腹腔镜与宫腔镜子宫壁间肌瘤切除术的疗效对比分析

目的:探讨腹腔镜与宫腔镜子宫壁间肌瘤切除术的优缺点及对患者妊娠结局的影响。方法:前瞻性纳入2015年11月至2017年3月收治的130例子宫壁间肌瘤患者,通过计算机随机编码分为两组,62例行腹腔镜手术(腹腔镜组),68例行宫腔镜手术(宫腔镜组),统计两组患者术中情况、术后恢复情况、妊娠情况、复发等。结果:两组患者手术均顺利完成,无中转开腹,围手术期无死亡,无严重并发症发生。两组手术时间、术后住院时间、术后妊娠率、新生儿出生体重、新生儿Apgar评分差异无统计学意义(P0.05),宫腔镜组术中出血量、术后第1天疼痛评分均优于腹腔镜组(P0.05),术后3个月、6个月肌层愈合率亦高于腹腔镜组(P0.05),术后首次妊娠时间宫腔镜组较腹腔镜组短(P0.05)。术后随访中位时间12个月,两组复发情况差异无统计学意义(P0.05)。结论:宫腔镜子宫壁间肌瘤切除术创伤小、康复快,对妊娠结局影响小,值得临床推广。     

开腹与腹腔镜下子宫肌瘤切除术后患者妊娠结局的临床分析

目的:探讨开腹与腹腔镜下子宫肌瘤切除术对子宫肌瘤患者术后妊娠结局的影响。方法:选取2013年5月至2014年5月收治的120例子宫肌瘤患者,根据随机数字表法分为开腹组(行开腹子宫肌瘤切除术,n=62)与腹腔镜组(行腹腔镜下子宫肌瘤切除术,n=58),观察两组手术情况及术后妊娠结局。结果:开腹组切除肌瘤数量、最大肌瘤直径均大于腹腔镜组(P<0.05);腹腔镜组住院时间、术中出血量均少于开腹组(P<0.05);两组总妊娠率、早产率、流产率、分娩方式、妊娠期高血压及糖尿病、异位妊娠发生率、术后6个月复发率差异无统计学意义(P>0.05);两组肌壁间肌瘤、浆膜下肌瘤患者的妊娠率差异有统计学意义(P<0.05)。结论:有生育要求的子宫肌瘤患者行腹腔镜或开腹子宫肌瘤切除术均是安全、可行的,且母婴结局均较好。     

腹腔镜子宫肌瘤剔除术治疗子宫肌瘤效果观察

目的探讨腹腔镜子宫肌瘤剔除术治疗子宫肌瘤效果观察。方法本组68例患者根据随机数字表法随机分为A、B两组,各34例。A组采用腹腔镜下子宫肌瘤剔除术治疗,B组采用开腹子宫肌瘤剔除术治疗。对比分析两组患者手术时间、术中出血量、排气时间、体温恢复正常时间、下床活动时间、住院时间、术后妊娠结局、术后并发症、肌瘤残留率与肌瘤复发率。结果 A组手术时间、排气时间显著短于B组,术中出血量显著少于B组,且具有统计学差异(P<0.05);A组体温恢复正常时间、下床活动时间及住院时间均显著短于B组,且具有统计学差异(P<0.05);两组患者术后妊娠结局比较不具有统计学差异(P>0.05);两组并发症比较不具有统计学差异(P>0.05);两组患者术后随访3个月肌瘤残留率和肌瘤复发率比较不具有统计学差异(P>0.05)。结论子宫肌瘤患者应用腹腔镜下子宫肌瘤剔除术效果优于开腹子宫肌瘤剔除术,具有重要临床研究价值。     

