改良腹腔镜大子宫全切除术与开腹手术的比较

目的:比较改良腹腔镜大子宫全切除术与开腹大子宫切除术的临床疗效,探讨改良方法的可行性。方法:选择2006年1月至2010年3月我院收治的因子宫肌瘤、子宫体积如孕13～22周的患者230例,按照患者的经济情况分为改良腹腔镜组(146例)和开腹组(84例),比较两组术后子宫重量、手术时间、术中出血量、术后病率、住院时间以及围手术期并发症的发生率。结果:改良腹腔镜组143例完全在腹腔镜下完成手术,3例经腹腔镜辅助腹部小切口完成。改良腹腔镜组术中出血量[(136.9±53.6)ml vs(199.5±66.0)ml],排气时间[(23.8±6.1)hvs(30.2±7.7)h],术后24h中、重度疼痛发生率(8.2%vs 56.0%),术后病率(4.8%vs 19.0%)以及住院时间[(5.5±1.3)天vs(8.0±1.4)天]均显著低于开腹组(P<0.01)。两组手术时间、子宫重量、围手术期并发症无统计学差异(P>0.05)。结论:改良腹腔镜大子宫切除术安全、可行,但需要加强术前病情评估、掌握针对大子宫特点的手术方法和技巧。     

腹腔镜下子宫次全切除术与腹腔镜辅助阴式子宫切除术的比较

目前欧美内镜技术先进的医院,70%的妇科剖腹手术已由腹腔镜手术所取代[1]。随着微创技术的不断开展,阴式子宫切除术的开展日趋广泛[2]。2000年10月至2004年12月我院共行腹腔镜子宫切除术112例[腹腔镜下子宫次全切除术(LSH)和腹腔镜辅助阴式子宫切除术(LAVH)],现报道如下。1资料     

腹腔镜辅助阴式子宫切除术与阴式子宫切除术适应证的探讨

目的通过比较腹腔镜辅助阴式子宫切除术(LAVH)与阴式子宫切除术(VH)的不同手术适应证及效果,探讨LAVH与VH手术病人的最佳选择。方法回顾性分析上海瑞金医院1999年6月至2002年12月间LAVH与VH手术病例381例,比较两种手术在手术时间、出血量、术后住院日、术中术后并发症及两者的手术适应证,尤其是子宫大小、盆腔粘连等的不同。结果两组手术在术中出血、手术并发症等方面差异无显著性意义,LAVH手术时间较长与患者子宫大、盆腔粘连者多、手术难度大有关。VH组患者均为正常或小于正常大小的子宫、无盆腔粘连、不伴有附件疾病者,手术适应证明显受限制。结论VH与LAVH均为创伤小、恢复快的微创手术,但VH适合于子宫小、无粘连并伴下垂者,而LAVH扩大了VH的适应证,是值得推广的手术。     

腹腔镜全子宫切除术1006例分析

目的:评价腹腔镜全子宫切除(LTH)和腹腔镜辅助阴式子宫切除(LAVH)两种术式的临床效果。方法:回顾分析两种腹腔镜子宫切除术1006例的手术时间、出血量、并发症及术后恢复情况等。结果:两组手术时间、并发症差异无显著性(P>0.05)。LTH组出血量193.13±38.21ml,LAVH组出血量156.24±23.3 ml,两组相比差异有显著性(P<0.01)。LTH组术后体温37.6±0.5℃,肠道恢复时间35.71±6.92小时,术后住院日4.1±0.4天;LAVH组术后体温37.9±0.8℃,肠道恢复时间39.37±8.53小时,术后住院日4.7±0.6天。两组相比,术后体温、肠道恢复时间、术后住院日差异均有非常显著性(P<0.01)。结论:LTH组优于LAVH组,如果腹腔镜下操作技巧熟练,LTH是一种理想的全子宫切除术式。     

腹腔镜子宫切除术两种手术方式疗效的比较研究

目的:探讨腹腔镜全子宫切除术(TLH)及腹腔镜辅助阴式全子宫切除术(LAVH)两种手术方式的疗效.方法:160例有全子宫切除手术指征的子宫肌瘤患者分为TLH组(80例)和LAVH组(80例),对比观察两组手术时间、术中出血量、肛门排气时间、术后住院时间及随访情况.结果:TLH组术中出血量及手术时间均小于LAVH组,差异有统计学意义(P＜0.05);而两组术后肛门排气时间及住院时间相比,差异无统计学意义(P＞0.05).术后3个月复查,两组患者阴道残端愈合均良好.结论:两种手术方式均有效、微创.TLH具有术中视野清晰、出血少、手术时间短的优点.应根据患者病情、医生的腹腔镜操作熟练程度及医院的设备等因素综合考虑,为患者提供最佳的手术方案,以达到最好的治疗效果.     

