氧氟沙星等药物盆腔热灌注治疗盆腔炎的临床观察

目的观察氧氟沙星、替硝唑和α-糜蛋白酶腹腔热灌注治疗盆腔炎的疗效。方法将84例盆腔炎患者随机分为治疗组和对照组,治疗组采用替硝唑、氧氟沙星和糜蛋白酶盆腔热灌注,对照组采用替硝唑和氧氟沙星静滴。结果治疗组与对照组相比,治愈率和总有效率差异均有统计学意义(P<0.05)。结论采用盆腔热灌注治疗盆腔炎疗效显著。     

以护生为主体的小讲课在临床护理教学中的应用

目的探讨α-糜蛋白酶溶液膀胱保留灌注治疗膀胱积血的疗效。方法将40例膀胱积血患者随机均分为观察组和对照组，两组均用生理盐水行膀胱冲洗，在此基础上观察组每天给予α-糜蛋白酶溶液行膀胱保留灌注；而对照组采用生理盐水行膀胱保留灌注。保留30min，连续3d，观察两组血块体积变化、尿色转清时间及患者不适症状。结果观察组患者保留膀胱灌注后B超测量膀胱血块体积显著小于对照组（P〈0．05）；且泌尿道不适程度、尿液中血色转清时间显著低于对照组（均P〈0．01）。结论α-糜蛋白酶溶液膀胱保留灌注治疗膀胱积血能快速有效清除膀胱积血，且可减轻患者泌尿道不适症状。     

糜蛋白酶溶液膀胱保留灌注治疗膀胱积血疗效观察

目的 探讨α-糜蛋白酶溶液膀胱保留灌注治疗膀胱积血的疗效.方法 将40例膀胱积血患者随机均分为观察组和对照组,两组均用生理盐水行膀胱冲洗,在此基础上观察组每天给予α-糜蛋白酶溶液行膀胱保留灌注;而对照组采用生理盐水行膀胱保留灌注.保留30 min,连续3 d,观察两组血块体积变化、尿色转清时间及患者不适症状.结果 观察组患者保留膀胱灌注后B超测量膀胱血块体积显著小于对照组(P＜0.05);且泌尿道不适程度、尿液中血色转清时间显著低于对照组(均P＜0.01).结论 α-糜蛋白酶溶液膀胱保留灌注治疗膀胱积血能快速有效清除膀胱积血,且可减轻患者泌尿道不适症状.     

肾上腺素鼓室注射佐治分泌性中耳炎疗效观察

目的观察肾上腺素鼓室注射佐治分泌性中耳炎的疗效.方法将130例(216耳)分泌性中耳炎患者随机分为治疗组88例(144耳)和对照组42例(72耳).治疗组采用地塞米松、α-糜蛋白酶、肾上腺素混合液行鼓室内注射;对照组仅采用地塞米松、α-糜蛋白酶混合液进行鼓室内注射.治疗1个月、6个月后观察疗效.结果治疗1个月后有效率治疗组为93.06%,对照组为69.44%,均未发现不良反应.两组治疗1个月、6个月后总有效率比较,差异有显著性意义(均P＜0.01).结论地塞米松、α-糜蛋白酶、肾上腺素三药联合行鼓室注射可提高分泌性中耳炎的治愈率,且安全可靠.     

中药保留灌肠治疗慢性盆腔炎疗效分析

目的探讨中药保留灌肠治疗慢性盆腔炎的临床疗效。方法选择72例慢性盆腔炎病患者,随机分为观察组和对照组。对照组患者采用抗生素滴注治疗方案,观察组患者应用中药保留灌肠,比较两组患者的临床疗效。结果观察组患者治愈率和总有效率明显提高,无效率明显降低,组间比较差异有统计学意义（P〈0.05）。结论中药保留灌法治疗慢性盆腔炎疗效确切,在直达病灶的同时迅速改善盆腔环境,从而提高患者的生存质量。     

腹腔镜在妇科急症中的应用

目的:探讨腹腔镜在妇科急症中的应用价值。方法:2002年以来,应用腹腔镜行妇科急症手术85例,其中异位妊娠62例中行患侧输卵管切除术36例,输卵管切开取胚术及病灶清除术23例,1例卵巢妊娠行卵巢部分切除术,输卵管病灶注药术2例;卵巢破裂10例,9例行电凝止血术,1例行患侧附件切除术;卵巢肿瘤蒂扭转6例,2例不全扭转行囊肿剥除术,4例完全扭转附件坏死行一侧附件切除术;急性盆腔炎7例,行脓肿清除、输卵管切除及盆腔粘连松解术。结果:85例急诊腹腔镜手术全部顺利完成,无一例并发症。结论:腹腔镜治疗妇科急症安全有效,较开腹手术有很多优越性。     

