INTRAPERITONEAL INSTILLATION OF BUPIVACAINE FOR ANALGESIA AFTER LAPAROSCOPIC STERILISATION: A CASE CONTROL STUDY

Efficacy of intraperitoneal instillation of bupivacaine at the time of laparoscopic sterilisation to provide postoperative analgesia was studied. In 40 patients undergoing laparoscopic sterilisation 0.75ml/kg of 0.125% bupivacaine was instilled in the peritoneal cavity (Group-I) and another 40 patients where the topical anaesthetic was not used served as controls (Group-II). Pain scores on Visual Analog Scale (VAS) were studied 1,2,4,6 and 24 hours after surgery in both groups. Mean VAS score was significantly lower in Group-I, 1,2 and 4 hours after surgery (p<0.05). Rescue analgesia was required in 20% patients of Group-I compared to 52.5% in Group-II which is definitely significant (p<0.001). No complications or side effects were noted in the bupivacaine treated group. This simple technique provides excellent analgesia in the immediate postoperative period following laparoscopic sterilisation which will go a long way in enhancing patient satisfaction and motivating other eligible clients to come forward for laparoscopic sterilisation.KEY WORDS: Bupivacaine, Laparoscopic sterilisation, Postoperative analgesia     

Orthopaedic Enhanced Recovery Programme for Elective Hip and Knee Arthroplasty – Could a Regional Programme be Beneficial?

IntroductionArthroplasty is commonplace in orthopaedic practice, and post operative pain has been shown to substantially hinder recovery and discharge from hospital.ObjectivesThe current study assessed a multidisciplinary, multimodal Orthopaedic ERP in terms of its effect on patient perceived post operative pain in hip and knee arthroplasty. Secondary outcome was in the form of a cost analysis.MethodsA prospective study was performed on consecutive arthroplasty patients across a 6 week period in a district orthopaedic unit. A multidisciplinary approach to devising an ERP was undertaken between anaesthetists, surgeons and physiotherapists. Domains included optimising pre-operative nutrition, anaesthetic pre-meds, standardised anaesthetic technique, standardised intra-operative technique and use of locally infiltrated anaesthetic (LIA), as well as a post operative pain regimen. The multidisciplinary team (MDT) involved physiotherapy for the patient on day 0. Demographic data, day 1 and day 2 post operative subjective pain scores using an analogue scale were recorded. Data was collated and analysed using appropriate statistical methods. A p-value of <0.05 was considered significant.ResultsA total of 40 patients (25 total hip replacements and 15 total knee replacements) were included. All conformed to the ERP. Reductions in patient reported pain scores were observed. Specifically, in total hip arthroplasty (THA), day 1 scores were not significantly improved (p=0.25), however day 2 scores improved significantly (p=0.02). For total knee arthroplasty (TKA), both day 1 and day 2 scores improved significantly (p=0.02 & p<0.001, respectively) Analgesic requirements were not significantly different between hip and knee replacements. Early mobilization occurred in 95% of patients. Length of stay was reduced significantly in hip (1.8 days, p=0.003) and knee (1.9 days(p<0.001) replacements following ERP. Cost analysis demonstrated a potential annual saving of approximately £200,000 for the study unit if ERP was applied to all elective hip and knee arthroplasty procedures.ConclusionsThe study demonstrates that a tailored, MDT orientated ERP can be beneficial in elective hip and knee arthroplasty. Reductions in pain scores, early ambulation and facilitated early discharge are beneficial to the patient, and cost effective for the unit. The implementation across the region may result in further cost savings.     

Conventional Versus Endoscopic Powered Adenoidectomy: A Comparative Study

Background

Adenoidectomy is a commonly performed ENT surgery. It is conventionally performed using the curettage method. This present article aims to evaluate endoscopic powered adenoidectomy as an alternative.

