腹腔镜下卵巢囊肿剥除术治疗卵巢囊肿的临床效果分析

目的 探讨腹腔镜下卵巢囊肿剥除术治疗卵巢囊肿的临床效果.方法 方便选取该院2016年1月—2017年1月收治的120例卵巢囊肿患者,按照不同治疗方法将其分成开腹组与腹腔镜组各60例,开腹组应用开腹卵巢囊肿剥除术治疗,腹腔镜组应用腹腔镜下卵巢囊肿剥除术治疗,对比两组患者治疗后的临床效果.结果 腹腔镜组的手术时间(60.8±5.5)min明显短于开腹组(72.9±7.6)min,且术中出血量(74.6±13.7)mL明显少于开腹组(122.3±30.5)mL,对比差异有统计学意义(P<0.05);腹腔镜组的肛门排气时间与住院时间(1.3±0.6)、(4.8±1.2)d均明显短于开腹组(2.5±1.1)、(7.0±1.5)d,但治疗费用(5056.1±315.9)元明显高于开腹组(4120.5±334.6)元,对比差异有统计学意义(P<0.05);开腹组的并发症发生率与复发率分别为6.7%、3.3%,腹腔镜组的并发症发生率与复发率均为1.7%,腹腔镜组明显低于开腹组,对比差异有统计学意义(P<0.05).结论 腹腔镜下卵巢囊肿剥除术治疗卵巢囊肿的临床效果满意,值得应用.     

超声刀在50例腹腔镜子宫肌瘤手术中的应用

目的 :评价超声刀用于腹腔镜子宫肌瘤手术的效果。方法 :使用超声刀行腹腔镜子宫肌瘤剥除术 10例 ,腹腔镜筋膜内子宫切除术 2 0例 ,腹腔镜辅助阴式子宫切除 (LAVH)术2 0例 ,与使用电凝法行腹腔镜子宫肌瘤剥除术 10例及LAVH术 2 0例进行比较。结果 :腹腔镜下超声刀手术 5 0例全部完成 ,电凝法有 1例行LAVH术的患者因血管回缩出血多而中转开腹。平均手术时间、平均术中出血量超声刀切瘤组分别为 ( 77.2± 2 2 .6)min和 ( 5 8.3±2 2 .4)ml,电凝法切瘤组分别为 ( 12 0 .2± 2 6.1)min和 ( 80 .5± 16.1)ml ,超声刀LAVH术组分别为 ( 10 2 .2± 2 8.3 )min和 ( 86.1± 2 4.1)ml,电凝法LAVH术组分别为 ( 167.3± 18.4)min和( 160 .4± 16.6)ml。结论 :超声刀行腹腔镜下子宫肌瘤手术平均手术时间及平均术中出血量均优于腹腔镜电凝术 ,并可以完全替代之     

探讨腹腔镜治疗卵巢巨大囊肿临床疗效

目的探讨腹腔镜治疗卵巢巨大囊肿患者的疗效。方法从该院选取80例卵巢巨大囊肿患者进行治疗观察,选取40例为观察组行腹腔镜手术治疗,另40例为对照组行开腹手术。结果手术中有1例患者快速冷冻病理显示卵巢黏液性乳头状囊腺癌转为开腹手术法,其余患者在腹腔镜下行手术均成功治疗,手术行卵巢囊肿剥除术和附件切除术两种方式。手术时间平均70min,出血30mL,术后患者住院平均6d,术中,术后无严重并发症。结论患者符合行腹腔镜手术标准,进行腹腔镜治疗卵巢巨大囊肿手术创伤小,康复时间快,降低了并发症,临床上可广泛应用。     

腹腔镜下卵巢囊肿剥除术65例临床分析

目的 探讨腹腔镜下卵巢囊肿剥除术的效果.方法 2005年5月～2008年3月采用腹腔镜行卵巢囊肿剥除术65例,并选择同期开腹行卵巢良性肿瘤剥除术的65例患者作对照,观察两组手术时间、术中出血量、肛门排气时间、术后住院天数,手术并发症及囊肿复发情况.结果 腹腔镜组术中出血量、肛门排气时间、术后住院天数均小于开腹组(P＜0.05);腹腔镜组1例(1.5%)发生皮下气肿,术后3d自行消失.开腹组2例(3.1%)腹部伤口脂肪液化并裂开,再行2期缝合后愈合;随访6～12个月,腹腔镜组囊肿复发5例(7.7%),开腹组4例(6.2%),两组比较无显著差异(P＞0.05).结论 腹腔镜下卵巢良性囊肿剥除术是首选的手术方法.     

