腹腔镜在子宫肌瘤切除术中的应用

目的 :探讨腹腔镜子宫肌瘤切除的手术方式、适应症和疗效。方法 :应用腹腔镜行子宫肌瘤切除术 5 2例。结果 :术中共发现肌瘤 6 7个 ,肌瘤直径 3～ 10 cm,平均手术时间及术中出血量分别为 93.7min和 79.8ml,术后平均住院时间 6 .2 d,肌瘤直径≥ 6 cm者比肌瘤 <6 cm者出血量明显增加 (P<0 .0 5 ) ,但手术时间无明显区别 (P>0 .0 5 ) ,术后无 1例并发症发生。结论 :腹腔镜下肌瘤切除术 ,创伤小 ,恢复快 ,术后患者月经正常 ,不影响妊娠。     

腹腔镜下行子宫肌瘤切除术的体会

目的观察腹腔镜下行子宫肌瘤切除术的治疗效果。方法腹腔镜下行子宫肌瘤切除术56例,其中单发肌瘤33例,包括肌壁间肌瘤19例,浆膜下肌瘤14例;多发性肌瘤23例。最大肌瘤直径8cm。结果手术均顺利完成,无一例中转开腹,手术时间(108±27)min,术中出血量(102±93)ml;术后发热发生率3%,肌壁间肌瘤和直径≥5cm者手术时间及术中出血量明显增加。结论在选择好病例的基础上,腹腔镜下行子宫肌瘤切除术具有安全、出血少、并发症少、术后恢复快等优点。     

腹腔镜子宫肌瘤剔除术前米非司酮预处理的临床效果观察

目的观察米非司酮预处理后行腹腔镜子宫肌瘤剔除术的效果及安全性。方法选择我院2005年5月～2010年5月拟行子宫肌瘤剔除术98例（肌瘤直径均〉5 cm）,术前应用米非司酮预处理52例纳入研究组,46例未用药者纳入对照组。两组均行腹腔镜子宫肌瘤剔除术,比较两组肌瘤直径、手术时间、术中出血量,观察研究组药物不良反应。结果研究组预处理前肌瘤平均直径（6.3±1.1）cm,预处理后（4.2±1.0）cm,预处理前、后比较差异有统计学意义（P〈0.01）;对照组术前肌瘤平均直径（5.8±1.3）cm。研究组预处理后肌瘤直径与对照组比较差异有统计学意义（P〈0.01）。研究组手术时间及出血量较对照组明显减少,差异有统计学意义（P〈0.01）。研究组用药期间全部闭经,8例出现轻微不良反应,停药后1个月恢复月经。结论对于直径〉5 cm的子宫肌瘤,腹腔镜子宫肌瘤剔除术前应用米非司酮预处理,可缩小肌瘤直径,从而缩短手术时间,减少术中出血。     

腹腔镜下子宫肌瘤剔除术196例临床分析

目的探讨腹腔镜下子宫肌瘤剔除术的影响因素和手术技巧。方法对2003年1月至2004年12月196例腹腔镜子宫肌瘤剔除术病例进行回顾性分析。结果单发肌瘤122例,多发74例;浆膜下肌瘤113例,肌壁间肌瘤62例,浆膜下与肌壁间肌瘤同时存在21例;肌瘤数最多12个,肌瘤平均直径4.51 cm;手术时间平均75.5 min,术中出血平均25.6 ml。子宫肌瘤直径≥6 cm者手术时间和术中出血量明显大于直径<6 cm者,肌瘤数目和肌瘤类型对手术时间和出血量无明显影响。结论子宫肌瘤大小是影响手术时间、术中出血的关键因素。严格掌握手术指征和具备熟练的镜下手术技能是体现腹腔镜手术优越性的关键和保证。     

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.     

传统开腹术与腹腔镜下子宫肌瘤剔除术对妊娠结局、肌瘤残留及复发情况的影响

【目的】探讨传统开腹术与腹腔镜子宫肌瘤剔除术对妊娠结局、肌瘤残留及复发情况的影响。【方法】选取2010年6月至2015年1月本院收治的子宫肌瘤患者100例,根据患者意愿分组,每组50例,观察组采用腹腔镜子宫肌瘤剔除术,对照组采用传统开腹子宫肌瘤剔除术,比较两组患者术后妊娠结局、子宫肌瘤残留、复发及并发症发生情况。【结果】与对照组比较,观察组术中出血量少,手术时间和住院时间短,其差异均有统计学意义（ P ＜00．5）;与对照组比较,观察组患者的肌瘤残留及复发率显著降低,其差异均有统计学意义（P ＜00．5）,但两组患者的妊娠率比较差异无统计学意义（P ＞0．05）;观察组并发症发生率为20．0％,显著低于对照组100．0％,差异有统计学意义（P ＜00．5）。【结论】与传统开腹术比较,腹腔镜子宫肌瘤剔除术出血量少,手术时间和住院时间较短,且降低肌瘤残留及复发情况,值得临床推广应用。     

