【作者】 张庆华；

【导师】 马丁；

【作者基本信息】 华中科技大学 ， 妇产科学， 2012， 博士

【摘要】 目的：分析腹腔镜手术下子宫肌瘤剔除的应用价值。方法：回顾性分析2008年1月至2011年12月武汉市中心医院就诊行腹腔镜下子宫肌瘤剔除术(Laparoscopic myomectomy, LM)145例,并与同期行开腹子宫肌瘤剔除术(Trans-abodominal myomectomy, TAM)435例患者比较其术中与术后情况。结果：两组患者临床特征无明显差异。腹腔镜手术剔除肌瘤个数为1个,2～4个及多于4个情况下,手术时间分别为73.89min、116.70min及162.41min,开腹组相应为75.40min、95.14min及123.33min。在术中出血量方面,肌瘤个数为1个,2～4个及多于4个情况下,分别为105.15ml、119.70ml及213.79ml,开腹组相应为142.90ml、164.44ml及191.11ml。对于单个肌瘤手术时间而言,腹腔镜手术与开腹手术相比,无论肌瘤部位及大小,两者均无明显差异。在术中出血量方面,单个肌壁间肌瘤及肌瘤直径在10cm以内单个肌瘤,腹腔镜手术少于开腹手术,差异具有统计学意义(P<0.05)。在术后恢复方面,腹腔镜组下床活动时间、通气时间及术后住院日等明显优于开腹组,差异具有统计学意义(P<0.05)。结论：腹腔镜子宫肌瘤剔除手术具有出血量少,术后恢复快的优势。目的：分析腹腔镜手术下全子宫切除的临床应用安全性及优越性。方法：回顾性分析2008年1月至2011年12月武汉市中心医院就诊行腹腔镜全子宫切除术(Total laparoscopic hyeterectomy, TLH)218例,并与同期行开腹全子宫切除术(Trans-abodominal hyeterectomy, TAH)654例患者比较其术中与术后情况。结果：两组患者临床基本资料无明显差异。腹腔镜手术时间及术中失血量分别为75.78min及123.21ml,开腹组分别为96.62min及214.57ml,差异具有统计学意义。在术后恢复方面,腹腔镜组下床活动时间、通气时间及术后住院日等明显优于开腹组,差异具有统计学意义(P<0.05)。结论：腹腔镜子宫肌瘤剔除手术具有出血量少,术后恢复快的优势。目的：分析腹腔镜手术治疗子宫内膜癌的临床应用安全性及优越性。方法：回顾性分析2008年1月至2011年12月武汉市中心医院因子宫内膜癌行腹腔镜下广泛全子宫切除术(Laparoscopic radical hyeterectomy, LRH)与盆腔淋巴结清扫术35例与同期行开腹广泛全子宫切除术(Abodominal radical hyeterectomy, ARH)35例,比较其术中、术后恢复情况及预后。结果：两组患者年龄、分期、病理类型等临床基本资料无明显差异。腹腔镜手术时间及术中失血量分别为227.35min及260.55ml,开腹组分别为230.65min及488.51ml,出血量差异有统计学意义。在术后恢复方面,腹腔镜组下床活动时间、通气时间及术后住院日等明显优于开腹组,差异具有统计学意义(P<0.05)。腔镜组发生尿潴留、伤口液化、淋巴囊肿等并发症分别为1例、0例、1例,开腹组分别为2例、2例、4例,差异有统计学意义。两组患者平均随访29个月(3-49个月),无复发生存率与总体生存率相近,差异无统计意义。结论：子宫内膜癌行腹腔镜下广泛全子宫切除术后恢复快、术后并发症少的优势。目的：分析腹腔镜手术治疗宫颈癌的临床应用安全性及优越性。方法：回顾性分析2008年1月至2011年12月武汉市中心医院因宫颈癌行腹腔镜下广泛全子宫切除术(Laparoscopic radical hyeterectomy, LRH)与盆腔淋巴结清扫术55例与同期行开腹广泛全子宫切除术(Abodominal radical hyeterectomy, ARH)55例,比较其术中、术后恢复情况及预后。结果：两组患者年龄、分期、病理类型等临床基本资料无明显差异。腹腔镜手术时间及术中失血量分别为260.41min及266.76ml,开腹组分别为268.11min及479.73ml,出血量差异具有统计学意义。在术后恢复方面,腹腔镜组下床活动时间、通气时间及术后住院日等明显优于开腹组,差异具有统计学意义(P<0.05)。腔镜组发生尿潴留、伤口液化、淋巴囊肿等并发症分别为2例、0例、2例,开腹组分别为4例、3例、5例,差异有统计学意义。两组患者平均随访29个月(3-49个月),无复发生存率与总体生存率相近,差异无统计意义。结论：宫颈癌行腹腔镜下广泛全子宫切除术手术具有出血量少、术后恢复快、术后并发症少的优势。更多还原