腹腔镜肠粘连松解术治疗粘连性肠梗阻效果分析

目的分析对粘连性肠梗阻患者实施腹腔镜肠粘连松解术治疗的临床效果。方法选取54例粘连性肠梗阻患者按照入院顺序分组,其中将2015-01—2016-12间入院行开腹手术的28例患者作为对照组、将2017-01—2018-12间实施腹腔镜手术的26例患者作为观察组。比较2组的疗效。结果 2组患者手术过程顺利。观察组手术时间、术中出血量,以及术后肛门恢复排气时间、住院时间、并发症发生率均优于对照组,差异均有统计学意义(P0.05)。结论对粘连性肠梗阻患者实施腹腔镜肠粘连松解术治疗具有创伤小、并发症少、术后恢复快,但应严格掌握手术适应证。     

微创治疗粘连性肠梗阻

目的:探索中西医结合疗法与腹腔镜技术分阶段联合微创治疗粘连性肠梗阻的效果。方法:粘连性肠梗阻31例,在急性期以中西医结合疗法辨证施治,解除急性梗阻;缓解期行腹腔镜粘连松解术,根除梗阻。结果:31例急性期经中西医结合治疗,肠梗阻均解除。缓解期行腹腔镜粘连松解术,成功26例(83.9％);中转开腹手术5例(16.1％)。腹腔镜粘连松解术后胃肠功能恢复时间0.5-2d;术后住院2-4d。26例腹腔镜粘连松解术后随访,均未再发肠梗阻表现,治愈率100％。结论:中西医结合与腹腔镜联合微创治疗粘连性肠梗阻中转开腹率低,并发症发生率低,术后效果好,无再发梗阻。     

腹腔镜侧入式盆腔粘连松解术21例临床分析

目的:探讨腹腔镜盆腔粘连松解术的安全性和可行性。方法:回顾分析我院为21例盆腔严重粘连患者行侧入式盆腔粘连松解术的临床资料。结果:手术时间15～50min,平均24.6min;出血10～40ml,平均22.5ml。肛门排气时间10～30h,平均18.4h。无肠管、输尿管损伤及肠梗阻发生。结论:腹腔镜侧入式盆腔粘连松解术安全、可行,可降低中转开腹率。     

不育患者不同程度盆腔粘连的相关因素探讨

目的探讨不育患者盆腔粘连的相关因素及与盆腔粘连程度的关系。方法选择接受腹腔镜诊治的合并不同程度的盆腔粘连不育症患者319例,根据盆腔的粘连致密程度、粘连范围、有无子宫直肠窝封闭、双侧卵巢输卵管是否与周围组织粘连,输卵管是否闭锁等进行评分。根据评分分组:轻度粘连组122例,中度粘连组84例,重度粘连组113例。对照组87例为同期接受腹腔镜检查,术中未发现盆腔粘连的不育症患者。结果(1)不同程度盆腔粘连患者的盆腹腔手术史发生率均显著高于对照组(16.4%,26.2%,20.4%vs 3.5%,P<0.01);盆腔炎史发生率对照组和轻度粘连组显著低于重度粘连组(6.9%,4.1%vs 15.0%,P<0.05,P<0.01)。(2)腹腔镜下诊断盆腔结核发病率重度粘连组显著高于对照组和轻度粘连组(7.1%vs 0%,0.8%,P<0.05);各粘连组输卵管梗阻、输卵管积液/积脓发生率均显著高于对照组(21.1%,27.6%,49.1%vs 9.9%,P<0.05)、(5.7%,10.7%,18.6%vs 0%,P<0.05);(3)腹腔镜下诊断卵巢内异囊肿的发生率各粘连组均显著高于对照组(6.6%,15.5%,10.6%vs 0%,P<0.05)。结论手术损伤、盆腔炎症和子宫内膜异位症是造成不育患者盆腔粘连的重要因素,并与盆腔粘连的严重程度密切相关。     

Assessment of risk for intra-abdominal adhesions at laparoscopy for urological tumors

