腹腔镜辅助式小切口在超大卵巢囊肿剥除术中的应用

目的探讨应用腹腔镜辅助式小切口剥除超大卵巢囊肿的可行性和应用价值。方法选择该院妇科2001年1月￣2004年1月收治的超大卵巢囊肿病人64例,随机分为改良组(腹腔镜辅助组)34例和对照组(腹腔镜组)30例,对比分析两种手术方式的手术时间、出血量、CO2用量以及术后病率的情况。结果两组病例均手术成功,无中转开腹,经统计分析:改良组的手术时间为(30±8.5)min,明显少于对照组(45±12.7)min,改良组CO2用量(60±10.1)L也明显少于对照组(102±18.7)L,差异有显著性。出血量、肛门排气时间和术后病率无差异。结论腹腔镜辅助的经腹壁小切口行大卵巢囊肿剥除是安全有效的,不仅同样具有微创的优点,而且简便易行,缩短了手术时间,节约了病人费用。     

腹腔镜下子宫肌瘤核除术40例临床分析

目的 探讨腹腔镜下子宫肌瘤核除术的手术适应证、禁忌证、手术技巧、手术效果及术后并发症。方法 对该院2002-年1月～2005年6月于腹腔镜下行子宫肌瘤核除术的40例病例作回顾性分析。结果 共核除肌瘤54个。单发肌瘤36例，多发肌瘤4例。镜下缝合38例，未缝合2例。手术时间、出血量与肌瘤的大小、个数成正比。术后平均住院时间4d，1例术后出现发热。结论 浆膜下肌瘤、单发壁间肌瘤直径小于7cm，于腹腔镜下行子宫肌瘤核除术效果好，手术时间短，出血少，并发症少。     

保持宫腔完整的黏膜下大肌瘤腹腔镜剔除术

目的探讨大的黏膜下子宫肌瘤腹腔镜剔除术时即保持宫腔完整又减少术中出血的手术方法的疗效。方法2006年3月～2007年3月对21例直径达6～9cm的部分位于黏膜下的大肌瘤采用假包膜套扎法进行腹腔镜下肌瘤剔除手术。结果所有21例患者均十分成功地完成保持宫腔完整的大黏膜下肌瘤腹腔镜下剔除术,术中无1例宫腔开放,术后无1例宫腔出血。手术时间61～98min,平均(72.8±17.6)min,术中出血25～85mL,平均(55.7±21.6)mL,术后8～12h,平均(9.5±0.7)h离床活动,术后排气时间14.5～20.6h,平均(17.6±1.5)h,术后住院天数3～5d,平均(3.8±0.5)d。19例术后随访3～12个月,术前有膀胱或直肠压迫症状者,术后均已消失。经血过多及经期延长症状均明显好转。结论肌瘤假包膜套扎法腹腔镜下大黏膜下肌瘤剔除术既确保术中宫腔的完整性,又减少术中出血,同时又不影响术后子宫的血运,是一种既安全可靠又效果显著的手术方法。     

Robotic-assisted vs. laparoscopic and abdominal myomectomy for treatment of uterine fibroids: a meta-analysis

Uterine fibroids are extremely common uterine neoplasms. However, whether robotic-assisted laparoscopic myomectomy (RALM) is superior to laparoscopic myomectomy (LM) or abdominal myomectomy (AM) is still debatable. Consequently, we aimed to compare the three currently major surgical techniques used in patients with uterine fibroids. We searched the PubMed, the Cochrane Library, MEDLINE, Embase, and Web of Science databases up to April 22, 2017. The meta-analysis included 20 studies involving 2852 patients. The number of complications [odd ratio (OR) 0.52, p?=?0.009], estimated blood loss (EBL) [weighted mean difference (WMD) ?33.03, p?=?0.02], conversions (OR 0.34, p?=?0.03), and postoperative bleeding (OR 0.18, p?=?0.03) in RALM cases was significantly less than that for LM. The numbers of complications (OR 0.56, p?=?0.03), length of hospital stay (WMD ?1.74, p?p?p?p?相似文献   

