宫腔镜电切术治疗子宫黏膜下肌瘤的超声引导62例

目的:探讨超声引导在经阴道宫腔镜电切术(TCRM)治疗子宫黏膜下肌瘤中的临床应用。方法:运用腹壁超声对宫腔镜电切术进行实时监测引导。结果:62例黏膜下肌瘤患者均手术成功,无一例发生子宫穿孔、大出血等并发症。结论:运用超声引导宫腔镜电切术治疗子宫黏膜下肌瘤手术不仅成功率高,还可及时评判手术效果。     

宫腔镜联合腹腔镜或B超治疗完全性子宫中隔22例

目的：探讨宫腔镜手术治疗完全性子宫中隔合并不孕的价值。方法2008年1月～2011年12月对22例完全性子宫中隔合并不孕分别施行腹腔镜监视下宫腔镜子宫中隔电切术（14例）或B超监护下宫腔镜子宫中隔电切术（8例）。均自宫颈内口上方用针状电极完全划开中隔,直至中隔基底部位。结果除1例宫、腹腔镜联合手术因中隔过厚行2次宫腔镜子宫中隔电切术外,余21例手术均顺利。术后2个月复查宫腔镜宫腔形态均恢复正常。术后随访21例,13例妊娠,妊娠率61．9％（13/21）,其中足月单胎分娩10例（自然分娩6例,剖宫产4例）,双胎孕35周早产自然分娩1例,自然流产2例（流产率15．4％,2/13）。术后妊娠时间5～21个月,平均11．3月。结论腹腔镜或B超监视下宫腔镜子宫中隔电切术治疗完全性子宫中隔合并不孕安全、有效。     

宫腔镜电切术治疗子宫黏膜下肌瘤168例分析

目的探讨宫腔镜电切治疗子宫黏膜下肌瘤的临床疗效及手术安全性。方法2000年1月～2004年12月168例子宫黏膜下肌瘤根椐肌瘤类型,选择不同的电切方式进行切割,对出血严重、年龄大于45岁的患者同时行子宫内膜电切。结果168例子宫黏膜下肌瘤宫腔镜电切术均成功完成,手术时间5～65min,（27.6±12.1）min;术中出血量8～50ml,（40.1±10.2）ml。子宫穿孔2例,低钠血症3例,术后一过性发热5例。168例随访1～24个月,（16.0±5.3）月,术后月经改善情况满意率95.2%（160/168）。结论宫腔镜电切治疗子宫黏膜下肌瘤是一种微创、安全、有效的方法。术前预处理,严格掌握手术指征,术中严密监测及娴熟手术操作,是预防并发症的基本措施。     

宫腔镜电切术联合左炔诺孕酮宫内缓释系统治疗子宫内膜息肉效果观察

目的探讨宫腔镜电切术联合左炔诺孕酮宫内缓释系统治疗子宫内膜息肉的临床疗效。方法随机将2017-05-2018-12间襄城县人民医院收治的88例子宫内膜息肉患者分为2组,各44例。宫腔镜组采用宫腔镜电切术,联合组采用宫腔镜电切术联合左炔诺孕酮宫内缓释系统。比较2组手术前后子宫内膜厚度、月经量及复发情况。结果联合组术后3个月、6个月子宫内膜厚度低于宫腔镜组,术后1个月、3个月、6个月月经量少于宫腔镜组,复发率低于宫腔镜组,差异均有统计学意义(P<0.05)。结论宫腔镜电切术联合左炔诺孕酮宫内缓释系统治疗子宫内膜息肉患者,可显著降低子宫内膜厚度,减少月经量,且复发率较低。     

宫腔镜治疗黏膜下子宫肌瘤72例

目的探讨宫腔镜电切手术治疗子宫黏膜下肌瘤的疗效. 方法 B超监测,根据肌瘤与肌层的关系,选择不同的电切方式进行切割,对出血严重、无生育要求的患者同时行子宫内膜部分或全部切除. 结果切除肌瘤直径1.5～7 cm;肌瘤数目1～3个;手术时间10～90 min,平均30 min.72例均一次完成手术,无子宫穿孔,出血及肠管损伤.72例术后随访4～20个月,平均6个月,术后满意率97.2%(70/72),6例有生育要求者2例妊娠,其中1例已分娩. 结论宫腔镜电切手术治疗子宫黏膜下肌瘤安全、有效,能显著改善术后月经状况及受孕率.     

