影响单囊胚冻融移植周期活产结局的相关因素分析

目的分析影响单囊胚冻融移植周期活产结局的相关因素,探讨单囊胚移植的可行性。方法回顾性分析2012年1月至2016年12月在本中心接受单囊胚冻融移植的共2 593个周期的临床资料,根据妊娠结局分为活产组(1 058个周期)和非活产组(1 535个周期),同时进行年龄(<35岁、35～39岁、≥40岁)和囊胚质量/发育速度分层分析,研究影响单囊胚冻融移植活产结局的相关因素。结果 (1)活产组移植年龄中位数显著小于非活产组(31岁vs.32岁),移植日内膜厚度(9.2 mm vs.9.0 mm)和优质囊胚率(72.5%vs.62.5%)则显著高于非活产组(P<0.05)。(2)不同女性年龄组内随着内细胞团和滋养层细胞评分等级降低活产率降低,差异有统计学意义(P<0.05),但并未发现不同囊胚腔扩张等级对活产率的影响(P>0.05);对于年龄<35岁和35～39岁患者,D5囊胚移植较D6/D7囊胚移植具有更高的活产率,差异有统计学意义(P<0.05)。(3)年龄<35岁的女性单囊胚移植活产率高于35岁以上具有相同囊胚评级的患者,并且年龄<35岁B...     

经皮肾镜碎石取石术并发出血的原因及防治

正泌尿系结石是泌尿外科的常见疾病,我国发病率高达5%~10%,以上尿路结石最常见,而经皮肾镜碎石取石术(percutaneous nephrolithotomy,PCNL)已经成为当今治疗复杂上尿路结石的首选方法[1]。但PCNL的术中并发症高达83%[2],出血为其最主要也是最严重的并发症之一[3]。本文就PCNL并发出血的原因及防治综述如下。一、PCNL肾出血的原因     

罗哌卡因经离体人胎盘单绒毛叶的转运及其影响因素

目的 研究罗哌卡因经离体人胎盘单绒毛叶的转运及母体低蛋白血症和胎儿酸血症对转运的影响。方法 获取刚娩出的健康胎盘18个,制备离体人胎盘单绒毛叶双侧灌注模型。随机分为正常组(A组)、胎儿侧酸血症组(B组)、母体侧低蛋白血症组(C组),每组6个。于加药后15、30、60、90、120 min,从储液瓶中抽取灌注液,测定罗哌卡因、安替比林、葡萄糖和乳酸浓度,计算罗哌卡因的绝对和相对转运率。结果 三组乳酸生成率和葡萄糖消耗率差异无显著性。罗哌卡因的绝对转运率随时间的延长而增加,加药后15 min时A组、B组、C组罗哌卡因的绝对转运率分别为:2.1％±0.4％、2.5％±0.4％、2.6％±0.6％,加药后120 min时A组、B组、C组分别增加至8.7％±1.0％,10.5％±1.6％和11.8％±1.1％,与A组比较,B组、C组加药后30、60、120 min时罗哌卡因的绝对转运率显著性升高(P<0.05或0.01),加药后15 min时差异无显著性。罗哌卡因的相对转运率不随时间增加而发生显著变化。B组、C组与A组的对应时点相比相对转运率增加(P<0.05或0.01)。结论 在离体人胎盘单绒毛叶双侧灌注模型中,罗哌卡因的绝对转运率随时间的延长而增加,母体低蛋白血症和胎儿酸血症均增加罗哌卡因的胎盘转运率。     

Factors affecting the arterial carbon dioxide tension during anæsthesia

Summaries of papers delivered at the meeting are printed below. A selection of these papers will be printed in full in this and subsequent issues.     

