甲氨蝶呤在异位妊娠手术中的作用

为观察异位妊娠手术时应用甲氨蝶呤与单纯手术治疗预后的影响 ,我院于 1 990～ 1 998年对手术治疗有再生育要求的输卵管妊娠 1 0 6例 ,预防性应用甲氨蝶呤 56例 ,常规手术治疗 50例 ,均定期随访 ,发现甲氨蝶呤能显著降低继续或再次异位妊娠发生率 ,提高输卵管复通率。1　对象和方法1 1　对象　 1 0 6例中 ,年龄 2 2～ 30岁 ,初次妊娠 5例 ,有 1～ 3次人工流产史 1 0 1例 ,均未生育。均表现为月经规律 ,停经≤ 60ｄ ,非间质部妊娠者 ,腹腔内出血 >1 0 0ｍｌ,对侧输卵管正常者 ,按就诊先后随机分为甲氨蝶呤组 56例 ,常规治疗组 50例。 2　治…     

氨甲喋呤与米非司酮治疗异位妊娠21例临床护理

异位妊娠 (俗称宫外孕 )是指受精卵在子宫腔以外着床发育 ,是妇科常见的急腹症之一。近年来其发生率有明显升高的趋势 ,并采用了一些保守治疗方法 ,使病人免于手术创伤 ,并能保留生育功能。我院妇产科用氨甲喋呤与米非司酮联合用药治疗异位妊娠 2 1例 ,取得良好效果 ,其治疗中护理体会如下。1　临床资料1 1　治疗对象　 2 1例病人均为异位妊娠未破裂型。全部住院治疗。年龄最小 18岁 ,最大 36岁 ,平均2 6岁。入院后均查血常规、肝、肾功能正常。1 2　临床表现　均有停经史 ,平均孕期 4 7ｄ (34～6 2ｄ)。 16例有阴道不规则少量流血。 18例有…     

76例异位妊娠临床分析

异位妊娠(俗称宫外孕)是指受精卵在子宫腔以外着床发育 ,是妇产科常见的急腹症之一 ,近年来国内外报道其发病率有明显增加的趋势〔1、2〕。本病如诊断及时 ,处理正确可减少病人的痛苦 ,使病人转危为安 ,我院自 2 0 0 0 -0 1～ 2 0 0 0 -1 2 ,共收治 76例异位妊娠 ,现分析如下。1　临床资料1 1　一般资料　患者年龄最小 2 0岁 ,最大 4 3岁 ,以 2 5～ 35岁最多 ,占 78 94 %。异位妊娠的类型 ,输卵管妊娠 73例 ,其中流产型 4 5例 ;破裂型 2 8例 ,陈旧性宫外孕 3例。在异位妊娠的发病因素中 ,有人工流产史 4 0例 ,慢性盆腔炎 2 3例 ,输卵管绝育…     

子宫内妊娠误诊为异位妊娠10例

近年来 ,由于人绒毛膜促性腺激素 ( β ＨＣＧ)检测敏感性的提高和高分辨的阴道Ｂ超的发展 ,使异位妊娠的早期确诊率有很大的提高 ,但部分受精卵着床较晚的子宫内孕 ,临床症状、体征与异位妊娠极其相似 ,易被误诊为异位妊娠。 1 9961 998年 ,我院收治子宫内孕被误诊为异位妊娠共 1 0例。1　临床资料1 1　一般情况　本组年龄 2 1 3 5岁 ,停经 3 762ｄ ,初孕3例 ,人工流产史 3例 ,药物流产史 4例。 2次以上人工流产史 (含药物流产 ) 4例 ,尿ＨＣＧ均阳性。1 2　误诊情况　 1 0例中 ,月经不规律 8例 ,就诊时下腹疼痛 7例 ,阴道少许出血 3例。…     

卵巢黄体破裂22例的临床分析

卵巢黄体血肿破裂临床较常见 ,但容易误诊。本院从1993年 1月～ 2 0 0 1年 12月共收此类患者 2 2例 ,现对其临床特点作一分析。1　临床资料1 1　一般资料　本组 2 2例 ,年龄 18～ 39岁 ,平均 2 8 5岁 ,已婚 2 0例 ,未婚 2例。有生育史 19例 ,未孕 3例。置环 19例。1 2　首发时间与诱因　 2 2例月经周期为 2 5～ 5 0ｄ ,30ｄ者 3例。急腹症发生于月经周期第 9～ 14ｄ者 5例 ,第 15～ 2 0ｄ者 4例 ,第 2 2～ 30ｄ者 10例 ,第 5 6～ 6 0ｄ者 3例。13例为同房后出现腹痛 ,2例为取环后腹痛 ,2例为腹泻后腹痛 ,其余 5例无诱因。1 3　临床表现　 2 …     

