右美托咪定对腹腔镜全子宫切除术患者氧化应激反应的影响

目的：观察并评价右美托咪定（dexmedetomidine,Dex）对腹腔镜全子宫切除术患者氧化应激反应的影响。方法择期全麻行腹腔镜全子宫切除术患者40例,随机分为两组：D组（Dex组,n＝20）,Dex静脉泵注负荷剂量为1μg·kg－1（15 min内输注完）,然后以0．5μg·kg－1·h－1持续泵注至手术结束前30 min。C组（对照组,n＝20）,同样方式输注生理盐水。于麻醉前（T0）、气腹结束即刻（T1）、气腹结束后30 min（T2）和术后24 h（T3）4个时间点记录平均动脉压（MAP）、心率（HR）并抽取静脉血,测定血清过氧化氢（H2 O2）、丙二醛（MDA）和总抗氧化态（TAS）浓度。结果与T0相比,C组MAP在T1、T2时间点差异有显著性（P＜0．05）。与T0相比,T1、T2时间点C组、D组H2O2、MDA增高,TAS降低（P＜0．05）。T3时D组H2O2、MDA与T0比较差异无显著性（P＞0．05）,而C组仍较高（P＜0．05）;与C组相比,D组T2、T3时间点H2O2、MDA浓度低,TAS浓度高（P＜0．05）。两组在T1时间点H2O2、MDA差异无显著性（P＞0．05）,但D组较C组TAS浓度高（P＜0．05）。结论右美托咪定可减轻腹腔镜全子宫切除术患者氧化应激反应。     

阴道B超与腹部B超在诊断异位妊娠中的效果对比

目的：探讨阴道B超与腹部B超在诊断异位妊娠中的临床效果。方法抽取本院妇产科2012年1月份~2013年1月份收治的68例异位妊娠患者作为研究对象,并随机分为对照组和观察组,其中观察组34例采用阴道B超诊断,对照组34例采用腹部B超诊断,比较和分析两组诊断结果。结果观察组经病理学确诊32例, B超诊断符合率为94.2%（32/34）;对照组确诊为28例,占82.4%（28/34）;两组比较差异有统计学意义（P〈0.05）;另外在误诊和漏诊率方面,观察组误诊率为2.9%,无一例漏诊,而对照组误诊率为11.8%,漏诊率为5.9%,比较差异同样存在统计学意义（P〈0.05）。结论在异位妊娠的诊断过程中,采用阴道B超诊断,相对于腹部B超来说,诊断准确率更高,并能够减少误诊、漏诊等情况发生,具有较高的临床应用价值。     

妇产科腹腔镜治疗输卵管梗阻性不孕症的疗效观察

目的:探讨腹腔镜手术治疗输卵管梗阻性不孕症的临床疗效。方法:60例输卵管梗阻性不孕症患者接受腹腔镜手术治疗同时行美蓝染液试验,使其输卵管恢复通畅并恢复其生育能力。结果:60例输卵管梗阻性不孕患者总通畅率为40.00%,术后再次美蓝通液证实输卵管总通畅率为70.00%,两者比较差异具有统计学意义(P<0.05)。60例病例全部获得成功随访,共妊娠23例,妊娠率38.33%,其中1例为异位妊娠,有14例已足月分娩。结论:腹腔镜下治疗输卵管梗阻性不育孕症是安全、简便和有效的方法,值得推广应用。     

腹部推拿配合针刺治疗慢性疲劳综合征42例临床观察

目的：观察腹部推拿及针刺治疗慢性疲劳综合征的疗效.方法：采用腹部推拿及针刺百会、内关、足三里、三阴交、太冲穴,灸中脘、关元穴.结果：显效20例,占47.6%;有效17例,占40.5%;总有效率为88.1%,与治疗前比较有显著性差异（P〈0.05,P〈0.01）.结论：腹部推拿及针刺治疗慢性疲劳综合征可以显著改善临床症状,消除体征.     

糖尿病肾病中医药诊治进展

糖尿病肾病是糖尿病患者的主要微血管病变之一,亦是导致终末期肾脏病的重要原因之一。中医药诊治糖尿病肾病有多种理论学说,从不同角度阐释了糖尿病肾病的病机,其中大部分医家认为气阴两虚,肾络瘀阻为主要病因病机。文章将糖尿病肾病中医药诊治进展进行了总结。     

CLINICAL OBSERVATION ON 36 CASES OF SCAPULOHUMERAL PERIARTHRITIS TREATED BY ABDOMINAL ACUPUNCTURE AND BODY-ACUPUNCTURE

Ａｂｄｏｍｉｎａｌａｃｕｐｕｎｃｔｕｒｅｔｈｅｒａｐｙｉｓａｎｅｗｔｈｅｒａｐｙｏｆｍｉｃｒｏ ａｃｕｐｕｎｃｔｕｒｅｓｅｒｉｅｓａｆｔｅｒａｐｐｅａｒ ａｎｃｅｏｆｅａｒ ａｃｕｐｕｎｃｔｕｒｅ ,ｓｃａｌｐａｃｕｐｕｎｃｔｕｒｅａｎｄｈａｎｄａｃｕｐｕｎｃｔｕｒｅ .ＩｔｓａｃｕｐｏｉｎｔｓｄｉｓｔｒｉｂｕｔｅａｒｏｕｎｄＳｈｅｎｑｕｅ (ＣＶ 8)ａｎｄｆｕｎｃｔｉｏｎｉｎｒｅｇｕｌａｔ ｉｎｇｄｙｓｆｕｎｃｔｉｏｎｏｆｚａｎｇ ｆｕｏｒｇａｎｓ.Ｉｔｓｐｒｅｓｃｒｉｐ ｔｉｏｎｓａｒｅｍａｉｎｌｙｍａｄ…     

A comparison of vaginal, laparoscopic-assisted vaginal, and minilaparotomy hysterectomies for enlarged myomatous uteri

Objective

To compare the operative data and early postoperative outcome of vaginal hysterectomy (VH), laparoscopic-assisted vaginal hysterectomy (LAVH), and minilaparotomy hysterectomy (MiniLPT).

