腹腔镜与输尿管镜治疗妇科手术致输尿管损伤的临床对比研究

目的:探究与分析腹腔镜与输尿管镜治疗妇科手术致输尿管损伤的临床效果。方法:选取我院自2012年9月至2015年9月收治的100例妇科手术致输尿管损伤患者,按照不同处理方式分为腹腔镜组与输尿管镜组,每组各50例,腹腔镜组给予腹腔镜下输尿管修补术联合内支架引流术,输尿管镜组给予输尿管镜下输尿管支架引流术,对比两组患者手术时间、术中失血量、尿瘘平均消失时间、双J管留置时、治疗前后肾功能及并发症发生率。结果:腹腔镜组与输尿管镜组相比尿瘘平均消失时间、双J管留置时间均无明显差异(P0.05)。相比手术时间、术中失血量有显著差异(P0.05),两组患者的随访时间无明显差异(P0.05),且均未出现感染、肾功能异常、肾积水、输尿管狭窄、输尿管梗阻等严重并发症,在随访期间未见1例复发。腹腔镜与输尿管镜组治疗后较治疗前相比Scr降低、BUN降低、肾小球滤过率升高(均P0.05)。两组治疗后相比SCr、BUN及肾小球滤过率无明显差异(P0.05)。结论:采用腹腔镜下输尿管修补术联合内支架引流术与输尿管镜下输尿管支架引流术治疗妇科手术致输尿管损伤均具有显著疗效,易于被患者认可接受,值得推广。     

妇科腹腔镜手术并发泌尿系统损伤的相关分析

目的:观察研究妇科腹腔镜手术并发泌尿系统损伤的情况,并探讨其相关因素。方法:选取2008年3月至2014年4月我院于妇科进行腹腔镜手术治疗的1895例患者为研究对象,将其中的泌尿系损伤发生率进行统计,并比较其中不同年龄、盆腔手术史、盆腔粘连情况、手术类型、子宫体积、子宫内膜异位症及电凝电切功率患者的发生率,并将上述因素与泌尿系损伤的关系采用Logistic分析进行处理。结果:1895例患者中共发生11例泌尿系损伤,发生率为0.58%,其中输尿管损伤3例(0.16%)、膀胱损伤8(0.42%),不同年龄者的发生率无明显差异,P0.05,而其中有盆腔手术史、盆腔粘连、子宫全切术、子宫体积较大、存在子宫内膜异位症及电凝电切功率过大者的发生率明显高于其他患者,经Logistic分析其均与泌尿系损伤有密切的关系,P均0.05,均有显著性差异。结论:妇科腹腔镜手术并发泌尿系统损伤的发生率较低,但是危害较大,其中盆腔手术史、盆腔粘连、手术类型、子宫体积较大、子宫内膜异位症及电凝电切功率较大均是其高危因素。     

不同术式膀胱阴道瘘修补术治疗妇科手术后膀胱阴道瘘的临床分析

目的:分析探讨不同术式膀胱阴道瘘修补术治疗妇科手术后膀胱阴道瘘的疗效。方法:回顾性分析北京大学第三医院泌尿外科2009年4月至2015年11月收治的12例膀胱阴道瘘患者的临床资料。12例患者均有妇科手术史:其中行子宫全切术10例,行盆腔肿物切除术1例,行膀胱电切术1例。从手术损伤致出现阴道漏尿的病程为5~12个月,平均8.4±2.9个月。膀胱镜检查测量瘘口直径0.3~2cm,平均(1.1±0.6)cm。12例均为单发瘘口。结果:6例患者行经阴道途径膀胱阴道瘘修补术。平均手术时间为(105.0±32.0)min,平均术中出血(4.5±1.2)mL,平均术后住院时间(3.0±1.5)d。6例患者术后6个月未见复发;3例患者行经腹腔镜途径膀胱阴道瘘修补术。平均手术时间为(345.3±192.3)min,平均术中出血(83.3±28.9)mL,平均术后住院时间(10.3±3.2)d。2例随访6月未见复发,1例术后6月发生膀胱阴道瘘复发,行二次手术修补;1例患者采用开放经腹腔途径膀胱阴道瘘修补术。手术时间为234min,术中出血200mL,术后住院时间40d。术后出现伤口脂肪液化,予定期换药治疗后好转,随访6月未见复发;1例患者发生Studer原位新膀胱阴道瘘,采用经腹经阴道联合途径的手术方式,手术时间为224min,术中出血100mL,术后住院时间20d,随访6月未见复发;1例患者因瘘口较小采用膀胱镜下膀胱阴道瘘口电凝术,手术时间为10min,术中出血2mL,术后住院时间2d,术后出现不自主漏尿,复查膀胱镜仍可见膀胱后壁瘘口,遂留置尿管1月,1月后行经阴道膀胱阴道瘘修补术,随访6月未见复发。结论:妇科手术导致的膀胱阴道瘘可以通过手术修补治愈。经阴道修补手术成功率高,术后恢复较快。对于能够经阴道显露、分离及缝合的膀胱阴道瘘尽可能行经阴道修补手术。     

