Name: fertility sparing procedure using carbon dioxide fiber laser vaporization of ovarian endometrioma
Uploaded: 2022-07-06T13:00:00
Description: Watch this Scientific Journal Video about Fertility Sparing Procedure using Carbon Dioxide Fiber Laser Vaporization of Ovarian Endometrioma at JoVE.com

没有为这项研究寻求或获得外部资金。

所有研究均按照《赫尔辛基宣言》进行，如良好临床实践协调指南国际会议所述。在手术治疗前的患者访谈期间，通常在该机构获得数据收集和匿名发布疾病相关信息的书面知情同意书。参与随机对照研究的妇女签署了一份具体的知情同意书。该机构的机构审查委员会批准了所有研究。研究方案的图表如图 1所示。
1. 患者选择
<ol><li>仅包?...

<ol>
	<li>Bafort, C., Beebeejaun, Y., Tomassetti, C., Bosteels, J., Duffy, J. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Laparoscopic+surgery+for+endometriosis.">Laparoscopic surgery for endometriosis.</a> The Cochrane Database of Systematic Reviews. 10 (10), (2020).</li><li>Somigliana, E., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Surgical+excision+of+endometriomas+and+ovarian+reserve:+a+systematic+review+on+serum+antim&#252;llerian+hormone+level+modifications.">Surgical excision of endometriomas and ovarian reserve: a systematic review on serum antim&#252;llerian hormone level modifications.</a> Fertility and sterility. 98 (6), 1531-1538 (2012).</li><li>Uncu, G., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Prospective+assessment+of+the+impact+of+endometriomas+and+their+removal+on+ovarian+reserve+and+determinants+of+the+rate+of+decline+in+ovarian+reserve.">Prospective assessment of the impact of endometriomas and their removal on ovarian reserve and determinants of the rate of decline in ovarian reserve.</a> Human Reproduction. 28 (8), 2140-2145 (2013).</li><li>Alborzi, S., Keramati, P., Younesi, M., Samsami, A., Dadras, N. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+impact+of+laparoscopic+cystectomy+on+ovarian+reserve+in+patients+with+unilateral+and+bilateral+endometriomas.">The impact of laparoscopic cystectomy on ovarian reserve in patients with unilateral and bilateral endometriomas.</a> Fertility and Sterility. 101 (2), 427-434 (2014).</li><li>Muzii, L., Bianchi, A., Croce, C., Manci, N., Panici, P. B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Laparoscopic+excision+of+ovarian+cysts:+is+the+stripping+technique+a+tissue-sparing+procedure.">Laparoscopic excision of ovarian cysts: is the stripping technique a tissue-sparing procedure.</a> Fertility and Sterility. 77 (3), 609-614 (2002).</li><li>Sanchez, A. M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+distinguishing+cellular+and+molecular+features+of+the+endometriotic+ovarian+cyst:+from+pathophysiology+to+the+potential+endometrioma-mediated+damage+to+the+ovary.">The distinguishing cellular and molecular features of the endometriotic ovarian cyst: from pathophysiology to the potential endometrioma-mediated damage to the ovary.</a> Human Reproduction Update. 20 (2), 217-230 (2014).</li><li>Benaglia, L., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Rate+of+severe+ovarian+damage+following+surgery+for+endometriomas.">Rate of severe ovarian damage following surgery for endometriomas.</a> Human Reproduction. 25 (3), 678-682 (2010).</li><li>Muzii, L., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Histologic+analysis+of+specimens+from+laparoscopic+endometrioma+excision+performed+by+different+surgeons:+does+the+surgeon+matter.">Histologic analysis of specimens from laparoscopic endometrioma excision performed by different surgeons: does the surgeon matter.</a> Fertility and Sterility. 95 (6), 2116-2119 (2011).</li><li>La Torre, R., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Ovarian+blood+flow+before+and+after+conservative+laparoscopic+treatment+for+endometrioma.">Ovarian blood flow before and after conservative laparoscopic treatment for endometrioma.</a> Clinical and Experimental Obstetrics &amp; Gynecology. 25 (1-2), 12-14 (1998).