腹腔镜在异位妊娠诊治中的价值

目的 探讨腹腔镜手术在异位妊娠诊断和治疗中的价值。方法 2003年1月～2005年1月,我院对342例临床拟诊异位妊娠行腹腔镜检查。诊断明确335例,行单侧输卵管切除术、输卵管开窗术、部分卵巢切除术或宫角切除术等：诊断不明确7例,进一步行诊断性刮宫术。结果 335例腹腔镜确诊异位妊娠,333例成功行腹腔镜手术（包括3例卵巢妊娠、3例输卵管间质部妊娠）,2例中转开腹。7例腹腔镜未见明显妊娠部位行诊断性刮宫术,其中1例子宫畸形（残角子宫）合并宫内妊娠行残角子宫及同侧输卵管切除术,1例卵巢黄体囊肿破裂合并宫内妊娠行黄体囊肿剥出术,5例宫内外均未发现妊娠部位,MTX治疗成功。340例腹腔镜术后8～24h肛门排气,除5例MTX保守治疗外,335例术后2～4d出院;2例中转开腹术后24～36h肛门排气,术后6d出院。结论 腹腔镜检查有利于异位妊娠的早期诊断;腹腔镜手术治疗异位妊娠安全有效、恢复快。     

探讨腹腔镜手术诊治异位妊娠的价值

目的:探讨腹腔镜手术诊断和治疗异位妊娠的应用价值。方法:2004年1月至2008年12月我院为226例拟诊为异位妊娠的患者行腹腔镜探查,明确诊断223例,同时行单侧输卵管切除术,输卵管开窗术及宫角切除术;诊断不明确3例,进一步行诊刮术。结果:223例经腹腔镜探查确诊为异位妊娠,221例成功行腹腔镜手术,2例中转开腹。3例腹腔镜下未见明显妊娠部位而行诊刮术,其中1例卵巢黄体破裂合并宫内妊娠行黄体囊肿剥除术,2例宫内宫外未见妊娠部位,注射MTX治疗成功。224例腹腔镜术后6～24h肛门排气,除2例用MTX保守治疗外,222例术后4d出院,2例中转开腹者术后24～36h肛门排气,术后5～6d出院。结论:腹腔镜探查有利于异位妊娠的早期诊断,腹腔镜手术治疗异位妊娠安全、有效、康复快。     

中国近21年成人先天性胆管扩张症流行学特征及诊治经验

目的：探讨成人先天性胆管扩张症的流行病学特征和诊疗经验。方法：联合检索维普数据库和中国期刊网等多家中文数据库中1990年1月～2010年11月有关成人先天性胆管扩张症的文章,总结分析成人先天性魍管扩张症的流行病学特征和诊治经验。结果：中国近2{年共报道5146例成人先天性胆管扩张症,有准确年龄及平均年龄报道4298例,平均年龄34．84岁,男女比例约为1：2．55,43．44％分布在华东地区,68．38％有不同程度腹痛表现,25．22％有发热或高热症状,32,46％有不同程度黄疸,18．31％可触及腹部包块,具有典型三联征表现患者占15．98％。Todani分型I型8041％,II型4．27％,III型123％,IV型1155％,V型占2,54％。手术治疗为主要治疗手段,胆管囊肿切除加胆管空肠Roux—en—Y吻合术占71．63％;术后并发症以胆管炎症状为主,发生率为12．24％;术后随访率83．55％,治愈率8684％。结论：成人先天性胆管扩张症女性多发,其中以华东地区较多,Todani分型I型为主,囊肿切除加胆肠Roux—en—Y吻合术为主要治疗手段。     

腹腔镜早期诊断及治疗特殊部位异位妊娠的价值

目的:探讨腹腔镜早期诊断及治疗特殊部位异位妊娠的价值。方法:回顾分析2002年7月至2007年7月经腹腔镜诊治45例特殊部位异位妊娠患者的临床资料,其中输卵管间质部妊娠23例,卵巢妊娠13例,宫角妊娠5例,腹腔妊娠2例,输卵管残端妊娠2例。结果:腹腔镜手术成功41例,成功率91.1%,平均手术时间(40.2±23.6)min,平均手术出血(66.5±35.5)ml;中转开腹4例;腹腔镜手术无术中、术后并发症发生。结论:腹腔镜用于早期诊断及治疗特殊部位异位妊娠安全可行,不断提高手术技巧,结合术中情况选择合适的手术方式,有助于提高手术成功率。     

Current trends in the treatment of ectopic pregnancy

Ectopic pregnancy represents even nowadays a problem with a major impact upon women reproductive health, with an incidence that is still growing. Modern diagnosis methods have allowed the disappearance of the mortality, but there are persisting significant tubal dysfunctions. The present clinical study has analyzed the evolutions of the diagnosis and treatment methods upon 238 cases of extrauterine pregnancy hospitalized in the Ist Clinic of Obstetrics and Gynecology Cluj-Napoca between years 2000 and 2006. The use of the new biochemical markers and the transvaginal ultrasound examination have allowed the diagnosis of extrauterine pregnancy in an early stage, with an increased percent of uncomplicated cases raising from 55.8% to 74%. Also the percent of laparoscopic approach has grown from 23.5 to 58.6%. The radical procedure, salpingectomy was predominantly used. The laparoscopic approach has been as successful as the laparotomy and no complications have been reported. The mean hospitalization period after laparoscopy has been significantly shorter than after laparotomy (p<0.05). These results confirm the medical and economical advantages of the laparoscopic approach and recommend laparoscopy as the election method in the management of ectopic pregnancy.     

