子宫腺肌病的非手术治疗研究进展

子宫腺肌病是妇科常见的一种良性病变,传统的治疗方法为手术为主、药物为辅。手术切除子宫创伤大、不能保留子宫,给患者带来身体及心理的极大创伤。随着医疗技术进步,非手术治疗方式逐渐成为首选治疗方式,包括药物治疗、子宫动脉栓塞、高强度聚焦超声等。每种治疗方式各有优缺点,而高强度聚焦超声是一种科学、无创、安全有效的治疗方法,近期疗效显著,有望成为子宫腺肌病的首选治疗方法。     

子宫动脉栓塞术治疗子宫腺肌病的临床疗效观察

子宫腺肌病是妇科常见病，药物治疗效果欠佳，手术切除子宫又不易被患者接受，子宫动脉栓塞（UAE）可有效缓解痛经症状，减少月经量，是一种有效的介入治疗方法。近1年来，本科对23例子宫腺肌病患者进行UAE治疗，并对术后疗效随访和卵巢内分泌功能测定，结果报告如下。     

子宫腺肌瘤病灶切除手术联合孕三烯酮药物治疗子宫腺肌病37例分析

目的:探讨子宫腺肌病病灶切除手术联合孕三烯酮药物治疗子宫腺肌病的效果。方法:回顾分析37例子宫腺肌病病灶切除手术,术后联合孕三烯酮药物治疗3个月,术后定期随访观察手术加药物治疗的效果。结果:术后1~3 a,中位随访时间1.5 a,复发率0,临床症状、痛经、月经量过多等症状消失,贫血纠正,有3例出现月经量减少表现。结论:子宫腺肌病病灶切除术加药物辅助治疗,能改善症状,降低复发,适合年轻要求保留子宫患者,也适合临床推广。     

子宫腺肌病研究进展

子宫腺肌病的定义随着研究历程的变化而变化，当前的定义是子宫肌层出现子宫内膜腺体和间质，伴有肌层细胞增生和 肥大。子宫腺肌病的发病原因大部分研究认为和雌激素相关，发病期间腺体的植入需要血管生成为其提供营养物质支持。在治 疗上，大多数患者主要使用促性腺激素释放激素激动剂等药物进行治疗，无生育需求的女性可以选择手术切除子宫进行根治治 疗。目前能有效治愈子宫腺肌病药物仍未被发现，加大限制了子宫腺肌病的治疗效果。本文旨在总结探讨子宫腺肌病病因病机 及药物治疗方法，为制定个体化治疗方案，提高子宫腺肌病治疗效果提供参考。     

经导管子宫动脉栓塞术治疗子宫腺肌症

子宫腺肌症是妇科常见病,以往该病的治疗方法是常规的药物治疗和手术切除。随着介入放射学的发展,国内外学者采用经子宫动脉栓塞术(TUAE)治疗子宫腺肌症1-2,取得了显著效果。我院应用介入治疗子宫腺肌症48例,均随访1年以上,疗效较好,现报道如下。1材料与方法1.1一般资料选择经药物保守治疗1～3年疗效不佳或无效的48例子宫腺肌症患者,行TUAE治疗。年龄28～47岁,平均40.2岁,临床表现均伴有继发性痛经1～5年,并呈进行性加剧,月经明显增多、经期延长,伴有不同程度的贫血。所有患者的诊断均由妇科检查和彩超表现(部分患者加行MRI检查)结合病…     

子宫腺肌病79例临床分析

子宫腺肌病近年来发病率有明显上升趋势，严重的影响中青年妇女的健康和生活质量。近年来，随着对其病因学研究的深人，有不少学者认为，子宫腺肌病与盆腔子宫内膜异位症为两个不同的概念。其在病因、流行病学、症状及治疗方面均有特殊性，目前尚无有效的药物治疗方法，经典的治疗为手术子宫切除。子宫腺肌病由于其临床表现多种多样，且常常误诊，为提高临床诊断的准确率，再手术前较难确诊。本文对术后经病理证实为子宫腺肌病的79例进行回顾性分析。     

子宫动脉栓塞术治疗子宫腺肌病的临床观察及护理

子宫腺肌病常引起难以忍受的进行性痛经、月经增多等症状,严重影响病人的生活质量,既往治疗方法主要是激素治疗以及手术,尚无较好的保守治疗方法。我们自2000年起采用子宫动脉栓塞术(UAE)治疗子宫腺肌病,获得了较好的疗效,现就治疗、护理总结如下。1资料与方法1.1一般资料选择1     