Methods

Sixty consecutive cases requiring adenoidectomy were randomized into two groups of thirty each. Group A underwent conventional adenoidectomy using the curettage method and Group B underwent endoscopic assisted micro-debrider adenoidectomy. The parameters studied were intra-operative time, intra-operative bleeding and completeness of resection, collateral damage, post operative pain and recovery time.

Result

Sixty cases of adenoidectomy were done using conventional surgery and powered endoscopic adenoidectomy in the study period from Aug 04 to Dec 05. The time taken in Group A (conventional surgery) varied from 22–39 minutes (95% Confidence Interval (CI) −27.7 – 30.9)and in Group B (powered endoscopic surgery) from 27–55 minutes(95% CI 36.6 – 41.9) (p<0.05). The average blood loss in Group A was 21 ml (range 10–50) as compared to 31.67 ml (range 10-60) in Group B (p<0.05). The resection was invariably complete in Group B whereas seven(23%) cases had more than 50% residual adenoid tissue in Group A. Three cases in group A had collateral damage whereas in Group B, there were no added injuries. Post operative pain was studied only in cases undergoing adenoidectomy alone. Group A (n=8) demonstrated a pain score of 1.64–2.63–3.63 (95% CI) whereas Group B (n=11) demonstrated a pain score of 1.19–2.13–3.06 (95% CI). This difference was not statistically significant. In group A, the mean recovery period was 3.5 days and 2.93 days in Group B(p<0.05).

Conclusion

Endoscopic powered adenoidectomy was found to be a safe and effective tool for adenoidectomy. The study parameters where endoscopic powered adenoidectomy fared better were completeness of resection, accurate resection under vision, lesser collateral damage and faster recovery time. On the other hand, conventional adenoidectomy scored in matter of lesser operative time and intra-operative bleeding.Key Words: Adenoidectomy, Powered adenoidectomy, Endoscopic adenoidectomy     

Evaluation of interactive teaching for undergraduate medical students using a classroom interactive response system in India

Background

The classical didactic lecture has been the cornerstone of the theoretical undergraduate medical education. Their efficacy however reduces due to reduced interaction and short attention span of the students. It is hypothesized that the interactive response pad obviates some of these drawbacks. The aim of this study was to evaluate the effectiveness of an interactive response system by comparing it with conventional classroom teaching.

Methods

A prospective comparative longitudinal study was conducted on 192 students who were exposed to either conventional or interactive teaching over 20 classes. Pre-test, Post-test and retentions test (post 8–12 weeks) scores were collated and statistically analysed. An independent observer measured number of student interactions in each class.

Results

Pre-test scores from both groups were similar (p = 0.71). There was significant improvement in both post test scores when compared to pre-test scores in either method (p < 0.001). The interactive post-test score was better than conventional post test score (p < 0.001) by 8–10% (95% CI-difference of means – 8.2%–9.24%–10.3%). The interactive retention test score was better than conventional retention test score (p < 0.001) by 15–18% (95% CI-difference of means – 15.0%–16.64%–18.2%). There were 51 participative events in the interactive group vs 25 in the conventional group.

Conclusions

The Interactive Response Pad method was efficacious in teaching. Students taught with the interactive method were likely to score 8–10% higher (statistically significant) in the immediate post class time and 15–18% higher (statistically significant) after 8–12 weeks. The number of student–teacher interactions increases when using the interactive response pads.     

Relationship of maternal factors and obstetric complications with term singleton vs term twin neonatal outcomes: A retrospective study in China

