剖宫产手术指征分析

目的：分析剖宫产手术指征,探讨降低剖宫产率的方法。方法：对我院2010年1月至2012年12月收治的剖宫产产妇临床治疗病例进行抽样,对150例剖宫产产妇临床治疗病例进行回顾性研究。结果：近年来我国剖宫产率不断上升,产妇因素、社会因素、家庭因素是导致剖宫产的主要原因。我院剖宫产前四位手术指征分别为头盆因素、社会因素、胎儿窘迫、妊娠合并症。结论：全面了解剖宫产手术指征,对于降低剖宫产率、加强新生儿体质有着重要影响。     

从306例剖宫产术中谈手术指征的掌握

目的：探讨如何正确掌握剖宫产指征。方法：对306例剖宫产手术指征进行回顾性分析。结果：剖宫产指征前五位的因素依次是疤痕子宫、头盆因素、臀位、产前出血、胎儿宫内窘迫。结论：剖宫产术是处理高危妊娠的重要方法之一,可有效降低高危孕妇和围产儿的病死率。但医务人员应正确掌握剖宫产指征,合理运用剖宫产术,才能有效降低剖宫产率。     

产科急症子宫切除手术指征、手术时机的探讨

急症子宫切除术（hysterectomy in obstetrical emergency）是控制产后出血的有效措施之一,掌握其手术指征、手术时机,关系到产科的医疗质量和医疗安全.1997年8月至2004年12月我院收治产后出血行急症子宫切除术25例,现总结如下.     

腹腔镜与剖腹行良性卵巢囊肿剥出术的对照研究

目的:比较腹腔镜术与剖腹术两种方法行良性卵巢囊肿剥出术的结果。方法:将妇科手术治疗的75例良性卵巢囊肿患者随机分为腹腔镜组(38例)和剖腹术组(37例),对两组患者的特征及术中、术后情况进行对比分析。结果:两组在年龄、体重、剖腹术史、囊肿大小、病理类型等方面差异无显著性(P>0.05)。术后病率、对镇痛药的需求、术后住院日及恢复时间,腹腔镜组显著减少(P<0.01或P<0.05)。结论:腹腔镜行良性卵巢囊肿剥出术优于传统剖腹术。     

3475例剖宫产指征分析

目的 探讨１９９７年初至１９９８年末剖宫产指征的掌握情况。方法 对３４７５例剖宫产病例进行回顾性分析。结果 剖宫产率为４５．２％。主要指征依次为：妊娠并发症（３６．６％）、胎儿窘迫（２２．６％）、妊娠合并症（１３．５％）、巨大儿（１０．２％）、珍贵儿（９．８％）、臀位（９．８％）、高龄初产（９．１％）,其中巨大儿的诊断符合率６２．３％、５６％（１３．５％）、巨大儿（１０．２％）、珍贵儿（９．８％）     

剖宫产手术指征把握对提高分娩质量相关性探讨

目的：探讨正确把握剖宫产手术指征对提高分娩质量的相关性。方法：本次研究选取2003年、2004年我院产科分娩资料,探讨剖宫产率及产科质量变化,并分析二者相关性。结果：对比两年产科质量,新生儿窒息率、产后出血率、剖宫产率无明显变化（P〉0．05）。对比剖宫产指征,社会因素在两年中均居第一,其次均为疤痕子宫,与2003年比较,2004年胎盘比例有所下降,胎儿窘迫比例上升,均有统计学差异（P〈0．05）,其它指征比较无明显变化（P〉0．05）。结论：我国剖宫产率居较高水平,易引发多种远期并发症,需加大健康宣教,降低因社会因素等引发的剖宫产率,并做好各项指征的把握,以全面提高产科分娩质量。     

剖宫产指征的现代概念

近年来随着剖宫产技术提高 ,手术时间缩短 ,手术损伤、感染等显著减少 ,麻醉和有效抗生素的应用 ,使剖宫产的安全性大大提高。世界各地和我国不少地方尤其大中城市剖宫产率迅速升高 ,以致不少妇产科界前辈感到不可理解 ,产科医生们也觉得压力沉重。究其现状 ,其影响因素应是多方面的。由于社会、家庭、管理者等的高标准、严要求 ,以致给第一线医生们所带来的强大精神负担 ,使剖宫产指征已远不止单纯医学指征的范围。为把分娩过程控制在最短 ,使分娩因素对分娩过程的不良影响减少到最小 ,各种各样的剖宫产理由均可看到。剖宫产率升高是剖宫产…     

