子宫血管缝扎在腹腔镜子宫切除术中的临床疗效研究

目的：探讨腹腔镜下全子宫切除(total laparoscopic hysterectomy,TLH)术中子宫血管缝扎的疗效、安全性以及临床应用价值。方法将78例行TLH患者随机分成子宫血管缝扎组(n=26)、子宫动脉游离结扎组(n=26)和子宫动脉电凝组(n=26),比较三组术中手术时间、出血量以及术后病率等情况。结果78例均在腹腔镜下完成手术,术后无1例并发症发生。子宫血管缝扎组在手术时间、出血量和术后病率等方面与子宫动脉游离结扎组相比,差异无统计学意义(>0.05);子宫血管缝扎组在手术时间和术后病率等方面与子宫动脉电凝组相比差异亦无统计学意义(>0.05),但出血量较后者明显减少,差异有统计学意义(<0.05)。结论子宫血管缝扎应用于TLH,有效阻断了子宫血供,减少了术中出血量,其疗效确切可靠,在TLH中具有较高的临床应用价值,可作为一种可行的手术方式在基层医院推广应用。     

3种胆囊床止血方法在腹腔镜胆囊切除术中应用效果比较

目的:观察腹腔镜下胆囊切除术（LC）中不同胆囊床止血方法的临床效果。方法:随机选取120例择期行腹腔镜下胆囊切除术患者,按照胆囊床止血方式不同分为3组:局部电凝组、全电凝组及生物纸组,比较3组患者术后2、12、24、48 h腹腔累积引流量,并在术前及术后24、72 h检测患者肝功能指标。结果:生物纸组各时间段累计腹腔引流平均量均少于其他两组（P<0.05）,各组组内术后24 h生化指标较术前显著升高（P<0.05）,各组间术后24 h生化指标比较无统计学差异（P>0.05）。结论:腹腔镜下胆囊切除术中应用生物纸处理胆囊床能够有效预防创面出血及渗出,同时具有较好的生物安全性,对人体无不良影响。     

高原肺水肿大鼠肺泡超微结构研究

高原肺水肿已有不少的临床资料报道,但有关高原肺水肿的肺泡超微结构方面的文献尚少。为此,本实验主要应用电镜和硝酸镧示踪电镜术,对模拟6,000米高原缺氧48h时大鼠肺泡超微结构进行了观察,以期为高原肺水肿的发病机制提供形态学基础资料。结果表明,缺氧48h后可引起肺泡结构改变:(1)光镜下肺泡隔增     

腹腔镜巨大子宫切除探讨

目的:探讨腹腔镜切除巨大子宫的可行性.方法:对7例巨大子宫(体积如孕5个月)实施腹腔镜下子宫切除.术中通过上移进腹穿刺点、凝切子宫动脉后,使用电动子宫旋切器切除宫体.结果:所有病例均顺利完成手术,无一例中转开腹.手术时间113～156 min,平均(139±11)min;术中出血量105～214 ml,平均(167±21)ml.术后随访2～18个月,平均(8.9±2.7)个月.无穿刺孔感染,无输尿管、膀胱、肠管损伤,阴道残端愈合良好.结论:腹腔镜切除巨大子宫,通过上移穿刺点和凝切子宫动脉后立即使用电动子宫旋切器切除宫体两项措施,能有效地为手术创造操作空间,有助于提高腹腔镜切除巨大子宫的安全性和可行性.     

腹腔镜卵巢囊肿剔除术中应用不同止血方式对卵巢功能的影响

目的探讨应用不同止血方式对腹腔镜卵巢囊肿剔除术后卵巢功能的影响。方法选取我院自2012年6月至2013年6月行腹腔镜卵巢囊肿剔除术的单侧卵巢囊肿的患者87例,按照止血方式分为电凝组44例及缝合组43例,电凝组采用双极电凝止血,缝合组采用镜下缝合止血,对比2组术前,术后3个月卵巢激素水平及血流参数。结果术前电凝组E2、FSH、LH、P值与缝合组比较,差异无统计学意义(P0.05)。术后E2、FSH、LH、P值与本组术前比较,差异无统计学意义(P0.05)。术后电凝组E2、FSH值较缝合组差异具有统计学意义(P0.05)。术前电凝组及缝合组卵巢截面面积及PSV差异无统计学意义(P0.05)。术后电凝组及缝合组卵巢截面面积差异无统计学意义(P0.05),PSV差异具有统计学意义(P0.05)。结论腹腔镜卵巢囊肿剔除术中应用镜下缝合止血较应用电凝止血对卵巢损伤小,更易保护卵巢功能。     

