妇科腹腔镜手术护理

目的探讨综合护理干预在妇科腹腔镜手术中的应用价值。方法选择我院进行妇科腹腔镜手术治疗的患者128例,按照随机分组分为观察组和对照组,每组各64例,对照组给予常规护理,观察组给予患者综合护理干预措施,观察两组治理并发症发生情况及临床护理满意度。结果观察组并发症发生率低于对照组,经统计学分析比较,差异有统计学意义(P<0.05)。观察组临床护理满意度优于对照组,经统计学分析比较,差异有统计学意义(P<0.05)。结论对进行妇科腹腔镜手术患者实施综合护理干预措施可以有效减少手术并发症的发生,提高患者临床护理满意度,值得在临床上大力推广使用。     

腹腔镜妇科手术围手术期护理方法的探讨

目的探讨妇科围腹腔镜手术期的护理方法。方法对93例行腹腔镜手术治疗患者的临床护理资料进行回顾性分析。结果所有患者均得到有效的护理治疗,术后5～7d康复出院。结论周密的术前准备,做好围手术期的观察和护理,及时发现并协助医生处理问题,是减少腹腔镜手术并发症的关键。     

妇科腹腔镜手术300例分析

300例腹腔镜手术病例均采用全麻,主要器械为单极双极电凝,异位妊娠术式为输卵管切开取胚术、输卵管切除术;卵巢囊肿手术采用囊肿剥除术及卵巢成形术、患侧附件切除术;子宫手术采用肌瘤剥除术、改良CISH术、子宫全切术及LAVH术。结果发现腹腔镜手术占同期妇科手术的52．3％,手术成功率98．67％,中转开腹率1．33％,并发症发生率2．67％,包括皮下气肿2例,皮下血肿4例,脐部切口裂开1例,盆腔血肿1例。认为掌握好适应证,妇科大部分手术可在腹腔镜下完成。     

腹腔镜妇科手术480例围手术期护理体会

1995年10月～2003年12月，我们施行腹腔镜妇科手术480例。现将护理体会总结如下。     

妇科腹腔镜手术126例分析

目的 分析妇科腹腔镜手术的临床效果.方法 回顾分析应用电视腹腔镜分别行异位妊娠、子宫穿孔、卵巢肿瘤、子宫肌瘤、不孕症等手术126例.结果 除2例中转开腹外,其余全部镜下手术成功,成功率达98.41%.术中出血少、痛苦少、恢复快、住院天数短、腹壁美容效果好.结论 腹腔镜治疗妇科疾病的适应证越来越广,已成为妇科主要的诊断及治疗技术之一.     

妇科腹腔镜手术148例分析

目的总结妇科腹腔镜手术的适应证及并发症。方法对148例妇科腹腔镜手术患者的临床资料作回顾性分析。结果本组分别行输卵管切除术、附件切除术、黄体破裂修补术、子宫肌瘤剔除术,镜下完成手术146例,出现并发症者2例。结论妇科腹腔镜手术的适应证主要为卵巢囊肿及异位妊娠,手术并发症发生率低。     

妇科腹腔镜手术的整体护理体会

2008年1-10月,我们共行腹腔镜妇科手术33例。现介绍其整体护理体会。 临床资料：本组33例患者的年龄为20-58岁,平均39岁。其中子宫肌瘤7例,异位妊娠13例,卵巢囊肿8例,输卵管粘连5例。均在全麻下行腹腔镜妇科手术。平均手术时间为（94±27）min,术中平均出血量为（60±15）ml,平均住院4～6d。     

妇科电视腹腔镜手术43例报告

自1998年3月以来,我院开展电视腹腔镜妇科手术43例,取得了满意效果。现报告如下。一般资料:本组患者年龄23～50岁,平均33岁。经产妇40例,已婚未产妇2例,未婚1例。输卵管妊娠18例,卵巢囊性肿瘤9例,卵巢冠囊肿7例,子宫内膜异位症卵巢巧克力囊肿3例,子宫肌瘤2例,子宫肥大症合并双侧卵巢畸胎瘤1例,多囊卵巢综合征1例,盆腔脓肿2例。43例中,输卵管切除术18例,附件切除术12例,卵巢囊肿剥出术7例,腹腔镜辅助阴式子宫切除术3例,脓肿穿刺抽吸术2例,多囊卵巢楔形切除术1例。手术方法:本组均采用连续硬膜外麻醉,2例因麻醉效果不满意改为气管插管麻醉。采…     

腹腔镜手术和开腹手术治疗妇科急腹症的临床效果研究

目的:对妇科急腹症患者使用腹腔镜手术和开腹手术进行治疗的效果进行探析.方法:将2018年2月-2020年2月前来我院治疗的64例妇科急腹症患者列为实验人员,根据随机数字表法把患者随机分成常规组和实验组,各组成员均为32例.常规组患者使用开腹手术进行治疗,实验组使用腹腔镜手术进行治疗,将两组患者治疗情况(临床指标、并发症...     