腹腔镜治疗有妇产科手术史的异位妊娠82例

目的 探讨有妇产科手术史的异位妊娠患者行腹腔镜治疗的可行性、适应证、手术方法和临床价值.方法 对82例有妇产科手术史的异位妊娠患者采用腹腔镜手术治疗.其中有1次手术史者60例,2次者21例,3次者1例.根据不同情况所采取的手术方式有:①腹腔镜直视下穿刺注药法;②输卵管切除术;③输卵管妊娠病灶切除术;④腹腔镜下输卵管切开取胚术;⑤输卵管妊娠孕囊吸出术;⑥间质部妊娠手术新方法,包括注射垂体加压素和电凝术式、妊娠组织排出前内套圈套扎术式和妊娠组织排出前荷包缝合术式等.结果 82例异位妊娠患者经腹腔镜探查发现,73例盆腹腔内有不同程度的粘连,粘连率为89.0%(73/82).其中有1次手术史的60例患者中,51例存在盆腹腔粘连,粘连率为85%;有2次以上手术史的22例患者中,全部有盆腹腔粘连,粘连率100%.70例腹腔镜手术成功,成功率85.4%,其余12例因盆腔粘连严重而中转开腹,占14.6%.12例中,合并子宫内膜异位症5例,慢性盆腔炎6例,既往有宫外孕手术史者9例;剖宫产手术史者2例;有复杂妇科手术史者1例.手术并发症包括合并盆腔子宫内膜异位症患者术中肠管损伤1例,转为开腹手术.合并盆腔子宫内膜异位症患者术后3天确诊输尿管损伤1例,转泌尿科手术治疗.腹腔镜手术时间为30～180min.结论 腹腔镜治疗有妇产科手术史的异位妊娠是一种理想的手术方式.慢性盆腔炎、子宫内膜异位症及宫外孕手术史尤其是2次宫外孕手术史会增加手术难度,中转开放手术几率较高,术前应做好相应的准备.     

B超误诊早期异位妊娠9例

B超在诊断异位妊娠中起重要作用 ,但诊断早期异位妊娠仍时有偏差。现将早期异位妊娠 9例的误诊情况分析如下。1　临床资料1 1　一般情况　 2 6～ 38岁。初次妊娠 2例 ,2～ 5次人流或药流史 7例。已生育 5例 ,未育 4例。停经 36～ 4 5天 ,尿HCG阳性 6例 ,弱阳性 3例。有停经、不规则出血伴腹痛 5例。1 2　方法　使用ALOKA 6 30型超声仪 ,3 5MHz线阵或扇扫 ,充盈膀胱取仰卧位 ,个别以侧卧位 ,于下腹部行纵、横、斜位扫查 ,显示子宫及邻近断面图像。1 3　结果　B超示宫腔内孕囊液性暗区 ,双附件未探及包块 4例 ,诊断为宫内孕 ,行药物流产…     

人工流产致子宫穿孔17例临床分析

我院 1985～ 1999年收治人工流产致子宫穿孔 17例 ,现就穿孔的原因和处理报道如下。1　临床资料1.1　 1985～ 1999年我院共施行人工流产术 10 436人 ,发生子宫穿孔 13例 ,发生率为 0 .12 %。院外转入 4例。年龄 17～36岁 ,平均 2 8岁。停经 36～ 10 8ｄ ,平均 5 1ｄ ,术前 3例未查尿ＨＣＧ ,6例未做妇科Ｂ超检查。未产妇 2例 ,经产妇 15例 ,其中 8例有剖宫产史 ,哺乳期 5例 ,1例为哺乳期闭经误诊为早孕而行人工流产术致子宫穿孔。1.2　子宫穿孔与使用器械 :探针穿孔 3例 ,扩张器和吸管 12例 ,刮匙 1例 ,同时使用吸管、卵圆钳、刮匙 1例。1.3…     

