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1.
子宫内膜切除术治疗子宫腺肌病28例分析 总被引:17,自引:0,他引:17
子宫内膜切除术是通过去除子宫内膜,达到减少经血量目的的腔内手术,主要适应症为功血,可同时切除突向宫腔的肌瘤。腺肌病因有进一步手术的指征,故非适应症。在1990年5月至1993年4月所施208例子宫内膜切除术中,经术中镜下所见,B超监视示灌流液进入肌层及病理证实,发现子宫腺肌病28例。经术后3~34个月随访,2例子宫切除,26例疗效满意,成功率92.86%,月经均有改善,贫血治愈,18例术前痛经者77.8%术后痛经消失,22.2%减轻。文中就子宫内膜切除术能治疗子宫腺肌病的机制进行了探讨,提出子宫腺肌病多发生于育龄妇女,子宫切除的治疗原则常使患者望而却步,若术前能对此病正确诊断,选择轻症患者行子宫内膜切除术,有可能成为代替子宫切除治疗子宫腺肌病的全新方法。 相似文献
2.
目的:探讨改良腹腔镜辅助阴式子宫切除术(LAVH)行大子宫切除的临床效果.方法:收集2007年9月至2012年3月在我院行子宫切除术的子宫腺肌病或子宫肌瘤(子宫均≥20孕周)患者175例的临床资料,其中传统经腹子宫切除术(TAH) 86例(对照组),改良LAVH 89例(研究组),比较两组术中、术后情况.结果:两组手术均顺利完成,均无严重并发症发生.研究组与对照组比较,术中出血量明显减少(P<0.05),肛门排气时间短(P<0.05).研究组术后无痛率明显高于对照组(P<0.01),剧烈疼痛率明显低于对照组(P<0.01).结论:改良LAVH作为一种大子宫切除术式,具有有效、微创、安全、术后恢复快等优点. 相似文献
3.
全子宫切除术手术途径研究进展 总被引:5,自引:0,他引:5
子宫切除术是最常见的妇产科手术之一,仅次于剖腹产术。其中90%以上是因子宫良性病变而施行,如盆腔痛、出血以及子宫良性肿瘤等。据不完全资料统计,全世界每年的子宫切除手术约500万例以上,美国每年有60万例子宫切除术。年龄≥60岁的妇女,平约每3人便有1人接受了子宫切除术。其中主要采取经腹子宫切除术(transabdomino hysterectomy,TAH),经阴道子宫切除手术(transvaginal hysterectomy,TVH)所占比例较少。随着麻醉方法的改进,内窥镜器械、设备、技术的发展, 相似文献
4.
陈建凤 《中国妇产科临床杂志》2006,7(2):131-132
子宫腺肌病是妇科临床较常见的疾病,治愈的主要手段是全子宫切除术。近年来有报道子宫内膜切除术可用于治疗子宫腺肌病及超过6个月以上的月经过多的患者。我院行子宫内膜切除术(TCRE)治疗超过6个月以上的月经过多、术后病理证实子宫腺肌病患者32例。现将治疗及随访情况报告如下。 相似文献
5.
李凡 《实用妇科内分泌电子杂志》2023,(12):118-120
目的 探讨围手术期护理干预在子宫腺肌病全子宫切除术的应用效果。方法 选取本院96例子宫腺肌病并接受全子宫切除术患者为研究对象,根据随机数字表法分为两组,各48例。对照组采用常规护理干预,观察组采用围手术期护理干预,比较两组的手术相关指标、疼痛程度、负性情绪等。结果 观察组术后出血量少于对照组,术后排气时间、下床时间及住院时间短于对照组(P<0.05);干预后,观察组数字疼痛评价量表、焦虑自评量表、抑郁自评量表评分低于对照组(P<0.05);干预后,观察组月经量少于对照组,子宫体积、子宫内膜厚度小于对照组(P<0.05);干预后,观察组卵泡刺激素、黄体生成素、雌激素水平高于对照组。结论 围手术期护理干预在宫腺肌病全子宫切除术的应用效果显著,值得推广。 相似文献
6.
