腹腔镜下卵巢囊肿剥除术的疗效观察及安全性分析

目的观察并探讨腹腔镜下卵巢囊肿剥除术的疗效观察及安全性。方法选取2017年2月~2018年9月期间我院收治的64例卵巢囊肿患者,随机将患者分为实验组与对照组,分别给予腹腔镜下卵巢囊肿剥除术及经阴道超声引导穿刺治疗,对两组患者的围手术期指标及并发症发生情况进行观察与对比。结果实验组患者的术中出血量、手术时间、排气时间及住院时间均显著优于对照组,且并发症发生率低于对照组,P<0.05,组间差异具有统计学意义。结论腹腔镜下卵巢囊肿剥除术治疗卵巢囊肿患者具有显著临床效果,值得推广。     

腹腔镜下卵巢囊肿剥除术治疗卵巢囊肿的临床疗效观察

目的：对腹腔镜下卵巢囊肿剥除术治疗卵巢囊肿的临床疗效进行观察分析,为今后的临床治疗工作提供可靠的理论依据。方法：抽取在2012年1月至2013年12月间我院收治的临床确诊卵巢囊肿行剥除术进行治疗的患者66例,将其按照手术方式分成传统开腹组和腹腔镜组,而后对这两组患者的治疗效果进行对比分析。结果：经对比发现,腹腔镜组术中出血量、术后排气时间、住院时间均较开腹组明显减少（P＜0.05）,术后并发症发生率明显低于开腹组（P＜0.05）。结论：腹腔镜下卵巢囊肿剥除术的临床疗效显著,缩短了住院时间,降低了并发症发生率,安全有效,值得关注并推广。     

经脐单孔腹腔镜卵巢囊肿剥除术

近年腹腔镜手术广泛用于妇科领域,治疗卵巢囊肿已由开腹手术逐渐被腹腔镜手术取代.近来腹腔镜-内镜外科医师共同提出自然腔道手术(nature orifice translumenal endo-scopic surgery,NOTES)概念,即通过人体口腔、阴道、直肠进入盆腹腔实施手术报道了经脐单孔腹腔镜输卵管切除术[2,3].在此基础上,2007年6月至2008年2月我院为15例卵巢囊肿患者成功实施了经脐单孔腹腔镜卵巢囊肿剥除术,效果良好,现报道如下.     

经阴道与经腹腔镜行良性卵巢囊肿剥除术的对比分析

目的:探讨经阴道与经腹腔镜行良性卵巢囊肿剥除术的临床价值。方法:对62例行经阴道和58例经腹腔镜卵巢囊肿剥除术的良性卵巢囊肿患者的临床资料进行分析,比较各项指标的差异。结果:经阴道手术组(研究组)手术时间、排气时间、住院费用、与经腹腔镜手术组(对照组)比较均有显著性差异(P<0.05)。2组术中出血、术后并发症、出院后随访1月内恢复日常家务及工作者比较差异无统计学意义(P>0.05)。结论:选择合适的适应证,经阴道行良性卵巢囊肿剥除术是一种微创、符合循证医学原则的手术。     

腹腔镜辅助下剥除巨大卵巢囊肿方法介绍

几乎所有卵巢囊肿均可通过腹腔镜进行诊断和处理.但对于巨大卵巢囊肿,因其占据整个盆腔或盆腹腔影响腹腔镜下视野而给手术带来困难,有时需改为开腹手术.但在手术方式上进行小的创新后,使手术难度明显降低,可避免开腹手术.本文介绍2例应用体会.     

腹腔镜下子宫肌瘤剥除术对子宫肌瘤患者疗效及术后康复的影响

目的 研究子宫肌瘤患者应用腹腔镜下子宫肌瘤剥除术治疗的临床疗效及对术后康复的影响。方法 选取40例子宫肌瘤患者,根据手术方法不同分为开腹组（采用开腹手术治疗）与腹腔组（采用腹腔镜下子宫肌瘤剥除术治疗）,每组20例。比较两组临床疗效、术后1年复发情况及围手术期指标。结果 开腹组总有效率80.00%和术后1年复发率15.00%与腹腔组的90.00%、10.00%比较,差异无统计学意义（P>0.05）。腹腔组手术时间、术后首次下床活动时间、恢复排气时间、恢复排便时间及住院时间均短于开腹组,术中出血量少于开腹组,差异有统计学意义（P<0.05）。结论 腹腔镜下子宫肌瘤剥除术治疗子宫肌瘤的疗效良好,术后复发率较低,且术中出血量较少,手术创伤性较小,大大加速康复进程,缩短住院时间。     