米非司酮对分泌早期人子宫内膜超微结构的影响

目的:探讨米非司酮对分泌早期人子宫内膜超微结构的影响。方法:子宫内膜组织取自10例排卵后1周内因非子宫内膜原因的疾病而接受子宫切除的育龄妇女。任选5例在手术前24 h口服米非司酮25 mg(米非司酮组), 其余5例未服药者为对照组。子宫内膜组织经常规电镜样品制备后, 进行电镜观察。结果:与对照组相比, 米非司酮组的子宫内膜出现下列明显的形态改变:(1)在腺上皮未见核仁管道系统及巨大线粒体, 核下糖原聚集少见, 但是, 巨大溶酶体常见; (2)腺上皮细胞间隙窄直, 侧膜褶迭少见; (3)基质细胞常出现溶解或核固缩, 并有红细胞渗出。结论:米非司酮引起的上述子宫内膜分泌早期形态改变势必造成胚泡植入的困难, 因而达到紧急避孕的效果。     

235例疑难病理标本的电镜诊断价值

电镜作为一种先进技术手段 ,在医学科研和疾病诊断中作出了重要贡献。近 1 0年我院将光镜与电镜密切配合进行病理诊断 ,现将相关材料分析如下。1　材料与方法1 .1　材料　本组 2 35例标本 ,多为光镜病理疑难诊断病例。每例经石蜡切片 ,先行光镜诊断 ,然后在光镜引导下用电镜观察细胞超微结构特征 ,做出最后病理诊断。标本来源 :①新鲜活检组织 (包括冷冻切片时获取的组织 )。②外检大标本 ,常规取材时有意留取电镜标本 ,以上均固定于戊二醛。③光镜下不能诊断 ,回顾性电镜观察甲醛固定的标本 ,按电镜要求取材 ,缓冲液浸泡 ,再用电镜常规制片…     

腹腔镜下卵巢囊肿剥除术中不同止血方式对卵巢储备功能影响

目的探讨腹腔镜下卵巢囊肿剥除术中创面采用双极电凝及缝合两种止血方式对卵巢储备功能的影响。方法选择卵巢囊肿行腹腔镜手术治疗的患者80例,根据术中创面止血方式随机分为两组：镜下缝合组、双极电凝组,每组各40例。于术前、术后1、3个月月经周期的第2~3d,分别检测患者卵泡刺激素(FSH)、黄体生成素(LH)、雌二醇(E2)、血清抗苗勒管激素(AMH)及阴道超声探测窦状卵泡数目(AFC)、患侧卵巢动脉收缩期峰值血流速度(PSV)为判断卵巢储备功能状态的指标。结果缝合组各项指标手术前后无显著差异(P>0.05)。电凝组术后E2水平,AMH及AFC、PSV与术前相比显著降低,术后FSH水平较术前显著升高(P<0.05)。两组患者LH水平手术前后无显著差异(P>0.05)。结论腹腔镜下卵巢囊肿剥除术中不同的止血方式对卵巢储备功能的影响有差异,其中双极电凝止血法较镜下缝合止血法所致卵巢储备功能下降更加显著。     

新生儿缺氧缺血性脑病62例血电解质分析

目的通过对新生儿缺氧缺血性脑病(HIE)患儿血电解质变化分析,以提高临床抢救的成功率.方法本文对62例HIE患儿进行血钠、血钾、血氯、血钙测定,并以42例正常新生儿作为对照.结果对照组与HIE组间、HIE不同临床分度间血钠、血氯、血钙均有显著性的差异(P<0.01,中、重度间血钙(P<0.05),各组间血钾测定均无显著性差异P>0.05).结论在处理HIE患儿时应严密监测血电解质,注意内环境平衡,避免更严重脑损伤.     