BackgroundNeonatal birth weight and length are important indicators of neonatal survival and morbidity during later life and are influenced by maternal factors and obstetrical complications. Therefore, we aimed to determine the relationship of maternal factors and obstetric complications with term singleton vs term twin neonatal outcomes in Wuhan University Renmin Hospital, Hubei, China.MethodsA total of 10517 neonatal births were recorded in a tertiary-hospital-based retrospective study and term singleton (n=7787) and term twins (n=169) were included for data analysis. Birth weight and birth length were measured immediately after birth. Correlation, independent student t-test, and backward multiple linear regression were used for statistical analysis.ResultsWomen with singleton gestation have an increased rate of obstetric complications compared to women with twin gestation. However, a higher frequency of cesarean section and breech were found in twin gestation compared to singleton gestation. Weight before pregnancy, gestational weight gain, and gestational diabetes mellitus were significantly positive (p<0.05) associated with singleton neonatal birth length and weight. In contrast, preeclampsia, placenta previa, oligohydramnios, premature rupture of membrane, breech, and multiparity had a significantly negative (p<0.05) association with singleton neonatal birth length and weight. Maternal age was significantly positive (p<0.05) associated with only singleton neonatal birth weight. Moreover, the nuchal cord was significantly positive (p<0.05) associated with singleton neonatal birth length. On the other hand, maternal age and multiparity were significantly positive (p<0.05) associated with twins'' neonatal birth length and weight. Furthermore, gestational weight gain was significantly positive (p<0.05) associated with only twins'' neonatal birth weight.ConclusionIn term gestation, obstetric complications were significantly associated with singleton birth size rather than twin birth size.     

Laparoscopic female sterilisation by a single port through monitor--a better alternative

Female sterilisation by tubal occlusion method by laparocator is most widely used and accepted technique of all family planning measures all over the world. After the development of laparoscopic surgery in all faculties of surgery by monitor, now laparoscopic female sterilisation has been developed to do under monitor control by two ports--one for laparoscope and second for ring applicator. But the technique has been modified using single port with monitor through laparocator in which camera is fitted on the eye piece of laparocator (the same laparocator which is commonly used in camps without monitor since a long time in India). In this study over a period of about 2 years, a total 2011 cases were operated upon. In this study, I used camera and monitor through a single port by laparocator to visualise as well as to apply ring on fallopian tubes. The result is excellent and is a better alternative to conventional laparoscopic sterilisation and double puncture technique through camera--which give two scars and an extra assistant is required. However, there was no failure and the strain on surgeon's eye was minimum. Single port is much easier, safe, equally effective and better acceptable method.     

Validity and reliability of Persian translated version of Pediatric Lower Urinary Tract Scoring System Questionnaire for Iranian children

Background

Pediatric lower urinary tract scoring system (PLUTSS) is a questionnaire contains items for assessmentof wetting episodes, voiding frequency and pattern. It is used for screening and evaluation of the responseof children with lower urinary tract symptoms to therapy. We studied the validity and reliability of Persiantranslated version of this questionnaire among Iranian children.

Methods

One hundred and ninety-seven children aged 5-15 years with urinary tract infection, voiding dysfunction,enuresis were enrolled in this study. Thirty-three healthy age-matched children without urinary complaintwere considered as controls. PLUTSS questionnaire was filled out for all children. Sonography was performedto rule out urogenital abnormalities. Internal consistency, test-retest reliability, and validity of the questionnairewere assessed using Cronbach’s alpha, intra-class correlation coefficient, and ANOVA test respectively.ROC curve was used to define cut-point and its validity in discrimination between groups. P-value < 0.05was considered significant.

Results

The means for PLUTSS items were 6.8 (±5.4) for voiding dysfunction, 14.4(±5) for enuresis,10.5(±7.8) for recurrent and 8.9(±6) for single urinary tract infection, and 1.9(±1.8) for controls (p<0.001).Cronbach’s alpha for the 14 items of questionnaire was 0.74. The intraclass coefficient correlation for assessingtest-retest reliability was 0.82 (p<0.001). ROC curve showed cut point of 5 for differing case from controls withsensitivity of 97.0 and specificity of 74.9(p<0.001).

Conclusions

Persian translated PLUTSS has a proper validity and reliability as an instrument for screeningchildren with urinary tract symptoms but some questions need to be changed in some way to be understandableby our culture.     