经脐单孔腹腔镜辅助下妊娠合并卵巢囊肿体外剥除术8例临床分析

目的:探讨经脐单孔腹腔镜辅助下妊娠合并卵巢囊肿体外剥除术的临床意义。方法:对我院自2017年1月至2018年6月完成的妊娠合并卵巢囊肿采用经脐单孔腹腔镜辅助下体外剥除术的8例患者进行回顾性分析。通过术后24小时疼痛视觉模拟评分(VAS)、围手术期并发症、超声检查、术后体象量表评分(BIS)及切口美观满意度评分(CS)等指标来评估手术疗效。结果:8例患者手术过程顺利,均未中转传统腹腔镜或者开腹手术;术后24小时VAS评分为2.25±0.71分;未出现围手术期并发症;术后病理结果显示3例为卵巢畸胎瘤,1例为卵巢浆液性囊腺瘤,4例为卵巢黏液性囊腺瘤;所有病例均未出现妊娠中止,并都随访至产后3个月,复查彩超均未见复发,BIS为7.87±1.46分,CS为21.63±1.69分。结论:经脐单孔腹腔镜辅助下妊娠合并卵巢囊肿体外剥除术对妊娠期母儿的创伤小,康复快,技术安全可行,并具有良好的美容效果,值得推广。     

循证管理护理干预对腹腔镜卵巢囊肿剥除术患者心理状态、术后康复及卵巢功能的影响

目的 分析循证管理护理干预对腹腔镜卵巢囊肿剥除术患者心理状态、术后康复及卵巢功能的影响。方法选取卵巢囊肿剥除术患者80例作为研究对象,以随机数字表法将其分为两组,对照组（40例,常规护理）、观察组（40例,常规护理+循证管理护理）。比较两组各项指标。结果 与干预前比,干预后两组精神性焦虑、躯体性焦虑评分及总分均降低,且观察组均低于对照组;观察组术后导尿管留置及住院时间均短于对照组,肛门排气、下床活动及自主排便时间均早于对照组;干预后对照组卵泡刺激素、黄体生成素水平均升高,差异有统计学意义（P<0.05）。结论 腹腔镜卵巢囊肿剥除术患者应用循证管理护理可有效减轻对卵巢功能的影响,改善患者心理状态,促进术后康复。     

妊娠期腹腔镜下卵巢囊肿剥除术10例临床分析

目的:初步探讨腹腔镜手术在妊娠期卵巢囊肿治疗中的临床应用价值.方法:10例患者全部行腹腔镜下卵巢囊肿剥除术,选择气管内插管全身麻醉,术中持续心电监护及血氧饱和度监测.术后常规预防性使用抗生素,并给予硫酸镁保胎治疗.结果:所有病例均在腹腔镜下顺利完成手术,无一例中转开腹,无手术并发症发生,平均手术时间48分钟,术中平均出血25ml,随诊至足月,10例患者全部正常分娩,新生儿健康,无窒息、畸形.结论:在妊娠期选择腹腔镜下卵巢囊肿剥除术是安全可行的.     

经脐单孔腹腔镜卵巢囊肿剔除术的临床疗效分析

目的 探究经脐单孔腹腔镜卵巢囊肿剔除术的临床疗效。方法 选取78例卵巢囊肿患者,根据患者自愿原则选择术式的不同分为单孔组（采用经脐单孔腹腔镜卵巢囊肿剔除术术治疗）与三孔组（采用传统三孔腹腔镜卵巢囊肿剔除术治疗）,每组39例。比较两组手术相关指标、术后腹壁外观满意度及并发症发生情况。结果 单孔组术后排气时间、住院时间均明显短于三孔组,术后1、3 d视觉模拟评分法（VAS）评分均低于三孔组,差异有统计学意义（P<0.05）;两组术中出血量和手术时间比较,差异无统计学意义（P>0.05）。单孔组腹壁外观满意度94.87%高于三孔组的76.92%,差异有统计学意义（P<0.05）;单孔组并发症发生率5.13%与三孔组12.82%比较,差异无统计学意义（P>0.05）。结论 经脐单孔腹腔镜卵巢囊肿剔除术具有较高有效性及安全性,且可显著提高腹壁外观满意度,值得临床推广与应用。     

Torsion of a giant para-ovarian cyst. Conservative laparoscopic treatment

Adnexal torsion is a condition that may result in serious consequences, including adnexa removal. Recently, de-torsion has replaced salpingo-oophorectomy as the treatment for a twisted ischaemic adnexum, and the best way to do it seems to be laparoscopic surgery. A case of adnexal torsion caused by a giant para-ovarian cyst treated, with good results, by a conservative laparoscopic approach is reported.     