子宫腺肌病188例临床护理

目的:探讨子宫腺肌病患者的诱发因素临床表现、治疗及护理方法。方法:对188例子宫腺肌病患者的临床资料进行回顾性分析,探讨其诱发因素、临床表现及治疗、护理方法。结果:宫腔手术是子宫腺肌病的主要诱发因素,痛经是其主要症状,子宫腺肌病应首选手术治疗,良好的护理是术后康复的关键。结论:子宫腺肌病为育龄期妇女常见疾病,应首选手术治疗,术后加强护理、预防复发是提高患者生活质量的关键。     

子宫腺肌病97例临床分析

子宫内膜异位症近年来有明显上升趋势，成为一种“现代病”、多发病，严重地影响中青年妇女的健康和生活质量，子宫腺肌病，即子宫肌层内的异病症，先前名日“内在性子宫内膜异位症”，但近年的研究表明，其在病因、流行病学、症状及治疗方面均有特殊性，故成内异症的“单列式”，目前尚无有效的药物治疗方法，经典的治疗为手术子宫切除。子宫腺肌病在手术前     

子宫内膜异位症不孕症患者宫腹腔镜手术治疗疗效的影响因素

目的 探讨子宫内膜异位症不孕症患者宫腹腔镜手术治疗疗效的影响因素。方法 选取2017年1～12月我院收治的93例子宫内膜异位症不孕症患者,所有患者均行宫腹腔镜手术治疗,术后随访2年,统计所有患者基线资料,包括年龄、不孕时间、病理类型、不孕类型、术后性激素药物辅助治疗、合并子宫腺肌病,分析子宫内膜异位症不孕症患者宫腹腔镜手术治疗疗效的影响因素。结果 随访2年内,93例子宫内膜异位症不孕症患者中妊娠55例,妊娠率为59.14%;未妊娠38例,未妊娠率40.86%;经单因素及Logistic回归分析发现,年龄、不孕时间、不孕类型及合并子宫腺肌病是子宫内膜异位症不孕症患者宫腹腔镜手术治疗疗效的影响因素(OR1,P0.05)。结论 年龄大、不孕时间长、原发性不孕症及合并子宫腺肌病是子宫内膜异位症不孕症患者经宫腹腔镜手术治疗疗效的影响因素,临床需制定针对性干预方案,进一步改善患者预后。     

介入溶栓治疗胸腔镜下肺癌根治术后高危肺栓塞的经验分析

目的探讨不同介入溶栓方式治疗胸腔镜下肺癌根治术后高危肺栓塞(PE)的价值。方法选取2018年就诊于河南大学第一附属医院的3例胸腔镜下肺癌根治术后发生高危PE的患者作为研究对象,其中1例接受单纯静脉溶栓治疗,1例接受单纯动脉介入溶栓治疗,1例接受静脉肺动脉联合介入溶栓治疗,分析3例患者住院治疗方式、溶栓治疗效果和术后并发症发生概率。结果接受单纯静脉溶栓治疗、单纯动脉介入溶栓治疗和静脉肺动脉联合介入溶栓治疗的患者,溶栓后住院时间分别为32、22和11 d,介入溶栓治疗的临床效果较传统静脉溶栓治疗好,3例患者出院后均进行6个月的随访,无明显并发症出现。结论因肺癌行胸腔镜根治术后发生高危PE的患者,采用肺动脉介入溶栓方式能够明显提高临床治疗效果,缩短患者住院时间,值得临床推广应用。     

药物涂层球囊治疗冠状动脉原位病变的有效性及安全性

目的 观察药物涂层球囊介入治疗对冠状动脉原位病变患者术后MACE事件发生的影响。方法 选择于2021年2月至2022年6月就诊且需进行介入治疗的冠状动脉原位病变的85例患者,用随机数字表法分为观察组和对照组。其中40例观察组患者接受药物涂层球囊介入治疗,45例对照组患者接受药物洗脱支架介入治疗。分别在术前及术后不同时间检测管腔直径。比较两组手术即刻成功率、术中并发症发生情况;比较两组患者术前、术后即刻、术后6个月最小管腔直径（MLD）和管腔狭窄程度;评估两组术后6个月时晚期管腔丢失（LLL）;观察两组术后6个月内不良心血管事件（MACE）和靶血管病变处再狭窄情况。结果 观察组即刻手术成功率为95.00%,对照组即刻手术成功率为97.78%,两组即刻手术成功率差异无统计学意义（P>0.05）;两组患者术中并发症发生差异无统计学意义（P>0.05）;观察组MLD术后即刻与术后6个月均低于对照组（P<0.05）;观察组管腔狭窄程度术后即刻均高于对照组（P<0.05）,而术后6个月与对照组比较差异无统计学意义（P>0.05）;观察组管腔再狭窄小于对照组,累计MACE发生率低于对照组（P<0.05）。结论 药物涂层球囊介入治疗即刻成功率较高,明显改善动脉血管狭窄情况,安全性较好。     