Methods

A total of 150 women who required hysterectomy for enlarged myomatous uteri were randomly allocated into 3 treatment groups: VH (n = 50), LAVH (n = 50), and MiniLPT (n = 50). The primary outcome was hospital discharge time. The secondary outcomes were operative time, blood loss, paralytic ileus, postoperative pain, and intraoperative and early postoperative complications.

Results

Mean hospital discharge time was longest with MiniLPT, and shortest with VH (P < 0.01). VH was the fastest operating technique, was associated with less blood loss, and resulted in shortest duration of paralytic ileus (P < 0.01). No intraoperative complications occurred.

Conclusion

VH should be the preferred surgical approach in patients with enlarged myomatous uteri. When VH is not feasible, LAVH should be considered an alternative to MiniLPT. Further controlled prospective studies are required to confirm these results.     

Characteristics of microorganisms cultured from infected wounds post-hysterectomy

Objective

To characterize organisms causing wound infection following abdominal hysterectomy.

Study design

All patients who underwent an abdominal hysterectomy (December 2002–January 2006) and developed abdominal wall wound infection proven by a positive culture were included in the study. Patient information was collected from the computerized files. The isolated microorganisms were characterized for antibiotics susceptibility.

Results

Sixty-eight (68/620, 10.96%) patients had positive wound cultures. Of 100 isolated microorganisms, 44 were resistant to cefonicid (prophylactic treatment) and 15 were resistant to combined ampicillin, gentamicin and metronidazole (empirical treatment). Major co-morbidities (including diabetes mellitus, hypertension, past malignancies, renal, cardiovascular and pulmonary diseases, hypothyroidism or anemia), were found to be significantly associated with pseudomonal infection (P < .008).

Conclusion

A significant portion of pathogens causing post-hysterectomy abdominal wall wound infection are resistant to the prophylactic treatment, and some are resistant to the empirical treatment. Further studies are necessary to evaluate the effectiveness of various prophylactic regimens with better coverage of Enterococcus fecalis, as well as the effectiveness of empirical treatment active against the resistant Enterobacteriaceae group.     

Foetal and neonatal ovarian cysts: a 5-year experience

Background Abdominal cystic formations in newborns are relatively common and often diagnostic suspicion arises in this regard even before birth as a result of ultrasound scans carried out during pregnancy. The aim of this study is to highlight the problems posed by the prenatal diagnosis of abdominal cysts in order to outline the most appropriate therapeutic approach in case of suspected ovarian cysts. Materials and methods Between January 2003 and January 2007, 57 women were enrolled in this study for a prenatal ultrasound (US) that revealed the presence of an echo-rare or echo-free area in the foetal abdomen. After birth all babies underwent blood tests and abdominal US scans in order to confirm or identify the nature of the cyst. If abdominal US could not show the nature of the cystic formation, magnetic resonance imaging with sedation was performed. When the radiological tests were not useful to identify the nature of the cysts and surgery was then necessary, surgical procedures were performed with laparoscopy. Results Ultrasounds were useful to identify the diameter of the cysts but not all their origins; also MRI confirmed the morphology and volume of the cysts, but could not give further details about their origin. Discussion Abdominal ultrasound and finally laparoscopy used to treat and remove the cysts were useful to monitor all simple abdominal cysts. MRI seemed not to be useful for the treatment of this condition, especially in the pediatric age when mild sedation is required.     

Ureteral catheter placement for prevention of ureteral injury during laparoscopic hysterectomy

AIM: Ureteral injury is among the most devastating complications of gynecologic surgery. Estimated incidence of ureteral injury during laparoscopic hysterectomy is 2.6-35 times (0.2-6.0%) that in abdominal hysterectomy. We investigated preoperative ureteral catheter (UC) placement as a way to prevent ureteral injury in laparoscopic hysterectomy. METHODS: Clinical records of 94 women who underwent laparoscopic hysterectomy between February 2006 and January 2007 in Yazaki Hospital, Kanagawa, Japan, were reviewed retrospectively. Thirty-four patients between February and June 2006 underwent the surgery without ureteral catheterization and 60 patients between July 2006 and January 2007 underwent surgery with ureteral catheterization. Clinical outcomes were statistically compared between the two groups. RESULTS: The average time required for catheter insertion was 9.35 min. The ureter in which the catheter was placed was visualized clearly. In one patient, whose left ureter was deviated by a massive myoma, catheter insertion was not possible. No complications arose from catheter placement except for minor complaints including low back pain, urinary discomfort, and transient hematuria. While one injury occurred in a patient without ureteral catheterization (1/34), no ureteral injury occurred in any patient with ureteral catheterization (0/60). Operative time, total blood loss, and hospital stay were not significantly different between the two groups. CONCLUSIONS: UC placement is simple, helping to prevent ureteral injury during laparoscopic hysterectomy and enhancing safety of this procedure.