超声监护在完全子宫纵隔伴有双宫颈双阴道畸形宫腔镜电切术的临床应用

目的探讨超声监视下宫腔镜电切术治疗完全子宫纵隔伴有双宫颈双阴道畸形的临床价值。方法在超声监视下，对17例完全子宫纵隔伴有双宫颈双阴道患者行宫腔镜子宫纵隔切开术。结果在超声监视下17例均一次完成纵隔电切手术，无子宫穿孔，膀胱、肠管损伤及水中毒等并发症。术后1年随访，宫腔形态正常，无粘连积血。17例患者术后妊娠情况与术前妊娠情况比较：足月活产率明显增高，流产及早产率明显下降，均有显著性差异（P〈0．001），足月分娩者均未发生子宫破裂、胎盘植入及产后大出血等分娩并发症发生。结论超声监护可以辅助完全子宫纵隔伴有双宫颈双阴道畸形宫腔镜电切术顺利进行并取得良好的效果，值得推广。     

B超在宫腔镜电切术中的应用

目的探讨B超在宫腔镜电切手术中的应用价值. 方法回顾分析我院2000年1月～2004年1月B超监视下宫腔电切手术治疗83例黏膜下子宫肌瘤、宫颈肌瘤、子宫纵膈及宫腔异物残留的临床资料. 结果 51例黏膜下子宫肌瘤、7例宫颈肌瘤均电切成功;9例子宫纵隔在宫腔镜下一次电切;16例宫腔异物残留宫腔镜电切联合刮宫完成.无一例并发症发生. 结论 B超监视能提高手术成功率,减少并发症,弥补宫腔镜电切手术中不能立体窥视子宫肌层的不足.     

宫腔镜下电切术联合左炔诺孕酮宫内缓释系统治疗子宫内膜息肉效果观察

目的探讨宫腔镜下电切术联合左炔诺孕酮宫内缓释系统治疗子宫内膜息肉的临床效果。方法随机将80例子宫内膜息肉患者分为2组,各40例。对照组采用宫腔镜下电切术治疗,观察组采用宫腔镜下电切术联合左炔诺孕酮宫内缓释系统(LNG-IUS)治疗。随访1 a,比较2组治疗效果。结果观察组PBAC、子宫内膜厚度、血红蛋白水平及复发率均优于对照组,差异均具有统计学意义(P0.05)。结论宫腔镜下电切术联合左炔诺孕酮宫内缓释系统治疗子宫内膜息肉,可显著减少月经量、子宫内膜厚度及复发率。     

宫腔镜联合超声诊治妊娠终止后宫腔异常回声的临床价值

目的探讨宫腔镜联合超声诊治妊娠终止后宫腔内异常回声的临床疗效。方法2005年7月～2007年7月,对正常妊娠终止后超声检查发现宫内异常回声患者45例行宫腔镜联合超声检查,并对宫腔内可疑部位行定位活检,对明确诊断宫内妊娠物残留的患者进行定位刮宫或宫腔镜下妊娠物切除术,合并宫腔粘连或子宫发育异常（如中隔子宫）等宫腔病变的患者,同时进行手术矫治或相应处理。结果45例中39例诊断宫内妊娠物残留（其中合并子宫中隔4例,宫腔粘连3例）,宫腔积血＋子宫内膜炎4例,剖宫产术后子宫切口瘢痕处憩室形成2例。超声诊断阳性预测值86.7%（39/45）,宫腔镜联合超声诊断阳性预测值100%（39/39）;全部宫内残留妊娠物均在宫腔镜下切除,宫腔粘连及子宫中隔同时在宫腔镜下矫治,治愈率100%。剖宫产憩室1例经宫腔镜电凝去除憩室内膜,1例药物治疗。结论宫腔镜联合超声安全、准确,是诊断宫腔妊娠物残留的首选方法;宫腔镜手术定位准确,在直视下切除残留妊娠物,不破坏正常内膜组织,可一并处理宫腔内并存病变。     

