腹腔镜下子宫肌瘤剔除术治疗子宫肌瘤的临床效果

目的 探讨腹腔镜下子宫肌瘤剔除术治疗子宫肌瘤的临床效果.方法 选取99例子宫肌瘤患者,根据手术方法不同分为研究组(56例)与对照组(43例).研究组采用腹腔镜下子宫肌瘤剔除术治疗,对照组采用常规开腹手术治疗.对比两组手术相关指标、术后并发症发生情况及复发率.结果 研究组术中出血量(57.63±3.40)ml明显少于对照...     

子宫肌瘤剔除术中的无瘤防御

随着医学技术的进步和女性对于生殖健康认知水平的提升,越来越多的子宫肌瘤患者要求保留子宫器官,子宫肌瘤剔除术备受青睐。由于腹腔镜技术的广泛应用,以及术者对无瘤原则的忽视,近年来频频发生微创术后寄生性子宫肌瘤,甚至子宫肉瘤盆腹腔的广泛播散种植,严重危害女性生命健康,已成为重大公共卫生问题。美国食品药品监督管理局（FDA）也对腹腔镜下子宫肌瘤分碎提出黑框安全警告。建立微创无瘤防御体系势在必行,应传承并恪守无瘤原则,强调以医学教育为基础,医院管理为保障,科技创新为引领,针对子宫肌瘤剔除术中医源性肿瘤转移的多种原因,构建全方位、多层次的安全防控屏障,注重于细节管理,采取相应措施,防御肿瘤的暴露、组织碎屑的产生、体液血液的污染,保障患者的安全。     

腹腔镜下子宫肌瘤剔除术与经腹子宫肌瘤剔除术治疗的预后分析

目的对比分析子宫肌瘤患者采用腹腔镜下子宫肌瘤剔除术与经腹子宫肌瘤剔除术治疗的预后。方法选取本院2016年6月~2019年1月期间收治的预行手术治疗的子宫肌瘤患者20例作为研究对象,将其随机分为两组,各10例。实验组行腹腔镜下子宫肌瘤剔除术;对照组行经腹子宫肌瘤剔除术。对比两组患者术后切口恢复时间、月经恢复时间、平均住院时间。结果实验组患者术后伤口恢复时间、月经恢复时间、平均住院时间明显短于对照组,差异具有统计学意义,P<0.05。结论子宫肌瘤患者采用腹腔镜下子宫肌瘤剔除术治疗患者的预后更佳,值得推广。     

腹腔镜下子宫肌瘤剔除术的临床进展

子宫肌瘤是女性生殖器官最常见的良性肿瘤，发生率为20％-30％。治疗症状性子宫肌瘤最常采用的治疗方法是子宫切除术。近年来，随着越来越多的妇女选择晚生育，并且更加重视子宫的生理功能以及身体的完整性，子宫肌瘤剔除术正在日益增加。自1990年，腹腔镜下子宫肌瘤剔除术(laparoscopic myomectomy，LM)取代开腹手术治疗肌壁间     

腹腔镜子宫肌瘤剔除术与开腹子宫肌瘤剔除术的治疗效果比较

目的 分析子宫肌瘤患者采取不同手术治疗方案对其预后的影响。方法 选取30例子宫肌瘤患者,采取随机数字表法分为对照组（15例,采用开腹子宫肌瘤剔除术治疗）与研究组（15例,采用腹腔镜子宫肌瘤剔除术治疗）。比较两组患者的手术指标、预后恢复情况、并发症发生情况、手术前后卵巢功能指标及炎性因子水平。结果 研究组的手术时间短于对照组,术中出血量少于对照组（P<0.05）。研究组的胃肠功能恢复时间、术后下床时间及住院时间均较对照组短（P<0.05）。研究组并发症发生率6.67%明显低于对照组的40.00%(P<0.05)。研究组术后的卵巢功能指标、炎性因子水平均显著优于对照组（P<0.05）。结论 腹腔镜子宫肌瘤剔除术治疗子宫肌瘤患者,有助于加快患者的预后恢复,提高临床疗效,同时也提升安全性,具有临床应用价值。     

