不孕症的腹腔镜检查及手术治疗

目的 :为探讨腹腔镜在不孕症诊治中的价值。方法 :对 6 3例女性不孕症进行了腹腔镜检查 ,并对其中的 5 5例施行了腹腔镜手术。结果 :6 0 .3 % (38 6 3)为输卵管因素 ,而输卵管因素中因盆腔炎引起的输卵管病变高达 94.7% (36 38)。其他因素为子宫内膜异位症、多囊卵巢综合征、卵巢囊肿等。HSG与输卵管腹腔镜检比较的总符合率为 71.2 1% (47 6 6 ) ,手术后输卵管通畅率比术前提高 99.6 7% (6 1.1 30 .6 % )。结论 :腹腔镜检查及手术是当前诊治女性不孕症最有效的方法 ,但手术难度大 ,手术费用较高。HSG操作简便 ,价格便宜 ,可做为腹腔镜检前的筛查。     

2158 例神经管缺陷儿的产前B型超声波诊断分析

回顾性分析1990～1993年全国28省、市、自治区233所医院,住院分娩的孕满28周的2158例神经管缺陷儿的产前诊断情况,了解我国神经管缺陷儿产前B型超声波诊断情况.结果显示:我国神经管缺陷产前诊断的比例为61.8%,产前B型超声波诊断的比例为56.5%,其中无脑畸形、脑膜脑膨出、脊髓外翻的产前B型超声波诊断比例分别为66.7% 、62.5%、52.5%.胸段(46.4%)、腰段(43.4%)的脊柱裂产前B型超声波诊断的病例较颈段 (35.5%)、骶段(31.7%)高(P<0.05).省级、市级、县级及部队工矿医院神经管缺陷的产前B型超声波诊断比例分别为55.7%、59.4%、49.0%、57.2%.1991～1993年神经管缺陷产前B型超声波诊断比例分别为53.5%、55.8%、60.7%、54.7%.无脑畸形、脑膜脑膨出、脊髓外翻产前B型超声波诊断的比例较高.     

Monitoring normal and aberrant electrocardiographic activity from an endotracheal tube: Comparison of the surface,esophageal, and tracheal electrocardiograms

Introduction. We designed an endotracheal (ET) tube with orthogonally spaced ECG cuff electrodes. This ET tube was evaluated in dogs and sheep to determine (1) whether ECGs recorded from our tube were sufficient to make accurate clinical decisions concerning heart rate and rhythm; and (2) whether metallic cuff electrodes in direct contact with the trachea could induce mucosal burn injury during episodes of defibrillation.Methods. Using experimental animals, we obtained ECGs from their tracheae and compared our findings with ECGs obtained from surface and esophageal electrodes. The electrical activity of the heart was modified by increasing the depth of anesthesia, occluding the left coronary artery, and administering beta-adrenergic drugs. Before the dogs were euthanized, they were subjected to episodes of transthoracic and intrathoracic defibrillation at energy levels of 200 to 400 J. A postmortem pathological examination of the trachea was performed to determine the incidence of mucosal burn injury.Results. Tracheal electrocardiography provided valid information on heart-rate monitoring and certain morphology profiles. The R-R, PR, QRS, and QT intervals measured from the trachea had a correlation of 1.0, 0.96, 0.83, and 0.98, respectively, when compared with the same intervals obtained from surface electrodes. Two tracheae subjected to intrathoracic defibrillation at >300 J revealed evidence of minor burn injury. Some localized epithelium loss was displayed in all tracheae; we attributed this to tracheal intubation.Conclusion. Tracheal electrocardiography may be useful in trauma patients who require intubation where injury precludes placement of chest ECG electrodes.     