D-dimer/Fibrinogen ratio and recurrent exacerbations might have a potential impact to predict 90-day mortality in patients with COPD exacerbation

BackgroundAccording to the World Health Organisation reports (WHO), COPD is the third leading cause of overall in the World by 2020.AimWe aimed to determine the prognostic predictors of 90-day mortality after an initial exacerbation in patients with acute exacerbation of COPD (AECOPD).ResultsIncreased Charlson Comorbidity Score(CCS) (HR:1.47; p<0.05), readmission after initial exacerbation (HR:1.47; p<0.05) were predictive risk factors for 30-day mortality in multivariable regression model. The 90-day mortality rate was %11.8. Hypertension, increased median age, nutrition risk score (NRS), CCS, CAT score, and mMRC 4th level were possible risk factors for 90-day mortality. There was a significant difference in the mortality of patients with D-dimer/Fibrinogen ratios>0.11 and ≤0.11 (HR:2.47; p<0.05). Recurrent exacerbations after discharge were predictive risk factors for 90-day mortality in the multivariable regression model (HR:2.25; p<0.001) with the increased mortality risk 4.73 times (HR:4.73; p=0.002). Furthermore, a 1-unit increment of acute exacerbation increased the mortality risk 3.39 times (HR:3.39; p<0.001).ConclusionOur study showed that D-dimer/Fibrinogen ratio but not D-dimer and recurrent exacerbations after discharge might have a critical impact on 90-day mortality.     

Electrophysiological course of uraemic neuropathy in haemodialysis patients

The objective of this study was to confirm electrophysiologically both the presence and course of uraemic neuropathy in haemodialysis patients. Nerve conduction studies of the lower extremities were done in 70 haemodialysis patients and 20 normal volunteers. Compared with that in normal volunteers, the distal motor latency in the tibial nerve of patients was prolonged significantly (p<0.05), and the minimal F wave latency in the tibial nerve was also prolonged significantly (p<0.05). Motor conduction velocity in the tibial nerve was reduced significantly (p<0.05), and sensory nerve conduction velocity in the medial plantar nerve also was reduced significantly (p<0.05). These results suggest the presence of uraemic neuropathy in haemodialysis patients. Twenty patients were investigated by a follow up study five years later. Parameters from F wave conduction studies, which were thought to be the most useful in the evaluation of neuropathy, showed no significant differences between the initial and follow up trials. These observations suggest that uraemic neuropathy does not progress during haemodialysis. These results also suggest that most haemodialysis patients showed electrophysiological evidence of uraemic neuropathy, but no remarkable electrophysiological change in uraemic neuropathy during haemodialysis was recognised.


     

Impact of Body Mass Index on Left Ventricular Function

Background

Obesity is associated with increased cardiovascular morbidity and mortality. A direct effect of isolated obesity on cardiac function is not well established. The study was designed to determine the direct effect of various grades of isolated obesity on echocardiographic indices of systolic and diastolic left ventricular function.

Methods

Fifty one obese and 25 normal weight, serving personnel without any other pathological condition were studied. Group I (n=25) consisted of subjects with normal weight and body mass index (BMI <25kg/m²), Group II (n=34) of overweight subjects (BMI 25-29.9 kg/m²) and Group III (n=17) of obese subjects (BMI >30 kg/m²). Echocardiographic indices of systolic and diastolic function were obtained and dysfunction was assumed when at least two values differed by ≥ 2 SD from the normal weight group.

Result

Ejection fraction, fractional shortening were increased (p<0.05) in Group II and III. Left ventricular dimensions were increased (p< 0.001) but relative wall thickness was unchanged. Systolic dysfunction was not observed in any of the obese patients. The mitral valve pressure half time (p< 0.01), left atrial diameter (p < 0.01) and the deceleration time were increased (p< 0.01) in obese subjects, while other diastolic variables were unchanged. No difference were found between obesity subgroups. Subclinical diastolic dysfunction was more prevalent among obese subjects. BMI correlated significantly with indices of left ventricular systolic and diastolic function.

