妇科腹腔镜手术体位安置方法的临床观察

目的比较两种体位安置方法对妇科腹腔镜手术患者的影响。方法选择妇科腹腔镜手术成人患者40例,随机分成两组:传统组患者安置手术体位为截石位;改良组患者取平卧位,两侧髋关节外展,双下肢水平分开100~110°。记录体位调整15 min后的心率、无创血压、心电图、血氧饱和度、气道峰值、呼气末二氧化碳分压以及随访术后24 h内不适主诉发生率。结果两组患者血压、心率、血氧饱和度、呼气末二氧化碳分压无差异(P>0.05),气道峰值及24 h内不适主诉发生率传统组高于改良组(P<0.05)。结论改良组体位安置方便,术中手术野暴露满意,可以预防和减少传统手术体位引起的并发症,从而提高手术安全性。     

The advocacy movement in gynecologic oncology

OBJECTIVES: To review the development of the advocacy movement in gynecologic oncology. DATA SOURCES: Professional journals, texts, newspapers, organization newsletters and briefs, and internet web sites. CONCLUSIONS: Advocacy in gynecology oncology has grown tremendously in the past 5 years. Advocacy groups offer information and resources to patients and family members; other groups target public policy and federal funding. IMPLICATIONS FOR NURSING PRACTICE: Nursing must remain involved in all aspects of patient advocacy and partner with leading advocacy movements to effect health care change.     

手术结束前腹腔注水对妇科腹腔镜术后肩痛发生的影响

目的探讨腹腔镜手术后肩痛的预防方法。方法2004年6月￣2004年8月期间在北京大学第一医院妇科一病房行腹腔镜手术的患者98例随机分为两组,研究组(49例)于手术结束时向腹腔内注入2000mL乳酸林格氏液,按传统方法排出腹腔内残余气体,之后再将腹腔内液体引流。对照组(49例)仅按传统方法排出腹腔内残余气体。采用国际通用的10分视觉量表法观察两组术后6h和1￣4d的肩痛的发生率、程度及持续时间。结果术后出现肩痛症状者研究组有18例,占36.7%;对照组有27例,占55.1%,研究组低于对照组,P<0.05。双侧肩痛的比例对照组27例中占25例(92.6%);而研究组18例中仅占7例(38.9%),其比例明显以对照组为高。肩痛出现的时间研究组和对照组均以术后6h和术后3d之内最常见,肩痛的持续天数研究组为(1.8±1.3)d,对照组为(2.4±1.3)d,P=0.056。疼痛者日平均疼痛分值研究组为(2.9±1.4),对照组为(3.3±1.6),P>0.05。两组平均住院时间和恢复工作的时间相似,术后均无明显并发症发生,患者对手术的满意度相似。结论肩痛是腹腔镜手术后的常见的并发症,手术结束前腹腔内注入液体协助排出腹腔内残余气体能明显减少患者术后肩痛的发生。     

妇科腹腔镜手术严重并发症临床分析

目的探讨妇科腹腔镜手术严重并发症发生原因及治疗情况。方法回顾性分析8 610例行妇科腹腔镜手术患者的临床资料,统计严重并发症发生情况,分析其发生原因及治疗方法。结果本组发生严重并发症33例（0.38%）,其中肠道损伤4例（直肠损伤2例,小肠损伤2例）,膀胱损伤12例,输尿管损伤3例,出血性损伤9例（大血管损伤2例,腹膜后血肿5例,阴道残端活动性出血2例）,闭孔神经损伤3例,戳孔疝1例,腹膜后脓肿1例;给予术中修补、二次手术、保守治疗等,患者均治愈出院。结论妇科腹腔镜手术严重并发症发生与手术难度、操作技术等有关。     

