阴式全子宫阴道顶端圆韧带悬吊术的探讨

子宫切除术是妇科常见的手术之一，近几年来，微创手术重新引起妇科领域的重视，阴式全子宫切除术越来越受到临床医师的青睐。临床工作中，我们注意到传统的阴式子宫切除术后，随着患者年龄的增长，其盆底越来越松弛，阴道残端脱垂、阴道穹隆脱垂的发生率越来越高。为此，我们自2003年1月～2004年1月对40例阴式全子宫切除的患者的阴道顶端行圆韧带悬吊术，经随访观察发现此术式可有效地防止阴道残端脱垂、阴道穹隆脱垂的发生，改善阴道的长度。现报告如下。     

新辅助化疗加腹腔镜手术治疗晚期阴道残端癌一例

原发性阴道恶性肿瘤较为罕见,约占女性生殖器官恶性肿瘤的1%~2%,鳞状细胞癌是最常见的组织学类型,约占所有阴道肿瘤的90%[1]。阴道残端癌是指全子宫切除后发生于阴道残端的恶性肿瘤[2]。因“子宫脱垂、子宫肌瘤”行全子宫切除术后10年发生的阴道残端癌更为少见,故目前尚无统一的治疗方案。现将兰州大学第一医院(我院)妇产科收治的1例晚期阴道残端癌报告如下。一般情况患者女,74岁,因“全子宫切除术后10年,阴道不规则出血1年余”,于2017年11月10日入院。患者自诉10年前因“子宫脱垂、子宫肌瘤”行全子宫切除术;1年前无明显诱因开始出现阴道不规则出血,量少,色暗红;半年前出现阴道异常流液,量多,色淡黄,有臭味,且阴道出血较前加重。     

全子宫切除术后输卵管脱垂四例

一、病例摘要 病例1：患者43岁,于2005年3月因多发性子宫肌瘤于外院行开腹全子宫切除术,手术顺利,术后给予抗炎治疗,患者术后体温正常。术后1个月逐渐出现阴道分泌物增多,粉色,就诊于北京大学人民医院,妇科检查：阴道断端可见肉芽样组织。于2005年5月在腰麻下行阴道断端肿物切除术＋阴道残端修补术,术中探查肿物为输卵管,完整切除后可见输卵管组织充血水肿。     

阴式子宫切除术后10个月性交出现阴道穹窿破裂

阴式子宫切除术后性交而致阴道破裂出血是非常少见的 ,作者报道 1例 37岁白人妇女 ,孕 2产 2 ,经阴式子宫切除术后 1 0个月 ,主诉性交后疼痛和粉红色阴道分泌物排出。她因子宫脱垂 ,进行性痛经和持续右附件疼痛 ,行子宫切除术和右输卵管、卵巢切除术。术后 8周因性欲减退、抑郁、焦虑而就诊 ,检查发现阴道残端愈合良好 ,但阴道粘膜萎缩 ,怀疑有卵巢早衰倾向 ,病人开始每日用雌激素治疗。病人有甲状腺功能减退病史 ,服用甲状腺素片 ,曾在腹腔镜下做过两侧输卵管结扎术和卵巢囊肿切除术及阴式子宫切除术和右附件切除术。病人有两胎足月臀位分…     

残端宫颈切除术手术方法的探讨

目的:探讨子宫次全切除术后经腹或经阴道行宫颈残端切除术的适应证及并发症的预防。方法:回顾分析2004年1月至2013年12月温州医科大学附属第二人民医院及温州医科大学温州市第三临床医院收治的行宫颈残端切除术的80例患者的临床资料。结果:80例行宫颈残端切除术的患者中,28例行经阴道宫颈残端切除术,其中17例宫颈残端脱垂、5例宫颈残端肌瘤及6例宫颈CINIII级;52例均行经腹宫颈残端切除术,其中11例宫颈残端鳞癌(IA~IIA期)、18例宫颈残端肌瘤、16例CINIII级、4例卵巢肿瘤和1例子宫内膜异位囊肿、2例子宫内膜腺癌(IA期)。患者均未发生术后并发症。经阴道与经腹宫颈残端切除术相比,术中出血量显著减少,住院时间明显缩短,差异均有统计学意义(P0.05)。结论:宫颈残端脱垂是经阴道宫颈残端切除术的主要适应证,而宫颈残端癌、宫颈残端肌瘤及CINIII级是经腹宫颈残端切除术的主要适应证。经阴道行宫颈残端切除术并发症相对较少。     

