腹腔镜下治疗输卵管妊娠不同术式的研究

目的:探讨腹腔镜不同手术方式治疗输卵管妊娠的安全性及治疗效果。方法:回顾分析2000年1月至2008年12月我院为236例希望保留生育功能并有随诊条件的输卵管妊娠患者行腹腔镜手术的临床资料。根据手术方式进行分组,A组124例,行输卵管开窗缝合术及输卵管内胚物取出术,患侧输卵管近端注射甲氨蝶呤50mg;B组112例,为对侧输卵管外观正常或无法保留患侧输卵管的患者,行输卵管切除术。比较两组术后宫内妊娠率和再次异位妊娠的风险。结果:术后1～2年内宫内妊娠率A组78例(62.97%),B组58例(51.8%),两组差异有统计学意义(P<0.05);再次异位妊娠发生率A组7例(5.6%),B组5例(4.5%),差异无统计学意义(P>0.05)。结论:输卵管妊娠行腹腔镜保留患侧输卵管手术微创、安全、有效,术后恢复快。宫内妊娠率高于输卵管切除者,更适于未生育的患者,不增加再次宫外孕发生的危险。     

甲氨蝶呤联合腹腔镜开窗取胚术治疗输卵管异位妊娠效果观察

目的探讨甲氨蝶呤联合腹腔镜开窗取胚术治疗输卵管异位妊娠的临床效果。方法对52例未破裂输卵管异位妊娠且有生育要求的患者先单次肌内注射甲氨蝶呤(MTX)50 mg/kg,24～48 h后给予腹腔镜开窗取胚术,并于术后适时行输卵管通液术。观察治疗效果及随访期间输卵管通畅情况和再次妊娠情况。结果 52例患者手术过程顺利。无中转行患侧输卵管切除术或开腹手术。手术时间为(42.3±10.6) min,术中出血量(20.3±1.6)mL,术后住院时间为6.02 d,术后β-HCG降至正常值时间为(9.73±4.26)d。术后随访24个月,3个月时复查超声显示:输卵管通畅40例(76.92%),输卵管通而不畅7例(14.81%),输卵管不通5例(9.62%)。其间再次宫内妊娠成功33例(63.16%),再次异位妊娠4例(7.69%)。结论甲氨蝶呤联合腹腔镜开窗取胚术治疗输卵管异位妊娠,创伤小,可提高输卵管通畅和再次宫内妊娠率,降低再次异位妊娠的发病率,安全性高。     

腹腔镜保留输卵管手术治疗输卵管妊娠56例报告

目的探讨腹腔镜保留输卵管手术治疗输卵管妊娠的效果.方法回顾性分析56例腹腔镜保守治疗输卵管妊娠的临床资料.结果 8例因创面出血经电凝止血无效而行输卵管切除术,余48例保留输卵管成功,其中3例因持续性宫外孕行MTX治疗一疗程.术后1～2个月47例保留输卵管成功者行输卵管碘油造影,患侧通畅36例,通而不畅8例,不通3例;对侧(3例已手术切除)通畅34例,通而不畅7例,不通3例.结论腹腔镜保留输卵管手术治疗输卵管妊娠在适宜条件下疗效确定.     

腹腔镜手术治疗输卵管妊娠89例分析

目的:总结腹腔镜下保留输卵管手术治疗输卵管妊娠的经验。方法:为输卵管妊娠89例行腹腔镜手术。结果:89例均在腹腔镜下行输卵管开窗术,保留了输卵管,手术时间15～110min,患者术后住院平均为5.3d,术后1月复查并行宫腔镜下输卵管插管通液术49条,输卵管通畅47条,通畅率为95.91％。结论:腹腔镜下保留输卵管手术治疗输卵管妊娠,患者创伤小,康复快,不干扰盆腔内环境,不影响卵巢功能,可保留生育能力。     

