评估妇科良性疾病腹腔镜术前机械性肠道准备的必要性#br#

Objective?To evaluate the necessity of mechanical bowel preparation (MBP) before benign gynecologic laparoscopic surgeries. Methods?This was a prospective, single-blind, randomized controlled study. A total of 160 patients were randomly divided into two groups: the study group had a low-residue diet the day before operation, the control group had a MBP in the day before operation (polyethylene glycol electrolyte powder, added 2 000 ml warm boiled water in it, and drunk it from 14:00). A visual analogue scale (VAS) score was used to evaluate gastrointestinal discomfort, a five-point scale was used to evaluate the quality of the surgical field. Results?The VAS scores of the abdominal bloating, anal irritation and willingness to try another preparation in the control group [0(0, 4) points; 0(0, 4) points; 5(0, 8) points] were significantly increased than those of the study group [0(0, 1) points; 0(0, 1) points; 2(0, 5) points] (P<0.05) on preoperative day. The proportions of “good” or “excellent” in the large bowel preparation, the small bowel preparation and the convenience of bowel handling were statistically higher in the control group (36.25%, 47.50% and 41.25%) than those of the study group (16.25%, 23.75% and 21.25%) (P<0.05), but there were no statistical differences in the proportions of “good” or “excellent” in the visual field at start and end and the visualization of posterior cul de sac in the study group (66.25%, 70.00%, 63.75%) compared with the control group (77.50%, 76.25%, 76.25%) (P>0.05). Conclusion?It is not necessary to perform routine mechanical bowl preparation before benign gynecologic laparoscopic surgeries.     

妇科手术中肠道损伤的防治

肠道损伤是妇科手术中较少见的并发症之一,但危害性较大.文章复习了近年来有关妇科手术肠道损伤的相关文献,并对其发生率、高危因素、诊断、处理和预防进行了讨论.     

番泻叶在妇科围手术期中的应用

妇科术前肠道准备及术后促进胃肠功能恢复是保证手术成功、减少并发症、提高疗效的关键条件之一。传统的灌肠法用于妇科术前清洁肠道，操作繁琐、患者痛苦，逐渐被临床摒弃。近年来，随着手术相关条件的改善及中西医结合的不断发展，医药工作者进行了口服番泻叶做术前肠道准备的临床研究，以其安全、有效、经济、简便易行而广泛应用于妇科术前肠道准备。本文结合我院临床实践介绍番泻叶在妇科围手术期中的应用。     

无痛技术在妇科手术中的应用

我院自2001年5月起将无痛技术广泛应用于妇科门诊的多种手术操作中，均收到了十分明显的效果。现报道如下。     

加速康复外科在妇科及妇科恶性肿瘤手术中的应用及研究进展

加速康复外科(ERAS)是基于通过采取围手术期一系列有循证依据的管理及护理措施,以减少围手术期应激并加快手术患者术后恢复的理念。其目的是在不增加术后并发症、再次住院率、医疗成本的原则下达到快速康复、增加患者满意度、缩短住院日及降低医疗费用。最近,虽然有国外学者提出ERAS理念在妇科及妇科恶性肿瘤手术围手术期管理措施及护理中应用,然而其切实的临床应用尤其是在妇科恶性肿瘤手术中的应用尚非常局限且仍然缺乏多中心、大样本的研究数据。本文就ERAS在妇科手术尤其是妇科恶性肿瘤手术中管理应用情况及研究进展的文献进行总结,并就ERAS在妇科手术及妇科恶性肿瘤手术的应用提出思考及展望。     

超声刀在妇科腹腔镜手术中的应用

我院自 1999年 11月至 2 0 0 0年 7月在腹腔镜下应用超声刀施行各种妇科手术 ,观察术中失血量、手术时间、围手术期体温和血象以及组织损伤的程度。结果证实 ,超声刀手术视野清晰而又安全有效 ,是一种较有实用价值的妇科手术刀。现报道如下。一、方法1 超声刀及使用方法 :超声刀采用美国强生公司产品(ＵｌｔｒａｃｉｓｉｏｎＧ2 2 0型 ) ,包括主机、超声传送索及可供选用的手术器械 ,如超声剪刀 (直径 10ｍｍ)、超声分离勾 (直径 5ｍｍ)和球状凝固棒 (直径 5ｍｍ)等 ,功率为 2 3 0Ｗ ,分 5个级别调节输出。由于功率输出 3级既可达到完善止血…     

半导体激光在妇科腹腔镜手术中的应用

半导体激光在妇科腹腔镜手术中的应用孙爱达王友芳李彩娟王勉镜高孟林龚卓侯秀荣刘绍金高功率半导体激光，于９０年代由英国Ｄｉｏｍｅｄ公司首先研制成功，在我国尚未见其应用于腹腔镜手术的报道。现将我院在腹腔镜局部麻醉下应用半导体激光手术治疗妇科疾病的情况，报道...     