改良腹腔镜辅助阴式子宫切除术行大子宫切除89例临床观察

目的:探讨改良腹腔镜辅助阴式子宫切除术(LAVH)行大子宫切除的临床效果.方法:收集2007年9月至2012年3月在我院行子宫切除术的子宫腺肌病或子宫肌瘤(子宫均≥20孕周)患者175例的临床资料,其中传统经腹子宫切除术(TAH) 86例(对照组),改良LAVH 89例(研究组),比较两组术中、术后情况.结果:两组手术均顺利完成,均无严重并发症发生.研究组与对照组比较,术中出血量明显减少(P＜0.05),肛门排气时间短(P＜0.05).研究组术后无痛率明显高于对照组(P＜0.01),剧烈疼痛率明显低于对照组(P＜0.01).结论:改良LAVH作为一种大子宫切除术式,具有有效、微创、安全、术后恢复快等优点.     

阴式大子宫切除术58例临床分析

近年国内外越来越多地报道了阴式大子宫切除术的安全性及可行性。以往阴式子宫切除术（TVH）多限于子宫脱垂的小子宫患者。随着技术水平的提高与手术方法改进，非脱垂的大子宫也能顺利地经阴道切除，现将我院施行的58例阴式大子宫切除术的经验报道如下。     

子宫腺肌病与子宫肌瘤的临床及实验室比较分析

探讨子宫腺肌病与子宫肌瘤的临床特点及实验室检查的价值,提高子宫腺肌病的术前诊断率。方法对比分析２５例子宫腺肌病患者和３１例子宫肌瘤患者的临床资料。结果两组患者发病年龄及临床表现相近,但子宫腺肌病的痛经症状明显。Ｂ超的诊断符合率子宫肌瘤组和子宫腺肌病分别为８７．５％和６０．０％,两者相比,有明显差异。     

Laparoscopic Radical Hysterectomy versus Abdominal Radical Hysterectomy: A Non-randomized Study

This study compared results obtained with laparoscopic radical hysterectomy (LRH) versus abdominal radical hysterectomy (ARH) to determine the applicability of LRH as an alternative for treatment of early stage cervical cancer. A class III LRH technique is described. Between January 1994 and November 1996, 49 radical hysterectomies were performed at Notre-Dame Hospital for Stage IA₂ and IB₁ cervical cancer. Three patients were excluded from the study because LRH was offered as an alternative only when the Quetelet Index (QI) was equal to or less than 33. Twenty-three patients were scheduled for LRH and 23 for ARH. Both groups were comparable for age, QI, stage, tumour diameter and histology. The mean operating time was 390 minutes for LRH and 240 minutes for ARH (p = 0.0001 ). Blood loss was less in the LRH group (475 cc versus 1,060 cc, p = 0.0001). One LRH patient required an immediate laparotomy to secure haemostasis. In the LRH group, one eventration occurred as well as two unusual neurological complications. The post-operative stay was shorter for LRH (p = 0.0265). The numbers of para-aortic and pelvic nodes obtained were comparable. There were three recurrences, one in the LRH group and two in the ARH group. The average follow-up was 49 months in both groups. With experience, the mean operating time, complication rate, need for analgesia and length of hospital stay decreased considerably with the LRH procedure. Cosmetic results were superior. This procedure remains time consuming and difficult to perform, limiting its applicability as an alternative to ARH for the treatment of early stage cervical cancer. Ongoing research is suggested.     

腹腔镜Semm式子宫切除与经腹Semm式子宫切除比较

目的 :探讨腹腔镜 Semm子宫切除术在妇科领域的应用价值。方法 :回顾性分析比较腹腔镜 Semm式子宫切除 72例 (N1组 )和经腹 Semm式子宫切除 49例 (N2组 )患者的手术情况及术后情况。结果 :N1组平均年龄 44 .13± 3.6 8岁 ,N2组平均年龄 45 .2 7± 3.13岁。N1组中子宫肌瘤 47例 ,子宫腺肌病 2 0例 ,子宫肌瘤合并腺肌病 5例 ,N2组中子宫肌瘤 36例 ,子宫腺肌病 10例 ,子宫肌瘤合并腺肌病 3例 ,其组成比例无差别 ;N1组子宫平均大小孕 9± 1.7周 ,N2组子宫平均大小孕 10± 2 .1周 (P<0 .0 5 )。N1组手术平均时间 82 .2 4± 2 4.0 6分钟 ,N2组手术平均时间 10 4.0 0± 17.39分钟(P<0 .0 5 ) ;N1组术中出血 86 .11± 49.6 3ml,N2组术中出血 16 5 .31± 72 .32 ml(P<0 .0 5 )。N1组术后平均 1.2 9± 1.40天体温恢复正常 ,N2组术后平均 2 .76± 1.2 0天体温恢复正常 (P<0 .0 5 )。N1组术后住院天数为 10 .5 6± 2 .0 8天 ,N2组术后住院天数为 12 .37± 1.72天 (P<0 .0 5 )。结论 :腹腔镜下子宫切除采用 Semm式方法进行 ,安全且手术效果好 ,在适当病例中可取代经腹手术     

Predictive Factors for Morcellation during Total Laparoscopic Hysterectomy: A Cohort Study