不同保守手术方式治疗输卵管妊娠疗效分析

目的比较开腹输卵管切开缝合、腹腔镜下输卵管开窗术与输卵管切开缝合术三种不同手术方式治疗输卵管妊娠的治疗效果。方法收集2010年1月~2015年1月在我院接受不同保守手术治疗的输卵管妊娠患者90例,按不同手术方式分为开腹输卵管切开缝合术(n=25)、腹腔镜下输卵管开窗术(n=40)与输卵管切开缝合术(n=25)三组。比较三组术中出血量、手术时间、肛门恢复排气时间以及术后患侧输卵管通畅率。结果腹腔镜开窗组和切开缝合组术中出血量、手术时间及术后肛门恢复排气时间均少于开腹手术组(P0.05),而两组不同腹腔镜手术组间比较差异无统计学意义(P0.05)。术后开腹组患侧输卵管通畅者8例(32.0%),腹腔镜开窗组15例(37.5%),腹腔镜切开缝合组16例(64.0%)。三组间术后通畅率比较有统计学差异(χ2=6.21,P=0.04)。腹腔镜切开缝合组分别与开窗组及开腹组间比较,差异均有统计学意义(χ2=4.33和5.13,P0.05)。结论腹腔镜下输卵管妊娠保守手术应作为输卵管保守手术首选,输卵管切开缝合可能更有利于保留输卵管功能。     

腹腔镜手术联合甲氨蝶呤保守治疗输卵管妊娠30例

目的探讨腹腔镜手术联合甲氨蝶呤保守治疗输卵管妊娠的临床价值。方法回顾性分析2001年1月至2006年1月经腹腔镜手术联合甲氨蝶呤治疗的30例输卵管妊娠的临床资料。结果30例输卵管妊娠患者均在腹腔镜下完成保守性手术,7例行输卵管内妊娠物挤出术,23例行输卵管线性切开造口术。术中均联合使用甲氨蝶呤病灶局部注射。手术时间45-125 min,平均66 min。术中出血量10-30 ml,平均65 ml。术后血γ-hCG降至5 mIU/ml以下时间为3-16 d,平均6.8 d。无持续性宫外孕发生。术后行子宫输卵管造影检查,患侧输卵管通畅22例（73.3%）,对侧输卵管通畅27例（90.0%）。结论腹腔镜手术联合甲氨蝶呤保守治疗输卵管妊娠具有出血少、并发症少、血hCG下降快、粘连少、能有效保留患侧输卵管的功能,提高正常妊娠率,有效预防持续异位妊娠的发生。     

宫腔镜下输卵管插管通液术对输卵管妊娠腹腔镜术后输卵管通畅度的评定价值

目的探讨宫腔镜下输卵管插管通液术对输卵管妊娠腹腔镜手术后输卵管通畅度评定价值.方法输卵管妊娠患者56例腹腔镜手术后2～24个月,行宫腔镜下输卵管插管通液术,判断输卵管的通畅程度.结果 15例患侧输卵管切除术,宫腔镜单侧输卵管插管通液术的完全通畅率60.0%(9/15),41例输卵管妊娠物剔出术,双侧通畅率43.9%(18/41),单侧完全通畅率43.9%(18/41).有生育要求的37例随访4～25个月,平均10.8月,已获得正常宫内妊娠20例(54.0%),输卵管完全梗阻采取IVF受孕3例,重复宫外孕1例(2.3%).结论宫腔镜下输卵管插管通液术对输卵管妊娠腹腔镜手术后输卵管通畅度评定较为直观、准确,对患者获得正常宫内妊娠有指导作用.     

宫、腹腔镜联合诊治输卵管性不孕102例分析

目的探讨宫腔镜联合腹腔镜对输卵管性不孕的诊断及治疗效果。方法 2005年2月~2008年2月,对腹腔镜监视下通液证实的输卵管梗阻性不孕患者102例,行腹腔镜下盆腔粘连分解、输卵管造口成形术以及宫腔镜联合腹腔镜输卵管插管复通手术。结果 102例203条输卵管中,远段不通145条,经粘连分解及伞端造口后复通72条,输卵管插管复通31条,共复通103条,复通率71.0%(103/145);58条近中段梗阻输卵管经分解粘连仅8条复通,输卵管插管复通26条,共复通34条,复通率58.6%(34/58)。复通失败的66条输卵管中病理证实为陈旧性结核病变36条(36/66,54.5%),其中30条为原发不孕患者,复通成功的输卵管仅2条为结核(2/137,1.5%),且为早期,通畅情况均为通而不畅。复通术后2年的62例中宫内妊娠24例(38.7%),输卵管妊娠4例(6.5%)。其中23例(23/28,82.1%)于术后3~12个月妊娠。结论腹腔镜下盆腔粘连分解、输卵管造口成形以及宫、腹腔镜联合输卵管插管复通是治疗输卵管梗阻性不孕的有效方法;输卵管结核是本地区妇女原发性输卵管性不孕的重要因素,治疗效果极差。     

