腹腔镜子宫切除术的临床研究

目的 探讨腹腔镜筋膜内子宫切除术(CISH)和腹腔镜辅助子宫切除术(LAVH)的临床价值。方法 对32例因各种良性妇科疾病而需行子宫切除术的患者采用CISH术18例，LhVH术14例。对照组30例采用腹式子宫切除术(AH)。结果 与AH术相比，CISH术和LAVH术具有术中出血少，术后镇痛用药少，术后病率少，住院时间短。结论 CISH术和LAVH术由于创伤小，恢复快等优点，值得临床推广应用。     

腹腔镜与腹腔镜辅助阴式全子宫切除术对子宫肌瘤的疗效比较

目的 探讨腹腔镜全子宫切除术（ TLH）与腹腔镜辅助阴式全子宫切除术（ LAVH）对子宫肌瘤的疗效。方法 将92例子宫肌瘤患者随机分为LAVH组和TLH组,比较两组疗效。结果 LAVH组手术时间和术中出血量均显著低于TLH组（ t值分别为11．312、10．990,均P＜0．05）,而两组肛门排气时间及住院治疗时间比较无显著性差异（t值分别为9．001、8．897,均P＞0．05）。术后3个月随访,两组患者阴道残端均愈合较好,盆腔检测结果未见异常,未见并发症的发生。结论 腹腔镜辅助阴式全子宫切除术对子宫肌瘤的治疗能够有效缩短患者手术治疗时间,减少患者术中出血量,值得临床应用与推广。     

3种子宫切除术式的临床应用效果比较

目的:探讨开腹子宫切除术(TAH)、腹腔镜下筋膜内子宫切除术(CISH)、腹腔镜辅助阴式子宫切除术(LAVH)3种子宫切除方式的临床应用效果.方法:102例子宫良性病变患者,子宫肌瘤72例,子宫腺肌病30例,分为3组:CISH组32例,LAVH组30例,TAH组40例,对3组患者的手术时间、术中出血量及术后情况进行比较.结果:LAVH、CISH组手术时间较TAH组明显延长,术中出血较TAH组明显减少,术后抗生素使用时间、下床活动时间、肛门排气时间、平均住院日较TAH组明显缩短,差异均有统计学意义(P＜0.05).结论:CISH和LAVH较TAH具有损伤少、恢复快的特点,是有效的子宫切除方式.     

腹腔镜辅助下阴式子宫切除术的观察及护理

目的探讨腹腔镜下阴式子宫切除术的护理方法。方法回顾性分析54例腹腔镜下阴式子宫切除术的临床资料。结果腹腔镜辅助下阴式子宫切除术病人术后恢复快,护理人员通过术前准备、术后严密观察护理,无因护理不当而出现并发症。结论实施良好的术前准备及术后护理是保证腹腔镜辅助下阴式子宫切除术成功,减少术后并发症的关键因素之一。     

腹腔镜辅助的阴式子宫切除术后并发症的原因分析与护理对策

目的:分析腹腔镜辅助阴式子宫切除术后并发症的原因及相应的护理措施。方法:选择2006年10月至2008年2月在我院妇科接受腹腔镜阴式子宫切除手术治疗的患者156例,分析术后并发症的原因并采取相应的护理措施。结果:156例患者手术后发生的并发症经采取相应的治疗与护理措施后均痊愈出院。结论:阴式子宫切除术后的并发症,经过精心的治疗和护理,采取妥当的护理措施能减少其发生,并能够消除其对机体的不良影响。     

Natural Orifice-Assisted Laparoscopic Appendectomy

Background and Objectives:

Natural orifice transluminal endoscopic surgery involves the introduction of instruments through a natural orifice into the peritoneal cavity to perform diagnostic and therapeutic surgical interventions. We report the utilization of the vaginal opening at the time of laparoscopic-assisted vaginal hysterectomy or total laparoscopic hysterectomy as a natural orifice for appendectomy.

Methods:

We reviewed cases of 42 patients who underwent total laparoscopic hysterectomy or laparoscopic-assisted vaginal hysterectomy followed by appendectomy, performed by applying a stapler and removing the appendix transvaginally. By using a small-diameter laparoscope, the appendix was mobilized, especially in patients with adhesions, endometriosis, or retrocecal appendix, to facilitate transvaginal access with the stapler.

