增加辅助孔的经脐单孔腹腔镜巨大卵巢囊肿手术

目的探讨改良经脐单孔腹腔镜治疗巨大(>10 cm)卵巢囊肿的安全性。方法2018年6月~2019年12月,行改良经脐单孔腹腔镜巨大卵巢囊肿手术57例,经脐开放式入路,切口2~2.5 cm,置入切口保护套及单孔Port,左下腹置5 mm trocar和器械协助。行卵巢囊肿剥除18例,附件切除25例,全子宫+单/双附件切除10例,全子宫+双附件+大网膜+盆腔淋巴结切除4例(其中2例加行阑尾切除术)。结果3例因严重粘连加右下腹5 mm trocar双人配合操作,其余54例均单人操作行增加一个辅助孔的经脐单孔腹腔镜手术,无中转开腹。术后随访1~18个月,平均12.3月,1例黏液性囊腺瘤剥除术后6个月复发。结论增加辅助孔的经脐单孔腹腔镜技术治疗巨大卵巢囊肿具有良好的器械操控性,可行切口保护,可安全、快速取出标本,具有一定的临床推广价值。     

Laparoscopic management of ovarian dermoid cysts: ten years' experience.

OBJECTIVE: To determine the safety and efficacy of laparoscopic management of ovarian dermoid cysts based upon our ten years' experience. METHODS: Charts of 81 patients who underwent laparoscopic removal of dermoid cysts since March 1988 at Stanford University Medical Center or the Center for Special Pelvic Surgery in Atlanta were reviewed retrospectively. RESULTS: Ninety-three dermoid cysts with a mean diameter of 4.5 cm were removed in 81 patients. Operative techniques used were cystectomy for 70 cysts, salpingooophorectomy for 14, and 9 salpingo-oophorectomy with hysterectomy. Fifty-three cysts were treated via enucleation followed by cystectomy or salpingo-oophorectomy and removal through a trocar sleeve. Twenty-two were treated via enucleation and removal within an impermeable sack. Nine were treated via enucleation and removal by posterior colpotomy. Nine were removed via colpotomy following hysterectomy. We had a total of 39 spillages. Spillage rates varied with removal method: 32 (62%) for trocar removal without an endobag, 3 (13.6%) for removal within an endobag, and 4 (40%) with colpotomy removal. No spillage occurred for the nine patients who had a colpotomy done for hysterectomy. Mean hospital stay after surgery was 0.98 days, and there were no intraoperative complications. In one case, there was a postoperative complication of an incisional infection in the umbilicus. CONCLUSION: Including this and 13 other studies, review of the literature reveals a 0.2% incidence of chemical peritonitis following laparoscopic removal of dermoid cysts. Thus, we conclude that laparoscopic management of dermoid cysts is a safe and beneficial method in selected patients when performed by an experienced laparoscopic surgeon.     

Fetal ovarian cysts management and ovarian prognosis: a report of 82 cases

Background/Purpose

Fetal ovarian cysts are frequently complicated by intracystic hemorrhage without associated clinical signs, which is often secondary to ovarian torsion leading to loss of the ovary. The aim of this study was to evaluate ovarian outcome and the place of prenatal management and surgery in the first few days of life in order to save the ovary.

Methods

Between January 1987 and June 2006, 82 fetal ovarian cysts in 79 patients were managed and clinically and ultrasonographically followed up for several months (median, 11 months; range, 6 months to 10 years) in all of the cases where the ovary was not removed. The ultrasonographic results regarding the ovarian parenchyma were broken down into 3 categories: follicular ovary, homogeneous ovary, and undetected ovary.

Results

Twenty-seven cysts remained simple throughout their evolution, and 55 were complicated by intracystic hemorrhage usually several weeks before birth. Overall, after disappearance of the cyst, a follicular ovary was detected in only 39% of the cases (32/82) and more often when the cyst was simple than when it presented an intracystic hemorrhage (85% vs 16.4%, χ², P < .0001).