腹腔镜下和经腹子宫肌瘤剔除术的临床比较

目的比较腹腔镜下子宫肌瘤剔除术和经腹子宫肌瘤剔除术的临床效果。方法收集经腹腔镜或开腹剔除肌瘤、最大肌瘤直径小于8cm的患者资料,其中腹腔镜组82例,开腹组78例,比较其手术前、手术中、手术后的情况,并进行随访。结果两组手术时间、剔除肌瘤总重量、剔除肌瘤个数差异无显著性;比较两组术中出血、最大肌瘤位于子宫后壁[腹腔镜组13.41%(11例)vs开腹组23.08%(18例)]、术后发热[腹腔镜组21.95%(18例)vs开腹组48.72%(38例)]、术后使用止痛剂[腹腔镜组41.46%(34例)vs开腹组67.95%(53例)]、住院时间[腹腔镜组(7.14±1.67)dvs开腹组(10.25±2.76)d]、生活恢复自理时间[腹腔镜组(5.45±2.82)dvs开腹组(10.61±5.27)d]和重返工作岗位时间[腹腔镜组(28.25±11.18)dvs开腹组(39.12±13.25)d],腹腔镜组均低于开腹组,差异有统计学意义。腹腔镜中转开腹比例为2.44%(2例)。2年(0.5～5.0年)的随访提示两组间复发率和妊娠率相似,复发率腹腔镜组2.44%(2例)、开腹组3.85%(3例),妊娠率腹腔镜组6.10%(5例)、开腹组5.13%(4例),无瘢痕破裂病例。结论对于子宫肌瘤最大直径小于8cm的病例,经腹腔镜剔除是安全有效的,具有术中出血少、术后疼痛少、恢复快的优势。     

Early identification of uterine scar defect by preconception magnetic resonance imaging to achieve successful pregnancy outcome after laparoscopic‐assisted myomectomy: Two case reports

Myomectomy improves the reproductive ability of women. However, the risk for uterine rupture and abnormal placentation remains a concern. In two cases with scar defects after laparoscopic‐assisted myomectomy, one case developed amniocele, while other case showed abnormally invasive placenta. Obstetrical management measures with cesarean sections yielded uneventful postoperative courses.     

Laparoscopy‐assisted distal gastrectomy in a case of gastric cancer with situs inversus totalis: a case report

Situs inversus totalis (SIT) is a rare congenital condition in which abdominal and thoracic organs are transposed from normal positions. Laparoscopy‐assisted distal gastrectomy for situs inversus totalis is technically difficult and has rarely been reported. Here, we report the case of man in his 40s with situs inversus totalis and a preoperative diagnosis of stage IA gastric cancer (cT1b, cN0, cM0). We successfully performed laparoscopy‐assisted distal gastrectomy with D1+ lymph node dissection and Billroth I reconstruction. To ensure a safe procedure, we evaluated the vessels preoperatively with 3‐D CT angiography. Furthermore, we performed the surgery by reversing our surgical positions, using a two‐monitor method, and then reconstructing under direct vision through the incision. The surgery was performed with minimal blood loss, and no severe postoperative complications were observed. Histopathological examination revealed poorly to moderately differentiated stage IA (pT1b, pN0, pM0) adenocarcinoma. No recurrence has been observed as of 2 years postoperatively.     

手辅助下电视腹腔镜肝切除术的手术配合

笔者报道2002年7月-2004年12月在手辅助系统下,腹腔镜肝叶切除术的手术配合.总结此类手术配合的要点在于：手术室护士把传统开腹手术和现代腹腔镜微创手术有机结合;根据手术过程灵活应变,随时调整以配合术式变化,术中准确快捷配合术者进行相应肝段切除,缩短手术时间,减少手术创伤.     

