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ABSTRACT Introduction: Currently, problems such as constipation due to outlet obstruction, rectal/vaginal prolapse and fecal and urinary incontinence have become increasingly more frequent because of the population aging process, with great impact on the quality of life. Objective: To describe a technique for surgical repair of middle/posterior pelvic floor compartments and extra-mucosal rectal wall treatment by transperineal and vaginal approach, using native tissues and present the results in twenty patients submitted to this surgical technique. Method: Patients with symptoms secondary to middle/posterior pelvic floor descent and anatomical changes confirmed by proctological exam and pelvic MRI defecography. Results were evaluated through the Agachan constipation score, using pre- and post-operative questionnaires. Results: Immediate repair of rectocele and musculature, with prompt improvement of constipation, sustained by 42 months. There were no severe complications in the postoperative period. Conclusion: This is an effective technique, with adequate anatomic repair, improvement of constipation scores and with low risk.
RESUMO Introdução: Problemas como constipação intestinal por obstrução de saída, prolapsos retal/vaginal e incontinências fecal e urinária são cada vez mais frequentes pelo envelhecimento populacional, com grande impacto na qualidade de vida. Objetivo: Descrever técnica para correção do compartimento médio/posterior do assoalho pélvico e tratamento extramucoso da parede retal, por vias perineal e vaginal, utilizando tecidos nativos. Apresentar os resultados da cirurgia em 20 pacientes submetidas à técnica. Método: Pacientes com sintomas secundários ao descenso de assoalho pélvico médio/posterior, submetidas à propedêutica - exame proctológico e defecografia por RNM de pelve que confirmaram as alterações anatômicas. A avaliação dos resultados foi feita com questionários no pré e pós-operatório, com a utilização do escore de Agachan para constipação intestinal. Resultado: Correção imediata da retocele e da musculatura, com melhora imediata da constipação intestinal, sustentada ao longo de 42 meses. Sem complicações graves no pós-operatório. Conclusão: Técnica eficaz, com correção anatômica adequada, associada a melhora significativa dos escores de constipação e de baixo risco.
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Humans , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Pelvic Floor/abnormalities , Pelvic Organ Prolapse/surgery , Pelvic Floor Disorders/surgeryABSTRACT
Objective To study the clinical curative effect of transvaginal and laparoscopic operation methods for treating exogenous uterine cesarean scar pregnancy.Methods Sixty patients with exogenous uterine CSP in our hospital from August 2013 to August 2016 were selected and divided into the two groups with 30 cases in each group.The control group adopted laparoscopic lesion resection,while the observation group adopted transvaginal lesion excision of lower uterine segment.Then the operation situation,postoperative VAS score,β-HCG levels and traumatic response indexes were compared between the two groups.Results The hospitalization time had no statistical difference between the two groups(P＞0.05).The hospitalization cost,blood loss volume and anal exhaustion time in the observation group were less than those in the control group(P＜0.05).The β-HCG level before and after operation had no statistical difference between the two groups (P＞0.05).The VAS score and traumatic response indexes in the observation group were better than those in the control group(P＜0.05).The complication occurrence rate in the observation group was lower than that in the control group(P＜0.05).Conclusion Transvaginal lesion excision of lower uterine segment in the treatment of exogenous uterine CSP has better curative effect and safety.
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[Objective] To explore the clinical effects of three methods in the treatment of cesarean scar pregnancy.[Method]All the patients with cesarean scar pregnancy accepted treatment at 2 affiliated hospitals of Sun Yat-Sen University from May 2006 to September 2016 were retrospectively analyzed.According to their different therapies,186 of them were divided into three groups:surgery group (undergone transvaginal removal of ectopic pregnancy tissue and repair of uterine defect,73 cases),medical treatment group (treated with medical and combined with curettage,51 cases),UAE group (treated with UAE and combined with suction curettage,62 cases).The success rate,hospitalization time,hospitalization expenses and treatment side effects of the three groups were compared.[Result] The success rates of the three groups were 98.6％,54.9％,and 80.6％;The hospitalization days of the three groups were (7.3 ± 3.3) days,(16.2 ± 11.2) days,(12.6 ± 10.4) d.The hospitalization expenses of the three groups were (7 967 ±1 987) yuan,(5 499-± 1 965) yuan,(15 863 ± 5 941) yuan.The treatment side effects of the three groups were 15.1％,23.5％,and 37.1％.The success rate,hospitalization days,hospitalization expenses and treatment side effects of the three groups were statistically different (P ＜ 0.05).The surgery group has a highest success rate,shortest hospitalization time,lower hospitalization expenses,and less complication.[Conclusions] Transvaginal removal of ectopic pregnancy tissue and repair of uterine defect is a reliable treatment for CSP.