</li><li>Loh, F. H., Tan, A. T., Kumar, J., Ng, S. C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Ovarian+response+after+laparoscopic+ovarian+cystectomy+for+endometriotic+cysts+in+132+monitored+cycles.">Ovarian response after laparoscopic ovarian cystectomy for endometriotic cysts in 132 monitored cycles.</a> Fertility and Sterility. 72 (2), 316-321 (1999).</li><li>Candiani, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Ovarian+recovery+after+laparoscopic+enucleation+of+ovarian+cysts:+insights+from+echographic+short-term+postsurgical+follow-up.">Ovarian recovery after laparoscopic enucleation of ovarian cysts: insights from echographic short-term postsurgical follow-up.</a> Journal of Minimally Invasive Gynecology. 12 (5), 409-414 (2005).</li><li>Donnez, J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Large+ovarian+endometriomas.">Large ovarian endometriomas.</a> Human Reproduction. 11 (3), 641-646 (1996).</li><li>Candiani, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Assessment+of+ovarian+reserve+after+cystectomy+versus+'one-step'+laser+vaporization+in+the+treatment+of+ovarian+endometrioma:+a+small+randomized+clinical+trial.">Assessment of ovarian reserve after cystectomy versus 'one-step' laser vaporization in the treatment of ovarian endometrioma: a small randomized clinical trial.</a> Human Reproduction. 33 (12), 2205-2211 (2018).</li><li>Candiani, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Fertility+outcome+after+CO2+laser+vaporization+versus+cystectomy+in+women+with+ovarian+endometrioma:+a+comparative+study.">Fertility outcome after CO2 laser vaporization versus cystectomy in women with ovarian endometrioma: a comparative study.</a> Journal of Minimally Invasive Gynecology. 28 (1), 34-41 (2021).</li><li>Ottolina, J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Ovarian+responsiveness+in+assisted+reproductive+technology+after+CO2+fiber+laser+vaporization+for+endometrioma+treatment:+preliminary+data.">Ovarian responsiveness in assisted reproductive technology after CO2 fiber laser vaporization for endometrioma treatment: preliminary data.</a> Minerva Endocrinologica. 45 (4), 288-294 (2020).</li><li>Candiani, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Recurrence+rate+after+&amp;#34;one-step&amp;#34;+CO2+fiber+laser+vaporization+versus+cystectomy+for+ovarian+endometrioma:+a+3-year+follow-up+study.">Recurrence rate after &amp;#34;one-step&amp;#34; CO2 fiber laser vaporization versus cystectomy for ovarian endometrioma: a 3-year follow-up study.</a> Journal of Minimally Invasive Gynecology. 27 (4), 901-908 (2020).</li><li>American Society for Reproductive Medicine. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Revised+American+Fertility+Society+classification+of+endometriosis:+1996.">Revised American Fertility Society classification of endometriosis: 1996.</a> Fertility and Sterility. 67 (5), 817-821 (1997).</li><li>Hart, R. J., Hickey, M., Maouris, P., Buckett, W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Excisional+surgery+versus+ablative+surgery+for+ovarian+endometriomata.">Excisional surgery versus ablative surgery for ovarian endometriomata.</a> The Cochrane Database of Systematic Reviews. (2), (2008).</li><li>Daniell, J. F., Kurtz, B. R., Gurley, L. D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Laser+laparoscopicmanagement+of+large+endometriomas.">Laser laparoscopicmanagement of large endometriomas.</a> Fertility and Sterility. 55 (4), 692-695 (1991).</li><li>Sutton, C. J., Ewen, S. P., Jacobs, S. A., Whitelaw, N. L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Laser+laparoscopic+surgery+in+the+treatment+of+ovarian+endometriomas.">Laser laparoscopic surgery in the treatment of ovarian endometriomas.</a> The Journal of the American Association of Gynecologic Laparoscopists. 4 (3), 319-323 (1997).</li><li>Donnez, J., Pirard, C., Smets, M., Jadoul, P., Squifflet, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Surgical+management+of+endometriosis.+Best+practice+&amp;+research.">Surgical management of endometriosis. Best practice &amp; research.