腹腔镜辅助下子宫肌瘤剥除手术患者的临床路径管理研究

目的 探讨腹腔镜辅助下子宫肌瘤剥除手术患者的临床路径管理.方法 选取2011年3月-2013年3月我院收治行腹腔镜辅助下子宫肌瘤剥除手术患者80例,随机分为实验组和对照组各40例,其中实验组实施临床路径管理,而对照组采用传统的医疗护理干预.结果 实验组患者给予临床路径管理后,其住院时间住院费用均获得了减少,且患者的满意度得到了提高,差异均存在统计学意义（P＜0.05）.结论 临床路径管理在行腹腔镜辅助下子宫肌瘤剥除手术患者围手期的护理模式具有良好的疗效,同时提高了患者的满意度,也有利于新护士的培训.     

A novel approach to infertility treatment of advance-age patient with prominent intramural fibroid

We report for the first time on a case of infertile advance-age patient with large intramural fibroid, who conceived following a course of Ulipristal. The patient underwent two fresh fertility preserving IVF cycles, with cryopreservation of 9?day-3 embryos, followed by a 12?weeks course of Ulipristal (5?mg per day) and a subsequent frozen-thawed embryo transfer with her own previously cryopreserved embryos. We, therefore, believe that Ulipristal is a valuable addition to treatment armamentarium of advance-age infertile patient with prominent intramural fibroid.     

The role of transvaginal ultrasound in the management of abnormal uterine bleeding

Abnormal uterine bleeding is a common symptom. Modern management should be based on a one-stop approach to which transvaginal ultrasound is ideally suited as a primary diagnostic tool. In premenopausal women focal pathology, such as fibroids and polyps, as well as extra uterine pathology, can be accurately diagnosed. In postmenopausal women endometrial cancer can be excluded. In the majority of women diagnostic hysteroscopy can thus be avoided, and patients with focal pathology detected with transvaginal ultrasound can be triaged for operative intervention. Outpatient endometrial biopsy should still be used to exclude endometrial pathology. This one-stop ultrasound-based clinical approach provides a rapid, accurate diagnosis, with the minimum of investigations and invasive procedures. In this way multiple outpatient visits and unnecessary inpatient admissions can be avoided.     

Comparison of Pain After Uterine Artery Embolization Using Tris-Acryl Gelatin Microspheres Versus Polyvinyl Alcohol Particles

When compared in a uterine artery embolization (UAE) animal model, Embospheres (ES) (Biosphere Medical, Rockland, MA) were found to induce less uterine ischemia than polyvinyl alcohol (PVA) particles. Given this finding, we aimed to test the hypothesis that ES is associated with less pain after UAE than PVA in human patients. We performed retrospective analysis on data from 72 consecutive UAE patients, collected from a prospectively acquired database. Patient-controlled analgesia (PCA) pump-delivered morphine sulfate (MS) dosages were compared between patients who received ES versus PVA. Subjective pain scores (SPS) were also compared between the two groups. Secondary outcome measures, including embolic volume and clinical outcome data, were also collected. Linear regression and t-test statistical analyses were performed. Null hypotheses were rejected at the p < 0.05 level. Mean follow-up period in the PVA population was 178 days (range 28–426), versus 96 days (range 24–197) in the ES population. The mean MS doses used by ES and PVA patients were 37.2 (s.d. 23.5) versus 47.1 (s.d. 26.8), respectively. This difference was not significant (p > 0.15). Utilizing a standard 0–10 pain scale, the mean peak SPS for the ES and PVA groups were 5.58 (s.d. 2.77) and 5.07 (s.d. 2.99), respectively. The difference was not significant. The mean amount of embolic material used in each ES and PVA patient was 4.86 cc (s.d. 3.01) and 3.52 cc (s.d. 1.63), respectively. The difference revealed a strong trend toward statistical significance (p = 0.05). There was one treatment failure in each group of patients. Within both patient samples, no significant correlation was found when comparing the volume of embolic used and subsequent MS dose. Despite a strong trend toward a significantly higher volume of ES used per patient, there is no subjective or objective difference in pain after UAE with ES when compared to PVA.     

