输卵管绝育术后异位妊娠50例分析

选取我院2010年~2013年就诊的输卵管绝育术后并发异位妊娠的患者50例,对其临床资料进行了回顾性分析。结果行抽芯包埋绝育法的患者13例,发生异位妊娠者1例、发生率为7.7%;行双折结扎切除绝育法者26例,发生异位妊娠者10例、发生率为38.5%;行银夹绝育法的患者11例,发生异位妊娠的患者有5例、发生率为45.5%。抽芯包埋绝育法与双折结扎切除绝育法相比,差异显著(P<0.05),具有统计学意义;抽芯包埋绝育法与银夹绝育法相比,差异显著(P<0.05),具有统计学意义;月经干净后行绝育手术的患者有33例,发生异位妊娠的患者有5例、发生率为15.2%;终止妊娠后行绝育手术的患者有17例,发生异位妊娠的患者有9例、发生率为52.9%。两者相比,差异显著(P<0.01),具有统计学意义。综上述,输卵管绝育术后异位妊娠的发生率较高,临床上要严格掌握手术适应证,选择最适宜的输卵管绝育方式,尽可能减少输卵管绝育术后异位妊娠的发生机率。     

健康教育在输卵管绝育术患者中的应用及效果观察

目的:探讨健康教育在输卵管绝育术患者中的应用及效果.方法:选取2009年1~12月在我站行输卵管绝育术的120例女性设为观察组,同时选择同期在我站行输卵管绝育术的女性120例设为对照组,两组均给予常规护理,观察组在此基础上给予健康教育.结果:观察组在疼痛程度、前两次取管成功率、脏器损伤、术中出血量及手术时间方面均优于对照组,两组比较差异具有统计学意义(P＜0.05);观察组术后出血血肿、感染、月经紊乱及盆腔慢性疼痛并发症明显少于对照组,两组比较差异具有统计学意义(P＜0.05).结论:对输卵管绝育术者实施健康教育能消除其不良情绪,提高手术耐受力,减少并发生的发生.     

腹腔镜下保守治疗输卵管妊娠不同手术方式效果观察

目的:探讨腹腔镜下保守治疗输卵管妊娠不同手术方式的效果.方法:将132例对侧输卵管缺如或者病变、要求保留生育功能的输卵管妊娠患者随机分为A、B、C 3组各44例,A组行腹腔镜下输卵管切开取胚间断缝合术,B组行腹腔镜下输卵管开窗取胚荷包缝合术,C组行腹腔镜下双极电凝开窗术,均给予精心围术期护理.结果:3组手术成功率、手术时间及术后血β-HCG恢复正常时间比较差异均无统计学意义(P>0.05),3组术后1个月输卵管复通率及术后2年宫内受孕率比较差异均有统计学意义(P<0.01,P<0.05).结论:腹腔镜下输卵管切开取胚间断缝合术是腹腔镜下保守治疗输卵管妊娠的最佳手术方式,其输卵管复通率及再次宫内受孕率均较高,值得临床推广应用.     

腹腔镜与经腹小切口输卵管绝育术的对比研究

目的探讨腹腔镜输卵管绝育术的安全性与临床价值。方法选取2006年1月～2008年12月来该院要求行输卵管绝育术的妇女,随机分为两组,分别行腹腔镜输卵管绝育术(腔镜组)与经腹小切口输卵管绝育术(开腹组),进行对比研究。结果术中失败率、脏器损伤率及术后切口疼痛、慢性盆腔痛腔镜组优于开腹组,差异有显著性(P<0.05);手术时间、出血量、切口感染率腔镜组稍优于开腹组,差异无显著性;2次剖宫产者腔镜组在手术时间、出血量方面更具优势(P<0.05)。腔镜组605例中发现合并症77例(12.7%)。结论腹腔镜输卵管绝育术安全、有效、微创、痛苦小、恢复快、术后并发症少,更适用于有剖宫产术等盆腹腔手术史者,可同时诊断和治疗妇科疾病,是值得推广的微创手术。     

腹腔镜下保守治疗输卵管妊娠不同手术方式效果观察

目的：探讨腹腔镜下保守治疗输卵管妊娠不同手术方式的效果。方法：将132例对侧输卵管缺如或者病变、要求保留生育功能的输卵管妊娠患者随机分为A、B、C3组各44例,A组行腹腔镜下输卵管切开取胚间断缝合术,B组行腹腔镜下输卵管开窗取胚荷包缝合术,C组行腹腔镜下双极电凝开窗术,均给予精心围术期护理。结果：3组手术成功率、手术时间及术后血β—HCG恢复正常时间比较差异均无统计学意义（P〉0．05）,3组术后1个月输卵管复通率及术后2年宫内受孕率比较差异均有统计学意义（P〈0．01,P〈0．0．5）。结论：腹腔镜下输卵管切开取胚间断缝合术是腹腔镜下保守治疗输卵管妊娠的最佳手术方式,其输卵管复通率及再次宫内受孕率均较高,值得临床推广应用。     

