子宫肌瘤的腹腔镜剔除术和开腹手术的比较研究

目的比较腹腔镜下与开腹子宫肌瘤剔除术的临床效果。方法回顾分析47例腹腔镜手术和39例开腹手术子宫肌瘤患者的临床资料,比较两组术中和术后情况。结果腹腔镜组的肌瘤剔除个数、术中出血量、术后体温恢复正常时间、肛门排气时间、下床活动时间、术后住院日、术后并发症发生率均显著低于开腹组（P〈0．05或P〈0．01）。结论两种手术方法各有优缺点,但对于肌瘤个数不多的患者腹腔镜手术更适合。     

腹壁切口内膜异位症产生的相关因素分析

目的：探讨行经子宫手术中清洗腹壁切口、规范使用可吸收线对预防切口内膜异位症的价值。方法：选取我院2005年11月～2009年12月剖宫产和子宫肌瘤剔除术中使用清洗腹壁切口、丢弃缝合子宫后的可吸收线的患者3000例作为观察组,2000年10月～2005年10月行剖宫产和子宫肌瘤剔除术中未使用清洗腹壁切口、丢弃缝合子宫后的可吸收线患者2100例作为对照组。分析两组发生切口内膜异位症的相关因素。结果：观察组和对照组经子宫手术后发生腹壁切口内膜异位症的几率分别为0.10%（3/3000）及0.86%（18/2100）,两组比较有显著性差异（P〈0.01）。结论：经子宫手术中清洗腹壁切口、丢弃缝合子宫后的可吸收线可达到预防切口内膜异位症的作用,值得推广。     

子宫肌瘤剔除术后雷公藤多甙预防复发的临床观察

目的探讨子宫肌瘤剔除术后使用雷公藤多甙预防肌瘤复发的临床疗效。方法选择行子宫肌瘤剔除术后患者70例,随机分为观察组（雷公藤多甙片）和对照组（米非司酮）各35例,观察比较两组用药后子宫肌瘤复发情况及血清性激素水平变化情况。结果观察组子宫肌瘤复发2例（5．7％）,对照组复发8例（22．86％）,两组复发率有显著差异（P〈0．05）。两组用药6个月后的孕激素、雌二醇均分别较用药前下降（P〈0．01）;观察组雌二醇水平低于对照组（P〈0．01）。结论雷公藤多甙用于子宫肌瘤剔除术后预防复发效果较好,能明显降低激素水平,适合基层医院推广应用。     

剖宫产同时行子宫肌瘤切除术可行性探讨

目的探讨剖宫产同时行子宫肌瘤切除术的安全性及可行性。方法回顾性分析我院128例剖宫产同时行子宫肌瘤切除术患者及130例妊娠未合并子宫肌瘤仅行剖宫产术患者的临床资料。结果剖宫产同时行子宫肌瘤切除术组手术操作时间较对照组延长（P〈0.05）,但2组患者术中出血量、产后出血率、术后恢复情况差异均无显著性。结论对于有经验的产科医生,根据患者具体情况,选择性地行剖宫产同时行子宫肌瘤切除术是安全、可行的。     

悬吊式免气腹腹腔镜子宫肌瘤切除术68例疗效观察

目的比较悬吊式免气腹腹腔镜和传统腹腔镜子宫肌瘤切除术临床疗效的差异。方法入选2008年1月至2010年3月连续收治的子宫肌瘤切除术患者136例,根据手术方法分为：悬吊式免气腹腹腔镜组（免气腹组）和传统腹腔镜组（传统组）,每组68例。记录和分析比较两组患者手术时间、术中出血量、术后肛门首次排气时间、术后体温、术后疼痛、术后住院时间和住院费用等临床指标的差异。结果与传统组比较,免气腹组手术时间缩短,术中出血量少,术后肛门首次排气时间缩短,术后体温〉38℃和术后需镇痛例数较少,同时术后住院时间和住院费用明显减少（均P〈0.05）。结论悬吊式免气腹腹腔镜子宫肌瘤切除术的临床疗效优于传统腹腔镜,值得在临床推广应用。     

MRI评估子宫肌瘤患者行腹腔镜下肌瘤剔除术的可行性

目的 探讨MRI评估子宫肌瘤患者行腹腔镜下肌瘤剔除术的可行性.方法 回顾性分析2019年1月至2019年12月于我院收治的60例子宫肌瘤患者临床资料,根据2011年FIGO新的子宫肌瘤分类标准对子宫肌瘤分类,测量子宫肌瘤大小及数目,按照临床及腹腔镜下子宫肌瘤剔除术的适应症标准,筛选符合腹腔镜下子宫肌瘤剔除术的病例,计算...     

