悬吊式腹腔镜下子宫肌瘤剥除术与小切口子宫肌瘤剥除术的临床分析

目的 比较以悬吊式腹腔镜与小切口行子宫肌瘤剥除术的疗效及应用价值.方法 对41例子宫肌瘤患者行悬吊式腹腔镜子宫肌瘤剥除术（悬吊组）,与30例行小切口开腹子宫肌瘤剥除术（开腹组）比较手术时间、术中出血量、术后排气时间、术后疼痛指数、术后并发症等相关指标.结果 悬吊组的手术时间长于开腹组（P＜0.05）,悬吊组的术中出血量、术后并发症、术后排气时间、术后疼痛指数、住院时间与开腹组无差异（P＞0.05）,住院费用悬吊组高于开腹组（P ＜0.05）.结论 悬吊式腹腔镜下子宫肌瘤剥除术及小切口子宫肌瘤剥除术具有疼痛轻、恢复快、住院时间短,悬吊式更具美观,小切口技术要求低,在妇科手术中值得推广.     

免气腹腔镜子宫肌瘤剥除术临床分析

目的探讨免气腹腔镜在子宫肌瘤剔除术中的应用。方法对2008-01-2009-09在解放军第181医院收治子宫肌瘤38例行免气腹腔镜手术（观察组）,35例行气腹腔镜行子宫肌瘤剥除（对照组）,观察手术时间、术中出血量、及术后并发症等结果。结果观察组均完成肌瘤剥除,无一例中转开腹。两组在手术时间、出血量、住院天数及肛门排气时间差异无统计学意义（P〉0.05）,术后下床活动时间、术后皮下气肿及术后肩部酸胀差异有统计学意义（P〈0.05）。结论免气腹腔镜较气腹腔镜手术更安全、实用,值得推广。     

单操作孔悬吊式腹腔镜在子宫肌瘤剔除术中的应用

目的 探讨单操作孔悬吊式腹腔镜在子宫肌瘤剔除术中的应用价值.方法 随机选取行腹腔镜下子宫肌瘤剔除术的患者39例,其中行单操作孔悬吊式腹腔镜下子宫肌瘤剔除术者18例,行气腹腹腔镜子宫肌瘤剔除术者21例.对两组患者在手术时间、术中失血量、术后体温恢复时间、术后排气时间、术后并发症及术后住院时间等方面进行比较.结果 单操作孔悬吊式腹腔镜组最大肌瘤直径大于气腹腹腔镜组(P＜0.05),手术时间、术中失血量均少于气腹腹腔镜组(P＜0.05),两组在术后体温恢复时间、术后排气时间和术后住院时间方面差异无显著性(P＞0.05).18例行单操作孔悬吊式腹腔镜下子宫肌瘤剔除术者,7例于术中发现术前B超或镜下未探及的肌瘤结节共12个,予以剔除.结论 应用单操作孔悬吊式腹腔镜行子宫肌瘤剔除术在缩短手术时间、减少术中失血量及彻底剔除肌瘤方面较气腹腹腔镜具有明显优势.     

棒球缝合法在腹腔镜下巨大子宫肌瘤剥除术中的应用

目的观察棒球缝合法在腹腔镜下巨大子宫肌瘤剥除术中的应用效果。方法将2013年01月至2015年12月在成都市妇女儿童中心医院妇科接受腹腔镜下巨大子宫肌瘤剥除术的患者96例,采用随机数字表法分为研究组(采用棒球缝合法)和对照组(采用传统连续扣锁缝合法),每组48例,比较两组子宫肌瘤剥除创面缝合时间、手术总时间、术中出血量、住院天数及术后并发症情况。结果研究组患者术中出血量明显低于对照组,差异有统计学意义(P0.05);两组术中缝合肌瘤剥除创面时间、手术总时间、术后住院天数比较,差异无统计学意义(P0.05)。两组患者均无术中术后并发症发生。结论在腹腔镜下巨大子宫肌瘤剥除术中采用棒球缝合法可以减少术中出血量,是一种值得临床应用的好方法。     

腹腔镜下卵巢囊肿剥除术治疗卵巢囊肿的可行性及安全性

目的对比经腹腔镜和开腹卵巢囊肿剥除术对卵巢囊肿术后卵巢储备功能的影响。方法本研究选取2015年2月~2016年1月与我院妇科进行诊断及治疗的卵巢囊肿患者170例,随机分为两组各85例,分别行腹腔镜下卵巢囊肿剥除术及开腹卵巢囊肿剥除术,手术结束后比较两组患者手术基本情况、卵巢储备功能、妊娠时间及妊娠率。结果观察组患者术中出血量、手术时间、术后肛门排气时间均明显低于对照组,分别P=0.000、P=0.014、P=0.037,差异具有统计学意义;两组患者术前、手术后3月雌二醇、黄体生成素、促卵泡激素分泌量水平比较均无明显统计学意义(P0.05);观察组患者术后妊娠时间明显低于对照组(t=10.601,P=0.000),妊娠率明显高于对照组,差异具有统计学意义(χ~2=8.893,P=0.002);术前、手术后3月两组患者卵巢体积(Vol)比较无统计学差异(P0.05),Fo水平比较无统计学差异(P0.05)。结论腹腔镜下卵巢囊肿剥除术治疗卵巢囊肿疗效确切,且不对患者的卵巢功能造成损伤,值得临床推广。     