悬吊式腹腔镜子宫肌瘤剔除术治疗子宫肌瘤疗效评价

目的：探讨双孔法腹壁皮下悬吊式腹腔镜子宫肌瘤剔除术的临床价值。方法：选取2018年8月~2020年1月治疗的子宫肌瘤患者77例,其中39例采用双孔法腹壁皮下悬吊式腹腔镜子宫肌瘤剔除术的患者为试验组,另38例采用气腹式腹腔镜子宫肌瘤剔除术的患者为对照组,比较两组手术时间、住院时间、术中出血量、肠功能恢复时间、肿瘤切除时间、手术并发症、术后3个月症状及生活质量改善情况。结果：两组住院时间、肠功能恢复时间比较无明显差异（P＞0.05）;试验组手术时间较对照组短,术中出血量较对照组少（P＜0.05）;试验组直径≤6.5 cm、直径＞6.5 cm及单个肿瘤切除时间均短于对照组（P＜0.05）;试验组手术并发症发生率5.13%（2/39）低于对照组的23.68%（9/38）（P＜0.05）;两组术后3个月症状严重程度评分低于术前,生活质量评分高于术前（P＜0.05）,但试验组术后3个月症状严重程度、生活质量评分与对照组相比无明显差异（P＞0.05）。结论：双孔法腹壁皮下悬吊式腹腔镜子宫肌瘤剔除术治疗子宫肌瘤患者具有手术时间短、术中出血量少的优势,且能进一步缩短肿瘤切除时间,改善生活质量。     

腹腔镜下子宫肌瘤核除术40例临床分析

目的 探讨腹腔镜下子宫肌瘤核除术的手术适应证、禁忌证、手术技巧、手术效果及术后并发症。方法 对该院2002-年1月～2005年6月于腹腔镜下行子宫肌瘤核除术的40例病例作回顾性分析。结果 共核除肌瘤54个。单发肌瘤36例，多发肌瘤4例。镜下缝合38例，未缝合2例。手术时间、出血量与肌瘤的大小、个数成正比。术后平均住院时间4d，1例术后出现发热。结论 浆膜下肌瘤、单发壁间肌瘤直径小于7cm，于腹腔镜下行子宫肌瘤核除术效果好，手术时间短，出血少，并发症少。     

腹腔镜阻断子宫动脉后行肌瘤挖除术的临床分析

目的研究腹腔镜阻断子宫动脉后行肌瘤挖除术的临床疗效。方法将172例子宫肌瘤患者分为两组,研究组72例,行腹腔镜下行双侧子宫动脉阻断后挖除子宫肌瘤,对照组100例,直接行腹腔镜下子宫肌瘤挖除。结果研究组平均手术时间为（115．2±24．1）min,手术出血量为（107．8±26．6）mL,而对照组的平均手术时间为（98．1±18．7）min,手术出血量为（234．0±87．2）mL,两组相比差异有统计学意义（P〈0．05）;术后2年随访中,研究组中97％患者临床症状明显缓解,7％例术后出现肌瘤复发,对照组中85％患者临床症状缓解,24％例出现肌瘤复发,两组相比差异有统计学意义（P〈0．05）。结论腹腔镜阻断子宫动脉后行子宫肌瘤切除术可明显减少术中出血,患者术后症状改善明显,术后肌瘤复发率低。     

腹腔镜下子宫动脉阻断辅助子宫肌瘤剔除术临床疗效观察

目的评价子宫动脉阻断在腹腔镜下子宫肌瘤剔除术中的临床作用。方法本院68例子宫肌瘤患者,随机分成2组：每组34例。观察组行腹腔镜下子宫动脉阻断联合肌瘤剔除术,对照组行常规腹腔镜下肌瘤剔除术。比较2组手术时间、术中出血量、术后排气时间、住院时间、术后病率,随访子宫肌瘤复发及月经改善情况。结果观察组术中出血量较对照组明显减少（P〈0．05）,2组手术时间、术后肛门排气时间及住院天数均无明显差异（P〉0．05）,与对照组比较观察组术后病率低、肌瘤复发率低、月经改善率高,差异有显著意义（P〈0.05）。结论腹腔镜下先行子宫动脉阻断再行肌瘤剔除能有效减少术中出血,降低肌瘤复发率,明显缓解月经过多症状。     

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.     

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.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.     

Wie zuverlässig sind Angaben zu nichtentzündlichen ausgedehnten Schmerzen?

ZusammenfassungFragestellung Es wurde geprüft, wie sich der Differenziertheitsgrad zweier Schmerzmessmethoden auf Angaben zur Ausgedehntheit klinischer Schmerzen auswirkt. Zugleich wurde der Referenzzeitraum variiert, über den die Patienten berichten sollten.Methode Erfasst wurde der Einfluss zu Lasten der Befragungsdifferenziertheit durch den Vergleich zweier Körperschema-Bildvorlagen. Drei Referenzzeiträume (Schmerz aktuell, letzte Woche, letztes halbes Jahr) wurden vorgegeben.Ergebnisse Patienten mit ausgedehnten Schmerzen gaben bei differenzierter Befragung um so mehr Schmerzen an, je weiter die Schmerzen zurück lagen und je größer der Berichtszeitraum war. Patienten mit gelenknahen Schmerzen gaben bei hoch differenzierter Befragung weniger ausgedehnte Schmerzen in der Vergangenheit an als bei globaler Einschätzung. Patienten mit Rückenschmerzen berichteten bei differenzierter Befragung zum aktuellen Schmerz über weniger ausgedehnte Schmerzen als bei globaler Befragung.Schlussfolgerung Die Angaben zur Schmerzausdehnung variieren vor allem bei Patienten mit ausgedehnten Schmerzen in Abhängigkeit von der Differenziertheit der Befragung. In diesen Fällen ist die Wahrscheinlichkeit erhöht, dass sich die Beschwerdesymptomatik zumindest teilweise erst in der Reaktion auf die situativen Befragungsbedingungen konstituiert und daher nicht auf andere Befragungsbedingungen generalisiert werden kann.