宫、腹腔镜联合手术与其他术式治疗剖宫产 瘢痕憩室的疗效分析

目的:探讨宫腹腔镜联合手术、宫腔镜手术、经阴道手术、开腹手术治疗剖宫产瘢痕憩室的临床疗效,为临床治疗提供参考。方法:回顾分析确诊为剖宫产瘢痕憩室的79例患者的临床资料。患者分为四组,A组(n=25)行宫、腹腔镜联合手术,B组(n=23)行宫腔镜手术,C组(n=20)行经阴道手术,D组(n=11)行开腹手术,评估四组治疗效果。结果:A组、C组术中出血量、术后肛门排气时间、术后住院时间差异无统计学意义(P>0.05); D组上述指标高于A组、C组,差异有统计学意义(P<0.05); B组低于其余组,差异有统计学意义(P<0.05)。A组手术时间长于其他3组,差异有统计学意义(P<0.05); B组低于C组、D组,差异有统计学意义(P<0.05); C组、D组差异无统计学意义(P>0.05)。A组、C组与D组患者憩室修复情况均较理想,症状缓解率分别为96.0%、95.0%、90.9%,差异无统计学意义(P>0.05)。B组术后临床症状缓解率低于其余3组,差异有统计学意义(P<0.05)。结论:宫腔镜手术临床疗效稍差。经阴道手术视野局限,适用范围相对较窄。开腹手术创伤大,不推荐。而宫腹腔镜联合手术适用范围相对较宽,是治疗剖宫产瘢痕憩室安全、有效的术式。     

腹腔镜子宫动脉上行支阻断联合子宫肌瘤剔除术治疗子宫肌瘤的临床价值研究

目的探讨腹腔镜子宫动脉上行支阻断联合子宫肌瘤剔除术治疗子宫肌瘤患者的临床价值。方法回顾性分析2018-02—2020-02间西平县人民医院妇产科行腹腔镜子宫肌瘤剔除术治疗的96例子宫肌瘤患者的临床资料,按手术方法分为2组,各48例.对照组行腹腔镜肌瘤剔除术,联合组实施腹腔镜子宫动脉上行支阻断联合肌瘤剔除术。比较2组患者的基线资料、术中情况、术后临床指标,以及随访12个月期间的月经恢复正效果、肌瘤复发率和妊娠率。结果 2组患者的基线资料差异无统计学意义(P>0.05)。联合组患者的手术时间、术中出血量,以及术后胃肠功能恢复时间、住院时间、首次月经来潮时间均短(少)于对照组,差异有统计学意义(P<0.05)。术后随访12个月,其间联合组患者的术后病率、肌瘤残留率、肌瘤复发率均低于对照组,差异有统计学意义(P<0.05)。2组患者的月经恢复正常率和妊娠率差异无统计学意义(P>0.05)。结论腹腔镜子宫动脉上行支阻断联合子宫肌瘤剔除术治疗子宫肌瘤患者,具有手术时间短、术中出血量少、术后恢复快,以及肌瘤残留率和复发率低等优势。而且不影响月经恢复正常效果和患者的妊娠率。     

宫、腹腔镜联合治疗子宫内膜异位症不孕的临床研究

目的:探讨宫腔镜联合腹腔镜手术治疗子宫内膜异位症不孕的临床效果。方法:选取2014年4月至2015年5月收治的86例子宫内膜异位症不孕患者作为研究对象,分为观察组(行宫、腹腔镜联合治疗)与对照组(行腹腔镜手术),每组43例。观察两组患者术中出血量、手术时间、术后住院时间及妊娠情况。结果:两组术中出血量[(69.72±8.59)ml vs.(68.19±8.62)ml]、手术时间[(46.85±6.31)min vs.(45.93±6.29)min]、术后住院时间[(6.97±1.24)d vs.(7.12±1.25)d]差异无统计学意义(P>0.05);观察组术后随访期间总妊娠率为65.12%,显著高于对照组(41.86%),差异有统计学意义(P<0.05)。结论:宫、腹腔镜手术联合治疗子宫内膜异位症不孕安全、有效,可显著提高妊娠率,值得推广应用。     