观察产前宣教联合术后低频电治疗对剖宫产术后镇痛的作用

目的：观察产前宣教联合术后低频电治疗对剖宫产术后镇痛的效果。方法：剖宫产产妇320例,随机分为4组各80例,术前后均给予常规护理,A组配合产前宣教;B组术后加用低频电治疗;C组进行产前宣教及术后低频电治疗;D组术前后不给予辅助治疗。结果：4组产妇术后24hVAS评分,A、C组明显低于B、D组;治疗4d后,B、C组明显低于24h时及A、D组,A组低于D组;5d后,4组均明显下降,其C组     

女性绝育术后输卵管复通术26例临床分析

目的：探讨输卵管复通术后复孕率与绝育方法、部位、复通与绝育间隔时间的关系。方法：回顾性分析1999年10月-2004年10月在本院实施输卵管复通术26例的复孕情况。结果：26例患者复通25例，复通率为96．15％．复孕24例，复孕率为92．31％。抽芯近端包埋法绝育术后复通复孕率最高，输卵管峡部吻合术后复孕率最高，绝育时间超过5年者，复通术的成功率低。结论：输卵管吻合术的复孕率与绝育方法、部位复通与绝育间隔的时间密切相关。     

输卵管复通术108例分析

我院自1988年～1995年，对108例输卵管结扎妇女行输卵管复通术，效果满意，分析如下。1资料与方法1．1一般资料：本组108例，年龄24～39岁，平均30．2岁，输卵管绝育术后最短3个月，最长12年，平均5.1年。术前月经规则，子宫正常大小，活动良好．双侧附件正常，生殖器无急性炎症表现，B超提示子宫附件正常。原绝育术式：波氏改良法104例，银夹法4例。1．2手术方法：均采用连续硬膜外麻醉，取下腹正中切口长约4～5cm。探查盆腔，如有粘连，先行分离术。用指板提出输卵管，组织钳固定。于原结扎的输卵管浆膜下注入生理盐水1～2ml，纵行切开浆…     

中西医结合预防高危人流术后宫腔粘连的临床观察

目的:观察中西医结合预防高危人流术后宫腔粘连的临床疗效。方法:选取30例普通人工流产术后患者为普通人流对照组(A组),90例高危人工流产术后患者随机分为高危人流对照组(B组)、西药对照组(C组)和中西药治疗组(D组),每组30例。4组均给予常规抗生素预防感染,C组术后给予补佳乐联合黄体酮人工周期药物治疗,D组在西药对照组的基础上给予自拟补肾活血方治疗。比较4组术后阴道流血时间、月经复潮时间以及月经复潮前子宫内膜厚度,比较4组术后第3个月的宫腔粘连情况。结果:C、D两组阴道流血时间、月经复潮时间均少于常规组和B组,D组阴道流血时间、月经复潮时间少于C组,差异均具有统计学意义(P<0.05);A组、B组和C组月经来潮前B超子宫内膜厚度均小于D组(P<0.05);A组、C组和D组术后宫腔粘连发生率均低于B组,D组术后宫腔粘连发生率低于C组,差异具有统计学意义(P<0.05)。结论:中西医结合治疗能增加子宫内膜厚度,显著缩短术后阴道流血时间、月经复潮时间,恢复月经周期,修复子宫创面,减少术后宫腔粘连发生率,促进子宫复旧。     

3种绝育方法对子宫卵巢多普勒血流及血清卵巢激素水平的影响

目的研究3种绝育方法对子宫卵巢多普勒血流及血清卵巢激素水平的影响。方法选取2013年1月~2015年1月我院附近社区内实施绝育术的妇女53例,19例使用Pomeroy法输卵管结扎术的妇女为A组,18例实施输卵管伞端切除术的妇女为B组,16实施例腹腔镜双极凝固术的妇女为C组,对所有研究对象应用多普勒进行检查,并检查其血清卵巢激素水平。结果 A组妇女双侧卵巢动脉搏动指数与平均子宫动脉阻力指数均较大,P0.05,差异有统计学意义;三组妇女卵巢各项激素水平均无较大差别(P0.05),经统计学分析,无统计学意义;三组妇女痛经主诉显著增多,其中,B组妇女痛经主诉最多。结论使用Pomeroy法输卵管结扎方法进行绝育的妇女,其多普勒测量值明显比另外两组高,引发此种现象的原因可能是输卵管切除长度较大。年轻妇女不适宜使用卵管伞端切除方法,因为进行此项手术后,会出现经常性痛经,且永久绝育。     

