宫腔镜诊治异常子宫出血432例中长期随访结果

目的 评价宫腔镜手术治疗异常子宫出血的中长期随访结果。方法 回顾分析我院2002年1月～2005年11月经宫腔镜诊治异常子宫出血且随访〉12个月的432例临床资料,诊断良性疾患391例[子宫内膜息肉96例（22.2%）,子宫黏膜下肌瘤38例（8.8%）,子宫内膜增生过长257例（59.5%）],行息肉或肌瘤切除、子宫内膜电切术;诊断子宫内膜腺癌41例（9.5%）,均为Ⅰ期,行经腹全子宫双附件切除、选择性盆腔淋巴结清扫术。结果 手术均获成功,未发生子宫穿孔等并发症。391例良性病变中,术后随访12～57个月,平均39个月,闭经占16.1%（63/391）,月经量少（每周期〈10片卫生巾）18.9%（74/391）,月经量正常（每周期10～20片卫生巾）58.3%（228/391）,术后改善不明显占6.6%（26/391）。26例月经量仍多者术后用孕酮治疗,7例有多发子宫肌瘤,术后32～44个月行全子宫切除术,8例复查阴道彩超子宫内膜厚度〉1.5 cm,术后5～19个月第2次行宫腔镜子宫内膜切除术,继续随访18～36个月,月经量少3例,闭经5例。41例子宫内膜癌Ⅰ期术后随访26～41个月,平均38个月,均无瘤存活。结论 异常子宫出血的治疗在结合病理学检查除外恶性病变后首选宫腔镜手术,严格B超监测是提高手术疗效和手术安全的保障。     

Laparoscopic surgical staging for uterine malignancies using harmonic shears (UltraCision) in comparison to electrosurgery: operative technique, feasibility and complications

This retrospective study assesses and compares perioperative parameters in two groups of patients treated by different operative techniques of laparoscopic surgical staging (LASS) for uterine cancer. Between April 1996 and May 2005, 119 consecutively selected women with cervical cancer (n=30) or clinical stage I endometrial cancer (n=89) underwent laparoscopic assisted vaginal hysterectomy (LAVH), total laparoscopic hysterectomy (TLH) or radical laparoscopic assisted vaginal hysterectomy (RALVH) plus bilateral salpingo-oophorectomy (BSO) and/or lymph node dissection (LND) during a primary surgical procedure using an electrosurgery (ELC, n=37) or ultrasonic (US, n=82) operative technique (harmonic shears, UltraCision). The UltraCision was used as a primary method of dissection and hemostasis from 1999. We were unable to perform prompt and thorough hemostasis in 2 patients from the US group (successful procedure rate 97.5%) because of ineffective post-ultrasonic coagulation of venous paravaginal varices (RALVH procedure) and of vena ovarica varices (LAVH, BSO procedure). The UltraCision was effective in all cases of lymphadenectomy. Successful procedure rate of the ELC operative technique was 100%. There were no statistically significant differences between the groups with regard to operation time, blood loss, hospital stay, and complications. There was a significant difference (P<0.001) in the number of lymph nodes harvested: a mean of 18.1 in the US group and 13.7 in the ELC group. We think that the difference was influenced by an increase in experience with laparoscopic lymph node dissection. The UltraCision operative technique ensures efficient dissection, coagulation, cutting, and grasping for LASS in women with cervical and endometrial cancer.     

Safety of the laparoscopy setup

The safety of the laparoscopy setup is an important issue to guarantee continuous quality of laparoscopic interventions. Important issues are visualization, the insufflator and especially electrosurgery. Appropriate training of the OR personnel and clear responsibilities should be defined. Checklists are advised.     

