妇科手术同时切除阑尾的探讨

对妇科手术同时是否常规切除阑尾 ,各学者意见不一。我们将 1983年 1月至 1997年 10月 15年间三所医院妇科手术同时切除阑尾 2 33例的临床资料作一分析探讨。1　临床资料1 1　一般情况　 2 33例患者年龄 186 9岁 ,平均 46 5岁。其中 <2 0岁 2例 ,2 130岁 35例 ,3140岁 6 0例 ,415 0岁 83例 ,5 16 0岁 43例 ,>6 0岁 10例。1 2　病种或组织类型　良性病变 143例 ,其中以一种病变为主的分别是 :子宫肌瘤 6 1例 ,占 42 6 6 % ;子宫腺肌病或子宫腺肌病合并子宫肌瘤、盆腔子宫内膜异位症、卵巢巧克力囊肿 38例 ,占 2 6 5 7% ;单纯卵巢囊肿 2 6…     

Routine appendectomy in extensive gynecologic operations

Based upon past clinical experience, a policy was established in a teaching service to remove the appendix whenever encountered during extensive gynecologic operations. Retrospectively, all patients operated upon during the subsequent 54 month period were reviewed to determine the success of instituting the policy of mandatory elective appendectomy and to assess the pathologic findings. We found that 93 per cent of the time the policy was followed and appendectomy performed. Definite pathologic findings were found in 14.6 per cent of the specimens and equivocal pathologic findings in an additional 14 per cent. No procedure related morbidity occurred. The incidence of metastasis to the appendix from specific gynecologic malignant diseases is discussed herein.     

Guidelines for therapeutic decision in incidental appendectomy

Incidental appendectomy is contraindicated in patients whose conditions are unstable, patients previously diagnosed with Crohn's disease, patients with an inaccessible appendix, patients undergoing radiation treatment, patients who are pathologically or iatrogenically immunosuppressed and patients with vascular grafts or other foreign material. In patients ten to 30 years of age--the age group associated with a higher incidence of acute appendicitis--who are otherwise healthy, incidental appendectomy is effective in preventing morbidity and death associated with acute appendicitis. In patients 30 to 50 years of age, incidental appendectomy should be left to the discretion of the surgeon. In this age group, the physician should give special consideration to the gender of the patient and the desire for future childbirth. In patients more than 50 years of age, the incidence of acute appendicitis decreases and the risk associated with operation and prolonged anesthesia is such that an incidental appendectomy is not beneficial. In mentally handicapped patients less than 50 years of age and who are physically healthy, incidental appendectomy should be performed. An inversion technique should be used in all instances of incidental appendectomy. In otherwise clean cases in which incidental appendectomy is anticipated, prophylactic antibiotics may be of value. Patients undergoing procedures that may compromise access to the appendix in the future should undergo incidental appendectomy.     

338例妇产科死亡病例分析

目的：研究妇产科死亡规律，探讨降低病死率的措施。方法：以回顾性分析方法收集44例死亡病例338例，按年代、产科和妇科分别统计，研究妇科和产科死亡例数及所占比率变化，妇科和产科病死率变化，妇科和产科死亡原因所占比率及顺位变化，认识妇产科疾病的死亡规律。结果：产科死亡者所占比率平均为43．49％，呈下降趋势；妇科死亡者所占比率平均为56．51％，呈上升趋势。产科病死率在0．19‰－1．96‰之间，平均0．57‰，呈下降趋势；妇科病死率在1．00‰-5.67‰之间，平均2．36‰，呈上升趋势。产科死亡原因主要是子痫、产科出血、产科感染、羊水栓塞及其全身严重并发症，其中子痫、产科出血比率逐渐减少，产科感染近20年已不复存在，羊水栓塞比率上升。妇科死亡原因主要是妇科恶性肿瘤，以绒癌、恶性葡萄胎、宫颈癌、卵巢癌、子宫体腺癌为主，占妇科死亡的84．82％（162／191）。其中绒癌、恶性葡萄胎、宫颈癌比率逐渐减少，卵巢癌、子宫体腺癌比率相对增加。结论：加强妇女保健，坚持产前检查、住院分娩，坚持妇女定期体检和肿瘤病人随诊、追踪治疗，提高医疗保健人员的医疗技术水平和对稳重症的诊断救治能力，是提高急重症抢救成功率，降低病死率的有效措施。     

