非脱垂子宫经阴道和经腹部切除术对比分析

目的　探讨非脱垂子宫经阴道切除术的优点、手术要点及适应证。方法　 2 0 0 1年 5月至 2 0 0 2年 12月间汕头大学医学院第一附属医院对非脱垂子宫行经阴道切除术 (TVH) 12 8例 ,与同期指征相近的经腹全子宫切除术 (TAH) 16 0例进行分析比较。结果　TVH组手术均成功 ,无术中、术后并发症 ,手术时间、肛门排气时间、术后下床活动时间及住院时间和伤口疼痛程度均小于TAH组 ,两组差异有显著性 (P <0 0 5 ) ,出血量差异无显著性 (P >0 0 5 )。结论　TVH损伤小 ,恢复快 ,是一种较好的手术方法     

阴式与腹腔镜子宫全切除术的临床效果比较

目的比较阴式子宫全切除术和腹腔镜子宫全切除术的临床效果。方法收集我院2002年1月至2004年6月接受以上不同途径子宫切除术的病例共301例的临床资料,其中阴式子宫全切除术197例(阴式组),腹腔镜子宫全切除术104例(腹腔镜组),比较两组疾病种类、手术时间、术中出血量、住院时间、医疗费用及术后恢复情况等。结果(1)疾病种类:宫颈非典型增生阴式组19例、腹腔镜组3例;子宫腺肌病、合并附件疾病或盆腔子宫内膜异位症,阴式组分别为58例、9例、8例,腹腔镜组分别为45例、33例、13例;(2)手术时间:阴式组(76±28)min、腹腔镜组(139±52)min;(3)术中出血量:阴式组(170±125)ml、腹腔镜组(206±153)ml;(4)肌瘤或腺肌瘤最大直径:阴式组(49±17)mm、腹腔镜组(57±22)mm;(5)手术费用:阴式组(1073±203)元、腹腔镜组(1526±676)元。以上各指标两组比较,差异均有统计学意义(P<0·05);(6)住院时间:阴式组(5·6±1·2)d、腹腔镜组(5·7±2·4)d;(7)子宫重量:阴式组(235±115)g、腹腔镜组(256±158)g;(8)手术并发症发生率:阴式组为2·54%、腹腔镜组为2·88%。住院时间、切除子宫重量及手术并发症发生率等两组比较,差异均无统计学意义(P>0·05)。结论无明显盆腔粘连和附件疾病的子宫全切除术可选择阴式途径,子宫大小并非选择术式的决定因素。     

非脱垂瘢痕子宫阴式切除术65例临床分析

目的:探讨非脱垂瘢痕子宫经阴道切除的可行性及临床应用价值.方法:引进特制阴道手术器械,对65例有盆腔操作史的瘢痕子宫行阴式全子宫切除(研究组),与同期经阴道无手术史非脱垂子宫切除66例(对照组)作对比分析.结果:研究组手术时间、术中出血比对照组明显增加(P＜0.05),但两组术后住院天数、肛门排气时间及术后病率相比,差异无显著性(P＞0.05).结论:非脱垂瘢痕子宫不再是阴式手术绝对的禁忌证,术后恢复仍能体现阴式手术的优势,但有2次或以上盆腔手术史和有慢性盆腔感染致严重粘连的,应选择腹腔镜或开腹手术为宜.     

新式非脱垂子宫经阴道切除术

非脱垂子宫经阴道切除术由Langenbeck 1813年首次施行，至今已有近200年历史，由于人们认为操作困难、并发症较多而未能得到广泛的应用。但近10年来，随着微创技术的开展，这一术式又逐步受到了国内外妇产科医师的重视，据文献报道欧美国家非脱垂子宫经阴道切除术已占全子宫切除术的61％-90％。笔者2000年开始将新式非脱垂子宫经阴道切除术这一简单易行的手术应用于临床，     