腹腔镜下子宫肌瘤剔除术临床应用

目的 评估腹腔镜下子宫肌瘤剔除术(LM)的临床应用价值.方法 2008年1月～2009年12月我院共在腹腔镜下行子宫肌瘤剔除术患者270例,术中肌壁注射垂体后叶素12U,子宫收缩变硬后,在子宫肌瘤最突出部位用单极电凝钩纵切口或横切口切开子宫肌层.如果肌瘤较大,可采用肌瘤表面梭形切口,切去部分肌瘤包膜,再用有齿抓钳钳夹固定瘤核边旋转边向上提拉,钝性分离肌瘤假包膜,完整剥除肌瘤.肌瘤剥除后剖面电凝止血,0-1薇乔线修复子宫.创面小者采用"8"字缝合,切口大者采用连续及扣锁缝合法.结果 本组病人均成功在腹腔镜下行子宫肌瘤剔除术,术后恢复顺利.结论 腹腔镜下子宫肌瘤剔除术(LM)是一种安全、可行、临床效果好的微创术式.     

A case-control study to compare the variability of operating time in laparoscopic and open surgery.

The purpose of this study was to compare the variability of operating times for some of the most common gynaecological procedures performed laparoscopically and by open surgery. The case notes of 60 women randomly selected from a cohort of 600 who had undergone laparoscopic surgery for ectopic pregnancy, ovarian cysts, leiomyoma and hysterectomy were reviewed. These patients were matched with an equal number of women who had been treated by open surgery for similar indications. Additional matching criteria included age (+/-2 years), size of the lesion in cases of ovarian cysts and fibroids (+/-3 cm), the period of amenorrhoea in ectopic pregnancies, and uterine size and pelvic pathology in women undergoing hysterectomy. Comparison of laparoscopy and laparotomy showed that the mean procedure times were similar for the two routes of surgery, with the exception of hysterectomy which took significantly longer if done laparoscopically. The duration of laparoscopic surgery for ectopic pregnancy, ovarian cystectomy and hysterectomy was significantly less predictable than at laparotomy. These data indicate that with the exception of hysterectomy, the average operating time for laparoscopic procedures is comparable to that for laparotomy. In contrast, the variability of duration of laparoscopic surgery tends to be much greater than with laparotomy for all procedures considered.     

Surgical routes and complications of hysterectomy for benign disorders: a prospective observational study in French university hospitals

BACKGROUND: Despite the advantages of the vaginal and laparoscopic approaches, most hysterectomies carried out involve laparotomy. The objective of this prospective observational multicentre study was to examine the routes and complications of hysterectomy for benign disorders. METHODS: Of the 15 university hospitals belonging to Collégiale de Gynécologie-Obstétrique de Paris-Ile de France, 12 participated in this study that took place between June and December 2004. We analysed the characteristics of the patients, the indications for hysterectomy and intra- and post-operative complications (and their determinants) according to the surgical approach. RESULTS: In total, 634 women underwent hysterectomy for benign disorders during the study period. The patients' mean age (+/-SD), BMI, parity and previous Caesarean sections were 51.4 +/- 10.3 years, 25 +/- 5.7 kg/m(2), 2 +/- 1.6 children and 0.2 +/- 0.6, respectively. Hysterectomy was performed by the laparoscopic, laparoscopically assisted vaginal hysterectomy (LAVH), laparotomic and vaginal routes in 19.1, 8.2, 24.4 and 48.3% of cases, respectively. The operating time was shorter with the vaginal route than with laparoscopy, laparotomy and LAVH (P < 0.0001). Intra- and post-operative complications were significantly more frequent in the laparotomic group (18%) compared with the vaginal group (8.2%), the laparoscopic group (5.8%) and the LAVH group (8.2%) (P < 0.0001). In a multivariate logistic regression model, obesity [odds ratio (OR): 2.84, 95% confidence interval (CI): 1.53-5.27, P = 0.001], history of pelvic surgery (OR: 2.47, 95% CI: 1.39-4.39, P = 0.002) and history of Caesarean section (OR: 2.04, 95% CI: 1.01-4.1, P = 0.046) were significantly associated with intra- and post-operative complications. Laparoconversion was necessary in 36 cases (7.5%) overall and was more frequent with laparoscopy and LAVH than with the vaginal route (P < 0.0001). CONCLUSIONS: This study confirms that the vaginal route is increasingly used for hysterectomy in France and that it is the route of choice for benign disorders.     

