超声诊断子宫动静脉瘘

目的探讨子宫动静脉瘘的超声表现及鉴别诊断。方法回顾性分析12例子宫动静脉瘘的超声表现,并与子宫动脉造影相对照。结果子宫动静脉瘘超声表现为近内膜处子宫肌壁或剖宫产切口处肌壁回声不均匀,可见不规则无回声区,典型者呈＂蜂窝样＂改变,CDFI显示局部区域血流异常丰富,呈＂湖泊样＂或＂五彩镶嵌样＂改变,频谱多普勒表现为高速低阻的血流频谱。子宫动脉造影结果与超声检查结果一致。结论超声结合子宫动脉造影有助于确诊子宫动静脉瘘。     

多次子宫动脉栓塞术治疗继发子宫动静脉瘘一例报道并文献复习

本文报道1例子宫动脉栓塞治疗子宫瘢痕妊娠术后继发子宫动静脉瘘伴阴道大量出血,并经再次子宫动脉栓塞成功止血的病例。本文讨论了子宫瘢痕妊娠后形成子宫动静脉瘘的诊断方法,并探讨了子宫动静脉瘘致阴道出血再次子宫动脉栓塞的安全性及有效性。     

超声引导下穿刺治疗盆腔囊性病变的临床应用价值

目的总结超声引导下穿刺治疗盆腔囊性病变的临床价值。方法对50例盆腔囊性病变患者给予超声引导下穿刺治疗,观察超声表现及临床效果。结果 50例患者穿刺治疗后超声检查囊性病变内部囊液均消失,3例阴道穿刺拔出穿刺针后阴道流血约10 ml。术后3个月B超复查结果显示1例子宫内膜异位囊肿复发,术后半年2例盆腔包裹性积液复发。结论超声引导下穿刺治疗盆腔囊性病变临床应用价值较高,值得推广使用。     

剖宫产术后瘢痕妊娠17例临床分析

目的探讨剖宫产术后瘢痕妊娠（CSP）的临床特点及治疗方法。方法对我院2007年1月～2010年8月收治的17例剖宫产术后瘢痕妊娠患者的临床数据进行回顾性分析。结果 17例患者中12例停经后有不规则阴道流血,6例患者人工流产术中大出血,3例人工流产术后阴道淋漓出血,6例术前明确诊断,均通过彩超诊断瘢痕妊娠,14例予子宫动脉栓塞术联合刮宫术均治疗成功,1例予药流后行清宫术,2例吸宫术发生大出血致休克直接行子宫切除术。结论子宫动脉栓塞术联合刮宫术是治疗剖宫产术后瘢痕妊娠最快捷、最有效的方法。     

中期妊娠引产清宫后胚物残留致“动静脉瘘”两例探讨

胚物残留在早、中孕期自然流产或人工流产术后,超声疑似“动静脉瘘”的病例屡见不鲜,不乏因担心大出血而建议行子宫动脉栓塞治疗而转诊的情况,医生的担忧难免也引起患者的恐慌。但临床所见大多数胚物残留病例,虽然有宫腔内占位和/或肌层内血流信号丰富的占位影像,但通常不伴有活跃的出血症状,不同于真正的子宫动静脉瘘,后者往往有“开关式”大量出血的特点,常需急诊处理。针对无明显出血且无感染征象的可疑胚物残留的患者,通常有保守观察和短期药物治疗的机会,无活性的胚物残留常有自限性,并随月经恢复后的内膜脱落而消退或缩小,不建议过于积极地进行再次清宫的操作,对于子宫动脉栓塞的使用更要谨慎。如1～2次月经后超声随诊仍有宫腔内占位,而局部血流信号不再丰富,是进行宫腔镜检查和治疗的最理想时机,首选无能量宫内旋切系统,对保护内膜和生殖潜能有益处。本文分享两例中期引产术后胚物残留超声提示动静脉瘘的病例的处理,强调个体化处理的原则,避免过度治疗。     