Bowel preparation for gynecological surgery

Bowel preparation is an established practice before abdominal surgery. Most surgeons would use both antibiotic prophylaxis and mechanical bowel preparation (MBP) before bowel surgery. In the literature, however, there is no evidence to support the use of MBP before elective colorectal surgery. Some randomized studies and a meta-analysis report a significantly higher incidence of wound infection in patients receiving MBP versus no bowel preparation. As to gynecological surgery, data are scanty, and there is a single randomized study reporting no advantage of MBP over no bowel preparation. Based on these evidences, the routine use of MBP should be reconsidered both in general and gynecological surgery.     

Povidone-iodine enema as a preoperative bowel preparation for colorectal surgery

To evaluate the effects of povidone-iodine (PI) enema on the bacterial flora of colorectal mucosa, the authors studied 113 patients who were candidates for colorectal surgery. The study of the rectum included 72 patients. Total bacterial concentrations after a PI enema (N=44) were significantly lower than after a simple water enema (N=12,P<0.001), or than after a water enema associated with intravenous metronidazole (N=16,P<0.01). The study of the colon included 41 patients. Total bacterial concentrations did not differ after a PI enema (N=24) than after a water enema (N=11); both groups were associated with intravenous metronidazole. In contrast, both preparations significantly reduced bacterial concentrations when compared with oral administration of polyethyleneglycol (N=6,P<0.01). Similar results were observed in rectal and colonic studies, when analysis was restricted to the anaerobic flora. PI is an antiseptic that, when administered alone in an enema or in association with metronidazole, significantly reduces bacterial concentrations in the mucosa of the colon and rectum. It may be proposed as a simple preoperative preparation for colorectal surgery.     

A systems approach to preoperative surgical patient skin preparation

BACKGROUND: The merits of a systems approach to preoperative surgical patient skin preparation are presented. A "system" may be defined as the addition of an antiseptic bath(s) or shower(s) within 24 hours before the application of a Food and Drug Administration-compliant patient preoperative skin preparation at the time of surgery. The expected outcome from this added effort is a further reduction in the transient and normal flora that contaminate the skin surrounding the operative site, and contribute to surgical infections. The Centers for Disease Control and Prevention has recommended the addition of this step to the preoperative site preparation regimen. METHODS: A human in vivo study comparing an alcohol-based (ethanol) system to an iodine-based approach, and 2 sets of clinical observations, are presented here. RESULTS: The data confirm the utility of the systems approach. The in vivo study demonstrates that significant reductions (> or =2 log(10)) in normal and transient flora can be achieved quickly and maintained out to 72 hours after the surgery, allowing for wound closure in a prolonged state of skin antisepsis. Clinical observations support the in vivo findings. After initiation of the system, the infection rates for the monitored procedures have decreased. CONCLUSIONS: The data presented here delineate the merits of a systems approach to preoperative surgical patient skin preparation. This approach has a positive impact on infection rates and may reduce the additional costs associated with this preventable event.     

乳腺癌腔镜手术的研究进展

乳腺癌已经成为全球最为常见的女性癌症,其治疗方式以手术为主。传统乳腺手术因手术切口大、并发症多且较为严重而影响患者的生存质量,在不断追求微创手术的今天已经不能满足女性美观的需求。腔镜手术的发展以及设备的迭代使乳腺癌腔镜手术成为可能,溶脂法和非溶脂法建腔技术的出现和完善为乳腺癌腔镜手术的开展奠定基础,其中短期疗效的安全性令人鼓舞。手术技术不断完善,各种共识及推荐指南的发布进一步降低学习成本,利于乳腺腔镜技术的进一步推广及发展。我国单孔腔镜和机器人辅助乳腺手术的出现标志乳腺腔镜技术的进一步发展,迈入国际领先行列。该文就乳腺癌腔镜手术的相关研究进展进行综述。     

Antimicrobial performance of two preoperative skin preparation solutions containing iodine and isopropyl alcohol

