腹腔镜辅助阴式子宫切除术与经腹子宫切除术的临床疗效分析

目的 对比分析腹腔镜辅助阴式子宫切除术与经腹子宫切除术的临床疗效. 方法 随机选取本院2008年8月至2012年7月收治的112名子宫肌瘤并行子宫全切除的患者,其中腹腔镜下阴式子宫切除术(LAVH组)51例,经腹子宫切除术(TAH)组51例,对比分析两组患者术后发热、血栓性静脉炎、阴道残端感染、胃肠功能紊乱、手术时间及出血量差异. 结果 LAVH组患者术后出现胃肠功能紊乱者2例,无术后发热、血栓性静脉炎、阴道残端感染者,手术平均时间123±6分钟,术中出血量150±30ml;TAH组患者术后出现发热者8例、血栓性静脉炎者3例、阴道残端感染者2例、胃肠功能紊乱者43例,手术平均时间98±4分钟,术中出血量145±28ml.两组术后并发症比较,经统计学检验,两组差距有统计学意义(P=0.015,P＜0.05). 结论 LAVH是一种安全可行的术式,具有腹腔镜及阴式手术共同的微创优点,具有较为广阔的应用及发展前景.     

腹腔镜辅助阴式子宫切除术86例临床分析

目的 探讨腹腔镜辅助阴式子宫全切术(LAVH)的临床应用价值.方法 收集子宫良性病变269例,其中LAVH 86例,开腹子宫全切术(TAH)183例,对比2组手术时间、术中出血量、术后恢复情况、术后并发症及平均住院时间.结果 与TAH相比,LAVH术后病率、肛门排气时间、住院时间、术后疼痛情况均明显低于TAH(P<0....     

阴式子宫切除术与腹腔镜辅助下阴式子宫切除术的比较

目的比较阴式子宫切除术(TVH)与腹腔镜辅助下阴式子宫切除术(LAVH)的临床效果.方法 TVH:切开阴道前后穹隆黏膜,进入腹腔,处理主、骶韧带,子宫动静脉.从前穹隆或后穹隆翻出子宫.处理输卵管、卵巢固有韧带、圆韧带,关闭腹腔,缝合阴道断端.LAVH:腹腔镜下处理圆韧带、输卵管、卵巢固有韧带,剪开膀胱反折腹膜,剪开阔韧带后叶,打开阴道后壁转入阴道操作,其他操作同阴式手术.结果与LAVH 组相比,TVH组手术时间短[( 75.6±30.2) min vs (110.3±20.5) min ,t=-5.207,P=0.000],2组术后病率(TVH 6例,LAVH 8例,χ2=0.372,P=0.541)、术中出血量[( 134.6±42.2) ml vs (141.8±45.2) ml, t=-0.638,P=0.526]、术后24 h镇痛情况(TVH 21例,LAVH 19例,χ2=0.300,P=0.584)、术后48 h 排气(TVH 27例,LAVH 24例,χ2=0.523,P=0.470)、住院时间[( 4.9±0.8) d vs (5.2±1.1) d ,t=-1.208,P=0.232]无显著性差异.结论 TVH手术时间短,创伤小,LAVH拓宽了阴式手术范围.     

腹腔镜子宫切除术式的评价

1989年Reich施行首例腹腔镜辅助阴式子宫切除术（laparoscopic assisted vaginal hysterectomy，LAVH）。1991年Semm完成腹腔镜下筋膜内子宫切除术（classic intrafascial Semm hysterectomy，CISH）。经过10多年的发展，腹腔镜子宫切除已具有多种术式，技术趋于成熟，但选用何种术式更能达到预期效果有待进一步探讨，现就相关问题综述如下。     

腹腔镜辅助下阴式子宫全切除术临床应用

<正>全子宫切除术是子宫病变的主要治疗手段之一,经腹全子宫切除术(TAH),经阴道全子宫切除术(TVH)及腹腔镜下全子宫切除术(LH)是目前主要的手术方式。而腹腔镜辅助下阴式子宫全切除术(LAVH)是近年来发展起来的微创手术,以其损伤小、术后恢复好、操作简单,逐渐受到临床医生的重视。为了探讨LAVH的临床应用价值,现将本院近年来所行的LAVH与经腹式子宫全切除术作一比较,报道如下。     

