生物反馈技术治疗慢性盆底疼痛综合征及慢性前列腺炎

目的：评估生物反馈刺激治疗对慢性盆底疼痛综合征(CPPS)及慢性前列腺炎(CP)的效果。方法：评估30例患者治疗前后，前列腺液(EPS)及精液(SF)和临床症状的变化，包括每日排尿次数、尿急、疼痛和生活质量。使用侵入型的生物反馈刺激治疗仪，治疗周期5～15d，每次20min。结果：30例患者中的14例进行了5次生物反馈治疗，10例进行了10次，6例进行了15次治疗(平均每位患者治疗8．6次)，追踪生物反馈治疗后0～2个月，并比较治疗前和治疗后的结果，显示病情有明显好转。结论：生物反馈刺激治疗对CP或CPPS患者能明显改善疼痛、尿频、尿急和生活质量，对CP患者能减少EPS或SF中的WBC。     

Fallopian tube carcinoma presenting as tubo-ovarian abscess: a report of two cases with literature review

Preoperative diagnosis of fallopian tube carcinoma is difficult, with fewer than 5% being diagnosed preoperatively. We describe tubal carcinoma, presenting as a tubo-ovarian abscess in two 47-year-old women. Both patients presented with abdominal pain, pelvic mass, and fever. Both patients were treated as having a tubo-ovarian abscess but failed to respond to therapy. During surgery a metastatic right tubal carcinoma was found. A definite operation was performed in both patients. Three additional cases of fallopian tube carcinoma, presenting as acute pelvic inflammatory disease, were found while reviewing the English literature. Actually all these three cases presented as tubo-ovarian abscess because of the existence of tender pelvic mass. Carcinoma of the fallopian tube should be considered in the differential diagnosis of tubo-ovarian abscess in those who failed to respond to a previously unreported clinical presentation.     

Emergency Treatment of Multiply Injured Patients with Unstable Disruption of the Posterior Pelvic Ring by Using the “C–Clamp”

Abstract Purpose: Evaluation of the therapeutic usefulness of the “pelvic C–clamp” (PCC) during emergency treatment of multiply injured patients with unstable disruption of the posterior pelvic ring. Patients and Methods: The data of 28 patients with polytrauma in combination with an unstable fracture of the posterior pelvic ring (average Injury Severity Score [ISS]: 49 points; average Polytrauma Score [PTS]: 41 points) were retrospectively analyzed from the moment they were admitted to the emergency room until 48 h after admittance. The PCC was used immediately for primary stabilization of the pelvis after clinical diagnosis of the unstable pelvic fracture. Main outcome measurements: development of mean blood pressure, development of oxygenation level, period of time until the PCC was placed, number of blood units needed, period of time until circulatory stabilization occurred. Results: The PCC was applied in all cases within an average of 64.7 min after trauma. Seven patients (25%) died within the first 45 min after admission. The surviving patients showed:• an increase in mean blood pressure of 25% 20 min after application of the PCC,• a hemodynamic stabilization 6 h after application of the PCC,• a stabilization of the oxygenation level 6 h after application of the PCC,• a decrease in the number of required blood units 6 h after application of the PCC. Conclusion: The present study shows, that the application of the PCC to critically injured patients with unstable pelvic fractures leads to stabilization of the vital parameters within a short period of time.     

Meta-analysis using individual patient data from randomised trials to assess the effectiveness of laparoscopic uterosacral nerve ablation in the treatment of chronic pelvic pain: a proposed protocol