腹腔镜和阴式全子宫切除术后阴道残端愈合的临床观察

目的探讨腹腔镜全子宫切除术和阴式全子宫切除术后阴道残端愈合情况。方法选择2013年1月~2015年2月在我院行腹腔镜全子宫切除术患者112例为腹腔镜组,同期选取在我院行阴式全子官切除术患者64例为阴式组。观察两组患者术后阴道残端肉芽组织发生、残端息肉形成、阴道流血流液等发生率。结果两组患者子宫切除术均获得成功,所有患者的阴道残端愈合情况相似,差异无统计学意义(P0.05)。结论对于单纯需要进行全子宫切除术的患者来说,这两种手术方法取得的效果相当,在临床上具体选择哪一种手术方式,还需要根据患者的实际情况来确定,以达到最佳疗效。实施腹腔镜手术的腹腔镜组患者阴道残端病率较低,即阴道残端出血量少,术后随访患者阴道残端肉芽增生少。     

阴道顶脱垂

阴道顶脱垂是指腹、阴子宫全切除后阴道穹窿的下垂和阴道翻出。广义上还包括子宫次全切除后残留宫颈的脱垂。是子宫脱垂治疗失败后的一种类型,多发生于阴式子宫切除术后,约占56～62%。阴道顶脱垂的发病率不高,文献报道约占妇科病人的0.2%,或占阴式子宫切除术的2～6.7%。它的发生使患者再度遭受极大痛苦,严重影响妇女身心健康。近年来随着阴式子宫切除的普遍开展,本症的发病有增加趋势。国外对此已有较多研究,而国内系统报道尚少。至今,手术仍是阴道顶脱垂的主要治疗手段,方法达数十种之多,然各家意见尚未统一,术后也仍有部     

宫颈残端切除9例临床分析

目的:探讨子宫次全切除术后需行宫颈残端切除的原因,宫颈残端病变的临床表现、治疗方法和预防。方法:回顾性分析1993年1月至2005年12月本院收治的9例行宫颈残端切除的患者的临床资料。结果:3例为宫颈残端平滑肌瘤复发,2例为宫颈残端鳞癌,另外2例于子宫次全切除术后病理检查诊断为子宫肉瘤,2例为子宫平滑肌瘤合并子宫内膜腺癌。主要表现为腹胀、尿潴留、阴道不规则流血、阴道流液和接触性出血、盆腔包块。以手术治疗为主,术后补充放疗、化疗。结论:严格掌握子宫次全切除术的指征,术前、术中不漏诊子宫、宫颈恶性肿瘤,术后应严密随访,及时发现处理宫颈残端病变。     

阴式全子宫切除术后输卵管脱垂7例分析

目的通过对阴式全子宫切除术后输卵管脱垂患者7例的分析,探讨输卵管脱垂发生的原因、预防及处理措施。方法归纳及分析阴式全子宫切除术后输卵管脱垂患者7例的临床资料。结果阴式全子宫切除术后输卵管脱垂患者7例均成功经阴道处理,术后恢复良好。结论对于阴式全子宫切除术后输卯管脱垂病例,完全可经阴道处理。手术前治愈阴道炎将有助于预防输卵管脱垂的发生。     

阴式子宫切除术适应证及并发症探讨

目的:探讨阴式子宫切除术的适应证、并发症及防治。方法:对187例非脱垂子宫行阴式子宫切除手术,其中单纯阴式子宫切除术143例,阴式子宫切除加阴道前壁修补术11例、加附件手术33例。187例中有腹部手术史者36例。子宫大小如孕9～12周136例、孕12～16周51例。结果:187例均经阴道手术无改开腹手术者。手术时间平均87分钟(40～170分钟),术中出血量平均174ml(80～400ml),子宫体积平均455cm3(115～1440cm3)。2例膀胱损伤于术中修复,2例术后阴道流血,再次经阴道手术止血。结论:阴式子宫切除术手术适应证的拓宽,使得手术难度相应增加,术中临近脏器损伤及术后阴道流血的防治,应引起临床医生的足够重视。     

Management of tubal prolapse after hysterectomy

Uterine tube prolapse into the vaginal vault is an uncommon complication after hysterectomy, and our 6 patients bring to 90 the number of cases reported in the literature. Symptoms consist almost exclusively of vaginal bloody discharge and/or leukorrhea, persistent pelvic pain, and dyspareunia. Surgical treatment must be individualized according to the patient's symptoms. In our series, sexually active women with pelvic pain and dyspareunia had the best outcome when a combined laparoscopic and vaginal approach was used.     

Tubal prolapse after total laparoscopic hysterectomy

Prolapse of a uterine tube is a rare event after hysterectomy with adnexal conservation. It has been described in the literature after abdominal or vaginal hysterectomy. We report two cases occurring after total laparoscopic hysterectomy. Both patients presented with pelvic pain and vaginal discharge. The diagnosis was clinically suspected and was investigated using transvaginal ultrasonography. The diagnosis may be helped by histopathology. The diagnosis was confirmed by laparoscopy, and both patients were managed laparoscopically without complications.     