腹腔镜下辅助阴式子宫切除术临床分析

目的总结腹腔镜辅助阴式子宫全切术的临床效果。方法将68患有子宫良性病变(子宫肌瘤、子宫腺肌症)需行子宫全切术的患者,随机分为观察组与对照组,各34例。观察组行腹腔镜辅助阴式子宫全切术。对照组行传统阴式子宫全切术。比较2组术中出血量和手术效果。结果观察组的术中出血量、手术时间、手术效果均优于对照组,差异有统计学意义(P<0.05)。结论腹腔镜辅助阴式子宫全切术具有出血量小,手术并发症少,安全性高、手术时间短,切口较小等优点,值得在临床上进一步完善、应用。     

腹腔镜辅助阴式子宫切除术临床研究

目的探讨腹腔镜辅助阴式子宫切除术的临床价值。方法子宫良性病变须行子宫全切术125例随意分为2组。研究组65例采用腹腔镜辅助阴式子宫切除术(laparoscop ic assisted vaginal hysterectomy,LAVH);对照组60例采用传统开腹全子宫切除术(TAH)。结果手术时间LAVH(127.0±4.1)m in,TAH(70.2±1.7)m in(t=99.669,P=0.000)。术中出血量LAVH(80.1±23.1)m l,TAH(190.8±53.0)m l(t=-15.339,P=0.000)。术后并发症发生率研究组30.8%(20/65),对照组58.3%(35/60),2组比较差异有显著性(2χ=9.621,P=0.002)。结论腹腔镜辅助阴式子宫切除术具有损伤小、出血量少、恢复快等优点,是一种较为理想的手术方式。     

腹腔镜辅助阴式子宫切除术临床应用体会

目的探讨应用腹腔镜辅助阴式子宫切除术与开腹子宫切除术治疗子宫肌瘤的效果比较。方法将100例需切除子宫肌瘤的患者分为观察组和对照组各50例,对照组患者给予开腹子宫切除术治疗,观察组给予患者腹腔镜辅助阴式子宫切除术治疗,对两组患者术中出血量、手术时间、肛门排气时间、住院时间、下床活动时间及并发症发生率进行对比分析。结果观察组患者的术中出血量、手术时间、肛门排气时间、住院时间、下床活动时间均明显优于对照组(P0.05),观察组患者的并发症发生率明显低于对照组(P0.05)。结论腹腔镜辅助阴式子宫切除术治疗子宫肌瘤创伤小,恢复快,并发症少,疗效肯定。     

腹腔镜辅助阴式子宫切除术临床分析

目的探讨腹腔镜辅助阴式子宫切除术的临床疗效。方法将80例子宫切除患者,随机分为对照组(阴式子宫切除术)和治疗组(腹腔镜辅助阴式子宫切除术),每组各40例,比较2种手术方式在手术时间、术中出血量、肛门排气时间、下床活动时间、平均住院日等方面的差异。结果与对照组相比,在手术时间、肛门排气时间、下床活动时间、平均住院时间等方面,观察组明显缩短,P<0.05,差异具有统计学意义。与对照组相比,观察组术中出血量也明显减少P<0.05,差异具有统计学意义。2组患者术中、术后都无严重并发症。结论腹腔镜辅助阴式子宫切除术扩大了阴式子宫切除术的适应证,而且疗效可靠,值得临床广泛推广。     

改良式阴式子宫切除术237例临床探讨

目的:开展阴道多元化微创手术.方法:将新式阴式子宫切除术与经腹子宫切除术比较.结果:两组手术时间差异无显著性,阴式组术中出血、排气时间显著低于经腹组.阴式组术后住院时间短.结论: 改良式阴式子宫切除术具有手术时间短、创伤小、术后疼痛轻、恢复快、住院时间短、腹部无瘢痕、医疗费用低等优点.     