【Abstract】 Objective:To analyze the application of laparoscopic myoectomy in clinic. Methods:We analyzed surgeical outcome of 145 TAM and matched 435 LM performed from Jan 2008 to Dec 2011 in the center hospital of Wuhan. Results:The clinicl charecterisitc of the patients were similar in the two groups. The operating time of LM were 73.89min,116.70min and 162.41min, respectively while it was 75.40min,95.14min and 123.33min and the blood loss of LM was 105.15ml.119.70ml and 213.79ml respectively, while it was 142.90ml,164.44ml and 191.11ml in TAM according to the quantity of myoma in 1,2-4 and more than 4. The operating time was similar between the LM and TAM regardless the location and size of the myoma in single myoma. The blood loss of single intramurao fibroid and myoma diameter less than 10cm in LM was less than that in TAM. The time of off-bed activity, bowl function recover, hospital stay postoperative in LMs was better than that of TAM. Conclusion:LM has advantage in blood loss and postoperative recovery. Objective:To analyze the application value of total laparoscopic hysterectomy in clinic. Methods:We analyzed surgeical outcome of 218 TLH and matched 654 TAH performed from Jan 2008 to Dec 2011 in the center hospital of Wuhan. Results:The clinicl charecterisitc of the patients were similar in the two groups. The operating time and blood loss was 75.78min and 123.21ml in TLH, which was 96.62min and 214.57ml (P<0.05). The time of off-bed activity, bowl function recover, hospital stay postoperative in TLH was better than that in TAH. Conclusion:TLH was a feasible procedure with an advantage of less blood loss, less operating time and postoperative recovery. Objective:To analyze the application value of laparoscopic radical hysterectomy in patients with endometrial cancer. Methods:We retrospectively analyzed surgeical outcome and prognositic results between 35 endometrial cancer patients performed LRH and pelvic lymphadenectomy and matched 35 ARH from Jan 2008 to Dec 2011 in the center hospital of Wuhan. Results:The age, clinical stage and pathological type were similar between the two groups. The operating time and blood loss was 227.35min and 260.55ml in LRH, which was 230.65min and 488.51ml in ARH (P<0.05 in blood loss). The time of off-bed activity, bowl function recover, hospital stay postoperative in LRH was better than that in ARH (P<0.05). Postoperative complication was occurred in 2 patients in LRH,1 with urinary retention and 1 with lymphocyst, while there ware 2 patients with urinary retention,2 with lymphocyst and 4 with incision fat liquefaction in ARH. There was no differecnce in the disease-free survival and over survival after follow up for 3-49 months (average:29 months). Conclusion:LRH had an advantage of less time in postoperative recovery and less postoperative complication. Objective:To analyze the application value of laparoscopic radical hysterectomy in patients with cervical cancer. Methods:We retrospectively analyzed surgeical outcome and prognostic results between 55 cervical cancer patients performed LRH and pelvic lymphadenectomy and matched 55 ARH from Jan 2008 to Dec 2011 in the center hospital of Wuhan. Results:The age, clinical stage and pathological type were similar between the two groups. The operating time and blood loss was 260.41min and 266.76ml in LRH, which was 268.11min and 479.73ml (P<0.05 in blood loss). The time of off-bed activity, bowl function recover, hospital stay postoperative in LRH was better than that in ARH (P<0.05). Postoperative complication was occurred in 4 patients in LRH,2 with urinary retention and 2 with lymphocyst, while there ware 4 patients with urinary retention,5 with lymphocyst and 3 with incision fat liquefaction in ARH. There was no differecnce in the disease-free survival and over survival after follow up for 3-49 months (average:29 months). Conclusion:LRH had an advantage of less blood loss, less time in postoperative recovery and less postoperative complication.更多还原