Sterilization of the female with special reference to laparoscopic tubal sterilization

Within recent years female sterilization has gained a place of great importance as an effective contraceptive method. Nowadays sterilization is hardly subject to any formal restrictions, but is solely the responsibility of the woman concerned, the couple or the physician. The indications for sterilization may be divided into two main groups, namely for medical indications and family planning. Sterilization is carried out on the uterus or tubes. Today the method of choice is laparoscopic tubal sterilization. The most frequently used procedure and the safest way of tubal occlusion is bipolar electrocoagulation of the entire isthmic tubal portions without additional section of the tubes. The complication rate in laparoscopic tubal sterilization depends on the type of anaesthesia, on the skill of the operator and on patient risk factors such as obesity etc. Minor intraoperative complications are of little importance since they are easily remedied during laparoscopy. Severe complications are rare, but have to be corrected immediately by laparotomy. Pregnancies on account of failure in sterilization procedure may be due to the occlusion technique, the lack of experience of the operator, the timing of sterilization and the observation period. Altogether 2372 laparoscopic tubal sterilizations were performed at the University Department of Obstetrics and Gynaecology in Graz between January 1st, 1975 and December 31st, 1985. During these eleven years a specific technique has been developed, whereby standard methods were simplified and improved. No intrauterine cannula for mobilizing the uterus is applied to avoid infection or perforation. The preferred "single-puncture technique" offers many advantages over the older "double-puncture technique", since fewer instruments are needed and the operation is less time-consuming, eliminating the danger of a second puncture. Moreover, the procedure is easier to perform and the cosmetic result better. In high-risk patients, especially the extremely obese, the laparoscopic technique has been improved by a special method of introducing the trocar.     

German pelviscopic statistics for the years 1978-1982

The second set of statistics on pelviscopy in Germany included information on 269,603 pelviscopies done in 322 general hospitals, and 22,859 pelviscopies done in private clinics between 1978 and 1982. In general hospitals the rate of serious complications was 1.9% and in private clinics 2.0%. Injuries to large blood vessels headed the list of complications. The main technique for tubal sterilization was the bipolar high-frequency current method with 75% in general hospitals and 73.1% in private clinics, followed by the endocoagulation technique according to Semm (36.8%). Sterilization failures were reported in 2.6%. Most failures were reported after sterilization with the bipolar electrocoagulation technique, followed by the clip technique. The rate of post-sterilization ectopic pregnancies was 1.06%. The highest rate of ectopic pregnancies was reported after using the bipolar tubal sterilization method (1.4%).     

腹腔镜保守性手术治疗输卵管妊娠

【目的】探讨腹腔镜保守性手术治疗输卵管妊娠的临床应用价值。【方法】选择2001年1月至2006年11月接受腹腔镜保守性手术治疗的217例输卵管妊娠患者为观察组,同期开腹行保守性手术的135例输卵管妊娠患者为对照组,观察两组手术时间、术中出血量、肛门排气时间、留置尿管时间、住院时间及术后输卵管通畅情况、再次宫内妊娠率、重复异位妊娠情况等。【结果】两组术中出血量、肛门排气时间、留置尿管时间、住院时间、术后患侧输卵管通畅率和宫内妊娠率比较差异有显著性(P<0.05),手术时间、重复异位妊娠情况比较差异无显著性(P>0.05)。【结论】腹腔镜保守性手术治疗输卵管妊娠具有微创,术后恢复快及再次宫内妊娠率高的特点,对有生育要求的输卵管妊娠患者宜尽早进行腹腔镜保守性手术。     

成人先天性冠状动脉瘘的临床特点及外科诊疗

目的总结29例成人先天性冠状动脉瘘的临床特点和外科治疗经验。方法对1985年3月￣2005年12月间外科治疗的29例成人先天性冠状动脉瘘的临床资料进行回顾性分析。结果全组无围术期死亡及严重手术并发症。长期随访未发现冠状动脉瘘再发和残余瘘以及冠状动脉瘘相关性并发症。结论成人冠状动脉瘘的外科治疗安全有效,中远期效果满意,而且可以预防并发症。     

降低手术切口感染的护理对策探讨

目的探讨降低手术切口感染的护理对策.方法以回顾性调查和跟踪随访的方法收集普外科手术切口感染情况的资料进行分析统计,并采取了一系列的护理对策.结果采用综合护理措施后,手术切口的感染率明显下降(P<0.01),环境微生物采样的合格率明显提高(P<0.05).结论在临床护理过程中,可以通过有效的空气净化消毒、加强环境管理和微生物学监测、改进原有的备皮和切口护理方法、改善洗手等卫生设施,加强患者营养支持,降低手术切口的感染.     