</a> Clinical Obstetrics &amp; Gynaecology. 18 (2), 329-348 (2004).</li><li>Sutton, C. J., Jones, K. D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Laser+laparoscopy+for+endometriosis+and+endometriotic+cysts.">Laser laparoscopy for endometriosis and endometriotic cysts.</a> Surgical Endoscopy. 16 (11), 1513-1517 (2002).</li><li>Roman, H., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Ovarian+endometrioma+ablation+using+plasma+energy+versus+cystectomy:+a+step+toward+better+preservation+of+the+ovarian+parenchyma+in+women+wishing+to+conceive.">Ovarian endometrioma ablation using plasma energy versus cystectomy: a step toward better preservation of the ovarian parenchyma in women wishing to conceive.</a> Fertility and Sterility. 96 (6), 1396-1400 (2011).</li><li>Muzii, L., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Histologic+analysis+of+endometriomas:+what+the+surgeon+needs+to+know.">Histologic analysis of endometriomas: what the surgeon needs to know.</a> Fertility and Sterility. 87 (2), 362-366 (2007).</li><li>Roman, H., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Vaporization+of+ovarian+endometrioma+using+plasma+energy:+histologic+findings+of+a+pilot+study.">Vaporization of ovarian endometrioma using plasma energy: histologic findings of a pilot study.</a> Fertility and Sterility. 95 (5), 1853 (2011).</li><li>Donnez, J., Wyns, C., Nisolle, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Does+ovarian+surgery+for+endometriomas+impair+the+ovarian+response+to+gonadotropin.">Does ovarian surgery for endometriomas impair the ovarian response to gonadotropin.</a> Fertility and Sterility. 76 (4), 662-665 (2001).</li><li>Vanni, V. S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Flexible+CO2+laser+fiber:+first+look+at+the+learning+curve+required+in+gynecological+laparoscopy+training.">Flexible CO2 laser fiber: first look at the learning curve required in gynecological laparoscopy training.</a> Minerva Ginecologica. 70 (1), 53-57 (2018).</li><li>Pados, G., Tsolakidis, D., Assimakopoulos, E., Athanatos, D., Tarlatzis, B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Sonographic+changes+after+laparoscopic+cystectomy+compared+with+three-stage+management+in+patients+with+ovarian+endometriomas:+a+prospective+randomized+study.">Sonographic changes after laparoscopic cystectomy compared with three-stage management in patients with ovarian endometriomas: a prospective randomized study.</a> Human Reproduction. 25 (3), 672-677 (2010).</li><li>Tsolakidis, D., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+impact+on+ovarian+reserve+after+laparoscopic+ovarian+cystectomy+versus+three-stage+management+in+patients+with+endometriomas:+a+prospective+randomized+study.">The impact on ovarian reserve after laparoscopic ovarian cystectomy versus three-stage management in patients with endometriomas: a prospective randomized study.</a> Fertility and Sterility. 94 (1), 71-77 (2010).</li><li>Roman, H., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Postoperative+recurrence+and+fertility+after+endometrioma+ablation+using+plasma+energy:+retrospective+assessment+of+a+3-year+experience.">Postoperative recurrence and fertility after endometrioma ablation using plasma energy: retrospective assessment of a 3-year experience.</a> Journal of Minimally Invasive Gynecology. 20 (5), 573-582 (2013).</li><li>Carmona, F., Mart&#237;nez-Zamora, M. A., Rabanal, A., Mart&#237;nez-Rom&#225;n, S., Balasch, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Ovarian+cystectomy+versus+laser+vaporization+in+the+treatment+of+ovarian+endometriomas:+a+randomized+clinical+trial+with+a+five-year+follow-up.">Ovarian cystectomy versus laser vaporization in the treatment of ovarian endometriomas: a randomized clinical trial with a five-year follow-up.</a> Fertility and Sterility. 96 (1), 251-254 (2011).</li></ol>

