根治性宫颈切除术1例并文献复习

目的：探讨广泛性宫颈切除术在早期宫颈癌手术治疗中的可行性和安全性。方法回顾性分析1例早期宫颈癌患者临床资料,并复习国内外文献,总结保留生育功能的根治性宫颈切除术（RT）的临床进展。结果患者术中术后无并发症发生,随访期间无复发。结论对年轻宫颈癌患者实施保留生育功能的RT手术是可行的,RT术后妊娠结局仍需大样本资料研究证实。     

腹腔镜广泛宫颈切除术及淋巴结清扫术治疗宫颈癌5例分析

目的：探讨腹腔镜广泛子宫颈切除术及盆腔淋巴结清扫术治疗早期宫颈癌的可行性。方法：对5例要求保留生育能力的早期宫颈癌患者行腹腔镜下淋巴结清扫术,若病理回报阴性,经阴道横断子宫颈及2 cm阴道。结果：腹腔镜下广泛宫颈切除及淋巴结清扫5例,术中术后均无并发症。术后住院3-6 d。结论：腹腔镜广泛性宫颈切除及淋巴结清扫治疗早期宫颈癌,创伤小、恢复快,能保留患者的生殖功能。     

宫颈癌保留生育功能手术方案优化

随着宫颈癌筛查的普及,宫颈癌患者诊断年龄有年轻化趋势,<35岁患者的构成比由9%上升到24%,部分年轻患者尚未完成生育功能,有迫切的生育愿望。目前保留生育功能的手术可经阴道、经腹腔镜或经开腹手术完成,包括宫颈锥形切除术、单纯宫颈切除术、广泛性宫颈切除术等。本文回顾了近年来在宫颈癌保留生育功能手术进展,并对亟待解决的问题进行简要论述。     

早期宫颈癌患者保留生育功能的研究进展

近年来宫颈癌的发病呈明显的年轻化趋势,未生育的患者显著增加。因而早期宫颈癌患者保留生育功能的手术日益引起人们的关注。本文综述了近年来关于早期宫颈癌保留生育功能手术治疗的相关文献,重点讨论其适应证、具体术式、不同期别的治疗方案以及治疗后的肿瘤结局与妊娠结局。     

非根治性宫颈切除术治疗早期宫颈癌的临床评价

1994年Dargent等报道了对早期宫颈癌运用根治性宫颈切除术（RT）治疗，RT被视为21世纪宫颈癌手术的发展标志。但RT术后子宫的解剖发生了改变，易影响妊娠的结局；故不断有新式早期宫颈癌保留生育功能手术的提出。     

非根治性宫颈切除术治疗早期宫颈癌的临床评价

1994年Dargent等[1]报道了对早期宫颈癌运用根治性宫颈切除术(RT)治疗, RT被视为21世纪宫颈癌手术的发展标志.但RT术后子宫的解剖发生了改变,易影响妊娠的结局;故不断有新式早期宫颈癌保留生育功能手术的提出[2].本院对43例宫颈原位癌和FIGO分期Ⅰa期宫颈癌年轻患者采用扩大的宫颈锥切术或阴式单纯宫颈切除术治疗,并探讨非根治性宫颈切除术的临床价值.     

宫颈癌保留生育功能治疗方案

早期宫颈癌的标准治疗方案是根治性子宫切除术(包括子宫、宫旁和盆腔淋巴结切除),但至少有40%的早期宫颈癌患者处于生育年龄,因此保留生育功能是治疗计划中重要的考虑因素[1]。1987年法国学者Dargent开创性使用腹腔镜行盆腔淋巴结切除并经阴道行子宫颈、宫旁和阴道上部切除术,也称腹腔镜阴式根治性宫颈切除术(laparoscopic vaginal radical trachelectomy,LVRT),给需要保留生育功能的早期小病灶宫颈癌患者带来了希望。     

21例早期宫颈癌行经阴道根治性宫颈切除的手术配合及护理

目的 探讨早期宫颈癌保留生育功能行经阴道根治性宫颈切除的手术配合和护理.方法 对21例早期宫颈癌患者行经阴道根治性宫颈切除,术中同时在腹腔镜下行淋巴清扫治疗,切除组织标记后均行病理检查.术后病理诊断:宫颈癌ⅠA2(FIGO分期),未发现淋巴结转移.并对其治疗配合及护理作回顾性分析.结果 患者术后恢复好,术后随访5例怀孕,均行剖宫手术顺利分娩,取得满意临床效果.结论保留早期宫颈癌患者的生育功能不仅必要,而且可行.     

宫颈癌保留生育功能手术的临床病例报道及文献复习

<正>宫颈癌是常见的妇科恶性肿瘤,近年来,宫颈癌的发病出现了年轻化的趋势[1],超过40%的宫颈癌患者年龄小于44岁[2]。随着生育年龄的推迟,未生育的宫颈癌患者数量逐年升高,有生育要求的患者增多[3]。我院从2010年5月至2014年11月,对4例Ⅰa2~Ⅰb1期要求保留生育功能的宫颈癌患者,实施保留生育功能的手术治疗,经腹或经腹腔镜根治性宫颈切除术及盆腔淋巴结清扫术,短期疗     

保留生育功能的早期宫颈癌治疗进展

近年宫颈上皮内瘤变及宫颈癌发病趋于年轻化,患者有保留生育功能的要求,早期宫颈癌的保守治疗也愈显重要。宫颈锥切术及根治性宫颈切除术既能保留生育能力又具有良好的预后,可与同期别肿瘤行根治性子宫切除术的生存率相近。本文就宫颈锥切术及根治性宫颈切除术的治疗进展进行综述。     

广泛性子宫颈切除术后妊娠患者的围术期护理

目的：探讨广泛性子宫颈切除术（ VRT）后妊娠行剖宫产患者的护理措施及效果。方法对9例VRT后妊娠行剖宫产的患者进行回顾性分析,按病情进行综合评估,加强孕期保健,对有自觉症状者做到早发现、早处理,同时做好产妇的健康教育及心理护理。结果无新生儿窒息,未发现新生儿畸形,无围产儿死亡。产后平均随诊22．9个月,患者宫颈细胞学检查结果正常,无肿瘤复发。结论加强孕期保健,做好孕妇的心理疏导,积极治疗和有效护理VRT后妊娠患者是降低孕产妇及围产儿死亡的重要环节。     

First case of four spontaneously conceived successful pregnancies after fertility‐sparing surgery for cervical cancer

Cervical cancer represents a particular burden when affecting women in their fertile years. Fertility‐sparing surgery such as trachelectomy can maintain a woman`s childbearing ability. Favorable outcomes are possible, as depicted in this case.     

Successful delivery after vaginal occlusion in addition to cerclage in a trachelectomy patient with recurrent second trimester pregnancy loss: a case report

Pregnancy outcome after trachelectomy has high risk of complications such as second trimester pregnancy loss and preterm birth. We report beneficial effect of a simple procedure of vaginal occlusion in addition to cerclage in a patient with trachelectomy and two prior second trimester pregnancy losses.     

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.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

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.