阴式与腹式子宫切除术式的临床比较分析

系统且较为全面的分析阴式与腹式子宫切除术的应用效果。方法 调研时限为2021.05~2021.12,入组此次甲组(腹式子宫切除术)、乙组(阴式子宫切除术)、丙组(腔镜子宫切除术)的研究对象为90例接受子宫切除手术治疗女性,分组方式为手术方式,分析手术治疗效果。结果 甲组手术时间、出血、疼痛与恢复指标值、并发症率均高于乙组与丙组,P<0.05;乙丙两组上述指标存在差异较小,P>0.05;甲组术后72h应激反应指标值(COR、IL-6、WBC、Hs-CRP、NE)、术后3个月卵巢储备功能指标值(E2、LH、AMH、FSH、窦状卵泡数)与乙组、丙组及乙组与丙组术后3个月E2、LH、窦状卵泡数存在差异较大,P<0.05;乙组与丙组术后72h应激反应指标及术后3个月AMH、FSH存在差异较小,P>0.05。结论 阴式子宫切除术应用价值显著优于腹式子宫切除术,前者对患者机体造成的应激反应更少且术后卵巢储备功能影响更小,手术时间、出血、疼痛以及恢复指标更优,可以获得与腹腔镜手术方式相似的微创效果。

Prognosis of gestational choriocarcinoma diagnosed incidentally during laparoscopy for a presumed cornual pregnancy:a report of five cases

The clinical presentations of gestational choriocarcinoma vary markedly, and a misdiagnosis could be made in atypical patients if simply relying on clinical features. Laparoscopic resection of uterine mass lesion is rarely used in gestational choriocarcinoma diagnosis because of the fear of heavy blood loss and distant metastasis. Five patients who were preoperatively diagnosed as having cornual pregnancy underwent laparoscopic resection of mass lesion and then proved to have gestational choriocarcinoma based on pathological examinations. Chemotherapy was started within two days after surgery, and the rate of complete remission was 100%. The mean follow-up time was 29.8±19.1 months, and no patient showed signs of relapse. Laparoscopic resection of uterine mass followed by timely postoperative chemotherapy may be an effective and safe way to obtain pathologic results in patients with suspected gestational choriocarcinoma.

LAPAROSCOPIC MYOMECTOMY

Objective. To investigate the indications, surgical techniques and complications of laparoscopic myomectomy. Materials and methods. A retrospective study was carried out in 74 patients with fibroids >3cm from March, 1995 until May,2000 at PUMC Hospital. Indications for surgery were symptomatic fibroids（ 20 cases） , mainly pain or urine frequency； progressively increasing fibroid size (7 cases)； coexistent adnexal pathology（ 26 cases） and infertility（ 21 cases） . Results. The number of fibroids of each patient varied from 1 to 4 with single fibroid of 62 cases (83.7％ ).The fibroids were located in anterior wall (30 cases), posterior wall (23 cases) and fundus (21 cases). A total of 93 fibroids were removed from these patients including 16 intramural fibroids and 77 subserous fibroids. The size of dominant fibroids ranged from 3～ 8 cm (mean 4.8 cm). In 19 cases (25.6％ ),the uterine wall was sutured in one layer. Mean duration of operation was 73 minutes and mean blood loss was 82 ml. Longer operating time and more blood loss were observed in patients with fibroids≥ 4cm than those with fibroids < 4cm. The difference was statistically significant (P< 0.05). Mean postoperative hospital stay was 3.2 days and overall complication rate was 1.4％ . The average postoperative follow- up period was 22 months (1～ 62 months). All the patients with symptoms showed remission of their complaints at 2- month follow- up. Recurrence of fibroid occurred in 1 case 1 year after initial operation and second laparoscopic myomectomy was given to her successfully. Five patients became pregnant. The pregnancy was uneventful and proceeded to selective caesarean section at term pregnancy in 4 cases. One miscarriage occured at 8 weeks in the 5th case. No adhesions at myomectomy site were found in these 5 patients. Conclusions. Our study suggests the feasibility of laparoscopic myomectomy in selected patients, which leads to effectiveness, low complication rate and satisfactory remission of symptoms. Further study on recurrence and fertility must be continued.