子宫切除术手术编码的探讨

目的掌握子宫切除术的编码.方法介绍子宫切除术的相关知识,根据子宫切除的具体部位进行分类.根据手术范围、入路、方式、伴随的其他操作决定手术编码.结果介绍了子宫切除术分类原则以及查找编码方法.结论编码员不但要熟练掌握手术操作编码原则,还要不断学习积累相关的医学知识,仔细阅读手术记录,才能准确编码.     

各种子宫切除术式的评价

子宫切除术（hysterectomy）是治疗子宫疾病最常用的手术方式之一.美国每年约有60万例子宫切除术,估计我国每年子宫切除术例数在250万以上.子宫切除术途径有经腹部子宫切除术、经阴道子宫切除术和腹腔镜子宫切除术三种.后两者系微创手术,近年来在临床上应用越来越多,正在全国快速推广和普及.以下就各种子宫切除术的途径、范围、适应证和优缺点做简要介绍,并重点介绍腹腔镜子宫切除术。     

经脐单孔腹腔镜全子宫切除术和传统腹腔镜全子宫切除术的临床护理措施比较

比较行经脐单孔腹腔镜全子宫切除术和传统腹腔镜全子宫切除术患者的临床资料,总结经脐单孔腹腔镜全子宫切除术围手术期的护理经验.经脐单孔腹腔镜全子宫切除术技术上安全可行,护理人员掌握单孔腹腔镜全子宫切除术的特点、做好围手术期护理,对确保患者康复起到重要的作用.     

腹腔镜全子宫切除术临床效果分析

目的 通过腹腔镜下全子宫切除术与腹腔镜辅助经阴道子宫切除术、经腹全子宫切除术的临床效果比较.分析腹腔镜下全子宫切除术的临床价值.方法 我院2009年1月至2012年3月行腹腔镜下全子宫切除术38例;腹腔镜辅助经阴道子宫切除术37例;经腹全子宫切除术的38例;将三组患者临床资料进行回顾性分析.结果 腹腔镜下全子宫切除术后患者较腹腔镜辅助经阴道子宫切除术及经腹全子宫切除术的术后疼痛程度较轻,术后肛门排气时间及术后住院时间短;两组比较差异有统计学意义(P<0.05).手术中出血量少;手术时间短,腹腔镜下全子宫切除术具有损伤小,恢复快,切口小,疼痛轻的优点,值得临床推广.     

经阴道非脱垂全子宫切除152例临床分析

目的 分析经阴道非脱垂全子宫切除术的临床特点和适应证范围.方法 收集2005年11月-2008年12月期间在上海交通大学附属国际和平妇幼保健院因妇科良性疾病经阴道行全子宫切除术的患者152例,并以同期行腹腔镜全子宫切除术(n=122)和经腹全子宫切除术(n=168)的患者为对照,比较三种术式患者的临床特点和手术适应证范围.结果 三种方式全子宫切除术患者在年龄、产次、绝经与否以及剖官产手术史方面比较差异均无统计学意义(P＞0.05).三组患者在手术适应证和子宫大小的选择方面比较差异也无统计学意义(P＞0.05).经腹、腹腔镜和经阴道同时行附件手术者分别为62例(36.9%)、36例(29.5%)和18例(11.84%),经腹组明显多于经阴道组(P＜0.05).经阴道全子宫切除术组的手术时间和住院时间最短,术中出血量和手术费用最少.结论 经阴道非脱垂子宫切除术效果好,并发症少,对于部分子宫较大、有盆腔手术史者也同样适用.     

非脱垂子宫经阴道全子宫切除术28例临床分析

目的 探讨非脱垂子宫经阴道切除术的临床应用的可行性和安全性.方法 分析笔者所在医院2009年3～9月非脱垂子宫患者行经阴道全子宫切除术的临床资料.结果 28例手术均顺利,无中转开腹,无膀胱、直肠、输尿管损伤,无尿潴留发生.术后恢复时间较经腹全子宫切除术患者明显缩短.结论 严格掌握手术适应证、禁忌证及手术的技术要点,应用阴式全子宫切除术手术时间短、出血量少、恢复较快,无腹部瘢痕等优点,体现了微创化、人性化、现代化手术理念,有很好的临床应用价值.     