宫腔镜联合腹腔镜在妇科手术中的应用

宫腔镜联合腹腔镜在妇科手术中的应用夏恩兰冯力民段惠兰段华随着内镜技术的发展和器械的不断改进，微创手术在妇科领域已取得许多进展。近年来我院开展了宫、腹腔镜联合手术，更充分体现了妇科内镜手术的优越性。一、资料与方法１．对象：为１９９５年３月至１９９７年２...     

舒适护理在妇科手术患者护理中的应用

总结了在妇科手术患者中实施过舒适护理的效果和经验,包括术前皮肤准备、肠道准备、阴道准备中的舒适护理、心理舒适护理、手术后搬运病人的舒适护理、术后体位安置、导管护理及预防并发症中的舒适护理等。认为对妇科手术患者进行术前、术后舒适护理,充分体现了“以人为本、以患者为中心”的护理内涵,使护理质量得到提高,使患者获得的护理服务更为完善,有效提高患者的满意度。     

脉搏氧饱和度在妇科手术中的应用

脉搏氧饱和度在妇科手术中的应用梁立双易文波刘荣国应诗达（山东医科大学附属医院）脉搏氧饱和度监测在临床麻醉中的应用已日趋广泛，但硬膜外阻滞及其辅助用药存在一些缺陷。我们应用脉搏氧饱和度连续监测３６例妇科手术期间血氧饱和度（ＳｐＯ２）的变化。现报告如下。...     

Bariatric surgery in the field of gynecological oncology

Obesity has become a foremost health problem. More than half of US adults are overweight or obese. This has been due to sedentary lifestyles, increased intake of refined carbohydrates, and fat-rich diets. Obese women are particularly susceptible to a variety of health risks including cancer, especially cancers of the breast, endometrium, and colon. Bariatric surgery appears to be a viable option for the treatment of severe obesity. As the role of surgery in the management of this condition becomes increasingly frequent, it is important for gynecological oncologists to recognize the potential for gynecological malignancies in this patient population.     

The impact of obesity on surgery in gynecological oncology: a review

Surgery represents a mainstay in the treatment of gynecological cancers. It is a common belief that operating on obese patients causes more peri- and postoperative complications than operating on nonobese patients. The surgical outcome in gynecological oncology can be evaluated by comparing intra- and postoperative complications, extent of lymphadenectomy, negativity of the specimens' margins, and percentage of optimal debulking between obese and nonobese patients affected by malignancies at the same stage. In this review, we analyze how obesity affects the feasibility of a correct oncologic procedure in case of cervical, endometrial, and ovarian cancer. We also describe the techniques that have been suggested in the literature to improve the surgical outcome on obese patients.     

妇科肿瘤腹腔镜手术的围手术期处理

随着腹腔镜技术的逐步推广,妇科肿瘤腹腔镜手术技术日渐成熟,已成为治疗妇科良、恶性肿瘤的有效手段,围手术期的处理直接影响手术疗效、决定着手术的成败,所以围手术期处理特别重要。     

Perioperative morbidity and mortality of gynecological oncologic surgery in elderly women

The study compares the perioperative morbidity and mortality rates of elderly (> or =70 years) and younger (< 70 years) patients. The study cohort consisted of 171 women undergoing explorative laparotomy due to uterine or ovarian cancer. Clinical data included patients' age, comorbidities, chronic use of medications, body mass index (kg/m(2)), past and current surgical procedures, surgical FIGO stage, histologic type and number of dissected lymph nodes, optimal versus nonoptimal debulking, occurrence of perioperative complications, and postoperative hospital stay (days). Participants were divided to 108 (63.2%) patients with uterine cancer and 63 (36.8%) patients with ovarian cancer. Women having uterine cancer were further subdivided to those <70 years of age (72 women, 66.7%) and those > or =70 years of age (36 women, 33.3%). Women with ovarian cancer were subdivided to those <70 years of age (48 women, 76.2%) and those > or =70 years of age (15 women, 23.8%). Excluding the occurrence of postoperative ileus and poorly controlled hypertension in the elderly subgroup of women with uterine cancer, the rate of early postoperative complications was similar between the two subgroups. Chronological age by itself should not be a contraindication for the treatment of elderly women with gynecological malignancy since it is a poor predicting factor for perioperative morbidity.     