免气腹腹腔镜肌壁间子宫肌瘤剔除术65例临床分析

目的探讨免气腹腹腔镜下肌壁间子宫肌瘤剔除术的临床价值。方法将2004年3月～2006年5月该院妇科实施免气腹腹腔镜下子宫肌瘤剔除术患者的临床资料进行回顾性分析。结果65例均完整剔除肌瘤,无1例中转进腹手术。术中出血量(146±110.7)mL,手术时间(86.5±27.7)min,术后肛门排气时间(15±7.2)h。无严重手术并发症。单发肌壁间子宫肌瘤最大径、不同部位子宫肌瘤(前壁、后壁、宫底部)、多发性子宫肌瘤组肌瘤数2个者与<6cm单发性肌壁间肌瘤,其术中出血量和手术时间比较差异均无显著性。多发性子宫肌瘤组肌瘤数2个者与≥3个者比较,其术中出血量和手术时间比较差异有显著性。结论免气腹腹腔镜下子宫肌瘤剔除术对机体损伤小、恢复快,尤其方便在腹腔镜下缝合,更适合应用于子宫肌瘤剔除术。     

腹腔镜下卵巢囊肿剥除术的疗效观察及其对预后的影响分析

以88例择期行卵巢囊肿剥除的患者为研究对象,患者随机均分为观察组和对照组各44例。观察组行腹腔镜下卵巢囊肿剥除,对照组患者行常规手术切除。比较两组患者临床疗效。观察组患者在手术时间、术中出血量、术后肛门排气时间、住院时间、抗生素使用时间方面,均优于对照组,差异具有统计学意义(P0.05)。术后随访半年,两组患者均未出现卵巢囊肿复发情况。腹腔镜下卵巢囊肿剥除术的疗效显著,预后效果好,值得临床推广。     

腹腔镜手术治疗卵巢囊肿临床疗效分析

选取我院妇科2012年12月~2015年6月收治的380例卵巢囊肿患者。随机分为对照组和试验组各190例。对照组患者行传统开腹卵巢囊肿剥除术,试验组患者则行腹腔镜卵巢囊肿剥除术。对比两组患者手术操作时间、手术出血量、术后肛门排气时间、术后下床活动时间、术后住院天数及并发症发生情况。结果试验组患者的手术操作时间、手术出血量、术后肠道功能恢复时间、术后下床活动时间、住院天数及并发症发生率均明显著低于对照组(P0.05)。采用腹腔镜手术治疗卵巢囊肿具有微创、术后恢复快等优点,值得进一步推广应用。     

经阴道与腹腔镜行卵巢囊肿剥除术效果比较

目的研究对比经阴道与腹腔镜卵巢囊肿剥除术在卵巢囊肿治疗中的应用效果。方法将2015年5月至2016年8月卵巢囊肿患者84例纳入研究,采用随机数值法将其分为对照组和观察组,每组42例,对照组行腹腔镜卵巢囊肿剥除术,观察组行经阴道卵巢囊肿剥除术,对比两组手术治疗指标。结果两组术中出血量比较差异未见统计学意义(P0.05),观察组术后排气时间、住院时间长于对照组,手术时间短于对照组,治疗费用低于对照组,差异有统计学意义(P0.05)。结论在卵巢囊肿治疗中,相比于腹腔镜卵巢囊肿剥除术,经阴道卵巢囊肿剥除术可行性更高,经济安全,操作简便,因此值得在临床实践中推广及应用。     

腹腔镜手术治疗小儿卵巢囊肿疗效观察

目的 探讨腹腔镜手术治疗小儿卵巢囊肿的临床可行性.方法 26例小儿卵巢囊肿在腹腔镜下进行剥除术与24例小儿开腹卵巢囊肿剥除术进行比较,比较两组之间手术时间、术中出血量、术后住院时间、术后肛门排气时间、切口疼痛、术中术后并发症、抗生素使用及术后复发率等.结果 两组患者的手术时间差异无统计学意义(P＞0.05),腹腔镜组患者术中出血量明显减少、术后肛门排气时间明显缩短、切口疼痛明显减轻、术后住院时间及抗生素使用时间缩短、无手术并发症发生,囊肿复发率及大小无差异.结论 腹腔镜下小儿卵巢囊肿剥除术是一种安全、可靠、适合于临床上广泛开展应用的手术方式.     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.