子宫肌瘤两种切除术式对妊娠结局的比较

 目的 比较子宫肌瘤两种切除术式对妊娠结局的效果。方法 回顾性分析2012-01至2014-06我科收治的240例因子宫肌瘤行手术治疗且有生育要求的患者的临床资料,按照手术方式将其分为腹腔镜组(128例)和开腹组(112例),观察两组患者子宫肌瘤的类型、位置、大小、数目和妊娠结局等情况,分析不同术式对患者妊娠的影响。结果 随访至2015年12月,开腹组切除子宫肌瘤直径[(7.6±3.0)cm、肌瘤数目(5.6±5.5)个]均高于腹腔镜组[ (6.8±2.0)cm、(2.4±2.1)个],差异有统计学意义(P<0.05);而子宫肌瘤的类型,腹腔镜组更多为浆膜下肌瘤,开腹组则更多为肌壁间肌瘤及黏膜下肌瘤;腹腔镜组与开腹组患者术后妊娠率分别为64.8%、62.5%,流产率分别为9.38%、7.14％,早产率分别为6.25%、4.46%,这3个率两组比较,差异均无统计学意义,且两组患者术后妊娠均未发生子宫破裂。结论 开腹和腹腔镜下子宫肌瘤切除术对于有生育要求的子宫肌瘤患者均行之有效,可获得满意的妊娠结局。     

三种术式治疗子宫内膜异位症疗效比较观察

目的：观察比较三种术式（腹腔镜、经阴道、开腹）治疗子宫内膜异位症的疗效。方法：将手术治疗子宫内膜异位症1547例,分为腹腔镜手术组1079例、经阴道手术组198例和开腹手术组270例,比较各组手术时间、出血量、术后妊娠率、痛经及下腹痛缓解率。结果：腹腔镜手术组平均手术时间、出血量均显著少于经阴道手术组和开腹手术组（P〈0.05）,术后妊娠率、痛经及下腹痛缓解率3组间差异不显著（P〉0.05）。结论：腹腔镜手术治疗子宫内膜异位症优于经阴道手术和开腹手术。     

剖宫产术中对子宫肌瘤的处理探讨

目的探讨剖宫产术中同时行子宫肌瘤剔除的效果。方法对妊娠合并子宫肌瘤行剖宫产57例产妇的临床资料进行回顾性分析。结果49例剖宫产同时剔除子宫肌瘤者,平均出血量比单纯剖宫产多50～800ml不等,无一例因剔除肌瘤出血过多、无法控制而切除子宫。7例未同时行肌瘤剔除者,多为多发性米粒样大小肌瘤,或肌瘤位于宫角近大血管、阔韧带近子宫动脉、输尿管等原因。结论剖宫产时是否行子宫肌瘤剔除术,要根据病人全身状况及肌瘤大小、数目、部位等综合考虑。     

开腹与腹腔镜子宫肌瘤剔除术的比较研究

目的：对开腹子宫肌瘤剔除术与腹腔镜子宫肌瘤剔除术进行比较。方法：选择行子宫肌瘤剔除术215例,随机分为开腹子宫肌瘤剔除术105例（开腹组）和腹腔镜子宫肌瘤剔除术110例（腹腔镜组）,比较两组手术时间、术中出血量,以及术后排气时间、进食时间、下床时间、体温恢复正常时间、住院时间和住院费用等围术期情况。结果：开腹组手术时间及住院费用均非常显著短于或低于腹腔镜组（P〈0.01）;而腹腔镜组术中出血量非常显著少于开腹组（P〈0.01）,术后排气时间、进食时间、下床时间、体温恢复正常时间和住院时间均非常显著短于开腹组（P〈0.01）。结论：子宫肌瘤剔除术的术式选择,应根据患者肌瘤的大小、多少和发生部位,盆腔有无粘连和病变,较适合的术式,术中和术后并发症,以及患者的经济状况、是否有妊娠需要等因素综合考虑。     

