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子宫肌瘤的开腹剔除治疗-子宫肌瘤的原因_子宫肌瘤的治疗方法_子宫肌瘤的症状_超声消融_99子宫网
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子宫肌瘤的开腹剔除治疗

作者:管理员        来源:99子宫网        发布日期:2010-11-15        访问量:5175
导读:子宫肌瘤是女性生殖器官最常见的良性肿瘤,发生率为20% 一40% ,随年龄增加呈上升趋势,其中50% 发生于30~50岁妇女 ,在不孕女性中子宫肌瘤则更为常见。

       子宫肌瘤是女性生殖器官最常见的良性肿瘤,发生率为20% 一40% ,随年龄增加呈上升趋势,其中50% 发生于30~50岁妇女 ,在不孕女性中子宫肌瘤则更为常见。过去常用子宫切除术、开腹子宫肌瘤剔除术。近年来,随着腹腔镜手术技术的成熟发展,及无创的超声消融技术的出现与完善,使子宫肌瘤的手术治疗更加趋于微创、无创。超声消融技术因其无创、不开刀、恢复快、不许住院、综合费用合理等优点,其可行性及安全性得到越来越广泛的关注。

       当然,每种治疗方法仍然尤其最佳适应症。对于不适合用超声消融治疗的患者,在采用腹腔镜治疗无效或者复发后,症状严重(如子宫肌瘤引起经量增多、腹痛、尿频、排便困难等),且未到绝经年龄的,可以考虑采用开腹剔除子宫肌瘤手术。

       开腹子宫肌瘤剔除术适应证广泛,它不受子宫肌瘤位置、大小和数目的限制,故特殊部位,如接近粘膜的子宫肌瘤、或多发性子宫肌瘤(>4个)、子宫体积>妊娠12周的子宫肌瘤、多发性子宫肌瘤剔除术后复发的子宫肌瘤,在腹腔镜和开腹之间,首选开腹手术。

       术前应经宫颈薄层液基细胞学(TCT)或阴道镜检查和诊刮术排除子宫颈子宫内膜恶性病变。术前常规B超检查了解子宫肌瘤生长部位、大小、数目。采用硬膜外麻醉,仰卧位,按传统的开腹子宫肌瘤切除术方法操作 。

       出血与感染是开腹子宫肌瘤剔除术不可忽视的问题。剔除子宫肌瘤后,如果医生操作不当,容易形成血肿。血肿形成后积血感染形成脓肿而使手术失败。因此,手术剔除子宫肌瘤后应仔细止血。

      子宫肌瘤开腹剔除治疗后45天同房为宜。至少应避孕2年后方考虑再次怀孕。因为子宫肌瘤剔除术后在子宫上遗留了疤痕,即疤痕子宫,因此要求患者术后避孕2年,以免再次妊娠时子宫破裂。

      开腹剔除子宫肌瘤后,复发率一般为20%。

      子宫肌瘤患者不孕的发生率近年来临床统计高达50%,自然流产9%,手术剔除子宫肌瘤后的妊娠率一般报道为4O%。当合并有附件疾病(如卵巢、输卵管疾病)时作肌瘤剔除术后妊娠机会也明显减少。

       为了降低传统治疗对女性身体的伤害,子宫肌瘤患者治疗时应优先考虑伤害小的无创超声消融治疗。如果超声消融医生判断不适合超声消融再考虑腹腔镜剔除子宫肌瘤,其次才是开腹子宫肌瘤剔除。子宫切除做为子宫肌瘤患者最后的选择,不作为99子宫网推荐方式。
 

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