目的:探讨子宫内膜异位症(EM)合并子宫腺肌症(AM)相关不孕患者的临床及手术特点。方法:回顾分析2017年1月至12月于北京协和医院妇产科行手术治疗的不孕患者的临床资料,其中39例同时合并EM和AM不孕患者(研究组),338例EM非AM不孕患者,39例AM非EM不孕患者,419例非AM非EM不孕患者(对照组)。比较研究组和对照组的临床特点及手术情况。结果:39例同时合并AM、EM的不孕患者,占同期内异症不孕手术者的10.34%,占同期腺肌症不孕手术者的50.0%。两组的年龄、孕产次、不孕类型、手术费用和住院费用方面无显著差异;研究组的中位住院时间、平均手术时间和术中出血量均显著高于对照组(P0.05)。研究组内异症IV期患者17例(43.59%),显著高于同期内异症不孕组(P0.01);深部浸润型内异症患者13例(33.3%),高于同期内异症不孕组,但差异尚无统计学意义。局灶型腺肌症与弥漫型腺肌症间内异症各分型无显著差异(P0.05)。结论:EM可协同AM共同影响女性的生育能力,与其他不孕手术相比,疾病程度重、手术难度大等,术前应充分评估。 相似文献
7.
宫颈套扎法全腹腔镜子宫次全切除术10例分析 总被引:2,自引:0,他引:2
我院于 1999年 6 10月采用自行设计的嵌入宫颈组织套扎法完成全腹腔镜子宫次全切除术 (totallaparoscopicsupracervicalhysterectomy ,TLSH) 10例 ,效果十分满意 ,报道如下。1 资料与方法1 1 一般资料 10例患者的平均年龄为 41 5岁 ( 35 46岁 ) ,手术指征均为子宫底部或体部的肌瘤 ,术前常规行宫颈刮片及CA12 5检查以除外恶性病变 ,最大的肌瘤结节为7 2 5cm× 6 45cm× 5 12cm ,单发肌瘤 6例 ,多发肌瘤 4例 ,整个子宫大小为 8 14cm× 5 2 7cm× 4 15cm 12 2 0cm×9 … 相似文献
8.
目的:观察腹腔镜下子宫腺肌病病灶切除术治疗子宫腺肌病的临床疗效。方法:2008年1月至2010年6月对74例子宫腺肌病患者行腹腔镜下子宫腺肌病病灶切除术。术后定期随访患者,观察临床疗效,包括痛经程度、月经情况(周期、经期、经量)、贫血及子宫体积的变化。结果:术后1、3、6、12、24个月痛经消失和明显缓解的患者分别为64例(86.5%)、68例(91.9%)、60例(81.1%)、51例(68.9%)和31例(41.9%);术前53例月经过多患者中45例术后月经量明显减少(P0.05);术前45例贫血患者,术后血红蛋白明显升高(P0.05);术后患者子宫体积较术前明显缩小(P0.05);术后患者月经周期和经期无明显改变(P0.05)。结论:腹腔镜下行子宫腺肌病病灶切除术治疗子宫腺肌病的近期疗效明确,对年轻希望生育或要求保留子宫的子宫腺肌病患者可作为一种可选择的微创手术方式。 相似文献
9.
目的分析子宫切除术后不同病理类型盆腔包块的临床特点及诊疗方案。方法回顾分析2017年1月至2021年6月因良性疾病行子宫切除后发现盆腔包块,于首都医科大学附属北京妇产医院就诊行手术的56例患者临床资料。结果子宫切除术后盆腔包块最常见病例类型为盆腔炎症性疾病39.3%(22/56),其次为卵巢良性肿瘤19.6%(11/56)、卵巢子宫内膜异位囊肿16.1%(9/56),卵巢输卵管瘤样病变12.5%(7/56),卵巢输卵管恶性肿瘤8.9%(5/56)。盆腔炎症性疾病及卵巢子宫内膜异位囊肿患者发病时间距离子宫切除后年限及发病年龄低于其他组(P<0.05)。盆腔炎性疾病组盆腹腔手术次数多于其他组(P<0.05)。随着子宫切除术后间隔延长,卵巢良恶性肿瘤比例增加。结论子宫切除术后盆腔包块病理类型多样,以良性为主,术后5年以上出现的盆腔包块,多为卵巢肿瘤,建议尽早手术。 相似文献
10.