输卵管妊娠腹腔镜保守治疗及术后输卵管通畅情况的观察

目的：探讨应用子宫输卵管造影评价输卵管妊娠经腹腔镜保守治疗后的通畅情况。方法：2003年1月～2006年5月108例经病史、体检及辅助检查诊断为输卵管妊娠，生命体征平稳，符合输卵管保守手术条件，腹腔镜下行输卵管切开取胎术或妊娠物挤出术。术后3～6个月输卵管造影检查了解输卵管通畅情况。结果13例行输卵管内妊娠物挤出术，95例行输卵管线性切开取胚胎术（4例术中加用MTX治疗）。术后84例行子宫输卵管造影检查，患侧输卵管术后检查通畅64例（76．2％），粘连13例（15．5％），不通7例（8．3％）；对侧输卵管通畅80例（95．2％），粘连3例（3．6％），不通1例（1．2％）。结论：输卵管妊娠腹腔镜保守治疗后，超过2／3的病人患侧输卵管通畅，有可能有正常的输卵管功能，对保护患者的生育功能有临床应用价值。     

腹腔镜下输卵管妊娠取胚后的重建术

目的通过与腹腔镜下输卵管取胚术比较,观察腹腔镜下输卵管妊娠取胚后重建术的临床疗效。方法 2007年5月-2010年5月,收治63例输卵管妊娠患者。30例行腹腔镜下输卵管妊娠取胚后重建术(试验组),33例行腹腔镜下输卵管妊娠取胚术(对照组)。两组患者年龄、妊娠时间、部位等一般资料比较,差异均无统计学意义(P>0.05),具有可比性。术中及术后1个月行通液检查,术后2个月行输卵管碘油造影(hysterosalpingography,HSG)观察输卵管通畅度,记录患者术后妊娠情况。结果试验组手术成功29例;1例因严重粘连无法施行重建术,排除统计学分析。术中通液检查示,试验组输卵管全程通畅26例,对照组2例,差异有统计学意义(Z=5.86,P=0.00)。术后1个月通液检查示,试验组全程通畅25例、对照组26例,差异无统计学意义(Z=0.48,P=0.63)。术后2个月HSG检查示,试验组全程通畅25例,对照组2例,差异有统计学意义(Z=5.35,P=0.00)。术后24个月内试验组有25例(86.20%)宫内妊娠,显著高于对照组的19例(57.58%)(χ2=7.72,P=0.01)。结论腹腔镜下输卵管妊娠取胚后重建术显著提高了宫内妊娠率,疗效优于腹腔镜下输卵管取胚术。     

Vasopressor hormone response following mesenteric traction during major abdominal surgery