Ureteral complications from laparoscopic hysterectomy indicated for benign uterine pathologies: a 13-year experience in a continuous series of 1300 patients

BACKGROUND: The aim of this study was to evaluate the risk of ureteral injuries and to discuss how to avoid their occurence after laparoscopic hysterectomy indicated for benign uterine pathologies. METHODS: This observational study covers the period from January 1993 to December 2005 (retrospective study from 1993 to 2000 and prospective from 2001). We reviewed incidence, methods of diagnosis and management of ureteral injuries. RESULTS: The rate of ureteral injuries was 0.3% (four patients). Three patients presented a ureteral fistula diagnosed secondarily some time after the operation. The fourth patient presented a ureteral injury that was diagnosed peroperatively. Three out of four of the lesions were observed on the right side. In every case, there were preoperative risk factors connected with a past history of surgery, or the lateral location of uterine myomas. All four patients needed ureterovesical reimplantation. The outcome was good in all four cases. CONCLUSIONS: The rate of ureter complications after laparoscopic hysterectomy is low and comparable to that observed after hysterectomy by laparotomy. The risk should not prevent laparoscopic hysterectomy being used more widely. Prevention depends on training in the technique and the surgeon's experience.     

单相抑郁症致病因素的研究

为了了解单相抑郁症的发病原因，对连续发作3次或发作1、2次，缓解≥8年，诊断符合CCMD－2－R抑郁症及DSM－4重症抑郁障碍的108例患者进行致病因素的研究。结果显示单相抑郁症患者女性显著多于男性；病前性格内向者显著多于中间及外向型；秋季发病者显著高于其他季节；家族中有单相抑郁症阳性家族史者显著高于其他精神疾病阳性家族史；一级亲属中单相抑郁症的发病风险显著高于群体。提示生物因素是单相抑郁症发病的重要因素。     

Ureteral injury during laparoscopically assisted radical vaginal hysterectomy

We report on a case of ureteral injury during laparoscopicallyradical hysterectomy to treat a patient with a stage IA² carcinomaof the uterine cervix. The advantage of laparoscopically radicalhysterectomy is the prevention of the identification and dissectingof the ureter from a vaginal approach, the main problem in theSchauta technique. However, ureteral injury may still occurwhile resecting the cardinal ligament without good visualizationof the ureter during a vaginal procedure. Because the ureterwas well identified and freed laparoscopically, a vaginal approachafter uterine removal may be an option for treatment. Moreover,using the ureteral stent as a marker during a modified Schautatechnique is helpful in the prevention of ureteral injury duringlaparoscopically assisted radical vaginal hysterectomy.     

新式非脱垂子宫经阴道切除术213例临床观察

目的探讨提高新式非脱垂子宫经阴道切除术优越性和安全性的技巧。方法2001年1月至2005年12月我院妇科行新式非脱垂子宫切除术213例,与1999年1月至2000年12月新式非脱垂子宫切除术76例作对比分析。结果2001年至2005年组手术时间缩短、术中出血减少、术后住院时间缩短、术后随诊半年残端息肉减少（P〈0.05）。2001年至2005年组与1999年至2000年组术后体温恢复正常时间与术后肛门排气时间比较,差异无统计学意义（P〉0.05）。结论通过不断提高手术技巧,优化手术细节,简化手术步骤,熟练术中配合,增加了阴式全子宫切除的优越性和安全性。     

Laparoscopic myolysis

This review will focus on the different techniques and the long-term effects of the technique called myolysis on myoma growth. Indications for myolysis are essentially pelvic pain, compression symptoms and global uterine volume in order to avoid hysterectomy. In the late 1980s, myolysis was performed laparoscopically with the help of the neodynium: yttrium aluminium garnet (Nd:YAG) laser. Later, bipolar needles were developed as an alternative to the Nd:YAG laser. Diathermy and cryomyolysis were also proposed but series are small in the literature. Very recently, myoma interstitial thermo-therapy (MITT) was performed using the diode laser and a specific optical light diffuser that is designed to transmit laser light in all directions. Laparoscopic myolysis was proved to be effective in provoking myoma shrinkage, with a dramatic decrease in size and a marked devascularization of the myoma and this technique can be proposed as an alternative to myomectomy in selected patients: only those aged >40 years or those not desiring to bear any more children.     