Conclusions

A review of our series confirms the poor ovarian outcome linked to ultrasonographic signs of intracystic hemorrhage. Preventive action by puncture of “simple” cysts is still being studied. The presence of a bilateral cyst can, if pulmonary maturity has been reached, be an argument for inducement of premature birth with a view to performing conservative surgery. After birth, surgery in the first few days of life is only justified if the signs of intracystic hemorrhage appeared in the period very close to birth.     

腹腔镜与开腹手术治疗卵巢子宫内膜异位囊肿的疗效比较

目的比较腹腔镜手术与开腹手术治疗卵巢子宫内膜异位囊肿的效果,探讨腹腔镜手术治疗卵巢子宫内膜异位囊肿的价值。方法回顾性对比分析随访4个月~5年,平均41.3月的92例腹腔镜手术(腹腔镜组)及52例开腹手术(开腹组)的临床资料。结果腹腔镜组手术时间(69±41.8)m in,术后住院(3.5±1.0)d,术中出血量(55±12.0)m l;开腹组手术时间(137±54.3)m in,术后住院时间(8.7±3.5)d,术中出血量(178±105.9)m l,两组比较差异均有显著性(t=-8.402,-11.048,-13.350;P=0.000)。术后复发率腹腔镜组19.6%(18/92),开腹组19.2%(10/52),两组差异无显著性(2χ=0.002,P=0.961)。术后痛经改善率腹腔镜组66.0%(35/53),开腹组52.8%(19/36),两组比较差异无显著性(2χ=1.580,P=0.209)。结论腹腔镜治疗卵巢子宫内膜异位囊肿的效果与开腹手术基本相同,但腹腔镜具有微创手术的优点,可作为治疗卵巢子宫内膜异位囊肿的首选方法。     

腹腔镜与开腹手术治疗卵巢子宫内膜异位囊肿的比较

目的探讨卵巢子宫内膜异位囊肿腹腔镜手术的临床价值. 方法对52例卵巢内膜异位囊肿腹腔镜手术(腹腔镜组)与同期75例卵巢内膜异位囊肿开腹手术(开腹组)进行分析比较. 结果腹腔镜组手术时间(61.4±9.3)min比开腹组(72.6±7.1)min明显缩短(t=7.692,P=0.000);腹腔镜组术后排气时间(25.3±4.1)h明显早于开腹组(49.8±6.9)h(t=22.935,P=0.000);腹腔镜组术后病率(9/52)显著低于开腹组(31/75)(χ2=8.216,P=0.004);腹腔镜组术后痛经缓解率(26/37)与开腹组(34/51)无显著差别(χ2=0.128, P=0.818);腹腔镜组术后妊娠率(5/22)与开腹组(7/25)无显著差别(χ2=0.171,P=0.747). 结论腹腔镜手术治疗卵巢内膜异位囊肿疗效与开腹手术相同,是一种理想的治疗卵巢内膜异位囊肿的手术方式.     

腹腔镜手术治疗卵巢囊肿386例

目的总结腹腔镜下卵巢囊肿手术的经验. 方法回顾分析1999年7月～2004年12月我院386例囊腹腔镜卵巢囊肿手术的临床资料. 结果 384例腹腔镜手术成功,2例因既往有手术史或盆腔粘连中转开腹.术中出血平均20.6 ml(10～60 ml).手术时间平均55 min(20～140 min ).术后住院平均3 d(2～5 d).194例随访1～60个月,平均24个月,盆腔检查和B超均正常. 结论腹腔镜下卵巢囊肿手术安全有效,具有创伤小、术后恢复快、住院时间短等特点.     

两种腹腔镜手术对卵巢良性囊肿手术相关临床指标的影响

目的:探讨常规三孔法与改良经脐单切口腹腔镜手术对卵巢良性囊肿相关临床指标的影响.方法:纳入2017年1月至2019年6月收治的186例卵巢良性囊肿患者,其中101例行常规三孔法腹腔镜手术(三孔组),85例行改良经脐单切口腹腔镜手术(单切口组);对比两组手术时间、手术失血量、术后24 h疼痛视觉模拟评分、术后首次排气时间...     