BackgroundHealthcare-associated infections (HAIs) are a persistent clinical challenge caused primarily by bacteria on the skin. Proper utilization of optimized antiseptic skin preparation solutions helps reduce the prevalence and impact of HAIs by decreasing patient skin microorganisms preoperatively. The purpose of this study was to evaluate the efficacy of 2 antimicrobial solutions containing iodine and isopropyl alcohol (IPA): Povidone iodine (PVP-I) with IPA (ie, PVP-I+IPA, PurPrep) and Iodine Povacrylex+IPA (DuraPrep).MethodsThe antimicrobial activity of the test solutions was evaluated in vitro by determinations of minimum inhibitory concentrations (MICs) and minimum bactericidal concentrations (MBCs) against 1105 diverse microbial isolates and a time-kill assay to evaluate efficacy against 120 strains of Gram-positive and Gram-negative bacteria and yeasts. Peel tests were performed between skin samples treated with test solutions and representative drape/dressing materials to determine effects of test solutions on the biomechanical adhesion properties. Finally, an Institutional Review Board (IRB)-approved, randomized, controlled, single-center, partially blinded in vivo study was performed to assess the immediate and persistent antimicrobial activity of the test solutions on the abdomen and groin.ResultsBoth PVP-I+IPA and Iodine Povacrylex+IPA solutions demonstrated broad-spectrum antimicrobial activity with MIC and MBC at less than 1% of the full-strength concentration of each product against a wide variety of microorganisms. In the time-kill tests, both solutions were able to successfully reduce all microbial populations by 99.99% (ie, 4 log₁₀) at the contact times of 30 seconds, 2 minutes and 10 minutes. The 2 solutions showed relatively similar adhesion results when tested with 3 representative operating room materials. Both PVP-I+IPA and Iodine Povacrylex+IPA met the expected Food and Drug Administration (FDA) efficacy requirements at 10 minutes and 6 hours post-treatment for both anatomic sites (ie, groin, and abdomen) in the clinical study, with no safety issues or adverse events.ConclusionsAnalysis of the in vitro antimicrobial activity, biomechanical adhesive strength, and in vivo efficacy of PVP-I+IPA demonstrated similar results compared to Iodine Povacrylex+IPA. Both products were efficacious at reducing or eliminating a wide range of clinically-relevant microorganisms in lab-based and clinical settings, supporting their use as antiseptic skin preparation solutions to reduce bacteria on the skin that can cause infection.     

从历史角度看结直肠术前肠道准备争议

加速康复外科（ERAS）概念自1999年由丹麦kehlet教授首次提出,其核心理念是在循证医学理念的基础上,对围术期进行一系列处理,减少手术创伤及应激对患者的伤害及体内平衡的干扰,使患者心理和生理状况尽快从手术中恢复,减少术后干扰并发症、缩短住院时间、再入院率。目前ERAS发展极为迅速,各大医疗中心均发展出自己特色的ERAS路径。我们在看到ERAS发展如此之快的同时,更应该注意到在ERAS推行过程中,其与传统理念及习惯的激烈碰撞,进而所产生对ERAS方案的疑问。其中就包括肠道准备。本文将从历史角度并综述国内外现有的关于肠道准备的证据,对肠道准备争议进行探讨。     

单孔腹腔镜下子宫内膜癌分期手术的研究进展

循证医学已证明腹腔镜全面分期手术可作为治疗子宫内膜癌的理想术式。经脐单孔腹腔镜成功完成子宫内膜癌分期手术的例数逐渐增多,虽然该术式与传统腹腔镜手术在术中及术后并发症、远期疗效方面差异并不明显,但单孔腹腔镜以美观程度更高、术后恢复更快的优点逐渐应用于子宫内膜癌分期手术中。由于手术难度大、学习曲线长和远期疗效缺乏大样本研究等原因,单孔腹腔镜在子宫内膜癌分期手术上尚未广泛应用。但随着医学的发展,该术式将在子宫内膜癌分期手术中占据越来越重要的地位,使更多女性从中获益。     

Rapid preoperative preparation for severe hyperthyroid Graves' disease

Thyroidectomy (TX) is no longer the preferred choice for the therapy of hyperthyroid Graves' disease but is an alternative in patients who are noncompliant with or have reactions to antithyroid drugs, have moderate to severe ophthalmopathy, have large goiters, or who refuse (131)I therapy and/or long-term antithyroid drug therapy. Seventeen clinically and biochemically severely thyrotoxic patients (16 female, mean age of 35 yr), all but one with large goiters, underwent TX after rapid preparation. The potent inhibitors of the deiodination of T(4) to T(3), iopanoic acid (IOP) (500 mg twice a day) and dexamethasone (DEX) (1 mg twice a day), were given with propylthiouracil or methimazole, when possible, and beta-blockers. Thyroid function tests were obtained before treatment and at TX. All patients were thyrotoxic (mean +/- SE: T(4), 21.6 +/- 1.2 micro g/dl; free T(4) index (FTI), 10.3 +/- 0.8; total T(3), 510 +/- 48 ng/dl). IOP and DEX rapidly lowered T(3) values (P < 0.0001; total T(3), 147 +/- 13 ng/dl) with a smaller but significant (P < 0.05) decrease in T(4)/FTI (T(4), 17.9 +/- 1.3 micro g/dl; FTI, 7.9 +/- 0.6). All patients were clinically euthyroid before surgery. None developed hypoparathyroidism, laryngeal nerve damage, or worsening of ophthalmopathy after surgery. The restoration of hyperthyroid Graves' disease to euthyroidism is rapidly accomplished with IOP and DEX, beta-blockers, and, when possible, antithyroid drugs. This is especially relevant in noncompliant patients with large goiters.