播散性腹膜平滑肌瘤1例

病人，42岁，孕2产1，无服避孕药物史。2004年3月因子宫肌瘤于市某医院行腹腔镜下子宫肌瘤剔除术，术中探查子宫前壁直径6cm大小肌壁间肌瘤，余无明显异常，行肌瘤剔除术，病理检查提示子宫平滑肌瘤。术后患者无不适，未复诊。2004年9月体检发现子宫增大，盆腔B超提示子宫多发性肌瘤。入院查体：生命征平稳，全身皮肤无黄染、皮疹，浅表淋巴结未扪及肿大，     

子宫肌壁间妊娠患者的彩色多普勒超声误诊分析

目的 探讨子宫肌壁间妊娠患者的彩色多普勒超声误诊原因,降低误诊率.方法 分析我院收治的12例子宫肌壁间妊娠患者的彩色多普勒超声声像图资料,分析超声误诊原因,旨在提高超声早期诊断率.结果 2例患者的前壁可见肌层内不均质回声内部回声强弱不均一,可见不规则区域.3例患者的彩色多普勒超声检查结果显示右侧卵巢内上方不均质团块.术前超声诊断为滋养细胞肿瘤的1例患者行开腹手术.其他6例患者在入院经彩色多普勒超声检查为子宫肌瘤的患者,入院后在持续硬膜外麻醉下行经阴道子宫肌瘤剔除术.要在术前做血β-HCG的测定对比,将会对疾病的诊断有所帮助.结论 子宫肌壁间妊娠患者的临床表现无特异性,常伴下腹部压痛,易产生误诊,针对这种情况应在术前做β-HCG测定,并进行腹腔镜探查术或送快速病理,若经病理确诊为子宫肌壁间妊娠,在术后还必须严密随访,以防止恶性滋养细胞病变.     

宫腔内放置水囊在腹腔镜下剥除宫壁间小肌瘤术中的应用

目的介绍在腹腔镜术中经阴道放置宫腔内水囊,使子宫肌壁间1．0—2．0cm的小肌瘤易于探查并剥除的方法。方法选择术前检查发现多发性子宫肌瘤,以2-4枚肌壁间1．0—2．0cm的小肌瘤为主的病例26例,行腹腔镜下子宫肌瘤剥除术。术中经阴道放置宫腔内水囊,在腹腔镜直视下注人生理盐水5—20ml,使官腔膨胀、宫壁变薄,肌壁间小肌瘤突出或肌瘤局部颜色变浅,容易触探和识别,便于肌瘤剥除。结果除1例“碎石样”肌瘤病例选择子宫次全切外,其余25例均能顺利剥除术前超声检查发现的肌瘤,术后无感染、大出血等发生,月经如期复潮,B超复查均未见肌瘤残留。结论腹腔镜术中经阴道放置宫腔内水囊,使官腔膨胀,宫壁变薄,肌壁间小肌瘤突出便于识别剥除,减少了肌瘤遗漏的发生。     

妊娠合并子宫肌瘤的类型对妊娠并发症的影响

目的探讨妊娠合并子宫肌瘤的类型对妊娠并发症的影响。方法回顾性分析2007年8月至2010年6月在我院治疗的302例妊娠合并子宫肌瘤患者的临床资料,按肌瘤类型进行分组,对其妊娠并发症进行比较,进一步研究肌壁间肌瘤大小对妊娠并发症的影响。结果与浆膜下肌瘤组比较,肌壁间肌瘤组、粘膜下肌瘤组胎膜早破的发生率无明显增加（P〉0.05）,而早产、胎位异常、前置胎盘、产后出血的发生率显著增加（P〈0.05）;与〈2cm肌瘤组、2～5cm肌瘤组相比较,〉5cm肌瘤组胎膜早破、早产、胎位异常、前置胎盘、产后出血发生率明显增加,且产后出血量明显增多。结论 〉5cm肌壁间肌瘤、粘膜下肌瘤明显增加妊娠期、产时、产后并发症的发生率,应于孕前高度重视。     

