卵巢子宫内膜异位囊肿的腹腔镜手术治疗

目的:探讨腹腔镜手术治疗卵巢子宫内膜异位囊肿的疗效及可行性。方法:回顾性总结了2003年5月~2004年12月在北京大学第一医院妇科腹腔镜手术治疗卵巢子宫内膜囊肿(R-AFS分期Ⅱ~Ⅳ期)的患者189例。结果:189例均在腹腔镜下完成,无中转开腹和并发症发生。行囊肿剥除术165例,其中单侧116例,双侧47例;子宫切除加囊肿剥除术2例;附件切除术19例;子宫加双附件切除5例。术中同时行异位病灶电灼术77例,盆腔粘连分解术158例。不孕者同时行输卵管通液术。189例术后随访175例,随访率92.6%。137例痛经患者症状消失86例,减轻31例,痛经缓解率为85.4%。术后复发17例,复发率为9.7%。其中术前、后联合药物治疗140例中复发10例,复发率7.1%,未辅助药物治疗的35例中复发7例,复发率20.0%,两者相比,差异有显著性意义(P<0.05)。不孕症41人术后随访37例,妊娠17例,妊娠率45.9%。结论:腹腔镜手术治疗卵巢子宫内膜异位囊肿创伤小,安全、有效,可重复应用。术前、后辅助药物治疗可能预防术后复发。     

Implantable contraceptives for women: effectiveness, discontinuation rates, return of fertility, and outcome of pregnancies

Progestogen-only contraceptive implants are highly effective. In most studies, 5-year cumulative pregnancy rates are less than 1.5/100 women for Norplant and Norplant II. No study has yet reported any failures with Implanon. Weight over 70 kg and age at insertion under 25 years both increase the failure rate of Norplant and Norplant II; however, data are as yet lacking for Implanon. The effectiveness of other progestogen-only implants for which there are as yet few data are unlikely to be any different. Continuation rates are high compared with other hormonal methods and with the intrauterine device. In most cohorts at least 35% of women, and often many more, are still using Norplant by the end of 5 years. Rates vary according to a number of factors, including population studied, age, and parity. Menstrual disturbance is by far the most common reason for discontinuation, with headache, acne, weight gain, and desire for pregnancy accounting for other common reasons for implant removal. Fertility returns rapidly following implant removal, and pregnancy rates (76-100% 1 year after removal) are usually no different from those following discontinuation of any other contraceptive method. There is no increase in the risk of ectopic pregnancy, fetal malformation, or impaired infant health in pregnancies conceived either during implant use or after removal.     

专用固定钳在皮下埋植剂取出术中的临床应用

目的:探讨皮下埋植剂硅胶棒专用固定钳的临床应用效果。方法:采用随机分组方法,将受术妇女分为研究组86例,应用皮下埋植剂硅胶棒专用固定钳;对照组88例,应用小弯纹式血管钳。比较两组手术时间、术中出血量、皮下埋植剂硅胶棒的断裂率和术后疼痛程度。结果:研究组的手术时间、术中出血量、硅胶棒断裂率均较对照组少(P<0.05),且术后疼痛程度也较对照组轻(P<0.05)。结论:临床上应用皮下埋植剂硅胶棒专用固定钳,与小弯纹式血管钳相比,具有安全、简便、省时、出血量少、断裂率低、疼痛轻及组织损伤小等优点,值得临床推广使用。     

湖南省一市青少年控烟效果的分析

目的探讨在学校学生中开展系列控烟干预活动，以提高中小学生对烟草危害的认知。方法选择中、小学各两所，其中各一所作为对照，一所进行干预，前后分别进行基线调查和终期评估。结果干预学校学生在烟草危害知识认知和拒烟行为形成情况较对照学校明显提高，表明干预措施取得一定的效果。结论针对中小学生进行一系列烟草危害和拒烟技巧等知识的健康教育与行为干预是降低中小学生吸烟率的有效途径。     

自制闭合式取器钩的临床应用观察

目的:观察自制闭合式取器钩的临床应用效果。方法:采用随机分组方法,将取器者分为研究组161例,应用自制闭合式取器钩;对照组163例,应用传统取器钩。比较两组术时疼痛程度、术时出血量和取器时间。结果:研究组术时疼痛程度较对照组轻(P<0.01);术时出血量较对照组少(P<0.05);手术时间和对照组比较无统计学差异(P>0.05)。结论:临床上应用闭合式取器钩钩取宫内节育器,与传统取器钩相比,具有疼痛轻和出血量少等优点,具有临床应用价值,值得推广使用。     

Effectiveness of mass screening for breast cancer in Japan

BACKGROUND: Breast cancer screening has been conducted in Japan mainly by physical examination, the standard method for breast cancer screening according to the Law of Health Services for the Elderly. The purpose of this study was to evaluate the effectiveness of mass screening for breast cancer in Japan. METHODS: We calculated the average coverage-rates for breast cancer screening per year from 1986 to 1995 for women aged 30-69 years for all of the 3255 municipalities in Japan, selecting "high coverage-rate" municipalities with average coverage-rates of 20%, 30%, 40% or more. Two municipalities were selected as "controls" for each high coverage-rate municipality, and were matched for population, National Health Insurance rate, and the age-adjusted death rate from cancer of the female breast in the period 1986-90. We compared the change in the age-adjusted death rate from 1986-90 to 1991-95 of the high coverage-rate municipalities and the comparable controls. RESULTS: The percent reduction in the age-adjusted death rate from cancer of the breast in the high coverage-rate municipalities was statistically significantly greater than those in the controls. CONCLUSIONS: The results suggest that mass screening for female breast cancer, mainly by physical examination, contributed to the reduction of mortality from breast cancer.     

Eficacia,seguridad y satisfacción de los procedimientos de sedoanalgesia en las urgencias españolas

Objectives

To offer analgesia and sedation should be a priority in paediatric emergency departments. The aim of this study was to determine the effectiveness and safety of the sedation-analgesia procedure, as well as the satisfaction of the doctors, patients and parents.

Norplant皮下埋植剂使用七年效果

对Norplant皮下埋植剂继续使用7年以上的效果作了多中心研究。3600余妇女使用满6年,2400余妇女使用满7年。第6、第7年的年妊娠率均为0.4/100妇女年。妊娠率随体重增加而增加(P<0.05),随年龄的增长而降低,第6、7年合并计算任何年龄组或体重组其年妊娠平均未超过1/100妇女年。