武汉地区妇科手术中泌尿道损伤的流行病学调查分析

目的:调查武汉地区妇科手术中泌尿道损伤的发生情况,并分析相关因素,为加强泌尿道损伤的管理提供参考。方法:回顾性分析2015年6月至2016年6月在武汉地区7362例行妇科手术的患者,对其进行回顾性研究分析。结果:7362例行妇科手术患者中,共有24例患者发生泌尿道损伤,发生率为0.32%,其中输尿管损伤16例(0.22%),膀胱损伤8例(0.11%)。在手术方法中,以腹腔手术导致术中泌尿道损伤的发生率最高,为0.45%。在疾病类型中,子宫内膜癌及内膜异位症术中致泌尿道损伤的发生率最高,均为0.07%;在妇科手术方式中,广泛性子宫全切术引起的泌尿道损伤发生率最高,为2.46%。在导致妇科手术中泌尿道损伤的原因中,因癌性致密粘连造成患者泌尿道损伤的发生率最高(33.33%),而失误操作也是导致妇科手术中泌尿道损伤的主要原因之一,为25.00%。结论:武汉地区妇科手术中泌尿道损伤以输尿管损伤为主,腹腔镜手术术中泌尿道损伤并发症发生率最高,子宫颈癌、内膜异位症等广泛性子宫全切术致泌尿道损伤高发,致密粘连、失误操作是造成泌尿道损伤的主要因素,而子宫骶骨韧带处及子宫动脉横跨输尿管处为泌尿道损伤的高发部位。     

腹腔镜广泛全子宫切除及盆腔淋巴结清扫术39例临床分析

目的研究在腹腔镜辅助下行子宫恶性肿瘤根治术的可行性及其近期疗效。方法建立CO2气腹、腹腔镜经腹探查肿瘤浸润程度及脏器转移等,腹腔镜下广。泛性全子宫切除及盆腔淋巴结清扫。对行腹腔镜广泛全子宫切除加盆腔淋巴结清扫术39例的临床资料作回顾性分析。结果39例均在腹腔镜下完成广泛全子宫切除加盆腔淋巴结清扫术,无中转开腹手术。手术时间（230．2±45．9）min,平均236min。术中出血量（298．2±85．3）ml,平均325ml,术中均未输血。清扫淋巴结（17．2±5．6）枚,平均清扫18枚。术中元脏器损伤发生,术后并发症发生率12．82％（5／39）。术后近期生活质量良好,远期生活质量有待观察。结论早期子宫恶性肿瘤行腹腔镜广泛全子宫切除加盆腔淋巴结清扫安全可行,根治效果与开腹手术相近,且具有创伤小、术后恢复迅速等优点。     