腹腔镜子宫切除术

回顾分析1994～1996年腹腔镜子宫切除术34例的手术效果及并发症情况,探讨腹腔镜手术的适应症及并发症的防治。结果显示手术平均时问为142min,平均术中出血量为407ml,术后住院2～5天者占79.4％。并发症发生率21.7％(7/34),包括小腿烧伤、轻度脑栓塞各1例,腹壁血肿、术后发热各2例,1例腹腔内出血再次开腹。术后6周随诊均无异常发现。作者认为,腹腔镜子宫切除术具有切口小、恢复快、住院时间短等优点,但要注意掌握手术适应征,并强调手术队伍的整体配合。     

COMPARATIVE EVALUATION OF THE INFLAMMATORY MEDIATORS IN PATIENTS UNDERGOING LAPAROSCOPIC VERSUS CONVENTIONAL CHOLECYSTECTOMY

Background : Injury induces systemic inflammatory response. The degree of response is proportionate to the trauma. Methods : Patients with ultrasound-proven gall stones posted for operation were randomized into two groups. Laparoscopic cholecystectomy was performed in one group while the other group underwent conventional cholecystectomy. Peripheral venous blood samples for inflammatory mediators, namely tumour necrosis factor, C-reactive protein, oxygen release from monocytes and polymorphonuclear leucocytes were drawn 1 day before surgery and repeated on the first and third days after surgery. Partial pressure of arterial oxygen was also measured in both groups. Only patients who met selection criteria and had uncomplicated postoperative courses were included in the study.There was a total of 40 patients for the final analysis, 20 in each group. Results : There was no significant difference (P > 0.1) in age, sex or body mass index in both groups of patients. The level of all of the inflammatory mediators was elevated on the first postoperative day; however, the elevation was significantly less following laparoscopic cholecystectomy compared to conventional cholecystectomy (P < 0.01). Although the values came down on the third postoperative day, they remained above the respective controls. Postoperative hypoxaemia was significantly more in patients of conventional than laparoscopic cholecystectomy (P < 0.001). Conclusions : Trauma-induced inflammatory response is significantly less following laparoscopic cholecystectomy compared to conventional cholecystectomy. It appears to be related to degree of trauma.     

超声去脂技术及临床应用进展

去脂术是当今最流行的美容外科手术之一。随着抽吸去脂技术 ( Suction- assisted liposuction,SAL )的发展 ,已能够通过小切口去除局部过多的脂肪组织。尽管抽吸去脂术得到了医生和患者的广泛欢迎 ,但在纤维组织过多及皮肤中度松弛部位的效果欠佳 ,此外对皮下组织的去除选择性较差和出血比较多也是其缺点。 2 0世纪 80年代后期 ,Zocchi〔1〕开始研制应用超声能量选择性地破坏脂肪细胞 ,根据实验研究结果 ,他认为超声去脂 ( U ltasound- assisted lipoplasty,U AL)具有更大的组织选择性 ,在有效去除脂肪组织的同时 ,完好地保留了神经、血…     

OPERATIVE CHOLANGIOGRAPHY IN THE LAPAROSCOPIC ERA: A RETROSPECTIVE REVIEW OF THE QUALITY AND INTERPRETATION OF THIS INVESTIGATION

Background: Operative cholangiograms during the year of introduction of laparoscopic cholecystectomy were reviewed to examine their quality and interpretation. Methods: 149 operative cholangiogram films (34 open and 115 laparoscopic) were reviewed retrospectively by a panel and scored for their ability to demonstrate biliary anatomy and detect bile duct stones. Results: Cholangiography performed by the cystic duct was of similar quality, whether performed laparoscopically or open. Cholangiography via the cystic duct (conventional films) produces superior results for both anatomical delineation and detection of choledocholithiasis (80% adequate) than cholangiography performed by direct gallbladder puncture (29–35% adequate). Conclusion: There is no clear evidence to suggest that an intra-operative specialist radiological review of cholangiograms performed by the cystic duct would improve the detection of bile duct stones.     

