肝移植围手术期出凝血功能障碍的防治

目的　探讨肝移植围手术期出凝血功能障碍的防治。方法　回顾性分析我院 2 0 0 2年 6月～ 2 0 0 3年 12月施行的 6 1例肝移植病例。结果　 6 1例肝移植术前肝功能ChildC级 35例 (5 7 4 % ) ,ChildB级 2 6例 (4 2 6 % ) ,ChildC组的患者术中凝血指标 (INR)的变化程度大于ChildB组 (P <0 0 5 )。与凝血有关的并发症中大出血 5例 (8 2 % ) ,肾衰 6例 (9 8% ) ,肝动脉血栓形成 5例 (8 2 % ) ,手术开展两阶段对比 ,第二阶段主要因限制了大量凝血药及血制品的使用 ,并发症明显减少。结论　掌握好不同时期、不同患者出血和血栓形成的平衡是防治肝移植围手术期出凝血功能障碍的关键     

99TCm-RBC显像在下消化道出血诊断中的应用

目的　研究 99TCm-RBC显像诊断下消化道出血的临床价值。方法　对 2 5例下消化道出血患者行 99TCm-RBC显像 ,并与手术及病理检查结果作比较。结果　99TCm-RBC显像诊断下消化道出血阳性率为 80 .0 %,定位诊断率为 68.0 %,特异性为 85 .0 %。结论99TCm-RBC显像可作为下消化道出血诊断及定位的一种有效方法。     

唇裂术止血减张固定器的研制和实验与临床研究

目的：为了减少唇裂修复术中出血，便于手术操作，缩短手术时间，相对地减少手术的危险性。方法：利用压迫止血及滑杆的原理，自行设计制作了唇裂术止血减张固定器，经过动物实验证实，在2h以内不会对组织有任何不可逆损伤，并成功地应用于唇裂修复术中。结果：临床应用68例，与传统止血方法比较，术中出血明显减少，便于手术操作，而且安全可靠，在2h以内不会对上唇组织有任何不可逆损伤，手术的危险性相对地减少。结论：应用唇裂术止血减张固定器进行唇裂修复术，术中出血明显减少．手术时间明显缩短，手术的危险性相对地减少，对减轻术后切口瘢痕有利，值得临床推广应用。     

实验性小肠动脉出血的垂体后叶素灌注治疗

经动脉导管灌注垂体后叶素治疗１０条犬小肠出血的实验研究结果表明，垂体后叶素灌注治疗的效果与出血部位累及的血管大小及出血速率有关。还提示垂体后叶素对较大血管引起的出血灌注治疗无效，其引起血管的收缩作用主要在末梢小血管。     

An analysis of fluid loss during transcervical resection of submucous myomas

Objective: To determine the contribution of several variables to fluid loss during transcervical resection of submucous myomas.Design: An observational study using multiple linear regression analyses.Setting: A university-affiliated training hospital and a university department of clinical epidemiology and biostatistics.Patient(s): Patients with submucous myomas.Intervention(s): Transcervical resection of submucous myomas and monitoring of fluid loss.Main Outcome Measure(s): Patient age, uterine enlargement, treatment with GnRH analogues or 8-ornithine-vasopressin, type of anesthesia, number of myomas, intramural extension of the myoma (type of myoma), and operating time were tested as variables.Result(s): Only intramural extension of the myoma and operating time were obviously related to fluid loss. For the other variables, such a relation was weak at best. The relation between fluid loss and operating time was not modified by any of the other variables.Conclusion(s): Because fluid loss is an important limiting factor in the transcervical resection of submucous myomas, special attention should be paid to reduction of the operating time and preoperative assessment of the intramural extension of the myoma to guide appropriate patient selection.     

宫腔镜诊治围绝经期子宫出血(附138例报告)

目的 :探讨宫腔镜在诊治围绝经期异常子宫出血 (perimenopausaluterinebleeding ,PMUB)的价值。方法 :回顾分析PMUB 138例用宫腔镜诊治的临床资料。结果 :138例中子宫内膜息肉 5 5例 ,子宫颈息肉 2 9例 ,粘膜下子宫肌瘤 4 0例 ,子宫内膜增生过长 6例 ,子宫内膜不典型增生 3例 ,子宫内膜癌 1例 ,正常子宫内膜 4例。总体检查阳性率为 97 10 %。术中 1例发生子宫穿孔并发症。术后随访 2 ～12个月 ,随访率为82 6 1% ,患者症状明显改善 10 6例 ,满意率为 92 98%。结论 :用宫腔镜诊断PMUB有相当高的特异性和准确性。可同时治疗良性病变 ,减少不必要的开腹手术 ,是治疗PMUB的首选方法。     