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Objective To evaluate the clinical effect and safety of transvaginal lesion resection for cesarean scar pregnancy (CSP).Methods A total of 30 patients with CSP in our hospital received the transvaginal CSP lesion resection from January 2013 to January 2016 and were followed-up to observe the clinical efficacy and safety.Results The operations were successfully completed except one case of conversion to open surgery.The operation time was 30-120 min (53.4±26.0 min), the intraoperative hemorrhage was less than 50 ml, the hospital time was 3-7 d (4.3±1.3 d), and the postoperative time of serum β-hCG decreased to normal value was 14-36 d (24.1±13.2 d).No continuous pregnancy or complications such as incision non-healing, infection, or bladder injury after operation.Conclusion The clinical effect of vaginal CSP lesion resection is good and has fewer complications, being worthy of application.
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[Summary] The paper reported 9 cases of external type cesarean scar pregnancy treated with transvaginal local lesion resection between January 2013 and March 2014 in this hospital .The surgical exposure was established by using vaginal tractors .The cervical front lip was pulled below outwards by using cervical clamp to expose the front vaginal fornix .Hemostatic water was injected into the cervix vaginal clearance (epinephrine 0.5 mg +NS 500 ml).The vaginal mucosa was opened at bladder cervix groove level for entering the bladder cervix clearance .The bladder was seperated upwards and to the side with fingers to expose uterine isthmus lesions . After cutting the thin muscle , the embryos and part of necrotic tissues were extracted for pathological examination .The incision scar around tissues were trimed and a drainage tube was placed in the uterine .A myometrium full-thickness continuous suture was performed with 1-0 absorbable sutures ( paying attention to avoid endometrial tissues ) , and the vaginal wall was continuously sutured with 1-0 absorbable thread .The drainage tube was removed 5 days after operation .The operations were successfully accomplished in all the 9 cases.The average operation time was 65 min (40-90 min), and the average blood lose was 60 ml (40-80 ml).Cervical tube adhesion occurred in 1 case, and no complications were observed in the remaining cases .The average hospitalization time was 7.5 days (5-10 days).The postoperative time of menstruous restoration was 28-40 days.We deem that transvaginal resection of cesarean scar pregnancy lesion is simple and deserves clinical popularization .
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Objective To observe the clinical curative effects of transvaginal surgery in treatment of uter -ine prolapse .Methods The clinical data of 301 cases of uterine prolapse in our hospital treated with transvagi-nal surgery were retrospectively analyzed .Results The surgeries of 301 cases were successful .Among the 114 cases with the first degree uterine prolapse,63 cases were cured(55.26%),25 cases were improved(21.93%), 23 cases were relapsed ( 20.18%) , and 3 cases were ineffectively ( 2.63%) .The clinical effective rate was 77.19%.Among the 178 cases with the second degree uterine prolapse ,101 cases were cured(56.74%),67 ca-ses improved(37.64%),and 10 cases were relapsed(5.62%).The clinical effective rate was 94.28%.Among the 9 cases with the third degree uterine prolapse , 1 case was cured ( 11.11%) , 5 cases were improved (55.56%),1 case was relapsed(11.11%),and 2 cases were ineffectively(22.22%).The clinical effective rate was 66.67%.Conclusion Transvaginal surgery is regarded as an good method for the first and second degree u -terine prolase because of its curative effects ,less pain ,low incidence of complications and quick recovery .Howev-er, it is ineffective and has a higher rate of recurrence for some cases of third degree uterine prolapse .
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Objective To explore the measure of the peri-operative care in patients undergoing nephroureterectomy with transvaginal NOTES-assisted hybrid endoscopy.Methods Nursing measures and the effect of 3 patients who underwent transvaginal NOTES-assisted hybrid endoscopy in nephroureterectomy were retrospectively analyzed.Results All procedures were successfully completed.There were no intraoperative or postoperative complications.All patients were cured and discharged.Conclusions For the patients receiving transvnginal NOTES-assisted hybrid endoscopy in nephroureterectomy,good psychological care,adequate preoperative preparation,postoperative care,and health education can reduce postoperative complications and play an important role in the success of the operation.
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Objective To describe the initial clinical experience of transvaginal NOTES-assisted laparoscopic nephrectomy. Methods From May to June 2010, 4 female patients with non-functioning kidney and 1 female patient with renal tuberculosis underwent transvaginal NOTES-assisted laparoscopic nephrectomy. The median age was 41 years (range 36 to 63). Three lesions were on the right side, and 2 on the left. After induction of general anesthesia, the patients were positioned in lithotomy with ipsilateral lumbar at 60° angle to the operating table. A 5 mm Trocar and a 10 mm Trocar were placed through the umbilicus, and a 10 mm Trocar for 30° laparoscope was placed through the posterior vaginal fornix under direct vision. The kidneys were put into a home-made bag and removed via the incision of posterior vaginal fornix after there were completely resected. Results The 5 procedures were successfully finished. The median operative time was 190 (range 150 to 260)min. The median estimated blood loss was 185 (range 150 to 210) ml. There were no intra-operative or postoperative complications. The patients resumed ambulation 1 day after surgery, and resumed nutrition 2 days after surgery. The drainages were removed on postoperactive day 3. The patients were discharged on postoperative day 7. The incision in vagina healed well. Conclusions Transvaginal NOTES-assisted laparoscopic nephrectomy is feasible and reproducible. This novel technique may provide additional benefits related to postoperative pain, recovery, and cosmetic results even when compared to today's minimally invasive procedures.