宫腹腔镜联合手术诊治不孕症120例分析

目的探讨宫、腹腔镜联合手术在女性不孕症诊治中的应用优势。方法联合应用宫、腹腔镜对120例不孕症患者进行检查,并对病因明确者行相应治疗。结果盆腔粘连和输卵管阻塞是造成妇女不孕的主要原因。子宫内膜异位症和卵巢疾病也是常见因素。术后妊娠率达43．8％。结论应用宫、腹腔镜联合诊治不孕症患者能直观、准确、全面地明确盆腔、官腔疾患,并予以针对性治疗,提高手术疏通输卵管的成功率,提高女性不孕患者的妊娠率。     

腹腔镜在瘢痕子宫全子宫切除术中的应用

目的 分析腹腔镜在瘢痕子宫全子宫切除术中应用的可行性和安全性。方法 选择2018年3月~2019年3月在我院行腹腔镜全子宫切除术的患者98例,依据子宫是否瘢痕分为瘢痕组和非瘢痕组,各49例。比较两组手术时间、术中出血量、肛门排气时间、下床活动时间、并发症以及1次剖宫产与2次或以上剖宫产患者手术指标和并发症情况（术中出血量＞500 ml、膀胱穿孔、盆腔血肿、阴道残端出血）。结果 瘢痕组手术时间、术中出血量均高于非瘢痕组,差异有统计学意义（P＜0.05）;瘢痕组肛门排气时间、下床活动时间与非瘢痕组比较,差异无统计学意义（P＞0.05）;瘢痕组并发症发生率为12.24%,与非瘢痕组的16.33%比较,差异无统计学意义（P＞0.05）;1次剖宫产患者手术时间、术中出血量均低于2次或以上剖宫产患者,差异有统计学意义（P＜0.05）;1次剖宫产患者并发症发生率为17.86%,与2次或以上剖宫产患者的14.29%比较,差异无统计学意义（P＞0.05）。结论 腹腔镜应用于瘢痕子宫全子宫切除术中难度大于非瘢痕子宫,手术时间相对较长,术中出血量相对较多。但仍具有良好的安全可行性,且多次剖宫产患者在有经验的医生操作下,仍可经腹腔镜完成手术。     

Comparison of laparoscopic and laparotomic surgery for the treatment of peritoneal inclusion cyst

Objectives: Peritoneal inclusion cyst (PIC) is defined as a fluid-filled mesothelial-lined cysts of the pelvis and it is most frequently encountered in women of reproductive age. The treatment options are observation, hormonal management, imaging-guided aspiration, image-guided sclerotherapy and surgical excision. The objective of this study is to compare between the laparoscopic and laparotomic surgery for the treatment of PIC.Methods: Thirty-five patients with laparoscopy and forty-eight patients with laparotomy were included in the study. We compared the perioperative and postoperative data, the complications and the recurrence between the two groups.Results: There was a significantly reduced mean length of the hospital stay, estimated blood loss and complication rate in the laparoscopic group as compared to that of the laparotomic group (P=0.037, P=0.047 and P=0.037 respectively). There was also no statistical difference of recurrence rate between thelaparoscopic and laparotomic groups on the Cox proportional hazards model (p=0.209).Conclusion: Our study showed that laparoscopy was superior to the laparotomy for the mean estimated blood loss, the mean length of the hospital stay and the complication rate except for the recurrence rate.     

Alternative energy sources for surgical treatment of atrial fibrillation in patients undergoing mitral valve surgery: microwave ablation vs cryoablation

The study aim was to compare maze outcomes using microwave ablation or cryoablation in patients with mitral disease and atrial fibrillation (AF). Between 1999 and 2005, 340 patients underwent mitral valve surgery and concomitant maze procedure involving either microwave ablation (n=96, MW group) or cryoablation (n=244, Cryo group). Mean age at operation was 50.0±12.5 yr. Follow-up period was 46.1±28.2 months. The Cryo group showed a longer aortic clamping time than the MW group (P=0.005). There were no differences in operative mortality and morbidity rates. The unadjusted 5-yr AF free rate was 61.3±1.2% in the MW group and 79.9±3.2% in the Cryo group (P=0.089). After adjustment, the MW group only showed a tendency toward more frequent AF recurrence than the Cryo group (Hazard ration 1.66, 95% confidence interval 0.89 to 3.07). Multivariate analysis revealed that older patient age (P<0.001) and greater left atrial size (P<0.001) were independent risk factors for AF recurrence. Although the use of microwave ablation results in shorter aortic clamping time, it has a tendency toward more frequent late AF recurrence than with cryoablation.     