Conclusion

Subclinical left ventricular diastolic dysfunction was noted in all grades of obesity which correlates with BMI.Key Words: Obesity, Systolic function, Diastolic function, Echocardiography     

CROSS SECTIONAL ANALYTIC STUDY OF AWARENESS REGARDING FACTORS RELATED TO CHILD SURVIVAL AMONG MARRIED WOMEN IN A SEMI-URBAN COMMUNITY

A cross sectional analytic study was undertaken on 480 married women living in a semi-urban locality in Pune, with the objective of assessing their awareness regarding factors related to child survival. It was observed that 62.1 per cent of the ladies had adequate knowledge about immunisation. A highly significant trend was evident as regards knowledge about immunisation and formal education and socio-economic status (p<0.01). 93 per cent ladies initiated breast feeding within 24 hours of birth of the new born. Significantly larger proportion of ladies from lower education favoured prolonged breast feeding (p<0.001) and favoured late introduction of top milk (p<0.001). In general, the awareness about growth chart was very poor with only 3.5 per cent ladies having adequate knowledge. Larger family size was significantly associated with declining probability of use of oral rehydration solution (ORS). Certain recommendations for improving the awareness regarding child survival have been submitted accordingly.KEYWORDS: Child survival, Health awareness     

A STUDY TO ASCERTAIN THE ADEQUACY OF OBSERVANCE OF UNIVERSAL PRECAUTIONS IN ACUTE MEDICAL AND SURGICAL WARDS OF A LARGE TEACHING HOSPITAL

The present study was a cross-sectional analytic epidemiological design to assess the frequency of observance of universal precautions in acute care wards of a large teaching hospital and to assess the epidemiological determinants of such observance. A total population of medical officers, nurses, paramedical and ancillary workers working in acute medical and surgical wards was studied using direct observations recorded on a pre-tested, structured format. The study revealed that handwashing was more frequently practiced by medical officers and ancillary staff (68% to 93%) as compared to nurses and paramedicals (38% to 58%) (p<0.01). Significantly higher proportion of medical officers in medical wards (93%) and nurses (63.3%) and ancillary workers in surgical ward (89%) were practicing handwashing (p<0.01). The practice of usage of gloves was significantly more frequent among medical officers and ancillary workers (72% to 100%) while it was quite inadequate among nurses and paramedicals (28% to 36%), (p<0.001). However, use of gloves was significantly better among nurses in surgical ward and paramedicals in medical ward (p<0.05). A linear trend analysis of the use of protective clothing revealed that the odds of nurses adequately using the same were much lower while those of ancillary workers were much higher as compared to medical officers, the trend being highly significant in both the type of wards (p<0.001). The study reveals a definite need of stepping up educational and motivational methods for observance of universal precautions by health care workers in large teaching hospitals. In particular, nurses and paramedical workers have been identified as high risk groups, needing concerted efforts for observing these precautions.KEYWORDS: Barrier Devices, Health Care Workers, Universal precautions     

A benchmark comparison of deterministic and probabilistic methods for defining manual review datasets in duplicate records reconciliation

Introduction

Clinical databases require accurate entity resolution (ER). One approach is to use algorithms that assign questionable cases to manual review. Few studies have compared the performance of common algorithms for such a task. Furthermore, previous work has been limited by a lack of objective methods for setting algorithm parameters. We compared the performance of common ER algorithms: using algorithmic optimization, rather than manual parameter tuning, and on two-threshold classification (match/manual review/non-match) as well as single-threshold (match/non-match).

Methods

We manually reviewed 20 000 randomly selected, potential duplicate record-pairs to identify matches (10 000 training set, 10 000 test set). We evaluated the probabilistic expectation maximization, simple deterministic and fuzzy inference engine (FIE) algorithms. We used particle swarm to optimize algorithm parameters for a single and for two thresholds. We ran 10 iterations of optimization using the training set and report averaged performance against the test set.