32例重度增生腺性膀胱炎临床诊断治疗

目的 探讨重度增生腺性膀胱炎的诊断及治疗措施.方法 对2009年12月～2013年12月新疆维吾尔自治区人民医院泌尿外科经影像学考虑为膀胱内实性占位、病理学检查确诊的32例重度增生腺性膀胱炎患者的病历资料进行回顾性的临床分析.患者均行经尿道等离子电切术,术后给予药物灌注治疗.结果 32例患者随访3～ 48个月,25例(78％)症状得以不同程度的恢复,行膀胱镜检查正常.6例(24％)出现复发,行再次手术更换膀胱灌注药物后,未出现复发.1例患者术后1年合并膀胱结石,行经尿道碎石取石并病灶黏膜电灼术.所有随访患者均未发现恶变.结论 彩色多普勒超声检查联合CT增强可提高对腺性膀胱炎定性诊断的准确性.经尿道等离子电切术联合术后膀胱灌注治疗重度增生腺性膀胱炎效果明显,安全有效,术后复发率低.     

经尿道等离子前列腺剜除术治疗高龄高危前列腺增生症

目的 探讨经尿道等离子前列腺剜除术治疗高龄高危良性前列腺增生(BPH)患者的安全性及疗效.方法 将70例高龄高危BPH患者随机分为两组,每组35例,分别行经尿道等离子前列腺剜除术(TUPKEP)和传统的经尿道前列腺电切术(TURP).比较两组患者的手术时间、出血量、前列腺腺体切除重量、术后膀胱冲洗时间、术后住院天数、术后国际前列腺症状评分(IPSS)、生活质量评分(QOL)、残余尿量(PVR)、最大尿流率(Qmax)等指标.对两组指标进行统计学分析.结果 TUPKEP组在手术的出血量、手术时间、术后膀胱冲洗时间以及术后的住院时间要明显小于TURP组(P＜0.05);TUPKEP组前列腺腺体切除重量大于TURP组(P＜0.05);两组患者术后随访3个月,残余尿、国际前列腺症状评分、生活质量评分差异均无显著性意义(P ＜0.05);TUPKEP组术后最大尿流率大于TURP组,两组比较有显著性差异(P＜0.05).结论 TUPKEP治疗BPH疗效确切,且安全性较好,特别适用于高龄高危的患者.     

尿道内窥镜冷刀内切开+电切与Vela 2μm激光在膀胱颈挛缩治疗上比较研究

目的 探讨Vela2μm激光及尿道内窥镜冷刀内切开+电切在膀胱颈挛缩治疗上的效果.方法 回顾性总结53例膀胱颈挛缩患者分别用尿道内窥镜冷刀内切开+电切28例,Vela 2 μm激光25例切开并切除挛缩的膀胱颈部.结果 Vela 2 μm激光与尿道内窥镜冷刀内切开+电切在膀胱颈挛缩治疗上手术时间(52±12min vs 31±12.5min,P=0.031)、血块堵管人数[4(14.2％)vs 1(4％),P=0.016]、术后膀胱冲洗时间[12-±2.3h vs2±1.5h,P=0.003]、膀胱颈挛缩复发人数[4(14.3％)vs 2(8％),P=0.033]及术后住院时间[5±2.5(4 ～ 10)d vs 2 ±2.3(2 ～5)d,P=0.021]有显著性差异.结论 Vela 2 μm激光与尿道内窥镜冷刀内切开+电切在处理膀胱颈部挛缩相比较,因Vela 2μm激光波长的特性,其精确、高效、良好的汽化止血效果功能,较浅穿透深度使膀胱颈部挛缩的治疗时间、血管堵管、术后膀胱冲洗时间及住院时间有优势,近期复发率也有所减低,是目前临床上较为安全可靠的膀胱颈挛缩的治疗手段.     