该方法的目的是全面概述自2015年以来，我们在圣拉斐尔科学研究所使用CO 2光纤激光技术的经验，当时该技术首次开始用于子宫内膜异位症的手术治疗。由于子宫内膜异位症是一种慢性良性妇科疾病，影响具有潜在后代欲望的育龄妇女，因此手术技术需要尽可能节省生育能力。
一项 Cochrane 评价18 比较了消融和剥离技术，报告了膀胱切除术组自发妊娠...

卵巢子宫内膜异位症的最佳手术治疗，特别是当保留生育能力是渴望后代的女性的首要任务时，仍然是一个有争议的问题。虽然膀胱切除术仍然是推荐的技术1，但以前的研究已经引起了一些担忧，即由于无意中切除健康的卵巢实质2，3，4，其可能对卵巢储备和生殖结局产生不利影响。
事实上，与非子宫内膜异位囊肿不同，子宫内膜异位症是一种假性囊肿，没有被真正的解剖胶囊5包围，其中由游离铁和活性氧（ROS）引起的炎症在用纤维组织6取代周围正常卵巢皮质组织中起作用。因此，缺乏明确的计划可能导致切除健康卵巢实质的风险增加，即使膀胱切除术由经验丰富的外科医生进行 7 ， 8 。
此外，膀胱切除术介导的损伤可导致血管形成受损，因为在凝血过程中，热损伤扩散到周围的健康卵巢实质，如先前的发现所示，其中膀胱切除术后报告了卵巢动脉血流的不良变化9，10，11。
在我们机构，对膀胱切除术后卵巢损伤的担忧导致自2015年以来引入CO 2光纤激光技术。这种外科手术可以以受控的组织穿透深度和很少的热扩散来传递能量，其灵感来自20多年前12年雅克·唐内兹（Jacques Donnez）的工作。
虽然涉及CO2 光纤激光技术的消融技术并不代表子宫内膜异位症手术治疗的新颖性，但许多外科医生可能对该手术没有信心。事实上，只有少数研究调查了这种技术对卵巢储备，妊娠结局和子宫内膜异位症复发率的影响。该协议的目的是概述自2015年推出CO 2光纤激光器技术以来使用CO2 光纤激光器技术获得的有希望的结果，并描述该技术的简单性和可重复性。
首先，为了评估CO2 光纤激光汽化和膀胱切除术对卵巢储备标志物的影响，于2017年至2018年间进行了多中心随机试验。通过使用使用简单随机化方法的计算机生成的随机化列表，共有60名患者以1：1的比例随机分配到第1组（膀胱切除术：30名患者）或第2组（CO2 激光蒸发：30名患者）。为了研究术后自发受孕，2015年至2019年间对142名女性进行了前瞻性观察性研究，比较了膀胱切除术和激光汽化14。当CO2 光纤激光汽化后未实现妊娠时，患者被转诊到体外受精（IVF）诊所，然后被纳入前瞻性观察性研究（n = 26），以研究卵巢对受控卵巢刺激的反应15。在此之后，对2015年至2018年期间接受治疗且随访至少12个月的较大样本量研究人群（n = 125，有或没有后代欲望的女性）进行回顾性分析，以评估两种手术技术后囊肿和/或疼痛症状的复发率16。

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>CO2 fiber laser</td>
			<td>UltraPulse Duo system, Lumenis Ltd</td>
			<td>AC-1059590</td>
			<td></td>
		</tr>
		<tr>
			<td>Insufflation Needle</td>
			<td>Covidien</td>
			<td>10065003</td>
			<td></td>
		</tr>
		<tr>
			<td>Laparoscopic Forceps</td>
			<td>Erbe Elektromedizin GmbH</td>
			<td>20195-133</td>
			<td></td>
		</tr>
		<tr>
			<td>Manipulator</td>
			<td>Lumenis Ltd</td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>UltraPulse Duo</td>
			<td>Lumenis Ltd</td>
			<td>GA-2000000</td>
			<td>CO2 laser system</td>
		</tr>
		<tr>
			<td>VIO 3</td>
			<td>Erbe Elektromedizin GmbH</td>
			<td>10160-000</td>
			<td>electrosurgical unit</td>
		</tr>
		<tr>
			<td>Voluson S8</td>
			<td>GE Healthcare</td>
			<td>186958SU5</td>
			<td>ultrasound scan voluson system 8</td>
		</tr>
	</tbody>
</table>

fertility sparing procedure using carbon dioxide fiber laser vaporization of ovarian endometrioma

