Gynaecological Endoscopy最新文献

英文中文

Pelvic infection: ovarian drilling is to blame? 盆腔感染:卵巢钻孔是罪魁祸首?

Gynaecological Endoscopy

Pub Date : 2008-10-09 DOI: 10.1046/j.1365-2508.1998.00163.x

Tamás Major MD, György Bacskó MD, Anatal Borsos MD

引用次数: 0

Forthcoming Events 即将到来的事件

Gynaecological Endoscopy

Pub Date : 2008-10-09 DOI: 10.1046/j.1365-2508.1999.008001061.x

引用次数: 0

One hundred laparoscopic myomectomies with ultrasonic energy: surgical evaluation of a new energy source 超声能量腹腔镜子宫肌瘤切除术一百例:新能源的手术评价

Gynaecological Endoscopy

Pub Date : 2008-10-09 DOI: 10.1046/j.1365-2508.1998.00161.x

Nelson H. Stringer

Objective

To evaluate the surgical efficiency of ultrasonic energy for laparoscopic myomectomies through review of the dissection and haemostatic capabilities of the energy source; the pregnancy results after surgery; formation of uterine fistulas and postoperative adhesions, and energy-related difficulties and complications.

Design

Retrospective chart review.

Setting

One surgeon, and the Department of Obstetrics and Gynecology, Rush Medical College, Chicago, Illinois.

Patients

100 women with symptomatic uterine leiomyomata.

Interventions

100 consecutive laparoscopic myomectomies were performed between April 1993 and May 1997. Ultrasonic cutting and coagulation (Ultrasonic Scalpel) was used on all cases for dissection of myomas from the myometrium.

Results

The indications for surgery were: menometrorrhagia (44%), chronic pain (29%) and increasing uterine size (27%), and 99 procedures were completed laparoscopically. One procedure was converted to an open laparotomy to remove a broken needle fragment from the Endostitch^TM (1% conversion rate). No energy-related complications occurred. A total of 320 myomas were removed laparoscopically from 99 patients. Dissection and achievment of haemostasis was easy and rapid with all types of myomas. To date, 10 patients have experienced 12 pregnancies. No fistulas or uterine dehiscence have occurred. A total of 26 patients had second-look evaluations, and 65% of these were clinically free of adhesions (grade 0 or grade 1).

Conclusions

When compared with published results of laparoscopic myomectomies performed with lasers and electrosurgical instruments, ultrasonic energy demonstrated equal dissection and haemostatic capabilities without the risks of toxic smoke, burns and thermal injuries. Ultrasonic energy is an effective energy source for laparoscopic myomectomies.

目的评价超声能量在腹腔镜子宫肌瘤切除术中的应用效果，探讨超声能量在子宫肌瘤切除术中的应用价值。手术后妊娠结果;子宫瘘的形成和术后粘连，以及能量相关的困难和并发症。设计回顾图表审查。一名外科医生和妇产科，拉什医学院，芝加哥，伊利诺斯州。患者100例有症状性子宫平滑肌瘤。干预措施:1993年4月至1997年5月间，连续进行了100例腹腔镜子宫肌瘤切除术。所有病例均采用超声切割和凝固(超声手术刀)从肌层剥离肌瘤。结果手术指征为:月经过多(44%)、慢性疼痛(29%)、子宫增大(27%)，腹腔镜下完成99例手术。其中一项手术转为开腹手术，从EndostitchTM上取出破损的针片(转换率为1%)。无能量相关并发症发生。99例患者共320例肌瘤经腹腔镜切除。所有类型的肌瘤均能快速、简便地分离和止血。迄今为止，已有10名患者经历了12次怀孕。未发生瘘管或子宫开裂。共有26名患者进行了二次评估，其中65%的患者临床无粘连(0级或1级)。结论与已发表的激光和电手术器械腹腔镜子宫肌瘤切除术的结果相比，超声能量显示出相同的解剖和止血能力，没有有毒烟雾、烧伤和热损伤的风险。超声能量是腹腔镜子宫肌瘤切除术的有效能量来源。