The early diagnosis of ectopic pregnancy.

In a survey of 235 consecutive cases of ectopic pregnancy it was found that over 50 per cent were incorrectly diagnosed by the general practitioner and 36 per cent by a hospital doctor. Ten per cent of patients were sent home before the diagnosis was made. Over 30 per cent of patients were sent to general surgical wards and these patients had different characteristics from those sent to gynaecological wards. High risk patients can be identified from their past history. The increasing use of the laparoscope has been associated with earlier detection of ectopic pregnancy before the stage of rupture.     

Abdominal paracentesis in the diagnosis of ruptured ectopic pregnancy.

A prospective study of the use of abdominal paracentesis in the diagnosis of suspected ectopic pregnancy was carried out. Paracentesis was performed in 189 patients, of whom 132 were subsequently shown to have ectopic pregnancies. Paracentesis confirmed the diagnosis in 90,9% of cases, but when this was corrected to exclude cases where no intraperitoneal haemorrhage was present, the success rate rose to 96,3%. We believe that this simple, harmless, bedside procedure has value in aiding and confirming the diagnosis of ruptured ectopic pregnancy.     

中国近25年脾脏炎性肌纤维母细胞瘤的流行病学特征及诊治经验

目的：探讨中国近25年来脾脏炎性肌纤维母细胞瘤（SIMT）的流行病学特征及诊治经验。方法：联合检索中国知网、维普等多家中文数据库获取国内近25年有关SIMT的病例资料进行回顾性分析。结果：本组64例中,男39例,女25例,男女比例1.56：1。年龄24～74岁,平均49.2岁。多为查体时B超或CT发现,部分表现为上腹部不适、乏力、低热等非特异性症状。影像学检查提示脾内单发或多发,界限多清楚占位性病变。有明确病理结果描述者43例：少细胞纤维型26例,黏液样/血管型12例,丰富梭形细胞型5例;免疫组化示多数病例梭形细胞对Vimentin、SMA等抗体阳性。治疗方式主要为脾脏切除,随访无复发及转移。结论：SIMT极为罕见,临床表现无特异性,通过影像学检查、病理组织学特点及免疫组化结果可与其他脾脏占位性病变相鉴别,术前诊断较为困难,治疗主要为脾切除术,预后良好。     

45例嗜铬细胞瘤的临床分析

目的：提高嗜铬细胞瘤的诊断和治疗水平。方法：回顾性分析10年来45例嗜铬细胞瘤的临床资料。结果：具有典型临床表现者39例(87％)。尿香草基苦杏仁酸和血儿茶酚胺定性诊断阳性率为73％，93％。B超、CT、MRI定位诊断阳性率为90％，96％，95％。肾上腺嗜铬细胞瘤35例(78％)，肾上腺外嗜铬细胞瘤10例(22％)。良性嗜铬细胞瘤39例(87％)，恶性嗜铬细胞瘤6例(13％)。全部患者均经手术成功切除肿瘤，无手术死亡患者。结论：嗜铬细胞瘤主要根据临床表现、实验室定性检查及影像学检查明确诊断。手术切除肿瘤是惟一有效的措施，充分的术前准备是确保手术成功的关键。术后应长期严密随访。     

疝外科十年回顾和今后的展望

自从Lichtenstein 1989年第一个正式提出无张力疝修补术概念后,国内也有介绍和开展手术,但发展缓慢.1997年我再次去美国研读期间,发现无张力疝修补手术的优点和一门新学科将有可能以此为起点的趋势后,在美国新泽西州疝中心参观学习手术技术和相关知识.1997年9月27日我在北京邮电总医院进行了第一例 Plug mesh hernia repair (perfix-plug○R),并把Plug mesh hernia repair翻译为"疝环充填式无张力疝修补手术"[现代外科,1998,4(2):47].1998年12月13日在北京九华山庄举行了我国第一次无张力疝修补学术研讨会.当时参会的约30余位医师.1998年12月在中央电视台的健康之路节目首次向全国电视观众介绍了无张力腹股沟疝修补手术.     

Medical treatment of ectopic pregnancy.

Methotrexate is an alternative to surgical treatment of unruptured tubal pregnancy. Among 39 women with the diagnosis of tubal pregnancy there were ten cases without rupture of the salpinx. Nine out of these were treated with methotrexate. In one case there was a tubal rupture immediately after the termination of the treatment. There were no major side effects from the treatment with methotrexate. Tubal patency was tested for laparoscopically three months after the treatment. There was patency of all previously affected tubes.