巨大卵巢囊肿的腹腔镜手术治疗

目的探讨腹腔镜下巨大卵巢囊肿手术的方法和可行性.方法对39例卵巢巨大囊肿患者行腹腔镜下卵巢囊肿剥除术或卵巢囊肿切除术.结果除1例术中冰冻病理报告为卵巢交界性浆液性囊腺瘤而中转开腹外,其余38例均在腹腔镜下完成手术,术中未发生任何并发症,术中出血(56±8.4)ml,平均手术时间(67±12.9)min,术后平均住院日3d余.结论腹腔镜下巨大卵巢囊肿手术可安全有效用于临床.     

124例妇科盆腔包块腹腔镜手术治疗

目的:通过对124例妇科盆腔包块行腹腔镜手术治疗的分析,探讨腹腔镜手术在妇科疾患中盆腔附件包块的应用价值。方法:回顾性分析1997年10月～2002年3月对124例盆腔附件包块行腹腔镜手术的疗效。结果:124例手术全过程均在腹腔镜下完成,对5种妇科疾病(卵巢囊肿、卵巢良性畸胎瘤、卵巢子宫内膜异位囊肿、异位妊娠、附件炎性包块)共行7种手术(卵巢囊肿切除或剥除术、卵巢子宫内膜异位囊肿切除及内异病灶电凝术、畸胎瘤切除术、输卵管切除及附件切除术、囊肿穿刺或切开术、输卵管切开取胚术、盆腔脓肿切开引流术)。平均手术时间(58±32)min,平均住院时间4d。结论:腹腔镜手术治疗妇科盆腔附件包块是一种安全有效的手术方法。     

单孔腹腔镜手术治疗儿童卵巢囊肿蒂扭转临床分析

目的　探讨单孔腹腔镜手术治疗儿童卵巢囊肿蒂扭转的临床价值。方法　回顾性分析大连市儿童医院2016年1月至2018年10月采用单孔腹腔镜行卵巢囊肿蒂扭转复位腹腔外囊肿剥除术22例的临床资料,其中左侧10例,右侧12例;年龄4～14岁［（10.2±2.9）岁］;体重指数13～23 kg/m²［（17.7±2.9）kg/ m²］;患儿均接受3～36个月的随访。观察患者的手术和术后情况。结果　22例患儿均顺利完成手术,无中转开腹及多孔腹腔镜手术。手术时间25～60 min［（41.4±9.2）min］,囊肿直径5～16 cm［（8.4±2.7）cm］,术中出血量5～20 mL［（11.4±3.5）mL］。患儿术后肠蠕动恢复时间8～20 h［（13.6±3.7）h］,术后住院时间3～6 d［（4.2±0.9）d］,住院治疗期间无手术相关并发症。21例扭转的卵巢囊肿复位后剥除囊肿保留卵巢组织,1例因卵巢及输卵管已缺血坏死,切除病变附件。手术切除的组织病理诊断均为良性病变。患儿术后随访3～36个月,彩色多普勒超声检查无卵巢萎缩及囊肿复发病例。结论　单孔腹腔镜手术治疗小儿卵巢囊肿蒂扭转操作简单,损伤小、恢复快、瘢痕不明显、手术确切可靠,该技术值得推广应用。     

腹腔镜手术治疗巨大卵巢囊肿26例临床分析

目的 探讨巨大卵巢囊肿行腹腔镜手术治疗的可行性.方法 将该院收治的直径≥12 cm 的52例巨大卵巢囊肿,随机分为26例腹腔镜下卵巢囊肿剔除术组(研究组)和26例开腹手术组(对照组).研究组先刺破囊肿,抽吸囊液,反复冲洗囊腔后再剥除囊壁,最后行残留卵巢创面连续聚合缝合+订书式缝合;对照组则采用传统开腹手术行囊肿剔除术.比较两组患者手术时间、术中出血量、术后排气时间、术后离床时间及住院天数等指标.结果 研究组26例患者全部在腹腔镜下顺利完成手术,无需中转开腹手术,术中术后无任何并发症发生,术中出血量、术后排气时间、术后离床时间及住院天数均明显少于对照组,两组比较差异有统计学意义(P＜0.01),但两组患者手术时间差异无统计学意义(P＞0.05).结论 腹腔镜手术治疗巨大卵巢囊肿只要掌握好手术技巧,手术是安全可行的,并且具有创伤小,出血少,术后恢复快等优势,具有临床应用价值.     