TUVP联合围术期用药治疗良性前列腺增生症合并慢性前列腺炎的临床疗效观察

目的 观察应用前列腺汽化电切术(TUVP)联合围术期用药治疗良性前列腺增生症(BPH)合并慢性前列腺炎(CP)的临床疗效及安全性.方法 选取本院自2009年5月至2012年3月收治的85例BPH合并CP患者作为研究对象,所有患者均给予TUVP治疗,术前给予抗生素、受体阻滞剂,术后给予胆碱能受体阻滞剂,观察治疗效果及并发症情况.结果 (1)本组85例患者手术均获成功,手术平均时间(45.2±10.3)min,术中平均出血量(38.5±11.2)mL,切除前列腺组织净重平均(36.2±9.8)g.术后尿液转清时间为4 ～31h,平均(12.4±3.5)h.术后拔管平均时间为(2.3±0.8)d.对所有患者随访6～18个月,尿频、尿不尽等临床症状均明显减轻甚至消失,无复发病例.(2)85例患者治疗后较治疗前IPSS、QOL及MFR各项指标均明显改善,比较有显著性差异(P＜0.01).(3)术后出现尿道出血2例,尿路感染1例,无膀胱痉挛、尿失禁、尿道狭窄病例.结论 应用TUVP联合围术期用药治疗BPH合并CP效果理想,且并发症少、术后恢复快,值得推广应用.     

前列腺电切对前列腺增生症患者下尿路症状和性功能的影响

目的 评估前列腺电切治疗前列腺增生症(BPH)患者下尿路症状(LUTS)和勃起功能障碍(ED)的疗效.方法 选择96例BPH合并ED患者,予以前列腺电切治疗.采用国际前列腺症状评分(IPSS)、国际勃起功能障碍症状评分(IIEF-5)来评估治疗前后的疗效.结果 患者治疗前后的IPPS评分比较,差异有统计学意义(P＜0.05),患者治疗前后的IIEF-5评分比较,差异无统计学意义(P＞0.05).结论 前列腺电切可有效治疗前列腺增生症的LUTS,但对ED无明显改善.     

女性膀胱黏膜白斑的诊断及治疗(附32例报告)

目的 探讨女性膀胱黏膜白斑的诊断及治疗方法.方法 回顾性分析2006年1月～2011年11月共32例女性膀胱黏膜白斑患者的临床治疗.结果 32例患者都顺利完成治疗,术后1～3周内症状消失20例,尿检异常者均转正常,术后6～8周症状消失者6例,术后2个月对同时伴发腺性膀胱炎的5例复查膀胱镜,1例腺性膀胱炎复发,再次电切治疗,术后3个月对单纯膀胱黏膜白斑的25例复查膀胱镜检查,均未见膀胱黏膜白斑复发,2例失访.结论 膀胱镜检加活检对膀胱黏膜白斑诊断具有重要作用,经尿道电切术治疗膀胱黏膜白斑或/和并发腺性膀胱炎手术方法简单,易于掌握,创伤小、出血少是治疗该病的有效方法.     

Electromagnetic interference caused by common surgical energy-based devices on an implanted cardiac defibrillator

Background

Surgical energy-based devices emit energy, which can interfere with other electronic devices (eg, implanted cardiac pacemakers and/or defibrillators). The purpose of this study was to quantify the amount of unintentional energy (electromagnetic interference [EMI]) transferred to an implanted cardiac defibrillator by common surgical energy-based devices.

Methods

A transvenous cardiac defibrillator was implanted in an anesthetized pig. The primary outcome measure was the average maximum EMI occurring on the implanted cardiac device during activations of multiple different surgical energy-based devices.

Results

The EMI transferred to the implanted cardiac device is as follows: traditional bipolar 30 W .01 ± .004 mV, advanced bipolar .004 ± .003 mV, ultrasonic shears .01 ± .004 mV, monopolar Bovie 30 W coagulation .50 ± .20 mV, monopolar Bovie 30 W blend .92 ± .63 mV, monopolar instrument without dispersive electrode .21 ± .07 mV, plasma energy 3.48 ± .78 mV, and argon beam coagulator 2.58 ± .34 mV.

Conclusion

Surgeons can minimize EMI on implanted cardiac defibrillators by preferentially utilizing bipolar and ultrasonic devices.