三种子宫肌瘤切除方法对比分析

目的 对比分析开腹子宫肌瘤切除术、经阴道子宫肌瘤切除术和腹腔镜下子宫肌瘤切除术的短期临床效果.方法 回顾性分析并比较腹腔镜子宫肌瘤切除术86例、经阴道子宫肌瘤切除术30例和腹腔镜下子宫肌瘤切除术72例,单发子宫肌瘤直径在5～8 cm之间的临床病例记录,包括手术时间、术中出血量、肛门排气时间、术后镇痛药使用率、并发症发生率、住院天数.结果 手术时间三者相比差异无统计学意义;术中出血量开腹子宫肌瘤切除术组最多,经阴道子宫肌瘤切除术组最少,三者相比差异有统计学意义;肛门排气时间开腹子宫肌瘤切除术组长于经阴道子宫肌瘤切除术组和腹腔镜下子宫肌瘤切除术组,后两者比较差异无统计学意义;术后镇痛药使用率开腹子宫肌瘤切除术组高于腹腔镜下子宫肌瘤切除术组和经阴道子宫肌瘤切除术组,三者相比差异有统计学意义;并发症发生率开腹子宫肌瘤切除术组3%,腹腔镜下子宫肌瘤切除术组1%,经阴道子宫肌瘤切除术组未发生,三者相比差异有统计学意义;住院天数开腹子宫肌瘤切除术组明显高于腹腔镜下子宫肌瘤切除术组和经阴道子宫肌瘤切除术组,后两者相比差异无统计学意义.结论 三种手术方式各有优劣,选择术式应个体化.在无禁忌证情况下经阴道子宫肌瘤切除术首选,腹腔镜下子宫肌瘤切除术次之,开腹子宫肌瘤切除术最后.     

腹腔镜阑尾切除在基层医院的应用

目的探讨腹腔镜阑尾切除术的优势以及是否适宜在基层医院推广。方法比较55例开腹阑尾切除术(开腹组)和54例腹腔镜阑尾切除术(腹腔镜组)的手术时间、术后镇痛、排气时间、住院天数、切口感染率和残余脓肿率。结果两组手术时间无显著差异,而在其余方面腹腔镜组均优于开腹组。结论腹腔镜阑尾切除术创伤小,术后疼痛轻,胃肠功能恢复快,术后并发症少,住院时间短,手术难度不大,无须昂贵附加设备,便于在基层医院推广。     

宫腔镜与开腹手术治疗粘膜下子宫肌瘤的对照研究

目的:探讨官腔镜子宫肌瘤切除术的手术方法、术后疗效及临床应用价值。方法:回顾性分析比较官腔镜治疗粘膜下子宫肌瘤34例(观察组)和因子宫肌瘤行子宫切除术42例(对照组)患者的手术和术后情况。结果:观察组手术时间(16．47±4．69)min,对照组手术时间(106．54±36．90)min(P<0．001)。观察组术中出血 (20．29±6．62)ml,对照组术中出血(96．19±49．53)ml(P<0．001)。观察组术后住院天数(4．38±0．82)d,对照组术后住院天数(8．33±2．50)d(P<0．001)。观察组术后排气时间(7．38±4．86)h,对照组术后排气时间 (35．33±15．75)h(P<0．001)。结论:官腔镜子宫肌瘤切除术具有创伤小、术中出血少、术后恢复快、住院时间短、免除开腹切除子宫之苦等优点,是目前治疗粘膜下子宫肌瘤的理想、有效、安全的方法。     

腹腔镜与开腹在巨大子宫肌瘤切除术中应用对比分析

目的探讨腹腔镜巨大子宫肌瘤切除术（1aparoscopic myomectomy，LM）与开腹巨大子宫肌瘤切除术（open myomectomy）优劣性及临床价值。方法回顾分析2009年12月至2010年12月我院妇科收治124例巨大子宫肌瘤（子宫肌瘤最大直径≥7cm，子宫体积〉12孕周）患者的临床资料，比较68例LM及56例同期开腹子宫肌瘸切除术的手术效果和术后康复情况。结果2ta患者均手术成功，无术后并发症发生。手术时间腹腔镜组（100．32±35．46）min显著长于开腹组（83．55±25．37）rain，术中出血量度腔镜组（115±65．77）mL与开腹组（107±68．24）mL无统计学差异，术后平均排气时间腹腔镜组（20．82±6．64）h显著短于开腹组（30．23±8．25）h。术后住院天数腹腔镜纽（4．45±O．S）d显著短于开腹纽（7．92±2．3）d。结论腹腔镜巨大子宫肌瘤切除术是安全可行的，与开腹手术相比LM创伤小、，住院时间短、康复快。术中出血量无增加，但手术时间延长，可能与肌瘸较大取出费时及缝合困难有关。     