子宫内膜异位症的手术治疗仍然是一个有争议的问题。膀胱切除术被认为是标准技术，似乎与由于无意中切除和健康卵巢组织的热损伤而导致的卵巢储备的潜在减少有关。新的消融技术具有降低的组织穿透深度和较少的热扩散到周围实质的热扩散，可能是膀胱切除术的可行替代方案。由于这些原因，本手稿的目的是证明使用CO2 光纤激光技术消融子宫内膜异位症胶囊并讨论临床结果。一旦囊肿被引流并清洗，就进行活检。囊肿外翻后，使用CO2 光纤激光器进行囊肿内表面的汽化。该技术简单且可重复，因为即使是没有任何手术经验的年轻外科医生也更有信心进行激光CO2 汽化而不是膀胱切除术。一项随机对照试验报告了 CO2 技术的积极影响，其中比较了切除子宫内膜异位症（膀胱切除术）的患者和接受 CO2 激光内膜异位瘤汽化的患者的术后滤泡计数 （AFC） 和抗苗勒管激素 （AMH） 水平的变化。与膀胱切除组相比，接受CO2 激光治疗的患者显示AFC显着增加，血清AMH水平降低，其中两个参数均显着降低。还评估了术后妊娠率，并在两种治疗后发现了可比的妊娠率。相反，与膀胱切除术相比，使用CO2 光纤激光技术治疗的患者具有更有利的体外受精（IVF）结果。
总之，CO2 光纤激光技术在卵巢保存，妊娠率和IVF结局方面可能是膀胱切除术在子宫内膜异位症手术治疗中的可行替代方案。此外，它具有独立于外科医生的技能和个人经验的优势。

纳入研究结果的详细信息见 表1。
一步激光汽化后的卵巢储备与膀胱切除术治疗卵巢子宫内膜异位瘤的比较13 这项随机对照研究的目的是比较子宫内膜异位症治疗的两种外科手术（膀胱切除术与CO2 激光汽化）对卵巢储备标志物（AFC和血清AMH浓度）的影响以及治疗前和治疗后3个月的卵巢体积。研究结果总结在 表1中。...

Watch this Scientific Journal Video about Fertility Sparing Procedure using Carbon Dioxide Fiber Laser Vaporization of Ovarian Endometrioma at JoVE.com

Fertility Sparing Procedure using Carbon Dioxide Fiber Laser Vaporization of Ovarian Endometrioma

在该协议中，CO2 光纤激光技术被证明用于卵巢子宫内膜异位症的手术治疗，这在保留生育能力方面代表了一种可行的替代方案，其主要优点是不依赖于外科医生的技能和个人经验。

使用二氧化碳光纤激光汽化卵巢子宫内膜异位瘤的生育保留程序

The surgical management of endometrioma is still a matter of debate. Cystectomy, which is recognized as the standard technique, seems to be associated ...

根据获得的结果，CO2光纤激光器在卵巢保存，妊娠率和IVF结果方面代表了标准剥离技术的下一个最佳替代品之一。简单性和可重复性使该技术成为膀胱切除术的可行替代方案，即使妇科医生在没有特定生殖和/或子宫内膜异位症手术技能的情况下接近子宫内膜异位症。任何在卵巢子宫内膜异位症手术治疗中没有手术经验的外科医生都可以使用这种技术。首先，将患者放在手术台上，将腿放入马镫中。将患者置于石体位，仰卧位的变体，其中腿部与中线分开，臀部弯曲，直到大腿形成80至100度之间的角度。使用浸泡在抗菌溶液中的海绵清洁脐带、腹部、会阴和大腿前三分之一的顶端，建立无菌区域。然后，用淋在碘溶液中的纱布擦洗，外阴和阴道内部，直到子宫颈，然后丢弃它。重复清洁步骤三次。使用浸在碘溶液中的新海绵，将肛门拭子两次并丢弃。用无菌毛巾擦干准备好的外部区域，然后将无菌窗帘放在上面。然后，插入尿道导管进行膀胱连续引流。使用阴道前后牵开器，露出子宫颈并将子宫操纵器插入子宫颈。通过非肥胖患者以45度角插入的Veress针头，在肥胖患者中以90度角插入，或使用开放技术在中线脐带下方做一个小的一厘米切口来创建气腹。将充气压力保持在12至14毫米汞柱之间。插入腹腔镜并检查上腹部和下腹部。将患者置于轻微的特伦德伦堡位置后，放置另一个腹腔镜通道。对于使用抽吸或灌溉装置进行一步二氧化碳光纤激光汽化，排出囊肿含量，灌溉并检查其内壁。使用剪刀收集囊肿壁活检，并将样本送去进行常规组织学检查，以确认子宫内膜异位症的诊断。接下来，选择基本操作模式，将设备设置为光纤激光模式，具有连续波和恒定定时曝光模式，功率密度为13至15瓦。用抓取镊子避开囊肿，以暴露囊壁，并用二氧化碳光纤激光以径向方式完全蒸发内壁，从中心到外围，使纤维的尖端与囊性表面保持一厘米的距离。汽化后，不要缝合卵巢。使用水测试仔细控制任何出血源，或略微减少气腹。手术后，小心取下子宫操纵器。然后，用中等吸收率编织缝合线尺寸0的筋膜，用3-0号的快速吸收率缝合的皮肤缝合筋膜，在所有切口上放置贴片并取下尿道导管，在手术后的第二天。此处显示了一步激光汽化后卵巢储备复发率和生育结局与膀胱切除术治疗卵巢子宫内膜异位症的比较。在单侧子宫内膜异位症中，与膀胱切除术相比，手术卵巢的窦卵泡计数在一步激光汽化后显着更高。相反，血清抗M