Management of gynecologic oncology emergencies

Gynecologic malignancies are the third most common cancer among women in the United States. Because of often subtle early findings, the diagnosis may not be made before the widespread dissemination of the disease. The Emergency Department physician will commonly encounter a woman with vaginal bleeding, pelvic pain, or a symptomatic abdominal mass. In this article, we have described the epidemiology, recognized patterns of spread, and associated findings of gynecologic tumors. The proper Emergency Department evaluation and management of these problems is emphasized with guidelines for the timing of referrals and consultation with the gynecologic oncologist. The treatment of gynecologic malignancies is often complicated and responsible for Emergency Department visits. The various modalities are addressed according to the organ systems affected and include sections on postoperative problems, gastrointestinal complaints, urologic complications of therapy, radiation therapy and its complications, with an emphasis on the most serious complications necessitating either careful outpatient management or hospital admission. As cost-containment pressure grows, we have included sections on chemotherapy and total parenteral nutrition, both of which are becoming common outpatient events for the cancer patient.     

Blood salvage use in gynecologic oncology

BACKGROUND: Blood salvage allows for collection and processing of surgical blood loss with the eventual reinfusion of washed red blood cells (RBCs) back to the patient. The use of blood salvage in patients undergoing surgery for malignancy is off-label. Controversy exists as to the risk of potential cancer dissemination resulting from the reinfusion of the processed blood, but no data are available to confirm this risk. Recent studies have demonstrated that filtering the salvaged blood using a leukoreduction filter (LRF) significantly decreases the number of cancer cells in the recovered RBC aliquot in a variety of cancer types.
STUDY DESIGN AND METHODS: Patients on the gynecologic oncology service as part of the bloodless surgery program at Englewood Hospital and Medical Center from April 1998 to April 2007 were identified. Three patients that had reinfusion of cell salvage blood (all reinfusions were performed after filtration with a LRF) were studied further with emphasis placed on long-term outcomes.
RESULTS: Two of the three patients did not show any evidence of metastases after surgery. The only patient that developed evidence of hematogenous progression had known liver metastases at the time of her initial diagnosis and therefore had hematogenous dissemination before her index surgery.
CONCLUSION: In this series of patients undergoing surgery for malignancies on the gynecologic oncology service, blood salvage with LRF was not definitively associated with hematogenous dissemination. Further large controlled studies are needed to demonstrate the clinical safety of the use of blood salvage in this setting.     

腹腔镜在老年女性妇科疾病中的应用观察

目的探讨腹腔镜在老年女性手术中的实用性。方法回顾性分析47例患者(其中妇科腹腔镜手术24例，开腹手术23例)腹腔镜手术和开腹手术临床资料的相关指标。结果腹腔镜组患者术中出血、手术后住院时间、抗生素应用总量上明显少于开腹手术。结论充分作好围手术期准备及熟练掌握手术适应证，老年女性行腹腔镜手术安全可行。     

The cul-de-sac packing method with a metreurynter in gynecologic gasless laparoscopy

Laparoscopic surgery has inherent restrictions with respect to the operative field of view and the range of surgical manipulation. Of the two procedures which secure sufficient operative space, the operative view of the gasless method is inferior to that of a pneumoperitoneum. In order to gain greater surgical visualization in gynecological gasless laparoscopy, the authors devised the cul-de-sac packing method employing a metreurynter, an instrument familiar to obstetricians in Japan. A metreurynter was lead into the cul-de-sac, and was inflated with saline, which resulted in the adnexae being raised up. This method was performed in three patients whose preoperative diagnoses were unknown infertility, ovarian cyst, and ectopic pregnancy, respectively. In all cases this method was able to keep the bowels out of the cul-de-sac space. In the first case, we were able to perform a tubal patency test under tension-free conditions, while at the same time bilateral tubal information could be obtained in a single view. In the latter two cases the adnexal lesions were maintained at an inspectional position throughout the operation without the necessity of being held by forceps to prevent them from falling down into the cul-de-sac space. No complications occurred in our three cases. This method will not be useful for patients whose cul-de-sac space is closed due to adhesions. However, except in such cases, this technique supplies a good operative view while being simple, safe, and inexpensive. Furthermore, this method supports gentler and less traumatic manipulation throughout the operation.     

