妇科恶性肿瘤患者术后并发尿瘘的护理新方法

目的 探讨妇科恶性肿瘤术后并发尿瘘的护理新方法.方法 对23例妇科恶性肿瘤术后并发尿瘘的患者采用OB卫生棉条进行阴道填塞,必要时阴道内置双腔导尿管引流,加强阴道、会阴护理,预防尿路感染,加强营养支持.结果 23例妇科恶性肿瘤术后并发尿瘘病例中,18例经精心治疗护理后瘘孔愈合出院,4例因尿瘘孔较小出院回家后自愈,1例因多发远处转移、多脏器功能衰竭而死亡.结论 对妇科恶性肿瘤术后并发尿瘘的患者采用卫生棉条进行阴道填塞,同时加强阴道、会阴护理,加强营养对尿瘘的治疗有积极的作用.

Abstract：

Objective To study the new nursing method of patients complicated with urinary fistula after gynecological malignancy operation. Methods Nursing measures were provided with sufficient nutritional support and prevention of urinary tract infection by perineal nursing, vaginal plugging by OB sliver,and using endovaginal catheter to 23 patients complicated with urinary fistula after gynecological malignancy operation. Results 18 patients recovered by treatment and nursing, 4 mild cases cured after discharge from hospital and 1 patient died of MODS and multiple metastasis. Conclusions Vaginal plugging by OB sliver, perineal nursing and sufficient nutritional support have positive effect for patients complicated with urinary fistula after gynecological malignancy operation.     

Detection of central pelvic recurrent disease with transvaginal color Doppler ultrasound in women treated for gynecological malignancy.

OBJECTIVE: To evaluate color Doppler characteristics of small recurrent tumors detected within the central pelvis in follow-up patients treated for gynecological malignancy. PATIENTS AND METHODS: A prospective study was performed on 340 patients who were being monitored following treatment for gynecological malignancies. A selected group of 27 patients, with small pelvic masses located in the central region of the pelvis, underwent a color Doppler examination. A subjective assessment of the vascularization (vascular score), the lowest resistance index (RI), the highest peak velocity (PSV) and the highest time averaged maximum velocity (TAMXV) of the vessels detected within the lesion were analyzed. RESULTS: In 16 patients the pelvic mass was found to be benign while in 11 patients a malignant recurrence was diagnosed. Gray-scale examination could not differentiate between benign and malignant lesions. The color score of tumor recurrences was significantly higher in comparison to that in benign lesions (color score 3 in 54% vs. 0%, P < 0.005). The malignant lesions showed significantly lower mean values of RI and significantly higher mean values of PSV and TAMXV when compared with benign lesions (0.39 +/- 0.09 vs. 0.81 +/- 0.22, P < 0.0001; 19.3 +/- 4.7 vs. 10.5 +/- 5.6 cm/s, P < 0.0001; 8.9 +/- 3.7 vs. 4.3 +/- 2.7 cm/s, P < 0.005). CONCLUSIONS: Color Doppler analysis added to transvaginal gray-scale ultrasonography seems to be a helpful tool in the diagnosis of recurrent tumors in the central region of the pelvis.     

腹膜外盆腔淋巴结清扫术在妇科恶性肿瘤根治术中的应用

目的探讨在妇科恶性肿瘤根治性手术中采用腹膜外盆腔淋巴结清扫术的优势。方法在浸润性宫颈癌及子宫内膜癌的根治性手术中,选择47例行腹膜外盆腔淋巴结清扫术,并对该术式的操作方法及其优势作了详细的阐述。结果除术中右髂总静脉及左闭孔静脉损伤各1例外,其余患者手术操作顺利。术中无恶心呕吐等胃肠道反应及心血管并发症,与腹膜内清扫术相比节省时间30min;术后并发淋巴囊肿11例,腹壁切口淋巴漏1例,均经相应治疗后痊愈。结论在宫颈癌及子宫内膜癌的根治性手术中采用腹膜外盆腔淋巴结清扫术,具有术野显露良好,无需腹壁自动牵开器,对盆腹腔干扰时间晚而短,避免因探查等操作而引起的恶心呕吐、血压下降等不良反应及减少术后肠粘连肠梗阻并发症等优点,而且坚持了“包抄歼癌”的手术原则,缩短了手术操作时间。     

Gene transfer approaches for gynecological diseases.