Laparoscopically assisted full thickness skin graft for reconstruction in congenital agenesis of vagina and uterine cervix

In patients with agenesis of the vagina and cervix but with a functional endometrium, the traditional treatment is hysterectomy with construction of a neovagina. We report successful treatment by laparoscopically assisted full thickness skin graft for reconstruction in a patient with congenital agenesis of the vagina and uterine cervix concomitant with haematometra and ovarian endometrioma in a 12 year old girl. Postoperatively, the vaginal skin graft healed well, and menstruation first appeared 4 weeks later. In our opinion, a combined laparoscopic and vaginal procedure with full thickness skin graft is an efficacious alternative in managing such genital defects.     

Is microscopic assessment of macroscopically normal hysterectomy specimens necessary?

AIM: To determine whether microscopic examination of macroscopically normal hysterectomy specimens yields findings that could alter subsequent clinical management. METHODS: All pathology reports on hysterectomy specimens submitted to the department of histopathology at the Northern General Hospital from January 1997 to December 1998 were reviewed. Cases were included for further assessment if the hysterectomy specimen was regarded as macroscopically normal by a consultant pathologist and if the patient had no history of, or suspicion of, neoplastic disease. The subsequent microscopic findings from these cases were assessed to determine whether any lesions of clinical importance were identified. RESULTS: Eight hundred and fifty four specimens were reviewed, of which 139 were suitable for inclusion. Only one of the 139 cases harboured a microscopic abnormality that necessitated specific clinical follow up; this was a focus of cervical intraepithelial neoplasia 2 (CIN 2). On follow up of that patient, no further neoplastic disease was identified. CONCLUSION: Microscopic assessment of macroscopically normal hysterectomy specimens does not contribute to patient management and is unnecessary in an era of manpower shortage and cost containment.     

Multipolar electrocoagulation in the treatment of active upper gastrointestinal tract hemorrhage. A prospective controlled trial

The benefit of nonsurgical therapy in the treatment of active nonvariceal upper gastrointestinal tract hemorrhage is uncertain. I performed a prospective controlled trial of endoscopic multipolar electrocoagulation for active upper gastrointestinal hemorrhage. Patients were considered for entry if they had a bloody nasogastric aspirate, melena, or hematochezia, and any of the following: unstable vital signs, a requirement of greater than or equal to 2 units of blood per 12 hours, or a drop in hematocrit of greater than or equal to 6 percent in 12 hours. Forty-four patients were randomly assigned to receive multipolar electrocoagulation or sham multipolar electrocoagulation if endoscopy revealed active bleeding from an ulcer (24 patients), a Mallory-Weiss tear (17), or a vascular malformation (3). The group receiving multipolar electrocoagulation did significantly better in terms of hemostasis (90 percent vs. 13 percent, P less than 0.0001), mean (+/- SE) transfusion requirements (2.4 +/- 0.9 vs. 5.4 +/- 0.9 U; P = 0.002), mean number of hospital days (4.4 +/- 0.8 vs. 7.2 +/- 1.1, P = 0.02), and percentage needing emergency surgery or another intervention (14 vs. 57 percent, P = 0.01). Although mortality was lower in the group receiving multipolar electrocoagulation (0 vs. 13 percent), this difference was not statistically significant. The mean cost of hospitalization for treated patients was less than half that for the controls ($ 3,420 +/- 750 vs. $ 7,550 +/- 1,480, P = 0.001). I conclude that multipolar electrocoagulation markedly improves the hospital course in patients with major, nonvariceal upper gastrointestinal hemorrhage.