59例难治性宫缩乏力产后出血首次手术干预分析

目的探讨首次选择5种干预性手术在抢救难治性宫缩乏力性产后出血的应用价值。方法回顾性分析2006年3月至2013年2月间,首次采用宫腔填塞(塞纱)、B-Lynch缝合、CHO缝合、子宫动脉栓塞术、子宫切除5种干预性手术的59例难治性宫缩乏力性产后出血病人的临床资料。结果首次止血成功50例,成功率84.75%,其中17例宫腔填塞(塞纱)成功14例,22例B-Lynch缝合成功17例,9例CHO缝合成功8例,9例经导管动脉栓塞术(TAE)及2例子宫切除术均抢救成功,各组间止血成功率比较,差异均无统计学意义(P>0.05)。结论 5种止血手术对于难治性宫缩乏力性产后出血均有良好的止血效果,具体处理方案需根据当时具体情况制定。     

腹腔镜下子宫全切除/次全切除手术并发症的原因分析及防治

目的 探讨腹腔镜下子宫全切/次全切除手术并发症的原因和防治措施.方法 对2004年1月-2010年10月2475例腹腔镜下子宫全切/次全切除手术的临床资料进行回顾性分析.结果 发生并发症279例（11.3%）,其中出血10例、肠道热灼伤4例、膀胱损伤1例、输尿管损伤1例、皮下气肿118例、感染10例、神经损伤7例、术后肩痛114例、暴露性角膜炎5例、皮肤电损伤5例、输卵管自阴道切缘脱出1例、切口疝3例.并发症中开腹处理1例,再次腹腔镜手术7例.2004-2006年并发症234例,手术并发症发生率31.4%（234/746）,2007-2010年并发症45例,手术并发症发生率2.6%（45/1729）.279例并发症中,以皮下气肿和术后肩痛多见,其中204例发生在前三年,28例发生在后四年,发生率分别为27 3%（204/746）、1.6%（28/1729）.结论 手术操作技术不成熟、腹腔镜开展初期、术中视野暴露不佳、穿刺口过大、未辨清解剖结构盲目操作、盆腹腔严重粘连、切口异物污染、腹腔内气体残留、穿刺口未避开腹壁血管是发生并发症的关键.     

Total Microlaparoscopic Radical Hysterectomy in Early Cervical Cancer

Background and Objective:

In less than 2 decades, laparoscopy has contributed to modification in the management of early cervical cancer patients, and all comparisons between open and laparoscopic-based radical operations showed an identical oncological outcome. The aim of this study is to describe surgical instrumentations and technique to perform total microlaparoscopy radical hysterectomy in early cervical cancer patients and report our preliminary results in terms of operative time and perioperative outcomes.

Methods:

Between January 1, 2012, and March 25, 2012, 4 consecutive early cervical cancer patients were enrolled in this study.

Results:

We performed 3 type B2 and 1 type C1-B2 total microlaparoscopy radical hysterectomy, and in all cases concomitant bilateral salpingo-oophorectomy and pelvic lymphadenectomy were carried out. Median operative time was 165 minutes (range: 155 to 215) (mean: 186), and median estimated blood loss was 30 mL (range: 20 to 50). Median number of pelvic lymph nodes removed was 12 (range: 11 to 15). All procedures were completed without 5-mm port insertion and without conversion. No intraoperative or early postoperative complications were reported.

Conclusions:

This report suggests a role of microlaparoscopy in the surgical management of early cervical cancer with adequate oncological results, superimposable operative time, and perioperative outcomes with respect to standard laparoscopy.     

Sentinel node mapping in high risk endometrial cancer after laparoscopic supracervical hysterectomy with morcellation

INTRODUCTIONOccult endometrial cancer after supracervical hysterectomy is very uncommon. Even if optimal management of those rare cases is still unproven, to guide the need for further therapies, restaging should be recommended in this situation.PRESENTATION OF CASEWe report of a 60-year old woman with occult high risk endometrial cancer after supracervical hysterectomy with morcellation. We describe the feasibility of laparoscopic intraoperative sentinel node identification with cervical stump removing to restage the suspicious early stage high risk endometrial cancer.DISCUSSIONIn high risk endometrial cancer surgical restaging is important, considering that 10–35% of cases can present pelvic nodal metastasis. To reduce the treatment related morbidity maintaining the benefit of surgical staging, with a negative preoperative PET/CT, we performed a laparoscopic SN mapping with cervical stump removing.CONCLUSIONThis report highlight the fact that SN mapping with cervical injection is a feasible and safe technique also without the uterine corpus after supracervical hysterectomy with morcellation.     

腹腔镜下广泛全子宫切除联合盆腔淋巴结清扫术治疗早期宫颈癌临床效果分析

目的 探讨腹腔镜广泛子宫切除术和盆腔淋巴结清扫术治疗早期宫颈癌的临床价值。方法 2010-06—2014-06间共实施47例经腹腔镜(腹腔镜组)和42例开放(开放组)广泛子宫切除加盆腔淋巴结清扫术,回顾性分析患者的临床资料。记录2组手术时间、术中出血量、淋巴结切除数量、胃肠功能恢复时间、住院时间、手术并发症发生率等。结果 腹腔镜组术中出血量、切除的淋巴结数、胃肠功能恢复时间、术后住院时间明显优于开放组(P0.05),2组手术时间无显著差异(P0.05)。腹腔镜组平均随访(28.8±6.6)月,并发症发生率为14.9%(7/47),开放组平均随访(26.2±5.8)月,并发症发生率为14.3%(6/42),2组差异无统计学意义。结论 腹腔镜下广泛全子宫切除加盆腔淋巴结清扫术治疗早期宫颈癌,安全有效,具有创伤小,恢复快等优势。     

全子宫切除联合双侧输卵管切除术对患者血清AMH及卵巢功能的影响

目的：探讨全子宫切除术联合双侧输卵管切除术对患者卵巢功能及血清抗苗勒管激素(AMH)的影响。方法收集2013年1月至2015年6月我院妇科拟行腹腔镜全子宫切除术治疗的子宫良性疾病患者188例,其中,72例同时行双侧输卵管切除术者为观察组,116例保留双侧输卵管者为对照组。比较两组患者手术前后的血清AMH水平及卵巢功能的差异。结果观察组患者术中出血量为(56.23±13.59) mL,手术时间为(109.12±15.78) min,术后肛门排气时间为(19.21±4.31) h,术后住院时间为(4.53±1.12) d,对照组依次为(55.34±12.68) mL、(107.87±16.02) min、(19.45±4.62) h、(4.67±1.35) d,组间比较差异均无统计学意义(P>0.05);术后1个月、3个月,两组患者的卵泡生成激素(FSH)、黄体生成激素(LH)升高,雌二醇(E2)、AMH降低(P<0.05),但组间术后比较差异均无统计学意义(P>0.05);术后3个月观察组与对照组的Kupperman评分分别为(5.29±1.43)分、(5.15±1.29)分,两组均较术前显著升高(P<0.05),但组间比较差异均无统计学意义(P>0.05);观察组7例(9.72%)确诊为围绝经期综合征(MPS),与对照组12例(10.34%)比较差异无统计学意义(P>0.05)。观察组盆腔包裹性积液发生率为1.39%,显著低于对照组的14.66%,差异有统计学意义(P<0.05)。结论全子宫切除术可导致卵巢功能及血清AMH降低,但术中联合双侧输卵管切除术并不加重这种影响,且可降低盆腔包块发生率,建议预防性切除。