影响前列腺电切组织缩水率的因素探讨

目的 :探索影响经尿道前列腺电切 (TURP)组织缩水率的因素 ,提高TURP应切除量的判断能力。方法 :在体外分熟练和不熟练两组 ,分别用F2 4、F2 7不同口径间断冲洗式电切镜 ,将良性前列腺增生症开放手术摘除的前列腺在体外即刻像TURP一样切碎 (体外TURP) ,观察其重量的变化。结果 :2 8次体外TURP组织平均缩水率 :熟练组为 2 0 .89% ,不熟练组为 33.2 6 % (P <0 .0 1)。F2 4为 30 .4 4 % ,F2 7为 2 3.71% (P <0 .0 5 )。结论 :体外TURP电弧刀移动速度、幅度、电弧刀大小均可影响前列腺电切组织缩水率。切除速度越快 ,组织缩水率越低     

Factors affecting urea clearance during continuous hemodiafiltration in the canine model

Continuous hemofiltration (CH) for the treatment of hypervolemia and electrolyte abnormalities in critically ill patients with acute renal failure has been shown to be an effective mode of therapy. This technique offers several advantages over peritoneal dialysis or hemodialysis: it is technically less complex, provides efficient ultrafiltration, and produces fewer hemodynamic disturbances. Recently, continuous hemodiafiltration (CHD) using a flow of dialysate fluid into the ultrafiltration chamber has been reported to augment urea clearance. The purpose of this study was to determine the blood flow and dialysate flow characteristics for optimal clearance of urea and creatinine using this technique. Six mongrel dogs (mean weight, 8.0 +/- 1.1 kg) underwent bilateral nephrectomy to induce anuric renal failure. Postoperatively, the animals were fluid resuscitated and fed ad libitum. Twenty-four hours following nephrectomy, venovenous hemofiltration was instituted. Blood flow was regulated via a roller pump, while dialysate flow was regulated using an infusion controller. An Amicon-30S hemofilter was used in the circuit. Blood flow rates of 5, 10, 15, 20, 25, and 30 mL/kg/min were used. Hemodiafiltration using Dianeal 1.5% solution was used in each animal. Net fluid losses via ultrafiltration were replaced using lactated Ringer's solution. Three of six animals survived for the complete five-hour hemofiltration period. No marked disturbances in electrolyte serum concentrations, including hyperkalemia, were observed. BUN concentrations were reduced by 35% and creatinine by 26%. Variation of the dialysate flow rate did not influence clearance of either urea or creatinine. Instead, clearance appeared to be flow dependent, and it was markedly increased at flow rates greater than 15 mL/kg/min.(ABSTRACT TRUNCATED AT 250 WORDS)     

微创经皮肾镜取石术出血量影响因素的分析

目的寻找微创经皮肾镜取石术（MPCNL）术中出血量的影响因素。方法2006年4月至8月,应用MPCNL治疗肾结石患者178例（219次手术）。以可能影响术中出血量的患者因素（年龄、体重指数、高血压、糖尿病、肝功能不全、肾功能不全、泌尿系感染、肾脏既往手术史、肾实质厚度、肾积水程度及结石表面积）和手术相关因素（肾盏人路、总穿刺次数、穿刺针流出液体是否血性液、扩张通道大小、通道数目、手术时间、术中操作因素引起的并发症、分期手术）为自变量,应用多因素逐步回归分析各因素与失血量之间的关系,找出影响术中出血量的主要因素。结果178例（219次手术）患者手术均成功。采用单通道取石177例次,多通道取石42例次,双侧手术13例。手术平均出血量（201．7±145．2）ml,单通道手术平均出血量（191．8±139．6）ml,多通道（244．9±162．2） ml。多因素回归逐步回归分析结果显示,术中操作并发症（P=0．000）、肾实质厚度（P=0．000）、分期手术（P=0．000）、通道数目（P=0．001）、手术时间（P=0．019）、肾积水程度（P=0．033）及结石表面积（P=0．044）对失血量有明显影响。结论术中出现操作并发症、肾实质肥厚、多通道取石、手术时间过长及结石体积较大都能显著增加失血量,分期手术可减少失血量。避免术中操作并发症发生、减少手术时间、对大体积结石或出现操作并发症的患者选择分期手术十分重要。     