腹腔镜治疗巨大卵巢囊肿19例报告

目的:探讨腹腔镜巨大卵巢囊肿手术的可行性及安全性.方法:回顾分析2008年3月至2010年7月行腹腔镜手术治疗19例直径15～24cm巨大卵巢囊肿患者的临床资料,总结分析其病例选择、手术方式、手术时间、出血量、住院时间、术后并发症等.结果:19例术中冰冻及病理结果均为良性肿瘤,手术均获成功,无一例中转开腹.16例行卵巢...     

经脐单孔腹腔镜与传统腹腔镜卵巢囊肿剥除术的比较

目的探讨经脐单孔腹腔镜卵巢囊肿剥除术的安全性和临床价值。方法对2017年3月~2019年8月我院87例良性卵巢囊肿剥除术进行回顾性分析,其中单孔腹腔镜卵巢囊肿剥除术43例(单孔腹腔镜组),传统腹腔镜卵巢囊肿剥除术44例(传统腹腔镜组),比较2组手术时间、术中囊肿破裂率、术后血红蛋白(hemoglobin,Hb)下降幅度、术后24 h疼痛视觉模拟评分(Visual Analogue Scale,VAS)、排气时间、住院时间。结果2组患者均无中转开腹和手术并发症发生。单孔腹腔镜组囊肿破裂率81.3%,明显高于传统腹腔镜组56.8%(χ^2=6.137,P=0.013),术后24 h疼痛VAS评分单孔腹腔镜组明显低于传统腹腔镜组[1(0~2)分vs.2(0~3)分,Z=-3.575,P=0.000],排气时间明显早于传统腹腔镜组[(26.5±11.1)h vs.(33.1±11.8)h,t=-2.654,P=0.009]。2组手术时间、术后Hb下降幅度和住院时间差异均无统计学意义(P>0.05)。结论经脐单孔腹腔镜良性卵巢囊肿剥除术是安全和可行的,但囊肿破裂率明显增高,应重视术前良恶性肿瘤的评估,交界性或恶性肿瘤慎用此术式。     

单孔腹腔镜联合经脐小切口体外妊娠期巨大卵巢囊肿剥除术的临床应用价值

目的评估利用单孔腹腔镜联合经脐小切口体外剥除妊娠期巨大卵巢囊肿的临床意义和治疗效果。 方法回顾性分析2018年5～11月在石家庄市第四医院实施单孔腹腔镜联合经脐小切口体外妊娠期巨大卵巢囊肿(10～11 cm)剥除术的6例患者的临床资料。 结果6例患者均顺利完成单孔腹腔镜联合经脐小切口体外巨大卵巢囊肿剥除。6例患者中,1例输卵管系膜囊肿扭转,2例卵巢囊肿蒂扭转,3例患者恢复正常解剖结构后卵巢均未发生坏死,行囊肿剥除术。中位囊肿直径10 cm(10～11 cm),中位手术时间51.50 min(43.75～63.50 min),中位术中出血7.5 ml( 5～20 ml),平均住院时间( 3.50±0.43) d。随访,6例患者中,5例(83.33%)妊娠至足月分娩,1例(16.67%)早产;其中2例(33.33%)行剖宫产,4例(66.67%)顺产;中位新生儿体质量3 050 g(2 750～3 162.5 g)。6例患者的新生儿均无畸形及窒息。 结论对妊娠期巨大卵巢囊肿,应用单孔腹腔镜联合经脐小切口体外巨大卵巢囊肿剥除术是安全可行的,值得临床推广。     

卵巢子宫内膜异位囊肿术后盆腔囊性包块分析

目的 探讨卵巢子宫内膜异位囊肿术后异位囊肿的复发和盆腔包裹积液发生的规律,以及合理有效的治疗方案.方法 比较两者发生的时间、手术范围,与年龄、服药、CA125的关系,以及影像学的特征.采用阴道超声引导下穿刺治疗,并就其囊液进行分析.结果 术后1～6月内,盆腔包裹积液发生率为41.7%（10/24）,没有发生卵巢子宫内膜异位囊肿复发,两者相比（P〈0.001）差异有统计学意义.术后18月以上出现的囊肿中,卵巢子宫内膜异位囊肿居多,发生率为40%（12/30）两者的发生率相比（P〈0.05）,差异有统计学意义.结论 子宫内膜异位症术后盆腔包裹积液出现一般早于卵巢子宫内膜异位囊肿的复发,且这种囊肿可以通过阴道超声进行介入治疗.     