腹腔镜与传统腹股沟切口手术治疗低位腹腔型隐睾效果比较

目的 比较腹腔镜与传统腹股沟切口手术治疗低位腹腔型隐睾的疗效。方法 回顾性分析2014年1月—2018年6月安徽医科大学附属安庆医院收治的小儿低位腹腔型隐睾116例(127侧)患儿的临床资料。患儿年龄8个月~7岁[(2.74±1.89)岁];右侧57例,左侧48例,双侧11例。116例患儿按手术方式不同分为传统手术组、腹腔镜组,对两组手术时间、术中出血量、术后并发症进行对比分析。结果 (1)腹腔镜组:均顺利完成手术,无一例中转开腹;术中发现13例合并对侧鞘状突未闭(19.40%),同时行对侧鞘状突高位结扎;单侧手术时间(53.62±4.44)min,术中出血量(6.57±1.05)mL;双侧手术时间(75.22±4.11)min,术中出血量(7.86±0.35)mL。所有患儿切口一期愈合,无明显手术瘢痕;术后阴囊血肿1例,予相应处理后好转。本组患儿术后随访3~24个月,平均15个月。随访期间所有患儿睾丸发育良好,无睾丸回缩或萎缩,无腹股沟疝及鞘膜积液发生。(2)传统手术组:均顺利完成手术,单侧手术时间(44.32±3.22)min,术中出血量(8.50±1.50)mL;双侧手术时间(68.70±5.16)min,术中出血量(10.23±0.71)mL。术后切口感染2例,阴囊血肿8例,均予相应处理后好转。患儿术后均获随访3~24个月,平均14个月。随访期间2例睾丸回缩至腹股沟区,2例睾丸萎缩,余病例睾丸血供良好,无睾丸萎缩或回缩;2例患儿因对侧新发腹股沟疝行腹腔镜疝囊高位结扎术。腹腔镜组术中出血量、并发症发生率低于传统手术组,但手术时间长于传统手术组,差异均有统计学意义(P值均＜0.05)。结论 腹腔镜手术治疗低位腹腔型隐睾,具有术中出血少、术后并发症少、切口美观等特点,术后睾丸回缩、睾丸萎缩等严重并发症减少,可作为手术治疗小儿低位腹腔型隐睾的常规术式。     

Influence of surgical procedures on interleukin-6 and monocyte chemotactic and activating factor responses: CABG vs. valvular surgery.

Interleukin-6 (IL-6) and monocyte chemotactic and activating factor/monocyte chemoattractant protein-1 (MCAF/MCP-1) play pivotal roles in systemic inflammation, immune response, and tissue damage after cardiopulmonary bypass (CPB). Previous reports have described transient rises in IL-6 and MCAF after CPB, but the data seem to vary according to the different surgical procedures used. To evaluate the influence of the different surgical procedures on the proinflammatory cytokine responses, we compared perioperative serum IL-6 and MCAF release in coronary artery bypass grafting (CABG) and valvular surgery cases. Eighteen CABG (CABG group) and 7 single valvular cardiac surgery patients (valve group) were included in this study. Blood samples were taken to measure the serum concentrations of IL-6 at the induction of anesthesia, at the removal of the aortic cross-clamp, at the end of CPB, at the end of surgery, and 24 h after the termination of surgery. Serum IL-6 and MCAF were assayed by ELISA. Serum IL-6 increased immediately after aortic declamping and reached its peak at the end of surgery in both groups. Serum IL-6 concentrations at the end of surgery and 24 h after surgery were significantly higher in the valve group than in the CABG group (123.9 +/- 21.7 pg/ml vs. 79.7 +/- 10.4 pg/ml, p = 0.049; 113.6 +/- 25.0 pg/ml vs. 39.9 +/- 11.5 pg/ml, p = 0.006, respectively). Serum MCAF increased immediately after aortic declamping, and the MCAF level at the end of surgery was significantly higher in the valve group than in the CABG group (1118.4 +/- 353.9 pg/ml vs. 241.0 +/- 71.2 pg/ml, p = 0.002, respectively). IL-6 and MCAF may play important roles in the pathophysiology of surgical damage with CPB, and the different surgical procedures appear to affect the proinflammatory cytokine release after cardiac surgery differently.     

