高频电灼加留置硅胶管治疗泪小管阻塞

目的 探讨高频电灼联合硅胶管植入术治疗泪小(总)管阻寨的适应证,手术方法和临床疗效.方法 对2年来行高频电灼联合硅胶管植入术治疗的泪道阻塞62例(68只眼),进行回顾性分析.结果 62例(68只眼)泪小(总)管阻塞有效率达88.2%.结论 高频电灼联合硅胶管植入术治疗泪小(总)管阻塞具有成功率高,操作简便,并发症少,经济,损伤小和美观等优点,具有临床适用价值.     

泪道内镜下治疗泪道阻塞性疾病的初步观察

Objective To evaluate the therapeutic efficacy of lacrimal endoscope treatment for lacrimal passage obstruction, and to compare the effectiveness of endoscopically controlled laser surgery and micro-drill surgery for lacrimal passage obstruction. Methods It was a prospective random controlled trial. Eighty nine patients (104 eyes) with lacrimal passage obstruction, including presaccal canalicular obstruction (PSCO) and nasolacrimal duct obstruction (NLDO), were collected from September 2006 to December 2006 in Department of Ophthalmology, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology. Patients were examined by endoscopy of the lacrimal drainage system under local anesthesia to detect the obstruction and changes of lacrimal mucous membrane. The obstructions were treated with laser or microdrill. Irrigation was performed to prove the recanalization of the lacrimal passage followed by injected ointment with 0.3% tobramycin and 0.1% dexamethasone into the lacrimal passage. All patients were followed up after the operation for 9-12 months. The difference between the laser and the microdrill treatment was observed. Chi-square test was used to evaluate the curative effect and complications differences between these two groups. Results The obstruction scene in the lacrimal passage of 89 patients could be observed effectively. All obstructions (104/104 eyes) were eliminated after the operation. Through the follow-up, the cure rate reached 78.85% (82/104 eyes). The cure rate of PSCO group and NLDO group, reached 77.78% (42/54 eyes) and 80.00% (40/50 eyes), respectively (χ2=0.077,P=0.782). The cure rate of laser group and micro-drill group, was 80.43% (37/46 eyes) and 77.59% (45/58 eyes), respectively (χ2=0.125,P=0.724). The cure rate of laser treatment was 89.66% (26/29 eyes) in the PSCO group and 64.71% (11/17 eyes) in the NLDO group (P=0.040). The cure rate of micro-drill treatment was 64.00% (16/25 eyes) in the PSCO group and 87.88% (29/33 eyes) in the NLDO group (χ2=4.664,P=0.031). Hemorrhage and palpebral edema occurred in 10.87% (5/46 eyes) and 4.35% (2/46 eyes) after laser treatment, respectively. Percentage of hemorrhage and palpebral edema after the micro-drill treatment was 55.17% (32/58 eyes) (compared to the laser group, χ2=21.969,P=0.000) and 6.90% (4/58 eyes) (compared to the laser group, χ2=0.017 ,P=0.896). Conclusions Lacrimal passage obstruction can be observed and treated directly through the endoscopy of lacrimal drainage system. Choosing an appropriate surgical procedure according to the locations of the obstruction can be helpful for improving the effectiveness of the operation.     

经尿道前列腺汽化电切术治疗前列腺增生56例报告

目的 为探讨经尿道前列腺汽化电切术治疗前列腺增生的治疗效果。方法 采用经尿道前列腺汽化切割术结合电切术治疗前列腺增生56例。结果 手术时间45～90分钟，平均60分钟；切除前列腺组织重量为15～80g，平均30g；术中输血5例。无发生经尿道电切综合征(TURS)，2～4天拔除尿管，均能自行排尿。随访2～22个月，IPSS评分由术前29．6分降至9．5分；QOL评分由术前4．7分降至2．05分；最大尿流率(Qmax)由术前7．3ml／s增加至18．5ml／s；短暂性尿失禁3例；尿道狭窄2例。结论 经尿道前列腺汽化电切术具有微创伤、安全有效、适应证相对较宽的特点。     