阴式与腹腔镜子宫全切除术的临床效果比较 总被引:22,自引:0,他引:22
目的比较阴式子宫全切除术和腹腔镜子宫全切除术的临床效果。方法收集我院2002年1月至2004年6月接受以上不同途径子宫切除术的病例共301例的临床资料,其中阴式子宫全切除术197例(阴式组),腹腔镜子宫全切除术104例(腹腔镜组),比较两组疾病种类、手术时间、术中出血量、住院时间、医疗费用及术后恢复情况等。结果(1)疾病种类:宫颈非典型增生阴式组19例、腹腔镜组3例;子宫腺肌病、合并附件疾病或盆腔子宫内膜异位症,阴式组分别为58例、9例、8例,腹腔镜组分别为45例、33例、13例;(2)手术时间:阴式组(76±28)min、腹腔镜组(139±52)min;(3)术中出血量:阴式组(170±125)ml、腹腔镜组(206±153)ml;(4)肌瘤或腺肌瘤最大直径:阴式组(49±17)mm、腹腔镜组(57±22)mm;(5)手术费用:阴式组(1073±203)元、腹腔镜组(1526±676)元。以上各指标两组比较,差异均有统计学意义(P<0·05);(6)住院时间:阴式组(5·6±1·2)d、腹腔镜组(5·7±2·4)d;(7)子宫重量:阴式组(235±115)g、腹腔镜组(256±158)g;(8)手术并发症发生率:阴式组为2·54%、腹腔镜组为2·88%。住院时间、切除子宫重量及手术并发症发生率等两组比较,差异均无统计学意义(P>0·05)。结论无明显盆腔粘连和附件疾病的子宫全切除术可选择阴式途径,子宫大小并非选择术式的决定因素。 相似文献
11.
12.
This report concerns the indications, morbidity, and death associated with 6,435 consecutive abdominal and vaginal hysterectomies at Hutzel Hospital during a 10 year period. There was an extraordinary number of high-risk patients included in this group. Morbidity and postoperative bleeding were more common following vaginal rather than abdominal hysterectomy. These complications were also more common when the operation was performed during the proliferative phase of the menstrual cycle. There were 17 deaths. Thromboembolic complications were the major cause of death. Selective use of prophylactic antibiotics and low-dose heparin and reduction in the number of blood transfusions by preoperative endocrine and hematinic therapy may reduce the postoperative morbidity and mortality rates. Probably few operations will ever contribute as much to improving the quality of life of women as do indicated hysterectomies. However, the added risk do not seem to justify utilizing this operation for the sole purpose of sterilization in preference to simpler and safer procedures. 相似文献
13.
Casey MJ Garcia-Padial J Johnson C Osborne NG Sotolongo J Watson P 《Journal of gynecologic surgery》1994,10(1):7-14
The first 115 laparoscopically assisted vaginal hysterectomies (LAVH) done by our faculty surgeons were compared with 220 vaginal hysterectomies (VH) and 194 abdominal hysterectomies (AH) done in our affiliated hospitals over the same period of time. Logistic regression analysis indicates that LAVHs were done for cases that would significantly be more likely selected for AH than for VH (p less than 0.0001). Matched case control studies with 28 LAVH/VH and 34 LAVH/AH pairs and bivariate analyses demonstrated that LAVH can be accomplished with low morbidity, short lengths of stay, and little, if any, increase in operating times compared with VH and AH. The LAVH procedure can be expected to replace many AHs in the future. 相似文献
14.