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引用次数: 12

Broken needle tip in Cooper's ligament: high occurrence rate with the EndostitchTM suturing device 库珀韧带针尖断裂:使用EndostitchTM缝合装置发生率高

Gynaecological Endoscopy

Pub Date : 2008-10-09 DOI: 10.1046/j.1365-2508.1998.00168.x

Brölmann, Ter Haar, Scholten

Objective

To study the frequency of needle breakage with the Endostitch^TM needleholder while performing Burch laparoscopic colposuspension, and its consequences for patient and doctor.

Design

A retrospective observational multicentred study, after selection of the centres by questionnaire.

Setting

Three general hospitals in the Netherlands with resident training facilities and special interest in endoscopic surgery.

Subjects

35 consecutive patients with genuine stress incontinence.

Intervention

Laparoscopic Burch colposuspension using the Endostitch needleholder.

Main outcome measure

Needle complications and postoperative recovery.

Results

In five patients (14%) six needles broke off in the Cooper's ligament. Four needle tips in three patients could not be located despite dissecting the ligament and intensive search, and were ultimately left in the patients. The recovery of all patients with and without needle complications was uneventful.

Conclusions

The Endostitch is designed for intracorporeal suturing and knot tying, but because of its shape it is not suited for suturing Cooper's ligament. Mesh stapling techniques save operating time, but result in foreign (mostly non-absorbable) material being left in the patient and the stability of the suspension in the longer term is not yet established. At the present time, conventional suturing and knot tying seem to be preferable in laparoscopic suspension procedures, as they lead to more similarity between the laparoscopic method and the ‘open’ approach whose efficacy is well accepted.

目的探讨内镜下腹腔镜阴道悬吊术中EndostitchTM持针器断针的频率及其对患者和医生的影响。设计通过问卷调查选择研究中心，进行回顾性观察性多中心研究。在荷兰设立三家综合医院，提供住院医师培训设施，并对内窥镜手术特别感兴趣。研究对象连续35例真正的压力性尿失禁患者。介入腹腔镜Burch阴道悬吊使用Endostitch针架。主要观察指标:针头并发症及术后恢复情况。结果5例(14%)患者有6根针在库珀韧带处断裂。3例患者的4个针尖在解剖韧带和密集搜索后仍无法定位，最终留在患者体内。所有有或无针头并发症的患者均恢复正常。结论Endostitch适用于体内缝合和打结，但由于其形状不适合缝合Cooper韧带。网片吻合器技术节省了手术时间，但会导致异物(大多数是不可吸收的)留在患者体内，并且悬浮液的长期稳定性尚未建立。目前，传统的缝合和打结在腹腔镜悬吊手术中似乎更可取，因为它们使腹腔镜方法与“开放”方法更相似，其疗效已被广泛接受。

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引用次数: 2

Laparoscopic myomectomy during pregnancy 妊娠期腹腔镜子宫肌瘤切除术

Gynaecological Endoscopy

Pub Date : 2008-10-09 DOI: 10.1046/j.1365-2508.1998.00167.x

Dov Luxman, Jacob R. Cohen, Menachem P. David

Objective

To describe a unique case of laparoscopic myomectomy during pregnancy.

Setting

A university-affiliated maternity hospital.

Subject

A 27-year-old primigravida presenting with acute abdominal pain at 15 weeks of gestation. A diagnosis of torsion of a subserous myoma was made following failure of conservative treatment.

Intervention

On laparoscopy, a 7-cm subserous pedunculated myoma was demonstrated. Laparoscopic myomectomy was successfully accomplished.

Results

No intra- or postoperative complications were recorded. The woman delivered vaginally a healthy baby at 39 weeks' gestation.