Background : We investigated the vasopressor hormone response following mesenteric traction (MT) with hypotension due to prostacyclin (PGI₂) release in patients undergoing abdominal surgery with a combined general and epidural anesthesia. Methods : In a prospective, randomized, placebo-controlled study we administered 400 mg ibuprofen (i.v.) in 42 patients scheduled for abdominal surgery. General anesthesia was combined with epidural anesthesia (T4-L1). Before as well as 5, 15, 30, 45, and 90 min after MT we recorded plasma osmolality, hemodynamics and measured 6-keto-PGFlα (stabile metabolite of PGI₂), TXB₂ (stabile metabolite of thromboxane A₂) active renin, and arginine vasopressin (AVP) plasma concentrations by radioimmunoassay. Catecholamine levels were assessed by high-pressure liquid chromatography (HPLC) with electrochemical detection. Results : Following MT, arterial hypotension occurred along with a substantial PGI₂ release. This was completely abolished by ibuprofen administration. Although plasma levels of 6-keto-PGF_1α (1133 (708) vs. 60 (3) ng/L, median (median absolute deviation), P=0.0001, placebo vs. ibuprofen) remained significantly elevated, blood pressure was restored within 30 min after MT in the placebo group. At the same point in time plasma concentrations of TXB² (164 (87) vs. 58 (1) ng/L, P=0.0001), epinephrine (46 (33) vs. 14 (6) ng/L, P=0.001), AVP (41 ± (18) vs. 12 (7) ng/L, P=0.0004), and active renin (27 (12) vs. 12 (4) ng/L, P = 0.001) were significantly higher in placebo-treated patients. Conclusion : Under combined general and epidural anesthesia arterial hypotension following MT due to endogenous PGI₂ release is associated with enhanced release of AVP, active renin, epinephrine and thromboxane A₂, presumably contributing to hemodynamic stability within 30 min after MT.     

A comparison of the inhibitory effects of four volatile anaesthetics on the metabolism of chlorzoxazone, a substrate for CYP2E1, in rabbits

Background: Halothane inhibits in vitro and in vivo activity of cytochrome P-450 (CYP) 2E1. There are several fluorinated volatile anaesthetics besides halothane, and most of them are defluorinated by CYP2E1. It is unclear whether other fluorinated anaesthetics inhibit the in vivo activity of CYP2E1.
Methods: We compared the inhibitory effects of therapeutic concentrations of four inhalational anaesthetics, halothane, enflurane, isoflurane, and sevoflurane, on chlorzoxazone metabolism in rabbits receiving artificial ventilation.
Results: All four inhalational anaesthetics decreased arterial blood pressure and increased plasma chlorzoxazone concentration. However, no significant differences in the plasma chlorzoxazone concentration were found between the four anaesthetics. The estimated chlorzoxazone clearance increased after beginning inhalation with all four agents, but no significant difference in clearance was noted between agents.
Conclusions: At therapeutic concentrations, the in vivo inhibitory effect on chlorzoxazone metabolism was similar for all four inhalational anaesthetics examined, even though their chemical characteristics and extent of hepatic metabolism differ considerably.     

A Teaspoon Pump for Pumping Blood with High Hydraulic Efficiency and Low Hemolysis Potential

Abstract: Virtually all blood pumps contain some kind of rubbing, sliding, closely moving machinery surfaces that are exposed to the blood being pumped. These valves, internal bearings, magnetic bearing position sensors, and shaft seals cause most of the problems with blood pumps. The original teaspoon pump design prevented the rubbing, sliding machinery surfaces from contacting the blood. However, the hydraulic efficiency was low because the blood was able to "slip around" the rotating impeller so that the blood itself never rotated fast enough to develop adequate pressure. An improved teaspoon blood pump has been designed and tested and has shown acceptable hydraulic performance and low hemolysis potential. The new pump uses a nonrotating "swinging" hose as the pump impeller. The fluid enters the pump through the center of the swinging hose; therefore, there can be no fluid slip between the revolving blood and the revolving impeller. The new pump uses an impeller that is comparable to a flexible garden hose. If the free end of the hose were swung around in a circle like half of a jump rope, the fluid inside the hose would rotate and develop pressure even though the hose impeller itself did not "rotate"; therefore, no rotating shaft seal or internal bearings are required.     

Microspheres Based Detoxification System: A New Method in Convective Blood Purification

Abstract: A variety of protein-bound or hydrophobic substances, accumulating as a result of pathologic conditions such as exogenous or endogenous intoxications, are removed poorly by conventional detoxification methods because of low accessibility (hemodialysis), insufficient adsorption capabilities (hemosorption), low efficiency (peritoneal dialysis), or economic limitations (high-volume plasmapheresis). Combining advantages of existing methods with microspheric technology, a module-based system was designed. Major operating parameters of the latter can be modified to allow for adjustment to individual clinical situations. An extracorporeal blood circuit including a plasmafilter is combined with a secondary high-velocity plasma circuit driven by a centrifugal pump. Different microspheric adsorbers can be combined in one circuit or applied in sequence. Thus, a prolonged treatment can be tailored using specially designed selective adsorber materials. Comparing this system with existing methods (high-flux hemodialysis, molecular adsorbent recycling system), results from our in vitro studies and animal experiments demonstrate the superior efficiency of substance removal.     