全凭静脉麻醉对腹腔镜手术CO2气腹患者内脏器官灌注的影响

目的：观察异丙酚-舒芬太尼全凭静脉麻醉对腹腔镜下CO2气腹患者内脏器官灌注的影响。方法：40例择期行腹腔镜手术的患者,随机均分为异氟醚静吸复合麻醉组（静吸组）和异丙酚-舒芬太尼全凭静脉麻醉组（静脉组）。测定气腹前（T0）、气腹后30min（T1）、60min（T2）和放气后10min（T3）时动脉pH（pHa）、PaCO2、i-pH、PgCO2和PCO2gap。术中同时记录心电图（ECG）、心率（HR）、收缩压（SBP）、舒张压（DBP）、血氧饱和度（SpO2）、气道压力（AWP）。结果：与T0比较,两组T1、T2和静吸组T3时PCO2gap升高,i-pH降低（P〈0.01或P〈0.05）。与静吸组比较,静脉组T1、T2和T3时PCO2gap降低,i-pH升高（P〈0.05）。与T0比较,两组T1、T2的AWP和HR升高（P〈0.01）。两组SBP、DBP、SpO2、pHa无显著性差异。结论：异丙酚-舒芬太尼全凭静脉麻醉可减轻腹腔镜患者CO2气腹期间的内脏低灌注,优于静吸复合麻醉。     

Travelling for earlier surgical treatment: the patient''s view.

As part of the northern region's programme within the national waiting list initiative, schemes have been funded to test the feasibility and acceptability of offering patients the opportunity to travel further afield in order to receive earlier treatment. A total of 484 patients experiencing a long wait for routine surgical operations in the northern region were offered the opportunity to receive earlier treatment outside their local health district; 74% of the patients accepted the offer. The initiative was well received by the participating patients and the majority stated that if the need arose on a future occasion they would prefer to travel for treatment rather than have to wait for lengthy periods for treatment at their local hospital. These findings, interpreted in the light of the National Health Service reforms introduced in April 1991, suggest that for some types of care, patients would welcome greater flexibility in the placing of contracts, not merely reinforcement of historical patterns of referral.     

Comparison of medical and surgical treatment for unstable angina pectoris. Results of a Veterans Administration Cooperative Study

We conducted a multicenter, randomized, prospective study comparing medical therapy alone with coronary-artery bypass surgery plus medical therapy in 468 men with unstable angina pectoris. Patients were entered in the study from June 1, 1976, to June 30, 1982. Among those assigned to surgery who received bypass grafts, operative mortality was 4.1 percent. Arteriography performed after one year of follow-up revealed that 74.8 percent of the grafts studied were patent. The cumulative rate of crossover from medical to surgical therapy after two years was 34 percent; the operative mortality among patients crossed over was 10.3 percent. Nonfatal myocardial infarction occurred in 11.7 percent of the patients treated surgically and 12.2 percent of those treated medically (no significant difference). Most of the nonfatal myocardial infarctions in the surgical group occurred in the perioperative period. Overall, the two-year survival rate computed by life-table analysis did not differ between the two groups. However, the curves reflecting mortality as a function of left ventricular ejection fraction were significantly different (P = 0.03); surgery was associated with a significantly reduced mortality among patients with lower ejection fractions. We conclude that patients with unstable angina pectoris have a similar outcome after two years whether they receive medical therapy alone or coronary bypass surgery plus medical therapy. However, patients with reduced left ventricular ejection fractions may have a better two-year survival rate after coronary bypass surgery.     

Results and outlooks of using cell technologies in the treatment of neurological diseases

An attempt was undertaken in the last decade of the 20th century to use a principally new approach to the treatment of neurological diseases--cell therapy. Main efforts were focused on developing a method related with replacement of neurons dying in neurodegenerative pathology, primarily, in Parkinson disease (PD). Outlined below are the key elements of the technology:--ensuring, in experiment, of a prolonged therapeutic effect in transplantation, to the affected part, first of embryonic neurons of the animal of the same species (allografting) and then of homologous embryonic neurons of man (heterografting);--obtaining, standardization and preparation (for transplantation) of embryonic nervous tissue of man; transplantation of embryonic nervous tissue of man to the brain of patient and evaluation, in situ, of the functional activity of its neurons; and evaluation of the therapeutic effect of grafting. Cell suspension of meseencephalon of 6-9 week human fetus containing around 10% of differentiating dopaminergic neurons was used for grafting in PD. Embryonic dopaminergic neurons, administered stereotactically into the striatum of patient, established synaptic links with neurons of the recipient, which was accompanied by the onset of synthesis and reverse uptake of dopamine (DA) as well as by the onset of spontaneous and stimulated release of DA. Neurografting ensured a temporary improvement of the condition in a part of PD patients but did not cure them. Moreover, such positive therapeutic effect was registered only in patients with the akineticorigid but not trembling variation of the disease. Hence, although there was a certain progress in clinical neurografting, the approach cannot be now recommended for introduction in neurology and neurosurgery. The limited therapeutic effect of the treatment method is primarily explained by a low rate of survival of transplanted dopaminergic neurons and, consequently, by the persisting DA deficit in patient's body. Therefore, the outlooks for perfecting the cell technology are related with increasing the survival rate of implanted dopaminergic neurons and with stimulating the innervation of target neurons in patient's striatum as well as with using the neural (glia) and non-neural (fibroblasts, myoblasts) cells with modified gene and stem cells. Finally, despite a certain progress of advancing the cell technology in neurology the approach still needs more research, which would enable further clinical trials.     