Background  Currently, there are a number of clinical trials, but no international collaboration for collating research on effectiveness of laparoscopic uterosacral nerve ablation (LUNA) for alleviating chronic pelvic pain.
Objective  Meta-analysis was used by collecting individual patient data (IPD) from the existing trials, to provide a comprehensive assessment of the effectiveness of LUNA that will be generalisable in various clinical contexts.
Methods  IPD will be sought and collected from all relevant (both already finished and continuing) randomised trials identified through previous systematic reviews. After obtaining raw data and cleaning the database, analysis will be of all patients ever randomised based on the intention-to-treat principle using endpoints measured at 12 months following randomisation.
Proposal  We will update searches, contact all authors, obtain data in whatever form it can be provided, build a single database, produce results for individual studies, have them verified by original authors, explore of any heterogeneity and reasons behind it and finally pool all raw data in to a meta-analysis using appropriate statistical methods. The project will test the effectiveness of LUNA for women with chronic pelvic pain. It will also motivate collaborating primary investigators to undertake new primary studies to corroborate or improve upon the conclusions derived from the retrospective analysis.     

慢性盆腔痛的腹腔镜诊治

目的 探讨腹腔镜在慢性盆腔痛(CPP)诊治中的应用。方法 对105例CPP患者行腹腔镜检查和治疗，术前均行B超检查。进行病例回顾性分析。结果 腹腔镜证实有病理改变者占95．24％。其中子宫内膜异位症56例，占53．33％，治疗有效率92．86％；慢性盆腔炎27例，占25．23％，治疗有效率88．89％：盆腔静脉瘀血症7例，占6．67％，治疗有效率57．14％；盆腔粘连10例，占9．52％，治疗有效率100．00％。术前B超发现病理改变并经腹腔镜证实者28例，占26．67％，准确率为28．00％。结论 腹腔镜能够明确CPP的病因，并能即时检测和治疗，可作为CPP诊治的常规和首选手段。     

经皮手术治疗骶髂关节损伤的临床解剖学数字化研究

[目的]研究CT扫描三维重建技术对于骶髂关节骨折进行闭合手术治疗的术前指导作用。[方法]选择30个骶髂关节,均行X线片和螺旋CT三维重建后,随机分为3组,每组10个关节。A组:根据CT数据资料于M in ics软件指导下行骨折克氏针固定;B组:于电视X线机下行骨折克氏针固定,根据X线片和螺旋CT资料行骨折克氏针固定。固定后通过生物力学和大体剖面观察,评价不同组间生物力学和解剖学效果。[结果]A、B 2组在力学强度和解剖位置方面均优于C组,差异均有统计学意义(P<0.05),A组和B组在力学强度和解剖位置方面差异不显著(P>0.05)。[结论]Minics软件及三维重建技术可以很好的指导骶髂骨折的手术操作。     

Minilaparotomy for type II and III radical hysterectomy: technique, feasibility, and complications

The objective was to assess the feasibility, the operative and postoperative outcome, and complications in the use of minilaparotomy for type II and III radical hysterectomy (RH) and pelvic lymphadenectomy (PLN) in early-stage cervical/endometrial cancer. A pilot study on 91 consecutive patients submitted to type II and III RH and PLN for early-stage cervical/endometrial cancer was performed between March 2002 and May 2003 in the Division of Gynecologic Oncology (UCSC, Rome). Thirty-two of 91 cases (35.2%) were eligible for minilaparotomy. The mean operative time was 156.7 min, whereas the mean intraoperative estimate of blood loss was 303.7 ml. A mean number of 32.7 pelvic lymph nodes and 6.2 common iliac nodes were removed. Ileus and removal of bladder catheter were on mean postoperative day 2.4 and 3.4, respectively. The mean number of postoperative days spent in the hospital was 3.7. Intra- and postoperative parameters were compared to laparotomy controls and literature data on laparoscopy and Pfannenstiel incision, showing substantially comparable results. Minilaparotomy is acceptable for selected patients undergoing radical abdominal hysterectomy (RAH) and PLN and does not compromise the adequacy of the procedure. It can be considered as an alternative to the classic midline vertical incision or even to the Pfannenstiel incisions and laparoscopy.     