腹腔镜子宫肌瘤剔除术治疗子宫肌瘤的效果研究

目的探究子宫肌瘤患者治疗中腹腔镜子宫肌瘤剔除术的应用效果。方法共计有48例子宫肌瘤患者参与本次研究,所有患者均于我院2018年3月~2019年3月进行手术治疗,对照组实施经腹子宫肌瘤剔除术治疗,研究组实施腹腔镜子宫肌瘤剔除术治疗,分组对比手术中出血量、手术后住院时间以及并发症发生情况。结果手术中出血量、手术后住院时间以及并发症对比研究组低于对照组,差异有统计学意义(P<0.05)。结论子宫肌瘤患者治疗中腹腔镜子宫肌瘤剔除术的操作效果显著,能够有效提升治疗效果,降低手术后各类并发症的发生,提升治疗安全性,具有较高的临床推广及应用价值。     

妇产科子宫肌瘤腹腔镜剔除术效果探讨

目的：探讨对患有子宫肌瘤的妇女使用腹腔镜子宫肌瘤剔除术的效果。方法：选取患有子宫肌瘤的妇女64例,平均分为两组,分别为实验组和对照组各32例。其中实验组使用腹腔镜子宫肌瘤剔除术进行治疗。对照组则应用传统的开腹手术进行治疗。对两组患者的术前、术中和术后的各项指标进行定量及定性的比较分析。结果：经观察对比发现,实验组在术中出血量（61．36±10．39）ml,住院时间（5．39±1．27）d等各项指标均优于对照组（87．36±15．59）ml。（9．17±2．09）d,其差异在统计学允许范围内。结论：相对于传统手术,对于患子宫肌瘤的患者采用腹腔镜子宫肌瘤剔除术效果更佳,建议该微创手术临床使用推广。     

腹腔镜子宫肌瘤剔除术40例临床分析

目的:探讨腹腔镜子宫肌瘤剔除术的临床应用价值。方法:对40例子宫肌瘤患者行腹腔镜下子宫肌瘤剔除术。结果:40例手术全部成功,其中浆膜下肌瘤22例、壁间肌瘤18例,肌瘤直径4~8cm。手术平均时间88.13±30.44分钟。术中出血91.27±83.41ml。术后体温最高37.8℃,2天后恢复正常,术后住院4.87±1.20天。结论:腹腔镜子宫肌瘤剔除术是一种安全有效的手术方法,其优点是损伤小、出血少、恢复快,是目前较为理想的微创手术治疗子宫肌瘤的方法之一。     

腹腔镜子宫肌瘤剔除术相关临床问题

腹腔镜子宫肌瘤剔除术已经成为治疗子宫肌瘤的重要术式,具有微创手术的优点。但由于腹腔镜手术本身的特点和技术局限,正确选择手术适应证和掌握良好的手术技巧,对保证手术效果,减少近期和远期的手术并发症尤其重要。     

腹腔镜子宫肌瘤剔除术与经腹子宫肌瘤术治疗子宫肌瘤的临床疗效分析

目的 探讨腹腔镜子宫肌瘤剔除术与经腹子宫肌瘤剔除术治疗子宫肌瘤的效果。方法 选择78例子宫肌瘤患者为研究对象,按照随机数字表法分为试验组和对照组,每组39例。试验组采用腹腔镜子宫肌瘤剔除术治疗,对照组采用经腹子宫肌瘤剔除术治疗,比较两组手术指标、并发症及术后复发情况。结果 试验组术中出血量少于对照组,术后肛门排气、术后住院时间均短于对照组（P<0.05）;试验组手术时间长于对照组（P<0.05）;试验组并发症发生率低于对照组,但差异无统计学意义（P>0.05）;试验组术后复发率低于对照组（P<0.05）。结论 腹腔镜子宫肌瘤剔除术治疗子宫肌瘤效果较好,可减少术中出血量、缩短术后肛门排气及术后住院时间,有利于术后机体恢复,且并发症发生率及复发率低,值得临床推广与应用。     