子宫中隔合并不育患者宫腔镜电切术后生育状况分析

目的 探讨子宫中隔合并不育患者宫腔镜矫形术后的生育状况.方法 2010年2月～2011年12月对58例因子宫中隔合并不孕或自然流产行宫腔镜下子宫中隔电切术.用针状电极完全划开中隔,直至中隔基底部位.如果宫颈管有中隔,则予保留.结果 58例手术均一次成功,未发生术中、后并发症.58例随访15 ～ 37个月,（22.4±3.9）月.完全子宫中隔妊娠率由术前29.4％（5/17）升至术后64.7％ （11/17）（Z=-2.031,P=0.042）,不完全子宫中隔妊娠率由术前34.1％（14/41）升至术后73.2％ （30/41）（Z=-3.522,P=0.000）;完全子宫中隔自然流产率由术前100.0％（5/5）降至术后9.1％ （1/11）（Z=-3.371,P=0.002）,不完全子宫中隔患者自然流产率由术前100％（14/14）降至术后3.3％ （1/30）（Z=-6.229,P=0.000）;完全子宫中隔患者的足月活产率由术前0％ （0/5）升至术后62.5％（5/8）（Z=-2.165,P=0.030）,不完全子宫中隔患者的足月活产率由术前14.3％（2/14）升至术后95.8％（23/24）（Z=-5.044,P=0.000）.结论 宫腔镜下子宫中隔矫形术有助于提高子宫中膈合并不孕或流产的不育患者妊娠率,降低自然流产率,增加足月活产率,改善患者生殖预后.宫腔镜下子宫中膈电切矫形术是一种有效、安全、简单的手术方式.     

Significance of hysteroscopy in the diagnosis and treatment of infertility

Hysteroscopy is an excellent additional instrument for evaluating the uterine characteristics in infertile women. Retrospective study analyses the importance of hysteroscopy in diagnostic and treatment of infertility. Patients were selected from 1st Clinic of Obstetrics and Gynecology Ia?i during 1997 and 2004. Study group included 602 hysteroscopy performed in our clinic with 480 cases of infertility. 28.9% were primary infertility and 49.1% were secondary infertility, rest of percentage been intrauterine synechia, septum, polyps and foreign bodies. Polyp ablation located near the tubal ostia (50 cases), synechia repair (90 cases), were the most common operative procedures. Good results in removal of foreign bodies (16 cases) were obtained pregnancy rate more than 75%. Operative hysteroscopy is similar to diagnostic hysteroscopy except that a ideal hysteroscope is used to allow operating instruments such as scissors, biopsy forceps, electrosurgical or laser instruments, and graspers to be placed into the uterine cavity through a channel in the operative hysteroscope. Fibroids, synechia, and polyps can be removed from inside the uterus. Congenital abnormalities, such as uterine septum, may also be corrected through the hysteroscope.     

宫腔镜手术在治疗子宫纵隔畸形的不孕不育患者中的价值

目的研究宫腔镜手术在治疗子宫纵隔畸形不孕不育患者中的临床疗效。方法选取我院在2010年2月至2012年2月间收治的72例子宫纵隔畸形不孕不育患者的临床资料,根据随机数字表,将患者分为两组,每组各36例。观察组经宫腔镜行子宫纵隔切除术,对照组经腹行子宫纵隔切除术,比较两组患者的手术时间、术中出血量、住院时间,并随访其流产率及分娩率。结果 1比较两组患者的住院时间、手术时间、术中出血量,观察组均低于对照组,差异具有统计学意义(P0.05)。在两组患者中,均无周围脏器损伤、感染、宫腔粘连、大出血等并发症。2手术前后组间比较流产率与分娩率对比差异不大,无统计学意义(P0.05)。组内手术治疗前后比较,两组治疗后的流产率均明显低于治疗前,治疗后的分娩率均明显高于治疗前,差异显著(P0.05)。结论通过采用宫腔镜手术对子宫纵隔畸形不孕症患者进行治疗,可提高临床疗效,缩短手术时间与住院时间,减少术中出血量,值得临床推广应用。     

1000 office-based hysteroscopies prior to in vitro fertilization: feasibility and findings.