阴式子宫切除术的临床体会

子宫切除术是子宫良性病变的主要治疗方法之一.以前经腹部行子宫切除术,随着微创手术的广泛开展,现总结我院开展的89例阴式子宫切除术,探讨阴式子宫切除术的手术方法和临床应用价值.     

基层医院子宫切除术的改良方法

目的 探讨基层医院子宫切除术的改良方法,经腹小切口改良子宫切除术的临床应用价值.方法 对45例经腹子宫切除术(改良组)与45例传统经腹子宫切除术(传统组)的临床资料进行回顾性分析.结果 改良组手术时间、术中出血量、住院时间、肛门排气时间均明显少于传统组.结论 经腹小切口改良子宫切除术具有手术操作简便、组织损伤小、出血少、恢复快等优点.     

筋膜内子宫切除术26例分析

目的 探讨筋膜内子宫切除术的方法和效果.方法 采用筋膜内子宫切除术26例,与传统经腹全子宫切除术26例做对照.结果 筋膜内子宫切除术手术操作简便、时间短、出血少、恢复快、组织损伤小,术后复发率低,取得良好效果.结论 筋膜内子宫切除术优于传统经腹全子宫切除术,值得临床推广应用.     

腹腔镜下全子宫切除术

1子宫切除术的概念子宫良性病变的子宫切除术是妇产科常见手术,良性病变的子宫切除术种类繁多,分类各异。一般而言,根据切除子宫的多少分,有全子宫切除和次全子宫切除;根据切除子宫的途径分,有经腹部、经阴道和腹腔镜等三种。根据切除子宫的多少,腹腔镜下子宫切除术有几个分类:     

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…     

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.     

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.     

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.     

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.     

Survey and practice of reporting quality of randomized controlled clinical trials on traditional Chinese medicine

Evidence obtained from randomized controlled trials （RCTs） has been generally accepted as the gold standard in the evaluation of clinical effectiveness. Readers need to understand the trial design, implementation, results, analysis and interpretation, so as to fully Jnderstand the results of RCTs. Thus, the investigators of RCTs have to report these items in a complete, accurate and clear manner. Since 1998, we have conducted several evaluations on the reporting quality of RCTs published in Chinese journals on traditional Chinese medicine （TCM） and results have shown that there is an urgent need for higher quality RCTs on TCM.     

TCM Treatment of Ankylosing Spondylitis by Tonifying the Kidney and Strengthening the Governor Vessel

Ankylosing spondylitis is a chronic and progressive disorder with inflammation mainly involving the central axis joints. It mainly affects the cervical spine and the lumbosacral area, with the pathogenesis closely related to the kidney and the Governor Vessel (GV). TCM holds that the syndrome is deficiency in origin and excess in superficiality, which is due to insufficiency of the kidney, deficiency of GV, and blocking of the channels with the invasion of exogenous evil, leading to poor circulation of qi and blood and malnutrition of the bones, muscles and joints. The TCM method of tonifying the kidney and strengthening GV to regulate circulation of qi and blood and check the arthralgia pain should be adopted, with the Kidney-Tonifying and GV Strengthening Decoction (益肾强督汤) prescribed.     

IMPROVING P-gp EXPRESSION IN HUMAN MONONUCLEAR CELLS IN VITRO TRANSFECTED BY MULTIDRUG RESISTANCE-1 mRNA

CHEMOTHERAPY playsa greatrolein the treat- ment of malignanttumors,especiallyingynecolo- gicalones.But inanticancerchemotherapy,leuko-cytopeniaisfrequentlytheprimarydose-limitingsideeffect factor.Moreover,cancersarefrequentlychemoresistantbe-causeof overexpressionof P-glycoprotein(P-gp), which isencodedby multidrugresistancegene (MDR1 ) and detectableinup to50% ofhuman cancersand renderscellsresistancetoanticancerdrugs.The safetyand potentialtherapeuticbenefitof mdr1 gene transferredto h…