子宫纤维瘤的微创治疗.ppt

P.M. Yuen 阮邦武 Director of Minimally Invasive Gynaecology, Hong Kong Sanatorium & Hospital Honorary Clinical Associate Professor, CUHK Honorary Professor, Capital University of Medical Sciences, Beijing Past President, Asia Pacific Association for Gynecologic Endoscopy & Minimally Invasive Therapy (APAGE) 子宫纤维瘤的微创治疗 纤维瘤的外科治疗 Surgical Treatment for Fibroids Surgery is the principal treatment for fibroids The main indications are: Symptomatic fibroids Enlarging fibroids, especially after menopause Subfertility and recurrent miscarriage Failed alternative treatment Large asymptomatic fibroids 外科是纤维瘤的原则治疗 主要的适应症是 症状性纤维瘤 增大性纤维瘤，特别是闭经后 低生育力和复发性流产 失败的交替治疗 大的无症状性的纤维瘤 MIS是……标准 纤维瘤的外科管理已经从剖腹术转变到了微创外科 大多数的纤维瘤能借助于内窥镜管理，腹腔镜或宫腔镜 外科的专业特长，特别是腹腔镜的缝合是很关键的 MIS is the standard… Surgical management of fibroids has changed from laparotomy to minimally invasive surgery Most fibroids can be managed endoscopically either by laparoscopy or hysteroscopy Surgeon’s expertise, especially laparoscopic suturing, is crucial 执行子宫切除术和肌瘤切除术的决定依赖于 妇女的年龄 对保留生育潜力的渴望 对保留子宫的渴望 纤维瘤的位置、数量和大小 妇女的优先权应该被尊重 子宫切除术或肌瘤切除术 Hysterectomy or Myomectomy The decision to perform hysterectomy or myomectomy depends on: The age of the woman The desire to retain reproductive potential The desire to retain the uterus The position, number and size of the fibroids The woman’s preference should be respected 子宫切除术 排除纤维瘤的症状和复发问题风险性的确定治疗 消除月经和将来的生育能力 提高生活质量 高满意度（>95%) 短期和长期，甚至在经历并发症的人群中 并发率10-15%，主要并发症4.5-5.6% 在性功能，肠功能或泌尿功能中没有副作用 A definite treatment which eliminates both symptoms and risk of recurrent problems from fibroid Remove menstruation and future fertility Improve quality of life High satisfaction rate (>95%), both short term and long term, even in those with experiencing complications Complication rate 10-15%, major complication 4.5-5.6% No adverse effects on sexual, bowel or urinary functions Hysterectomy Pinion et a