ObjectivesOur objective was to identify predictors of morcellation during a total laparoscopic hysterectomy (TLH).MethodsA retrospective cohort study (Canadian Task Force classification II-2) taking place in a university hospital center in Quebec, Canada. Participants were women undergoing a TLH for a benign gynaecologic pathology from January 1, 2017, to January 31, 2019. All women underwent a TLH. If the uterus was too voluminous to be removed vaginally, surgeons favoured in-bag morcellation by laparoscopy. Uterine weight and characteristics were assessed before surgery by ultrasound or magnetic resonance imaging to predict morcellation.ResultsA total of 252 women underwent a TLH and the mean age was 46 ± 7 (30–71) years old. The main indications for surgery were abnormal uterine bleeding (77%), chronic pelvic pain (36%) and bulk symptoms (25%). Mean uterine weight was 325 (17–1572) ± 272 grams, with 11/252 (4%) uterus being >1000 grams and 71% of women had at least 1 leiomyoma. Among women with a uterine weight <250 grams, 120 (95%) did not require morcellation. On the opposite, among women with a uterine weight >500 grams, 49 (100%) required morcellation. In addition to the estimated uterine weight (≥250 vs. <250 grams; OR 3.7 [CI 1.8 to 7.7, P < 0.01]), having ≥ 1 leiomyoma (OR 4.1, CI 1.0 to 16.0, P = 0.01) and leiomyoma of ≥5 cm (OR 8.6, CI 4.1 to 17.9, P < 0.01) were other significant predictors morcellation in multivariate logistic regression analysis.ConclusionsUterine weight estimated by preoperative imaging as well as the size and number of leiomyomas are useful predictors of the need for morcellation.     

改良腹腔镜筋膜内子宫切除术68例分析

目的:探讨改良腹腔镜筋膜内子宫切除术(ICISH)的临床效果。方法:对我院2002.01-2006.03间行ICISH的68例和传统腹腔镜筋膜内子宫切除术(CISH)96例的临床资料进行回顾分析,比较2种术式的手术时间、术中出血量、住院天数、术后阴道出血、宫颈囊肿等情况。结果:2种术式的手术时间和住院天数无差异,ICISH术出院后有4.4%的患者(3例)阴道出血,比CISH的10.2%(10例)少(χ2=9.27,P=0.004);ICISH后宫颈囊肿发生率为0,比CISH的4.1%(4例)少(χ2=8.32,P=0.010);但ICISH术中出血量(41.5±7.7ml)略多于CISH(35.2±8.5ml)(t=-4.93,P=0.046)。结论:ICISH和CISH均具有创伤小、腹腔内干扰小、恢复快等优点,效果肯定;且ICISH比CISH并发症少。     

Natural Orifice Transluminal Endoscopic Surgery-assisted Versus Single-port Laparoscopic-assisted Vaginal Hysterectomy: A Case-matched Study

ObjectiveNatural orifice transluminal endoscopic surgery (NOTES) is currently a very important procedure for surgeons. This study aimed to describe the initial clinical experience of NOTES-assisted vaginal hysterectomy (NAVH) and to investigate its feasibility and surgical outcomes compared with single-port laparoscopic-assisted vaginal hysterectomy (SP-LAVH).DesignRetrospective chart analysis (Canadian Task Force classification II-1).SettingOne university-affiliated hospital.PatientsWomen undergoing NAVH or SP-LAVH for benign uterine diseases.InterventionNAVH using a novel homemade NOTES system comprised a glove-wound retractor NOTES port or SP-LAVH using conventional laparoscopic instruments and an umbilical glove port.Measurements and Main ResultsSince July 2012, 16 patients with benign uterine disease have undergone NAVH. Another 32 paired, SP-LAVH patients from the registered database were used to compare these 2 modalities of laparoscopic-assisted techniques for vaginal hysterectomy. All NAVHs were completed successfully without the need of an additional port or conversion to the standard laparoscopic approach. Intraoperative and postoperative surgical outcomes were assessed in both groups of patients. There was also no significant difference between both groups in perioperative outcomes such as estimated blood loss, decrease in hemoglobin on postoperative day 1, amount of analgesic drugs used, postoperative visual analog scale pain score, and febrile complications, except for operative time and length of postoperative hospital stay. The mean operative time was 70.6 ± 12.8 minutes for NAVH and 93.2 ± 21.4 minutes for SP-LAVH (p < .001). The median postoperative hospital stay was 3.5 days (range, 3–5) for NAVH and 4 days (range, 3–6) for SP-LAVH (p < .001).ConclusionThe findings show that NAVH is a feasible and safe surgical technique and has a short operative time and postoperative hospital stay compared with SP-LAVH. This new technique at least offers similar surgical outcomes and superior cosmesis in our opinion compared with SP-LAVH. However, prospective studies are needed to determine its full clinical application.     

The Power Law of Learning in Transumbilical Single-Port Laparoscopic Subtotal Hysterectomy

Study Objective

To analyze the surgical outcomes and learning curve of transumbilical single-port laparoscopic subtotal hysterectomy, which requires sutures of the cervical stump.