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。     

阴式大子宫切除术25例临床分析

目的 探讨阴式大子宫切除术的方法和经验。方法 在１９９７年９月至１９９８年１月对２５例子宫增大如６～１６孕酮、活动、估计无粘连的子宫肌瘤、肌腺病患者,有式子宫切除术。减小子宫体积的手法包括子宫对半切开、子宫肌瘤切除、子宫分碎、子宫肌瘤剔除术,其中最常用的方法是子宫对半切开、肌瘤剔除及分碎的结合使用。结果 ２４例经阴道手术成功,平均子宫重量为３６０ｇ（１５５～７５５ｇ）,平均手术时间为９５分钟（６０     

大子宫经阴道切除25例临床分析

目的 探讨大子中经阴道切除的安全性和可行性。方法 采用子宫劈开、肌核剜除、碎解等缩小子宫体积的方法,对２５例子宫增大如１２～１７孕周「平均（１４．０±１．７）周」、重２８０～５７０ｇ「平均（３７２±７４）ｇ」的子宫肌瘤患,行经阴道子宫切除术（ＴＶＨ）。对手术方式、时间、出血量、副损伤及术后病率进行分析。结果 ２２例成功经阴道切除,３例改经腹手术。手术成功率８８％。术中膀胱损伤１例,大出血１例,输     

不同途径子宫全切除术的临床效果比较

目的探讨4种不同途径子宫全切除术的临床效果。方法回顾性分析756例子宫全切除术患者的临床资料,其中行传统腹式子宫全切除术(TAH)260例(TAH组)、改良腹式小切口子宫全切除术(MAH)180例(MAH组)、阴式子宫全切除术(TVH)106例(TVH组)、腹腔镜辅助阴式子宫全切除术(LAVH)210例(LAVH组),比较各组患者术中及术后的情况。结果平均手术时间TAH组为(98±23)min、MAH组为(67±18)min、TVH组为(63±19)min、LAVH组为(99±35)min,TAH、LAVH组平均手术时间与MAH、TVH组比较,差异有统计学意义(P<0·05);术中平均出血量TAH组为(180±49)ml,显著多于MAH组的(102±43)ml、TVH组的(93±31)ml和LAVH组的(111±39)ml,差异有统计学意义(P<0·05);术后使用抗生素时间和肛门排气时间TAH组为(5·2±2·6)d,(36±9)h;MAH组为(3·3±1·7)d,(23±7)h;TVH组为(3·2±1·6)d,(21±4)h;LAVH组为(3·5±1·9)d,(23±6)h;TAH组与其他3组比较,差异均有统计学意义(P<0·05);术后体温升高的发生率TAH组也显著高于其他3组;术后平均住院时间TAH组为(5·4±2·3)d,MAH组为(5·6±1·9)d,均显著长于TVH组的(3·3±1·2)d和LAVH组的(3·6±1·1)d,差异有统计学意义(P<0·05);但平均治疗费用比较,LAVH组显著高于其他3组,差异有统计学意义(P<0·05)。结论不同途径子宫全切除术各有优势,且互不能完全替代,应根据患者的情况、手术医生的技术水平、医院的条件等综合考虑。     

Abdominal hysterectomy for the enlarged myomatous uterus compared with vaginal hysterectomy with morcellation

OBJECTIVE: The purpose of this study was to compare intraoperative and postoperative complications of abdominal hysterectomy for the enlarged, myomatous uterus with vaginal hysterectomy with morcellation. STUDY DESIGN: Medical records of 139 patients who underwent vaginal hysterectomy with morcellation and 244 patients who underwent total abdominal hysterectomy for an enlarged, myomatous uterus between August 1990 and July 2001 were reviewed. Uterine weights of >982 g were excluded because this was the largest uterus removed vaginally, which left 208 evaluable cases of total abdominal hysterectomy. The perioperative and postoperative course of the two groups was compared. The Student t test was used for continuous variables, and the Fisher exact test was used for binary or categoric data. RESULTS: There were no significant differences between the two groups in surgical or anesthetic risk factors (P>.05). Operative time was similar between the groups (P>.05). Length of hospital stay was increased significantly with total abdominal hysterectomy (mean, 3.9 days vs 2.6 days; P<.001). Perioperative complications were increased with the abdominal route (10% vs 25%, P<.001). CONCLUSION: In this large series, uterine morcellation at the time of vaginal hysterectomy is safe and facilitates the removal of moderately enlarged and well-supported uteri and is associated with decreased hospital stay and perioperative morbidity rate compared with the abdominal route.     