妇科微创手术在剖宫产子宫切口瘢痕憩室治疗中的疗效分析

目的:分析比较单纯宫腔镜电切术、宫腹腔镜联合手术及阴式憩室修补术治疗剖宫产子宫切口瘢痕憩室的临床疗效。方法:选择2013年3月至2016年7月40例剖宫产子宫切口瘢痕憩室患者,其中12例行宫腔镜下电切术(A组),15例行宫腹腔镜联合手术(B组),13例行阴式憩室修补术(C组)。比较三组手术时间、出血量、术后住院时间、住院费用及治愈率。结果:A组在手术时间、出血量、术后住院时间、住院费用方面少于其他两组,治愈率低于其他两组,差异有统计学意义(P<0.05)。B组手术时间、住院费用多于C组,差异有统计学意义(P<0.05)。B、C两组在出血量、术后住院时间、治愈率方面差异无统计学意义(P>0.05)。结论:三种微创手术各有优势,宫腔镜电切术住院时间短,住院费用低,治愈率也较低;宫腹腔镜联合手术时间较长、住院费用高,但疗效确切;阴式手术住院费用较低,疗效确切;应根据患者的实际情况选择合适的手术方式。     

腹腔镜与宫腔镜治疗子宫疤痕妊娠临床疗效分析

目的探讨腹腔镜与宫腔镜手术方式治疗子宫疤痕妊娠的临床应用价值。方法回顾性分析2013年1月~2015年12月收治的65例子宫疤痕妊娠患者临床资料,其中行腹腔镜手术治疗30例(腹腔镜组),行宫腔镜手术治疗35例(宫腔镜组)。比较两组患者术中出血量、手术时间与住院天数、术后并发症、术后β-HCG水平恢复正常时间、月经恢复时间及术后3个月子宫疤痕情况。结果腹腔镜组30例患者均顺利完成腹腔镜手术,宫腔镜组除2例患者因病灶较大,出血量多致术野模糊而改行腹腔镜手术外,其余33例患者均完成宫腔镜手术。组间比较,腹腔镜组术中出血量大,手术时间与住院时间长,住院费用高,术后并发症发生率高,但术后3个月子宫下段疤痕面积小,差异均有统计学意义(P<0.01);两组β-HCG恢复正常时间相近,无统计学差异(P>0.05)。腹腔镜组术中膀胱损伤2例,即刻行膀胱修补,术后留置尿管10 d,拔除尿管后痊愈出院;肠管损伤1例,行肠管修补术,术后恢复好,痊愈出院;术后10例出现一过性发热。宫腔镜组术后伤口感染1例(2.86%)。两组患者均门诊随访至3个月,均在2个月内月经复潮。结论子宫疤痕妊娠行腹腔镜下局部病灶切除联合子宫修补术及宫腔镜下疤痕妊娠组织切除术均可以有效终止妊娠,微创,各有利弊。腹腔镜可以同时修补瘢痕缺陷、保留生育功能,适应证较广,宫腔镜手术则无腹腔手术创伤,术后恢复快,但是术后宫腔形态恢复存在疤痕组织较大,不利于再次妊娠。     

腹腔镜术后联合米非司酮治疗子宫内膜异位症临床研究

目的：探讨腹腔镜术后联合低剂量米非司酮治疗子宫内膜异位症周期及临床疗效。方法选取我院收治的66例子宫内膜异位症患者作为研究对象,随机均分为A、B、C三组,A组采用腹腔镜术后米非司酮治疗,B组采用术后孕三烯酮胶囊治疗,C组术后不予以任何辅助药物治疗,比较三组1年内复发率、缓解率、妊娠率、月经恢复时间及排卵恢复时间。结果三组缓解率差异比较无统计学意义（P＞0.05）,复发率及妊娠率比较差异有统计学意义（P＜0.05）;A组复发率明显低于B组及C组,妊娠率高于B组及C组,差异有统计学意义（P＜0.05）;A组及C组月经恢复时间及排卵恢复时间明显短于B组,差异比较有统计学意义（P＜0.05）。结论采用腹腔镜术后联合低剂量米非司酮短期疗法治疗子宫内膜异位症有助于缩短月经及排卵恢复时间,提高受孕率,降低复发率,临床疗效显著,值得在临床上推广应用。     