From laparoscopic assisted radical vaginal hysterectomy to vaginal assisted laparoscopic radical hysterectomy

Radical hysterectomy with pelvic lymphadenectomy is the standard surgical treatment for patients with early stage cervical cancer. The majority of radical hysterectomies are performed with the open technique. However, laparoscopic, combined laparoscopic and vaginal, and robotic-assisted approaches may also be used. Compared with the abdominal radical hysterectomy (ARH), laparoscopic techniques are associated with less blood loss, shorter hospital stay, better cosmesis, and faster recovery. A further breakthrough in laparoscopic technique can only be made if safety and oncological clearance are comparable with ARH. We describe the technique and results of laparoscopic assisted radical vaginal hysterectomy and the transition to vaginal assisted laparoscopic radical hysterectomy.     

阴式广泛全子宫切除加腹腔镜下淋巴结切除术与开腹手术治疗早期宫颈癌疗效比较

目的探讨阴式广泛全子宫切除加腹腔镜下淋巴结切除术治疗早期宫颈癌的临床价值。方法 2004年11月至2011年4月于佛山市妇幼保健院,回顾性分析行阴式广泛全子宫切除加腹腔镜下淋巴结切除术的90例早期宫颈癌患者(阴式组)的病例资料,抽取同期行开腹广泛全子宫切除加盆腔淋巴结切除术42例(开腹组)作为对照。结果两组手术时间差异无统计学意义(P>0.05)。阴式组术中出血量[(348±114)mL]、肠道功能恢复时间[(36.76±4.9)h]、住院天数[(10.56±2.10)d]均少于开腹组的[(398±127)mL]、[(40.09±6.5)h]、[(11.79±2.45)d],差异有统计学意义(P<0.05)。阴式组切除阴道长度[(3.12±0.17)cm]大于开腹组的[(3.05±0.21)cm](P<0.05)。阴式组尿潴留发生率(30.0%)较开腹组(11.9%)高(P<0.05)。阴式组术后5年内复发率(14.6%)低于开腹组(31.5%)(P<0.05)。结论阴式广泛全子宫切除加腹腔镜下淋巴结切除术式创伤小,术后恢复快,手术彻底,有临床应用价值。     

Renaissance der Operation nach Schauta

100 years of radical vaginal hysterectomy according to Schauta is an occasion to evaluate the value of this “forgotten” surgical technique. The possibility of laparoscopic removal of paraaortic and pelvic lymph nodes in patients with cervical cancer opened the way for the reintroduction of “Schauta's operation”. In a curative approach to primary tumors lymphonodectomy is performed laparoscopically. In presence of negative lymph nodes and if bladder and rectum are free of disease laparoscopic assisted radical vaginal hysterectomy is performed. A combination of laparoscopic and vaginal surgical techniques permits individualized, risk-adjusted approaches to cervical carcinoma. Even in cases of large tumors, a nerve-sparing approach to radical vaginal hysterectomy results in maintenance of motoric bladder function with high surgical radicality and locoregional safety. It is possible to surgically treat early tumor states by laparoscopically assisted radical trachelectomy to preserve fertility when oncological standards are observed. At present, the laparoscopically assisted radical vaginal hysterectomy and the well-established abdominal Wertheim operation represent two oncologically equivalent surgical procedures available for treatment of early cervical carcinoma.     

Laparoscopically assisted modified radical vaginal hysterectomy (type II) with pelvic lymphadenectomy: ultrasonic operative technique

OBJECTIVE: The aim of this study was to incorporate an ultrasonic operative laparoscopic technique to complete a type II laparoscopically-assisted modified radical vaginal hysterectomy (LARVH) and pelvic lymph node dissection (PLND) in early cervical cancer. METHODS AND MATERIALS: LARVH type II and PLND using a laparoscopic ultrasonic operative technique and conventional vaginal surgery were indicated in five cases of early cervical cancer (IA2). RESULTS: Complete pelvic lymphadenectomy and the laparoscopic phase of modified radical vaginal hysterectomy were successfully performed using ultrasonic instruments in all women. Uterine artery and ureteral dissection with resection of the cervicovesical fascia, cardinal and uterosacral ligaments were successful with ultrasonically activated instruments only. CONCLUSION: Our initial experience with laparoscopically assisted radical vaginal hysterectomy type II confirmed that the use of a minimally invasive ultrasonic technique is feasible. Further investigations into the indications of disease where laparoscopic surgery is appropriate in the management of early cervical carcinoma are required.     