腹腔镜和开腹行卵巢囊肿剥除术患者的临床对照观察

目的:对比腹腔镜和开腹行卵巢囊肿剥除术患者的临床效果。方法:选取100例卵巢良性囊肿患者,随机分成对照组和观察组,每组各50例。对照组患者采取开腹卵巢囊肿剥除术,观察组患者采取腹腔镜下卵巢囊肿剥除术。对两组患者的手术时间、出血量以及手术效果等要素进行对比和分析。结果:两组患者的手术均获得了比较理想的治疗效果,但是在手术时间、出血量以及手术效果等方面比较,观察组患者都要明显优于对照组(P<0.05)。结论:腹腔镜下卵巢囊肿剥除术比开腹手术对患者造成的创伤面和不良反应更小,恢复时间也明显占优。     

腹腔镜下卵巢囊肿剥除术与开腹卵巢囊肿剥除术治疗卵巢良性囊肿的疗效比较

目的:观察腹腔镜下卵巢囊肿剥除术在治疗卵巢良性囊肿中的应用效果。方法:取86例卵巢良性囊肿患者为观察对象,以术式差异分为观察组与对照组,各43例。对照组采用传统开腹卵巢囊肿剥除术治疗,观察组采用腹腔镜下卵巢囊肿剥除术治疗,比较手术效果。结果:观察组手术时间、出血量、肛门首次排气时间与住院时间均低于对照组(P <0. 05);治疗后观察组患者的E2水平明显低于对照组,LH、FSH水平显著高于对照组(P <0. 05)。两组患者术前、术后6个月Vol、FI及Fo方面比较,差异无统计学意义(P> 0. 05);观察组术后并发症发生率为4. 65%,显著低于对照组的18. 6%(P <0. 05),但两组1年内怀孕率比较差异无统计学意义(P> 0. 05)。结论:腹腔镜下卵巢囊肿剥除术治疗卵巢良性囊肿疗效较好,安全性较高,值得临床推广。     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.     

Luo Lingjie's Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.     

Dr.Zhang Ren's Experience in the Acupuncture Treatment of Different Diseases with the Same Therapeutic Principle

Dr.Zhang Ren,the chief physician,is the chairman of Shanghai Acupuncture and Moxibustion Association.Having been engaged in medicine for about 40 years,he is experienced in treating various intractable diseases.In his long years of clinical practice,he advocates taking the TCM differentiation as the basis to seek for the acupuncture method for treatment of modern intractable diseases.The author of this essay had the fortune to follow Dr.Zhang in study.The following is a summary of Dr.Zhang's experience in the acupuncture treatment for different intractable diseases with the same therapeutic principle.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

猪肺磷脂注射液联合经鼻持续气道正压通气对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性的影响

目的 探讨猪肺磷脂注射液联合经鼻持续气道正压通气(NCPAP)对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性(CK-MB)的影响.方法 选取呼吸衰竭早产儿80例,分为观察组和对照组各40例.对照组采用NCPAP给氧治疗,观察组给予NCPAP给氧联合猪肺磷脂气管内给药.观察两组患儿治疗前及治疗12h、24 h后PaO2、PaCO2、血氧饱和度(SaO2)、pH的变化情况,检测治疗前及治疗5d后血清CK-MB水平;评估两组患儿的临床治疗效果.结果 两组患儿PaO2、PaCO2、SaO2、pH比较,差异均有统计学意义(P＜0.05),其中观察组治疗后的PaO2、SaO2、pH均高于对照组,PaCO2则低于对照组.两组的PaO2、SaO2、pH均随观察时间延长而升高(P＜0.05),PaCO2均随观察时间的延长而降低(P＜0.05).观察组治疗有效率为87.5％,显著高于对照组的70.0％ (P ＜0.05).治疗5d后两组患儿血清CK-MB水平均较前降低(P＜0.05),且观察组明显低于对照组(P＜0.05).结论 猪肺磷脂注射液气管内给药联合NCPAP可以显著降低呼吸衰竭早产儿CK-MB的含量,提高治疗有效率,起到很好的呼吸循环支持作用.