泌尿系输尿管子宫内膜异位症临床的诊断及治疗特点分析

目的：探讨泌尿系输尿管子宫内膜异位症临床的诊断及治疗特点。方法：收集我院从2000年3月-2006年3月间入院治疗的输尿管子宫内膜异位症患者35例。平均年龄39±1．5（25—55）岁，病程平均时间为1．3±0．6（1～4）年。按照病变部位分型分为：输尿管左侧18例，右侧17例。临床上以腰腹部不适为发病特点，影像学检查肾盂分离2．5±0．2（2．0—4．5）cm，输尿管中上段扩张1．3±0．1（1．0～2．0）orn。15例患者均行手术治疗，术后病理结果显示均为输尿管子宫内膜异位症。术后为患者服用17d-乙炔睾丸酮200mg，2＆／d，疗程为半年～1年。结果：35例患者均得到完整随访，随访年限平均为3．8±0．9（1～5）年，其中33例患者治疗效果良好，未见复发。2例输尿管子宫内膜异位症患者于术后2年出现复发，进行内置输尿管支架管后给予口服17a-乙炔睾丸酮及注射戈舍瑞林治疗，治疗4个月后治疗成功。结论：输卵管子宫内膜异位症由于前期无特异性的临床表现术前确诊困难，需术后进行病理确诊。在治疗上采取手术效果显著，术后进行药物配合可减低和预防复发的机率。     

宫颈癌患者腹腔镜广泛子宫切除术中盆腔自主神经功能保留对患者性功能的影响分析

目的:探讨宫颈癌患者腹腔镜广泛子宫切除术中盆腔自主神经功能保留对患者性功能的影响。方法:选取本院2014年6月至2015年6月在院并经病理证实为宫颈癌并行腹腔镜下广发全子宫切除术的患者70例,采用随机数字表法分为观察组和对照组各35例,对照组采用常规腹腔镜下广泛子宫切除术,观察组采用腹腔镜下广泛子宫切除术并保留盆腔自主神经,比较两组术后性功能、生命质量及尿流动力学。结果:两组患者术前性功能FAFI评分无明显差异,术后6个月两组患者FAFI评分均较术前下降,差异有统计学意义;观察组术后1年FAFI评分与治疗前无明显差异,对照组术后1年FAFI评分较术前下降,观察组术后6个月、术后1年FAFI评分均明显高于对照组,差异有统计学意义(P0.05);观察组患者躯体功能及情绪功能均高于对照组,差异有统计学意义(P0.05);而社会功能评分、认知功能、角色功能及症状子量表总评分、总健康状况评分及总生命质量评分在两组之间无明显差异(P0.05);观察组患者尿意初始时的膀胱容量、最大排尿量、排尿次数、残余尿体积、尿意强烈的膀胱容量等尿流动力学指标均优于对照组,差异有统计学意义(P0.05)。结论:保留盆腔自主神经的腹腔镜下广泛子宫切除术有利于宫颈癌患者术后性功能的恢复。     

阴道旁修补联合骶棘韧带固定术治疗阴道前壁脱垂疗效观察

目的:探讨经阴道阴道旁修补(VPVR)联合骶棘韧带固定术(SSLF)在阴道前壁脱垂治疗中的疗效及安全性。方法:回顾性分析柳铁中心医院2008年1月至2012年12月57例经盆腔器官脱垂定量分期法进行分期(POP-Q),确定为子宫及阴道前壁脱垂患者的临床资料,按手术方式的不同分为对照组和观察组。对照组32例行传统经阴道子宫切除术(TVH)及阴道前壁修补术,观察组25例在阴式子宫切除(TVH)基础上行阴道旁修补术(VPVR)及骶棘韧带固定术(SSLF)组合术式。术后定期随访,对手术临床效果及并发症情况进行评估。结果:两组手术时间及术中出血量比较对照组优于观察组(P0.05);术后随防1年,观察组的临床治愈率明显高于对照组(P0.05);术后不适感发生率观察组明显低于于对照组(P0.05);两组均未发生膀胱、尿道损伤及其他部位损伤。结论:阴道旁修补联合骶棘韧带固定术修复阴道顶端及中段旁缺陷,较好恢复原有解剖状态,在治疗阴道前壁脱垂中疗效满意。     