Minimal access approach to the management of large ovarian cysts

Laparoscopy has become an accepted method of management for ovarian cysts. Large ovarian cysts, however, have traditionally been, and continue to be treated by laparotomy. This is mainly due to technical difficulties and the possibility of malignancy. We describe four patients in whom laparoscopy was used to remove large ovarian cysts. Laparoscopic guided aspiration was performed, followed by extra-abdominal excision of the cyst. This approach has the advantages of minimising the risk of spillage of cyst fluid, a smaller incision compared to laparotomy, as well as faster recovery. We advocate this method for large unilocular benign cysts.     

不同手术方式处理卵巢子宫内膜异位囊肿对体外受精-胚胎移植妊娠结局的影响

目的探讨卵巢子宫内膜异位囊肿剔除术和经阴道穿刺抽吸术对体外受精-胚胎移植(IVF-ET)妊娠结局的影响。方法选择2010年1月至2016年3月在我院行IVF-ET助孕治疗的98例卵巢子宫内膜异位囊肿患者为研究对象,根据助孕前处理不同分组:52例曾在外院接受囊肿剔除术的患者为囊肿剔除组,46例促排卵前行经阴道行囊肿穿刺抽吸术的患者为穿刺组;并选择同期来我院就诊因单纯输卵管因素不孕的55例患者为参照组。比较不同手术组的促排卵情况及妊娠结局,以及与本中心一般IVF患者的临床结局差异。结果穿刺组窦卵泡数显著低于参照组[(10.41±4.69)vs.(13.68±7.78)个](P0.05)。囊肿剔除组和穿刺组的HCG日E_2水平[分别为(15 746.24±7 821.86)、(16 704.57±7 860.99)pmol/L]显著低于参照组[(21 082.45±10 316.09)pmol/L](P0.05)。囊肿剔除组和穿刺组的获卵数[分别为(11.37±5.98)、(10.84±6.01)个]显著低于参照组[(14.05±7.27)个](P0.05),但3组间双原核(2PN)受精率、优质胚胎率、移植胚胎数比较均无显著性差异(P0.05)。穿刺组的临床妊娠率(39.13%)呈低于囊肿剔除组(53.85%)的趋势,但无显著性差异(P0.05)。结论卵巢子宫内膜异位囊肿术后的IVF-ET临床结局与本中心一般IVF妊娠结局相似。卵巢子宫内膜异位囊肿行剔除术和穿刺术各有优势,在临床工作中应根据患者实际情况选择合适的治疗方式。     

腹腔镜卵巢皮质撕开法剥除卵巢囊肿手术临床分析

目的:探讨腹腔镜卵巢皮质撕开法剥除卵巢囊肿手术的应用价值。方法:回顾分析125例B超示卵巢囊肿小于6 cm患者的手术时间、出血量及术后病率等。结果:腹腔镜卵巢皮质撕开法剥除小于6 cm的卵巢囊肿与开腹手术相比具有手术时间短,术中出血少,术后病率低等优点。结论:腹腔镜卵巢皮质撕开法剥除小于6 cm的卵巢囊肿,既能完整剥除肿瘤,又能保护卵巢组织,创伤小,康复快,安全适用。     