Gene transfer presents a potentially useful approach for the treatment of diseases refractory to conventional therapies. Various preclinical and clinical strategies have been explored for treatment of gynecological diseases. Given the direst need for novel treatments, much of the work has been performed with gynecological cancers and ovarian cancer in particular. Although the safety of many approaches has been demonstrated in early phase clinical trials, efficacy has been mostly limited so far. Major challenges include improving gene transfer vectors for enhanced and selective delivery and achieving effective penetration and spread within advanced and complex tumor masses. This review will focus on current and developmental gene transfer applications for gynecological diseases.     

叙事护理对首次确诊妇科恶性肿瘤患者创伤后应激障碍的影响研究

目的 探讨叙事护理对首次确诊妇科恶性肿瘤患者创伤后应激障碍(Post-traumatic stress disorder, PTSD)的应用效果。方法 采用便利抽样法,选取2021年10月—2023年3月在南京市某三级甲等医院住院的88例首次确诊妇科恶性肿瘤患者作为研究对象,按照随机数字表法将研究对象划为研究组和对照组各44例。干预时间为确诊后3个月每次住院期间,共干预4次。研究组每次住院期间在常规妇科专科护理工作的基础上开展叙事护理,对照组实施常规妇科专科护理工作。比较两组患者创伤后应激障碍平民版量表(PCL?C)得分、心理弹性量表(CD?RISC)得分和疾病接受度量表得分。结果 干预前研究组和对照组PTSD发生率为11.36%和18.18%,差异无统计学意义(P>0.05)。干预后研究组患者的创伤后应激障碍评分低于对照组,研究组患者的心理弹性得分、疾病接受度得分高于对照组,差异均具有统计学意义(P<0.05)。结论 实施叙事护理能有效改善首次确诊妇科恶性肿瘤患者的PTSD水平,提高患者的心理弹性和疾病接受度,降低PTSD的发生率。     

Screening for hemochromatosis.

BACKGROUND: Hereditary hemochromatosis is the most common autosomal recessive disorder in populations of northern European descent. ISSUES: Many experts consider hemochromatosis to be an almost ideal disease for population screening because it essentially fulfills almost all the criteria for screening proposed by the WHO. However, others disagree and suggest that more data are required particularly with regard to the natural history and penetrance of the disease. There is also disagreement about the best diagnostic/screening test for the disease and the performance of these tests in the context of screening. Other concerns are the variability and lack of standardization in screening test measurements, the selection of screening threshold values and the identification of false positive cases. The advent of a genetic test for the condition has brought other worries with regard to informed consent and the ethical, legal and social implications of screening particularly in relation to medical and general discrimination. Other important issues include compliance, cost effectiveness and the evidence that screening has lessened the burden of disease in the community. CONCLUSIONS: At the present time, we believe that further data regarding both the exact disease burden and the outcomes of screening studies particularly in the general community are required before widespread population screening is introduced.     

The gynecological Pap test.

The gynecologic pap test is one of the most successful tests ever developed for reducing the incidence of cancer of the uterine cervix. Despite this undisputed fact, cervical cancer is still present in unacceptably high numbers in the United States. A review of the gynecologic Pap test is presented. Data show that the high incidence of cervical cancer in the US is attributed mostly to failure on the part of the client, with smaller but significant failures on the parts of the healthcare provider and medical laboratory. The only way to reduce the incidence of cervical cancer is to increase the screening rate of patients at risk.     

Screening for colorectal cancer.