Luteinizing hormone in peritoneal and ovarian cyst fluids: a predictor of ovarian carcinoma

Objective: The aim of this study was to define the role of luteinizing hormone (LH) as a tumor marker, specific for ovarian cancer. Methods: The study included 34 women with functional and benign ovarian cysts, 11 women with borderline ovarian tumors, 22 patients with advanced ovarian cancer and 15 patients with non-ovarian intraperitoneal malignancies. Serum, peritoneal fluid and ovarian cyst aspirates were obtained intraoperatively (laparoscopy or laparotomy) and were subjected to the LH analysis. Results: Peritoneal fluid LH levels were significantly increased in patients with ovarian cancer and those with borderline ovarian tumors as compared to patients with functional and benign ovarian cysts (P=0.005 and P=0.007, respectively). The patients with non-ovarian malignancies demonstrated the same peritoneal fluid LH levels as patients with benign ovarian tumors. There was no significant difference in the level of peritoneal fluid LH between ovarian cancer patients with and without ascites. The patients with functional and benign ovarian cysts demonstrated also significantly lower cyst fluid LH levels as compared to patients with malignant and borderline ovarian cysts (P=0.01 and P=0.03, respectively). Peritoneal and ovarian cyst fluid levels of LH were significantly increased in patients with fibrothecomas as compared to patients with other benign ovarian cysts. There were no significant differences in the serum LH levels comparing patients from all study groups. Conclusion: LH, detectable in peritoneal and ovarian cyst fluids, can be used as a tumor marker for identification of patients with borderline and malignant ovarian tumors.     

腹腔镜卵巢子宫内膜异位囊肿剥除术对卵巢储备功能的影响

目的:探讨腹腔镜卵巢子宫内膜异位囊肿(巧囊)剥除术对卵巢储备功能可能造成的影响。方法:前瞻性对照研究,对照组:单侧卵巢成熟性囊性畸胎瘤行腹腔镜囊肿剥除术20例;实验组:卵巢子宫内膜异位囊肿行腹腔镜囊肿剥除术80例。实验组分为4组:A组:单侧巧囊35岁(27例),B组:单侧巧囊≥35岁(13例),C组:双侧巧囊35岁(28例)和D组:双侧巧囊≥35岁(12例)。比较各组手术前、手术后24h内血清FSH,LH,E2的变化并根据单侧巧囊的大小和类型分层分析。随访患者术后6月基础FSH的恢复情况,术后6月超声测量患者双侧卵巢的体积。结果:双侧各组(C,D两组)卵巢子宫内膜异位囊肿剥除术后24h内FSH较术前明显增高(P0.05),E2明显减低(P0.05),LH变化不明显。畸胎瘤组及单侧各组(A,B组)手术前后各激素水平均无统计学差异,分层分析单侧巧囊大小和类型,各组内组间激素水平变化亦无明显差异。C组患者术后6月基础FSH恢复至正常范围内占72.22%,而D组患者基础FSH恢复至正常范围内仅占55.56%,差异有统计学意义(P0.05)。单侧卵巢囊肿剥除术后6月患侧与对侧卵巢缩小率均有显著差异(P0.05),单侧卵巢囊肿剥除术后与双侧卵巢囊肿剥除术后患侧卵巢缩小率无统计学差异。结论:腹腔镜双侧卵巢子宫内膜异位囊肿剥除术对卵巢储备功能有一定的影响,但大部分患者可在术后6个月内恢复。     

The safety and efficacy of laparoscopic surgical staging of apparent stage I ovarian and fallopian tube cancers

OBJECTIVE: To compare the safety and efficacy of laparoscopic staging of ovarian or fallopian tube cancers to staging via laparotomy for epithelial ovarian carcinoma. STUDY DESIGN: We performed a case-control study of all patients with apparent stage I adnexal cancers who had laparoscopic staging from October 2000 to March 2003. The control group consisted of all patients with apparent stage I epithelial ovarian carcinoma who had staging via laparotomy during the same time period. RESULTS: Staging was laparoscopic in 20 patients and via laparotomy in 30. There were no differences in mean age and body mass index. There were also no differences in omental specimen size and number of lymph nodes removed. Estimated blood loss and hospital stay were lower for laparoscopy, but operating time was longer. There were no conversions to laparotomy or complications in the laparoscopic group, compared with 3 minor complications in the laparotomy group. CONCLUSION: In this preliminary analysis, it appears that patients with apparent stage I ovarian or fallopian tube cancer can safely and adequately undergo laparoscopic surgical staging.     