Is the recovery profile of mivacurium independent of the rate of decay of its plasma concentration in patients with normal plasma cholinesterase activity?

Background: The duration of action of muscle relaxants is poorly correlated to the rate of decay of their plasma concentration. The plasma concentration of mivacurium may rapidly decrease below its active concentration because of the extensive hydrolysis of mivacurium. By inflating a tourniquet on one upper limb for 3 min after the administration of atracurium, mivacurium or vecuronium, we studied the influence of the initial decline of their plasma concentration on their effect. Methods: In 50 patients anaesthetised with thiopental, isoflurane and fentanyl, the effect of bolus doses of 0.15 or 0.25 mg . kg^?1 mivacurium (MIV 15, MIV 25), 0.3 or 0.5 mg . kg^?1 atracurium (ATR 30, ATR 50) and 0.06 or 0.1 mg . kg^?1 vecuronium (VEC 06, VEC 10) were measured on both arms (evoked response of the adductor pollicis to train-of-four stimulation every 12 s), a tourniquet being applied on one arm just before and during 3 min after the muscle relaxant bolus. Results: Tourniquet inflation of 3 min almost abolished the neuromuscular effect of mivacurium. In the vecuronium groups and in the ATR 50 group, tourniquet inflation did not modify the maximum degree of depression of the twitch response. Also, the duration of action of vecuronium was unaffected by the tourniquet. In the ATR 30 group, times to return of the twitch response to 25% (duration 25%) and 75% (duration 75%) of control response were significantly shorter in the cuffed arm, 23 min vs 27 min, and 41 min vs 45 min, respectively. In the ATR 50 group, only duration 25% was significantly shorter in the cuffed arm (41 min vs 45 min). Conclusion: The results suggest that the rate of decline of the plasma concentration of mivacurium is so rapid, that a very low and almost clinically ineffective concentration is present as soon as 3 min after its administration. The results also indicate that the recovery from a mivacurium-induced neuromuscular blockade is not influenced by the rate of decay of its plasma concentration in patients with genotypically normal plasma cholinesterase.     

Membranes in Artificial Organs

Abstract: Membrane processes play a pivotal and enabling role in modern replacement therapy for acute and chronic organ failure and in the management of immunologic diseases. In fact, virtually all contemporary extracorporeal blood purification methods employ membrane devices, and the next generation of artificial organs and tissue engineering therapies are almost certain to be similarly grounded in membrane technology. In this short essay, we comment on the similarities and differences among synthetic membranes and their natural counterparts and also provide a critical overview of the demographics and technology of hemodialysis, hemofiltration, apheresis, oxygenation, and emerging membrane technologies and applications.     

Tissue perfusion in relation to cardiac output during continuous positive-pressure ventilation and administration of propranolol or verapamil

Background : Our objective was to determine whether administration of propranolol or verapamil modifies the hemodynamic adaptation to continuous positive-pressure ventilation (CPPV), in particular the regional distribution of cardiac output (CO).
Methods : General hemodynamics and regional blood flows assessed by microsphere technique (15 (μm) were recorded in 16 anesthetized pigs during spontaneous breathing (SB) and CPPV with 8 cm H₂O end-expiratory pressure (CPPV8) before and after intravenous administration of propranolol (0.3 mg · kg⁻¹ followed by 0.15 mg · kg⁻¹ · h⁻¹, n=8) or verapamil (0.1 mg · kg⁻¹ followed by 0.3 mg · kg⁻¹ · h⁻¹, n=8).
Results : CPPV8 depressed CO by 25% without shifts in its relative distribution with the exception of a noteworthy increase in adrenal perfusion. Propranolol increased arterial blood pressure, and due to a fall in heart rate, CO dropped by 25%. The kidneys and, to a lesser extent, the splanchic region and central nervous system received increased fractions of the remaining CO at the expense of skeletal muscle flow. Similar patterns were seen during SB and CPPV8 such that the combination of propranolol and CPPV8 depressed CO by 50%. The circulatory effects of verapamil were less evident but myocardial perfusion tended to increase.
Conclusions : The combination of propranolol or verapamil with CPPV does not result in any specific hemodynamic interaction in anesthetized pigs, except that the combined effect of propranolol and CPPV may severely reduce CO.     