570例可弯曲支气管镜术患儿临床诊治分析

目的 通过分析570例行可弯曲支气管镜（FB）术儿童的临床资料,探讨FB在儿童呼吸道疾病诊断及治疗中的价值。方法 回顾性分析2016年1月－2020年12月在该院儿科行FB检查及介入治疗术的570例患儿的临床资料。结果 570例患儿中,术后综合诊断的疾病构成为：气管支气管内膜炎433例（75.96%）,气管支气管异物42例（7.37%）,喉软骨软化41例（7.19%）,塑型支气管炎18例（3.16%）,气管/支气管软化7例（1.23%）,声带麻痹6例（1.05%）,先天性气管食管瘘3例（0.53%）,声门下狭窄3例（0.53%）,气管狭窄3例（0.53%）,舌根囊肿3例（0.53%）,声门下血管瘤2例（0.35%）,原发性纤毛运动不良症2例（0.35%）,烟曲霉菌性肺炎2例（0.35%）,会厌囊肿1例（0.18%）,声门囊肿1例（0.18%）,喉蹼1例（0.18%）,X连锁慢性肉芽肿病1例（0.18%）,后鼻孔闭锁1例（0.18%）。病原体以革兰氏阳性菌为主,肺炎链球菌占比最大。结论 FB检查大大提高了儿童疑难和急危重疾病的诊断速度和准确率,减少了误诊、漏诊,结合经FB介入治疗术可微创、高效、安全地治疗上述疾病。因此,FB检查具有重要的临床价值。     

Evidence-based practice in the management of lower limb lymphedema after gynecological cancer

Purpose: Lower limb lymphedema (LLL) is characterized as a physical-functional chronic complication that impacts the quality of life of women who have gone through treatment for gynecological cancer. The present study aims to check the conservative treatments available for lymphedema after gynecological cancer in the context of evidence-based practice. Methods: The selection criteria included papers from May 1993 discussing treatment protocols used in LLL after treatment for gynecological cancer. The search was performed until October 2014 in MEDLINE, SciVerse, and PEDro using “rehabilitation,” “treatment outcome,” “therapeutics,” “clinical protocol,” “gynecologic surgery,” “lower extremity,” “lower limb,” and “lymphedema” as keywords, focused on women with a previous diagnosis of gynecological cancer who received radiation and/or chemotherapy and/or surgery and/or lymphadenectomy as part of their treatment. Results: From 110 studies found, 3 articles that used the complex decongestive therapy (CDT) as a treatment protocol were selected. There were no randomized clinical trials associated with the conservative treatment of LLL post-treatment of gynecological cancer. The three selected articles are retrospective, and had the same outcome – decreased volume of the affected limb lymphedema. Conclusions: Although LLL is more or as frequent and detrimental as upper limb lymphedema post-cancer treatment, there are only a few studies about this subject. Publications are even scarcer when considering studies with interventional approach. Randomized controlled trials are necessary to support rehabilitation resources on lymphedema post-gynecological cancer treatment.     

Nursing care of 22 patients with complex intracranial aneurysms treated with flow-diverting stents: A retrospective study

ObjectiveTo summarize the nursing treatment of patients who underwent implantation of a blood flow diverter to treat complex intracranial aneurysms.MethodsData from 22 patients with complex aneurysms, diagnosed at an interventional center for blood flow diverter implantation between February 2015 and February 2016, treated in the Henan Provincial People’s Hospital (Zhengzhou, China), were retrospectively analyzed. Nursing methods, including preoperative, intraoperative, and postoperative care, were analyzed.ResultsAll 22 patients underwent successful surgery, with no related complications or hospital mortality, and were cured in hospital.ConclusionInterventional flow diverter therapy for patients with complex intracranial aneurysms is a new technology, and involves intensive care by nursing staff and appears to be a promising new treatment method.     

儿童声门下瘢痕性狭窄呼吸介入治疗效果观察(附23例报告)

目的 观察儿童声门下瘢痕性狭窄介入治疗的效果,总结治愈成功的经验,探讨儿科呼吸介入技术在儿童声门下瘢痕性狭窄中的应用价值.方法 回顾性分析2017年12月-2020年12月昆明市儿童医院呼吸内科收治的23例声门下瘢痕性狭窄患儿的临床资料.其中,男14例,女9例;年龄28 d～8岁.所有病例均有气管插管史,且在拔管后出现...     