PURPOSE: Abdominal wall adhesions at laparoscopy may predispose patients to access related injuries and increase the complexity of the procedure. We have observed concern from referring physicians regarding the safety of laparoscopy in patients who previously underwent surgery because of the risk of abdominal adhesions. To assess the risk of adhesions at laparoscopy a retrospective cohort study was performed. MATERIALS AND METHODS: All patients who underwent a transperitoneal urological laparoscopic procedure in a 6-year period at our institution were included in this study. A chart review was performed to obtain demographic/surgical data and identify preoperative risk factors for adhesions, such as previous abdominal or pelvic surgery, radiation and/or intra-abdominal inflammatory disease. Operative videotapes were reviewed to determine the presence and location of adhesions. Standard statistical analyses were performed. RESULTS: During the study period 127 patients underwent transperitoneal laparoscopy and videotapes on 82 (65%) were available for review. A total of 44 patients (54%) were identified with preoperative risk factors for adhesions (group 1), while 38 (46%) had no risk factors (group 2). The relative risk of adhesions was 1.34 (95% CI 0.89 to 2.01, p = 0.18) when risk factors were identified. There were no differences in the groups in patient age, operative time, access technique, conversion to open surgery or complications. Estimated blood loss was significantly higher in group 2, likely due to the preponderance of cytoreductive laparoscopic nephrectomy in this group. CONCLUSIONS: There was no difference in the risk of intra-abdominal adhesions in patients with and without identifiable preoperative risk factors. Preoperative risk factors for adhesions should not contraindicate the transperitoneal laparoscopic approach for urological oncology procedures.     

Laparoscopy in the management of children with chronic recurrent abdominal pain.

BACKGROUND AND OBJECTIVES: The purpose of the present study was to evaluate the results of diagnostic laparoscopy in children with chronic recurrent abdominal pain. PATIENTS AND METHODS: Thirteen children with chronic recurrent abdominal pain were subjected to diagnostic laparoscopy. Ages varied from 10 to 17 years. There were six males and seven females. Abdominal pain was present from 3 weeks to 12 months (mean, 2 months). Extensive laboratory and imaging studies did not contribute to the diagnosis. In all patients, the pain was disabling and severe enough to warrant repeated visits to the pediatrician, emergency room visits, or hospital admissions, as well as absence from school. RESULTS: All children recovered uneventfully. Laparoscopic findings that identified the cause of abdominal pain were obtained in 12 of 13 patients. Laparoscopic appendectomy was done in all patients. There were no operative complications. One child presented three months later with incomplete small bowel obstruction, which resolved with conservative management. There were no other postoperative complications. Follow-up varied from six months to three years. Abdominal pain resolved in ten patients. One patient presented eight months later with biliary dyskinesia. She improved following laparoscopic cholecystectomy and later on sphincterotomy, but her pain has not yet completely resolved. One patient presented six months later with abdominal pain secondary to intestinal adhesions. Her pain completely resolved after laparoscopic lysis of adhesions. A third patient who developed lower abdominal pain six months after laparoscopy improved with conservative management and antibiotics for pelvic inflammatory disease. CONCLUSIONS: Diagnostic laparoscopy is a valuable procedure in the management of children with chronic recurrent abdominal pain. In the present study, laparoscopic examination revealed the cause of abdominal pain in most patients, and this pain resolved in most cases. Based on our experience, we recommend diagnostic laparoscopy early in the course of debilitating chronic recurrent abdominal pain in children. Appendectomy should be done when no other significant cause of abdominal pain has been identified, even if the appendix looks normal.     

Role of laparoscopy in identifying the clinical significance and cause of adhesions and chronic pelvic pain: a retrospective review at the Kiel School of Gynecological Endoscopy.

OBJECTIVES: We sought to define the role of laparoscopy in identifying the clinical significance, cause, and association between adhesions and chronic pelvic pain. METHODS: A retrospective chart review was conducted from October 2004 to July 2005, at the Kiel School of Gynecological Endoscopy, University Hospitals Schleswig-Holstein, Campus Kiel, Germany. Included in the study was the analysis of 462 laparoscopic procedures; 275 (59.5%) of the patients undergoing these procedures had pelvic or abdominal adhesions. Of these, 84 (30.5%) patients were admitted with the main complaint of chronic pelvic pain. Further evaluation and assessment of this group was carried out. RESULTS: Among those patients with adhesions, the second most frequent reason for admission was chronic pelvic pain (30.5%) (P<0.0005). In our study, adhesions were found in 79.2% (n=84) of patients (n=106) with chronic pelvic pain. These adhesions were thin-filmy (19.0%) or thick-fibrous (81.0%) adhesions containing blood vessels. Thick-fibrous adhesions were present in 50.0% of patients at multiple abdominopelvic sites (P<0.005). CONCLUSIONS: Thick-fibrous adhesions that extend beyond the pelvic sidewall can cause significant chronic abdominopelvic pain.     