腹腔镜胆囊切除联合阑尾切除术30例临床经验与分析

目的 探讨急、慢诊施行腹腔镜胆囊(Laparoscopic cholecystectomy,LC)联合阑尾切除术(Laparoscopic appendectomy,LA)的操作要点和临床价值.方法 回顾性分析了我院2006年9月至2010年2月对30例患者施行腹腔镜胆囊联合阑尾切除术.其中,急性胆囊炎合并慢性阑尾炎1...     

A COMPARISON OF REUSABLE VERSUS DISPOSABLE LAPAROSCOPIC INSTRUMENT COSTS

Background: Between 1991 and 1993 a single set of reusable laparoscopic instruments was used to perform 404 cholecystectomies, 102 hernia repairs and 66 advanced procedures. Disposable instruments were used only when no suitable reusable instrument was available or when reusable instruments were not working to the satisfaction of the surgeon. Methods: The cost of performing those laparoscopic operations using this policy was calculated by adding the purchase cost, the maintenance costs and the repair and replacement costs of the reusable instruments. To this figure was added the cost of disposable instruments which were used instead of reusable instruments during the study period. Results: The total cost was $253 385, at an average of $443 per case. The cost per case for reusable instruments remained approximately $100 through the 3 years, while the cost per case of disposable instruments fell from almost $600 in 1991 to about $200 in 1993. Conclusions: Our future policy is to continue using reusable instruments initially, with backup disposable instruments.     

THE MORBIDITY OF SURGICAL ACCESS: A STUDY OF OPEN VERSUS LAPAROSCOPIC CHOLECYSTECTOMY

A prospective non-randomized study of 37 adult patients undergoing open cholecystectomy and 40 patients undergoing laparoscopic cholecystectomy was undertaken to test the hypothesis that surgical access alone has a significant impact on postoperative morbidity. Specifically the study examined the deterioration of pulmonary function, development of pulmonary complications, postoperative narcotic requirement and total bed stay as markers of postoperative morbidity. The results showed that significantly less deterioration of pulmonary function occurred in patients treated using the laparoscopic approach. In this group there was also significantly less requirement for postoperative narcotics, less consequent development of pulmonary complications and a shorter bed stay in hospital. The study documents the substantial impact of surgical access on postoperative morbidity and highlights the benefits of the laparoscopic ‘minimal access’ approach.     

腹腔镜胆囊切除术治疗急性胆囊炎104例临床分析

目的 探讨腹腔镜胆囊切除术治疗急性胆囊炎的可行性及安全性.方法 对104例急性胆囊炎行腹腔镜胆囊切除术患者的临床资料进行回顾性分析.结果 手术时间40～120 min,出血量10～150 ml,腹腔引流95例,平均住院时间7.2d,中转17例,中转率16.3％,术后胆漏5例,经保守治疗痊愈.结论 准确掌握急性胆囊炎腹腔...     

Outpatient laparoscopic hysterectomy: evaluation of pain

Background and Objectives:

The purpose of this study was to assess the differences in patient pain postoperatively, comparing 2 types of outpatient hysterectomy procedures.

Methods:

This is a nonblind, nonrandomized, prospective study of surgeries performed at 1 ambulatory surgery center by 1 surgeon over 14 months. Patient pain was assessed using a visual analog scale before and after laparoscopically assisted vaginal hysterectomy and total laparoscopic hysterectomy. Patients were followed through a 2-week postoperative period.

Results:

Nineteen laparoscopically assisted vaginal hysterectomies and 17 total laparoscopic hysterectomies were performed. The 2 groups were similar in age, BMI, uterine weight, and surgical time. Comparing the 2 groups, there were no statistically significant differences in pain throughout any time points of the study.

Conclusion:

There were no statistically significant differences in pain during the postoperative period between the 2 groups. Outpatient hysterectomy is a safe procedure that may improve patient satisfaction surgically and financially, and either approach is well tolerated by patients.