Management of traumatic peripheral artery pseudoaneurysm: A 10-year experience at a single center

PurposeThis study aimed to report our 10-year experience with the management of iatrogenic (penetrating trauma) and traumatic (blunt or penetrating trauma) peripheral artery pseudoaneurysms, based on data from a tertiary referral center.MethodsFrom January 2012 to December 2021, the medical records of consecutive patients with iatrogenic and traumatic peripheral artery pseudoaneurysms were retrospectively reviewed. Patient demographics, clinical features, imaging data, treatment details, and follow-up results were analyzed.ResultsSixty-one consecutive patients were included in this study; 48 (79%) were men and 13 (21%) women, with a mean age of 49.4 ​± ​13.4 years (range 24–73 years). There were 42 patients (69%) who underwent open surgery, 18 (29%) undergoing endovascular embolization or stent implantation, and one (2%) undergoing ultrasound-guided thrombin injection. All patients successfully underwent open or interventional treatment. The median follow-up was 46.8 months (2.5–117.9 months), and the overall reintervention rate was 10%. Of these, one (5%) patient in the interventional treatment group and five (12%) patients in the open surgery group underwent reintervention. The overall complication rate was 8%, with complications occurring only in the open surgery group. No deaths occurred in the peri-operative period. No late complications, such as thrombosis or pseudoaneurysm recurrence, were observed.ConclusionPeripheral artery pseudoaneurysms arising from iatrogenic or traumatic causes can be effectively treated by both open surgery and interventional procedures in selected patients with acceptable mid- and long-term outcomes.     

Angiology

The management of vascular disease has become more and more important due to increasing evidence of the extent of peripheral arterial disease in the population and venous thromboembolism in nonsurgical patients. The treatment not only includes the therapy of the cardiovascular risk factors and the application of platelet inhibitors but also the use of new drugs and new endovascular devices. Up till now it is still unclear whether the interventional therapy of carotid stenoses and the endovascular application of stent grafts in abdominal aortic aneurysm are superior to surgery. If the indication is given, hemodynamic renal artery stenoses should be treated by interventional procedures. The effect of medical prophylaxis of venous thromboembolism in nonsurgical patients is evident and proven by large studies. New anticoagulants enlarge the therapy of prophylaxis and treatment of venous thromboembolism.     

超声引导下药物介入治疗辅以中医手法松解治疗冻结肩的疗效观察

目的 探讨超声引导下药物介入治疗并辅以手法松解治疗冻结肩的疗效。方法 对46例冻结肩患者,在高频超声引导下探查肌间沟臂丛并进行臂丛置管,以2%盐酸利多卡因与1%罗哌卡因混合液15 ml阻滞后行肩部手法松解术,并辅以激素类药物注入。比较治疗前、后的效果。结果 治疗后1个月,肩关节被动前屈、外展、外旋活动度,Constant-Murley评分均较治疗前提高,视觉模糊评分较治疗前降低（P均<0.05）。药物介入治疗并辅以手法松解治疗后1个月总有效率为65.22%（30/46）、治疗后2个月总有效率为89.13%（41/46）、治疗后3个月总有效率为93.48%（43/46）。结论 超声引导下药物介入并辅以手法松解治疗冻结肩安全、有效,值得临床推广。     

超声引导下无水乙醇硬化治疗卵巢囊肿后卵巢功能的改变

目的探讨超声引导下无水乙醇硬化治疗卵巢囊肿后卵巢功能的改变。方法观察54例患者59个卵巢囊肿治疗前后囊肿体积改变、卵巢内卵泡、月经周期及月经量、血雌二醇、雌三醇、孕酮水平。结果第1次治疗后,47个囊肿6月内消失,治愈率79.7%(47/59),12个月内55个囊肿消失,治愈率93.2%(55/59)。4个囊肿第2次治疗后6个月内消失,2次治疗后治愈率100%。治疗后第1、2、3次月经周期,在非治疗侧卵巢内可见卵泡,在治疗侧卵巢内未见卵泡。治疗前后雌二醇、雌三醇、睾酮水平均在正常范围。治疗后53例患者月经延迟,延迟时间在2~20天,平均延迟时间(7.2±0.9)天,1例患者月经提前5天。治疗后51例患者月经量减少,2例患者月经量增多,1例患者月经量无变化。治疗后第2或第3次月经周期恢复正常,月经量亦恢复正常。双侧卵巢囊肿同时治疗时,月经延迟时间比单侧更长。结论超声引导下无水乙醇硬化治疗卵巢囊肿后,会造成卵巢功能的短时间紊乱。