宫腔镜与腹腔镜手术治疗输卵管妊娠效果观察

目的比较宫腔镜与腹腔镜手术治疗输卵管妊娠的效果。方法选取2016-01—2017-04间中牟县人民医院收治的72例输卵管妊娠患者,按照不同术式分为2组,各36例。宫腔镜组采取宫腔镜手术,腹腔镜组采取腹腔镜手术。结果 2组均顺利完成手术。2组手术时间、术中出血量、术后血β-HCG转阴时间差异无统计学意义(P0.05)。宫腔镜组患者术后肛门排气时间及术后48 h疼痛评分优于腹腔镜组,差异有统计学意义(P0.05)。术后随访18个月,宫腔镜组有生育要求患者的宫内妊娠率高于腹腔镜组,差异有统计学意义(P0.05)。结论宫腔镜与腹腔镜手术治疗输卵管妊娠均具有创伤小、效果可靠的优势。但宫腔镜手术患者术后疼痛轻、恢复快,宫内妊娠率高。应严格掌握手术指征,以保证手术的安全性。     

Hazards and complications of endoscopic transurethral ureterolithotripsy and lithoextraction and means of prevention

Complications related to ureterolithotomy and ultrasonic ureterolithotripsy performed under the control of visual endoscope were analyzed in 86 ureterolithiasis patients, methods of their prevention discussed. All the aforementioned complications were distributed into three groups: inapplicability of surgery due to anatomic and functional defects of lower and upper urinary tracts, intraoperative, and postoperative complications. The commonest ones were ureteral abruption and perforation, acute pyelonephritis, temporary vesicoureteral reflux. Their control measures were considered as relative methods of treatment: immediate surgical intervention in case of ureteral abruption, renal catheterization in patients with insignificant ureteral perforation or acute pyelonephritis. Adequate ureteroscopy, careful consideration of pro- and contraindications, catheterization of renal pelvis and urinary bladder performed within 2-3 days after the surgery and adequate antibacterial therapy are the most decisive steps in the control of aforementioned complications.     

牙体牙弓颌骨阻力中心及其临床意义

牙体、牙弓及颌骨的阻力中心在正畸矫治力系统中具有重要的意义,也是正畸学领域争论较多的一个问题。Dermaut等研究表明,当力作用于物体阻力中心时,物体将发生平动,否则将发生平动和转动的复合运动。目前,国内外多数学者认为牙体、牙弓及颌骨存在阻力中心,但其位置存在争议。本文就牙体、牙弓及颌骨的阻力中心及其临床意义作一综述。     

Characterisation and differentiation of chondroblastomas and chondromyxoidfibromas - presence and expression of collagen types I and II

AIM: Chondroblastomas and chondromyxoidfiibromas are rare benign skeletal neoplasms with reported overlapping histology. Aim of this study was to analyse the biochemical composition of the matrix of these tumour entities in order to further characterise the cellular phenotypes of these neoplasms using typical cell biological marker genes. METHODS: The matrix compositions of chondroblastomas and chondromyxoidfibromas were analyzed by HE-histology, histochemistry, and immunolocalization techniques. Cellular gene expression patterns were detected by mRNA in situ hybridization. RESULTS: Chondroblastomas are rich in collagen type I and show foci of an osteoid-like matrix, whereas collagen type II as a typical marker of chondrocytic differentiation was not detected in any of the specimens. Chondromyxoidfiibromas had foci of chondroid appearance with chondroblastic cellular differentiation characterised by collagen type II expression. CONCLUSION: These results characterise chondroblastomas and chondromyxoidfiibromas as skeletal neoplasms that have a different biology and which can be distinguished by matrix protein expression products: collagen type II, the typical marker of chondroblast differentiation, could only be detected in chondromyxoidfibromas, but not in chondroblastomas. Thus, both neoplasms are clearly different on the cell biological level.     

Histochemical and contractile properties of striated muscles of urethra and levator ani of dogs and sheep

AIMS: To understand their possible importance in long- and short-term control of continence, some properties of the striated muscles of the urethra and pelvic floor (levator ani) of dogs and sheep were investigated, especially fiber types and contractile characteristics. MATERIALS AND METHODS: Striated muscles of urethra and levator ani of 29 male and 6 female dogs and 11 male and 6 female sheep were removed and cut into strips. Some strips were frozen and stained for ATPase at pH 9.4 and 4.3 for fiber typing; others were set up in an organ bath to study contractile responses to nerve stimulation. RESULTS: All muscles contained both type I (slow) and type II fibers, ranging from 97% type II in female greyhound urethra to 60% in female sheep levator ani. For each muscle, there were fewer type II muscles in sheep than in dog. The diameters of the urethral fibers were about 60% of the levator ani in dogs and 34% in sheep. Contraction of the urethral muscle was faster than for levator ani and declined to about 80% of the peak, 500 msec after the beginning of stimulation at 20 Hz. The levator ani contraction rose to a steady level as long as stimulation continued. CONCLUSIONS: Both the levator ani and urethral striated muscles contain slow and fast fiber types. The levator ani muscles are capable of sustained contraction with rapid onset which will produce long-term closure of the urethra. The circular urethral muscle contraction was faster but less well maintained.     