BACKGROUND AND OBJECTIVES: Hysteroscopy offers diagnostic accuracy and the ability to treat uterine pathology, but practitioners may be reluctant to perform it without a high index of suspicion because it traditionally requires an operating room. This study reviews the findings and feasibility of office-based diagnostic and operative hysteroscopy in an unselected in vitro fertilization (IVF) population to evaluate whether first-line hysteroscopy should be recommended. METHODS: One thousand consecutive infertile patients scheduled for in vitro fertilization underwent office hysteroscopy. A rigid 20-degree 5-mm hysteroscope, with an operative channel for grasping forceps, scissors, or coaxial bipolar electrode was used. Operative findings, complications, and patient tolerance were noted. RESULTS: Sixty-two percent of patients had a normal uterine cavity. Thirty-two percent had endometrial polyps. Other pathology included submucous fibroids (3%), intrauterine adhesions (3%), polypoid endometrium (0.9%), septum (0.5%) retained products of conception (0.3%), and bicornuate uterus (0.3%). The pathology was treated in all patients without complication. CONCLUSIONS: When hysteroscopy is routinely performed prior to in vitro fertilization, a significant percentage of patients have uterine pathology that may impair the success of fertility treatment. Patient tolerance, safety, and the feasibility of simultaneous operative correction make office hysteroscopy an ideal procedure.     

Feasibility of transgastric ultrasonography of the abdominal aorta

Purpose: Transesophageal echocardiography provides detailed images of the thoracic aorta, but imaging of the abdominal aorta and its branches does not occur routinely when the transesophageal echocardiography transducer is advanced into the stomach. Transgastric aortic ultrasonography (TAUS) was investigated as an intraoperative procedure to determine whether transgastric imaging of the abdominal aortic, mesenteric, and renal arteries could be obtained and whether pathologic lesions of these arteries could be identified.Methods: Twelve patients with diagnoses of aortic aneurysmal or occlusive disease, chronic mesenteric ischemia, or renal artery stenosis that required operative treatment were examined. Preoperative transabdominal duplex imaging was performed in all 12 patients. Transgastric B-mode and color-flow ultrasonography of the abdominal aorta and branches was performed as an intraoperative procedure with the patients under general anesthesia. After the abdomen was opened but before the vascular reconstruction was performed, the transesophageal transducer was advanced into the stomach and directed by the surgeon's hand to obtain an image of the underlying aorta and branches. TAUS images were compared with those obtained by standard transabdominal duplex imaging.Results: TAUS provided high-resolution images of both aneurysmal and occlusive aortic disease. In all 12 cases the images of the aortic lumen, plaque, and thrombus obtained with TAUS had greater detail and better resolution than those obtained with transabdominal duplex imaging. The origins of the renal arteries were seen with TAUS in 23 of 24 cases, whereas transabdominal ultrasonography obtained images of the origins in only 6 of 24 cases ( p < 0.01). In the five renal arteries and the one mesenteric artery with hemodynamically significant stenoses in which transabdominal ultrasonography identified the stenoses based on velocity criteria alone, TAUS visualized the occlusive plaque at the origin of the renal and mesenteric arteries.Conclusion: Intraoperative TAUS is feasible and may be useful for evaluating atherosclerotic disease of the abdominal aorta and renal arteries. (J Vasc Surg 1996;24:834-42.)     

甲状腺乳头状微小癌42例临床分析

目的 总结甲状腺乳头状微小癌(PTMC)的诊治经验.方法 对42例PTMC的临床资料进行回顾性分析.结果 有25例临床查体未触及的PTMC经高分辨率甲状腺超声发现.19例行冰冻病理检查，其中14例经术中冰冻切片检查确诊；30例接受腺叶切除术，其中11例补充Ⅵ区淋巴结清扫，随访期间无复发.3例行甲状腺大部切除的多发病灶患者随访期间复发.对术后复发有统计学意义的影响因素为PTMC多灶性(P＜0.05)和患侧甲状腺余留量(P＜0.01).结论甲状腺乳头状微小癌起病隐匿，术前较难诊断.大多数临床未能触及的PTMC可经高分辨率超声检出并经术中冰冻切片确诊.手术为PTMC的主要治疗手段，对于颈侧区临床淋巴结阴性的PTMC患者施行腺叶切除加Ⅵ区淋巴结清扫是可行的.     

