腹腔镜与开腹子宫肌瘤剔除术近期临床疗效及组织损伤程度观察

目的：比较腹腔镜下与开腹子宫肌瘤剔除术近期临床疗效和组织损伤程度。方法：选取符合标准的患者80例,随机分为观察组和对照组各40例。观察组应用腹腔镜下子宫肌瘤剔除术,对照组应用开腹子宫肌瘤剔除术,比较二者临床疗效和血清超敏C反应蛋白（hs-CRP）水平。结果：观察组患者手术持续时间稍长于对照组,但是差异无统计学意义（P〉0.05）;观察组术中出血量、术后镇痛、术后病率、下床活动时间、术后肛门排气时间及住院时间均优于对照组,差异有统计学意义（P〈0.05）。两组手术前血清hs-CRP水平相似,差异无统计学意义（P〉0.05）;两组术后第1天血清hs-CRP水平较术前均升高（P〈0.05）,但是观察组升高幅度较对照组小（P〈0.05）;术后第3天两组血清hsCRP水平开始下降,术后第5天,对照组组血清hs-CRP水平高于观察组,差异有统计学意义（P〈0.05）。结论：腹腔镜下子宫肌瘤剔除术组织创伤小,术后恢复快,有利于妇女的身体健康。     

腹部实质性脏器损伤38例临床分析

目的　探讨腹部实质性脏器损伤的诊断与治疗原则。方法　总结 38例腹部各种实质性脏器损伤的临床主要表现、检查所见、诊断及治疗方法。结果　在 38例损伤中 ,33例治愈 ,2例发生胰瘘 ,3例出现腹腔感染。经过治疗 ,全部病例均治愈出院。结论　腹部实质性脏器损伤 ,只要早期正确诊断 ,及时采取适当治疗方法 ,临床预后均佳。     

Sigmoid volvulus in Department of Veterans Affairs Medical Centers

PURPOSE: Sigmoid volvulus is the third leading cause of large-bowel obstruction. The optimal management strategy remains controversial. This study was undertaken to evaluate the care of patients with sigmoid volvulus recently treated at Department of Veterans Affairs hospitals. METHODS: All patients with the International Classification of Diseases, Ninth Revision, Clinical Modification, Third Edition code for colonic volvulus during the period 1991 to 1995 were identified in the computerized national Department of Veterans Affairs database. Data on patient demographics, clinical course, and outcomes were analyzed. RESULTS: Two hundred twenty-eight patients had volvulus of the sigmoid colon and sufficient clinical data for evaluation. The mean age was 70; all were males. Endoscopic decompression was attempted in 189 of 228 (83 percent) patients and was successful in 154 of 189 (81 percent). Management included celiotomy in 178 of 228 (78 percent) patients. There were no intraoperative deaths. Twenty-five of 178 (14 percent) patients died within 30 days of surgery. The mortality rate was 24 percent for emergency operations (19/79), and 6 percent for elective procedures (6/99). Mortality was correlated with emergent surgery (P<0.01) and necrotic colon (P<0.05). Among those 50 patients managed by decompression alone, six (12 percent) died during the index admission. Ten of the remaining 44 (23 percent) patients eventually developed recurrent volvulus requiring further treatment, and 2 of 10 (20 percent) patients died. CONCLUSIONS: In this cohort sigmoid volvulus often presents as a surgical emergency. Initial endoscopic decompression resolves the acute obstruction in the majority of cases. Surgical intervention carries a substantial risk of mortality, particularly in the setting of emergent surgery or in the presence of necrotic colon.     