220例剖宫产术后的观察护理

自从 1999年 1月～ 2 0 0 0年 8月共分娩 75 3例其中剖宫产 2 2 0例 ,占分娩总数的 30 4%,现将护理体会作总结如下 :1　临床资料和方法1.1　一般资料　 2 2 0例剖宫产中 ,年龄 2 1～ 37岁 ,平均2 6 5岁剖宫产原因分类 ,过期妊娠 ,巨大儿 35例 ,占11 36 %,双胎 5例 ,占 2 3%,产前子疒间12例 ,占 5 4%,胎儿宫内窘迫 47例 ,占 2 1 3%,头盆不称与高直后位 5 9例 ,占2 6 6 %,臀足位 2 6例 ,占 11 6 %,妊娠合并子宫肌瘤 ,卵巢囊肿 6例 ,占 2 7%,妊娠合并心律不齐 5例 ,占 2 2 7%,2次剖宫产女结扎术 9例 ,占 4 0 9%,胎膜早破 ,羊水过多 16例…     

腹腔镜治疗有妇产科手术史的异位妊娠76例

目的：探讨腹腔镜治疗有妇产科手术史的异位妊娠患者的可行性和安全性。方法研究对象为126例有妇产科手术史、并再次接受腹腔镜治疗的异位妊娠患者,其中有1次妇产科手术史者84例,有2次及以上妇产科手术史者42例。比较1次手术史、2次及以上手术史患者术中情况及术后并发症。结果126例患者中,手术成功112例,中转开腹14例,发生并发症7例。结论腹腔镜治疗有妇产科手术史的异位妊娠手术成功率高,1次手术史有效性与安全性更高。     

Dealing with cancer--conversations with radiotherapy patients

Thirty in-patients treated by radiotherapy were questioned in qualitative interviews about the information they had received from the physicians and their way to deal with the disease and the physicians. Furthermore 18 persons out of this group were accompanied continuously. The confidential relationships between the patients and the author of the study brought about spontaneous conversations showing some new aspects of the way to experience disease and therapy. Despite a poor prognosis and an initially insufficient information, the patients formulated their questions openly. Generally they desired a clearer communication. They criticized above all the lack of information and attention from the physicians. A need for confidence, frankness, and the conveyance of a justified hope was expressed. The physician's stress and resulting lack of time was complained of. During the time of accompanying which lasted several weeks, it became evident that information means a way to deal with the disease to which the patient can make his individual contribution. The majority of questions as well as emotional reactions as fear or depression came from those patients who seemed to be quiet persons.     

Radiochemotherapy with temozolomide for patients with glioblastoma

Background

The objective of this retrospective analysis was to assess long-term outcome and prognostic factors of unselected patients treated for glioblastoma (GB) at a single center with surgery, standard radiotherapy (RT), and concomitant temozolomide (TMZ). From 1999?C2005, the institutional protocol included surgery and RT with TMZ. From 2005 on, adjuvant TMZ was routinely added.

Patients and Methods

Between April 1999 and September 2009, 181 patients with GB were treated with RT (60 Gy in 30 fractions) and concomitant TMZ (75 mg/m²/day throughout RT). Biopsy only had been performed in 53 patients (29.3%), 128 patients (70.7%) had undergone resection, which was complete based on postoperative MRI in 51 patients (28.2%). Adjuvant TMZ was applied in 67 of 181 patients (37%).

Results

Median overall survival (OS) and progression-free survival (PFS) were 15.0 (95% CI, 13.1?C16.8) and 7.2 months (95% CI, 5.9?C8.5), respectively. After complete resection, partial/subtotal resection and biopsy, median OS was 23.20, 14.75, and 7.89 months (p < 0.001), respectively. In multivariate Cox proportional hazards regression models, extent of resection (p < 0.0001), Karnofsky??s performance score (p < 0.0001) and adjuvant TMZ (p = 0.001) were significant independent prognostic factors for OS. RT with concomitant TMZ was well tolerated in the majority of patients and could be completed as scheduled in 146 patients (80.7%), while 11 patients (6.1%) discontinued RT. Another 35 patients (19.3%) interrupted concomitant chemotherapy.

Conclusion

RT with concomitant TMZ is a feasible regimen with acceptable toxicity in routine practice. Our data are compatible with a beneficial effect of adjuvant TMZ on OS and PFS.     

Bronchogenic carcinoma: staging with MR compared with staging with CT and surgery

Thirty-three patients suspected of having bronchogenic carcinoma were studied prospectively using magnetic resonance (MR). In this group, 30 underwent examination with computed tomography (CT), 15 underwent thoracotomy, six had mediastinal biopsy procedures performed, and eight underwent bronchoscopy. MR studies, which included transaxial spin-echo imaging (TR, 0.5 and 2.0 sec; TE, 28 and 56 msec) of all patients and sagittal or coronal imaging of 18, were performed without knowledge of CT findings, using only plain radiographs as a guide. CT and MR studies were interpreted separately. CT and MR provided comparable information regarding the presence and size of mediastinal lymph nodes. MR better discriminated mediastinal nodes from vascular structures. However, in two of 11 patients who had multiple mediastinal lymph nodes that were normal in size at CT examination and surgery, MR suggested a confluent abnormal mass, probably because of its poorer spatial resolution. MR was superior to CT in showing enlarged hilar lymph nodes, but CT was better for demonstrating bronchial abnormalities. In three of four patients who had a proved hilar mass with distal obstructive pneumonia, MR (TR, 2.0 sec) helped distinguish between the mass and collapsed lung.     