原发性骶前肿瘤的手术切除(附20例临床分析)

目的总结原发性骶前肿瘤的诊断、手术方法及主要并发症。方法回顾性分析20例原发性骶前肿瘤患者资料,临床表现无特异性,经直肠指诊、B超、CT确诊,均行手术切除,其中经腹前切除10例,经骶尾部切除9例,经腹骶尾部联合入路切除1例。结果肿瘤完整切除17例,大部切除3例,其中联合邻近脏器切除3例。发生围手术期并发症7例,其中大出血3例,误伤直肠1例,术后骶尾部切口坏死并感染2例,术后排尿困难1例。16例患者平均随访15(3~36)月,肿瘤完整切除的患者获随访14例,复发2例,死亡1例;大部切除的患者获随访2例,均已死亡。结论原发性骶前肿瘤早期诊断困难,手术时应注意选择合适的入路,良性肿瘤和低度恶性肿瘤应完整切除,并积极防治骶前静脉丛大出血等并发症。     

Ultrasonographic changes of the female bladder neck during development.

BACKGROUND: Our previous study showed that the anteroposterior vesical wall angle (APVA) at the bladder neck on transabdominal ultrasonography varied widely between women. The present study examines whether the APVA changes during development in girls with a normal bladder. METHODS: Seventy-four females aged 0-29 years with normal bladders were examined by transabdominal ultrasonography. They were divided into six age groups and their APVA was measured in the supine position by sagittal ultrasonography. Intravenous urography was conducted to examine bladder neck descent and bladder neck opening. RESULTS: The APVA ranged from 85 to 200 degrees. The mean APVA in girls aged 0-4 years was 129 +/- 30 degrees (+/-SD) and the mean APVA in girls aged 5-9 years was 135 +/- 25 degrees. The mean APVA at ages 10-14 years was 161 +/- 26 degrees; at 15-19 years, 164 +/- 33 degrees; at 20-24 years, 164 +/- 18 degrees; and at 25-29 years, 163 +/- 16 degrees. The APVA values of these four groups were significantly larger (P < 0.05) than those of the two younger groups. No bladder abnormalities were found on intravenous urography. CONCLUSION: The APVA was small in some girls under 10 years of age, but the APVA of girls aged over 10 years was similar to that in young adults. The APVA may reflect bladder base plate tone and be partially related to hormonal changes in females during development.     

New laser hysteroscope for neodymium-YAG endometrial ablation

A multichannel operating hysteroscope was developed for use with the Nd-YAG laser. The telescopes measure 350 mm in length, with a 4 mm outer diameter (OD), and are available with 0 degree or 30 degrees objectives. The operating sheath incorporates two isolated operating channels (2 mm OD) through which an Nd-YAG quartz fiber and an aspiratory cannula can be inserted simultaneously. The design of this instrument permits constant or intermittent aspiration of debris from the intrauterine milieu and very clear vision throughout the operative procedure. The entire cavity of the uterus may be flushed with the distending medium by injecting the liquid through the instillation channel and opening one of the two operating channels.     

超声技术在羊水污染检测中的应用

目的对羊水污染中超声技术的应用进行分析探讨。方法选取我院接收的150例足月的妊娠临产妇,并使用超声检测其产前的羊水、产中的羊水和破膜时残余的宫内羊水,将检测结果与实际的羊水污染情况作对比,使用的超声仪型号为MEDISON SONOACE X8。结果数据表明,使用超声技术进行羊水污染检测,其对于羊水污染的阴性预测值、阳性预测值、敏感性分别为93．33％、27．62％、90．63％,此外对Ⅱ～Ⅲ度的羊水污染的阳性预测值可达到100％。结论超声主要反映羊水的混浊现象,提示的是羊水的外形物理特征,而难以鉴别羊水污染时可能含有的粪块和正常羊水含有的有形成分（胎脂）,所以羊水污染较难完全通过超声技术诊断,但是如果超声检测显示羊水没有出现混浊,则羊水只有很小的可能性出现污染。