腹腔镜下根治性子宫切除术治疗宫颈癌的效益与风险探讨

目的:探讨腹腔镜下根治性子宫切除术治疗宫颈癌的效益与风险。方法:选取我院妇科收治的160例宫颈癌患者,随机分为两组,观察组80例采用腹腔镜下根治性子宫切除术(LRH),对照组80例采用经腹根治性子宫切除术(ARH),比较两组患者术中、术后各项指标(包括手术时间、术中失血量、淋巴结清扫数、切缘残留、首次肛门排气时间、术后盆腔引流量、住院天数、住院总费用及手术相关并发症),并对两种治疗方式的优缺点进行对比分析。结果:LRH组在术中失血量、术后肛门首次排气时间、住院时间、术后盆腔引流量及手术并发症方面优于ARH组(P0.05),但两组手术时间、淋巴结清扫数目、切缘残留及住院总费用比较差异无统计学意义(P0.05)。结论:LRH手术治疗宫颈癌在技术上是安全可行的,具有创伤小、失血少、肠道功能恢复快及住院时间短等优势,并且可达到与ARH手术相同的根治效果,具有较好的效益和风险比,值得临床推广应用。     

腔镜手术与开腹手术对妇科盆腔手术患者术后生殖系统功能影响的对照研究

目的：观察及比较腔镜手术与开腹手术对妇科盆腔手术患者术后生殖系统功能的影响。方法：选取2010年9月至2013年4月于本院进行妇科盆腔手术治疗的98例患者为研究对象,将其根据手术方式分为A组（开腹手术组）49例和B组（腔镜手术组）49例,然后将两组患者手术前和手术后1个月、3个月的卵巢功能指标、国际女性性功能评估量表评分及月经异常发生率进行比较。结果：B组手术后的卵巢功能指标波动均小于A组,国际女性性功能评估量表评分均好于A组,月经异常发生率低于A组,P均〈0.05,均有显著性差异。结论：腔镜手术对妇科盆腔手术患者术后生殖系统功能的不良影响小于开腹手术,临床应用价值相对更高。     

Outcomes and adverse effects of ablative vs nonablative lasers for skin resurfacing: A systematic review of 1093 patients

It is generally believed that ablative laser therapies result in prolonged healing and greater adverse events when compared with nonablative lasers for skin resurfacing. To evaluate the efficacy of ablative laser use for skin resurfacing and adverse events as a consequence of treatment in comparison to other modalities, a PRISMA‐compliant systematic review (Systematic Review Registration Number: 204016) of twelve electronic databases was conducted for the terms “ablative laser” and “skin resurfacing” from March 2002 until July 2020. Studies included meta‐analyses, randomized control trials, cohort studies, and case reports to facilitate evaluation of the data. All articles were evaluated for bias. The search strategy produced 34 studies. Of 1093 patients included in the studies of interest, adverse events were reported in a total of 106 patients (9.7%). Higher rates of adverse events were described in nonablative therapies (12.2% ± 2.19%, 31 events) when compared with ablative therapy (8.28% ± 2.46%, 81 events). 147 patients (13.4%) reported no side effects, 68 (6.22%) reported expected, transient self‐resolving events, and five (0.046%) presented with hypertrophic scarring. Excluding transient events, ablative lasers had fewer complications overall when compared with nonablative lasers (2.56% ± 2.19% vs 7.48% ± 3.29%). This systematic review suggests ablative laser use for skin resurfacing is a safe and effective modality to treat a range of pathologies from photodamage and acne scars to hidradenitis suppurativa and posttraumatic scarring from basal cell carcinoma excision. Further studies are needed, but these results suggest that ablative lasers are a superior, safe, and effective modality to treat damaged skin.     

New fillers for the new man

ABSTRACT:  Two new collagen-based lidocaine-containing dermal fillers, ArteSense™/ArteFill™ (Artes Medical, San Diego, CA) and Evolence® (Colbar LifeScience Ltd., Herzliya, Israel), have proved to be of particular interest to men, many of whom seek a long-lasting or permanent correction. ArteFill™ has been available in the United States since 2006, and it is expected that Evolence® will reach the American market in 2008. The properties of the two products will be described, and experience based on the administration of many hundreds of syringes of both products by a Canadian dermatologist will be detailed here, with tips and precautions to optimize patient outcomes.     

Multiple New-Onset Subcutaneous Nodules of the Upper Extremity Digits: Giant Cell Tumor of Tendon Sheath and Lipoma

A black woman with the concurrent onset of two subcutaneous nodules located on the digits of her upper extremities is described. Initially, a single systemic disorder was considered; yet, the lesions differed in morphology and consistency. Microscopic examination of the nodules showed a giant cell tumor of tendon sheath and a lipoma. Although Occam's “razor” suggests that multiple lesions in the same person are more likely to represent variable manifestations of a single disorder than several different diseases in that individual, the simultaneously appearing lesions in this patient represented two different conditions.     

