米索前列醇不同用药途径对妊娠早期无痛人流的影响

目的:探讨米索前列醇口服用药和阴道用药对初次妊娠早期无痛人流的临床彩响.方法:100例18～26岁初次妊娠早期择期行人工流产术患者随机分为口服米索前列醇组(A组)和阴道放置米索前列醇组(B组),每组50例.A组术前2小时口服米索前列醇400ug,B组术前2小时阴道放置米索前醇400ug,在异丙酚静脉麻醉下行无痛负压吸宫人流术.观察两组患者用药不良反应、宫颈扩张效果、宫缩幅度、术中出血量、手术时间及术后出血时间.结果:B组患者恶心、呕吐发生率显著低于A组,P<0.05,两组患者手术时间及及术后出血时间比较.无统计学差异,P>0.05,但B组的术中出血量、宫颈扩张效果、宫缩幅度明显好于A组,P<0.05.结论:阴道放王米索前列醇具有官颈扩张效果好,宫缩幅度强,术中出血量少,不良反应少等优点,临床效果优于口服给药.     

胃癌合并肝硬化门静脉高压症术后腹水的危险因素和防治

目的：探讨胃癌合并肝硬化患者接受手术后腹水的危险因素及防治方法。
　　方法：回顾性分析37例合并肝硬化的胃癌患者手术治疗后腹水的发生情况，并对可能影响腹水发生的因素行统计学分析。
　　结果：全组患者围手术期无死亡，术后均出现不同程度的腹水。Logistic回归分析发现，Child分级、术前腹水、术中出血是患者术后出现中等量腹水的影响因素（均P<0.05）。术中输血、手术时间、肿瘤部位等与术后中等量腹水的的发生无明关系（均P>0.05）。
　　结论：对于合并肝硬化的胃癌患者，积极进行围手术期处置，调整术前Child分级，遵循损伤控制性手术原则，减少出血量，能有效控制术后腹水的发生。     

肝移植患者术前的凝血治疗

目的探讨肝移植患者术前凝血治疗的时机、目标和方法选择.方法回顾性分析我院2002-2004年实施肝移植手术的168例病例资料.统计患者术前凝血酶原时间（PT）、凝血酶原活动度（PTA）、国际标准化比率（INR）、纤维蛋白原（FIB）、活化的部分凝血酶原时间（APTT）、血小板计数（PLT）和相应的凝血治疗措施,术中出血量、各种血制品的用量.分析术前因素与术中出血的关系,PTA分级与术中出血量、术中各种血制品用量的关系,术前血浆置换对术中出血量和术中输血制品量的影响.结果术前PTA趋于正常,术中出血量则少,对于严重凝血障碍的患者,术前应调整PTA至30%以上;术前实施血浆置换可以显著减少重症肝炎患者的术中出血量和血制品用量.结论肝移植患者术前应根据具体情况选择合适的治疗方法,尽量改善患者的凝血状态,以减少术中出血和血制品用量.     

手动负压吸宫术与电动负压吸宫术在终止早期妊娠的临床对比

目的对比手动负压吸宫术(Manual vacuum aspiration,MVA)与电动负压吸宫术(Electrical vacuum aspiration,EVA)终止早期妊娠的临床效果。方法选择2017年3月至2018年3月妊娠42～60天在医院行人流术的240例妇女为研究对象。采用随机数表法分为2组,手动组120例给予手动负压吸宫术终止妊娠,电动组120例给予电动负压吸宫术终止妊娠,对比两组流产效果,术中术后情况及安全性。结果手动组和电动组完全流产率分别为98.33%、97.50%,两组相比差异无统计学意义(P0.05);两组均无人流综合征发生,月经量减少情况、月经恢复时间相比差异无统计学意义(P0.05);扩张宫颈、术中出血量、手术时间、术后阴道相比差异有统计学意义(P0.05);手动组和电动组VAS评分分别为(5.12±0.41)分、(8.57±0.56)分,差异有统计学意义(P0.05)。结论 MVA与EVA终止早期妊娠均具有较好的效果,MVA可减少扩张宫颈和术中出血量,缩短手术时间和术后阴道出血时间,并缓解疼痛,患者痛苦小。     