阴道B超介导下后穹窿穿刺治疗盆腔囊肿

目的　介绍阴道B超介导下后穹窿穿刺治疗盆腔囊肿的方法和疗效。方法　 38例盆腔囊肿病人在阴道B超介导下行后穹窿穿刺术 ,并与 2 8例住院行经腹囊肿切除术病人进行对比。结果　阴道B超介导下后穹窿穿刺术治愈率 10 0 % ,复发率 2 6 %。与经腹囊肿切除术相比 ,手术时间短 ,术中出血少 ,病人可接受程度高 ,花费少 ,差异显著 (P <0 0 1)。结论　阴道B超介导下后穹窿穿刺治疗盆腔囊肿 ,方法简便、安全高效、创伤小、价廉 ,是一项理想的保守疗法 ,值得推广应用。     

重组人生长激素对老年人骨盆骨折蛋白质代谢及免疫功能的影响

目的 探讨应用重组人生长激素(recombinant human growth hormone,rhGH)对接受常规肠内营养支持的老年骨盆骨折患者蛋白质代谢及免疫功能的调理作用.方法 选择多发性骨盆骨折(骨折3处以上),年龄＞70岁患者30例,随机分为2组: 治疗组15例,采用标准肠内营养 rhGH[rhGH 0.2U/(kg·d)皮下注射,共计8天];另外15例作为对照组,治疗前和治疗后的第8天,分别测定血清白蛋白、血清转铁蛋白、血清前白蛋白浓度、免疫球蛋白(IgA、IgG、IgM)、T淋巴细胞亚群(CD3、CD4、CD8),并统计医院获得性肺炎的发生情况.结果 治疗组患者在治疗后第8天的血清白蛋白、血清转铁蛋白和血清前白蛋白水平比对照组显著升高(P＜0.05), IgA、IgG、IgM、CD3、CD4、CD4/CD8与对照组相比有明显增高(P＜0.05);治疗组患者医院获得性肺炎的发生率也较对照组显著降低(P＜0.05).结论 在肠内营养支持下加用rhGH可以明显促进老年骨盆骨折患者的蛋白质合成代谢,并改善免疫功能,增加肌肉的收缩力,增强排痰力度,减少医院获得性肺炎的发生率.     

Systematic pelvic and para-aortic lymphadenectomy in advanced ovarian cancer patients with no residual intraperitoneal disease

A comparative non-randomized study was carried out to evaluate the role of systematic pelvic and para-aortic lymphadenectomy (SL) on patients with no residual intraperitoneal disease (NRID) of advanced ovarian cancer (stage IIIC–IV). A total of 142 optimally cytoreduced patients (macroscopic disease absent on peritoneal surface) were divided into two groups: Group A, consisting of 98 patients (53 previously untreated and 45 pretreated at other Institutions), who underwent SL; Group B, consisting of 44 patients (21 previously untreated and 23 pretreated at other Institutions), who did not undergo SL. Each group had statistically equivalent histology, grading, performance status and variety of cytoreductive operations performed. Group A pretreated patients had a greater number of stage III than Group B ( P  = 0.03). Systematic pelvic and para-aortic lymphadenectomy could be carried out with an acceptable morbidity and no mortality. All 142 patients received post-operative chemotherapy including carboplatin. The number of chemotherapy sessions did not differ between the two groups. Comparison of survival revealed that SL significantly improved the survival of previously untreated patients ( P  = 0.02). The survival was significantly different with nodal status ( P  = 0.006). Cox's proportional hazard analysis showed that only systematic lymphadenectomy was a significant covariate. The survival was not significantly different in Group A vs Group B pretreated patients; however, it was significantly different with respect to nodal status ( P <0.001). Cox's proportional hazard analysis showed that only the initial stage of disease was a significant covariate. The results of the present study shows that aggressive surgical cytoreduction with SL could be therapeutic in previously untreated patients with NRID. Currently, an international prospective randomized study is ongoing to clarify definitively the clinical role of SL.