One-year treatment follow-up of plantar fasciitis: radial shockwaves vs. conventional physiotherapy

OBJECTIVE:

To compare radial shockwave treatment with conventional physiotherapy for plantar fasciitis after 12 months of follow-up.

METHOD:

This was a randomized, prospective, comparative clinical study. Forty patients with a diagnosis of plantar fasciitis were divided randomly into two treatment groups: group 1, with 20 patients who underwent ten physiotherapy sessions comprising ultrasound, kinesiotherapy and guidance for home-based stretching; and group 2, with 20 patients who underwent three applications of radial shockwaves, once a week, and guidance for home-based stretching. All patients were assessed regarding pain and functional abilities before treatment, immediately after and 12 months after treatment. The mean age was 49.6±11.8 years (range: 25-68 years), 85% were female, 88% were overweight, 63% were affected bilaterally, and 83% used analgesics regularly.

RESULTS:

At the 12-month follow-up, both treatments were effective for improving pain and functional ability among the patients with plantar fasciitis. The improvement with shockwaves was faster.

CONCLUSION:

Shockwave treatment was not more effective than conventional physiotherapy treatment 12 months after the end of the treatment.     

The variability of the interaural line vs the stability of bregma in rat stereotaxic surgery.

A comparison of the accuracy of stereotaxic localization using the interaural line and the bregmoidal intersection as the zero referent was made in male rats ranging in weight from 161 to 782 g. As body weight increased so did head length such that the angle of the skull and the distance from the interaural line to both the incisors and bregma varied as a linear function of body weight. Consequently, an electrode placement could recede by up to 4 mm from a target as rats' size increased. If head angle was held constant interaural line values could be adjusted by using an appropriate regression formula. With head angle constant and bregma used as the zero referent, the placement variation was less than 0.5 mm and was not systematically affected by body weight. The results show that coordinates from avoilable stereotaxic atlases can be adjusted for use with adult rats of widely varying body size.     

Follicular-Patterned Tumors of the Thyroid: The Battle of Benign vs. Malignant vs. So-called Uncertain

This article will review the controversial area of follicular-patterned thyroid tumors. The literature is discussed with emphasis on pathologic diagnosis and the criteria for malignancy. In addition, the current state of knowledge regarding molecular markers and their utility in diagnosing benign from malignant nodules is described. Finally, the apparent lack of consistency with regard to results of certain immunohistochemical markers is included.     

Adhesion determination of dental porcelain to zirconia using the Schwickerath test: Strength vs. fracture energy approach

Two approaches to measure the fracture energy to delaminate four different porcelains from zirconia substrates are compared using Schwickerath adhesion strength test specimens. In all instances it was possible to stably extend the crack along or adjacent to the porcelain–zirconia interface. The fracture energy expended to delaminate the porcelain was found by determining the work of fracture upon loading to 12 N and then unloading. Additional tests were undertaken on specimens notched along the interface, which enabled the compliance of the cracked Schwickerath specimens to be calibrated. The strain energy and deflection of the Schwickerath specimen as a function of crack length were derived. On this basis a simple expression was determined for the strain energy release rate or interfacial fracture toughness from the minima in the force–displacement curves. Consequently two measures of the adhesion energy were determined, the work of fracture and the strain energy release rate. It was found that the ranking for the four porcelains bonded to zirconia differed depending upon the approach. The work of fracture was substantially different from the strain energy release rate for three of the porcelain–zirconia systems and appears to be directly related to the residual stresses present in the bonded structures. The relative merits of the strain energy release rate, work of fracture vs. the stress to initiate cracking in the case of the Schwickerath adhesion test, are discussed. The advantage of this test is that it enables three estimates of the adhesion for porcelain veneers bonded to zirconia.