子宫肌腺症的临床病理特点及手术指征的探讨

目的:探讨子宫肌腺症的临床病理特点及手术指征。方法:2004年1月至12月手术治疗且病理证实为子宫肌腺症340例,其中全子宫切除284例,保守手术(子宫肌腺症病灶切除术)56例,回顾分析其临床病理特点并探讨手术方式及指征。结果:340例子宫肌腺症中合并子宫内膜异位囊肿95例(27.94%),合并子宫肌瘤148例(43·5%),合并贫血95例(27.9%),合并子宫内膜息肉20例(5.9%)。痛经组与无痛经组患者合并不孕症差异无统计学意义(P>0.05),两组合并内膜息肉有显著的统计学差异(P<0.01),痛经者合并内膜息肉是非痛经组的5倍,95%CI为0.079~0.509。两组合并子宫内膜异位囊肿有显著的统计学差异(P<0.01)。痛经患者合并卵巢子宫内膜异位症的风险是无痛经患者的3.369倍,95%CI为1.699~6.681。多因素Logistic回归分析表明,绝经前、月经量多和子宫大的患者易并发卵巢子宫内膜异位囊肿;年轻、分娩次数多和痛经重的患者易并发子宫内膜息肉;绝经前年轻女性和子宫体积大的患者易并发子宫肌瘤。分析不同手术途径表明:腹腔镜组年龄偏低,贫血、不孕比例明显增高。结论:对年轻合并性交痛、肛门坠痛等症状,伴有贫血或不孕患者首选腹腔镜检查/手术;子宫较大、B超提示合并肌瘤或既往有剖宫产史,估计盆腔粘连重者选择开腹手术;合并子宫脱垂、尿失禁等盆底组织缺陷性疾病选择阴式途径完成。保留子宫的手术可以根据患者主要症状、手术医师的技能和仪器来选择术式。对年龄大且无生育要求,合并贫血、子宫肌瘤,服药有严重副作用或无明显疗效的可行全子宫切除术。     

303例阴道侧切产钳指征分析

本文回顾分析了2002-2003年全部阴道侧切产钳病历303例，重点对侧切产钳的指征加以讨论，以总结经验，提高产钳的质量。     

大卵巢囊肿腹腔镜手术的可行性探讨

对直径较大的卵巢囊肿 ,施行腹腔镜手术切除多数人认为技术上有一定难度 ,故持保留态度。甚至有人认为 ,直径大于 10ｃｍ的卵巢肿块属腹腔镜手术禁忌证[1,2 ] ,但是亦有大于妊娠 4个月子宫的卵巢肿瘤用腹腔镜手术的个案报道[3 ] 。近 2年我们对 11例此类患者实施了腹腔镜手术。现报道如下。1　资料与方法1.1　临床资料　 1999年 1月至 2 0 0 1年 6月我院收治直径大于 12ｃｍ的卵巢囊肿患者 11例 ,15～ 4 4岁 ,无性生活史 5例 ,余已婚无生育要求 ;病程 2年以内 ;10例无手术史 ,1例有 2次剖腹手术史。1.2　方法　1.2 .1　术前诊断与准备　术前…     

腹腔镜手术和开腹手术治疗良性卵巢囊肿的比较研究

目的探讨腹腔镜手术治疗良性卵巢囊肿的临床应用价值。方法 回顾性分析1999年1月至2001年8月间80例腹腔镜手术治疗的卵巢囊肿病例(其中完成腹腔镜手术者为腹腔镜组),选择同期54例开腹手术治疗的良性卵巢囊肿病例作为对照组。结果80例腹腔镜手术有4例术中转开腹,其中1例为卵巢恶性肿瘤;76例卵巢囊肿为良性,以子宫内膜异位囊肿和成熟性畸胎瘤最多见。囊肿切除术腹腔镜组占88.2％,开腹手术组占64.8％。两组手术时间差异无显著性。腹腔镜手术组术中出血、术后住院及恢复时间短于开腹手术组,差异有显著性。结论腹腔镜手术治疗良性卵巢囊肿比开腹手术更具优越性。     

A laparoscopic approach may be used to improve the surgical management of advanced ovarian cancer

A laparoscopic approach may be used to improve the surgical management of advanced ovarian cancer.     

Giant ovarian cyst in a woman in rural Africa

A 42-year-old woman presented to the open access surgical outpatients clinic run by an international Non-Governmental Organisation in the south western region of Chad in central Africa. She gave a 2-year history of increasing abdominal girth, which had recently been associated with breathlessness and lower back pain. This had forced her to stop work, culminating in her self-referral to the clinic. In the absence of access to helpful investigatory modality, we performed an exploratory laparotomy, during which a large cyst (15.1 kg, 12.5 l) in the left ovary was excised and abdominoplasty was performed. She made a good recovery with no complications and was discharged 5 days postoperatively.     