Pyosalpingitis after interadnexal laparoscopic hysterectomy. Two cases

The prolapse of a uterine tube is a rare event after hysterectomy with adnexal conservation. It is described in the literature after abdominal or vagina hysterectomy. We report two cases occurring after laparoscopic hysterectomy, and complicated by pyosalpingitis. Patients have presented with pelvic pain and vaginal discharge. Diagnosis was not easy, clinically suspected with the transvaginal ultrasonography, and confirmed by celioscopy. It may be helped by biopsy. The laparoscopic management was carried out without complications.     

Laparoskopische Operationsverfahren in der Gynäkologie

The international significance of, for example, vaginal surgical techniques has been increased by laparoscopy. Surgery for extrauterine pregnancy, or adnexectomy and partial adnexal resection are only carried out with a laparotomy in exceptional cases; for the therapy of benign uterine diseases this is used in less than 10% of cases. The spectrum of laparoscopy ranges from endometrial ablation over hysteroscopic resection and laparoscopic enucleation of myomas, to the various types of hysterectomy: laparoscopic assisted vaginal hysterectomy (LAVH), laparoscopic assisted supracervical hysterectomy (LASH) and total laparoscopic hysterectomy (TLH). In addition, tumor surgery can be carried out, either partially or completely, using laparoscopy. Laparoscopic pelvic and para-aortic lymphadenectomy are also established techniques. Endoscopic surgical techniques are still not as widely used as could be. In 2003, 60% of hysterectomies in Germany still involved abdominal surgery. Future developments in operative techniques require our particular attention, as do the establishment of already evaluated procedures in their total breadth, especially in the training of the younger generations of gynecologists.     

Laparoscopically assisted vaginal hysterectomy versus abdominal hysterectomy in stage I endometrial cancer

Abstract. Fram KM. Laparoscopically assisted vaginal hysterectomy versus abdominal hysterectomy in stage I endometrial cancer.
The purpose of this study was to evaluate and compare laparoscopic treatment for stage I endometrial cancer with the traditional transabdominal approach. From July 1996 to July 1998, 61 patients with clinical stage I endometrial cancer were treated at the Gynaecology Oncology Unit at the Royal North Shore of Sydney, Australia. Twenty-nine patients were treated with laparoscopic assisted vaginal hysterectomy (LAVH) and bilateral salpingo-oophrectomy (BSO) ± laparoscopic pelvic lymphadenectomy (LPLA), while 32 patients were treated with the traditional laparotomy and underwent total abdominal hysterectomy (TAH) and BSO ± pelvic lymphadenectomy (PLA). The main outcomes studied were operative time, blood loss, blood transfusion, intraoperative complications, postoperative complications, duration of hospital stay, and number of lymph nodes obtained. In conclusion, laparoscopic treatment of endometrial cancer is safe in the hands of experienced operators with minimal intraoperative and postoperative complications. This procedure is associated with significantly less blood loss and shorter hospitalization; however, it is associated with significantly longer operating time. Proper selection of patients for the laparoscopic procedure is the vital step in achieving the major goals of this approach.     

Recovery from vaginal hysterectomy compared with laparoscopy-assisted vaginal hysterectomy: a prospective, randomized, multicenter study

OBJECTIVE: To evaluate short-term recovery of vaginal hysterectomy with those of laparoscopic assisted vaginal hysterectomy performed in a prospective, randomized multicentric study. STUDY DESIGN: Eighty patients referred for hysterectomy for benign pathology were randomized to either vaginal hysterectomy (40 patients) or laparoscopic assisted vaginal hysterectomy (40 patients). Inclusion criteria were uterine size larger than 280 g and one or more of the following: previous pelvic surgery, history of pelvic inflammatory disease, moderate or severe endometriosis, concomitant adnexal masses, and indication for adnexectomy. No upper limit of uterine size was set. All the laparoscopic and the vaginal hysterectomies were done under endotracheal general anesthesia. RESULTS: There was no statistically significant difference in terms of patient's age, parity, postmenopausal state, indication for surgery and mean uterine weight between the 2 groups. Laparoconversion was performed in three women in the laparoscopic group. Operative time was significantly shorter in the vaginal versus the laparoscopic groups 108+/-35 and 160+/-50 respectively (p<0.001). The use of paracetamol, non steroidal anti-inflammatory drugs, and opioid during hospitalization were similar in the 2 groups. There was no difference in the 1st day hemoglobin level drop, time of passing gas and stool, or hospital stay between the 2 groups. CONCLUSION: In contrast with earlier reports, there was no difference in short-term recovery between patients undergoing vaginal or laparoscopic hysterectomy. No advantage was found performing laparoscopic assisted vaginal hysterectomy in comparison with the standard vaginal hysterectomy.