腹腔镜手术与开腹手术在治疗子宫肌瘤方面的比较研究

目的对比分析腹腔镜手术与开腹手术在治疗子宫肌瘤方面的临床疗效,以便选择最佳适合患者的手术方式。方法随机选取我科住院部2008年8月至2011年8月收治的120例施行子宫肌瘤剔除术患者为研究对象,其中腹腔镜手术60例为观察组.开腹手术60例作为对照组,比较两组患者的手术各项指标及疗效。结果腔镜组手术时间和术中出血明显长于开腹手术组,而排气时间、停留尿管时间、住院时间和术后并发症明显低于开腹手术组,术中出血量与开腹组比较无显著差。结论腹腔镜下子宫肌瘤剔除术治疗子宫肌瘤具有手术创伤小、术后并发症少、术后恢复快的优点,值得临床推广应用。     

剖宫产术中子宫肌瘤剔除术53例临床分析

妊娠合并子宫肌瘤占妊娠的0．1％～3．9％,在肌瘤患者中的发病率为0．5％～1％。本文分析了2003—03—2009—08在我院剖宫产术同时行子宫肌瘤剔除术的妊娠合并子宫肌瘤患者53例,同时取同期50例剖宫产术同时未行子宫肌瘤剔除术的妊娠合并子宫肌瘤患者进行比较,探讨剖宫产术中同时剔除子宫肌瘤的临床意义。     

The percutaneous treatment of uterine fibromas by means of transcatheter arterial embolization

INTRODUCTION: We report our preliminary experience with arterial embolization of uterine fibroids in seven women, focusing on the technical aspects of the procedure and the clinical and morphological results during the follow-up. MATERIAL AND METHODS: February to December 1999 seven women (mean age 47) underwent transcatheter arterial embolization of both uterine arteries as a permanent treatment for fibroids. We included in this study single or multiple, bleeding and/or large fibroids, symptomatic on compression, contraindicated for myomectomy because of high surgical or anesthesiologic risks or myomata in which myomectomy could probably be converted into hysterectomy. Fibroids enlarging the uterus to the size of 25 weeks' pregnancy or more, pedunculated myomata or small submucous fibroids--smaller than 5 cm--were excluded. Uterine arterial embolization was performed bilaterally, till a total blockage of flow, by injecting permanent embolization material: polyvinyl-alcohol (PVA) particles of increasing size from 150 to 500 mu and in varying amounts from 10 to 24 mL, depending on fibroid size and degree of vascularization. RESULTS: A technical success was achieved in all cases and no late complications were seen. At 6-month clinical follow-up all compressive symptoms had disappeared; regular menses had returned in 57% of patients, milder hyper-dysmenorrhea was present in 28% compared to pretreatment symptoms; only in one case (14%) was permanent amenorrhea observed. The 3-month and 6-month US follow-up studies showed an average 40.7% (range 10-50%) and 51% (range 25-83%) reduction in the fibroid size, respectively. All the small myomata (about 2 cm in size) were unidentifiable at 6-month US follow-up. In no cases did new fibroids appear. DISCUSSION: Surgery is the traditional treatment for symptomatic uterine fibroids (hysterectomy, myomectomy). More recently, hormone therapy and operative endoscopy (laparoscopy and hysteroscopy) have been introduced as alternatives, together with uterine embolization previously applied preoperatively in extensive bleeding neoplasms or to control post-partum hemorrhage. Transcatheter embolization of the uterine arteries feeding large fibroids is a minimally invasive technique which could be safely used as an alternative to surgery, and a valuable in the definitive treatment of symptomatic, large or multiple, intramural or submucosal fibroids. In agreement with literature findings, in the present series symptoms resolved completely in over 85% of cases after embolization, with an average reduction in fibroid size over 50% at 6-month follow-up in large fibroids, whereas smaller size myomata were no longer detectable at US and no new fibroids had formed. CONCLUSIONS: Our preliminary experience confirms that arterial embolization is a promising alternative to surgery in the definitive treatment of fibroids, thanks to its high efficacy and safety, also reducing patient hospitalization and costs.     

