早期宫颈癌患者保留生育功能手术的研究现状

<正>宫颈癌是女性生殖系统常见的肿瘤,目前发病呈年轻化趋势,有研究显示[1],40%确诊宫颈癌的患者处于育龄年龄,随着医学技术日新月异的发展和生物-心理-社会医学新模式的转变,妇科恶性肿瘤患者保留生育功能的治疗越来越受到重视,越来越多患者渴望保留生育功能。而对于早期宫颈癌,其更多还原     

妇科恶性肿瘤保留生育功能:希望抑或陷阱

妇科恶性肿瘤逐年呈年轻化趋势,这部分患者保留生育功能的治疗近年来引起了妇产科专家的关注。本文简述了子宫颈、子宫内膜以及卵巢恶性肿瘤患者保留生育功能治疗的指征、方法及预后,评价了妇科恶性肿瘤保留生育功能治疗对患者生育力的影响,介绍了生殖医学技术尤其是冷冻技术的发展对于妇科恶性肿瘤保留生育功能治疗的助力,权衡了患者的获益及风险。分析认为,妇科恶性肿瘤患者保留生育功能治疗既给患者带来了希望,又为临床诊疗布下了陷阱,妇科恶性肿瘤保留生育功能治疗需多学科协作、全面评估病情,鼓励患者参与多中心临床研究,将是未来的研究方向。     

子宫内膜癌保留生育功能和内分泌功能的治疗探讨

子宫内膜癌是常见的妇科恶性肿瘤,随着年轻患者的增多,保留患者生育功能的治疗和内分泌功能的治疗越来越受到重视,而如何尽可能安全地保留年轻早期患者的生理功能是当前需要解决的一个重要问题。保留生育功能的治疗主要包括:大剂量孕激素、促性腺激素释放激素激动剂(Gn RH-a)、含孕激素的宫内节育器(如曼月乐)、宫腔镜下病灶切除术等,后期的辅助生育技术的应用也至关重要;保留内分泌功能的治疗主要是指:手术时保留一侧或双侧卵巢。目前已有不少相关的研究报道,积累了一定的临床经验与处理共识,如大剂量孕激素治疗的有效性、严密随访和辅助生育技术的应用的重要性等,但在适应证、治疗方案的选择、孕激素的剂量和用药时间、完成生育后子宫切除的必要性等方面仍存在一定争议。     

宫颈癌保留生育功能根治术1例的护理

宫颈癌是女性生殖器中最常见的一种恶性肿瘤。文献报道[1],颈癌的发病率占发展中国家妇科恶性肿瘤的首位,且呈上升和轻化趋势,传统根治性手术治疗使年轻妇女丧失了生育功能而妇科肿瘤工作者面临着巨大挑战。早期宫颈癌的传统治疗方根治性子宫切除术或放射治疗。虽然治愈率高,但两种方法均患者失去生育能力[2],根治性宫颈切除术给有生育要求的早期颈癌患者带来了机会和希望。1994年,国外首次报道对年轻渴望生育的早期宫颈癌患者实施根治性宫颈切除盆腔淋巴结清扫术,术后成功妊娠[3],它改变了宫颈癌传统的治疗方其疗效同标准治疗方法相近,却使患者保留了生育功能。我科于2010年3月对宫颈癌患者行保留生育功能的根治性宫颈切除术,效果满意,现将护理报告如下。     

25岁以下妇科恶性肿瘤109例临床分析

目的:分析华西第二医院近7年25岁以下妇科恶性肿瘤的临床特点,并探讨治疗有关问题,为肿瘤防治工作提供理论依据。方法:对华西第二医院1998～2004年收治的25岁以下妇科恶性肿瘤患者进行回顾性分析。结果:①25岁以下妇科恶性肿瘤患者109例,占同期妇科恶性肿瘤患者的4.6%(109/2409);②25岁以下患者中卵巢癌占68.8%(75/109)、绒癌占15.6%(17/109)、宫颈癌占9.2%(10/109),居前三位;③25岁以下卵巢恶性肿瘤患者中,生殖细胞肿瘤占42.7%(32/75),交界性肿瘤占29.3%(22/75),上皮性肿瘤占21.3%(16/75);④除绒癌外,2例未手术,51.1%(46/90)保留了生育功能,其中卵巢恶性肿瘤患者中61.3%(46/75)保留了生育功能。结论:25岁以下女性常见的妇科恶性肿瘤是卵巢癌、绒癌和宫颈癌,对这个年龄段女性不应忽视盆腔检查和宫颈癌筛查;治疗应适度,尽量保留生育功能。     