代谢综合征对胃癌术后并发症短期结局影响的多因素分析

目的 探讨胃癌术后并发症的影响因素,评价代谢综合征及其相关因素对胃癌术后并发症的影响作用。方法 2006年1月至2008年6月青岛大学医学院附属医院普外科共行开腹手术治疗胃癌639例。统计其并发症发生情况及常见胃癌并发症影响因素。进行单因素及多因素Logistic回归分析。结果 98例发生了不同的术后并发症,总体发生率为15.3%。包括手术时间、术前血红蛋白、术中出血量、体重指数(body mass index, BMI)、入院血糖、术后血糖、术前总胆红素、术前前白蛋白、术后超敏C反应蛋白、联合脏器切除、营养不良、体重减轻＞10%、代谢综合征（metabolic syndrome, MS）、糖尿病（diabetes mellitus, DM）、肥胖、高血压病、术者手术例数、肝硬化、肿瘤出血、TNM分期、年龄、浸润深度等22项因素与本组病人术后并发症的发生有关。其中联合脏器切除、营养不良、MS、肥胖、T4期、DM、手术时间、术中出血量、年龄、术前总胆红素、术者手术例数等11种因素被纳入回归方程。结论 联合脏器切除、营养不良、MS、肥胖、T4、DM、手术时间、术中出血量、年龄、术前总胆红素、医师手术例数等是影响本组胃癌病人术后并发症的主要危险因素;MS对胃癌术后并发症的影响较大,应加以重视。     

急性胆囊炎合并胆囊结石行腹腔镜胆囊切除术的困难因素分析

目的:分析急性胆囊炎合并胆囊结石患者行腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)的困难因素,以提高手术安全性,减少术后并发症的发生。方法:随机选取219例急性胆囊炎合并胆囊结石行LC的患者,观察术前发作次数、伴随疾病、术前住院时间、手术时间、术后住院时间等指标。应用ANOVA单因素分析与多重线性回归分析统计结果。结果:胆囊大小、患者性别与手术操作难度相关,胆囊壁厚度、胆囊炎发作次数与手术时间、出血量、术后住院时间的关系较小,同时非上腹部大手术不会影响手术时间、出血量及术后住院时间。结论:胆囊大小、患者性别与手术操作难度存在一定联系,而胆囊壁厚度、胆囊炎发作次数可能并不是影响LC手术难度的主要因素,同时下腹部手术、上腹部微创手术都不会影响手术的操作难度。     

大动脉炎开放手术围手术期并发症的危险因素分析

目的：探讨影响大动脉炎（TA）患者行开放手术治疗发生围手术期并发症的相关危险因素。 方法：回顾性分析2003年1月—2018年12月136例行开放血管重建治疗的TA患者资料,采用单因素及多因素Logistic统计学方法分析影响开放手术围手术期并发症的相关危险因素。 结果：136例患者共行开放手术141例次,涉及病变257处。围手术期并发症共发生36例次（25.5%）,其中5例患者（3.7%）死亡。单因素分析结果显示,脑梗死病史、术前CRP升高、颈动脉受累、围手术期输血、血管受累数量、动脉阻断时间及术中出血量与围手术期并发症的发生有关（均P<0.05）;多因素Logistic分析显示,脑梗死病史（OR=3.141,95% CI=1.062~9.288,P=0.039）、血管受累数量（OR=1.280,95% CI=1.016~1.612,P=0.036）和术中动脉阻断时间（OR=1.045,95% CI= 1.007~1.084,P=0.019）是围手术期并发症的独立危险因素。 结论：术前脑梗死病史,血管受累数量多和术中动脉阻断时间长会增加TA患者开放手术围手术期并发症的风险。     

原发性甲状腺机能亢进症524例外科治疗分析

目的 探讨原发性甲状腺机能亢进症（甲亢）患者术前服碘的方法以及手术改进方式。方法 采取术前院外服碘准备；术中不切断颈前肌群，采用囊内结扎法处理血管；利用缝扎牵引腺体改善术野暴露；用钳夹法次全切除腺体，减少术中出血。结果 院外服碘可缩短住院时间；改良后的手术方法安全，出血量少，术野清楚，术后并发症少；可缩短手术时间及减少术中出血量。术后随访1－8年，1例复发（0．2％）。结论 原发性甲亢患者采取术前院外服碘方法安全可靠；术中彩和腺体牵引法可获得良好的术野暴露，简便实用；钳夹法切除腺体可减少术中出血；囊内结扎法简化了手术步骤，缩短了手术时间，可有效地减少术中副损伤。     

Multivariate Logistic regression analysis of the risk factors of gastrectomy postoperative complications

目的 探讨与胃癌术后并发症有关的危险因素.方法 回顾性分析20 06年6月至2011年10月行胃癌手术病人的临床资料,对术前、术中各种指标进行单因素分析,对其中有统计学意义的变量进行多因素Logistic回归分析,筛选出影响胃癌术后并发症的危险因素.结果 术后并发症与联合脏器切除、Ⅲ～Ⅳ期、肝硬化、全胃切除、术前合并症、术中出血量、手术时间、年龄＞60岁等危险因素相关.结论联合脏器切除、肿瘤分期Ⅲ～Ⅳ期、术前合并症、肝硬化、全胃切除、术中出血量、手术时间、年龄＞60岁为胃癌术后并发症的独立危险因素.     