Incorporation and release of85Sr and14C-proline-hydroxyproline in mineral and collagen of bone and incisor teeth of growing rats

The extent to which exchange and reutilization processes of mineral tracers affect skeletal mineral accretion and resorption measurements was evaluated by comparing the rates of appearance and disappearance of⁸⁵Sr and¹⁴C-proline-hydroxyproline in bones and teeth in growing rats for 12 days following simultaneous parenteral injection of these tracers. Expressions for the relative rates of collagen synthesis and breakdown, which unlike mineral metabolism are considered not to be complicated by exchange phenomena, were based on¹⁴C-proline conversion to¹⁴C-hydroxyproline; the specific activity of the latter was determined. Both the mineral and the collagen specific activities reflected the rates and patterns of growth of the samples assayed; rapid growth and a short interval of time between formation and resorption of tissue in themetaphyseal bone which contains the cartilagineous growth plate, slow growth and an interval of time between formation and resorption of tissue indiaphyseal bone and incisor teeth which is longer than the 12 days of the experiment. However, in metaphyseal bone the specific activity collagen/mineral ratio dropped by one half during the 4–12 day interval in contrast to diaphyseal bone and incisor teeth in which no change in this ratio was observed during this period of time. The data indicate that collagen in the metaphyseal growth zone is removed by resorption before it has become fully mineralized, and that exchange is a relatively unimportant factor in the long term kinetics of bone mineral.

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Zusammenfassung Das Ausmaß, bis zu welchem Austausch- und Wiederverwendungsprozesse der mineralen Tracer die Messungen des mineralen Skelett-Auf- und Abbaues beeinflussen können, wurde ausgewertet; zu diesem Zweck wurde die Geschwindigkeit des Auftretens und Verschwindens von⁸⁵Sr und von¹⁴C-Prolin-Hydroxyprolin in Knochen und Zähnen von wachsenden Ratten während der 12 auf die simultane parenterale Injektion dieser Tracer folgenden Tage verglichen.Der Ausdruck für die relative Geschwindigkeit des Kollagen-Auf- und Abbaues, bei welchem im Gegensatz zum Mineralmetabolismus kein Mitwirken des Austauschphänomens vermutet wird, basiert auf der Umwandlung von¹⁴C-Prolin zu¹⁴C-Hydroxyprolin; die spezifische Aktivität des letzteren wurde bestimmt.Aus der spezifischen Aktivität des Minerals sowie jener des Kollagens konnten die Geschwindigkeit und die Art des Wachstums der untersuchten Proben ersehen werden, d.h.schnelles Wachstum und ein kurzes Zeitintervall zwischen Bildung und Resorption des Gewebes imKnochen der Metaphyse, die auch die knorpelige Wachstumsplatte enthält, und andererseitslangsames Wachstum und längeres Zeitintervall (länger als die 12 Tage des Experimentes) zwischen Bildung und Resorption des Gewebes imKnochen der Diaphyse und in den Schneidezähnen. Immerhin fiel die spezifische Aktivität des Kollagen/Mineral-Anteils im Knochen der Metaphyse während dem 4–12tägigen Zeitintervall auf die Hälfte, im Gegensatz zum Knochen der Diaphyse und der Schneidezähne, bei welchen während dieser Zeitspanne kein Unterschied in diesem Verhältnis beobachtet wurde.Diese Ergebnisse zeigen, daß Kollagen in der Wachstumszone der Metaphyse durch Resorption verschwindet, bevor es ganz mineralisiert ist, und daß der Austausch ein relativ unwichtiger Faktor in der Kinetik auf lange Sicht des Knochenminerals ist.