腹腔镜下Vecchietti阴道成形术36例临床分析

目的探讨腹腔镜下Vecchietti阴道成形术的手术方法及临床应用效果。方法回顾分析36例腹腔镜下行Vecchietti阴道成形术患者的临床资料。36例均为先天无阴道无子宫患者,手术方式参照Vecchietti术式,所有操作在腹腔镜下完成。术后6个月复查并询问性生活情况。结果36例手术全部成功,无膀胱、尿道与直肠损伤等并发症发生。术后人工阴道黏膜光滑红润,具有女性阴道形态和生理功能。28例结婚,性生活满意。结论腹腔镜下Vecchietti阴道成形术具有创伤小、手术时间短、简单、安全、不易损伤膀胱尿道与直肠、不破坏外阴形态、形成阴道符合阴道生理状态等优点,达到微创手术的目的,是理想的阴道成形方法。     

超声引导下PTGD在低位恶性梗阻性黄疸疾病中的应用

目的讨论超声引导下经皮经肝穿刺胆囊置管引流术(PTGD)在低位恶性梗阻性黄疸疾病中的应用价值。方法对2006年3月—2007年3月在我院超声科所施行的8例PTGD术进行回顾性分析。结果8例PTGD术均获得成功。术中超声均能较清晰地显示穿刺针穿入胆囊床的位置、导丝进入胆囊的深度,导管在胆囊中的位置。并发症主要有:疼痛、发热、渗血、引流管阻塞等。结论在低位恶性梗阻性黄疸疾病的诊治中,超声引导下PTGD具有实时、准确,置管快捷、方便等优点,提高患者的生活质量,延长了患者的生存时间,同时为外科手术提供了必要的准备和条件,但也存在携带不便等缺点。     

子宫动脉栓塞联合经皮乙酸注射治疗子宫肌瘤的临床研究

目的：探讨子宫动脉栓塞(UAE)联合经皮乙酸注射(PAI)治疗子宫肌瘤的临床价值。材料与方法：64例，年龄19岁～47岁，肌瘤直径5cm～14cm，其中肌壁间肌瘤50例，黏膜下肌瘤14例，全部行经皮穿刺插管双侧子宫动脉碘化油和明胶海绵颗粒栓塞，栓塞后3个月彩色多普勒观察肌瘤内血流信号，有血流信号的13例采用超声引导经皮穿刺乙酸注射．结果：插僻栓塞成功率100％，87．5％(56／64)的患者临床症状减轻，68．75％(44／64)的患者月经基本恢复正常，82．81％(53／64)的患者下腹疼痛消失。栓塞3个月后肌瘤平均缩小56％。乙酸注射后肌瘤内血流信号消失。结论：单纯子宫动脉栓塞可能出现肌瘤复发，子宫动脉栓塞联合经皮乙酸注射是治疗子宫肌瘤的安全有效方法。     

局部麻醉支气管软镜下氩气刀治疗中心气道阻塞性病变的困难

目的观察评价局部麻醉支气管软镜下氩等离子体凝固（argon plasma coagulation，APC简称氩气刀）治疗中心气道阻塞性病变的困难。方法局部麻醉支气管软镜下应用ERBE的APC300型氩气刀治疗中心气道阻塞性病变，观察治疗中的困难。结果2003年11月～2006年1月，28例中心气道阻塞的患者，共接受APC治疗71例次。术中遇到的主要困难如下。3例气管严重堵塞的患者，1例在APC治疗中少量出血，患者不愿承担手术风险而放弃继续手术，另2例术中窒息，其中1例改用全身麻醉完成手术，另外1例双侧主支气管严重堵塞未完成手术；肿物完全堵塞气道超过4cm以上的7例患者，每例患者短期内都进行了多次长时间APC治疗。患者难以耐受，其中3例被迫改用全身麻醉；8例患者在15例次的治疗中，靶组织结构不清，通过优先凝切、剥离管腔中心病变和分次治疗完成治疗；12例病变广泛的患者，在24例次的治疗中，清创费时，使用冷冻探头清创缩短了时间。3例因伴有软骨环损害气道塌陷和管壁外压，联合使用气道支架方才缓解了气道阻塞。结论局部麻醉软镜下氩气刀治疗气道阻塞性病变有一些困难，应该选择风险小、短时间能完成的手术。靶组织结构不清需要采取分次治疗。清创费时，冷冻探头能缩短清创时间。其局限性决定了软骨环损害致管壁塌陷和管壁外压者需联用支架。     

痔上黏膜环切钉合术治疗重度痔的临床观察

目的 比较痔上黏膜环切钉合术（PPH）与传统Milligan-Morgan手术治疗重度痔（Ⅲ、Ⅳ度）的疗效。方法分别采用PPH手术（PPH组）和Milligan-Morgan法痔切除术（传统组）治疗重度痔各40例，比较手术时间、住院时间、术后疼痛、出血、术后尿潴留、恢复时间。结果PPH组手术时间为（29.45±6.91）min，传统组为（48.65±10.65）min；PPH组住院时间为（3.03±1.49）d，传统组为（6.10±2.51）d：PPH组恢复工作时间为（8.00±1.73）d，传统组为（19.78±10.60）d，三项组间差异均有统计学意义（t分别=17.81、11.40、12.48，P均〈O.05）。PPH组术后疼痛轻，无1例肛门狭窄发生，二组差异均有统计学意义（X^2分别=11．52、11．40，P均〈O．05）。PPH组和传统组术后出血发生率分别为5％和10％，术后尿潴留发生率分别为25％和30％，两组差异无统计学意义（X^2分别=O.52、O.18，P均〉O.05）。结论PPH术具有安全、有效、住院时间短和恢复快等优点，对于合适的病人可替代传统的手术治疗方法。     

