保留盆腔自主神经的直肠系膜全切除术对患者术后排尿和性功能的影响

目的　研究保留盆腔自主神经的直肠系膜全切除术后患者的排尿和性功能。方法　将 63例DukesA、B期直肠癌患者随机分为对照组 (2 9例 )和研究组 (3 4例 )。对照组行Miles手术 (13例 ) ,Dixon手术 (16例 ) ;研究组行保留盆腔自主神经的直肠系膜全切除术 ,保留肛门 2 5例 ,未保留肛门 9例。观察比较 2组患者术后自主排尿的情况 ,膀胱残余尿量及性功能。结果　研究组患者术后轻、中、重度排尿障碍的发生率分别为 11.8%、5 .9%和 0 ,明显低于对照组 (2 4.1%、2 0 .7%和 3 .5 % )。研究组中 17例男性患者术后 2例 (11.8% )阴茎不能勃起 ,4例 (2 3 .5 % )不能完成性交及射精 ;17例女性患者术后 1例 (5 .9% )性交时阴道湿润性差 ;7例男、女患者 (2 0 .6% )术后不能体会性高潮。对照组中 15例男性患者术后 11例 (73 .3 % )阴茎不能勃起 ,13例 (86.7% )不能完成性交及射精 ;14例女性患者术后 6例 (4 2 .9% )阴道湿润性差 ;2 5例男、女患者 (86.2 % )术后不能体会性高潮。研究组男、女患者术后性功能障碍发生率显著低于对照组。结论　保留盆腔自主神经的直肠系膜全切除术能较好保留直肠癌患者术后的排尿和性功能。     

盆腔静脉瘀血症患者瘀血静脉超微结构观察

为探讨盆腔静脉瘀血症患者瘀血静脉形态学改变,本文对11例瘀血症患者和6例结扎术后无任何症状和体征的妇女盆腔静脉进行了扫描及透射电镜观察.发现瘀血静脉壁间渗出增多;内皮细胞数量增多、体积变小且外形肿胀;细胞表面粗糙,突起增粗,小孔及凹陷增多、变大;细胞质致密并含大量饮液泡,线粒体肿胀而数量增多;染色质呈块状分布于核的周边;内皮细胞间嵌合连接和紧密连接正常存在.这些变化说明缺氧是引起本症盆腔静脉超微结构改变的主要原因,提示本症是一种功能性疾病.     

Lateral asymmetries in the trigeminal ganglion of the male rat

We have applied stereological methods to estimate the number and perikaryal size of primary sensory neurons in celloidin-embedded trigeminal ganglia of male albino rats, specifically looking for inter-individual and side variability. The mean total number of neurons per ganglion was 35,300, with a moderate variability among ganglia. On average, 66% of the neurons were classified as A-type and 34% as B-type. Although for individual cases there could be notable side differences in the number of neurons of each type, on a population basis these differences were not significant. Mean neuronal volume was four times larger for A- than for B-cells, and both populations exhibited a moderate variability among individuals. High intra-animal side differences were found for A-cells, which were on average a significant 23.5% larger in the right ganglia. B-cells did not show significant side differences. The distribution of individual volumes around the mean value was consistently skewed to the right, particularly in the case of A-cells, which partially overlapped with the largest B-cells. In the right ganglion the distribution of A-cells, but not of B-cells, showed a rightward bias, revealing the increase in bigger neurons. The existence of larger A-type neurons in the right trigeminal ganglion may provide a structural substrate for some somesthetically based complex behaviors which are best performed by rats using their right vibrissae.     

多层螺旋CT盆腔扫描重建图像质量与X射线剂量的关系

目的分析扫描参数的设置与图像质量和吸收剂量之间的关系,选择适合于二维和三维重建较高图像质量和较低吸收剂量的扫描方式。方法使用GE L ightspeed U ltra 16层螺旋CT机,对人体盆腔模型进行扫描。扫描条件:120 kV,管电流分别为250 mA或200 mA,螺距分别为1.375或0.985,层厚分别为5 mm或7.5 mm。评价二维和三维图像质量,在辐射剂量观测栏,观测剂量长度乘积(DLP)的变化。选择其中图像质量较好和DLP相对较低的4种扫描方式对患者进行扫描。结果DLP随管电流的增加、螺距的减小而增大,而二维和三维图像质量也随mA的增加、螺距的减小而提高。二维图像选择250 mA、1.375螺距、7.5 mm层厚,图像噪声低,影像细节能清晰显示,且DLP相对较低;三维图像选择200 mA、0.938螺距、7.5 mm层厚,能够满足诊断需要。结论遵循医疗照射的正当性和防护最优化原则,科学地设置管电流、层厚、螺距等扫描参数,一方面能够保证二维和三维图像质量,另一方面又能减少DLP值,减少X射线辐射对盆腔生殖器官的损伤。     

182例不孕妇女腹腔镜诊断结果分析

目的:探讨腹腔镜检查对不孕妇女盆腔因素的诊断价值。方法:对1998~2004年因不孕症在我院行腹腔镜检查患者182例进行分析。结果:盆腔炎、子宫内膜异位症分别占53.8%和29.1%,输卵管阻塞占35.2%,镜下输卵管阻塞与术前比较诊断符合率为82.7%。其余镜下诊断分别为:多囊卵巢、盆腔结核、卵巢肿瘤、盆腔瘀血和正常盆腔。盆腔炎在继发不孕妇女中发生率高,药物流产引起的输卵管阻塞发生率比人工流产高。腹腔镜下行盆腔粘连松解术,其复通率为59.2%。结论:盆腔炎、子宫内膜异位症是不孕患者最常见的盆腔因素。药物流产造成的盆腔炎和输卵管阻塞发生率较人工流产高,应引起重视,腹腔镜下对不孕妇女的盆腔因素诊断有极大的价值。     