胰腺术后胰瘘发生相关危险因素分析（附303例胰腺手术报告）

目的 探讨影响病人胰腺手术后胰瘘发生率的危险因素。方法 回顾性分析2012年2月至2015年1月中国医科大学附属第一医院收治的303例行胰腺手术病人资料,其中术后发生胰瘘50例。对影响术后胰瘘发生的相关因素进行单因素分析及Logistics回归分析。结果 单因素分析结果显示,影响术后胰瘘发生的因素包括性别、病理类型、胰管扩张、手术时间、术中出血量、术前血红蛋白、术前血清总胆红素、术后血清总胆红素（P<0.05）。非条件Logistic回归分析结果显示,影响术后胰瘘发生的独立危险因素为：性别（OR=12.001,95%CI 3.049~47.230,P<0.05）、病理类型（OR=1.605,95%CI 1.108~2.324,P<0.05）、胰管扩张（OR=1.177,95%CI 0.188~0.468,P<0.05）、手术时间（OR=1.641,95%CI=1.173~2.339,P<0.05）、术中出血量（OR=1.096,95%CI 1.094~1.099,P<0.05）、术前血红蛋白（OR=0.888,95%CI 0.823~0.921,P<0.05）、术前血清总胆红素（OR=1.359,95%CI 1.335~1.381,P=0.010）、术后血清总胆红素（OR=1.030,95%CI 1.064~1.004,P<0.05）。结论 男性、手术前后血清胆红素浓度高、壶腹部癌或十二指肠癌是胰瘘发生的独立危险因素,而胰管扩张则可减少胰腺手术后胰瘘的发生。     

Assessment of Risk Factors of Intrauterine Adhesions in Patients With Induced Abortion and the Curative Effect of Hysteroscopic Surgery

Objective: To explore the risk factors for intrauterine adhesions in patients with artificial abortion and clinical efficacy of hysteroscopic dissection. Methods: 1500 patients undergoing artificial abortion between January 2014 and June 2015 were enrolled into this study. The patients were divided into two groups with or without intrauterine adhesions. Univariate and Multiple logistic regression were conducted to assess the effects of multiple factors on the development of intrauterine adhesions following induced abortion. Results: The incidence rate for intrauterine adhesions following induced abortion is 17.0%. Univariate showed that preoperative inflammation, multiple pregnancies and suction evacuation time are the influence risk factors of intrauterine adhesions. Multiple logistic regression demonstrates that multiple pregnancies, high intrauterine negative pressure, and long suction evacuation time are independent risk factors for the development of intrauterine adhesions following induced abortion. Additionally, intrauterine adhesions were observed in 105 mild, 80 moderate, and 70 severe cases. The cure rates for these three categories of intrauterine adhesions by hysteroscopic surgery were 100.0%, 93.8%, and 85.7%, respectively. Conclusion: Multiple pregnancies, high negative pressure suction evacuation and long suction evacuation time are independent risk factors for the development of intrauterine adhesions following induced abortions. Hysteroscopic surgery substantially improves the clinical outcomes of intrauterine adhesions.     

Maternal and procedural factors associated with estimated blood loss in second trimester surgical uterine evacuation: a retrospective cohort analysis