Indications for hand-assisted laparoscopic radiofrequency ablation for liver tumors

PURPOSE: Radiofrequency ablation has established itself as the preferred treatment for irresectable liver tumors. It can be performed either percutaneously, laparoscopically, or by open surgery. The choice of approach depends on the patient and tumor-related variables. The laparoscopic approach appears to be the safest and most effective method for small tumors on the liver surface. It also provides additional information on the intrahepatic tumor burden with the use of intraoperative ultrasound and staging laparoscopy. Furthermore, the pneumoperitoneum reduces the flow of the portal vein and increases the efficacy of the ablation. Depending on the location of the tumor, mobilization of the liver or lysis of adhesions from previous surgery can require open surgery. Our aim was to study the combined use of laparoscopy and laparotomy by using hand-assisted laparoscopic radiofrequency ablation. MATERIALS AND METHODS: We performed hand-assisted laparoscopy to ablate nine tumors in seven patients, enabling us to combine most of the advantages of laparoscopy and open surgery. The radiofrequency ablation was technically simple to perform. A laparoscopy of the entire abdominal cavity and a thorough examination of the entire liver via ultrasound was also performed. RESULTS: The electrode was accurately placed in all patients. In four patients, a complete mobilization of the right lobe was performed to obtain the easiest possible access to the tumor. In three patients, severe adhesions from previous surgeries were removed prior to insertion of the laparoscopic tools. The ablation was completed safely and successfully in all patients. CONCLUSION: Our overall impression of the hand-assisted laparoscopic approach is that it seems to have a major advantage in comparison with simple laparoscopy, specifically for adhesions from previous surgeries and when the right liver lobe requires mobilization. Also, needle placement seems to be far more accurate than with simple laparoscopy.     

A case of laparoscopy-assisted vaginal cuff suturing for vaginal cuff dehiscence after total laparoscopic hysterectomy

IntroductionVaginal cuff dehiscence after hysterectomy is a rare complication and occurs in less than 1% of patients. It can present with serious complications, such as bowel evisceration and peritonitis.Presentation of caseA 51-year-old multigravida Korean woman underwent total laparoscopic hysterectomy for leiomyoma. Six months later, she reported lower abdominal pain and vaginal bleeding. Physical examination revealed rebound tenderness in the lower abdomen, and pelvic examination showed a small amount of vaginal bleeding with an evisceration of the small intestine through the vagina that exhibited healthy peristalsis. The eviscerated bowel, which seemed to be a part of the ileum, was carefully manually reduced transvaginally into the abdominal cavity. Laparoscopic observation revealed adhesions between the omentum, small intestine, and the peritoneum. Specifically, the small intestine was adhered around the vaginal cuff. An abdominal abscess was found in the left lower abdominal cavity. An adhesiotomy was performed and the abdominal abscess was removed and irrigated. Complete separation of the anterior and posterior vaginal cuff edges was obtained. The vaginal cuff was closed with interrupted 0-polydioxanone absorbable sutures without bowel injury. A 6-month follow-up examination revealed complete healing of the vaginal cuff.DiscussionIn this case, we were able to make use of both laparoscopic and transvaginal methods to perform a successful repair with a minimally invasive and safe technique.ConclusionLaparoscopically assisted vaginal cuff suturing for vaginal cuff dehiscence after total laparoscopic hysterectomy was found to be effective, safe, and minimally invasive.     

Prospective randomized trial of right-sided paracolic adhesiolysis for chronic pelvic pain.

BACKGROUND: Prior study has shown that right paracolic adhesions are found in 90% of patients with chronic pelvic pain and less frequently in pain-free patients. We set out to determine whether paracolic adhesiolysis will reduce site-specific pain. METHODS: This was a prospective, randomized trial of right paracolic adhesiolysis at the time of diagnostic and operative laparoscopy for chronic pelvic pain. Twenty-five patients with a diagnosis of chronic pelvic pain were randomized to either undergo or withhold lysis of right paracolic adhesions at the time of operative laparoscopy. RESULTS: Right paracolic adhesions were found in 100% of our patients. For all subjects, there was a significant reduction of right and left lower quadrant pain (P<0.001) following the operative laparoscopy. Those who underwent right paracolic adhesiolysis had significantly greater right pelvic pain reduction than those who did not (P=0.014). There was no difference in the reduction of left or mid pelvic pain between the treatment and control groups. CONCLUSIONS: Right paracolic adhesiolysis reduces short-term site-specific tenderness in patients with chronic pelvic pain. Patients who would benefit from diagnostic or operative laparoscopy are likely to benefit further from paracolic adhesiolysis.     

诊断性腹腔镜和粘连松解术:是否有助于外科手术中复杂盆腹腔疼痛综合征患者的治疗?