子宫肌瘤阴式全宫切除术护理体会

目的探讨子宫肌瘤阴式全宫切除的护理措施。方法将38例子宫肌瘤阴式全宫切除术作为观察组，随机抽查38例开腹全宫切除术患者作为对照组。比较观察组和对照组术后肛门排气时间、最高体温、住院天数、手术时间、出血量。结果观察组术后肛门排气时间、最高体温、住院天数与对照组之间的差异，具有统计学意义（P〈0．05）。而手术时间、出血时间差异无统计学意义（P〉0．05）。结论子宫肌瘤阴式全宫切除术的术式及护理优于传统开腹的术式及护理。     

腹腔镜下子宫肌瘤剔除术41例临床分析

目的探讨子宫肌瘤的治疗方法。方法选择子宫肌瘤自愿要求腹腔镜肌瘤剔除术的41例患者(腹腔镜组),并同期自愿选择开腹子宫肌瘤剔除术46例(传统开腹组)作为对照组。比较2组患者手术时间、术中出血量、术后排气时间、术后发热率及术后平均住院时间等。结果腹腔镜组患者行手术时间(118.94±15.09)min,高于开腹组(99.20±13.67)min;而术中出血量(63.62±16.22)ml、术后发热率12.19%、术后排气时间(16.22±3.85)h及术后平均住院天数(5.25±0.81)d均低于传统开腹组,分别为(74.40±22.60)ml、30.43%、(29.91±6.79)h、(6.60±1.25)d,差异均有统计学意义(P<0.05)。结论腹腔镜下子宫肌瘤剔除术具有创伤小、排气早、住院时间短、腹部切口美观等优点,是子宫肌瘤剔除较好的术式选择。     

悬吊式免气腹腹腔镜子宫肌瘤切除术的可行性分析

目的比较悬吊式免气腹腹腔镜子宫肌瘤切除与传统开腹子宫肌瘤切除术的临床效果。方法将拟行子宫肌瘤切除术的64例患者随机分为两组,观察组31例采用悬吊式腹腔镜子宫肌瘤切除术,对照组33例采用传统开腹子宫肌瘤切除术,所有患者均由相对固定的一组医生进行手术,记录手术时间,患者术中的出血量,切除肌瘤数量以及术后患者体温恢复时间,出院时间等情况。结果观察组术后住院时间、肛门排气时间、体温恢复正常时间、生活恢复自理时间均显著短于开腹组(P<0.01),两组手术时间、术中出血量比较差异无统计学意义(P>0.05)。结论悬吊式腹腔镜子宫肌瘤切除术具有创伤小,术后康复快等优点,安全有效,具有可行性。     

腹腔镜子宫壁间肌瘤切除术临床观察

目的:观察与比较腹腔镜下子宫壁间肌瘤切除术与传统开腹子宫肌瘤切除术之间的差异.方法:选择2001年1月～2003年12月腹腔镜下子宫壁间肌瘤切除56例为观察组(A组),随机选择经腹子宫壁间肌瘤切除术38例为对照组(B组).结果:术中出血A组少于B组,A组术后下床活动时间早于B组,A组术后排气时间明显早于B组,A组术后住院天数明显短于B组.有显著性差异(P＜0.001).结论:腹腔镜子宫肌瘤切除术与传统开腹子宫肌瘤切除术比较具有创伤小、胃肠功能恢复快、术中出血少、住院时间短等优点,必将成为今后发展方向.     

开腹及腹腔镜辅助全子宫切除术128例临床效果比较

目的比较开腹全子宫切除术和腹腔镜辅助全子宫切除术治疗子宫肌瘤的临床效果,为子宫肌瘤的术式选择提供指导。方法因子宫肌瘤行子宫切除术128例,将其分为开腹全子宫切除术组(开腹组)60例和腹腔镜辅助全子宫切除术组(腹腔镜组)68例,两组病例术前临床资料有可比性。结果两组手术时间比较差异无显著性,腹腔镜组术中出血量多于开腹组(P<0.01),术后3h、24h、48h疼痛评分腹腔镜组均低于开腹组(P<0.01),腹腔镜组术后排气时间短(P<0.01)、术后体温低(P<0.01)、住院天数短(P<0.01);腹腔镜组术后病率为0,开腹组为5.0%。结论对于单纯性全子宫切除术,腹腔镜组在术后疼痛、术后排气、腹部创伤上明显优于开腹组。     

腹腔镜与开腹手术治疗子宫肌瘤的临床对比研究

目的对比分析腹腔镜与开腹手术治疗子宫肌瘤的临床疗效。方法 100例子宫肌瘤患者随机分为腹腔镜手术组（55例）和开腹手术组（45例）,对比两组手术时间、术中出血量、术后肛门排气时间、术后住院天数等指标。结果腹腔镜手术组手术时间比开腹手术组长（P〉0.05）,但术中出血量、术后肛门排气时间、术后住院天数均明显小于开腹手术组（P〈0.05）。结论腹腔镜手术治疗子宫肌瘤具有创伤小、出血少、康复快,值得临床推广应用。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.