保留盆腔自主神经根治性子宫切除术的临床分析

目的:研究保留盆腔自主神经根治性子宫切除术的临床效果。方法:将60例分成对照组和研究组,对照组选用传统Piver RutledgeⅢ型宫颈癌根治术,研究组选择保留盆腔自主神经根治性子宫切除术,对比两组患者手术的出血量、时间以及术后直肠、膀胱功能的恢复水平。结果:将两组宫颈癌患者通过手术指标做出比较后得知,研究患者的术中出血量、手术时间明显多于对照组患者,组间对比差异显著,(P 0. 05),具有统计学意义。同时,对比两组宫颈癌患者在术后膀胱及直肠功能的恢复速度,研究组患者明显优于对照组患者,组间对比差异显著,(P 0. 05),具有统计学意义。结论:采用保留盆腔自主神经根治性子宫切除术促进宫颈癌患者的预后,使患者生活质量水平得到极大的改善,减少缩短住院时间,使患者家属少以些负担。     

保留盆腔自主神经宫颈癌根治术和广泛性子宫切除术对宫颈癌患者术后膀胱、直肠和性功能的影响

目的 探讨保留盆腔自主神经宫颈癌根治术和广泛性子宫切除术对宫颈癌患者术后膀胱、直肠和性功能的影响.方法 选取2014年12月—2019年12月收治的宫颈癌90例,根据手术方法不同将其分为观察组(48例)和对照组(42例)两组,观察组行保留盆腔自主神经宫颈癌根治术,对照组行广泛性子宫切除术.比较两组手术相关情况,术后膀胱...     

腹腔镜下保留盆腔自主神经广泛性子宫切除术治疗宫颈癌的效果及对膀胱功能的影响

目的探讨宫颈癌采用腹腔镜下保留盆腔自主神经广泛性子宫切除术的疗效及对膀胱功能的影响。方法选取2015年4月至2017年8月84例宫颈癌患者,按手术方案分为对照组和研究组,每组42例。对照组行腹腔镜下广泛性子宫切除术治疗,研究组行腹腔镜下保留盆腔自主神经广泛性子宫切除术治疗,比较两组手术相关指标,随访3个月,比较两组膀胱功能。结果两组住院时间、术中出血量、阴道切除长度比较,差异未见统计学意义(P0.05);对照组手术时间短于研究组,尿潴留率、腹压排尿率、尿失禁率、膀胱功能障碍率均高于研究组,差异有统计学意义(P0.05)。结论子宫颈癌采用腹腔镜下保留盆腔自主神经广泛性子宫切除术治疗效果确切,可减轻对膀胱功能的损伤。     

保留盆腔自主神经在广泛性子宫切除术中的应用分析

目的：探讨保留盆腔自主神经广泛性子宫切除术治疗宫颈癌患者的效果。方法：采用随机数字表法将2017年1月~2019年1月收治的宫颈癌患者100例分为试验组（保留盆腔自主神经广泛性子宫切除术,50例）与对照组（广泛性子宫切除术,50例）,对两组临床指标、膀胱功能恢复及预后情况进行比较。结果：两组宫旁切除长度、手术时间、淋巴结切除数量、阴道切除长度、术中出血量及术后尿失禁发生率对比,差异无统计学意义（P＞0.05）;试验组术后尿管留置时间短于对照组,腹压排尿、膀胱功能障碍及尿潴留发生率低于对照组（P＜0.05）;术后随访1年,两组复发率及病死率对比,差异无统计学意义（P＞0.05）。结论：宫颈癌患者采用保留盆腔自主神经广泛性子宫切除术治疗具有一定的临床疗效,可有效保护患者的膀胱功能。     