Genetic alterations in RAS‐regulated pathway in acral lentiginous melanoma

Studies integrating clinicopathological and genetic features have revealed distinct patterns of genomic aberrations in Melanoma. Distributions of BRAF or NRAS mutations and gains of several oncogenes differ among melanoma subgroups, while 9p21 deletions are found in all melanoma subtypes. In the study, status of genes involved in cell cycle progression and apoptosis was evaluated in a panel of 17 frozen primary acral melanomas. NRAS mutations were found in 17% of the tumors. In contrast, BRAF mutations were not found. Gains of AURKA gene (20q13.3) were detected in 37.5% of samples, gains of CCND1 gene (11q13) or TERT gene (5p15.33) in 31.2% and gains of NRAS gene (1p13.2) in 25%. Alterations in 9p21 were identified in 69% of tumors. Gains of 11q13 and 20q13 were mutually exclusive, and 1p13.2 gain was associated with 5p15.33. Our findings showed that alterations in RAS‐related pathways are present in 87.5% of acral lentiginous melanomas.     

Deutliche Einschränkung der Lebensqualität bei Patienten mit Pemphigus vulgaris: Ergebnisse der deutschen Bullous Skin Disease (BSD)‐Studiengruppe

Background: Pemphigus vulgaris is a potentially life‐threatening autoimmune disorder of the skin and mucous membranes characterized by antibodies against epidermal adhesion molecules. Clinically characteristic are painful chronic blisters or erosions of mucous membranes and skin. There are no published studies on the impact o this disease on quality of life. Patients and methods: This registration was performed within the scope of the German BSD (Bullous Skin Disease) study group, from November 1997 until January 2002. A total of 36 patients with the first diagnosis of pemphigus vulgaris were registered at the university hospitals of Dresden, Erlangen, Kiel, Mannheim, München and Würzburg. Thirty of the 36 (83 %) patients participated in the quality of life questionnaire utilizing the German version of ‘Dermatology Life Quality Index’ (DLQI) provided by A. Y. Finlay. The DLQI varies from 0 to 30 with an increased DLQI score indicating a decrease in quality of quality. Results: The overall DLQI total score of 10 ± 6,7 in the investigated pemphigus patients was significantly increased in comparison to other skin diseases. Conclusions: These results suggest that the DLQI can be a very useful additional outcome criteria for clinical studies with pemphigus vulgaris and in the treatment of these patients.     

Medición del impacto psicológico en pacientes con psoriasis en tratamiento sistémico

Background and objectives

The negative impact of psoriasis on patient quality of life can be as important as the physical consequences of the disease. We could assume that clearance of the disease would also lead to an improvement in its psychosocial impact. The present study assesses the psychological state of patients with psoriasis receiving systemic treatment in a psoriasis unit, especially those with mild or no disease involvement.

Mutations in mevalonate pathway genes in patients with familial or sporadic porokeratosis

Porokeratosis comprises heterogeneous keratinization disorders that are characterized by one or more atrophic patches surrounded by a ridge‐like cornoid lamella. In this study, we evaluated seven families affected by porokeratosis and five sporadic patients of the disease in a Chinese population. We performed Sanger sequencing of exons and flanking intron–exon boundaries of mevalonate pathway genes (MVD, MVK, PMVK and FDPS) and of SLC17A9. In five familial and three sporadic patients, we detected six variations, including four novel mutations (MVD c.1A>G; p.Met1?, c.916G>A; p.Ala306Thr, c.1013+1G>A, and PMVK c.65A>G; p.Lys22Arg) and two recurrent mutations (MVD c.746T>C; p.Phe249Ser, and MVK c.1028T>C; p.Leu343Pro). We then applied I‐TASSER and iGEMDOCK to assess these variants for probable functional impacts. The findings of this study extend the mutation spectrum of porokeratosis and provide further evidence for the genetic basis of this disease.