妇科肿瘤术后并发下肢深静脉血栓24例分析

目的：探讨妇科肿瘤患者术后并发下肢深静脉血栓形成（DVT）的原因、诊断治疗要点及预防措施。方法：回顾性分析24例妇科术后DVT的临床特点及诊断、治疗的方法。结果：发生DVT的高危因素是盆腔恶性肿瘤、老年妇女、血粘度增高、合并高血压、糖尿病及术后常规应用止血药等。治疗采用肝素、小剂量尿激酶、低分子右旋糖酐及复方丹参等，取得满意效果。结论：对有DVT高危因素的妇科肿瘤患者，手术前后应加强预防措施。     

The safety of incidental appendectomy at the time of abdominal hysterectomy

OBJECTIVE: The purpose of this study was to assess the complication rates of incidental appendectomies in women who undergo benign gynecologic procedures. STUDY DESIGN: This was a retrospective case-controlled study of patients who did (n=100 women) or did not (n=100 women) undergo incidental appendectomies at the time of an abdominal hysterectomy between June 1995 and January 2001. Information was abstracted from hospital and clinic records and a gynecologic oncology database. Data were obtained about age, body mass index, hypertension, diabetes mellitus, the number of days with nothing by mouth, the length of hospital stay, and postoperative complications (cellulitis, fever, ileus, pneumonia, thromboembolic disease). Data were analyzed with the use of two-sample t tests, Wilcoxon Rank sum tests, chi(2) tests, and multiple logistic regressions. RESULTS: There was no difference in preoperative diagnosis or operative procedure for either group. The number of patients in the group that did have incidental appendectomy versus the group that did not have incidental appendectomy with additional procedures at the time of abdominal hysterectomy was bilateral salpingo-oophorectomy (66 vs 61 women), unilateral oophorectomy (19 vs 19 women), lysis of adhesions (9 vs 8 women), and others (12 vs 8 women). Compared with the group that did not have incidental appendectomy, the group that did have incidental appendectomy was younger (mean age+/-SD: 44+/-9.6 years vs 48+/-13.6 years, P=.02) and had a lower mean body mass index (26.1+/-6.0 kg/m(2) vs 29.8+/-8.9 kg/m(2), P=.0009). No significant differences were found between the two groups (the group that did have incidental appendectomy vs the group that did not have incidental appendectomy, respectively) with respect to the following postoperative complications: fever (40 vs 27 women), cellulitis (1 vs 2 women), wound collection (4 vs 6 women), wound dehiscence (1 vs 5 women), wound abscess (7 vs 6 women), ileus (3 vs 2 women), and urinary tract infection (4 vs 10 women). The mean length of hospital stay was significantly longer in the group that did have incidental appendectomy than in the group that did not have incidental appendectomy (3.6+/-1.52 days vs 3.1+/-1.1 days, P=.006). However, the difference was no longer significant when patients who were fed electively on the postoperative day 2 were excluded from the analysis (3.16+/-1.13 days vs 3.04+/-1.13 days, P=.507). Thirty-one percent of the histologic specimens were abnormal, with fibrous obliteration being most common, and there was one case of acute appendicitis. CONCLUSION: An incidental appendectomy at the time of benign gynecologic procedures does not increase postoperative complication rates or length of hospital stay. The inclusion of incidental appendectomies in all abdominal hysterectomies could potentially decrease the morbidity and mortality rates because of appendicitis in elderly women.     

妇科微创手术学研究进展

古希腊医学家曾指出：“医学干预首先必须尽可能的无创伤，否则，治疗效果可以比疾病的自然病程更坏”。可见，在治疗疾病过程中的“微创”是自古以来我们要遵循的医疗原则，也是每一位手术医生必须遵循的行为准则。微创的概念是：在进行医学干预过程中，保持机体最佳的内环境稳定状态或将干扰患者内环境稳定的因素降至最低。以最小的组织器官损伤、最轻的炎症反应、最理想的瘢痕愈合达到最好的治疗效果，即微创应体现在对病人进行诊治的每一个环节中。     