宫腔镜电切术治疗子宫纵隔23例临床分析

目的:探讨子宫纵隔患者接受宫腔镜电切术治疗后的妊娠结局。方法:回顾性分析23例子宫纵隔患者接受宫腔镜下子宫纵隔电切术后的妊娠结局。结果:23例子宫纵隔患者中,子宫完全纵隔5例,不完全纵隔18例,23例均在超声监视下完成手术,平均手术时间25min,平均出血30ml。与术前相比,术后足月活产率从4.35%增至48.83%,流产率从85.55%降至30.43%,具有显著性差异(P<0.01)。结论:宫腔镜电切术治疗子宫纵隔是安全、有效地治疗方法,能显著提高足月活产率,明显降低流产率。     

新式非脱垂子宫阴式全子宫切除术45例报告

目的探讨非脱垂子宫经阴道改良切除的可行性及方法。方法将103例子宫肌瘤、子宫腺肌瘤、功能性子宫出血等需行全子宫切除术的患者随机分为两组，常规经腹式全子宫切除术(腹式组)58例，经阴道全子宫切除术(阴式组)45例，比较两种手术方法的优劣。结果阴式组较腹式组手术时间短，术中出血少，术后痛苦少；48h内肛门排气阴式组40例(88．9％)，腹式组31例(53．4％)；平均住院天数阴式组5．1d，腹式组7．1d。结论新式非脱垂子宫的阴式全子宫切除术相对于经腹式全子宫切除术有一定的优势，但要严格选择其手术适应证。     

"Endoview" project of intrapartum endoscopy.

INTRODUCTION: The change in obstetrical practices over the last decade in favor of trials of labor in patients with uterine scars has resulted in increased incidences of uterine ruptures. Although neither repeat cesarean delivery nor a trial of labor is risk free, evidence from a large multicenter study shows vaginal birth after the cesarean (VBAC) is associated with shorter hospital stays, fewer postpartum blood transfusions, and a decreased incidence of postpartum maternal fever. The uterine rupture remains the most serious complication associated with VBAC. Factors associated with uterine rupture include excessive exposure to oxytocin, dysfunctional labor, and a history of more than 1 cesarean delivery.2 Because uterine rupture may be a life-threatening event, intrapartum surveillance and the ability to perform an emergency surgery are both necessary when trial of labor is allowed. Until now, no early symptoms pathognomonic to uterine rupture had been described. We share our experiences with the novel approach to the problem - an intrapartum endoscopy. MATERIALS AND METHODS: Endoscopic examination was accomplished by using the intraoperational fiberscope (Olympus and Endoview system (Costa Mesa, CA, USA). A gas-sterilized 25-cm long fiberscope is introduced into the amniotic cavity through the cervical canal after rupture of the membranes. The distance between the fiberscope and the object varies from 3 to 50 mm. The fiberscope has a separate channel for the fluid infusion (normal saline) throughout the procedure; the surgeon looks through the eyepiece directly and exhibits control over the flexible scope. The duration of endoscopy is less than 15 minutes. The inserting of the endoscopic device is very similar to that of insertion of an intrauterine pressure catheter. The IRB Committees of both participating institutions approved the study protocol. Twenty-eight patients with an unknown or poorly documented site of the uterine scar were included in the study. An ultrasound examination had been performed on all patients prior to endoscopy to assess fetal wellbeing and placental location. The ages of the patients ranged from 21 to 38 years. Eighteen women had 1 previous cesarean delivery, and 10 had 2. The performance of intrapartum endoscopy did not interfere with fetal monitoring; 21 fetuses were monitored externally, 7 internally. Indications for previous cesarean deliveries were as follows: fetal distress in 11 cases, failure to progress in labor in 8, placenta previa in 2, and unknown in 7. Twenty-one patients delivered vaginally; 7 had had repeat cesarean deliveries. All neonates were born in satisfactory condition. The Apgar scores at 1 minute varied from 7 to 9 and at 5 minutes from 8 to 10. The integrity of the uterine wall was assessed by manual postpartum uterine exploration in each case of vaginal delivery and by visualization and palpation of the scar site in each abdominal delivery. RESULTS: The lower uterine segment and contractile portion of the anterior uterine wall were visualized successfully in all patients. In 25 patients, the presumed scar site looked totally indistinguishable from the rest of the lower uterine segment and anterior uterine wall. Two scars were identified as vertical in 2 patients who were delivered by a repeat abdominal operation. A vertical scar appears as a groove running in a cephalad-caudad direction from the lower uterine segment into the contractile portion of the anterior uterine wall. The usefulness of the intrapartum endoscopy is best demonstrated by the following case reports (2 of 28 study cases).     

Atypical Allergic Colitis in Preterm Infants

ABSTRACT. Two atypical cases of colitis due to cow's milk protein intolerance (CMPI) are reported, affecting preterm infants. One developed a toxic dilatation of the colon and responded well to a casein hydrolysate based feed. The second presented insidiously and failed to tolerate a casein hydrolysate, but responded well to a chicken-based modular feed.