BackgroundPrior studies examining bleeding with uterine evacuation have focused on high-volume centers performing over 1100 procedures annually. The aim of this study was to examine associations between blood loss and patient and procedural characteristics in a center performing fewer than 50 procedures annually.MethodsThis retrospective cohort study, with institutional review board approval, utilized procedural codes to identify patients undergoing uterine evacuation procedures between 14 weeks’ and 24 weeks’ gestational age across a 50-month period. The primary outcome was estimated blood loss; secondary outcomes were hemorrhage, transfusion and hospital re-admission. Associations between blood loss and other variables were examined using linear regression models.ResultsCharts of 161 women met inclusion criteria. Median estimated blood loss was 400 mL (IQR 300 mL) with 37% of patients having blood loss of ≥500 mL. In univariate analyses, increased blood loss was associated with later gestational age (P <0.001) and pregnancy termination (P <0.001). In a multiple linear regression model, both remained significant. Each one-week increase in gestational age was associated with a 7.1% mean increase in estimated blood loss (95% CI 2.47% to 11.9%; P=0.003). Patients whose uterine evacuation was indicated for pregnancy termination had an 80.6% increase in blood loss compared with those with pre-operative fetal demise (95% CI 37.5% to 137.2%; P <0.001). Rates of peri-operative transfusion and re-admission for bleeding were <4%.ConclusionWhile blood loss may be greater in low volume centers, our transfusion and re-admission rates were low following second trimester uterine evacuation.     

Oxytocic drugs and anaesthesia. A controlled clinical trial of ergometrine, syntocinon and normal saline during evacuation of the uterus after spontaneous abortion

A randomised controlled clinical trial compared ergometrine 0.25 mg, syntocinon 10 mg and normal saline injected intravenously during evacuation of the uterus after spontaneous abortion showed no difference between any drug with respect to uterine contraction, change in blood pressure, blood loss or postoperative vomiting.     

腹腔镜手术治疗妊娠合并卵巢肿瘤30例报告

目的:探讨妊娠合并卵巢肿瘤的临床特点及腹腔镜手术技巧.方法:回顾分析2003年1月至2010年7月为30例妊娠合并卵巢肿瘤患者行腹腔镜手术的临床资料.患者平均27.3岁,其中18例孕周小于12周,12～18周12例.经产妇7例.11例有腹部症状,2例阴道流血.肿瘤直径平均76.7mm.结果:30例均顺利完成腹腔镜手术,...     

Hysteroscopic Transcervical Resection of Uterine Septum

Objective:

To explore the method of diagnosis for uterine septum and the clinical effect of hysteroscopic transcervical resection of the septum.

Methods:

One-hundred ninety cases of patients with uterine septum who were diagnosed and treated at our hospital during 2007–2011 were selected, and their general information, perioperative status, postoperative recovery treatment, and postoperative pregnancy rates were statistically analyzed.

Results:

All 190 patients were cured with one surgery, with an average hysteroscopic operating time of 22.60 ± 10.67 minutes and intraoperative blood loss of 15.74 ± 9.64 mL. There were no complications such as uterine perforation, water intoxication, infection, or heavy bleeding. Among the 115 patients that we followed up, 86 became pregnant and delivered infants, 81 of which were born at term and 5 that were born premature.

Conclusion:

The combination of hysteroscopy and laparoscopy is still the most reliable method for the diagnosis of uterine septum. With a shorter operative time, less blood loss, a significantly increased postoperative pregnancy rate and live birth rate, and a significantly lower spontaneous abortion rate, transcervical resection of the septum was the preferred method for the treatment of uterine septum, and surgical instruments and skills were critical to the prognosis of uterine septum.     

腹腔镜在妊娠期急腹症诊疗中的应用

目的 评价腹腔镜在妊娠期急腹症的临床诊疗价值. 方法 回顾分析1997年6月～2004年10月40例孕周在7～17周（平均13.2周）的妊娠期急腹症临床资料,其中宫内宫外妊娠16例,卵巢扭转3例,卵巢囊肿蒂扭转5例,急性胆囊炎5例,急性阑尾炎11例,应用腹腔镜诊断及治疗. 结果 40例均在腹腔镜下明确诊断,除1例宫内宫外妊娠盆腔粘连严重中转开腹外,余全部手术成功.手术时间25～70 min,平均38.2 min.术后皮下气肿1例.术后随访36例,先兆流产3例,难免流产3例,早产1例,足月分娩31例. 结论 腹腔镜手术治疗早、中期妊娠急腹症安全有效.     