经阴道子宫肌瘤剔除术的临床研究

目的 探讨经阴道子宫肌瘤剔除的可行性及优越性。方法 对58例要求保留子宫的子宫肌瘤患者在全麻或硬膜外麻醉下实施经阴道子宫肌瘤剔除术。观察手术适应证、术中并发症、手术时间、术中出血量、术后病率、并发症及住院时间等。结果 57例(98．3％)手术成功,无中转开腹。平均手术时间：48．16min;平均出血量：70．58ml;术后病率：3．4％(2例)。术后并发症：1．7％(1例),系子宫切口感染。平均体温正常时间：1．8天。平均排气时间：1．3天。平均住院时间：4．9天。术后随诊：4例肌瘤复发,复发率为7．0％。结论 经阴道子宫肌瘤剔除术对腹腔骚扰小,术后恢复较快,腹壁不留疤痕。     

Magnetic Resonance Imaging (MRI) Analysis of Fibroid Location in Women Achieving Pregnancy After Uterine Artery Embolization

The purpose of this study was to evaluate the fibroid morphology in a cohort of women achieving pregnancy following treatment with uterine artery embolization (UAE) for symptomatic uterine fibroids. A retrospective review of magnetic resonance imaging (MRI) of the uterus was performed to assess pre-embolization fibroid morphology. Data were collected on fibroid size, type, and number and included analysis of follow-up imaging to assess response. There have been 67 pregnancies in 51 women, with 40 live births. Intramural fibroids were seen in 62.7% of the women (32/48). Of these the fibroids were multiple in 16. A further 12 women had submucosal fibroids, with equal numbers of types 1 and 2. Two of these women had coexistent intramural fibroids. In six women the fibroids could not be individually delineated and formed a complex mass. All subtypes of fibroid were represented in those subgroups of women achieving a live birth versus those who did not. These results demonstrate that the location of uterine fibroids did not adversely affect subsequent pregnancy in the patient population investigated. Although this is only a small qualitative study, it does suggest that all types of fibroids treated with UAE have the potential for future fertility.     

子宫瘢痕妊娠清宫术前高强度聚焦超声和子宫动脉栓塞的比较

 目的 比较子宫瘢痕妊娠(cesarean scar pregnancy,CSP) 清宫术前高强度超声聚焦(high intensity focused ultrasound,HIFU)与子宫动脉栓塞(uterine artery embolization, UAE)的差异。方法 回顾性分析2013-01至2018-10武警特色医学中心妇产科收治的77例CSP病例资料,根据清宫术前预处理方法的不同分为两组,海扶组先行高强度超声聚焦治疗,子宫动脉栓塞组先行子宫动脉灌注栓塞治疗,均在治疗后2～3 d再行清宫术。分析孕龄、剖宫产次数、距前次剖宫产时间、妊娠时间、孕囊平均直径、子宫瘢痕处肌层厚度、手术时间、术中出血量、住院时间、住院费用、清宫术时转为开腹手术的例数、手术方式及CSP分型情况等。结果 海扶组术中出血>50 ml的有2例,占5.41%,子宫动脉栓塞组出血>50 ml的有6例,占17.14%,海扶组比例明显低于子宫动脉栓塞组(P＜0.05)。CSPⅢ型的5例患者,其中海扶组有2例,子宫动脉栓塞组有3例,刮宫术时均因出血多转为开腹手术。两组在清宫时间、住院时间和住院费用方面,海扶组明显低于子宫动脉栓塞组,差异有统计学意义(均P＜0.05)。结论 HIFU联合清宫术终止CSP安全、有效。     

腹腔镜子宫肌瘤剔除术52例临床分析

目的探讨腹腔镜治疗特殊部位子宫肌瘤的临床价值。方法选择2007年6月到2008年9月在我院妇产科行腹腔镜下子宫肌瘤剔除术且无合并其他部位子宫肌瘤、无其它联合手术、无内外科合并症者共52例,观察手术时间、术巾出血量、术中术后并发症、术后住院日。结果52例手术均获成功,术中出血量20～320ml,平均85．00±65．23ml;手术时间（110．56-41．35）min;术后肛门排气（1．79±0．25）d;术后住院天数（6．81±1．32）d,无1例子宫肌层血肿形成;无严重并发症。结论腹腔镜下特殊部位子宫肌瘤剔除术是可行的、安全的。     