子宫肌瘤子宫切除术临床路径患者住院费用影响因素分析

目的：分析子宫肌瘤子宫切除术临床路径患者住院费用的相关影响因素。方法选择某三级甲等医院2012~2014年3年间子宫肌瘤子宫切除术临床路径患者380例,应用SPSS软件进行方差分析、Logistic回归方程等统计学分析。结果3年的住院平均费用呈逐年增高趋势(F=12.71,P<0.01),住院日、医疗付费方式、药费、手术费是影响子宫肌瘤子宫切除术临床路径患者住院费用的主要因素( P<0.01)。结论控制住院费用的关键仍在于缩短住院日、确定适宜的医疗付费比例、降低药费和手术费用上,建议继续科学研制临床路径,丰富我国本土化DRGs预付费体系。     

米非司酮治疗绝经过渡期子宫肌瘤45例临床疗效观察

目的 观察米非司酮在治疗绝经过渡期子宫肌瘤方面的疗效.方法 将45例确诊为绝经过渡期子宫肌瘤的患者,每日口服米非司酮125mg连续6个月,观察治疗前后子宫及肌瘤体积,月经情况.结果 30例患者闭经有效率达66.67%,贫血得到改善,子宫肌瘤体积明显缩小.结论 米非司酮治疗绝经过渡期子宫肌瘤方面有较好的临床效果.     

Prospective Study of Elective Bilateral Versus Unilateral Femoral Arterial Puncture for Uterine Artery Embolization

The purpose of this study was to assess the effect of elective bilateral femoral arterial punctures for uterine artery embolization (UAE) of symptomatic fibroids on fluoroscopy and procedural time, patient dose, and ease of procedure. We conducted a prospective study of UAE with either the intention to catheterize both uterine arteries using a single femoral puncture (n = 12) or elective bilateral arterial punctures from the outset (n = 12). The same two operators undertook each case. Main outcome measures were total procedure time, fluoroscopy time, dose-area product (DAP), and total skin dose. A simulation was then performed on an anthropomorphic phantom using the mean in vivo fluoroscopy parameters to estimate the ovarian dose. Bilateral UAE was achieved in all patients. None of the patients with initial unilateral arterial puncture required further contralateral arterial puncture. The mean fluoroscopy time in the group with elective bilateral punctures was 12.8 min, compared with a mean of 16.6 min in patients with unilateral puncture (p = 0.046). There was no significant difference in overall procedure time (p = 0.68). No puncture-site complications were found. Additional catheters were required only following unilateral puncture. The simulated dose was 25% higher with unilateral puncture. Although there was no significant difference in measured in vivo patient dose between the two groups (DAP, p = 0.32), this is likely to reflect the wide variation in other patient characteristics. Allowing for the small study size, our results show that the use of elective bilateral arterial punctures reduces fluoroscopy time, requires less catheter manipulation, and, according to the simulation model, has the potential to reduce patient dose. The overall procedure time, however, is not significantly reduced.     

超声对80例子宫肌瘤与子宫腺肌病的对比分析

探讨子宫肌瘤与子宫腺肌病B超图像特征及其鉴别诊断。方法：常规B超检查，并将子宫肌瘤及子宫腺肌病两组B超图像进行比较分析。结果：37例子宫肌瘤（92．5％）有假包膜或界限清楚，23例子宫腺肌病（92．0％）界限欠清；32例子宫肌瘤（80．0％）探及栅栏样图像，33例（82．5％）后方回声衰减，22例（55．0％）呈低回声；而子宫腺肌病呈栅栏样图像和后方回声衰减仅各有2例（8．0％）、15例（60．O％）呈高回声。结论：B超对子宫肌瘤和子宫腺肌病的诊断与鉴别诊断具有重要作用。