Factors affecting blood loss during percutaneous nephrolithotomy: prospective study

BACKGROUND AND PURPOSE: Bleeding is a major concern during percutaneous nephrolithotomy (PCNL), especially with the use of multiple tracts. This prospective study aimed to identify factors affecting blood loss during PCNL. PATIENTS AND METHODS: Data were collected prospectively from 236 patients undergoing 301 PCNL procedures at our institute since June 2002. Blood loss was estimated by the postoperative drop in hemoglobin factored by the quantity of any blood transfusion. Various patient-related and intraoperative factors were assessed for association with total blood loss or blood transfusion requirement using stepwise multivariate regression analysis. RESULTS: The average hemoglobin drop was 1.68 +/- 1.23 g/dL. Stepwise multivariate regression analysis showed that the occurrence of operative complications (P < 0.0001), mature nephrostomy tract (P < 0.0001), operative time (P < 0.0001), method of access guidance (fluoroscopy v ultrasound) (P = 0.0001), method of tract dilatation (P = 0.0001), multiple (> or =2) tracts (P = 0.003), size of the tract (P = 0.001), renal parenchymal thickness (P = 0.05), and diabetes (P = 0.05) were significant predictors of blood loss. The overall blood transfusion rate for all patients was 7.9%. Preoperative hemoglobin, multiple tracts, stone size, and total blood loss were significant in predicting perioperative blood transfusion requirement. Factors such as age, hypertension, renal insufficiency, urinary infection, the degree of hydronephrosis, stone bulk, and the function of the ipsilateral renal unit did not have any effect on the blood loss. Technical factors such as the operating surgeon and the calix of entry also did not affect the blood loss. CONCLUSIONS: Diabetes, multiple-tract procedures, prolonged operative time, and the occurrence of intraoperative complications are associated with significantly increased blood loss. Atrophic parenchyma and past ipsilateral intervention are associated with reduced blood loss. On the basis of this evidence, maneuvers that may reduce blood loss and transfusion rate include ultrasound-guided access, use of Amplatz or balloon dilatation systems, reducing the operative time, and staging the procedure in cases of a large stone burden or intraoperative complications. Reducing the tract size in pediatric cases, nonhydronephrotic systems and those with a narrow infundibulum, and secondary tracts in a multiple-tract procedure may also reduce blood loss during PCNL.     

Factors affecting acid base status during hepatectomy in cirrhotic patients

ObjectiveTo study acid base changes during hepatectomy in cirrhotic patients and their relations to intraoperative variables and different preoperative scoring systems used to asses hepatic patients.MethodsAfter obtaining approval of the Ethics and Research Committee of the National Liver Institute – Menoufia University and written informed patient consent, 80 patients scheduled for hepatectomy for hepatocellular carcinoma were included in the study. Anesthesia was induced with propofol, fentanyl, and rocuronium then maintained with desflurane and 50% O₂ in air. Samples for arterial blood gases and serum lactate were withdrawn from a left radial artery catheter just before the start of resection of liver parenchyma and immediately after its completion. Intraoperative events were recorded including use of Pringle maneuver and fluids and blood products infusions.ResultsNo differences were found in study parameters between Child class A and B patients except for the preresection lactate (p = 0.02). Patients with MELD score <11 had higher preresection HCO₃ (p = 0.004), higher BE (p = 0.002), and lower lactate (p = 0.001) than patients with MELD score ?11. These findings were true also for patients with MELD-Na score <11 as they had higher preresection HCO₃ (p = 0.001), higher BE (p = 0.001), and lower lactate (p < 0.001) than patients with MELD-Na score ?11. All patients had significant decrease in pH (p < 0.001), HCO₃ (p < 0.001), and BE (p < 0.001) and significant increase in lactate (p < 0.001). These changes were augmented by intraoperative RBCs and FFP transfusion, using Pringle maneuver, but type of hepatectomy had significant effect only on HCO₃ and BE. Again these changes in pH, HCO₃, BE, and lactate were more obvious in patients with preoperative MELD score ?11, and this was also true in patients with preoperative MELD-Na score ?11 only with HCO₃, BE, and lactate, but not with pH.ConclusionChanges occurred in acid base status during hepatectomy in cirrhotic patients are affected by the preoperative condition of the patient (MELD and MELD-Na scores) as well as by intraoperative transfusion of blood products, use of Pringle maneuver and to a lesser extent by major versus minor hepatectomy.     