Robotic-assisted laparoscopic myomectomy compared with standard laparoscopic myomectomy--a retrospective matched control study

OBJECTIVE: Compare robotic-assisted laparoscopic myomectomy (RALM) to a matched control standard laparoscopic myomectomy (LM). DESIGN: A retrospective matched control study. SETTING: Private practice setting. PATIENT(S): Premenopausal and postmenopausal women who underwent either robotic-assisted or standard laparoscopic myomectomy. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Retrospective chart review was performed. Cases of laparoscopic robotic-assisted myomectomies were compared with a matched control group of standard LM. Comparisons were based on Fisher's exact, Mann-Whitney, and exact chi-square tests. RESULT(S): Between January 2006 and August 2007, 15 consecutive RALMs were performed at our institution, compared with 35 matched control standard LMs. The two groups were matched by age, body mass index, parity, previous abdominopelvic surgery, size, number, and location of myomas. Mean surgical time for the RALM was 234 minutes (range 140-445) compared with 203 minutes (range 95-330) for standard LMs. Blood loss, hospitalization time, and postoperative complications were not significantly different. CONCLUSION(S): The RALM required a significant prolonged surgical time over LM. It appears that in the hands of a skilled laparoscopic surgeon, the RALM does not offer any major advantage. This technology, however, offers exciting potential applications while learning endoscopic surgery. Further studies are warranted to asses the utility of RALM for general gynecologic surgeons.     

Uterine perfusion following laparoscopic clipping of uterine arteries at myomectomy

Laparoscopic clipping of uterine arteries facilitates laparoscopic myomectomy with minimal blood loss. This paper shows the return to normal myometrial perfusion following this procedure with literary evidence of the safety and efficacy of this technique.     

腹腔镜子宫肌瘤剔除手术的相关因素分析

目的探讨腹腔镜子宫肌瘤剔除的指征、局限、技巧和影响手术疗效的因素.方法对2001年1月～2003年8月167例腹腔镜子宫肌瘤剔除术患者的临床资料进行回顾性分析.结果 167例患者共剔除肌瘤293个,每例患者剔除肌瘤数目1～9个不等;其中单发肌瘤102例,多发肌瘤65例;肌壁间肌瘤92例,浆膜下肌瘤50例,25例子宫肌壁间与浆膜下肌瘤同时存在;平均肌瘤三径分别为:(6.30±1.49)cm、(5.62±1.41)cm、(5.49±1.30)cm.最大肌瘤体积为11.3 cm×10.0 cm×8.7 cm.腹腔镜下完成手术操作157例,10例小切口辅助或中转开腹手术,包括1例肠管损伤,2例腺肌瘤无明确肌瘤包膜,开腹行腺肌瘤挖除及子宫体重建术.平均手术时间114.80 min,平均术中出血量87.28 ml.肌瘤直径大于等于6 cm时手术时间和术中出血量明显延长和增加(P<0.05);肌壁间肌瘤的手术时间和术中出血量明显高于浆膜下肌瘤(P=0.001);手术并发症1.19%.结论腹腔镜子宫肌瘤剔除是一种微创伤、安全、有效的手术方法,合适的指征选择和镜下缝合技术是保证手术成功的关键.     

A case-controlled study comparing harmonic versus electrosurgery in laparoscopic myomectomy

Objective

To compare the safety and effectiveness of the harmonic scalpel and conventional electrosurgery in laparoscopic myomectomy (LM).

