conversion rate to laparotomy was 1.51%. The average drop in hemoglobin concentration was 1.06+/-SD0.86 g/100 mL (range, 0.7 to 2.2 g/100 mL). No blood transfusions were required. No major intraoperative complications occurred. The duration of the procedure ranged from 30 minutes to 360 minutes (mean, 124+/-SD52.6). The dimensions of the myomas removed increased with experience (4.91+/-SD2.2 cm of the earlier cases to 6.76+/-SD2.7 of the latest group, P<0.000). The learning curve positively influenced the length of the procedures in the first cases. The introduction of electromechanical morcellation in 1996 reduced the procedure time. Data showed significantly reduced Hb drop after the introduction in 1998 of vasoconstrictive agents (DeltaHb 1.62 g/100 mL versus 0.95; P<0.001). The running suture offered few advantages in terms of procedure time. However, the drop in hemoglobin was advantageous (DeltaHb 1.1 g/100mL vs 0.61, P<0.01). The overall rate of intrauterine pregnancy following LM was 65.5%. No uterine ruptures occurred. We had 2 serious postoperative complications. CONCLUSION: With increased experience, the technical improvements and clinical results have changed our approach and decision making regarding laparoscopic myomectomy. Our results and extremely low conversion rate suggest that laparoscopic myomectomy is a safe and reliable procedure even in the presence of multiple or enlarged myomas.