Volatile anaesthetics reduce adhesion of blood platelets under low-flow conditions in the coronary system of isolated guinea pig hearts

Background : Inhibitory effects of volatile anaesthetics on platelet aggregation have been demonstrated in several studies. However, the influence of volatile anaesthetics on intracoronary platelet adhesion has not been elucidated so far.
Methods : Isolated hearts of guinea pigs were perfused with buffer in the absence or presence of volatile anaesthetics (0.5 and 1 MAC) at constant coronary flow rates of 5 ml/min for 25 min, then 1 ml/min for 30 min and again 5 ml/min for 10 min. Before, during and after low-flow perfusion, a bolus of human platelets was applied into the coronary system. To simulate thrombogenic conditions, 0.3 U/ml human thrombin was infused during low-flow perfusion and reperfusion. The number of platelets sequestered to the endothelium was calculated from the difference between coronary in- and output of platelets. The myocardial production of lactate and consumption of pyruvate and coronary perfusion pressure were also determined.
Results : At a flow rate of 5 ml/min only about 3% of the applied platelets did not emerge from the coronary system, in any group. In contrast, 13.1±1.2% (mean±SEM) of infused platelets became adherent in low-flow perfusion in the control group without anaesthetic. The adherence was reduced with each 1 MAC isoflurane (to 6.2±1.2%), sevoflurane (to 4.4±0.9%) or halothane (to 3.2±1.5%) (each P <0.05 vs. control). Volatile anaesthetic, 0.5 MAC, did not inhibit platelet adhesion to a statistically significant extent in any case. Perfusion pressure and metabolic parameters were not statistically different between the control and the hearts exposed to anaesthetics.
Conclusion : Volatile anaesthetics in a concentration of 1 MAC can reduce the adhesion of platelets in the coronary system under reduced flow conditions. This action does not arise from vasodilation or inhibition of ischaemic stress.     

Bariatric Surgery in Some "Central and East-European (former Eastern bloc)"Countries - Current Status and Prediction for the Next Millennium

Background: Obesity is increasing globallly, including in the formerly "Eastern Bloc" countries. Methods: A survey was made of obesity and bariatric surgery. Results: In the 8 East and Central European countries studied, with total population 300 million, roughly 43% of the population was overweight (BMI 25-30), 23% obese (BMI > 30), with about 15 million people morbidly obese (BMI > 40). From 0-10 morbidly obese individuals/100,000/year undergo bariatric surgery. Conclusion: Most countries were found to provide inadequate treatment for obesity.The majority of the morbidly obese are not treated effectively. However, health-care awareness of obesity and bariatric surgeons are slowly increasing.     

Dilemma of Membrane Biocompatibility and Reuse

Abstract: Numerous articles have been published on the multiple use of dialyzers and on the effect of different reprocessing chemicals and techniques on the dialyzer biocompatibility and performance. The results often appear contradictory, especially those comparing standard biocompatibility parameters. Despite this confusion, a discerning review of the published works allows certain limited conclusions to be drawn. Reprocessing of used hemodialyzers changes the biocompatibility profile of a dialyzer as defined by the parameters complement activation. leukopenia, and cytokine release. The effect of reprocessing depends on the chemicals and reprocessing technique applied and also on the type of membrane polymer being subjected to the reprocessing procedure. Reports of pyrogenic reactions indicate that the flux of the membrane also influences how suitable it is for safe reuse. An increased risk of allergic and pyrogenic reactions appears to be associated with dialyzer reuse. Furthermore, there has been a lack of investigations into the immunologic effect of the layer of adsorbed and chemically altered proteins that remains on the inner surface of reprocessed dialyzers. We conclude that the clinical benefit of dialyzer reuse cannot be generally accepted from a biocompatibility point of view.