前置胎盘、胎盘粘连及胎盘植入与人工流产的关系研究

目的：研究前置胎盘、胎盘粘连及胎盘植入与人工流产的相关性。方法对入我院进行分娩的3280例孕妇资料进行分析,选择其中342例发生胎盘异常孕妇进行研究,包括未经人工流产和人工流产的孕妇前置胎盘、胎盘粘连及胎盘植入的发生率;人工流产的次数与前置胎盘、胎盘粘连及胎盘植入的关系以及围产期感染相关因素的研究。结果未经人工流产孕妇胎盘总的异常率为3.7%,人工流产孕妇胎盘总的异常率为14.3%,两组胎盘异常总发生率比较显著差异（P＜0.05）;流产次数越多,胎盘异常发生率随着次数增高而增高;围产期感染与产前贫血、宫腔感染和产妇营养不良关系密切（P＜0.05）。结论前置胎盘、胎盘粘连及胎盘植入与人工流产的关系密切,多次人工流产易导致胎盘异常情况的发生,又易由于胎盘异常导致产后出血,育龄女性应尽量避免人工流产。     

Alternating nitroglycerin and syntocinon to facilitate uterine exploration and removal of an adherent placenta

Nitroglycerin (NTG) has been demonstrated to provide uterine relaxation in the management of various obstetric complications. A 32-yr-old woman presented 40 min postpartum for manual removal of a retained placenta. Repeated, alternating doses of NTG 250 μg and syntocinon (SYN) 10Uiv were used over 15 min to produce periods of uterine relaxation and contraction respectively for uterine exploration. Multiple attempts to extract the placenta failed and a diagnosis of placenta accreta was made. There were no major side effects from this combination of drugs apart from a transient 20% decrease in blood pressure after NTG, which responded to ephedrine 10– 15 mg iv. The rapid change in uterine tone was believed to be due not only to the short duration of action of NTG and SYN, but also to the possible physiological antagonism between the two drugs. The mechanism of interaction may involve calcium mobilization and myosin light chain phosphorylation. We conclude that NTG and SYN can be used to produce alternating periods of uterine relaxation and contraction rapidly and consistently with little sustained effects from either agents.     

Retained surgical sponge

Surgical foreign bodies are retained more commonly than is suspected. About 50% will become symptomatic in the form of erosion into the bowel or vessels, fistulae, abscesses, obstruction, bleeding, or chronic pain. Expeditious removal is recommended. Laparoscopic retrieval is feasible especially if discovered early.     

Retained pacemaker leads

Increasingly, functionless pacemaker leads are being abandoned in place because they cannot be safely removed. One hundred eighty-nine intact or partially removed pacemaker leads were abandoned in situ in 152 patients between Jan. 1, 1965, and Dec. 31, 1985. The leads, sometimes several leads in a single patient, were deemed uninfected at the time of abandonment in 137 patients and contaminated with Staphylococcus epidermidis in 15 patients. All of the contaminated leads have remained clinically uninfected during follow-up. One clean lead became infected early after implantation and the patient died after an open cardiac operation to remove that lead and an adjacent abandoned lead that was adherent to the subclavian vein. No other patient has had a late complication during follow-up to 256 months (mean 47.6). Properly managed abandonment of an uninfected lead can carry a very low complication rate.     

Retained surgical sponges,needles and instruments

Introduction

Retained sponges and instruments (RSI) due to surgery are a recognised medical ‘never event’ and have catastrophic implications for patients, healthcare professionals and medical care providers. The aim of this review was to elucidate the extent of the problem of RSI and to identify preventative strategies.

Methods

A comprehensive literature search was performed on MEDLINE^®, Embase™, the Science Citation Index and Google™ Scholar for articles published in English between January 2000 and June 2012. Studies outlining the incidence, risk, management and attempts to prevent RSI following surgical intervention were retrieved.

Results

The overall incidence of RSI is low although its incidence is substantially higher in operations performed on open cavities. Sponges are the most commonly retained item when compared with needles and instruments. Clinical presentation is varied, leading to avoidable morbidity, and the error is indefensible medicolegally. Risk factors include emergency operations, operations involving unexpected change in procedure, raised body mass index, and a failure to perform accurate sponge and instrument counts. The existing strategy for prevention is manual counting of sponges and instruments undertaken by surgical personnel. This, however, is fallible. Computer assisted counting of sponges using barcodes and gauze sponges tagged with a radiofrequency identification device aiding manual counting have been trialled recently, with success.

Conclusions

Vigilance among operating theatre personnel is paramount if RSI is to be prevented. Prospective multicentre trials to assess efficacy of new technologies aiding manual counting should be undertaken if this medical error is to be eliminated completely.     

Retained surgical items and minimally invasive surgery

A retained surgical item is a surgical patient safety problem. Early reports have focused on the epidemiology of retained-item cases and the identification of patient risk factors for retention. We now know that retention has very little to do with patient characteristics and everything to do with operating room culture. It is a perception that minimally invasive procedures are safer with regard to the risk of retention. Minimally invasive surgery is still an operation where an incision is made and surgical tools are placed inside of patients, so these cases are not immune to the problem of inadvertent retention. Retained surgical items occur because of problems with multi-stakeholder operating room practices and problems in communication. The prevention of retained surgical items will therefore require practice change, knowledge, and shared information between all perioperative personnel.     

Retained fecalith after laparoscopic appendicectomy

The subhepatic abscess due to retained fecalith is a rare complication following appendicectomy. The incidence of this complication is probably going to increase due to high rate of laparoscopic appendicectomy. We report 2 cases of subhepatic abscess 1 and 2 years after laparoscopic appendectomies. This potentially serious complication could be preventing with technical recommendations. When it occurs, this complication has to be directly treated by surgical drainage, percutaneous drainage couldn't be successful because it leaves fecalith in its place which is a cause of recurrence. Our reports are the first to use a laparoscopic treatment of this complication.     

保留十二指肠乳头的胰十二指肠切除术

目的介绍保留十二指肠乳头的胰十二指肠切除术。方法对2例重型十二指肠合并胰腺损伤患者行保留十二指肠乳头的胰十二指肠切除术。结果无手术死亡,术后无胰瘘等严重并发症,均痊愈出院。结论对胆总管完整、十二指肠乳头尚存的重型胰十二指肠损伤患者,急诊手术行保留十二指肠乳头的胰十二指肠切除是值得考虑和应用的安全手术方法。     

Retained fecalith after laparoscopic appendectomy

An intraabdominal abscess developed from a retained fecalith following laparoscopic appendectomy. We discuss the prevention and management of retained fecaliths in light of the numerous reports of retained gallstones. Received: 24 January 1997/Accepted: 17 November 1997