The Wittmann Patch s a temporary abdominal closure device after decompressive celiotomy for abdominal compartment syndrome following burn

BACKGROUND: Abdominal compartment syndrome is frequently the result of aggressive fluid resuscitation after burn. Management of the open abdomen following decompressive celiotomy is a major problem. METHODS: From 2004 to mid-2005, six patients required decompressive celiotomy after developing abdominal compartment syndrome as a result of burn. A Wittmann Patch as used to close the abdominal wound. Patients were re-explored when clinical parameters improved and the abdomen was closed, with long-term follow-up for the abdominal wound. RESULTS: Of the six patients, five had thermal injury and one had electrical injury. The mean total body surface area affected for thermal burn was 78% and for electrical burn was 37%. Diagnosis of abdominal compartment syndrome was based on elevated bladder pressure and organ dysfunction. The patients were treated with decompressive celiotomy and Wittmann Patch closure. Survivors subsequently underwent primary abdominal closure, with no evidence of ventral hernia at long-term follow-up. CONCLUSION: In burn cases with abdominal compartment syndrome, a Wittmann Patch ay prove a helpful method of temporary abdominal closure, followed by primary closure with no complications.     

两种术式行胆囊切除对肺功能影响的比较

我们分别选择了以剖腹和使用腹腔镜行胆囊切除术的病人各３０例，其中男性备５例，女性各２５例，平均年龄分别为５０±１０岁和５０±１１岁。于术前１天和剖腹术后７天．腹腔镜术后４天测定肺功能，结果表明，两种术式术后肺功能均有损害，但使用腹腔镜行胆囊切除术对肺功能损害明显小于剖腹胆囊切除术。     

腹腔镜辅助阴式全子宫切除术治疗巨大子宫肌瘤临床研究

目的探讨腹腔镜辅助阴式全子宫切除手术治疗巨大子宫肌瘤的临床疗效、安全性及其优点。方法 126例经严格术前评估的巨大子宫肌瘤患者,随机分成腹腔镜辅助阴式全子宫切除术组和开腹组。比较两组相关手术指标。结果两组手术成功率和术后并发症率等无统计学意义（P〉0.05）,腹腔镜组手术时间显著长于开腹组（P〈0.05）,但排气时间,下床活动时间和发热率显著小于开腹组（P〈0.05）。结论经谨慎选择病例,腹腔镜辅助阴式全子宫切除术治疗巨大子宫肌瘤,具有疗效好、创伤小、痛苦少、恢复快等优点,是一种安全、有效的手术方法,值得临床考虑。     

腹腔镜阑尾切除术的临床观察

目的探讨腹腔镜阑尾切除术治疗阑尾炎的临床经验和优势。方法回顾性分析126例阑尾炎患者,观察组(73例)采用腹腔镜阑尾切除术治疗,对照组(53例)采用传统的开腹治疗,比较二者的手术时间、术中出血量、胃肠功能恢复时间、住院时间和并发症发生率。结果观察组手术时间、术中出血量、胃肠功能恢复时间、住院时间和并发症发生率均优于对照组,差异有统计学意义(P<0.05)。结论腹腔镜阑尾切除具有创伤小、恢复快、住院时间短、并发症少等特点,值得临床推广应用。     

急腹症手术切口选择失误的防范与应对

目的　探讨急腹症手术切口选择失误的原因、预防及处理。方法　回顾分析我院 1990～ 2 0 0 3年间发生的 5 2例急腹症手术切口选择失误的临床资料。结果　切口选择失误多因术前诊断错误、病变定位不当引起。经更改切口后 ,5 2例均顺利完成手术。术后并发切口疝 2例 ,切口延迟愈合 1例 ,肠粘连 3例。结论　正确的术前诊断是避免或减少急腹症手术切口选择失误的前提 ,及时合理的更改切口是保证手术成功的关键。     

剖宫产儿窒息原因的分析

近10年来，由于围产技术的不断提高和监测方法的普及．能够早期发现胎儿宫内的安危使不少临危儿得到抢救，这也是近年来剖富产率上升的原因之一，但如何掌握剖宫产指征时机至关重要，本文仅就我科1985年1月至2003年1月剖官产儿窒息、死亡情况进行分析。