腹腔镜子宫动脉阻断下子宫肌瘤剔除术61例疗效观察

目的]探讨急性硬膜外血肿患者术后脑水肿发生的影响因素.方法]回顾性分析2001年12月至2009年12月本院经手术治疗的112例急性硬膜外血肿患者的临床资料,分析患者术后脑水肿与年龄、原发昏迷、血肿部位、GCS评分、受伤至手术时间、瞳孔大小、血肿量及脑中线移位程度的关系.结果]112例患者中有37例术后出现脑水肿,单因素分析显示术前GCS评分、受伤至手术时间、瞳孔大小、血肿量、脑中线结构移位程度是术后脑水肿相关因素,而年龄、是否有原发昏迷及血肿部位与术后脑水肿无明显相关.Logistic回归分析显示术前GCS和术前瞳孔大小是术后脑水肿相对危险度较高的独立因素.结论]急性硬膜外血肿术后脑水肿主要是急性脑受压造成的,脑受压程度越重、时间越长,术后脑水肿越严重,早期手术是避免或减轻术后脑水肿的有效措施,对术后发生较大范围的脑水肿病例应及时去骨瓣减压.

Clinical Observation of Laparoscopic Uterine Arterial Blockage Combined with Myomectomy

Objective]To evaluate the effect of laparoscopic myomectomy after uterine arterial blockage. Methods]Totally 183 cases of hysteromyoma in our hospital from August 2007 to May 2010 were divided into group A, group B and group B with 61 cases in each. Group A underwent uterine arterial blockage before myomectomy. Group B was locally injected 6U hypophysin before myomectomy. Group C underwent routine laparoscopic myomectomy. The operation state, the postoperative efficacy and the effect on sex hormones were compared. Results] The operation time, bleeding volume, anus passage time and hospital day in group A and group 13 were less than those in group C（ P 〈0.05）. The recurrence of hysteromyoma and symptomatic relief rate in group A and group B were lower than those in group C（ P 〈0.05）, but Hh recovery in group A was faster than that in group B and group C（ P 〈0.05）. There was no significant difference in the changes of the levels of sex hormones after operation among three groups（ P 〈0.05）. The levels of sex hormones in 3-6 months after operation were lower than the baseline value before operation（ P 〈0.05）, and those in 6- 12 months after operation returned to the levels before operation（ P 〈0.05）. Conclusion] Laparoscopic myomec tomy after uterine arterial blockage can relief the symptoms apparently and has no influence on the physiological function of uterus and ovarian.