腹腔镜全子宫切除术后阴道残端的处理体会

目的:探讨腹腔镜全子宫切除术后阴道残端的处理方法。方法:随机将2009年5月至2012年2月267例腹腔镜全子宫切除术患者分为两组,对照组(n=132)经阴道行连续锁边缝合;研究组(n=135)经腹腔行连续锁边缝合,比较两组患者术中阴道流血量、阴道残端处理时间、术后阴道流血量及阴道流血时间、住院时间、术后并发症及随访情况。结果:两组术中、术后阴道流血量及流血时间、术后并发症、术后3个月内阴道排液量差异有统计学意义(P<0.01),而处理时间、住院时间差异无统计学意义(P>0.05)。结论:两种方法均适用于腹腔镜全子宫切除术,但经腹腔行连续锁边缝合具有术中、术后阴道流血量少、时间短、术后并发症少等优点,更利于妇科微创手术的临床推广。     

腹腔镜下子宫腺肌病病灶切除术后联合应用GnRH-a的临床价值分析

目的探讨腹腔镜下子宫腺肌病病灶切除术后联合应用GnRH-a的临床价值。方法选取2011年3月至2014年3月在我院妇科微创中心行腹腔镜下子宫腺肌病病灶切除术的子宫腺肌病患者96例为研究对象,其中48例患者术后接受GnRH-a治疗为研究组,未接受GnRH-a治疗的48例为对照组。腹腔镜下行病灶切除术后实验组给予GnRH-a治疗,随访18个月。比较两组患者围手术期情况、月经和身体情况、并发症及药物副作用。结果两组患者术前的痛经程度、月经量、CA125水平、Kupperman评分、手术时间、术中出血量、术后排气时间、住院时间均无显著差异P>0.05;术后1、6、18个月研究组的痛经评分、月经量显著低于对照组,术后1个月和6个月研究组的Kupperman评分显著高于对照组,P<0.05;术后18个月两组患者的Kupperman评分无显著差异,P>0.05。治疗过程中两组患者未见并发症,但研究组有11例患者出现了烦躁、阴道不规则出血等症状,其中2例肝功能异常,停药后1~3个月症状均缓解、肝功恢复正常。结论腹腔镜下子宫腺肌病病灶切除术后联合应用GnRHa,能有效改善患者的痛经、月经量多等症状,也可以降低子宫腺肌病的复发率,值得临床推广应用。     

妇科腹腔镜术后泌尿系损伤4例报告

本文回顾分析近5年我院妇科腹腔镜术后发生输尿管阴道瘘、膀胱阴道瘘患者的临床资料,结合文献分析报道如下。例1,2005年4月27日患者因“子宫腺肌症,双侧输卵管积水”行腹腔镜全子宫＋双侧输卵管切除术,术中见子宫增大,如孕2’月,活动度稍差,子宫骶韧带增粗,盆腔内见散在内异症病灶,术中用PK刀处理子宫、     

腹腔镜手术联合孕三烯酮治疗盆腔子宫内膜异位病灶

目的探讨腹腔镜手术联合孕三烯酮治疗盆腔子宫内膜异位病灶的临床疗效。方法观察组68例患者采用腹腔镜手术剔除盆腔子宫内膜异位病灶,术后辅以孕三烯酮治疗;对照组52例采用单纯腹腔镜手术剔除盆腔子宫内膜异位病灶,随访痛经、月经量及复发情况。结果术后6、12个月随访观察组较对照组月经量减少,痛经明显缓解,复发率明显低于对照组。结论腹腔镜手术联合孕三烯酮治疗盆腔子宫内膜异位病灶临床效果显著,复发率低。     

聚乙烯醇颗粒子宫动脉栓塞治疗子宫腺肌病

目的观察PVA(聚乙烯醇)颗粒子宫动脉栓塞(UAE)治疗子宫腺肌病的临床效果。方法对26例根据临床症状、彩色超声或磁共振成像检查诊断为子宫腺肌病的患者行UAE治疗。术后观察月经量、痛经程度及子宫体积等变化。结果26例患者子宫动脉栓塞均一次成功，UAE治疗后平均观察5个月，21例患者术后痛经完全消失，3例明显缓解，2例缓解7～9个月后复发；临床显效率达92．3％；月经量明显减少，而月经周期及经期无变化；术后疼痛评级比术前明显降低，彩色超声或．MR检查显示子宫体积明显缩小。结论PVA栓塞剂子宫动脉栓塞治疗子宫腺肌病是一种近期疗效显著、安全有效的治疗途径。     

Vaginal calculi secondary to urethrovaginal fistula with vaginal stenosis in a 14-year-old girl

The author reports a case of vaginal calculi secondary to urethrovaginal fistula with vaginal stenosis in a 14-year-old girl. The initial urethrovaginal fistula and vaginal stenosis resulted from pelvic trauma after a traffic accident, with subsequent surgical urethral realignment and anterior colporrhaphy without success. The patient had continuous urinary incontinence for a duration of 11 years after surgery, and was finally diagnosed with urethrovaginal fistula with primary multiple vaginal calculi in our hospital. Surgeries were performed to remove the stones and repair the urethrovaginal fistula. Colpoplasty was also given by an obstetrician–gynecologist to solve the vaginal stenosis. After the procedure, the girl urinated normally. At her 3-month follow-up, the patient had no sign of urine leakage.     

