游离型腰椎间盘突出症的手术治疗

目的 探讨游离型腰椎间盘突出症(LDH)的临床表现、影像学特点及手术疗效.方法 手术治疗游离型LDH患者24例,记录其发病情况、临床表现、MRI特点,均行后路减压游离间盘取出术,记录手术情况并采用数字疼痛评分(NRC)和Oswestry量表(ODI)评估患者疼痛和生活质量变化情况.结果 24例均获随访,时间8个月～4年.平均手术时间(1±0.3)h,平均出血量(300 ±30)ml.24例患者术前腰NRC、腿NRC、ODI评分分别为(7.34±1.63)分、(7.26±2.16)分、(52.35±6.49)分,术后8个月随访时分别为(3.26±1.14)分、(3.65±2.73)分、(73.78±8.60)分,术前和术后8个月随访时评分差异有显著性(P＜0.05).患者手术满意程度:优19例,良2例,可3例.结论 游离型LDH临床症状较重,MRI扫描有助于明确诊断,腰椎后路减压游离间盘切除一般可获得满意疗效.     

一家系5例多发性内分泌腺瘤2A型患者的护理

总结一家系5例多发性内分泌腺瘤2A型(MEN2A)患者的围手术期护理.通过家系调查确诊患者,术前给予心理支持和健康教育,注意肾上腺嗜铬细胞瘤患者的降压、扩容护理.术后积极预防并发症,给予个性化的激素替代护理,建立家族健康管理档案,制订详细的随访计划,完善健康教育.本组5例手术顺利,围手术期未发生并发症,均痊愈出院.     

人工股骨头置换围术期患者的护理

人工股骨头置换术是股骨骨折、股骨头坏死常用的手术方法，由于老年人骨质疏松，稍有不慎跌倒极易引发股骨骨折。且老年人体弱多病，各脏器功能衰退，骨愈合能力差，若护理不当，可带来一系列严重并发症，故做好临床护理十分重要。     

中央型颈脊髓损伤的手术治疗

近年来颈脊髓损伤的发病呈逐年增加的趋势,其中中央型脊髓损伤(central cord syndrome,CCS)最常见[1].CCS主要表现为手部、大小便功能障碍,下肢症状一般不重.由于该病具有一定自限性,既往多采用保守治疗,随着对该病确切发病机制深入了解,手术治疗得到广泛应用[2].     

宫腔镜双极汽化切割手术86例分析

目的 :探讨宫腔镜双极汽化切割手术治疗子宫内病变的疗效。方法 :为前瞻性临床研究。 2 0 0 1年 3月至 2 0 0 2年 7月应用宫腔镜双极汽化进行宫腔内电手术 86例 ,其中子宫内膜息肉 4 2例 ,粘膜下子宫肌瘤 2 0例 ,功能性子宫出血 19例 ,子宫粘连 3例和不全子宫纵隔 2例。结果 :所有手术均成功完成 ,摘除子宫息肉 (TCRP) 35例 ,TCRP +去子宫内膜术 (TCRE) 7例 ,切除粘膜下子宫肌瘤 (TCRM) 18例 ,TCRM +TCRE 2例 ,TCRE19例 ,分解子宫内粘连 3例和切开子宫中隔 2例。平均手术时间范围为 (2 2 .2± 7.9)～ (6 5 .0± 7.1)min。6 9例术前诉有月经过多的病人中 ,经TCRE、TCRP、TCRP +TCRE、TCRM和TCRM +TCRE术后其症状缓解率分别为 10 0 %、93.3%、10 0 %、88.9%和 10 0 %。结论 :采用以生理盐水膨宫的宫腔镜双极汽化切割手术易于操作、安全 ,能达到去除子宫内病变的疗效     

后路减压侧块钢板内固定治疗颈段脊柱脊髓损伤

颈脊髓损伤临床常见．其治疗方法视其损伤类型、损伤程度、损伤节段、受压部位等因素综合决定。对于3个节段以上或跳跃性2节段及以上的多节段颈脊髓损伤临床多采用后路减压治疗，既往多采用单纯椎板减压或椎管成形术，远期存在一定的并发症，包括颈椎失稳、脱位、迟发性神经根损伤、再关门等。颈椎后路侧块钢板内固定系统近年来在临床逐渐得到广泛应用并取得显著的疗效。我院1999年2月-2005年10月应用颈椎后路侧块钢板治疗外伤性颈脊髓损伤78例，疗效满意。     