Conclusions

Laparoscopic myomectomy during pregnancy is feasible. This procedure cannot be generally recommended since data concerning the safety of laparoscopic operation in general and myomectomy in particular, are limited. The patients should be carefully selected, and the operation should be performed by an experienced surgeon to guarantee a favourable outcome.

目的报道一例独特的妊娠期腹腔镜子宫肌瘤切除术。设置大学附属妇产医院。研究对象一名27岁的初产妇，妊娠15周出现急性腹痛。在保守治疗失败后，诊断为浆膜下肌瘤扭转。腹腔镜检查发现一个7厘米的浆膜下带蒂肌瘤。成功完成腹腔镜子宫肌瘤切除术。结果无术中、术后并发症发生。这名妇女在怀孕39周时顺产了一个健康的婴儿。结论妊娠期腹腔镜子宫肌瘤切除术是可行的。由于有关腹腔镜手术的安全性，特别是子宫肌瘤切除术的数据有限，因此不能普遍推荐该手术。患者应仔细选择，手术应由经验丰富的外科医生进行，以保证良好的结果。

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引用次数: 2

A randomized study comparing levonorgestrel intrauterine system (LNG IUS) and transcervical resection of the endometrium (TCRE) in the treatment of menorrhagia: preliminary results 一项比较左炔诺孕酮宫内系统(LNG IUS)和经宫颈子宫内膜切除术(TCRE)治疗月经过多的随机研究:初步结果

Gynaecological Endoscopy

Pub Date : 2008-10-09 DOI: 10.1046/j.1365-2508.1998.00165.x

Nina Kittelsen, Olav Istre

Objective

To identify the effect of the levonorgestrel coil (Mirena; LNG IUS) vs. transcervical resection of the endometrium (TCRE) for treatment of menorrhagia.

Design

A randomized study of 60 patients performed at a gynaecological clinic specializing in operative hysteroscopy.

Results

24 patients in the LNG IUS group and 29 patients in the TCRE group completed 20 months of follow up. In the TCRE group one patient refused to continue after the result of randomization. Reasons for discontinuation in the LNG IUS group included abdominal pain (2), acne (1) and bleeding or continuous spotting (3). The bleeding intensity was assessed using the PBAC score and was reduced in both groups, from 418 to 42 in the LNG IUS group, and from 378 to 6.6 in the TCRE group.

Conclusion

Both methods have a dramatic effect on bleeding intensity and furthermore the LNG IUS is reversible and has no operative hazards or side-effects.

目的探讨左炔诺孕酮卷管(mrena;LNG IUS)与经宫颈子宫内膜切除术(TCRE)治疗月经过多。设计一项随机研究，60例患者在妇科诊所进行手术宫腔镜检查。结果LNG IUS组24例，TCRE组29例，随访20个月。在TCRE组中，1例患者在随机化结果后拒绝继续。LNG IUS组停药的原因包括腹痛(2)、痤疮(1)和出血或持续点滴(3)。使用PBAC评分评估出血强度，两组的出血强度均有所降低，LNG IUS组从418降至42,TCRE组从378降至6.6。结论两种方法均可显著降低出血强度，且LNG IUS具有可逆性，无手术危害和副作用。

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引用次数: 62

Gasless laparoscopic ovarian cystectomy with minilaparotomy during pregnancy 妊娠期小切口无气腹腹腔镜卵巢囊肿切除术

Gynaecological Endoscopy

Pub Date : 2008-10-09 DOI: 10.1046/j.1365-2508.1998.00158.x

Hiromi Inoue, Kaoru Nabuchi, Yuki Ishihara, Yumiko Fukumoto, Masaru Kobayashi

Objective

Recently there have been many reports of laparoscopic surgery during pregnancy, despite serious concerns about the possible consequences of fetal damage caused by the pneumoperitoneum and anaesthetics, or the risk of the trauma to the enlarged uterus. We have attempted gasless laparoscopic surgery with extra-abdominal cystectomy under regional anaesthesia for ovarian cysts in pregnancy to avoid or minimize such risks.