实施专科护理会诊对术后慢性伤口愈合效果的影响

目的:探讨伤口专科护理会诊在术后慢性伤口患者护理中的应用效果。方法:对2011年11月~2013年4月22例术后慢性伤口患者进行专科会诊,总结专科护理会诊的成效。结果:伤口专科护理会诊后,3例患者伤口1周内愈合,10例伤口基底颜色由100%黄色转变为75%红色,25%黄色,9例伤口面积缩小率10%~42.5%。结论:伤口专科会诊制度,解决了患者疑难问题,提高了护理质量,体现了伤口专科护士的专业价值。     

Laparoscopic Nissen solo surgery using PMAT (first experience)

This article describes the use of a Postural Mechatronic Assistant Trainer (PMAT) in pediatric Nissen surgery. This mechatronic system enables users to establish the logistical considerations for solo surgery and determine the advantages this new tool offers for the autonomous handling of optics.     

Long-term clinical experience with laparoscopic ventral hernia repair using a ParietexTM composite mesh in severely obese and non-severe obese patients: a single center cohort study

Abstract

Background: The treatment of incisional and ventral hernias is associated with significant complications and recurrences, especially in severely obese patients. Recent studies have shown a reduced rate of surgical site infections and length of hospital stay in severely obese patients undergoing a laparoscopic ventral hernia repair.

Aim: This study aims to describe the clinical experience in terms of efficacy and safety with laparoscopic ventral hernia repair using the ParietexTM Composite mesh (Covidien Sofradim Production, Trevoux, France) in severely obese patients (body mass index ≥35) compared with non-severe obese patients in a seven-year single-center cohort.

Material and methods: All patients with a primary ventral or incisional hernia admitted to our hospital from 2006 until December 2012 who underwent a laparoscopic repair with the Parietex Composite mesh were included in this study. Pain scores using a numeric rating were collected prospectively 24–48?hours postoperatively. Patient data were retrospectively collected.

Results: A total number of 210 patients were included; 173 with a BMI <35 and 37 with a BMI ≥35. Mean follow-up was 31 months. No statistically significant differences were found with regard to operation time, hospital stay, use of analgesics and postoperative complications. The long-term follow up recurrence rate in non-severely obese patients was 13% compared to 16% in severely obese patients (p?=?.60).

Conclusion: Laparoscopic ventral and incisional hernia repair using the Parietex Composite mesh is feasible and safe in severely obese patients compared to non-severely obese patients.     

“会阴部伤口保护罩”的研制及应用

正阴茎阴囊手术是男性会阴部最常见的手术,在男科手术中占据了大部分比例,主要包括:阴茎弯曲矫形术、阴茎背神经阻断术、阴茎假体植入术、睾丸穿刺取精术、睾丸附睾囊肿切除术、隐睾下降固定术等[1]。手术会引起疼痛和一系列并发症,如阴茎假体植入手术成功率为95%,约5%的患者会因为各种原因导致手术失败[2]。其中,感染是常见的严重并发症,也是手术失败的主要原因,疼痛、龟头水肿也为术后常见现     

Measurement of muscle stiffness using robotic assisted gait orthosis in children with cerebral palsy: a proof of concept

Purpose.?To evaluate the feasibility and reliability of a novel stiffness assessment tool implemented in the driven gait orthosis Paediatric Lokomat; to investigate the influence of single robotic-assisted gait training (RAGT) on muscle stiffness in children with cerebral palsy (CP).

Methods.?Ten children with spastic CP conducted a single standard RAGT session and stiffness was assessed before and after the RAGT. Nine of the ten subjects were tested twice on the same day to investigate test–retest reliability, intraclass correlation coefficients (ICCs), standard error of measurement (SEM), coefficient of variation of the method error (CV_ME) and resistive torques during passive leg movements (stiffness in Nm/°) were calculated.

Results.?ICCs showed high reliability (0.83–0.97) for hip and knee movements. SEM and CV_ME indicated 0.028–0.085 Nm/°, 9.5–23.0% of test–retest variability in hip and 0.018–0.064 Nm/°, 13.3–43.5% in knee measures. Using the assessment tool, a significant decrease in muscle stiffness in participants, especially in children with high levels of muscle tone, could be shown after a single session of RAGT.

