腹腔镜与宫腔镜施行子宫粘膜下大肌瘤切除术的疗效比较

目的探讨及比较腹腔镜与宫腔镜施行子宫粘膜下大肌瘤切除术的临床疗效。方法方便选取2013年2月—2015年6月于该院进行手术治疗的70例粘膜下大肌瘤患者为研究对象,将其随机分为A组(腹腔镜手术组)35例和B组(宫腔镜手术组)35例,然后将两组患者的术中出血量、排气时间、住院时间及手术前后的创伤应激相关血清指标进行比较。结果两组的术中出血量≥20 m L比例分别为34.29%和37.14%,其差异无统计学意义,P>0.05,而B组排气时间<10 h及住院时间<3 d者比例分别为68.57%和71.43%,其均高于A组的48.57%和45.71%,创伤应激相关血清指标也均低于A组,P<0.05,差异有统计学意义。结论宫腔镜手术在子宫粘膜下大肌瘤切除术中的应用价值较高,其对患者造成的创伤应激程度相对较小。

腹腔镜辅助阴式全子宫切除术治疗巨大子宫肌瘤的临床效果分析

目的分析对巨大子宫肌瘤患者采用腹腔镜辅助阴式全子宫切除术方案进行治疗的临床效果。方法方便收集该院2013年10月—2015年10月间收治的经临床确诊的200例巨大子宫肌瘤患者,将所有患者随机分成两组:对照组包含100例患者,施行传统开腹全子宫切除术进行治疗;研究组包含100例患者,施行腹腔镜辅助阴式全子宫切除术方案进行治疗。观察及比较两组患者的手术操作时间、手术出血量等手术情况与术后排气时间、住院天数及并发症发生率等术后情况。结果与对照组相比,研究组患者的手术出血量(84.17±20.63)m L相对更少更少,术后排气时间(22.93±9.52)h及住院天数(5.21±0.78)d均明显更短,且术后并发症发生率(3.0%)相对更低(P<0.05),差异有统计学意义。结论对巨大子宫肌瘤患者采用腹腔镜辅助阴式全子宫切除术方案进行治疗具有微创、术后恢复快及并发症少等优点,值得进一步推广。

Laparoscopic hysterectomy as optimal approach for 5400 grams uterus with associated polycythemia: A case report

BACKGROUND Uterine myomas are the most common benign gynecological soft tissue tumors in women but polycythemia associated with these tumors is rare.Polycythemia is significantly associated with risk of venous thromboembolism(VTE),which is further increased in case of a large pelvic mass and obesity.Here we report the surgical challenges in the case of an obese patient with a giant fibromatous uterus and associated polycythemia.CASE SUMMARY A 42-year-old obese woman was referred to our department for treatment for a huge fibromatous uterus.She suffered of pelvic pressure and abdominal distension and reported severe dyspnea from several months.Laboratory analyses including hemoglobin(Hb)19.2 g/dL and hematocrit(Hct)59.7%were indicative of polycythemia.Arterial blood gas analysis showed arterial oxygen pressure(pO2)of 81.5 mmHg.Abdominal computed tomography confirmed a giant fibromatous uterus measuring 28.2 cm×17 cm×25 cm.To reduce the thromboembolic risk,the patient underwent low molecular weight heparin,phlebotomy twice before surgery,and we opted for a laparoscopic hysterectomy.The uterus weighed 5400 g and the histology confirmed a diagnosis of leiomyoma.We did not find increased erythropoietin levels in the supernatant of the myomatous uterine tissue.There were no complications.On postoperative day 1,the Hb and the Hct levels normalized to 13.3 g/dL and 41.7%,respectively.Arterial blood gas analysis after surgery showed a pO2 of 144.7 mmHg.These results suggested the diagnosis of myomatous erythrocytosis syndrome.The patient was discharged on the second postoperative day in very good condition with no symptoms.CONCLUSION We believe this is the first reported laparoscopic hysterectomy in a patient with a giant uterus,polycythemia and obesity.Multiple VTE risk factors warranted a laparoscopic approach.

艾滋病病毒感染者5例子宫巨大肌瘤的手术体会

目的研究HIV病毒感染者5例子宫巨大肌瘤的手术体会。方法选取我院2016年1月至2018年3月收治的5例子宫巨大肌瘤同时患有艾滋病的患者为研究对象,分析其执行手术治疗的体会与临床价值。结果手术约历时3h,术中出血约600m L,术中出血量185~2500m L,平均785m L,5例患者中0例发生腹损伤、尿路感染,未出现肠管、输尿管等损伤,不良反应率为0%,术后第12~13天均康复出院。结论合理调整手术步骤,明确解剖位置,总结术前和术中存在的不足,能够有效保证瘤体与子宫顺利切除,保障临床疗效,值得进一步推广研究。