宫颈癌的手术治疗研究进展

宫颈癌是妇科常见恶性肿瘤,虽然随着对已婚妇女筛查、HPV疫苗应用及预防工作的加强,宫颈癌发病率逐年下降,但在我国仍是主要的女性生殖道恶性肿瘤之一,发病率6110万,因此宫颈癌的治疗仍是妇产科医生的一大重任。对于宫颈癌患者,尤其是年轻患者,如何既达到治疗目的,又能提高治疗后的生活质量,甚至保留生育功能,越来越成为妇产科医生关注的焦点。宫颈癌的治疗有手术、放疗、化疗及靶向治疗等,手术是最重要的治疗方式。现对宫颈癌的手术治疗文献作一综述。     

早期宫颈癌患者行根治性子宫颈切除术的疗效分析

<正>最新的统计数据[1]表明,宫颈癌的发病率已经降至妇科恶性肿瘤发病率的第3位,但近年来其发病呈年轻化趋势。随着社会的发展,女性的婚育年龄逐渐推后,越来越多的早期宫颈癌患者有保留生育能力的要求。1987年,Dargent等[2]首次开展经阴道根治性宫颈切除联合腹腔镜盆腔淋巴结清除术的阴式根治性宫颈切除术(LRVT)治疗早期宫颈癌,使得早期宫颈癌患者保留生育功能的愿望变成了可能,并在全球范     

宫颈癌保留生育功能手术的临床病例报道及文献复习

<正>宫颈癌是常见的妇科恶性肿瘤,近年来,宫颈癌的发病出现了年轻化的趋势[1],超过40%的宫颈癌患者年龄小于44岁[2]。随着生育年龄的推迟,未生育的宫颈癌患者数量逐年升高,有生育要求的患者增多[3]。我院从2010年5月至2014年11月,对4例Ⅰa2~Ⅰb1期要求保留生育功能的宫颈癌患者,实施保留生育功能的手术治疗,经腹或经腹腔镜根治性宫颈切除术及盆腔淋巴结清扫术,短期疗     

保留生育功能的宫颈癌手术：关于手术指征的争议

宫颈癌是女性生殖系统最常见的妇科恶性肿瘤,其发生呈现年轻化趋势。据统计,25～34岁患宫颈癌的人数增加了77％,育龄期妇女发病率占宫颈癌的10％～15％。宫颈癌也是目前我国女性生殖系统中发病率最高的恶性肿瘤,例如上海市25～34岁和35～44岁年龄组的宫颈癌的发病率已由1984—1986年的0．24／10万和0．14／10万上升到1996～1999年的1．79／10万和2．33／10万。由于很大一部分早期宫颈癌患者尚未生育,因此保留生育功能的宫颈癌手术成为宫颈癌治疗中一种新选择,也是近年来宫颈癌治疗的新趋势。     

子宫内膜癌保留生育功能的研究进展

子宫内膜癌是我国发病率位列第二的妇科恶性肿瘤。发现时10%的患者未绝经,4%的患者年龄<40岁。年轻患者保留生育功能是目前治疗的热点问题。本文拟从患者特点、患者筛选、药物治疗选择及预后等方面进行讨论。     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.     

Wie zuverlässig sind Angaben zu nichtentzündlichen ausgedehnten Schmerzen?

ZusammenfassungFragestellung Es wurde geprüft, wie sich der Differenziertheitsgrad zweier Schmerzmessmethoden auf Angaben zur Ausgedehntheit klinischer Schmerzen auswirkt. Zugleich wurde der Referenzzeitraum variiert, über den die Patienten berichten sollten.Methode Erfasst wurde der Einfluss zu Lasten der Befragungsdifferenziertheit durch den Vergleich zweier Körperschema-Bildvorlagen. Drei Referenzzeiträume (Schmerz aktuell, letzte Woche, letztes halbes Jahr) wurden vorgegeben.Ergebnisse Patienten mit ausgedehnten Schmerzen gaben bei differenzierter Befragung um so mehr Schmerzen an, je weiter die Schmerzen zurück lagen und je größer der Berichtszeitraum war. Patienten mit gelenknahen Schmerzen gaben bei hoch differenzierter Befragung weniger ausgedehnte Schmerzen in der Vergangenheit an als bei globaler Einschätzung. Patienten mit Rückenschmerzen berichteten bei differenzierter Befragung zum aktuellen Schmerz über weniger ausgedehnte Schmerzen als bei globaler Befragung.Schlussfolgerung Die Angaben zur Schmerzausdehnung variieren vor allem bei Patienten mit ausgedehnten Schmerzen in Abhängigkeit von der Differenziertheit der Befragung. In diesen Fällen ist die Wahrscheinlichkeit erhöht, dass sich die Beschwerdesymptomatik zumindest teilweise erst in der Reaktion auf die situativen Befragungsbedingungen konstituiert und daher nicht auf andere Befragungsbedingungen generalisiert werden kann.