Simultaneous tubal pregnancy and twisted ovarian cyst

Background Simultaneous or concomitant bilateral adnexal pathology is rare. But simultaneous tubal pregnancy and twisted ovarian cyst is even rarer.Case A 25-year-old woman, gravida 2, parity 0, presented with acute abdomen after 12 weeks of amenorrhea. Simultaneous right tubal pregnancy and twisted left ovarian cyst were intraoperatively diagnosed. Right salpingostomy and left salpingo-oophorectomy were performed. The follow-up serum beta-hCG was negative at the nineteenth postoperative day. She was well at discharge and throughout the 4-week follow-up period.Conclusion Although simultaneous or concomitant bilateral adnexal pathology is uncommon, a careful assessment of both adnexa is mandatory especially in the cases with inconsistent site of symptom and pathology in order to avoid undiagnosed simultaneous pathologies that may be missed.     

Recurrent fetal complex ovarian cysts with rupture followed by simple cyst in the neonatal period with no adverse sequelae

Fetal ovarian cysts are the most frequent type of abdominal tumors in female fetuses with prenatal detection rate of more than 30%. The etiology of fetal ovarian cysts is unclear, but hormonal stimulation as well as presence of maternal diabetes, hypothyroidism, Rh iso-immune hemolytic disease and toxemia has been generally considered responsible for the disease. Complications of fetal ovarian cysts include compression of other viscera, cyst rupture, hemorrhage and, most frequently, ovarian torsion with consequent loss of the ovary. Management is controversial with several options described in the literature, including watchful expectancy, antenatal aspiration of simple cysts to prevent torsion and ovarian loss and finally, resection of all complex cysts in the neonatal period. To date, no case report has described recurrent complex cysts with rupture in the fetal period and recurrence of simple cyst in neonatal period. By presenting this case, we wanted to show that surgical intervention in case of prenatally diagnosed fetal ovarian cyst should be considered postnatally and only in symptomatic or complicated cases.     

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.     

腹腔镜卵巢子宫内膜异位囊肿剔除术及不同手术方式对卵泡丢失的影响

目的:探讨腹腔镜下卵巢子宫内膜异位(EMs)囊肿剔除术及不同手术方式对卵泡丢失的影响。方法:采用前瞻性对照研究,将腹腔镜单侧卵巢EMs囊肿剔除术患者106例随机分为两组,研究组采用改良锐性分离法,对照组采用传统钝性撕拉法。显微镜下观察剥离囊壁标本的卵巢门附近、卵巢窝处、中间部位的标本厚度、存在卵巢皮质的标本数、存在卵巢皮质厚度、皮质内是否存在卵泡及分级等指标,并比较分析腹腔镜下两种剥离方法对卵泡丢失影响。结果:卵巢门附近的标本厚度明显厚于卵巢窝处和中间部位标本,差异有统计学意义(P0.05);卵巢门附近、卵巢窝处、中间部位存在卵巢皮质的标本数比较差异无统计学意义(P0.05);卵巢窝处存在的的皮质厚度要明显薄于卵巢门附近、中间部位(P0.05);卵巢窝处及中间部位剥离囊壁的皮质内大多为始基卵泡或未发现卵泡,卵巢门附近多为初级、次级卵泡,差异有统计学意义(P0.05)。两种剥离方法在卵巢窝处的四项观察指标比较差异均无统计学意义(P0.05);研究组在中间部位的标本厚度和卵巢皮质厚度明显薄于对照组(P0.05);研究组在卵巢门附近的标本厚度和存在的卵巢皮质厚度明显薄于对照组,存在卵巢皮质的标本数明显少于对照组,差异有统计学意义(P0.05)。术后6个月,研究组与对照组的FSH、LH、E2比较,差异无统计学意义(P0.05),患侧卵巢窦卵泡数(Fo)及卵巢体积研究组高于对照组,差异有统计学意义(P0.05)。结论:卵巢EMs囊肿的腹腔镜剔除术会造成正常卵巢组织的丧失,改良的锐性分离法可避免卵巢门附近过多的初级或(和)次级卵泡的丢失。