湿润烧伤膏与手术联合治疗褥疮的护理

目的 :减少溃疡期褥疮的术前准备时间 ,缩短褥疮的总病程。方法 :将 1996年 5月至 2 0 0 2年 5月收住院的 4 2例溃疡期褥疮病人按随机原则分为 2组 ,2 1例术前用湿润烧伤膏纱换药处理 ,为A组 (试验组 ) ;2 1例用庆大霉素紫草油纱布换药处理 ,为B组 (对照组 )。 2组病例的年龄、性别、发病原因、病灶部位、病灶范围等经统计学处理 ,无显著性差别 ,有可比性。两组病人均换药至创面新鲜行皮瓣转移手术 ;比较两组平均术前换药时间 ,及换药 +手术的总住院日。术前术后两组患者均运用护理程序施行整体护理。结果 :A组术前平均换药时间为 8 4 9± 2 2 3天 ,B组为 15 6 0± 6 70天 ;A组平均治愈时间为 2 0 5 0± 4 81天 ,B组为 35 31± 7 70天。结论 :湿润烧伤膏换药与庆大霉素紫草油纱布换药比较 ,前者可明显缩短褥疮手术的术前准备时间及病人的总住院天数。     

臭氧治疗船员下肢损伤89例

2006年10月至2007年4月,我科采用引进的德国赫尔曼Medozon型臭氧发生装置系统产生的臭氧治疗船员下肢损伤89例,疗效满意.现报告如下.     

多虑平、雷尼替丁治疗消化性溃疡81例临床观察

1995年 1月～ 1 998年 2月 ,我们采用多虑平、雷尼替丁治疗消化性溃疡 (ＰＵ) ,并与雷尼替丁为对照组进行治疗观察 ,疗效满意 ,现总结报告如下。1　临床资料1 1　一般资料　本组 81例ＰＵ均因上腹痛、返酸、腹胀及食欲不振等症状 ,经胃镜诊断为溃疡活动期患者。病程 2个月～ 5ａ,平均 1 7ａ。伴有焦虑、抑郁及夜眠欠佳等症者59例。随机分为 2组 :治疗组 4 1例 ,男 3 8例 ,女 3例 ;年龄 1 8～ 3 6岁 ,平均 2 4岁。其中胃溃疡 1 1例 ,十二指肠球部溃疡 3 0例。对照组 4 0例 ,男 3 7例 ,女 3例 ;年龄 1 9～ 3 5岁 ,平均 2 4 5岁 ;胃溃疡 1 2…     

Tumor Burden Assessment with Positron Emission Tomography with

Objective: In patients with advanced cancer, total tumor burden affects the likelihood of tumor response and has important implications for prognosis. The aim of this study was to select the optimum 2-[F-18]fluoro-2-deoxy-D-glucose-positron emission tomography (FDG PET) tumor uptake parameter to accurately measure tumor burden in advanced metastatic renal cell cancer, in comparison with volumes measured with computed tomography (CT), as a reference test.Materials and Methods: Six patients with metastatic renal cell carcinoma measurable on CT were studied. CT and FDG PET scans were carried out on all patients within 4 weeks prior to their entry into a phase I-II radioimmunotherapy trial. CT-based evaluation of disease extent (tumor volume) and 4 PET-based measurements (standardized uptake value[SUVmax], SUVav, volume, and total lesion glycolysis [TLG]) were performed independently by a radiologist (VN) and a nuclear medicine physician (TA). The degree of correlation between conventional (CT) extent of disease and parameters describing tumor concentration of FDG was then determined.Results: Fifty-seven CT-measurable metastatic lesions in lung, abdomen, and scalp were evaluated in 6 patients. There was a high correlation between CT and FDG PET volume estimates for lesions greater than 5 cm(3) in size. However, a PET-derived parameter that embodies both FDG uptake and lesion size, the TLG, correlated better with CT-derived tumor volume than did FDG PET volume alone.Conclusion: Using CT volume as a gold standard, the optimal PET-based estimate of total tumor burden in patients with metastatic renal cancer is the sum over all lesions of the total lesion glycolysis.