OBJECTIVE: To correlate the listing of multiple preoperative indications for hysterectomy with the risk of non-confirmation of the preoperative diagnosis. METHODS: Records of 171 women undergoing consecutive hysterectomies for all indications at a large teaching hospital were reviewed for preoperative indication(s), compliance with published preoperative validation criteria for cases in which tissue pathology was not expected, and histologic verification of the preoperative diagnosis for cases in which tissue pathology was expected. Rates of confirmation (histologic verification plus successful compliance with validation criteria) of the preoperative diagnosis were compared between subgroups of cases in which single indications were listed (N = 124) or multiple indications were listed (N = 47) preoperatively. RESULTS: The rate of confirmation of single indications (115 of 124 cases, 93%) was significantly higher than the rate of confirmation of even one indication in cases in which multiple indications were listed (28 of 47 cases, 60%, P < .0001; relative risk for non-confirmation of multiple indications = 1.55). Multiple indications were more likely to be listed when tissue pathology was not expected, representing 49% of validatable indications as compared with only 18% of histologically verifiable indications (P < .0001). Overall, the rate of compliance with validation criteria (70%) was significantly lower than the rate of histologic verification (90%) (P < .01). CONCLUSION: These data suggest that listing of multiple preoperative indications for hysterectomy is associated with both decreased appropriateness, as reflected in decreased compliance with generally accepted preoperative validation criteria, and decreased diagnostic accuracy, as reflected in lower rates of histologic verification. 相似文献
15.
During a period of 36 years, the rate of hysterectomy was 0.054% of all obstetric patients in our hospital, 0.0446% of cesarean section cases, and 0.005% of vaginal deliveries respectively. From 50 s to 80 s, the cesarean section rate greatly increased while the hysterectomy rate in parturition decreased. The indications for cesarean hysterectomy change from ruptured uterus, abruptio placenta and intrapartum infection to uterine atony highly increased placenta or myoma of the uterus. Cesarean hysterectomy rate due to splitting of uterine wound after cesarean section highly increased in 80 s. Bleeding for more than 1,000 ml during operation accounted for 62.7% of them. However, operative complication rate reached to 11.8%. To reduce cesarean hysterectomy rate, we suggest emphasizing maternal health care, use of uterine packing to lessen bleeding and careful management of operation as important means for reducing uterine incision wound splitting after cesarean section. 相似文献
16.
Beckmann M Neppe C 《The Australian & New Zealand journal of obstetrics & gynaecology》2007,47(1):70-75
Hysterectomies performed vaginally are associated with less perioperative risk than those performed abdominally but the risk is not negligible. There are little sizable and/or contemporary Australian data of adverse outcomes associated with vaginal hysterectomy available. A retrospective analysis was undertaken in each of five Queensland public teaching hospitals of the last 200 women in each centre who underwent a vaginal hysterectomy for benign reasons. Serious morbidity complicated 14.0% of vaginal hysterectomies, minor morbidity was associated with 24.0% of hysterectomies and, overall, 29.9% suffered any (ie serious or minor) morbidity. Following multivariate analysis there remained an association between serious perioperative morbidity and ASA > or = 2 (relative risk (RR) 1.89 (1.37-2.61)) and omission of prophylactic antibiotics (RR 2.0 (1.45-2.78)). There also remained an association between any morbidity and use of antidepressants (RR 1.35 (1.07-1.72)), epilepsy (RR 2.00 (136-2.95)), preoperative hypoalbuminaemia (albumin < or = 35 g/L RR 2.08 (1.33-3.24)) as well as ASA > or = 2 (RR 1.24 (1.00-1.54)) and omission of prophylactic antibiotics (RR 1.45 (1.18-1.79)). 相似文献
17.