Research

JoVE Journal

Medicine

Epidural Intracranial Pressure Measurement in Rats Using a Fiber-optic Pressure Transducer

硬膜外颅内压测量中使用的光纤压力传感器的大鼠

Elevated intracranial pressure (ICP) is a significant problem in several forms of ischemic brain injury including stroke, traumatic brain injury and ...

科研

医学

Surgical Fixation of Sternal Fractures: Preoperative Planning and a Safe Surgical Technique Using Locked Titanium Plates and Depth Limited Drilling

胸骨骨折内固定手术：术前设计和安全的手术技术采用锁定钛板和深度钻探有限公司

Different ways to stabilize a sternal fracture are described in literature. Respecting different mechanisms of trauma such as the direct impact to the ...

Nerve-sparing Mid-urethral Obstruction (NeMO) in Female Small Rodents

Nerve-sparing Mid-urethral Obstruction NeMO in Female Small Rodents

在女小鼠害保留神经的中期尿道梗阻（NEMO）

Partial bladder outlet obstruction (pBOO) has a high prevalence, causes significant patient burden, and immense health care costs. The most common animal ...

Standardized Technique of Aortic Valve Re-implantation for Valve-sparing Aortic Root Replacement

主动脉瓣重置术治疗瓣膜备用主动脉根置换的规范化技术

Despite the obvious advantages of the preservation of a normal aortic valve during aortic root replacement, the complexity of valve sparing procedures ...

Vessel-sparing Excision and Primary Anastomosis

血管保留切除术与原发性吻合术

Urethroplasty is considered to be the standard treatment for urethral strictures since it provides excellent long-term success rates. For isolated short ...

Introduction of Intracapsular Rotary-cut Procedures (IRCP): A Modified Hysteromyomectomy Procedures Facilitating Fertility Preservation

Introduction of Intracapsular Rotary-cut Procedures IRCP: A Modified Hysteromyomectomy Procedures Facilitating Fertility Preservation

囊内旋切手术 (ircp) 的介绍: 一种改良子宫肌瘤切除术促进生育保护

Uterine fibroids are common benign tumors in the female reproductive system. A hysterectomy is the most effective treatment for symptomatic fibroids. For ...

Evaluation of Cerebral Blood Flow Autoregulation in the Rat Using Laser Doppler Flowmetry

使用激光多普勒流测量测量大鼠脑血流自动调节的评估

When investigating the body&#39;s mechanisms for regulating cerebral blood flow, a relative measurement of microcirculatory blood flow can be obtained ...

Endoscopy Guided Photoablation of Endometrial Cysts using a 980 nm Laser with a Contact Fiber in Mares

内窥镜引导光活内膜囊肿使用 980 nm 激光与接触纤维在马雷斯

In mares, endometrial cysts are associated with endometriosis and can cause maternal recognition failure or compromise and delay pregnancy diagnoses. ...

Fertility Preservation Through Oocyte Vitrification: Clinical and Laboratory Perspectives

通过卵母细胞维他化保存生育能力：临床和实验室视角

Preserving female fertility is crucial in a multifunctional healthcare system that takes care of patients' future quality of life. Oocyte cryopreservation ...

Focal Laser Ablation of Prostate Cancer: An Office Procedure

前列腺癌聚焦激光消融：办公室程序

In this article, we describe and illustrate an outpatient procedure for focal laser ablation (FLA) of prostate cancer (PCa). The procedure is conceptually ...