Conclusions.?The assessment tool L-STIFF is a feasible tool for automated measurement of stiffness in children with CP, but it is not sensitive enough to record small changes in muscle tone.     

Infection control in wound care: a study of fatalism in community nursing

As part of a study of community nurses' perceptions of quality in nursing care, the author conducted in-depth qualitative interviews with seven community-based nurses. As part of the study, nurses were asked to describe episodes of wound care and to discuss the factors which could affect the quality of such care. One of the most interesting themes to emerge from the data was the apparent ambivalence of the nurses' attitudes towards infection control in wound care. Nurses discussed the concept of 'aseptic technique' in fatalistic terms and seemed uncertain about what could be achieved in terms of infection control. Although their policy guidelines referred to 'aseptic technique', their educational experience appeared to have made them feel uncertain about the implementation of the measures involved. With the proviso that this was a small scale qualitative study, the author concludes by suggesting that there is a need for greater clarity, both in what is taught and in what is included in practice policy with regard to infection control in wound care.     

人工智能辅助评分系统联合超声弹性成像诊断甲状腺结节良恶性的价值

目的 分析人工智能辅助评分系统联合超声弹性成像在甲状腺结节良恶性诊断中的应用价值.方法 纳入甲状腺结节患者414例(共543个结节),分别使用甲状腺人工智能辅助评分系统和超声弹性成像技术对甲状腺结节进行分析,记录人工智能评分(AIAS)、应变率比值(SR).对甲状腺良恶性结节的AIAS和SR进行二元Logistic回归...     

Equine assisted activities and therapies in children with autism spectrum disorder: A systematic review and a meta-analysis

Introduction: The multifactorial nature of Autism Spectrum Disorder (ASD) is the reason why complementary and alternative methods of treatment are sought in order to support the classic approach.Objectives: The aim of the study was to assess the effectiveness of Equine-Assisted Activities and Therapies (EAAT) in ASD patients based on a review of the literature.Methods: A review of the literature and a meta-analysis were conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PUBMED, Cochrane Library, Web of Science, ClinicalTrials.gov and PEDro databases were searched until July 20, 2017. Only articles published in English, in a journal with a review process, after 1999, with a control group or presentation of comparative pre-/post-therapy results in ASD patients, and clear inclusion/exclusion criteria were considered. The methodological quality of the included studies was assessed using the Quality Assessment Tool for Quantitative Studies (QATQS).The meta-analysis of three studies was conducted.Results: A total of 15 studies with 390 participants (aged: 3–16 years) were included. The interaction between psychosocial functioning and EAAT was investigated in most studies. Improvement was reported in the following domains: socialization, engagement, maladaptive behaviors, and shorter reaction time in problem-solving situations after EAAT. The meta-analysis revealed no statistically significant differences for the investigated effects.Conclusions: Despite the need for further, more standardized research, the results of the studies included in this review allow us to conclude that EAAT may be a useful form of therapy in children with ASD.     

Tangential gunshot wound to the chest causing venous air embolism: a case report and review

This is a case report of a 53-year-old woman who presented to the Emergency Department after sustaining a tangential gunshot wound to the left anterior chest wall. On arrival, the patient was somnolent, hypotensive, hypoxic, and had impaired speech. The patient's cardiopulmonary status stabilized quickly after fluid resuscitation and supplemental oxygen. Because the initial chest radiograph revealed only mild vascular congestion without traumatic injuries, a computed tomography angiogram of the chest was subsequently obtained, which showed air within the right ventricle and pulmonary arteries. Significant bilateral pulmonary infiltrates were also noted without evidence of pneumothorax, penetrating lung, or vascular injuries. There are numerous case reports of venous air embolism (VAE) after penetrating neck, chest, and abdominal injuries, surgical procedures, or secondary to unintentional air injection through venous catheters. Due to the wide range of neurological and cardiopulmonary clinical presentations, the non-specific signs and symptoms of VAE may frequently be attributed to other causes, especially in the setting of trauma. An overview of the pathophysiology, clinical presentation, diagnosis, and treatment of VAE is presented, with emphasis on diagnostic imaging modalities.