Recent surgical approaches to gynecologic oncology

The development of gynecologic oncology as a specialty has contributed to the progress of the treatment and management of women with genital and reproductive cancers. The trend toward less aggressive and less invasive surgery has yielded an improved quality of life for women with gynecologic cancer. Multimodal interdisciplinary care is the principle and practice of gynecologic oncology. Prevention and screening have not always kept stride with the other advances in treatment, which include diagnostic imaging, laparoscopic surgery, chemotherapy, genetic susceptibility, and tumor marker assays. Educating patients and health care providers is the challenge in gynecologic oncology.     

The nursing role in radiation oncology

OBJECTIVES: To reflect on the historical evolution of radiation oncology nursing. DATA SOURCES: Published articles and texts, historical archives of professional organizations, and the authors' experience. CONCLUSIONS: The radiation oncology nursing role is multifaceted. Role components include patient assessment, patient education, support and counseling, physical care, continuity of care, research, and administrative and leadership activities. There is wide variation in staffing patterns and role implementation throughout the world, and in recent years there has been increasing interest in the development of advanced practice nursing roles in this specialized area of oncology. IMPLICATIONS FOR NURSING PRACTICE: Changes in the health care environment make it difficult to predict how the role of the nurse in radiation oncology will evolve in the future. Radiation oncology nurses will need to be proactive in developing the knowledge and skills needed to meet the challenges of the future.     

麻醉后留置导尿在妇科手术中的应用

目的针对麻醉前后导尿对患者的生理反应、不适程度及非肾小球性红细胞检出率进行对照研究,探讨留置导尿的最佳时机。方法将100例妇科手术患者随机分为两组,每组50例,实验组患者手术室麻醉后留置导尿,对照组患者进入手术室前半小时在病房导尿。比较两组患者导尿前、导尿时的脉搏、血压、不适程度,监测导尿后尿液中非肾小球性红细胞的阳性结果。结果对照组患者插管时的脉搏、血压高于插管前,差异有统计学意义（P〈0．05）;实验组患者插管前后脉搏、血压无变化（P〉0．05）;对照组和实验组患者导尿后尿液中非肾小球性红细胞阳性检出率第1次分别为30．0％,12．0％,第2次分别为24．0％,6．0％,差异均有统计学意义（x2值分别为4．882,6．353;P〈0．05）;对照组患者导尿时不适程度高于实验组患者,差异有统计学意义（P〈0．01）。结论为了减少术前导尿引起的不适和尿道黏膜损伤,导尿宜选择麻醉后。     

腹腔镜在妇科急腹症中的应用(附570例分析)

目的:探讨腹腔镜在妇科急腹症的应用价值,对手术的适应症及可能出现的问题进行讨论。方法:回顾性分析2004-11-2010-10湖北省沙洋人民医院妇产科收治的570例妇科急腹症患者,根据手术方式分为两组:A组:常规开腹手术组共207例;B组:腹腔镜手术组共363例,对比分析两组患者疗效及术后并发症。结果:所有患者均行急诊手术,无手术死亡病例,其中B组患者中14例中转开腹(中转率3.9%),在平均住院时间,胃肠道功能恢复时间及术后并发症方面显著低于A组患者(P<0.05),B组部分患者术后出现皮下气肿、腹壁血管损伤及皮下淤血等,均经保守治疗痊愈。结论:有经验的医师采用腹腔镜治疗妇科急腹症具有诊断和治疗双重意义,且损伤小、恢复快,具有较高的临床价值,值得在基层医院推广。     

12例妇科腹腔镜手术中输尿管损伤的护理

通过分析12例输尿管损伤患者的手术原因、尿瘘症状出现的时间、处理方法,提出护士应提高对妇科腹腔镜手术的认识。术前护士需要全面了解病史,术后要密切观察引流液的性状及量的变化,同时做好出院前的个体化指导,这些护理措施对输尿管损伤患者的早期诊断、处理及改善预后有重要的意义。