Leiomyomas in pregnancy: sonographic study

With ultrasound monitoring, analysis of the behavior of uterine leiomyomas (fibroids) and their impact on the course of pregnancy was undertaken in a group of 113 patients. Fibroid size changes were analyzed on the basis of trimesters. In the second trimester, smaller fibroids increased in size, whereas larger fibroids decreased in size. In the third trimester, a decrease in size was documented regardless of initial size. The most common patterns of echotexture were hypoechoic, heterogeneous, and echogenic rim. The development of a heterogeneous pattern or anechoic/cystic spaces on a follow-up study was accompanied in seven of ten patients by severe abdominal pain, compared with 12 cases of abdominal pain in 103 patients without such echotexture changes. Although the number of patients was small, the development of these patterns apparently indicates significant degeneration of the fibroid. Fibroids located in the lower uterine segment were accompanied by a higher frequency of cesarean section and retained placenta. Fibroids located in the uterine corpus were more frequently associated with early abortions. Multiple fibroids were accompanied by a higher frequency of malpresentation and premature contractions compared with cases with one or two fibroids.     

腹腔镜下与经腹子宫肌瘤核除术的临床对比分析

目的：观察分别用腹腔镜与经腹子宫肌瘤核除术治疗妇科子宫肌瘤的临床疗效,并比较两者差异。方法选择2014年1月～2015年6月收治的80例子宫肌瘤患者作为研究对象,按照随机数字表法将研究对象分为实验组和对照组,每组各40例,实验组患者实施腹腔镜下子宫肌瘤核除术,对照组患者实施经腹子宫肌瘤核除术,对两组患者手术情况及术后情况进行对比分析。结果对照组患者的手术时间、术中出血量及住院时间分别为（76.5±13.5）min、（104.1±2.4）L、（10.5±3.2）d,实验组患者的手术时间、术中出血量和住院时间分别为（70.5±10.5）min、（76.1±2.1）L、（6.2±2）d,与对照组相比,实验组患者的手术时间、术中出血量及住院时间均明显减少。对照组患者的发热情况、镇痛药物应用、肛门排气时间及下床时间分别为18（45％）、19（47.5％）、（31±13）h、（4.3±2.1）d,实验组患者的发热情况、镇痛药物应用、肛门排气时间及下床时间分别为14（35％）、5（12.5％）,（21±6）h、（2.7±0.5）d,实验组的发热情况、镇痛药物应用、肛门排气时间及下床时间等均优于对照组。结论与经腹子宫肌瘤剔除术相比,应用腹腔镜进行子宫肌瘤核除术具有手术时间短、出血量少、发热概率低、恢复快等优势,治疗子宫肌瘤安全有效,值得在临床推广应用。     

恶性潜能未定子宫平滑肌瘤临床表现及诊治方法分析

 目的 探讨梭形细胞分化的恶性潜能未定子宫平滑肌肿瘤(uterine smooth muscle tumor of uncertain malignant potential,STUMP)的临床表现、辅助检查及诊断方法。方法 选取2009-01至2015-12在医院妇科接受手术治疗的梭形细胞分化的STUMP患者,病理科医师采用同一诊断标准对病理切片再次复核。通过搜集临床资料进行回顾性研究。结果 共23例,均为育龄期或围绝经期女性,年龄41~50岁的占60.9%;均表现出与子宫肌瘤或肉瘤相似的临床症状,但以月经量增多,经期延长者最多见(56.5%);22例术前超声将该肿瘤诊断为良性平滑肌瘤,1例被诊断为卵巢肿物;术中见肿瘤多生长于宫体肌壁间(60.9%);最大径线2～16 cm,平均6.4 cm;剖面与良性子宫肌瘤类似。结论 STUMP患者的年龄分布、临床表现、超声声像图等均与良性子宫平滑肌瘤更为相似,术前难以区分,确诊仍需依靠病理学检查。