Comparison of cesarean delivery outcome after robotic and laparoscopic myomectomy

ObjectiveThe aim of this study was to determine whether robotic myomectomy (RM) resulted in any measurable clinical improvement over laparoscopic myomectomy (LM) in subsequent cesarean delivery.Materials and methodsThe medical records of 273 patients who had undergone LM or RM followed by subsequent cesarean delivery for the period of September 2015 to December 2020 were retrospectively reviewed. The patients were divided into LM (n = 222) and RM (n = 51) groups. The cesarean delivery outcomes between the two groups were compared.ResultsRM had significantly more myomas removed (6.0 ± 4.8 vs. 3.6 ± 3.5, p < 0.001) and a larger size of largest myoma (7.7 ± 2.4 vs. 6.1 ± 2.4, p = 0.002) at myomectomy compared with LM. However, there were no significant differences in the groups’ surgical characteristics at cesarean section, in their pregnancy complications, or in adhesion formation.ConclusionsAlthough more and larger myomas were removed in the RM group, RM showed similar cesarean delivery outcomes and adhesion formation to LM.     

腹腔镜下子宫动脉阻断术联合肌瘤切除术治疗子宫肌瘤的临床研究

目的评价腹腔镜下子宫动脉阻断联合肌瘤切除术治疗子宫肌瘤的临床可行性及中远期疗效。方法对520例子宫肌瘤患者的临床资料进行回顾性分析,其中348例行腹腔镜下子宫动脉阻断联合肌瘤切除术（LUAO-M）;172例行腹腔镜下单纯肌瘤切除术（LM）,比较两种术式的相关手术指标及随访结果。结果LUAO组术中出血量（88．2±52．7）ml少于LM组（103．2±54．9）ml（P=0．003）;LUAO组术后病率5．7％低于LM组19．2％（P〈0．05）;LUAO组术后住院天数（7．7±2．5）d低于LM组（8．6±3．2）d（P=0．001）。LUAO组术后子宫体积缩小率（48．9±38．6）％大于LM组体积缩小率（39．2±41．6）％（P=0．019）;LUAO组月经过多缓解率97．0％高于LM组86．4％（P〈0．05）;LUAO组术后肌瘤复发率3．0％低于LM组10．7％（P=0．001）。结论腹腔镜下子宫动脉阻断术联合肌瘤切除术有助于拓宽腹腔镜下子宫肌瘤切除术的手术适应证,减少术中出血量,降低术后病率及子宫肌瘤复发率。     

A novel modification of conventional laparoscopic myomectomy using manual assistance for multiple uterine myomas

Objectives

To evaluate the efficacy and feasibility of finger-assisted laparoscopic myomectomy for multiple myomas.

Study design

A total of 565 patients with symptomatic myomas underwent finger-assisted laparoscopic myomectomy between January 2006 and March 2011 to remove multiple myomas at our center. Laparoscopic myomectomy technique was modified, and involved the insertion of two fingers into the vagina to elevate the uterus, while one or two fingers of the other hand were inserted into the abdomen through a suprapubic 15-mm trocar port for palpation of small myomas, which did not distort the uterine contour.

Results

The mean (SD; range) patient age was 38.26 years (5.84; 25–48 years). The diameter of the largest myoma in each case was 6.13 cm (1.21; 4–15 cm). The total number of myomas enucleated in the initial enucleation was 2228. There were 597 additional myomas enucleated with finger-assisted guidance. The mean diameter of the additionally enucleated myomas was 1.1 cm (range, 0.2–2.5 cm), which was significantly smaller than those of the initially enucleated myomas (p = 0.002). The mean operative time was 97.1 min (30.2; 35–180 min). The decrease in postoperative hemoglobin concentration was 1.6 g/dL (0.7; 0.4–3.2 g/dL). During the operation, no patients required a blood transfusion. Six patients developed postoperative fever. There was no occurrence of bowel or urinary tract injury. The mean postoperative hospital stay was 3.2 days (0.9; 2–6 d). All procedures were successfully completed without the need for laparotomy.

Conclusions

Finger-assisted laparoscopic myomectomy is a feasible and safe approach in the surgical treatment of multiple myomas.