腹腔镜子宫肌瘤剔除术180例分析

2001年7月～2004年12月,我科及北京安贞医院妇产科对180例要求保留子宫的患者进行腹腔镜下子宫肌瘤剔除术,获得满意效果.

腹腔镜下子宫肌瘤剔除术探讨

腹腔镜下子宫肌瘤剔除术具有创伤小,恢复快等优点.但术中及术后存在一些问题值得探讨:(1)术中出血;(2)穿透子宫内膜;(3)肌壁间较大肌瘤剔除后缝合困难;(4)阔韧带内肌瘤剔除时输尿管损伤;(5)术后出血及术后感染;(6)肌瘤残留和复发.

腹腔镜下子宫肌瘤剔除术进展

子宫肌瘤是女性生殖器官最常见的良性肿瘤,多见于30—50岁的妇女,发生率为20%-30%^[1-2]。根据其生长部位不同可分为:(1)浆膜下肌瘤;(2)肌壁间肌瘤;(3)黏膜下肌瘤。子宫肌瘤因生长部位不同可有不同的临床表现。由于子宫肌瘤是良性肿瘤,因此可选用保留子宫的子宫肌瘤剔除术。术式的选择主要根据患者的年龄、生育的要求、肌瘤生长的部位、肌瘤的数目及患者对保留子宫的需求程度而定^[1]。

子宫肌瘤经腹腔镜剔除术后并发下肢深静脉血栓风险评分系统的 建立

Objective:To investigate the risk factors of lower extremity deep vein thrombosis (DVT) after laparoscopic excision of uterine fibroids, and to establish a risk nomogram model. Methods:The clinical data of 493 patients with uterine fibroids who underwent laparoscopic excision in our hospital from January 2017 to January 2021 were retrospectively analyzed, and the patients were divided into DVT group and non -DVT group according to whether DVT occurred after operation. According to the clinical conditions of the group, univariate and multivariate Logistic regression analysis was used to screen the influencing factors of DVT after laparoscopic removal of uterine fibroids, and a nomogram risk model was established based on independent risk factors to verify the predictive efficacy. Results:Among 493 patients with uterine fibroids who underwent laparoscopic excision, 41 cases were complicated with lower extremity DVT after operation, and the incidence rate was 8.32% (41/493). The differences were statistically significant (P<0.05) when comparing age, body mass index, preoperative comorbidities, anesthesia, operative time, intraoperative pneumoperitoneal pressure, plasma D-dimer, and postoperative bed rest in the two groups. Multivariate Logistic regression analysis showed that age ≥ 60 years (OR=3.786, 95%CI: 1.749-8.197), preoperative comorbidities (OR=3.390, 95%CI: 1.524-7.543), general anesthesia (OR=3.778, 95%CI: 1.722-8.287), operation time ≥ 2 h (OR=2.884, 95%CI: 1.384-6.010), intraoperative pneumoperitoneum pressure ≥ 15 mmHg (OR=3.295, 95%CI: 1.539-7.055), plasma D-dimer ≥ 500 ng/mL (OR=4.141, 95%CI: 1.925-8.909), and postoperative bed rest time ≥ 5 d (OR=3.628, 95%CI: 1.710 -7.697) were all independent risk factors for postoperative complications of lower limb DVT in patients with uterine fibroids (P<0.05); based on 7 independent risk factors, the nomogram early warning model of postoperative DTV in patients with uterine fibroids after laparoscopic excision was established. The results showed that age ≥60 years was 93 points, 85 points for preoperative complications, 93 points for general anesthesia, 74 points for operation time ≥2 h, 83 points for intraoperative pneumoperitoneum pressure ≥15 mmHg, 100 points for plasma D-dimer ≥500 ng/mL, and the postoperative bed rest time ≥5 days was 91 points. The model validation results showed that the C-index was 0.853 (95%CI: 0.822-0.884), and the predicted value of the calibration curve was basically the same as the measured value. Internally validated gynecological abdominal surgery patients were combined. The area under the ROC curve (AUC) of the risk nomogram model for lower extremity DVT was 0.832 (95%CI: 0.804-0.860). Conclusions:Age ≥60 years old, preoperative complications, general anesthesia, operation time≥ 2 h, intraoperative pneumoperitoneum pressure ≥15 mmHg, plasma D-dimer ≥500 ng/mL, and postoperative bed rest time ≥ 5 days were all independent risk factors for lower extremity DTV after laparoscopic myomectomy. The nomogram based on the above seven independent risk factors is helpful to predict the risk of lower extremity DTV after laparoscopic myomectomy.

腹腔镜下大子宫肌瘤剔除术82例手术探讨

目的探讨腹腔镜下大子宫肌瘤剔除术的可行性,安全性和手术技巧.方法对82例子宫孕14周的子宫肌瘤行腹腔镜下子宫肌瘤剔除术,并与同期子宫孕14周185例进行对比分析.结果子宫孕14周组77例在腹腔镜下完成,其中有气腹腹腔镜68例,无气腹腹腔镜9例.1例中转开腹,4例辅以腹部小切口完成手术.77例成功者与子宫14孕周组相比,手术时间长[(157.6±89.7)minvs(35.3±26.2)min,t=16.929,P=0.000],术中出血量多[(218.0±108.2)mlvs(108.5±67.5)ml,t=9.904,P=0.000].结论超过孕14周的子宫肌瘤剔除术可在腹腔镜下完成,手术成功的关键是熟练的手术技巧.无气腹腹腔镜下巨大子宫肌瘤剔除适合于子宫孕16周者.