Laparoscopic removal of a rudimentary uterine horn in a previously hysterectomized patient.

BACKGROUND: The unicornuate uterine anomaly is often difficult to diagnose and usually low on the list of differential diagnoses for pelvic pain and dysmenorrhea. The authors present a case of a rudimentary uterine horn as a cause for continued pelvic pain and dysmenorrhea in a previously hysterectomized woman. CASE REPORT: A 43-year-old woman, gravida 1, para 1, presented for evaluation of right lower quadrant pain of several years' duration. Her past surgical history was significant for multiple prior laparoscopies and a vaginal hysterectomy. Radiographic studies revealed a mass in the right lower quadrant. Laparoscopy revealed a solid mass in the right pelvis that was diagnosed as a rudimentary uterine horn. CONCLUSION: Uterine anomalies, although uncommon, should be thought of as part of the differential diagnosis for pelvic pain and dysmenorrhea. A thorough inspection of the pelvis should be performed at the time of any operative procedure for abdominal pain.     

Only metastasis to uterine corpus from superficial bladder cancer that of no original recurrence

We report a rare case of uterine corpus metastasis from superficial bladder cancer. A 78-year-old female presented with abnormal vaginal bleeding. She received transurethral resection of bladder tumor (TUR-Bt) two years previously, and the pathological findings were transitional cell carcinoma (TCC) grade 3 pT1. Eight courses of BCG instillation were performed postoperatively. There was no recurrence of bladder cancer when vaginal bleeding occurred. Cytology of vaginal discharge was class V, and transitional cell carcinoma suspected. Pathological finding of transvaginal uterine corpus biopsy was TCC. We diagnosed metastases to uterine corpus from bladder cancer.     

Uterine leiomyoma associated non-puerperal uterine inversion misdiagnosed as advanced cervical cancer: A case report

INTRODUCTIONUterine inversion is an un-common complication of parturition which often occurs in the immediate postpartum period. The chronic (non-puerperal) uterine inversion is rarer and most times tumour associated.PRESENTATION OF CASEA 51-year old grand multiparous lady presented with a month history of abnormal vaginal bleeding associated with offensive vaginal discharge, lower abdominal pain and dizziness. The initial evaluation suggested severe anaemia secondary to advanced cervical cancer. Examination under anaesthesia (EUA), staging and biopsy was attempted but this was however inconclusive due to profuse haemorrhage. A repeat EUA revealed chronic uterine inversion secondary to fundal submucous uterine leiomyoma. Myomectomy was done with tissue histology confirming benign uterine leiomyoma. Two weeks later, a modified Haultain's procedure was done followed by simple hysterectomy and posterior colpoperineorrhaphy. She had satisfactory recovery.DISCUSSIONThis is the first reported case of chronic non-puerperal uterine inversion in our hospital. When it occurs, it is usually tumour associated with the commonest tumour being prolapsed myoma and leiomyosarcoma. The diagnosis is based on high index of suspicion.CONCLUSIONChronic uterine inversion is a rare gynaecological condition and can be misdiagnosed as advanced cervical cancer or other causes of severe genital haemorrhage in women. A high index of suspicion is needed for its proper diagnosis. Sometimes, an EUA and biopsy was required to determine the cause here and conveniently it could be described as a “gynaecolological near miss”.     

经子宫动脉氨甲蝶呤灌注及栓塞 在宫颈妊娠保守治疗中的应用

目的探讨经子宫动脉氨甲蝶呤灌注化疗及栓塞术在宫颈妊娠保守治疗中的应用价值.方法 6例宫颈妊娠患者,孕龄36～68天,经阴道超声检查明确诊断后,行双侧子宫动脉氨甲蝶呤灌注及栓塞治疗.结果所有患者均一次治疗成功,术后患者的阴道出血明显减少或中止,血β-HCG水平迅速下降.患者的宫颈形态及月经周期于治疗后4个月内恢复正常.结论子宫动脉氨甲蝶呤灌注化疗及栓塞术是保守治疗宫颈妊娠的有效方法.     

