大步迈向新百年

过去的一年非凡、辉煌,我们隆重地庆祝伟大的、光荣的、正确的中国共产党百年华诞,我们也纪念敬爱的林巧稚大夫诞辰120周年。新的百年开始了!紧跟祖国快速发展的步伐,作为妇产科医生,我们一定要做出更多的、更出色的工作,实现“健康中国2030”的宏伟目标。从脱贫、致富、图强,国民的健康日趋重要。     

卵巢子宫内膜异位囊肿粘连程度及相关因素分析

Objective To investigate the relationship between degree of endometrioma adhesions and clinical feature, surgical treatment and postoperative recurrence. Methods From Jan 2003 to Mar 2008, 662 patients with endometrioma undergoing laparoscopic ovarian endometrioma excision in Peking Union Medical College Hospital were studied retrospectively. All patients were classified into four groups according to the extent of adhesions: 31 cases in none adhesions group, 123 cases in mild adhesions group (filmy thickness, avascular, easily separated adhesions), 310 cases in moderate adhesions group (less than a half of ovary was adjacent to dense thickness adhesions which was difficult to separate, or above a half of ovary were adjacent to filmy thickness adhesions) and 198 cases in severe adhesions group (above a half of ovary was adjacent to dense thickness, well vascularized adhesions which was difficult to separate, and always involved the other pelvic organs, observed angiogenesis). The comparison of degree, characteristics, period of pain, lab test, surgical management and postoperative recurrence was performed among those above groups. In the mean time, risk factors and multinomial logistic regression were analyzed. Results (1)Clinical characteristics: The incidence of patients with dysmenorrhea, dyspareunia, straining feeling in anus, chronic pelvic pain and the level of CA125 (>35 kU/L) was remarkably higher in moderate-to-severe adhesion groups than in none-to-mild adhesions groups (P=0.000, 0.000, 0.001, 0.006 and 0.000, respectively). Infertility rate were significantly higher in severe adhesions group(15.7%,31/198) than none adhesions group(3.2%,1/31), mild adhesions group(11.4%,14/123) and moderate adhesions group(9.7%,30/310, OR=1.728, P<0.05).(2)Operating time and blood loss: Operating time of each groups was as followed: (37±15) min in none adhesions group, (42±19) min in mild adhesions group, (50±20) min in moderate adhesions group and (63±22) min in severe adhesion group. Blood loss was (23±12) ml in none adhesion group, (31±27) ml in mild adhesion group, (40±32) ml in moderate adhesion group and (70±67) ml in severe adhesions group. Thicker adhesions result in longer operation time and more blood loss. (3)Combined with other disease: The ratio of patients who combined with adenomyosis or deeply infiltrating endometriosis in moderate-to-severer adhesion groups was higher than patients in none-to-mild adhesions groups (OR=3.466, P=0.000). (4) Postoperative recurrence: It was categorized into recurrence of pain and cyst. Moderate-to-severe adhesions was related to higher recurrence rate of pain (OR=1.685,P=0.046), but was irrelevant to recurrence of cyst. Conclusion The more extent of endometrioma adhesions was related to severer pelvic pain symptoms, longer operating time and more blood loss. Postoperative pain recurrence rate was observed in moderate-to-severe adhesion group. Extent of adhesions was irrelevant to cyst recurrence.     

舶来的"四泉利润"

“做个加盟店很不划算，交加盟费、风险金，还要给特许商管理费……”，许多意向加盟商都有这种说法。有些特许商也常说：“开上几十家店，加盟费都赚不过来，自已还可以直营，还有管理费、促销费、培训费……”这正应了“羊毛出在羊身上”这句古话。     

腹腔镜下性腺切除术17例临床分析

性分化和发育异常，临床非常少见，其中一部分患者因含有Y染色体需要切除性腺。传统的手术方式是开腹探在，再行陛腺切除。我们自2003年7月至2005年10月，开展了腹腔镜下性腺切除术，效果满意。现报道如下。     

CMU化疗方案辅助手术治疗临床Ⅲ期乳腺癌

 1982年6月至1984年12月，随机分组采用CMU方案辅助手术治疗可手术的临床Ⅲ期乳腺癌71例（用药组35例，对照组36例）。所有病人均行根治术及术后给予放疗。其5年无瘤生存率两组分别为74.2%及44.4%（P=0.01），表明围手术化疗可以提高Ⅲ期乳腺癌的预后。     

应用超声吸引装置行腹腔镜下胆囊切除术

近年来，腹腔镜下胆囊切除术由于其低侵袭性巳在欧美及日本等先进国家迅速普及，成为胆囊良性疾病治疗的第一选择。但由于在腹腔镜下操作的特殊性，时有各种并发症出现，尤其在处理有炎症粘连或肥胖患者的Calot三角部时，容易损伤胆管或其它脏器导致严重后果。最近，我们应用超声吸引装置(CUSA)对3例胆囊结石患者做了腹腔镜下胆囊切除术，发现其在管道结构的显露上有独特优点，现报告如下：     

橙皮苷葡糖苷对风湿病模型小鼠的治疗作用

对温州蜜橘所含的橙皮苷（Hsp），用环糊精合成酶使之附加葡萄糖，形成橙皮苷葡糖苷（Hsp—G），从而使水溶性明显增强。曾报道，经口给予柑橘类黄酮Hsp后，可以减轻胶原诱发关节炎（CIA）的病情。此次，对Hsp—G单独给予以及与Hsp联合给予对CIA发病的影响进行了探讨。     

复杂主动脉病变的腔内血管外科治疗

目的 探讨复杂主动脉病变的腔内血管外科治疗方法。方法 对21例合并有内脏动脉缺血等复杂的主动脉病变,双球管定位下经锁骨上动脉到股动脉交换导丝以确保真腔内植入带膜支架,对真腔完全被假腔压闭的患者采取真腔内加压推进以通过导丝,用超长带膜支架来封堵大破口治疗夹层合并巨大假性动脉瘤形成,对夹层合并腹主动脉瘤患者采取血管腔内技术联合开腹手术等方法。结果 术后内漏3例,其中2例7 d后停止,1例漏血持续存在。3例主动脉创伤术后完全康复,余18例复杂主动脉夹层术后即时造影示瘘口已被完整覆盖,假腔无血漏入,内脏动脉等恢复真腔供血。18例中6例合并肠管缺血,3例合并肾动脉缺血,3例肠管缺血、肾动脉缺血,2例腹主动脉真腔完全被假腔压迫,以及2例合并下肢缺血术后均逐渐恢复,无脏器及肢体缺血坏死发生。2例合并腹主动脉瘤夹层行支架型人工血管封闭夹层破口后行开腹手术切除腹主动脉瘤、人工血管置换。16例随访5～36个月,平均22.3月,1例内漏持续存在,但假腔未继续加大,其余患者存活良好。结论 对复杂的主动脉病变的治疗,通过对腔内血管外科技术进行改进,并适当结合传统手术方法,使某些过去被认为不能够治疗的复杂主动脉病变可得以成功治疗。     

疑为脑卒中的症状要点之三--视力障碍

目前，脑卒中和心肌梗塞的“Heart Attack”一样在发病后应立即采取急救措施，做为“Brain Attack”其重要性被再次认识。在美国，开展了“Stroke is a emergen-cy”的Brain Attack宣传活动，为强调早期就诊、早期治疗的必要性，列举了以下5条脑卒中的症状①急性半身无力、瘫痪；②急性语言障碍、意识障碍；③急性视力障碍；④急性眩晕、走路摇晃，步行障碍；⑤突发的剧烈头痛。