妇产科疾病合并腹腔闭室综合征35例分析

目的　对妇产科疾病并发腹腔闭室综合征 (ACS) 35例患者腹腔减压的治疗作用进行观察 ,并探讨ACS与多器官功能障碍综合征 (MODS)的关系。方法　通过测量膀胱压力 (IBP)动态观察 35例妇产科疾病并发ACS患者的腹腔内压力 (LAP)与治疗效果的关系 ,及对患者各脏器功能的监测 ,了解ACS与MODS的关系。结果　 35例患者治疗前IBP(3 5 5± 1 1 5 )kPa ,显著高于治疗后IBP(1 1 5± 0 35 2 )kPa(P <0 0 1 ) ;循环指标中HR及CVP在治疗后较治疗前显著降低 (P <0 0 1 ) ;呼吸指标RR在治疗前后显著改善 ,PaO2 明显上升 (P <0 0 1 )。本组治愈 30例 ,5例因并发MODS死亡。结论　妇产科疾病在一定条件下可并发ACS ,并促使多个脏器发生功能障碍 ,而导致MODS ,若不及时处理 ,低氧血症逐步加重 ,极易发展为MODS而致死亡     

Metastasectomy, a feasible treatment in selected cases with gynecologic malignancy

We present the course of six gynecological patients who underwent surgical intervention because of a solitary metastasis. After a considerable follow-up period five patients are alive without evidence of disease and with a good quality of life. Metastasectomy should play a role in the management of gynecologic malignancies.     

三维适形放射治疗妇科恶性肿瘤腹腔淋巴结转移13例分析

妇科恶性肿瘤腹腔淋巴结转移 ,以往的主要治疗是全身化疗或手术治疗。近年来发展起来的三维适形放射技术以其定位准确 ,可大剂量集中照射病灶区的特点 ,给恶性肿瘤的治疗带来了希望。 2 0 0 1年 1月至 2 0 0 1年 8月 ,本中心共收治妇科恶性肿瘤腹腔淋巴结转移 13例 ,用三维适形放射治疗取得了较好的效果。现报道如下。1　资料与方法1.1　一般资料 :本组年龄 4 2～ 6 9岁 ,中位年龄 5 5 .6岁 ,卡氏评分 (ＫａｒｎｏｆｓｋｙＰｅｒｆｏｒｍａｎｃｅＳｔａｔｕｓ ,ＫＰＳ)≥ 70 ,造血功能正常 (ＷＢＣ >4 0× 10 9/Ｌ ,ＰＬＴ >10 0× 10 9/Ｌ…     

复发性子宫内膜异位症再手术11例临床分析

目的 探讨子宫内膜异位症术后复发再手术的可行性，再手术治疗的适应证、手术方法和减少术后复发的措施。方法 选择2001年1月1日～2006年6月30日收治的11例子宫内膜异位症患者术后复发再手术的病例，分析复发原因，再手术方式、术后用药情况、术后随访情况。结果 11例患者均进行了二次手术，7例为腹腔镜手术，其中1例中转开腹；4例开腹手术。11例手术中分离粘连中肠管损伤1例进行修补，肠管浆肌层异位病灶切除并缝合3例，输尿管病灶切除并膀胱植入1例，膀胱异位病灶切除修补1例，经阴道腹部联合切除后穹隆异位灶2例。结论 第1次手术的彻底性以及术后的正规用药是减少复发的因素。二次手术应慎重选择手术途径与方式，充分做好术前准备，二次手术应该进行病灶的减灭术，术后正规用药可防止再复发。     

腹腔镜手术在妇科恶性肿瘤治疗中的应用价值

随着技术与设备的进步和更新,有关腹腔镜用于恶性肿瘤的手术分期、治疗的报道逐年增加.迄今的研究结果显示,早期妇科恶性肿瘤手术治疗,不但可以降低患者的死亡率及肿瘤复发的机会,也可显著提高患者术后的生活质量,特别是与单纯根治性放疗比较时,优势更为明显.[第一段]     

妇科手术后下肢深静脉血栓形成21例临床分析

目的探讨妇科手术后下肢深静脉血栓形成（LEDVT）的防治措施。方法收集21例妇科手术后发生LEDVT患者的临床资料，并进行分析。结果妇科恶性肿瘤手术和阴式手术是发生下肢深静脉血栓的高危因素。2例手术取栓，19例经抗凝、溶栓治疗，患者治疗后均好转出院。结论LEDVT是妇科术后的常见并发症，应引起充分重视，对于高危患者并加强预防性治疗；抗凝、溶栓综合治疗是LEDVT的有效治疗手段。     