Results

The overall estimated duplicate rate was 6%. FIE and simple deterministic algorithms allowed a lower manual review set compared to the probabilistic method (FIE 1.9%, simple deterministic 2.5%, probabilistic 3.6%; p<0.001). For a single threshold, the simple deterministic algorithm performed better than the probabilistic method (positive predictive value 0.956 vs 0.887, sensitivity 0.985 vs 0.887, p<0.001). ER with FIE classifies 98.1% of record-pairs correctly (1/10 000 error rate), assigning the remainder to manual review.

Conclusions

Optimized deterministic algorithms outperform the probabilistic method. There is a strong case for considering optimized deterministic methods for ER.     

The association between dietary antioxidant intake and semen quality in infertile men

Background

Oxidative stress is detrimental to semen quality and has a significant role in the etiology of malesubfertility.

Methods

Dietary intake of antioxidants were compared between thirty two men with oligolastheno/ teratazoospermic(cases) and 32 normospermic volunteers (controls) attending fertility clinic in Mirza Koochak-khanHospital in Tehran, Iran. All participants were nonsmokers and matched according their age and Body MassIndex (BMI). Nutrient consumption was calculated using a semi- quantitative food frequency questionnaire.Semen samples were collected and were assessed by measuring volume, concentration, motility and morphology.

Results

infertile subjects had a significantly lower intake of zinc and folate compare to control ones(p<0.001). Dietary intake of vitamin C and E was lower than recommended values in 59.4% of case group thatwas significantly different from control ones (p<0.05). In control group, 36.4 and 40.9% of participants had insufficientdietary intake of vitamin C and E, respectively. Significant correlations were found between folate(r=0.5, p<0.001), zinc (r=0.6, p<0.001) and percentage of motility and also between vitamin E and morphology(r=0.3, p=0.03), zinc and concentration (r=0.4, p=0.004) in all participants.

Conclusion

summary, a low intake of folate, zinc, and vitamin E were related to poor sperm concentrationand motility.     

Review of advantages of Joel-Cohen surgical abdominal incision in caesarean section: a basic science perspective

Caesarean section is a common operation and the best postoperative outcomes are desired. Surgical techniques have been devised or modified to reduce operative and post operative discomfort. Many studies have evaluated or compared the Joel-Cohen abdominal incision with Pfannenstiel incision and found the former to be superior for various reasons such as less postoperative febrile morbidity, less analgesia requirements, shorter operating time, less intra operative blood loss and adhesion formation, reduction in hospital stay and wound infection in the group undergoing Caesarean section by this technique. This study is to find whether better postoperative outcomes of the Joel-Cohen incision group can be justified by the explanations of fundamentals of the basic sciences. Literature was reviewed for randomized clinical trials and review articles comparing the different kinds of abdominal incisions for Caesarean section. The study revealed that the Joel-Cohen method was beneficial. The fundamentals of basic sciences were studied to try to find an explanation to the enumerated advantages of the Joel-Cohen procedure; attributing to the differences in the techniques used.     

Marginal Accuracy of Castings Produced with Different Investment Systems

Background

The use of casting ring to produce accurate castings has been challenged with the introduction of a ringless casting technique. This study compared the marginal accuracy of all - metal complete coverage crowns fabricated with ringless, split plastic ring and metal ring investment systems.

Methods

A total of 40 all- metal complete coverage crowns were fabricated on a metal die. The crowns were divided in 4 groups (Group A, B, C and D) of 10 patterns each. A ringless system of investing and casting was used for group A whereas a split plastic ring system was used for group B. Groups C and D utilized metal ring with single and double layers of asbestos free cellulose acetate liner respectively for investing and casting procedures. The restorations were seated on the metal die and the vertical marginal discrepancy was evaluated by measuring the gap between the finish line on the die and the margins of the crown on four specific sites with an optical microscope. Statistical analysis was carried out using ANOVA and multiple comparison “t” test.

