腹腔镜手术和开腹手术治疗盆腔炎性包块的比较

目的:探讨腹腔镜手术治疗盆腔炎性包块的可行性及其价值。方法:收集1999年6月至2004年7月间,41例腹腔镜手术治疗的盆腔炎性包块及13例开腹手术病例,比较其住院天数、费用、疾病种类、手术和术后恢复情况。结果:腹腔镜手术和开腹手术相比较,两组手术时间、住院费用及手术费用差异无显著性(P>0.05),腹腔镜组手术并发症、术中出血量少于开腹手术组,术后排气时间、体温恢复到正常时间、血象恢复时间、术后拆线时间、住院时间均短于开腹手术组,差异有显著性(P<0.05)。结论:腹腔镜手术治疗盆腔炎性包块是可行的,具有较好的临床应用价值。     

输卵管妊娠术后生殖状况及其影响因素分析

目的分析引起输卵管妊娠手术治疗后不同生殖状况的相关因素,探讨改善生殖状况,提高宫内妊娠率的方法.方法对自1999-01-2003-12在中山大学附属第一医院等两家医院的424例输卵管妊娠患者经腹腔镜或剖腹手术治疗后患者生殖状况及其相关影响因素进行多重Logistic回归分析及x2分析,找出引起术后不孕及重复性异位妊娠的原因.结果424例患者术后宫内妊娠177例,占41.7%;出现重复性异位妊娠102例,占24.1%;有145例患者术后仍然未孕,占34.2%.多重Logistic回归分析提示,盆腔炎、不孕、异位妊娠、输卵管手术、输卵管粘连、输卵管伞端闭锁是输卵管妊娠术后不孕及重复性异位妊娠的危险因素.结论积极预防盆腔病变,治疗不孕症是改善输卵管妊娠术后生殖状况的重要手段.     

子宫全切术不缝合盆腔腹膜对术后并发症的影响

目的观察子宫全切术不缝合盆腔腹膜与缝合盆腔腹膜术后并发症有无差异。方法选择子宫全切术缝合盆腔腹膜41例(对照组),子宫全切术不缝合盆腔腹膜44例(观察组),分别观察子宫全切术后性生活及并发症的情况。结果观察组与对照组相比,术后性生活感觉良好(P<005),对照组术后盆腔疼痛以及淋巴囊肿发生率较多(P<005),观察组淋巴囊肿发生率低。结论子宫全切术不缝合盆腔腹膜术后并发症较少,患者生活质量较高,建议子宫全切术取消缝合盆腔腹膜的习惯。     

Rectus abdominis myocutaneous flap in radical oncopelvic surgery: A safe and useful procedure

AIMS: The aim of this retrospective study was to evaluate the usefulness of rectus abdominis myocutaneous (RAM) flaps to treat locally advanced pelvic gynaecological or digestive tumours. METHODS: We reviewed 46 patients, who received RAM flaps after radical oncopelvic surgery, including: (a) total vaginal reconstruction (TVR); (b) partial vaginal reconstruction (PVR); (c) perineal reconstruction (PR). RESULTS: Between 1989 and 1998, 46 patients underwent pelvi-perineal reconstruction with RAM flaps after radical pelvic surgery for carcinoma of the cervix (n=22), anal carcinoma (n=11), rectal carcinoma (n=7), or other pelvic tumours types (n=6). There were two post-operative deaths. Overall surgical morbidity was 45, 6% (n=21). Specific morbidity of the RAM flap was 21, 7% (n=10). Global re-intervention rate was 13% (n=6). CONCLUSION: Rectus abdominis myocutaneous flap in radical oncopelvic surgery is useful for vaginal or perineal reconstruction and prevention of pelvic collections after extended resections with a low rate of associated morbidity.     

经会阴四维盆底超声动态成像对初产妇膀胱膨出疾病分级与分型的临床价值

目的 探讨经会阴四维盆底超声动态成像对初产妇膀胱膨出疾病分级与分型的临床价值。方法 选取西安市第三医院2018年1月~2018年6月收治的盆底功能障碍性疾病（膀胱膨出）初产妇92例为研究对象,根据产妇的分娩方式分为经阴道分娩组（n=46）及剖宫产组（n=46）。在静息、屏气向下用力动作（Valaslva）及缩肛状态下观察两组患者膀胱尿道及盆膈裂孔的超声成像变化,测量膀胱相关参数数值并进行膀胱膨出Green分型。 结果 两组产妇经会阴盆底超声参数比较中,静止期BSD、尿道膀胱后角比较,差异均无统计学意义（均 P＞0.05）;剖宫产组产妇张力期BSD、尿道膀胱后角及膀胱颈移动度、尿道旋转角均明显小于经阴道分娩组产妇（均 P＜0.05）。 经阴道分娩组产妇膀胱膨出Green分型中,Ⅰ型6例（13.04%）,Ⅱ型26例（56.52%）,Ⅲ型14例（30.43%）;剖宫产组产妇膀胱膨出Green分型中,Ⅰ型14例（30.43%）,Ⅱ型23例（50.00%）,Ⅲ型9例（19.56%）。经阴道分娩组Ⅰ型膀胱膨出者明显少于剖宫产组,差异有统计学意义（P＜0.05）;而两组产妇Ⅱ型、Ⅲ型膀胱膨出例数比较,差异无统计学意义（P＞0.05）。结论 经会阴四维盆底超声检查可清楚显示盆底解剖结构,有效区分不同分娩方式产妇的盆底Green类型,为临床制定治疗方案提供可靠的影像学资料。     

骨科损伤控制治疗不稳定骨盆骨折合并四肢多发骨折的临床疗效观察

目的:分析研究骨科损伤控制(DCO)治疗不稳定骨盆骨折合并四肢多发骨折的临床效果。方法:回顾性分析我院收治的42例不稳定骨盆骨折合并四肢多发骨折患者采用骨科损伤控制治疗的效果。结果:42例患者救治成功39例,痊愈率92.9%,死亡3例,所占比例为7.1%。术后5个月观察可见4例患者因患肢功能异常,其余35例患者可自理生活;术后10个月随访观察可见,骨折愈合效果良好。结论:不稳定骨盆骨折合并四肢多发骨折实施连续性骨科控制,疗效显著。     

Tubo-ovarian Abscess in Virginal Adolescent Females: A Case Report and Review of the Literature

BackgroundA tubo-ovarian abscess (TOA) is a serious complication of pelvic inflammatory disease (PID), predominantly polymicrobial and present in sexually active women. TOA in virginal adolescent females are extremely rare but have serious and lifelong consequences.CaseA 13 y.o. virginal female presented to the Emergency Room of a tertiary care pediatric hospital with abdominal pain and vomiting. Imaging suggested bowel compromise with potential perforation. An exploratory laparotomy revealed TOA which grew Escherichia Coli. This is the first reported case of Escherichia Coli TOA due to suspected bowel translocation.ConclusionReview of the literature identified 8 cases of TOA in virginal adolescents. Given the severity of outcomes following TOA, this pathology should be considered in the differential diagnosis of virginal adolescents who present with fever and abdominal pain. If suspected, a prompt gynecology consult should be initiated, followed by a first line antibiotic therapy and when indicated, surgical drainage.