Interventions

We report three cases of laparoscopically assisted abdominal cystectomy during early pregnancy using a gasless method (Laparolift in two cases and surgical wire in one case) and combined spinal-epidural anaesthesia (CSE). Extra-abdominal cystectomy was performed after a minilaparotomy directly above the ovarian cyst.

Results

In all three cases, there were no intraoperative complications and postoperative recoveries were rapid and uneventful for both the mother and the fetus. Intra-abdominal procedures in gasless laparoscopy are more difficult than those with pneumoperitoneum because of the limited visual field. In respect to anaesthesia, all the patients experienced discomfort with the head-down tilt during the operation, although this position was maintained for the shortest possible period of time. However, the procedures were performed smoothly and with relative ease with extra-abdominal cystectomy. All the patients were discharged on the second postoperative day and subsequently completed their normal pregnancies with spontaneous vaginal delivery of healthy full-term babies.

Conclusion

Gasless laparoscopic cystectomy with a minilaparotomy in early pregnancy may be an alternative approach to ovarian cysts in pregnancy, considering the absence of fetal risk from CO₂ pneumoperitoneum and a relatively low risk of trauma to the enlarged uterus. With regard to the choice of anaesthesia in this approach, general anaesthesia may be preferable.

目的近年来有许多关于妊娠期腹腔镜手术的报道，尽管人们严重担心气腹和麻醉可能对胎儿造成损害，或可能对扩大的子宫造成创伤。为了避免或减少妊娠期卵巢囊肿的风险，我们尝试了在区域麻醉下进行无气腹外腹腔镜卵巢囊肿切除术。我们报告了3例在妊娠早期使用无气腹腹腔镜辅助腹部膀胱切除术(2例腹腔镜手术，1例手术钢丝)和脊髓-硬膜外联合麻醉(CSE)。腹外囊肿切除术是在卵巢囊肿正上方的小切口后进行的。结果3例患者均无术中并发症，术后恢复迅速，母婴均顺利。由于视野有限，无气腹腹腔镜下的腹腔内手术比气腹手术更困难。在麻醉方面，所有患者在手术过程中都有头部向下倾斜的不适，尽管这种姿势保持了尽可能短的时间。然而，腹外膀胱切除术的手术过程顺利且相对容易。所有患者均于术后第二天出院，并顺利完成正常妊娠，顺产健康足月婴儿。结论考虑到CO2气腹对胎儿无危险，且对增大子宫的创伤风险相对较低，妊娠早期无气腹腹腔镜卵巢切除术加小切口可能是治疗妊娠期卵巢囊肿的一种替代方法。关于在这种方法中麻醉的选择，全身麻醉可能是可取的。

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引用次数: 7

Reply to Dr Cornier concerning ‘Blind endometrial biopsies: insufficient for diagnosis in women with intrauterine pathology’ 回复Cornier医生关于“子宫内膜盲活检:不足以诊断子宫内病变”的问题

Gynaecological Endoscopy

Pub Date : 2008-10-09 DOI: 10.1046/j.1365-2508.1999.00287.x

Kent mrcp frcs frcog dch , Coats

引用次数: 0

Forthcoming Events 即将到来的事件

Gynaecological Endoscopy

Pub Date : 2008-10-09 DOI: 10.1046/j.1365-2508.2001.010001075.x

引用次数: 0

Peritoneal seeding following hysteroscopic diagnosis of cervical adenocarcinoma (Gynaecological Endoscopy 1999; 8: 179–81) 子宫颈腺癌宫腔镜诊断后腹膜播种(妇科内镜1999;8: 179 - 81)

Gynaecological Endoscopy

Pub Date : 2008-10-09 DOI: 10.1046/j.1365-2508.2000.00352-3.x

J.F. Admiraal md

引用次数: 0

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