Result

The mean vertical marginal discrepancy for groups A, B, C and D was 95μm, 136μm, 128μm and 104μm respectively. Vertical marginal discrepancy on each surface was compared among the four groups. Difference of vertical marginal discrepancy on buccal surface (p<0.0001) as well as distal surface (p<0.005) was highly significant whereas it was non-significant on lingual and mesial surfaces (p>0.05).

Conclusion

Accurate castings with better marginal fit can be produced with ringless casting technique.Key Words: Vertical marginal discrepancy, All-metal complete coverage crowns, Ringless technique     

钢丝环形结扎联合张力带治疗髌骨骨折

目的：通过对此方法的临床应用及与其他治疗方法的比较，证明此种手术是一种更为简单有效的治疗髌骨骨折的方法。方法：对１５例各种类型的髌骨骨折用Ｐｙｒｆｏｒｄ描述的钢丝环扎并通过股四头肌腱和髌韧带的短形或“８”字形钢丝张力带并加以改进，术后不用石膏固定。结果：按照Ｉｎｓａｌ评定标准，优１４例，良１例。结论：此种手术方法简单实用，明显优于其他治疗方法     

Comparative Study of Recovery after Sevoflurane versus Halothane Anaesthesia in Adult Patients

Background

Induction and maintenance characteristics of sevoflurane and halothane have been studied, but little work has been done to compare the postoperative recovery of these two agents.

Methods

Sixty adult, ASA I and II patients were allocated randomly into Group A and Group B of 30 each. Group A received sevoflurane and Group B received halothane for maintenance. At the end of surgery early recovery, intermediate recovery and discharge criteria were assessed.

Results

Early recovery assessed with the mean time to extubation was 6.7 ± 2.29 min in Group A and 9.07 ± 1.64 min in Group B; eye opening was 7.28 ± 2.3 min in Group A and 10.6 ± 1.77 min in Group B; response to verbal command was 8.52 ± 2.83 min in Group A and 12.33 ± 2.17 min in Group B, while orientation was 10.43 ± 3.15 min in Group A and 14.77 ± 2.66 min in Group B. These differences were statistically significant (p<0.001). The mean time to reach post anaesthesia care unit discharge criteria was shorter for Group A (21.1 ± 4.69 min) as compared to Group B (27.43 ± 6.51 min) and this difference was statistically significant (p<0.001)

Conclusion

Early recovery time and time taken to achieve discharge criteria were faster with sevoflurane.Key Words: Sevoflurane, Halothane, Post-operative recovery     

宫颈癌手术414例近期并发症分析

目的 :探讨宫颈癌术后近期并发症及其发生率 ,降低并发症的方法。方法 :414例宫颈癌手术病人进行了回顾性分析。临床分期 ,Ⅰa2 5例 ,Ib10 5例 ,Ⅱa2 0 5例 ,Ⅱb39例 ,放疗后未控或中心复发 2 0例 ;病理诊断宫颈鳞癌393例 (94.93 % ) ,其他类型约 5 % ;少数病例作了术前或术后放疗 ;手术方式包括 :Ⅰ类手术 (筋膜外全宫手术 ) 8例 ,Ⅱ类手术 (次广泛子宫切除术 ) 10例 ,Ⅲ类手术 (次广泛子宫切除 +盆腔淋巴结切除术 ) 110例 ,Ⅳ类手术 (广泛子宫切除 +盆腔淋巴结切除 ) 2 86例。结果 :术后常见的近期并发症为泌尿系统并发症 ,包括泌尿道感染发生率 2 6 .0 9% ,尿潴留发生率 2 4.4% ,术后尿瘘发生率 2 .6 6 %。其他少见的并发症包括术后腹部伤口感染 (1.2 % ) ,肺部感染 (0 .48% ) ,盆腔感染 (0 .48% )和手术相关的死亡 (0 .2 4% )等。结论 :本组病例术后并发症发生率与文献报道一致 ,改进手术方式可以降低术后泌尿道感染和尿瘘发生率