腹腔镜手术治疗良性卵巢肿瘤115例疗效分析

目的　探讨应用腹腔镜手术治疗良性卵巢肿瘤的疗效。方法　广东省中山市人民医院将 2 0 0 1年 6月至 2 0 0 3年 12月间住院治疗的 196例卵巢良性肿瘤患者 ,分为腹腔镜手术组和剖腹手术组 ,对比观察两组手术效果及手术并发症等。结果　腹腔镜手术组手术时间与剖腹手术组比较差异无显著性意义 (P >0 0 5 ) ,腹腔镜手术组术中出血量、肛门排气时间、术后平均住院日及术后发热、镇痛剂使用例数均明显少于剖腹手术组 (P <0 0 1)。结论　腹腔镜对机体内外环境干扰少。腹腔镜手术组术中出血量少 ,术后恢复快 ,适于临床应用。     

Diet and risk of seromucinous benign ovarian cysts

Objective: To analyze the relation between selected dietary indicators and the risk of seromucinous benign ovarian cysts. Study design: We used data from a case–control study on risk factors for benign ovarian cysts conducted in Italy between 1984 and 1994. Cases included 225 women with a histologically confirmed diagnosis of benign seromucinous ovarian neoplasm dating back no more than 2 years. Controls were 450 women below the age of 65 years admitted for acute non-gynecological, non-hormonal, non-neoplastic conditions. Results: Women with seromucinous cysts reported more frequent consumption of beef and other red meat and cheese and less frequent consumption of green vegetables. The multivariate odds ratios (ORs) in highest versus less frequent consumption levels were 2.7 (95% confidence interval (CI) 1.8–4.3) for beef and other red meat, 0.6 (95% CI 0.3–0.9) for green vegetables and 1.4 (95% CI 1.0–2.2) for cheese. Conclusion: Seromucinous benign ovarian cysts are associated with beef and cheese consumption, whereas high intake of green vegetables seems to have a protective effect.     

Comparison of laparoscopy versus laparotomy for the surgical treatment of ovarian dermoid cysts

To compare laparoscopy with laparotomy for the surgical management of ovarian dermoid cysts, a retrospective analysis of data of 108 patients who had surgery at our institution from January 1998 to August 2001 was performed. The surgical data of these patients were obtained from a computerized data base. The following data were abstracted: the patients demographic features, size of dermoid cysts, spillage rate, estimated blood loss, operative times, duration of hospital stays, and intraoperative or postoperative complications. Statistical techniques included Students t-tests, Fishers exact tests, Mann-Whitney tests, and chi-square analysis. Of 108 patients with dermoid cysts, 53 (49.1%) underwent laparoscopy and 55 (50.9%) had laparotomy. The mean estimated blood loss was significantly less in laparoscopy (71.6±63.5 ml) compared with laparotomy (119.2±101.6 ml). Hospital stay was significantly shorter in the laparoscopy group (0.6±0.8 days) compared with the laparotomy group (2.2±1.0 days). Also, the postoperative complication rate was lower in the laparoscopy group (3.8%) compared with the laparotomy group (14.5%), but the difference did not reach statistical significance. Whereas the laparotomy groups spillage rate of 4.1% and operative time of 86.7±39.6 min were significantly lower than the laparoscopy groups spillage rate of 31.4% and operative time of 118.4±51.5 min, the laparoscopy group had less blood loss, shorter hospital stay, and fewer complications. The laparoscopic management of benign cystic teratomas can be safely performed.Presented at the American Association of Gynecologic Laparoscopists meeting (2001).     

Factors influencing the choice of laparoscopy or laparotomy in pregnant women with presumptive benign ovarian tumors

Objective

To evaluate the factors associated with physicians’ choice of laparotomy or laparoscopy in pregnant women with presumptive benign ovarian tumors.

Methods

Retrospective comparative analysis of pregnant women who underwent laparotomy or laparoscopy for ovarian tumors and who delivered at Samsung Medical Center, Seoul, Korea, between July 1995 and April 2008.

Results

Univariate analysis revealed that the following factors had a significant or a borderline significant association with the choice of operation type: maternal age (P = 0.044); surgeon type (professor vs clinical fellow; P = 0.094); tumor mass size (P = 0.081); gestational age (P = 0.035); and time since surgery (P < 0.001). Multivariate analysis showed that tumor size (P = 0.030), gestational age (P = 0.027), and time since surgery (P = 0.004) were independent factors associated with physicians’ choice of laparoscopy or laparotomy for the management of presumptive benign ovarian tumors during pregnancy.

Conclusions

In the latter years of the present study, physicians at the study center preferred the laparoscopic approach for managing presumptive benign ovarian tumors during pregnancy. Furthermore, they preferred this approach to laparotomy for pregnancies at a relatively early gestational age and for treating small tumors.