腹腔镜下不同子宫切除术2272例临床分析

目的　评价腹腔镜鞘膜内子宫切除术 (LISH)、腹腔镜子宫次全切除术 (LSH)、腹腔镜全子宫切除术(LTH)和腹腔镜辅助阴式子宫切除术 (LAVH)4种术式的临床效果。方法　回顾性分析各种腹腔镜子宫切除术 2272例的手术时间、出血量、并发症及术后恢复情况等。结果　保留子宫颈的两种术式中,LISH1323例(LISH组),手术时间为(91±21)min,出血量为 (93±23)ml,并发症发生率为 4 1%;LSH229例(LSH组),手术时间为(70±18)min,出血量为 (69±17)ml,无一例并发症发生;LISH组的手术时间、出血量及并发症发生率均高于LSH组,差异有统计学意义 (P<0.01)。去除子宫颈的两种术式中,LAVH588例(LAVH组),手术时间为(119±28)min,出血量为 (156±23)ml,并发症发生率为 1 0%;LTH132例(LTH组),手术时间为 (121±30)min,出血量为 (193±38)ml,并发症发生率 1 5%;LAVH组的手术时间、并发症发生率与LTH组比较,差异无统计学意义(P>0.05),而术中出血量LTH组明显多于LAVH组,差异有统计学意义(P<0.01)。结论　4种术式均为腹腔镜下子宫切除的有效术式,且各有利弊;应根据患者的具体情况选择适宜术式。     

Experience with laparoscopic-assisted vaginal hysterectomy for the enlarged uterus

Objective  The aim of this study is to evaluate the effect of uterine weight on the perioperative and postoperative outcomes of laparoscopically assisted vaginal hysterectomy (LAVH) for benign gynecological conditions. Methods  In a retrospective observational study, 367 patients underwent LAVH (type I laparoscopic hysterectomy) for benign disorders at the Department of Gynecology at the Istanbul Bakirkoy Women and Children Hospital. Patients were divided into two groups with uterine weight <500 g and uterine weight ≥500 g. Outcome measures for both groups were studied comparatively in terms of length of operative time, pain score, amount of blood loss, requirement of blood transfusion, and length of hospital stay. Results  There were no differences in patients’ mean age, parity, gravidity, rate of postmenopausal state, previous pelvic surgery, and body mass index. The most common indications for surgery were myoma and abnormal uterine bleeding. The duration of operation, estimated blood loss and requirement of blood transfusion were significantly less for <500 g group than for ≥500 g group. Three women in the <500 g group sustained a blood loss in excess of 500 ml. By comparison, 18 women in the ≥500 g group sustained a blood loss in excess of 500 ml (P = 0.000). Total complication rate was 8.7%. Postoperative ileus and febrile morbidity were the most common complications. No significant difference was noted in overall complications between groups (P = 0.13). During the vaginal part of the procedure bladder injury occurred in one patient who had uterine weight ≥500 g. Conclusion  LAVH is a safe and efficient way to manage benign uterine disease and despite the increased operating time and blood loss, LAVH can be safely performed for enlarged uterus.     

子宫颈癌保留神经广泛性子宫切除术与传统广泛性子宫切除术的比较性研究

生活满意度(29%,7/24)明显好于RH患者(9%,6/69),两者比较,差异有统计学意义(P=0.042);NSRH患者排便正常,RH患者中有2例患者出现大便次数增多.结论 NSRH手术能有效保护早期宫颈浸润癌患者的盆腔自主神经功能,且安全可行.