Laparoscopic appendectomy in pregnancy

BACKGROUND: Laparoscopic appendectomy (LA) is a safe, effective, and beneficial procedure for the treatment of acute appendicitis. However, limited data are available regarding the safety and feasibility of LA during pregnancy. METHODS: Between January 2001 and August 2004, 1235 patients with clinically suspected appendicitis underwent laparoscopic surgery at our hospital. Eleven patients (0.9%) were pregnant women (mean age, 25 years; age range, 19-37 years; range of gestational age, 4-30 weeks). Clinical data collected retrospectively included demographic information; preoperative, procedural, and postoperative information; and outcome of the pregnancy. RESULTS: All 11 pregnant women underwent laparoscopic surgery without need of conversion. Ten patients underwent LA and were found to have acute appendicitis on histologic analysis. One patient had torsion of the right fallopian tube and a healthy-looking appendix; she underwent detorsion of the fallopian tube and incidental appendectomy. Mean operative time was 50.5 minutes (range, 20-135 minutes). Length of postoperative hospital stay averaged 4.2 days (range, 1-11 days). One patient had a surgical wound infection, which was managed conservatively. Mean follow-up period was 14 months (range, 2-46 months). Seven pregnant women delivered healthy term infants, 2 had planned abortions, and 1 experienced fetal loss due to uterine infection and premature contractions 1 month after LA. Another patient had normal results at prenatal examination. CONCLUSION: Our data support the accumulating evidence that LA is a safe and feasible procedure for the treatment of acute appendicitis in all trimesters of pregnancy. Close maternal and fetal monitoring is essential during and after the operation.     

全程超导可视无痛人工流产术的临床应用

目的探讨全程超导可视无痛人工流产术的临床应用价值。方法选择自愿要求进行全程超导可视无痛人工流产术的早孕患者150例为观察组,同期自愿选择行传统无痛人工流产术的早孕患者148例为对照组,观察两组手术时间、术中出血量及手术并发症的发生情况。结果两组患者术中均无疼痛,观察组手术时间较对照组短,两组比较差异有统计学意义（P〈0.05）;术中出血量及手术并发症均比对照组低,差异有统计学意义（P〈0.05）。结论全程超导可视无痛人工流产术用于早期终止妊娠术中,具有操作简单、直观性强、寻找妊娠囊迅速的优点,克服了常规手术的盲目性,减少术中宫腔的操作次数,能及时检测宫腔内的残余物是否吸刮干净,还能检测术后的子宫情况,提高手术的安全性及准确性,最大限度地减少了并发症的发生,值得临床推广应用。     

多发性子宫肌瘤腹腔镜剔除术后影响患者生育力的多因素分析

目的 观察腹腔镜多发性子宫肌瘤剔除术后生育状况并探讨其影响因素.方法 2005年1月～2011年12月,对169例多发性子宫肌瘤行腹腔镜子宫肌瘤剔除术,观察其术后宫内妊娠率、妊娠结局、流产率、复发情况,采用Logistic回归分析盆腔粘连、子宫的切口数、年龄等对术后生育结局的影响.结果 随访1～6年,腹腔镜多发性子宫肌瘤剔除术后自然宫内妊娠率60.9％(103/169),流产率5.9％(10/169),足月分娩率53.3％(90/169),异位妊娠率5.3％ (9/169).所有妊娠患者无妊娠子宫破裂及产科合并症.单因素分析结果显示,影响腹腔镜下多发性子宫肌瘤剔除术后宫内妊娠率的自变量是年龄、术前宫腔形态、子宫切口数、肌瘤数目、盆腔粘连(P＜0.05),而肌瘤是否穿透内膜、肌瘤大小无统计学意义(P＞0.05).多因素分析显示,术后宫内妊娠率的影响因素是年龄(OR=0.110,95％ CI:0.050 ～0.240),盆腔粘连(OR=0.018,95％ CI:0.003 ～0.117),术前宫腔形态(OR=0.057,95％ CI:0.014 ～0.232),子宫切口数(OR=0.398,95％CI:0.226 ～0.702)(P＜0.05).结论 腹腔镜多发性子宫肌瘤剔除术具有微创、安全、术后自然宫内妊娠率满意的优点,患者的年龄、术中盆腔粘连状况、术前宫腔形态、子宫切口数是影响术后宫内妊娠率的相对独立因素,对于年龄＞ 35岁、重度盆腔粘连、子宫切口数＞4个的患者,若1年无自然受孕,建议辅助受孕.     

影响钬激光前列腺剜除术中出血的多因素分析

目的:评价经尿道钬激光前列腺剜除术(HoLEP)术中出血量的情况,探讨影响出血量的相关因素.方法:回顾性分析299例良性前列腺增生(BPH)患者的临床资料,其中268例行HoLEP,31例行经尿道前列腺电切术(TURP).在手术前和术后第1天晨测量血红蛋白和红细胞比容,并记录术后的输血情况.分析年龄、糖尿病、高血压病、...