保留盆腔自主神经根治性宫颈癌切除术对患者直肠和膀胱功能及血清Hcy和IGFⅡ水平的影响

目的探讨保留盆腔自主神经根治性宫颈癌切除术对患者直肠和膀胱功能及血清同型半胱氨酸(Hcy)、胰岛素样生长因子Ⅱ(IGFⅡ)水平的影响。方法回顾性分析2016年1月至2018年5月在抚顺市中医院行保留盆腔自主神经根治性宫颈癌切除术的宫颈癌患者95例,按照治疗方法不同将其分为研究组(n=48)和对照组(n=47)。研究组患者实施保留盆腔自主神经根治性宫颈癌切除术,对照组患者实施不保留盆腔自主神经根治性宫颈癌切除术。比较两组患者术中及术后情况,术后直肠功能、膀胱功能,以及术前、术后的血清Hcy、IGFⅡ水平的变化。结果两组患者的淋巴结切除个数、子宫切除时间、术中出血量比较,差异无统计学意义(P 0.05);研究组患者的手术时间明显高于对照组,住院时间、并发症明显低于对照组,上述差异均具有统计学意义(P 0.05)。研究组患者的排气时间、排便时间、残余尿量50 ml时间、残余尿量100 ml时间明显低于对照组,膀胱最大容积、最大尿流率明显高于对照组,上述差异均具有统计学意义(P 0.05)。两组患者术后Hcy、IGFⅡ水平均较术前降低[(8.64±1.70)μmol/ml vs.(12.33±1.73)μmol/ml]、[(35.39±9.19) pg/ml vs.(47.37±11.43) pg/ml],差异具有统计学意义(P 0.05);研究组患者的术后Hcy、IGFⅡ水平明显低于对照组,差异具有统计学意义(P 0.05)。结论对宫颈癌患者给予保留盆腔自主神经根治性宫颈癌切除术,可缓解疾病的发生、发展,以及疾病的严重程度,降低Hcy、IGFⅡ水平,对直肠功能和膀胱功能具有改善作用。     

腹腔镜下保留盆腔自主神经根治性子宫切除术的临床研究

目的探讨腹腔镜下保留盆腔自主神经根治性子宫切除术对降低膀胱功能障碍并发症作用以及其安全性和可行性。方法对2008年9月～2012年9月在本院住院1A2—182期宫颈癌患者42例实施腹腔镜下保留神经的根治性子宫切除术（LNSRH组）,42例实施腹腔镜下子宫根治术而未保留盆腔自主神经（LRH组）。观察2组术中的出血量、手术时间及术后膀胱功能恢复情况等指标。结果所有患者均完成了保留盆腔自主神经根治性子宫切除术。LRH组仅1例患者术中发生膀胱损伤并在腹腔镜下完成了修补。LNSRH组的手术时间为（240±34）min,明显长于LRH组的（186±35）min（P〈O．05）;2组术中出血量、切除盆腔淋巴结的数目、切除宫旁组织长度、阴道长度比较均无显著差异（P〉O．05）;LNSRH组的术后尿管拔除时间为（7．4±2．5）d,明显短于LRH组的（17．6±7．6）d（P〈0．05）。结论腹腔镜下保留盆腔自主神经的根治性子宫切除术能够降低手术对膀胱功能的损伤,促进术后膀胱功能的恢复。     

保留盆腔自主神经广泛性子宫切除术治疗早期宫颈癌的效果分析

目的:对于保留盆腔自主神经广泛性子宫切除术在早期宫颈癌治疗中的应用进行充分的探讨,并且还要将其治疗效果进行分析。方法:将54例患者分为参照组(27例,广泛性子宫切除术)和研究组(27例,保留盆腔自主神经广泛性子宫切除术),比较两组患者的手术指标、膀胱功能、性功能障碍。结果:研究组各项手术指标与参照组相比,均无统计学意义(P>0.05);研究组各项膀胱功能均优于参照组,两组数据对比统计学差异显著(P<0.05);术前两组患者性功能障碍对比无统计学差异(P>0.05),术后研究组性功能障碍为8例(29.62%),参照组性功能障碍为20例(74.07%),两组数据对比统计学差异显著(P<0.05)。结论:对于子宫切除术的治疗来说,保留盆腔自主神经广泛性子宫切除术是有着极为显著的效果的,对患者膀胱功能以及性功能的影响较小,对于患者生活质量有着良好的保证。     