阴道前后壁修补术联合阴式子宫全切术治疗中重度子宫脱垂的疗效

目的探究阴道前后壁修补术联合阴式子宫全切术治疗中重度子宫脱垂的疗效及其对性功能的影响。 方法选择芜湖市第五人民医院妇产科自2014年8月至2018年8月收治的中重度子宫脱垂患者60例,随机分为观察组与对照组,每组各30例。观察组行阴式全子宫切除术加阴道前后壁修补术治疗,对照组行单纯阴道前后壁修补术治疗,对比2组围手术期临床指标、术后并发症发生率及复发情况,采用盆腔器官脱垂/尿失禁性功能问卷（PISQ-12）对比2组术前、术后随访6个月的性功能变化情况。 结果观察组平均手术时间、肛门排气时间、住院天数明显短于对照组,观察组术中出血量少于对照组,差异有统计学意义（P<0.05）;观察组术后并发症发生率与对照组差异无统计学意义（P>0.05）;观察组的治愈率为90.00%,好转率为10.00%,高于对照组的80.00%、3.33%,观察组无复发者,对照组复发率为16.67%,差异均有统计学意义（P<0.05）;术后随访6个月后观察组PISQ-12评分为（35.12±3.37）分,低于对照组（38.83±5.62）分,差异有统计学意义（P<0.05）。 结论阴式全子宫切除术联合阴道前后壁修补术治疗中重度子宫脱垂的临床效果较理想,与单纯阴式子宫切除术相比可显著缩短手术时间较短,减少术中出血,提高手术疗效,降低术后复发率,但在改善术后性功能方面并不具有优势。     

Subtotal cystectomy and ileal substitution cystoplasty for complicated vesicovaginal fistula: a case report

A 68-year old female underwent laparoscopic vaginal hysterectomy for uterine wall perforation, following the removal of an intrauterine contraceptive device (IUD). The patient entered our hospital complaining of persistent genital bleeding, lower abdominal pain and urinary incontinence. She was diagnosed with a vesicovaginal fistula. The diameter of the fistula was over 3 cm and extended from the trigone to the internal urethral orifice, complicating the right distal ureteral obstruction. Therefore, curative surgery required a subtotal cystectomy and substitution cystoplasty due to severe urothelial changes, hydronephrosis and poor bladder compliance. An ileal neobladder (modified Studer's method) was successfully created and the postopertive course was uneventful. Although minor urinary incontinence persists, she can void through the urethra which has improved her quality of life.     

Complete bladder eversion concurrent with total uterine prolapse

Complete eversion of the urinary bladder is rare, and a case with concurrent total uterine prolapse is an extremely rare problem. A 75-year-old multiparous, postmenopausal female presented with two huge masses protruding from the vagina. Total transurethral eversion and concurrent uterine procidentia were noted. Manual reduction of the bladder, vaginal hysterectomy, suprapubic cystostomy, and urethral closure were performed under general anesthesia. The neck of the bladder was reinforced with retropubic prolene mesh to prevent recurrence. The patient was well, with no eversion, prolapse of bladder, or other pelvic organ prolapse at 6 months follow-up.     

腹腔镜巨大子宫切除术200例体会

目的：探讨腹腔镜巨大子宫切除的可行性、安全性。方法2010年1月～2013年12月对子宫超过孕3个月的巨大子宫行腹腔镜全子宫切除术,第一穿刺孔位于宫底上5 cm,手术关键步骤是恰当处理子宫血管,选择子宫动脉上行支进行电凝,分前、后、外侧切割子宫血管。结果200例均在腹腔镜下完成手术,无一例中转开腹。手术时间80～170 min,平均120 min;术中出血量20～250 ml,平均60 ml,无因术中出血致输血者。2例术后3 d发生下肢静脉血栓,抗凝治疗后痊愈。2例术后15 d阴道残端炎,阴道放置甲硝唑粉末后治愈。1例术后1个月发生阴道残端出血,缝合2针后治愈。余均无严重并发症发生。术后住院（5±2）d。144例随访6个月,阴道残端愈合良好,B超示双肾输尿管正常,盆腔未见异常。结论使用双极电凝行腹腔镜巨大子宫切除术、安全、可行。