导
读
随着医疗技术的不断发展，妇科手术治疗模式经历了从开腹到微创，从微创到无痕的演变，那么您知道哪些妇科疾病可以采取微创无痕的术式吗？您知道阴式手术是如何入路，端掉病灶却为何不留痕迹吗？何种妇科术式能够实现微创无痕？
辽宁公共频道
《大咖驾到》6月10日18:15
《北方名医》6月11日19:18
-快听大咖怎么说！-
特别鸣谢
本期权威嘉宾：赵曼曼
赵曼曼
医院
妇产科主任主任医师
硕士研究生导师
擅长妇科阴式手术、宫腔镜，腹腔镜手术、盆底功能障碍性疾病重建、尿失禁及私密整型手术，对妇科内分泌疾病的诊断及治疗，产科复杂手术及危重症的抢救有丰富的经验。
特别鸣谢
本期权威嘉宾：李全红
李全红
医院
妇二科主任主任医师
擅长妇科肿瘤，妇科常见及疑难病症的诊治，能够熟练进行腹腔镜、宫腔镜，阴式切除子宫等病症的微创手术，对妇科不孕症，输卵管整形及妇科内分泌疾病的诊治经验丰富。
前沿解读
——妇科各种术式PK
病例分享
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妇产科主任
妇科手术的最新进展
开腹手术
优点：开腹手术作为一种传统的手术方法，具有适应性广、术野清晰、操作空间大等优点。
缺点:对盆腹腔其它脏器干扰较大，盆腹腔脏器暴露易造成术后并发症，且腹部切口大术后影响美观。
腹腔镜
优点：微创手术的典型代表，在临床中广泛应用，具有创伤小、并发症少及恢复快等优势。
缺点：存在体表有切口、可能出现穿刺口疝等相关并发症；某些恶性肿瘤有一定限制，要求全麻，高龄或心肺功能异常的不适合。
阴式手术
优点：利用阴道这一女性独有的自然腔道，腹壁无切口、体表无瘢痕恢复快，住院时间短，对盆腹腔脏器影响小，疼痛轻等优点，适合高龄且有严重心肺功能异常和肥胖患者，较传统腹腔镜术后无穿刺口疝等相关并发症，无需全麻。
缺点：术野狭窄，操作空间小，培养周期长，无法完成严重粘连手术、无法实现盆腔淋巴结取样及清扫。
李全红
妇二科主任
单孔腹腔镜
（1)经脐单孔腹腔镜
优点：因肚脐是腹壁最薄区域，神经、血管、肌肉很少，术后并发症较传统腹腔镜少，并且减少穿透腹壁切口，减少套管针插入相关并发症，术后美容满意度更高。
缺点：与传统腹腔镜手术相似
（2）经阴道单孔腹腔镜（vNOTES）
优点：较腹腔镜手术而言，具有体表无切口、腹部无疤痕等优势，较传统阴式手术而言，vNOTES可对盆腹腔充分探查、处理粘连。
缺点：一般适用于良性疾病，要求术者有一定的阴式手术经验，存在技术高要求、空间定位障碍及缺乏专用器械等困难。
宫腔镜
优点：在宫腔镜下对患者的宫腔内病灶进行手术，更清晰直观，能够看到病变的部位，观察宫颈管、宫腔输卵管开口的情况，可以保留子宫的完整性，也不会影响到卵巢的功能，对女性的创伤比较小，术后恢复比较快，患者住院的时间短，花费少。
缺点：并发症比较少见，但后果严重，如子宫穿孔、空气栓塞、水中毒及水电解质紊乱等。
本期热点
——哪些妇科疾病可以做阴式手术
科普
哪些妇科疾病做可以做阴式手术？
遵循的原则？
近年来，随着阴式手术操作技术的提高和手术方法的改进，妇科阴式手术适应症也在不断扩展，大多数妇科手术均可经阴道进行。比如：子宫良性肿瘤、子宫脱垂、卵巢良性肿瘤、甚至早期子宫内膜癌，宫颈癌等均可经阴道手术。尤其是一些肥胖、疤痕体质及心肺功能异常的患者更适合这种术式。遵循原则是保证患者安全的前提下，符合手术适应症，在无禁忌证的情况下行阴式手术。
医患互联
——疑问医答
01
网友提问：
刘女士：60岁,一打喷嚏咳嗽就漏点尿，但不是特别严重，这种情况是暂时观察，还是尽早做手术，如果现在做手术，会不会随着年龄的增大而做第二次手术？
赵曼曼妇产科主任
大咖解答
咳嗽漏尿如果症状不严重，可以采取生物反馈的治疗方式，就能够得到缓解，如果症状持续并且加重，再建议手术治疗。手术10分钟左右，1厘米小口，不需要第二次手术。
02
网友提问：
何女士：29岁,有多个子宫肌瘤，最大的在浆膜下4厘米左右，结婚了但是还没生育，请问这么大的肌瘤是否可以采取阴式的手术，能不能切干净，多久可以怀孕？
李全红妇二科主任
大咖解答
子宫肌瘤4厘米建议治疗，因为大的子宫肌瘤孕期有增加流产的风险，如何选择术式，需要根据实际情况综合进行评估才能决定。
浆膜下的子宫肌瘤切除以后，半年就可以妊娠，但是如果肌瘤位置在壁间或者是粘膜层，恢复的时间相对较长，手术一年后才能够妊娠。
03
网友提问：
方女士：27岁,因为异常出血检查发现是子宫内膜息肉，这种情况是否可以进行阴式手术？手术后应该注意什么？如何避免子宫粘连？
赵曼曼妇产科主任
大咖解答
子宫内膜息肉，经过评估以后，可以通过宫腔镜来解决，临床手术很常见，谨慎操作，一般不用担心宫腔粘连的问题。
04
网友提问：
王女士：31岁,体检发现双侧卵巢囊肿，都不是特别大，因为还没有生育，所以想问是否能够做阴式手术？能否双侧一起做？
李全红妇二科主任
大咖解答
不是所有的卵巢囊肿都需要做手术，有些卵巢囊肿属于生理性的，所以要具体情况具体分析。如果确实需要手术，也符合阴式手术的条件，就可以择期进行手术。
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