Juliane U. Theben Alexander R. M. Schellong Christopher Altgassen Katharina Kelling Stephanie Schneider Dietmar Große-Drieling 《Archives of gynecology and obstetrics》2013,287(3):455-462
Objective
The objective of this research was to identify the rate of unexpected malignancies after laparoscopic-assisted supracervical hysterectomies (LASH) and describe the therapy regime.Methods
The research is based on a retrospective chart analysis of patients undergoing a simple hysterectomy in the gynecological endoscopy department of a general hospital in Germany.Results
2,577 simple hysterectomies conducted between March 2005 and March 2010 were sub-classified in different types of hysterectomies (vaginal-, abdominal-, total-, abdominal supracervical hysterectomy, LAVH, and LASH). This study focuses on the LASH sub-group of 1,584 patients and does not make any comparisons to other operative approaches. Out of the 1,584 patients, 87.8 % (n = 1,391) received preoperative screening to exclude dysplasia or malignancy based on the policy of the German Association for gynecology and obstetrics (DGGG). The screening includes cytology (Pap-smear) and preoperative ultrasound of the uterus or dilatation and curettage (d&c). Unexpected malignancies were found in 0.25 % (n = 4) of the patients pre-screened according to DGGG protocol. Out of the four malign patients, two had endometrial cancer. Two patients had leiomyosarcoma.Conclusion
The study shows that there is a small probability of unexpected malignancies even in correctly pre-screened patients for LASH procedures. Yet in the short-term (28–52 months), malign patients remain recurrence free after treatment. LASH is therefore a good procedure for assumed benign disease. 相似文献18.
目的:总结残角子宫合并单角子宫各型的临床特征、分析诊断及处理要点。方法:回顾分析我院收治的155例残角子宫合并单角子宫(U4型女性先天性生殖道畸形)的临床资料。结果:(1)U4a型与U4b型患者的就诊年龄、重度痛经、有自然流产史或不孕史、合并子宫内膜异位症等方面比较,差异均有统计学意义(P0.001)。(2)患者术前二维超声、三维超声、核磁共振诊断符合率分别为87.7%、97.2%和97.4%。(3)32例为妊娠晚期行子宫下段横切口剖宫产术;其余为妇科手术。U4a型中,2例行通液术或卵巢囊肿剥除术,其余均行腹腔镜或经腹残角子宫和/或输卵管切除。U4b型患者均未切除残角及输卵管。(4)与开腹组比较,腹腔镜组术中出血少、手术时间短、术后住院日短,差异有统计学意义。(5)术后随访60例妊娠,包括宫内妊娠55例,自然流产5例,无异位妊娠发生。结论:核磁共振检查及三维超声有助于提高残角子宫的诊断率。单角子宫合并残角子宫型别不同,其临床特征及手术治疗方案亦有差异。 相似文献
19.
Michal Amir MD M.Michael Shabot MD Beth Y. Karlan MD 《American journal of obstetrics and gynecology》1997,176(6):1389-1393
OBJECTIVE: Our purpose was to develop a profile of preoperative and perioperative characteristics that would enable gynecologic oncologists to identify those patients with ovarian cancer who would benefit most from postoperative surgical intensive care unit care and thereby optimize resource utilization and cost effectiveness.STUDY DESIGN: A retrospective analysis was performed of 85 patients admitted to the surgical intensive care unit after cytoreductive surgery between Jan. 1, 1989, and Dec. 31, 1993. Fifty-three patients admitted to the surgical intensive care unit for <24 hours were compared with 32 patients admitted for >24 hours. Five preoperative characteristics (age, American Society of Anaesthesiology classification, body mass index, albumin, primary versus recurrent disease) and six perioperative characteristics (estimated blood loss, ascites, surgical time, bowel resection, Swan-Ganz catheter, ventilator dependence) were compared across the two groups by univariate analysis and multivariate logistic regression analyses.RESULTS: All preoperative variables were similar across the two groups. Ascites volume and length of surgery were not significant, whereas estimated blood loss was significant in the univariate analysis but not in the logistic regression analysis. Three perioperative variables were found to be predictive of extended surgical intensive care unit care by logistic regression analysis: placement of a Swan-Ganz catheter (odds ratio 4.31, 95% confidence interval 1.13 to 16.4), bowel resection (odds ratio 13.0, 95% confidence interval 1.96 to 86.5), and ventilator dependence (excluded from logistic regression analysis for mathematic reasons).CONCLUSIONS: The patient's preoperative medical condition proved to be less important than how she fares during surgery. The patient most likely to benefit from surgical intensive care unit care had undergone bowel resection, required invasive hemodynamic monitoring, or was ventilator dependent postoperatively. This patient profile may prove to be a useful screening tool to optimize resource utilization and cost effectiveness, but it cannot replace clinical judgment. (Am J Obstet Gynecol 1997;176:1389-93.) 相似文献