盆腔器官脱垂患者盆底支持组织超微结构特征的研究

目的了解盆腔器官脱垂(pelvicorganprolapse,POP)患者盆底支持组织的超微结构特征。方法选择2004年7月至2004年8月于我院手术治疗的POP患者5例,同期因卵巢单纯囊肿行全子宫切除术的绝经后患者2例作为老年对照,宫颈癌手术治疗2例作为年轻对照。在光镜及透射电镜下观察子宫主韧带、阴道壁、肛提肌组织的超微结构特征。结果光镜下POP组标本中平滑肌弥漫性萎缩、变性、纤维化。阴道粘膜固有层广泛小血管周围炎,血管内皮肿胀。电镜下POP组平滑肌细胞共同超微结构特征为细胞膜结构不完整;胞核异染色质增多;线粒体呈基质型肿胀甚至消失。阴道粘膜固有层终末小动脉内皮肿胀,中膜平滑肌萎缩断裂,甚至消失。老年非脱垂组可见平滑肌萎缩,灶状纤维化,但平滑肌变性、血管病变不明显。年轻非脱垂组未见平滑肌萎缩变性及血管病变。同时发现POP组肛提肌中骨骼肌成分损伤不明显,而平滑肌成分出现损伤性改变。结论POP患者主要盆底支持组织如主韧带、阴道壁、肛提肌普遍存在平滑肌细胞不可逆损伤性超微结构改变,可造成盆底组织松弛、支持能力减弱,导致POP的发生。肛提肌中平滑肌成分与POP发生密切相关。     

腹腔镜手术和开腹手术治疗盆腔炎性包块的比较

目的:探讨腹腔镜手术治疗盆腔炎性包块的可行性及其价值。方法:收集1999年6月至2004年7月间,41例腹腔镜手术治疗的盆腔炎性包块及13例开腹手术病例,比较其住院天数、费用、疾病种类、手术和术后恢复情况。结果:腹腔镜手术和开腹手术相比较,两组手术时间、住院费用及手术费用差异无显著性(P>0.05),腹腔镜组手术并发症、术中出血量少于开腹手术组,术后排气时间、体温恢复到正常时间、血象恢复时间、术后拆线时间、住院时间均短于开腹手术组,差异有显著性(P<0.05)。结论:腹腔镜手术治疗盆腔炎性包块是可行的,具有较好的临床应用价值。     

输卵管妊娠术后生殖状况及其影响因素分析

目的分析引起输卵管妊娠手术治疗后不同生殖状况的相关因素,探讨改善生殖状况,提高宫内妊娠率的方法.方法对自1999-01-2003-12在中山大学附属第一医院等两家医院的424例输卵管妊娠患者经腹腔镜或剖腹手术治疗后患者生殖状况及其相关影响因素进行多重Logistic回归分析及x2分析,找出引起术后不孕及重复性异位妊娠的原因.结果424例患者术后宫内妊娠177例,占41.7%;出现重复性异位妊娠102例,占24.1%;有145例患者术后仍然未孕,占34.2%.多重Logistic回归分析提示,盆腔炎、不孕、异位妊娠、输卵管手术、输卵管粘连、输卵管伞端闭锁是输卵管妊娠术后不孕及重复性异位妊娠的危险因素.结论积极预防盆腔病变,治疗不孕症是改善输卵管妊娠术后生殖状况的重要手段.     

子宫全切术不缝合盆腔腹膜对术后并发症的影响

目的观察子宫全切术不缝合盆腔腹膜与缝合盆腔腹膜术后并发症有无差异。方法选择子宫全切术缝合盆腔腹膜41例(对照组),子宫全切术不缝合盆腔腹膜44例(观察组),分别观察子宫全切术后性生活及并发症的情况。结果观察组与对照组相比,术后性生活感觉良好(P<005),对照组术后盆腔疼痛以及淋巴囊肿发生率较多(P<005),观察组淋巴囊肿发生率低。结论子宫全切术不缝合盆腔腹膜术后并发症较少,患者生活质量较高,建议子宫全切术取消缝合盆腔腹膜的习惯。     

Rectus abdominis myocutaneous flap in radical oncopelvic surgery: A safe and useful procedure

AIMS: The aim of this retrospective study was to evaluate the usefulness of rectus abdominis myocutaneous (RAM) flaps to treat locally advanced pelvic gynaecological or digestive tumours. METHODS: We reviewed 46 patients, who received RAM flaps after radical oncopelvic surgery, including: (a) total vaginal reconstruction (TVR); (b) partial vaginal reconstruction (PVR); (c) perineal reconstruction (PR). RESULTS: Between 1989 and 1998, 46 patients underwent pelvi-perineal reconstruction with RAM flaps after radical pelvic surgery for carcinoma of the cervix (n=22), anal carcinoma (n=11), rectal carcinoma (n=7), or other pelvic tumours types (n=6). There were two post-operative deaths. Overall surgical morbidity was 45, 6% (n=21). Specific morbidity of the RAM flap was 21, 7% (n=10). Global re-intervention rate was 13% (n=6). CONCLUSION: Rectus abdominis myocutaneous flap in radical oncopelvic surgery is useful for vaginal or perineal reconstruction and prevention of pelvic collections after extended resections with a low rate of associated morbidity.