剖宫产同时行子宫肌瘤剔除术61例临床分析

目的探讨剖宫产同时行子宫肌瘤剔除术的安全性和可行性。方法回顾性分析了在扬州市江都人民医院剖宫产同时行子宫肌瘤剔除术的患者61例与妊娠未合并子宫肌瘤的剖宫产患者122例的临床资料。结果剖宫产同时行子宫肌瘤剔除术组和对照组比较,手术时间延长（P〈0.05）,两组差异有统计学意义,但两组的术中出血量、术后血红蛋白下降值、产褥病率和住院时间等指标差异无统计学意义（P〉0.05）。结论选择性地剖宫产同时剔除子宫肌瘤是安全和可行的。     

Conservative two-step procedure including uterine artery embolization with embosphere and surgical myomectomy for the treatment of multiple fibroids: preliminary experience

Objective

To evaluate the feasibility and safety of combined uterine artery embolization (UAE) using embosphere and surgical myomectomy as an alternative to radical hysterectomy in premenopausal women with multiple fibroids.

Materials and methods

Mid-term clinical outcome (mean, 25 months) of 12 premenopausal women (mean age, 38 years) with multiple and large symptomatic fibroids who desired to retain their uterus and who were treated using combined UAE and surgical myomectomy were retrospectively analyzed. In all women, UAE alone was contraindicated because of large (>10 cm) or subserosal or submucosal fibroids and myomectomy alone was contraindicated because of too many (>10) fibroids.

Results

UAE and surgical myomectomy were successfully performed in all women. Myomectomy was performed using laparoscopy (n = 6), open laparotomy (n = 3), hysteroscopy (n = 2), or laparoscopy and hysteroscopy (n = 1). Mean serum hemoglobin level drop was 0.97 g/dL and no blood transfusion was needed. No immediate complications were observed and all women reported resumption of normal menses. During a mean follow-up period of 25 months (range, 14–37 months), complete resolution of initial symptoms along with decrease in uterine volume (mean, 48%) was observed in all women. No further hysterectomy was required in any woman.

Conclusion

In premenopausal women with multiple fibroids, the two-step procedure is safe and effective alternative to radical hysterectomy, which allows preserving the uterus. Further prospective studies, however, should be done to determine the actual benefit of this combined approach on the incidence of subsequent pregnancies.     

肌瘤剔除术治疗子宫肌瘤的探讨

目的：探讨子宫肌瘤行肌瘤剔除术治疗效果及可行性。方法：对135例行肌瘤剔除术的子宫肌瘤患者的治疗效果及存在的问题进行分析探讨。结果：135例肌瘤剔除术患者中,126例得到随访,其中肌瘤复发7例,占5．6％,月经过多10例,占7．9％,妊娠69例,占54．8％,其中原发性不孕者妊娠13例,妊娠率40．6％,15例流产史的患者术后妊娠13例,再次流产3例,再次流产发生率23．1％,无流产史患者流产2例,占3．5％,宫颈癌1例,占0．8％。结论：肌瘤剔除术治疗子宫肌瘤的方法是可行的,且疗效满意。     

Comparative study between robotic laparoscopic myomectomy and abdominal myomectomy

Study objectiveTo compare short-term surgical outcomes of robotic and abdominal myomectomy and to analyze the factors affecting the short-term outcomes.DesignRetrospective study of a consecutive case series at Emory Saint Joseph’s Hospital, Atlanta, USA.Subjects and methodFrom February 2007 to June 2009, 122 patients with symptomatic leiomyomata underwent either robotic assisted laparoscopic myomectomy (RALM, n = 77) or abdominal myomectomy (AM, n = 45). The variables investigated included the type of surgery, age, BMI, gravity, parity, number of leiomyomata, diameter of largest tumor size, total operative time, estimated blood loss, and length of hospital stay.ResultsNo significant differences were found between the two groups regarding age, gravity and parity. However, BMI, number of leiomyomata and tumor sizes were significantly higher in AM compared to RALM. The total operative time was significantly longer in RALM compared to AM. The total estimated blood loss and length of hospital stay were significantly lower in RALM compared to the AM group. The predicted odds of staying one day or less in the hospital for patients receiving RALM was 193.5 times the odds for patients receiving AM when adjusted for the number of leiomyomata and the tumor size. The probability of one day admission or less in the hospital was significantly increased for patients receiving RALM.ConclusionRALM has shorter hospital stay, less blood loss and increased operative time compared to AM, regardless of tumor size and number of tumors. Although operative time was increased with the RALM procedure, blood loss and hospital stay were integral outcomes in the study result.