慢性宫颈炎电环宫颈切除术51例治疗体会

目的:分析51例慢性宫颈炎电环宫颈切除术。方法:高频电波刀宫颈切除术。结果:51例慢性宫颈炎治愈率 96.07％。结论:此方法具有创伤小、疗效好、恢复快、不损伤宫颈机能等优点。     

高危前列腺增生症经尿道前列腺电汽化切除的围手术期处理

目的总结高危前列腺增生症(BPH)围手术期处理体会,提高手术治疗的疗效和安全性。方法进行全面详细的临床检查,客观评价重要脏器功能,有效治疗内科原有疾病,然后采用经尿道前列腺电汽化切除术(TUVP)治疗高危患者96例。结果平均随访6.8个月,前列腺症状评分、生活质量评分、最大尿流率和残余尿量均较术前明显改善。结论TUVP治疗BPH期间,加强围术期处理措施,不仅其疗效显著,且可做到创伤小、安全性高和并发症少。     

高龄前列腺增生症患者经尿道前列腺汽化电切术并发症的防治

经尿道前列腺汽化电切术(TUVP)是前列腺增生症(BPH)新兴术式．与传统手术相比具有创伤小．恢复快、住院时间短的优点，能最大限度地减少术中及术后出血．并限制灌洗液体的吸收，避免产生电切综合征。我院自2001-02-2003-05对96例高危BPH患者进行此项手术，现报告如下。     

宫腔镜电切术中灌洗液吸收对患者血生化指标的影响

目的了解宫腔镜手术中灌洗液的吸收对患者血生化指标的影响。方法选择宫腔镜电切术患者60例,以5%葡萄糖作为膨宫介质,于术前、术毕、术后1、3h分别采静脉血测定血清钠、氯、钾、CO2-CP、尿素氮、肌酐、血浆渗透压、阴离子间隙及血糖等指标,结果应用SPSS10.0统计软件进行分析。结果60例患者除1例液体吸收超过2000ml者出现轻微恶心外,无手术并发症的发生。术后血清钠、钾、血浆渗透压、阴离子间隙、尿素氮均较术前明显下降,血糖较术前明显升高(P<0.05)。其中血清钠、尿素氮、血浆渗透压、阴离子间隙于术后1h最低,而血糖的最高值及血钾最低值均出现在手术结束时,术后3h各项指标逐渐恢复正常。结论宫腔镜电切术中灌洗液的吸收可导致一过性血清钠、钾、尿素氮、血糖、血浆渗透压及阴离子间隙的改变,减少灌洗液的吸收,术中术后严密监测血生化指标的变化是宫腔镜手术成功与安全的关键。     

TUVP结合TURP治疗前列腺增生症体会

我院1998年3月～2003年2月开展经尿道前列腺电气化术(TUVP)结合经尿道前列腺切除术(TURP)治疗前列腺增生症(BPH)387例，效果满意。     

脑电双频指数用于全麻闭环靶控输注丙泊酚和吸入异氟醚的临床观察

靶控输注(Target controllxd infusion)是根据药物药代动力学模型以血浆浓度或效应室浓度来反馈控制药物效应的计算机输注系统。临床常用丙泊酚静注，但麻醉深度没有监测指标，本文以脑电双频指数(BIS)作为麻醉深度监测指标，比较靶控和传统的吸入维持方法对应激参数及心率、血压的变化，来探讨合理的靶控复合麻醉方法。     

3例经尿道前列腺电切综合征治疗体会

目的 :探讨经尿道前列腺电切综合征的发生原因及治疗措施。方法 :回顾性总结1996年11月～2003年8月 ,施行经尿道前列腺电切术 (TURP)258例的经尿道前列腺电切综合征 (TURS)的发生情况。结果 :本组发生TURS3例 ,经治疗病情均得到了妥善控制 ,本组无死亡病例。结论 :TURS是TURP最严重的并发症。其发生机理是低渗灌注液吸收引起稀释性低钠血症。手术切破前列腺包膜是在短期内造成大量冲洗液吸收的主要原因。当确定为TURS时 ,立即给予速尿、吸氧、高渗盐水、胰岛素、地塞米松等治疗 ,同时应中止手术。