腹腔镜下子宫动脉阻断术加病灶旋切术治疗子宫腺肌病医学临床研究2007午筮鲞箜塑!!!!:!!!!?1923??论着?腹腔镜下子宫动脉阻断术加病灶旋切术治疗子宫腺肌病付敏彭凤云李桂林徐丛剑(1.徐州市妇幼保健院,江苏徐州221009;2.复旦大学附属妇产科医院,上海200011)[摘ig]I目的】探讨腹腔镜下子宫动脉阻断术加病灶旋切术治疗子宫腺肌病的临床疗效.【方法】对30例局限型子宫腺肌病患者行腹腔镜下子宫动脉阻断术加病灶旋切术治疗,残留病灶采用单极法电消融术.异位症,盆腔粘连者行粘连分离及盆腔子宫内膜异位灶电灼术.术后观察月经量,痛经程度,子宫体积等变化.【结果】术后月经量减至术前的(49±19),23例(76.7)痛经完全消失,9例(16.6)痛经明显缓解,2例(6.7)痛经部分缓解.术后疼痛评分,分级均明显降低(P<O.01);子宫体积明显缩小.【结论】腹腔镜下子宫动脉阻断术加病灶旋切术治疗子宫腺肌病是一种安全,有效治疗子宫腺肌病的新方法,近期疗效显着,患者易于接受.[关键词]子宫疾病/外科学;外科手术,腹腔镜LaparoscopicUterineArteryblockageandExcisionofLesionfortheTreatmentofAdenomyosisFUMin,PENGFeng—yun,LIGui—Z,etal(XuzhouMaterality&ChildHospital,Xuzhou,221009,Jiangsu)[Abstract]【0bjective】Toassesstheclinicalefficacyoflaparoscopicuterinearteryblockageandexcisionoflesionforthetreatmentofadenomyosis.[Methods]Laparoscopicuterinearteryblockageandexcisionoflesionwereperformedin30patientswithadenomyosis,monopoleelectromyolysiswasperformedinremnantsofle—chocolatecystofovary.Lysisofadhesionandvaporizationofendometriosiswereperformedinsomepatients.Symptomsanduterinevolumesofallpatientswereinvestigatedaftertreatment.【Results]Relievedclinicalsymptomswerefoundinall30patients.Menstrualbloodvolumewasreducedto(49±19).Completedisap—pearanceofdysmenorrheawasfoundin23patients(76.7),significantlyalleviatedin9patients(16.6),partiallyalleviatedin2patients(6.7).Painscoreandclassificationweredecreasedsignificantly(P<O.01).Theuterinevolumedecreasedsignificantly.[Conclusion]Laparoscopicuterinearteryblockageandexcisionoflesionareaneffectiveandsafemethodforthetreatmentofadenomyosis.[Keywords~uterinediseases/SU;surgicalprocedures,laparoscopic[中图分类号]R711.74[文献标识码]A[文章编号]1671—7171(2007)ll一1923-03用本术式.本组成功的12例患者中女性多于男性,组病例少,且仅针对中低位早中期直肠癌,随访时间较短,长期疗效,手术经验和对高位直肠癌乃至乙状结肠癌的是否适用,外翻过程中对肿块的挤压是否增加癌细胞肛周转移机会等有待进一步观察总结.[参考文献]currenceandsurvivalafterlaparoscopicandconventionalresec—tionsforcolorectalcarcinomas[-J].AnnSurg,2000,232(2):181—186.的临床研究[J].外科理论与实践,2003,8(5):361—364.直肠癌[J].中华外科杂志,2002,40(12):899—901.治疗体会[J].中国现代手术学杂志,2004,8(6);354—355.E63葛芙蓉,曹俊.腹腔镜直肠Dixon术26例分析[J].中国内镜杂志,2004,1O(6):36-37.(本文编辑:詹道友)[收稿日期]2007—07—09匿堂究o01生月第24卷第l1期JClinRes,Nov.2007,aVo124,11o11子宫腺肌病是妇产科良性疾病中的常见病,传统育龄期妇女,患者对传统的子宫切除术治疗难以接加病灶旋切术治疗子宫腺肌病,取得了满意效果.1资料与方法对3O例在本院就诊,根据临床症状,彩色超声检查诊断为子宫腺肌病,药物治疗无效的患者,行腹腔镜(26～45)岁,痛经时间(9±6)年,痛经程度根据慢性疼痛分级问卷法评级_】]:3～4级22例,2级6例,1±子宫肌瘤,13例(43.3)合并有卵巢巧克力囊肿,贫血24例(80),术前子宫体积(280±128)CITI..1.2手术方法全部采用连续硬膜外麻醉,麻醉上方穿刺注入CO气体建立气腹至腹内压达2kPa(12mmHg),用10mm套管针穿刺置人腹腔镜镜头,在双下腹相当于麦氏点分别作5ITIITI,10ITIITI切口置人第2,3套管针.经阴道放置举宫器,将举宫器前举并偏向一侧,于宫旁宫骶韧带上2CITI处打开阔韧带...