Transumbilical single-port laparoscopic cholecystectomy

Background  Many laparoscopic surgeons have been attempting to reduce incisional morbidity and improve cosmetic outcomes by using fewer and smaller ports. We performed transumbilical single-port laparoscopic cholecystectomy (TUSPLC) in 15 patients with cholelithiasis by using a special “single-port” with virtually no scar. Methods  We used an extra-small wound retractor and a surgical glove as the “single-port.” The wound retractor was set up through the small umbilical incision and the surgical glove attached with one trocar and two pipes was then fixed to the outer ring of the wound retractor. The commonly used trocar and two slim pipes attached to the surgical glove served as three working channels. Using this single-port and conventional laparoscopic instruments, such as a straight 5-mm dissector, grasper, scissors, and a 30-degree 5-mm rigid laparoscope, we performed TUSPLC in 15 patients with cholelithiasis. The overall procedure was similar to three-port laparoscopic cholecystectomy. Results  Fifteen well-selected patients with cholelithiasis underwent TUSPLC (4 males and 11 females; mean age, 39 (range, 29–63) years). Body mass index ranged from 20 to 34 (mean, 25.2). No case required extra-umbilical skin incisions or conversion to standard laparoscopy. The mean operative time was 79 (range, 35–165) min. Blood loss was minimal in all cases. The mean postoperative hospital stay was 1.6 (range, 1.0–2.5) days. No postoperative complications were observed. Conclusions  The results of our initial experience of TUSPLC in 15 well-selected patients with cholelithiasis are encouraging. All procedures were completed successfully within a reasonable time. No extra-umbilical incisions were used and virtually no scar remained. TUSPLC could be a promising alternative method for the treatment of some patients with symptomatic gallstone disease as scarless abdominal surgery.     

经脐入路腹腔镜手术的初步临床报告

目的探讨经脐入路内镜手术(transumbilical endoscopic surgery,TUES)的临床应用。探索操作更为简单、安全的腹壁无瘢痕手术入路。方法13例分别实施TUES肝囊肿开窗引流(1例)、腹腔探查(1例)、阑尾切除(5例)和胆囊切除术(6例)。3例用上消化道内镜及其器械完成,10例用三通道套管技术及其改良的器械完成。结果13例TUES手术均获成功。无中转常规腹腔镜或开腹手术。6例胆囊切除手术时间90~150min,5例阑尾切除手术时间15~40min,1例用普通内镜完成的肝囊肿开窗引流术手术时间90min,1例腹腔探查为膀胱周围腹膜挫伤,电凝止血,手术时间50min。无出血、胆漏等并发症发生。除脐部皱褶部位外,基本无可见的腹壁瘢痕。结论经脐入路内镜手术操作简单、安全,技术上是可行的。TUES胆囊切除难度仍较大,在开展TUES手术初期应慎重选择病例。     

经脐部三孔法腹腔镜胆囊切除术

目的 探讨经脐三孔腹腔镜胆囊切除术(transumbilical laparoscopic cholecystectomy, TULC)的可行性. 方法 取脐下缘10 mm、脐右上缘3 mm及脐左上缘5 mm穿剌孔,分别置入Storz 10 mm 30°腔镜及直线型刚性器械,超声刀或电凝钩进行组织分离,应用腔镜下结扎缝...     

妇科单孔腹腔镜卵巢囊肿剔除术对卵巢功能的影响

卵巢囊肿是妇科常见疾病,对育龄期女性卵巢功能有重大影响,随着腹腔镜技术的成熟与发展,腹腔镜囊肿剔除术已成为卵巢良性囊肿的首选治疗术式。单孔腹腔镜于脐部做小切口,具有更好的美容效果,正不断应用于年轻女性卵巢囊肿剔除术。但其较传统腹腔镜具有视野小、单孔操作困难等劣势,对卵巢功能是否会造成不利影响,尚不可知。故本研究针对该问题整合国内外相关研究作一综述。     

腹腔镜诊治卵巢囊肿蒂扭转

目的:探讨腹腔镜在诊断和治疗卵巢囊肿蒂扭转方面的应用价值。方法:对1994年1月至2006年2月14例经腹腔镜诊断和治疗的卵巢囊肿蒂扭转患者的临床资料进行回顾性分析。结果:14例中12例(85.7%)临床表现为急性腹痛,8例(57.14%)伴有恶心呕吐;仅6例术前诊断为卵巢囊肿蒂扭转;14例均经腹腔镜确诊并于镜下完成治疗,行患侧附件切除术9例,蒂扭转复位后行卵巢囊肿剥出术5例,平均手术时间114.3m in,平均出血24.3m l,无手术并发症发生;术后病理诊断卵巢成熟囊性畸胎瘤10例,浆液性囊腺瘤3例,卵巢单纯性囊肿1例。结论:腹腔镜对早期诊断卵巢囊肿蒂扭转有重要价值,在诊断的同时治疗卵巢囊肿蒂扭转安全有效。