Results:

All procedures were performed successfully without intraoperative or major postoperative complications. The appendectomy portion of the procedure took approximately 5 minutes to 10 minutes. Appendiceal pathology included serosal adhesions (14), fibrous obliteration of the lumen (12), endometriosis (4), serositis (2), and carcinoid tumor (1), among others.

Conclusions:

Appendectomy performed with an endoscopic stapler introduced transvaginally for amputation and retrieval following total laparoscopic hysterectomy or laparoscopically assisted vaginal hysterectomy appears to be a safe and effective modification of established techniques with acceptable outcomes.     

阴式或腹式子宫切除术在非脱垂性子宫良性疾病中的应用比较

目的：探讨阴式或腹式子宫切除术在非脱垂性子宫良性疾病中的应用比较。方法：选取行阴式子宫切除术的非脱垂子宫患者40例为观察组,另选择同期进行腹式子宫切除术的非脱垂子宫患者40例为对照组。结果：两组手术时间和术中出血量比较差异无统计学意义（P〉0.05）。观察组患者术后肛门排气时间、术后下床活动时间和术后住院时间均明显短于对照组（P〈0.05或P〈0.01）。两组术中均未发生并发症,观察组患者术后出现并发症2例,对照组患者术后出现并发症4例。两组术中术后并发症比较差异无统计学意义（χ^2=0.18,P〉0.05）。两组患者术后3个月均进行随访,阴道残端愈合好,未发现残端肉芽组织增生、息肉形成和盆腔炎性包块等并发症。结论：阴式子宫切除术治疗具有术后胃肠功能恢复快,术后下床活动时间早、术后住院时间短和术后腹部无疤痕等优点,已逐渐取代腹式子宫切除术成为治疗非脱垂子宫良性疾病的首选术式。     

Lapabot: A compact telesurgical robot system for minimally invasive surgery: Part II. Telesurgery evaluation

This study was undertaken to determine the usefulness of routine intra‐operative cystoscopy in documenting ureteral patency after laparoscopy‐assisted vaginal hysterectomy (LAVH). There were eighty patients who underwent LAVH for benign tumors of the uterus (adenomyosis and myoma), uterine prolapse, persistent intraepithelial neoplasm of the cervix (CIN3) and cervical carcinoma in situ (CIS). Intra‐operative cystoscopy with ureteral stenting was performed at the time of LAVH to evaluate the urinary tract. From among the 80 patients who underwent LAVH, 52 had myoma, 19 had adenomyosis, six patients had uterine prolapse, one had CIS and seven patients were diagnosed to have CIN3. Cystoscopy discovered one unsuspected bladder injury. Hematuria was the immediate complication caused by intraoperative cystoscopy. It was observed in ten patients. Urinary tract evaluation, including cystoscopy and ureteral stenting at the time of complex gynecologic surgery such as LAVH could be incorporated in the whole surgical procedure. It decreases morbidity associated with unrecognized injury.     

探讨腹腔镜辅助阴式子宫切除术50例的临床疗效

目的：探讨腹腔镜辅助阴式子宫切除的f}缶床疗效。方法：我院2008年11月-2009年10月共施行LAVH50例，另选50例行经腹子宫全切术（TAH组），观察比较两种术式的手术效果及术后并发症情况。结果：LAVH组在手术时间、术中出血量及术后住院时间方面明显短于TAH组，经统计学处理，差异有显著性（P〈0．05）。LAVH组的术后的并发症，包括阴道残端感染、切口延期愈合、胃肠功能紊乱、血栓性静脉炎等的发生率明显低于TAH组并发症的发生率，经统计学处理，差异有显著性（P〈0．05）。结论腹腔镜辅助阴式子宫全切术（laparoscopically assisted hysterectomy，LAVH）具有创伤小、恢复快，住院时间短，术后并发症少，无粘连等优点，值得临床推广和应用。     

PK刀在腹腔镜辅助阴式子宫切除术中的应用

目的探讨等离子PK刀在LAVH中的应用价值。方法回顾性分析我院妇科2004年5月-2007年4月，住院行LAVH的248例患者的临床资料。比较PK刀与双极电凝钳在LAVH中的手术时间、术中腹腔出血量、术中术后并发症和术后患者恢复情况。结果与双极相比，PK刀明显减少术中出血量、显著缩短手术时间。结论PK刀在LAVH中具有一定的优势，改变了双极凭经验掌握电凝程度的不足，避免了组织凝固不均、组织凝固过度炭化和凝固不全出血等缺点，并具有止血效果佳、热辐射损伤范围小、操纵简单等优点，值得推广使用。