氩离子束凝固术治疗气道腔内病变的价值

目的探讨氩离子束凝固术（APC）在经支气管镜的腔内介入治疗中的疗效及安全性。方法应用APC技术对12例多种气道腔内痛变（脂肪瘤、纤维组织细胞瘤、内膜结核、鳞癌、混合性乳头状瘤、腺样囊性癌和淀粉样变性）患者进行凝固治疗，并观察其安全性及并发症发生情况。结果经APC手术治疗后，所有病例均取得了非常好的疗效，未见严重的并发症发生。结论APC技术经支气管镜腔内治疗已经完全可以取代高频电反激光治疗技术，并且更为安全和经济，将会成为支气管腔内病变治疗的主流技术。     

Posterior Fibular Groove Deepening Procedure With Low-Profile Screw Fixation of Fibrocartilaginous Flap for Chronic Peroneal Tendon Dislocation

Chronic peroneal tendon dislocation is an uncommon disorder that frequently presents with concomitant pathology. Posterior fibular groove deepening and retinaculum repair have been increasing in popularity for treatment of peroneal tendon dislocations. The purpose of the present study was to introduce a posterior fibular groove deepening procedure using low-profile snap-off screws to securely and simply fix the fibrocartilaginous flap to facilitate faster rehabilitation and to assess the clinical outcomes of patients with chronic peroneal tendon dislocation and associated pathologic features. In the present retrospective case series, 34 ankles in 34 patients underwent the fibular groove deepening procedure using low-profile screws with superior peroneal retinaculum repair. The clinical outcomes were evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale and patient subjective satisfaction rate. The time of return to recreational and sports activities was also assessed. Weightbearing ankle radiographs were evaluated to assess the stability of the flap by checking the screws. The mean follow-up period was 47.96 (range 12 to 142) months. The mean AOFAS scale score for all patients improved from 69.96?±?13.14 to 87.72?±?10.13 at the last follow-up examination (p?<?.001). Overall, 85.3% of patients subjectively rated their operative outcomes as excellent or good. The 18 (52.9%) patients with an isolated peroneal tendon dislocation had a faster return to recreational or sports activities than the 16 (47.1%) patients with concomitant pathologic features (2.95?±?0.19 versus 4.14?±?1.34 months; p?=?.002). No patient experienced residual dislocation, screw loosening, or irritation from the screws. The fibular groove deepening procedure using low-profile screws is be a simple procedure that offers rigid fixation. This leads to relatively fast rehabilitation and resumption of recreational or sports activities.     

Assessment of blood administration procedures: problems identified by direct observation and administrative incident reporting

BACKGROUND: Adverse events in blood administration frequently involve the identification of transfusion recipients or components. This report details the results of an investigation of the efficacy of direct observation and that of a hospital-wide incident-reporting system in detecting standard operating procedures (SOPs) for deviations in blood administration. STUDY DESIGN AND METHODS: A process-driven audit form targeting 19 blood administration steps was developed for direct observation monitoring of blood administration. Over 18 months, 202 transfusions were observed in selected hospital locations. Data from this audit were compared with data collected from the incident reporting system. RESULTS: Through direct observation, 334 events were identified for a rate of 1.65 SOP deviations per transfusion. The incident reporting system identified 52 adverse events. Deviations were categorized as being related to the patient or component information, transfusion, patient monitoring, record documentation, and ordering or delivery of the component. Fifty-five percent of the events detected with direct observation related to identification of the patient or component, compared with 17 percent of incident reports. Using direct observation, 9 percent of transfused patients had wristband identification deviations. Such SOP deviations were not detected with the incident reporting system. Transfusion SOP deviations represented 15 percent of direct observation reports and 38 percent of incident reports. Direct observation identified deviations in monitoring practices and record documentation not detected by incident reporting. CONCLUSION: Direct observation appears to be an effective means for identifying deviations related to patient identification, patient monitoring, and record documentation.     

子宫肌瘤介入栓塞治疗34例分析

目的 评价经导管子宫动脉栓塞治疗子宫肌瘤的疗效。方法 34例子宫肌瘤患均采用超选择性双侧子宫动脉插管方法，注射聚乙烯醇（PVA）和明胶海绵栓塞。结果 所有病例随访1－15个月（平均6个月），总的症状改善率91．2％（31／34），表现为月经增多症状均有不同程度改善，下腹部胀痛消失，栓塞后肌瘤均有缩小，B提示瘤体缩小1／3或以上达79．4％（27／34）。结论 子宫动脉栓塞治疗子宫肌瘤病是一种安全、有效的治疗方法。