Latissimus dorsi tendon transfer for irreparable posterosuperior rotator cuff tears. Factors affecting outcome

BACKGROUND: The purpose of this study was to evaluate the clinical results of latissimus dorsi tendon transfer in patients with an irreparable posterosuperior rotator cuff tear to help determine which patient and anatomic factors affect clinical outcome. METHODS: Fourteen patients with a latissimus dorsi tendon transfer were clinically evaluated with use of the PENN (University of Pennsylvania) shoulder score as well as with quantitative measurement of isometric muscle strength and the range of motion of both shoulders at a minimum of twenty-four months postoperatively. The anatomic results were evaluated with postoperative magnetic resonance imaging and electromyography. RESULTS: Nine patients were satisfied with the outcome, had significant clinical improvement, and reported that they would have the operation again under similar circumstances. The other five patients were dissatisfied with the result and had significantly worse PENN scores, active elevation, and objective measures of strength. Eight of the nine patients with a good clinical result were male, and four of the five with a poor result were female. Patients with a good clinical result had had significantly better preoperative function in active forward flexion and active external rotation compared with the patients with a poor result. The magnetic resonance imaging demonstrated healing of the tendon to the greater tuberosity in twelve patients and equivocal healing in two. There was no significant atrophy of any of the transferred muscles. Electromyography demonstrated clear activity in the transferred latissimus muscle during humeral adduction in all fourteen patients, some electrical activity with active forward elevation in only one patient, and some electrical activity with active external rotation in six of the nine patients with a good clinical result. None of the patients with a poor clinical result demonstrated electrical activity of the transferred muscle with active forward flexion or external rotation. CONCLUSIONS: Synchronous in-phase contraction of the transferred latissimus dorsi is a variable finding following the surgical treatment of irreparable posterosuperior rotator cuff tears, but when it is present it is associated with a better clinical result. Preoperative shoulder function and general strength influence the clinical result. Female patients with poor shoulder function and generalized muscle weakness prior to surgery have a greater likelihood of having a poor clinical result.     

Factors affecting pregnancy outcome in a gamete intrafallopian transfer (GIFT) programme.

OBJECTIVE: To identify the factors that most significantly affected pregnancy rates in a gamete intrafallopian transfer (GIFT) programme. METHODS: A total of 863 GIFT cycles were analysed retrospectively. The variables found to be associated significantly with pregnancy were then used to obtain multivariate analysis using logistical regression. RESULTS: Overall and ongoing pregnancy rates were significantly better in patients < or = 38 years than in patients > 38 years (37.3% and 28.4% v. 23.7% and 11.0% respectively), and age was positively associated with success after GIFT (odds ratio (OR) 1.87, 95% confidence interval (CI): 1.22-2.85). Metaphase I (MI) oocytes were negatively associated with pregnancy (OR 1.54, 95% CI: 0.28-1.04). The highest pregnancy rates occurred when 3 metaphase II (MII) oocytes were transferred (39.8%, OR 7.51, 95% CI: 1.74-32.42). With regard to sperm morphology, overall pregnancy rates of 25.5% (< or = 4% normal forms) and 37.2% (> 4% normal forms) were obtained. Morphology of > 4% normal forms was positively associated with pregnancy (OR 1.58, 95% CI: 1.04-2.42). CONCLUSION: The results of this study suggest that the most important factors influencing pregnancy rates in a GIFT programme are the woman's age and those factors pertaining to the characteristics of the gametes. Considering the emotional and financial costs it is important to relate this information to all prospective participants in a GIFT programme.     