保留盆腔自主神经根治性宫颈癌手术对患者直肠及性功能的影响分析

目的分析保留盆腔自主神经根治性宫颈癌手术对患者直肠及性功能的影响。方法选取2012年6月至2013年5月收治的86例宫颈癌患者,根据随机数表法分为观察组和对照组,每组各43例。对照组进行腹腔镜下根治性子宫切除术,观察组进行保留盆腔自主神经根治性子宫切除术。比较两组患者手术情况,术后直肠功能、膀胱功能,相关量表评分,并发症情况。结果观察组的术中出血量显著少于对照组[(487.34±32.21)ml比(524.76±35.32)ml](P0.05)。观察组术后排便时间、排气时间、术后残余尿50 ml时间及术后残余尿100 ml时间显著短于对照组[(95.32±6.32)h比(112.43±8.12)h,(63.54±5.43)h比(78.32±7.43)h,(14.43±2.44)h比(18.43±3.51)h,(12.04±1.43)h比(16.43±2.24)h],差异均有统计学意义(P0.05)。术后1年,观察组患者的女性性功能量表(FSFI)、尿失禁生活质量问卷(I-QOL)评分显著高于对照组[(13.46±2.45)分比(10.35±1.87)分,(88.34±7.54)分比(84.32±7.12)分],生存质量调查表(EORTC OLO-C30)评分显著低于对照组[(51.42±3.25)分比(55.63±4.56)分],差异均有统计学意义(P0.05)。观察组和对照组的并发症发生率比较无显著性差异[8.82%(3/43)比11.76%(4/43)](χ~2=0.1555,P0.05)。结论保留盆腔自主神经根治性子宫切除术治疗宫颈癌,能改善患者的直肠功能及性功能,可有效提高患者的生存质量。     

腹腔镜下保留一侧盆腔自主神经广泛性子宫切除术治疗早期宫颈癌对膀胱功能的影响

目的:探讨腹腔镜下广泛性子宫切除术(LRH)中保留一侧盆腔自主神经治疗早期宫颈癌对术后膀胱功能的影响。方法:早期宫颈癌患者79例,根据手术方式分为LRH组40例和保留一侧自主神经广泛性子宫切除术(LUNSRH)组39例,分别给予常规LRH和LUNSRH。比较2组术后膀胱和直肠功能恢复情况。结果:2组的手术时间、术中出血量、术后住院时间、淋巴结清扫数量、阴道及宫旁切除长度、术后肛门排气时间差异均无统计学意义(P0.05)。LUNSRH组和LRH组的术后尿管留置时间分别为(21.4±2.5)d、(33.5±3.2)d,差异有统计学意义(P0.05)。结论:LUNSRH能显著减少术后膀胱恢复时间,且不延长手术时间。     

腹腔镜下宫颈癌保留神经平面广泛子宫切除术的临床效果

目的:探究腹腔镜下宫颈癌保留神经平面广泛子宫切除术的临床应用效果。方法:选取2016年3月至2017月7月116例在本院接受宫颈癌治疗的患者为研究对象,根据手术方法进行分组,47例不实施保留神经平面广泛子宫切除术的患者为对照组,69例实施宫颈癌保留神经平面广泛子宫切除术患者为观察组,比较两组患者的手术指标、直肠、膀胱恢复情况及不良反应。结果:观察组手术时间、手术出血量高于对照组,住院时间低于对照组(P<0.05);观察组排气时间、排尿间隔时长、尿管留置时间均低于对照组,而最大尿流率高于对照组,差异具有统计学意义(P<0.05);观察组不良反应率为8.70%,对照组不良反应为40.43%,观察组低于对照组,差异具有统计学意义(P<0.05)。结论:腹腔镜下宫颈癌保留神经平面广泛子宫切除术手术时间长、出血量增加,但是安全可靠,术后恢复快。     

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.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

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.     

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.