A voluntary colorectal screening program was carried out in North Carolina to evaluate the public's willingness to perform a do-it-yourself bowel test, to educate the public on the importance of routine colorectal screening, and to assess the efficacy of a small-scale screening program in detecting colorectal cancer. A screening kit was requested by 1,204 individuals after hearing or reading about the program; 770 kits were returned. Of 29 (3.7%) positive test results, six were negative after retesting. Adequate follow-up was available for 18 of the remaining 23 positive results. Thirteen were due to anal bleeding, diverticulosis, or heavy ingestion of aspirin; five were considered false-positive results, since no evidence of disease could be found. No cases of polypoid tumors or carcinoma were detected. The main value of such a program in an area with a small population base is to increase the awareness of the public of the importance of routine screening for colorectal cancer.     

Hemolymphangioma with multiple hemangiomas in liver of elderly woman with history of gynecological malignancy: A case report

BACKGROUNDHepatic hemolymphangioma is an extremely rare benign congenital malformation composed of cystically dilated lymphatic and blood vessels, and they have nonspecific clinical symptoms and laboratory results. In this study, hepatic hemolymphangioma with multiple hemangiomas in an elderly woman was initially reported and analyzed.CASE SUMMARYA 61-year-old female patient, with a history of hysterectomy and bilateral adnexectomy, was referred to the hepatobiliary surgery department with the complaint of multiple hepatic hemangiomas that had been diagnosed 2 years prior in a preoperative contrast-enhanced computed tomography (CECT) examination. Upon entering our hospital, no abnormal physical examination and laboratory data were found. The latest CECT revealed a new 7.0 cm × 6.2 cm cystic-solid lesion with multiple internal divisions in segment II of the liver, with delayed CECT enhancement characteristics that presented as solid parts with internal division. On the positron emission tomography (PET)/CT, no significant uptake of ¹⁸F-fluorodeoxyglucse was observed. Finally, hepatic hemolymphangioma was confirmed based on the pathological and immunohistochemical results after surgery. At 1-year follow-up, her posthepatectomy evaluation was uneventful, and she had recovered full activity. In addition, no postoperative recurrent or residual lesion was found on CECT imaging.CONCLUSIONHepatic hemolymphangioma with multiple hemangiomas was reported and observed by CECT and PET/CT imaging.     

Therapeutic apheresis in malignancy.

Plasmapheresis (PP), staphylococcal protein A immunoadsorption (SPI), and extracorporeal photochemotherapy (EP) have been utilized in cancer treatment for about 20 years. PP removes immune complexes and induces a temporary increase in T4/T8 ratio, natural killer cell activity, and blastogenic responses. SPI removes immune complexes, enhances lymphocytic responses, and activates complement. EP increases lysis of circulating lymphoma cells by CD8+ cytotoxic T cells and increases tumor necrosis factor production by host monocytes. PP induces partial remission in about 28% of patients, but this remission is short lived. SPI gives similar results. Addition of PP to chemotherapy has been reported to prolong survival in patients with multiple myeloma. EP appears useful in treating cutaneous T cell lymphomas with 25% of patients achieving complete response and 50% of patients attaining partial remission. Thus, PP and SPI induce short-lived immune responses, but have no proven clinical utility. EP may be useful in the treatment of cutaneous T cell lymphomas.     

Sonographic features of decidualized ovarian endometriosis suspicious for malignancy.

The discovery of an ovarian mass during pregnancy is often a difficult issue because of the risk related to surgical intervention during pregnancy. Moreover, ultrasound examination is often unable to provide a definitive diagnosis. A case of decidualized ovarian endometriosis is presented to highlight the challenges in this diagnosis. We report the transvaginal ultrasound findings, including color Doppler examination, magnetic resonance characteristics and tumor marker longitudinal evaluation during the first trimester of pregnancy, as well as the final histological characteristics of the lesion. Decidualization is a rare occurrence in ovarian endometriosis and must be differentiated from malignant transformation.