聚乳酸-三亚甲基碳酸酯可吸收性导管治疗周围神经缺损的实验研究

介绍聚乳酸－三亚甲基碳酸酯 ［Ｐ （ＬＡ－ＴＭＣ）］ 可吸收性导管用于治疗神经缺损的实验研究。以Ｐ （ＬＡ－ＴＭＣ） 导管桥接鼠坐骨神经７ ｍ ｍ 缺损, 术后定期分别取导管及周围组织和鼠心、肝、肾标本送检。结果表明： Ｐ（ＬＡ－ＴＭＣ） 导管在体内 （长度、内径和外径等） 随时间逐渐降解吸收, 在体内可导致局部炎症反应, 但对局部组织及全身重要器官（心、肝、肾） 无严重损害, 初步证明了Ｐ（ＬＡ－ＴＭＣ） 可吸收性导管应用于临床周围神经缺损治疗的可能性     

异丙酚复合芬太尼维持麻醉对脑代谢的影响

观察异丙酚复合芬太尼维持麻醉对脑代谢的影响。方法： 择期手术病人８ 例, 芬太尼、硫贲妥钠、维库溴铵诱导插管, 静脉联接Ｇｒａｓｅｂｙ 微泵异丙酚８ ｍｇ／ （ｋｇ·ｈ） , 芬太尼１ μｇ／ （ｋｇ·ｈ）维持麻醉。连续监测ＭＡＰ、心电图、脉搏氧饱和度和呼气末二氧化碳分压, 同步采集动脉血和颈内静脉血作血气分析, 计算动－ 静脉氧含量差（Ｄａ － ｖＯ２） 和脑氧摄取率（ＥＲＯ２） 。结果： 异丙酚麻醉维持平稳, Ｄａ － ｖＯ２ 和ＥＲＯ２ 在给药３０ ｍｉｎ 、６０ ｍｉｎ 较气管插管后５ ｍｉｎ 无明显改变, 有平均动脉压下降和心动过缓。结论： 异丙酚复合芬太尼维持麻醉可保持脑氧供需平衡稳定。     

输卵管阻塞的介入治疗

目的：为明确输卵管阻塞的部位及程度,提供一种安全、可靠成功率高的治疗方法。方法：用自制的输卵管再通器具对５２例病人共８９条输卵管作选择性造影,并对其中７５条间质部或峡部阻塞的输卵管作再通术,术后抗炎及定期输卵管通液治疗。结果：插管成功率为９１％,再通成功率为８１．３％,无严重并发症。结论：该技术操作简单,集诊断及治疗于一体。成功率高,病人痛苦少,是诊治输卵管首选方法。     

长引流管在乳癌根治术中的应用

目的：探讨乳癌根治术后放置长引流管对促进术后伤口愈合、预防和减少继发感染的效果;方法：共观察７２例乳癌根治术病例,每例病人在术后均放置前端多侧孔长度９０ｃｍ乳胶引流管,以负压吸引对创曲渗液进行引流;结果：本组病例中没有发生一起与放置长引流管有关的皮瓣感染,仅有２例出现术后切口轻度感染;结论：长引流管的应用能有效促进创面愈合、减少感染。     

Postoperative sore throat: cause, prevention and treatment

Sore throat is a common postoperative complaint, occurring most often following tracheal intubation. Factors such as tracheal-tube size and cuff design have been shown to be important causative factors. Routine tracheal intubation for elective surgical procedures can result in pathological changes, trauma and nerve damage which may also account for postoperative throat symptoms. Sore throat following the use of a laryngeal mask appears to be related to the technique of insertion but the contribution of intracuff pressure remains to be clarified. It would appear, however, that high intracuff pressure is associated with nerve palsies due to neuropraxia and nerve compression. Careful insertion techniques for both the tracheal tube and laryngeal mask are of paramount importance in the prevention of airway trauma and postoperative sore throat.     

输卵管性不孕的X线诊断与腹腔镜对照(附34例分析)

目的：通过子宫输卵管造影和腹腔镜检查的对照,提高对输卵管性不孕的Ｘ线诊断。方法：输卵管不孕症患进行了输卵管造影和腹腔镜检查,将其结果进行比较。结果：子宫输卵管造影;输卵管各部阻塞１５支,通而不畅２１支,输卵管未通１５支,输卵管积水９支,输卵管通畅７支。