腹腔镜手术并发症34例分析

目的 探讨腹腔镜手术的并发症及其相关因素。方法 回顾性分析北京协和医院妇产科近6扑的1769例腹腔镜手术病例及34例出现并发症的病例情况。手术包括附件手术1421例，子宫肌瘤剔除术52例，腹腔镜辅助的阴式子宫切除术296例，并发症指术中出现的需额外处理或术后出现的因手术术身引起需行再次手术或保守治疗的情况。结果 并发症发生率为1.9%，需开腹手术处理者6例（0.3%)。附件手术、肌瘤剔除术及阴式子宫切除术的并发症发生率分别为0.9%、1.9%及6.8%。与穿刺及气腹有关的并发症12例（35.3%)，包括腹壁血管、大网膜血管损伤及严重的皮下气肿；术中并发症5例（14.7%)，其中大出血3例，膀胱破裂1例，均改开腹手术，另1例为负极板放置处大腿皮肤烧伤；术后并发症17例（50.0%)，其中2例术后腹腔内出血再次开腹止血，术后并发症还包括肠道并发症、神经麻痹及发热。结论 妇科腹腔镜手术的并发症不容忽视，并发症的发生与手术的难度有关。阴式子宫切除术并发症的发生远高于附件手术及子宫肌瘤剔除手术。     

妇科电视腹腔镜手术150例分析

腹腔镜手术在妇科疾病诊治中的应用日渐广泛 ,我院1997年 9月至 2 0 0 0年 4月行电视腹腔镜手术 15 0例 ,现报道如下。1　临床资料1 1　一般资料　本组对象年龄 2 0～ 47岁 ,平均年龄为(2 9 0 6± 4 98)岁。经产妇 6 1例 ,未产妇 89例。其中有腹部既往手术史 2 1例 (包括绝育手术 9例 ) ,异位妊娠药物保守治疗史 4例。1 2　仪器设备　日本ＯＬＹＰＵＳ公司生产的电视摄像监视系统 ,0度腹腔镜及基本设备和器械。1 3　病种　本组疾病按腹腔镜下所见分类见表 1。其中 ,异位妊娠 75例 ,包括输卵管妊娠 73例 ,卵巢妊娠 1例 ,大网膜妊娠 1例 ;子宫…     

48例卵巢囊肿蒂扭转的手术治疗分析

目的:探讨不同卵巢囊肿蒂扭转手术方式治疗的安全性及有效性。方法:选取2009年1月至2013年6月于山东省阳谷县人民医院行手术治疗的48例卵巢囊肿蒂扭转患者,其中26例行保留附件的囊肿剥除术(A组)和22例行患侧附件切除术(B组)。比较两组患者的发病时间、卵巢囊肿扭转周数、手术时间、术中平均出血量、术后住院时间、雌激素及孕激素水平。结果:A组的发病时间、囊肿扭转周数小于B组(P0.05),手术时间长于B组(P0.05),雌、孕激素水平恢复情况优于B组(P0.05);而两组的术中平均出血量、术后住院时间无统计学差异(P0.05)。结论:卵巢囊肿蒂扭转手术治疗中卵巢的去留由多因素决定,保留卵巢的保守性手术具有一定的安全性及有效性。     

妇产科盆腔手术中输尿管损伤96例分析

目的 :探讨妇产科盆腔手术中减少及避免输尿管损伤的措施。方法 :回顾分析妇产科盆腔手术所致输尿管损伤 96例的临床资料。结果 :术中及时发现和术后 4 8h内明确诊断 5 6例 ,均Ⅰ期修复成功 ;术后延迟诊断明确 4 0例 ,除 2例行肾切除术、1例死亡外 ,37例经暂时性尿流改道后 ,Ⅱ期修复成功。结论 :手术野渗液多 ,输尿管扩张 ,术后腰腹疼痛 ,不明原因发热伴切口渗液 ,无尿或腹腔积液等应考虑输尿管损伤的可能。术前充分准备 ,进行相关检查 ,术中分清解剖关系 ,细心操作 ,术后密切观察是防治输尿管损伤的关键     

妇科腹腔镜手术并发症54例临床分析

目的探讨妇科腹腔镜手术并发症发生的相关因素及其防治方法。方法对中南大学湘雅二医院妇科2003年6月至2008年6月妇科腹腔镜手术患者54例并发症的临床资料及相关因素进行回顾性分析。结果4832例妇科腹腔镜手术发生并发症54例（1．12％）。其中腹腔镜全子宫切除术并发症13例,发生率为4．22％（13／308）,子宫肌瘤剔除术并发症9例,发生率为1.60％（9／563）,附件手术并发症22例,发生率为0．76％（22／2885）,其他手术并发症10例,发生率为0．93％（10／1076）。并发症种类主要为血管和周围组织器官损伤、皮下出血、气肿和术中出血等。结论正确掌握手术适应证和合适的开腹时机,可减少腹腔镜手术并发症的发生。