糖尿病患者妇科手术围手术期处理要点

糖尿病是以高血糖为主要特点,引起代谢紊乱综合征的一种疾病。糖尿病患者对手术耐受性差,手术应激、麻醉、术后疼痛等均增加其手术复杂性及危险性。做好糖尿病患者围手术期管理是手术成功以及减少并发症的重要因素,应当把需要接受手术治疗的糖尿病患者视为高危和疑难病例进行全面系统的围手术期综合管理,重点包括：健康教育、饮食调节、血糖控制、心血管事件和感染预防等。     

老年妇女妇科手术特点和围手术期管理

因妇科疾病需要手术的老年女性逐年增多,但老年人随着年龄增长器官功能逐渐衰退,且多数合并内科疾患,手术风险和围手术期并发症增高。因此了解老年妇女的妇科手术特点和加强围手术期管理至关重要。     

经自然腔道内镜手术在妇科恶性肿瘤中的应用

微创治疗对妇科肿瘤有重要意义。单孔腹腔镜手术（LESS）与经自然腔道内镜手术（NOTES）是微创治疗领域最新发展起来的技术。目前多种妇科良性手术均可以经LESS或NOTES完成,并取得了良好的临床疗效。妇科恶性肿瘤手术较为复杂,LESS与NOTES用于妇科恶性肿瘤的治疗尚有争议,目前国内外学者对NOTES用于恶性肿瘤的治疗已经进行了一些有益的尝试,初步数据证实了该术式的可行性,但是由于操作空间小,造成操作难度较大,手术操作技巧仍有待开发。文章结合笔者单位初步探索的经验,对NOTES在妇科恶性肿瘤中应用的现状、优势、困难与技术经验进行阐述。     

Perioperative bowel management for gynecologic surgery

Postoperative intestinal care after major gynecologic surgery has changed considerably. The purpose of this review was to describe these changes. Our findings are that (1) preoperative mechanical bowel preparation does not lower the risk of anastomotic leakage and infection, (2) elective postoperative nasogastric tube decompression increases postoperative pneumonia and does not decrease the incidence of other postoperative complications, (3) early feeding after major gynecologic surgery reduces hospital stay and does not increase (and may decrease) pneumonia and other postoperative complications, and (4) early feeding, gum chewing, bowel stimulation, alvimopan, and ketorolac may decrease the incidence of postoperative ileus.     

妇科围手术期静脉血栓栓塞症的预防

静脉血栓栓塞症（VTE）包括深静脉血栓形成和肺栓塞,是妇科常见的围手术期并发症,严重威胁患者生命安全。如今,VTE已逐渐引起人们的重视,VTE预防不容忽视。结合中国妇科术后VTE防治经验,2017年制定了“妇科手术后深静脉血栓形成及肺栓塞预防专家共识”。文章就妇科围手术期VTE预防的重要性及预防措施进行详解。     

Attitudes to radical gynecological oncology surgery in the elderly: a pilot study

Abstract. Nordin AJ, Dixon S, Chinn DJ, Moloney I, Naik R, de Barros Lopes A, Monaghan JM. Attitudes to radical gynecological oncology surgery in the elderly: a pilot study.
Does age-related inequality of cancer care reflect patient preference or physician prejudice? We hypothesize no difference between elderly and younger patients' desire for optimal surgery and disease cure, and psychological adaptation to cancer. A newly developed questionnaire to assess attitudes to radical gynecological surgery in the elderly (ARGOSE) and a battery of established instruments were administered to 54 gynecological cancer patients (32 aged 65 + years; and 22 aged < 65 years) by structured interview. Disease diagnosis differed between cohorts ( P = 0.007), but treatment modalities were similar ( P = 0.46). There was no difference between cohorts in desire for optimal surgery and disease cure. Trends suggest the young consider a patient's age is less important than do the elderly, but the elderly may oppose age-related economic rationing of treatment more than the young. Furthermore, elderly individuals tend to perceive their seniors too elderly for treatment, but not themselves. The elderly believe more strongly that doctors should make management decisions. Perceptions of change in body image after cancer treatment did not differ between cohorts. The influence of age in determining attitudes is complex. A larger study with increased power is indicated to examine trends revealed in this pilot study.