继发于粘连的腹痛是常见的主诉,但是除非患者存在肠梗阻症状,多数外科医生不会因此主诉而行手术治疗。本研究的目的是评价肠粘连松解术是否对治疗腹痛有效。我们回顾性分析了仅经历腹腔镜粘连松解术,而非器官切除的盆腹腔疼痛综合征(CAPPS)的患者在手术后疼痛改善情况。分别在手术后3,6,9和12个月随访了31例经腹腔镜粘连松解手术的患者,随访中第6,9和12个月后患者的疼痛评分显著降低,因此得出腹腔镜粘连松解手术对于粘连相关性疼痛有效的结论。粘连引起的疼痛可能有更复杂的疼痛传导通路,相比简单的切除瘢痕组织的手术,如截肢后的"幻肢痛",腹腔镜粘连松解手术患者术后的疼痛减轻需要较长时间。     

Diagnostic Laparoscopy and Adhesiolysis: Does It Help with Complex Abdominal and Pelvic Pain Syndrome (CAPPS) in General Surgery?

Abdominal pains secondary to adhesions are a common complaint, but most surgeons do not perform surgery for this complaint unless the patient suffers from a bowel obstruction. The purpose of this evaluation was to determine if lysis of bowel adhesions has a role in the surgical management of adhesions for helping treat abdominal pain. The database of our patients with complex abdominal and pelvic pain syndrome (CAPPS) was reviewed to identify patients who underwent a laparoscopic lysis of adhesion without any organ removal and observe if they had a decrease in the amount of abdominal pain after this procedure. Thirty-one patients completed follow-up at 3, 6, 9, and 12 months. At 6, 9, and 12 months postoperation, there were statistically significant decreases in patients' analog pain scores. We concluded that laparoscopic lysis of adhesions can help decrease adhesion-related pain. The pain from adhesions may involve a more complex pathway toward pain resolution than a simple cutting of scar tissue, such as "phantom pain" following amputation, which takes time to resolve after this type of surgery.     

输卵管远端阻塞的腹腔镜治疗临床分析

目的:探讨腹腔镜诊治输卵管远端阻塞的优点。方法:回顾性分析我院2004年1月至2006年4月应用腹腔镜诊治72例输卵管远端阻塞患者的临床资料。所有病例均经腹腔镜明确诊断并分期,根据分期行腹腔镜粘连松解或造口术。结果:术后总的有效妊娠率为23.8%,术后输卵管阻塞各期宫内妊娠率分别为Ⅰ期66.7%、Ⅱ期44.4%、Ⅲ期11.1%、Ⅳ期0。结论:腹腔镜对输卵管远端阻塞既可明确诊断,又能根据镜下分期进行粘连松解或输卵管造口术。     

Results after laparoscopic lysis of adhesions and placement of seprafilm for intractable abdominal pain

Background: The surgical treatment of patients with chronic abdominal pain resulting from intraabdominal adhesions is controversial. We report our experience with treatment of this challenging patient population using laparoscopic lysis of adhesions (LOA) and placement of Seprafilm (Genzyme, Cambridge, MA, USA). Methods: The participants in this study were 19 consecutive patients (2 men and 17 women) who underwent laparoscopic LOA and placement of Seprafilm between July 1998 and July 2001. Patients with abdominal pain resulting from irritable bowel syndrome, hernias, or endometriosis were excluded. The patients had undergone a mean of 6.4 previous abdominal procedures (range, 1–14) and 2.3 previous LOAs (range, 0–10). They had experienced chronic, intractable abdominal pain for at least 4 months (range, 4–180). Eight patients had preoperative obstructive symptoms. Results: A completely laparoscopic procedure was used to treat 16 patients, whereas the procedure for 3 patients was converted to open surgery because of dense adhesions. Perioperative complications included two patients in whom enterocutaneous fistulae developed and one patient with intraabdominal hematoma. At follow-up (mean, 9.6 months; range, 1–32 months), 14 patients (73.7%) had completely discontinued all pain medications. At this writing, 12 of these patients are completely symptom free. Two patients are taking nonsteroidal antiinflammatory drugs (NSAIDs) as needed, and three patients require round-the-clock narcotics. Three patients were readmitted with small bowel obstruction, which was managed nonoperatively. One patient had diagnostic laparoscopy for recurrent pain 6 months postoperatively, but had no adhesions. Conclusion: Chronic intractable abdominal pain is relieved in most patients via this approach. Repeat laparoscopy in two patients showed no intraabdominal adhesions. Laparoscopic LOA and placement of Seprafilm is an excellent approach to this challenging patient population with symptoms caused by intraabdominal adhesions.