An assessment of hysterosalpingosonography (HSSG) as a diagnostic tool for uterine cavity defects and tubal patency.

The value of hysterosalpingosonography (HSSG) as a diagnostic tool was evaluated in 76 patients and compared to hysteroscopic, laparoscopic, and/or hysterosalpingographic (HSG) findings. Saline solution and Dextran 60 were used as distension media. Patients were divided in three groups: group A (n = 22), patients submitted for control post-tubal electrocoagulation. Group B (n = 38), patients with a history of pathological metrorrhagias, and group C (n = 16) infertile women with possible tubal pathology. Comparison between the different diagnostic techniques for the evaluation of the uterine cavity and tubes was carried out. Our results indicated that HSSG had more sensitivity but less specificity than hysteroscopy or HSG in the diagnosis of uterine cavity pathology. Hysteroscopy seems to be the best technique for the diagnosis of endometrial pathology, and HSSG seems to be the most effective in the study of the myometrium. HSSG cannot be considered a reliable and accurate method for the diagnosis of tubal patency.     

改进器械装载方式对手术器械清洗质量的影响

目的探讨改进器械装载方式对手术器械清洗质量的影响。方法将4000件污染的手术复用器械根据随机数字表法分为对照组(n=2000,传统装载方式)与研究组(n=2000,基于器械的结构特点及清洗机清洗原理的改进器械装载方式)。比较两组手术器械的清洗质量。结果研究组的管腔类器械、轴节齿纹类器械、实体类器械的清洗合格率及灭菌合格率均高于对照组(P<0.05)。研究组的外观清洁度、轴节齿纹部清洁度、管腔清洁度、清洗质量及消毒质量评分均高于对照组(P<0.05)。结论基于器械的结构特点及清洗机清洗原理改进器械装载方式,有利于提高手术器械的清洗质量,提高灭菌效果。     

Thioethers in urine of sterilization personnel exposed to ethylene oxide.

Biological monitoring of exposure to ethylene oxide (EO) was carried out in 31 hospital workers in the sterilization facilities of five hospitals. The excretion of total thioethers was determined in the urine of sterilization workers. An occupational nonexposed group served as a control (n = 31). The air EO level was not monitored routinely, however, peak concentrations of EO up to 200 p.p.m. were detected mainly when the sterilization chambers were open. Our results show a significant difference in urinary thioether excretion between the exposed and control groups (P less than 0.001). Sterilization workers seem to absorb significant quantities of EO. We feel that other alternative and more sensitive methods for detecting thioether metabolites of EO should be carried out to confirm our results.     

参与式教学法在外科护理学实训教学中的应用

目的探讨参与式教学法在外科护理学实训教学中应用的效果。方法按随机数字表法将常州卫生高等职业技术学校2007级高职护理班4个班级的238名学生分为观察组120名和对照组118名,观察组采用参与式教学的方法,对照组采用传统的教学方法。采用学习积极主动性量表(active learning state,ALS)对两组学生的学习积极主动性进行比较并对其进行技能考核。结果实训教学后观察组学生学习积极主动性量表各维度的得分均高于对照组,差异有统计学意义(均P<0.01);技能考核成绩总及格率明显高于对照组(P<0.01)。结论参与式教学法在教学中体现了以学生为主体的理念,能有效激发学生的学习主动性和参与度,有利于提升教学效果,。     

音乐疗法在外科重症监护病房中的应用效果

目的 探讨音乐疗法对改善外科重症监护病房患者不良情绪及疼痛的效果.方法 将90例全身麻醉手术后进入外科重症监护室的患者随机分为观察组(44例)和对照组(46例),对照组术后采用专科常规护理,观察组在此基础上采用音乐疗法,比较两组患者术前及术后第1、3、5天的抑郁量表(self-rating depression scale,SDS)评分、视觉模拟评分法(visual analogous scale,VAS)、收缩压和舒张压.结果 治疗前和术后第1天,两组患者的SDS、VAS评分及血压差异无统计学意义(P>0.05);术后第3天和第5天,观察组患者的SDS、VAS评分及舒张压和收缩压均低于对照组,差异有统计学意义(P<0.05或P<0.01).结论 音乐疗法可减轻ICU患者的抑郁情绪,稳定血压,减轻疼痛,增加患者的舒适感.