Factors affecting postoperative pain

OBJECTIVE: To determine the influence on the intensity of postoperative pain of the following variables: sex, age, type of surgery, surgical approach, anesthetic technique and analgesia administered. PATIENTS AND METHODS: Six hundred twenty-three hospitalized patients were enrolled from the units of general and digestive surgery, gynecology and obstetrics, ophthalmology, otorhinolaryngology, traumatology and orthopedics, and urology. Pain intensity was measured on a visual analog scale (VAS) when the patient left the post-anesthesia recovery ward (PARU) and 24 and 48 h after surgery, and on a verbal evaluation scale (VES) during the first and second days after surgery. RESULS: Gynecology is the department where the most pain is reported, both when the patient leaves the PARU (>= 4 for 56.6% of patients) and during the first day on the ward (71.3% of patients suffer pain of moderate or high intensity). The correlation of pain with duration of procedure was strongest in the urology and surgery units, with common variances of 32.3% and 23.4%, respectively. More pain is felt during open procedures in the traumatology and urology units, which is not the case in gynecology and surgery. Patients receiving general anesthesia leave the PARU with pain at 3.4 +/- 1.8 cm on the VAS scale, versus 1.3 +/- 1.6 cm for patients receiving locoregional anesthesia. Patients who received only ketorolac for pain in the PARU generally experienced less intense pain (2.5 +/- 2.0 cm) than did those who received metamizol (3.3 +/- 1.5 cm), morphine (4.0 +/- 1.8 cm) or tramadol (4.5 +/- 1.8 cm). CONCLUSIONS: Surgical department, surgical approach, anesthetic technique and, finally, analgesic administered are the factors that determine the intensity of postoperative pain. These factors should therefore be taken into account when establishing treatment protocols to assure adequate control of postoperative pain. Neither sex nor age were determining factors for the intensity of postoperative pain.     

影响贲门癌患者术后生存期的相关因素研究

目的 揭示影响贲门腺癌手术预后的临床病理特征和危险因素.方法 收集2009年6月-201 1年8月52例外科手术且随访资料完整的贲门癌患者的临床资料.对可能影响患者预后的因素进行单因素、多因素分析及生存风险分析.结果 1、2、3年生存率为73％、54％、46％.单因素分析显示T分期、N分期、TNM分期、Siewert classification、MSLN、静脉浸润与预后之间存在明显的相关性.逐步Cox比例风险模型显示T分期、N分期、MSLN是独立的危险因素.腹膜、肝脏是复发转移主要途径,腹膜转移与T分期、淋巴管浸润有关;而肝脏转移与MSLN有关.Kaplan-Meier法患者的生存曲线表明肝转移及腹膜转移患者生存期明显缩短.结论 规范化的淋巴结清扫是影响预后关键因素,D2手术应该是贲门癌手术根治的标准.     

Factors affecting nonunion of the allograft-host junction

Nonunion of allograft-host junction after bone transplantation is not uncommon, and its treatment frequently is problematic. To improve the understanding of these nonunions, a retrospective review was performed of 163 nonunions in 945 patients who underwent allograft transplantation (17.3%) for various benign and malignant tumors at the authors' institution between 1974 and 1997. Of these 945 patients, 558 did not receive adjuvant therapy. Chemotherapy was administered to 354 patients and only 33 patients received radiation therapy alone. Seventy-one patients had radiation treatment and chemotherapy. Of the 163 patients who had nonunion develop at the allograft-host junction, there were 269 reoperations performed on the involved extremity. In 108 patients, treatment was successful resulting in union of the allograft-host junction. Forty-nine patients did not respond to multiple surgical treatment attempts. The greater the number of surgical procedures, the worse the outcome. The rate of nonunions increased to 27% for the patients who received chemotherapy as compared with 11% for the patients who did not receive chemotherapy. The order of allografts from highest rate of nonunion to lowest was as follows: alloarthrodesis, intercalary, osteoarticular, and alloprosthesis. Infection and fracture rates were higher in the patients with nonunions as compared with the patients without nonunions.