优选输卵管助孕预防异位妊娠的疗效观察

目的 探讨优选输卵管助孕的疗效及预防异位妊娠的效果.方法 将379例不孕症患者按随机数字表法分成两组,对照组187例,试验组192例.对照组接受综合优化治疗,试验组接受综合优化治疗及优势输卵管侧助孕治疗.所有患者均接受子宫输卵管造影检查,试验组用超声监测卵泡以确定优势卵泡,均观察6个排卵周期.结果 试验组的官内妊娠率[43.23%(83/192)]明显高于对照组[31.55%(59/187)](P<0.05),异位妊娠率[5.21%(10/192)]明显低于对照组[10.70%(20/187)](P<0.05),未受孕率[51.56%(99,192)]与对照组[57.75%(108/187)]比较差异无统计学意义(P＞0.05).输卵管通而不畅者异位妊娠率[12.59%(18/143)]高于输卵管阻塞[2.63%(2/76)]和输卵管尚通者[2.70%(2/74)](P<0.05).结论 通过子宫输卵管造影确定优势输卵管,辅以超声监测卵泡发育确定优势卵泡,可使主卵泡在较好输卵管侧卵巢发育并受孕,提高宫内妊娠率,预防异位妊娠的发生.     

microRNA在脊髓损伤修复机制中的研究进展

微小RNA（miRNA）通常指大小为22 nt左右的单链非编码RNA,其生物学功能主要表现在RNA沉默和基因表达转录后调节中发挥作用。随着对其研究的不断深入,越来越多的证据表明miRNA在生物体内发挥着包括转录调控、生长繁育、肿瘤、炎症免疫及修复损伤等在内的多种生物学功能。近年来研究结果发现,mRNA参与了脊髓损伤（S...     

肥胖伴或不伴多囊卵巢综合征无排卵患者干预治疗的疗效观察

国内关于女性排卵功能的监测、多囊卵巢不孕患者的促排卵方案的研究很多,但研究单纯肥胖及肥胖合并多囊卵巢不孕患者不孕问题的研究较少.未见报道通过减肥和药物等干预措施观察单纯肥胖患者排卵功能恢复情况的文献.     

开腹与腹腔镜下输卵管吻合术回顾性队列研究及术后妊娠影响因素分析#br#

【Abstract】?Objective?To evaluate the safety and effectiveness of laparotomic and laparoscopic tubal anastomosis, and evaluate the influencing factors of pregnancy rate. Methods?The clinical data of 356 ligation patients who underwent tubal anastomosis in the First Affiliated Hospital of Zhengzhou University from March 2012 to October 2017 were analyzed retrospectively, including 85 cases of laparotomy and 271 cases of laparoscopy. The differences of perioperative status and postoperative pregnancy rate between the two groups were analyzed, and the independent influencing factors of postoperative pregnancy rate were analyzed. Results?①There was no significant difference in operation time, postoperative fever and exhaust time between the two groups (P>0.05), but laparoscopic bleeding was less[(18.1±12.1) ml, (33.4±22.1) ml], and the pain score was lower[(3.6±0.9), (4.5±0.9) score], duration of hospital stay was shorter[(5.9±0.6) d, (7.1±0.7) d](P<0.05). 2 cases of laparotomic group had abdominal wall incision infection, cases of laparoscopic group all healed well. The cost of laparotomic group was lower than that in laparoscopic group[(9 524±881), (12 903±1 162) yuan](P<0.05).② There was no significant difference in the patency rate of intraoperative anastomosis, residual tube length and ectopic pregnancy rate between the two groups (P>0.05). The uterine pregnancy rate two years after anastomosis was higher in laparoscopic group (76.4%) than in laparotomic group(61.2%)(P<0.05). The postoperative gestation time of the laparoscopic group was (7.6±4.9) months, and the postoperative gestation time of the open group was (8.3±5.3) months, with no statistically significant difference(P>0.05).③ Anastomotic procedure (OR=1.847, 95%CI: 1.028~3.320, P=0.040), age (OR=3.673, 95%CI: 1.690~7.984, P=0.001), multiple pelvic operation history (OR=3.092, 95%CI: 1.650~5.796, P=0.000), and length of residual tube (OR=4.716, 95%CI: 2.552~8.714, P=0.000) were independent factors influencing intrauterine pregnancy rate after anastomosis. There was no significant correlation between body mass index (BMI), length of ligation, method of ligation and site of ligation and pregnancy rate. Conclusion?Compared with open surgery, laparoscopic tubal anastomosis is a better treatment option for patients with tubal ligation. Anastomosis mode, age, history of multiple pelvic surgeries and length of remaining fallopian tubes were the influencing factors of pregnancy rate after anastomosis.