腹腔镜下治疗早期卵巢癌的临床疗效分析

目的探讨腹腔镜下广泛性子宫切除术治疗早期卵巢癌的疗效以及对患者预后和生命质量的影响。方法回顾性分析2002年1月1日--2013年1月1日在我科行腹腔镜手术的60例早期卵巢癌患者（腹腔镜组）和行开腹广泛性子宫切除术的60例早期卵巢癌患者（开腹组）的临床病理资料,采用自制的质量量表对存活患者进行生命质量调查,比较两组患者的疗效及生命质量调查结果。结果腹腔镜组和开腹组的手术时间分别为（280．1±78．7）min和（221．5±65．9）min,与开腹组相比,腹腔镜组的手术时间明显增加（拄2．17,P〈0．05）;术中出血量分别为（371±107．1）ml和（488±99．5）ml;与开腹组相比,腹腔镜组的出血量明显减少（t=6．38,P〈0．05）;术后肛门排气时间分别为（44．5±7．1）h和（67．2±9．0）h,与开腹组相比,腹腔镜组的肛门排气时间明显缩短（t=10．12。P〈0．05）;而术后并发症发生率两组患者之间无明显差异（t=1．23,P〉0．05）：开腹组与腹腔镜组患者的复发率和病死率、生命质量调查结果比较,差异均无统计学意义（P〉O．05）。结论腹腔镜下广泛性子宫切除术治疗卵巢癌是安全、可行的,远期疗效良好,可以作为卵巢癌手术治疗的选择方式之一。     

腹腔镜与开腹全子宫切除术对机体细胞免疫功能影响的对比研究

目的 比较分析腹腔镜与开腹全子宫切除术对机体细胞免疫功能的影响.方法 选取行腹腔镜全子宫切除术患者28例(腹腔镜组)和开腹全子宫切除术患者28例(开腹组),比较两组手术效果及术前、术后T淋巴细胞亚群的变化情况.结果 腹腔镜组术中出血量、肛门排气时间、住院时间及术后并发症发生率均明显优于开腹组[(84.7±21.7) ml比(108.0±23.8) ml、(19.3±4.1)h比(23.8±3.8)h、(5.12±1.14)d比(7.81±2.27)d、7.1％(2/28)比17.9％(5/28),P＜0.05].腹腔镜组和开腹组术后1dCD4、CD8水平均较术前明显降低[腹腔镜组:(38.41±5.52)％比(40.72±6.46)％和(24.41±3.78)％比(26.33±4.17)％,开腹组:(38.41±4.97)％比(40.13±6.12)％和(24.41±6.32)％比(26.25±4.56)％,P＜0.05],但术后3d腹腔镜组CD4、CD8基本恢复至术前水平[(40.15±6.29)％、(27.23±5.12)％],术后3d开腹组CD4、CD8[(36.15±5.12)％、(23.15±4.87)％]与术前比较差异仍有统计学意义(P＜0.05).结论 腹腔镜全子宫切除术具有术中出血少、术后恢复快、并发症少等优点,且对机体细胞免疫功能的影响少,其疗效优于开腹全子宫切除术,值得推广和应用.     

早期子宫内膜癌腹腔镜手术的临床分析

目的探讨腹腔镜手术治疗早期子宫内膜癌的可行性及临床效果。方法回顾性分析130例早期子宫内膜癌患者的临床资料,分为A、B两组,分别行腹腔镜下手术和开腹手术,将两组患者手术情况及手术效果进行对比分析。结果 A组手术时间为(155.3±49.6)min;B组为(161.6±37.9)min,两组手术时间无统计学差异(P0.05)。A组手术出血量(223.5±125.5)ml;B组出血量(437.5±392.4)ml,A组手术出血量明显少于B组(P0.05)。A组淋巴结切除数目平均为(18.2±6.9)枚,B组为(17.3±8.4)枚,两组差异无统计学意义(P0.05)。腹腔镜组的术后肛门排气时间明显短于开腹组(P0.05)。留置导尿管时间,两组间差异无统计学意义(P0.05)。A组术后住院时间明显短于B组(P0.05)。所有患者术中均未出现明显并发症,B组有2例患者术后出现切口愈合不良,其余均恢复良好。结论腹腔镜手术治疗早期子宫内膜癌是安全可行的,该术式创伤小、术后康复快,近期效果好,但远期效果尚待进一步观察。     

腹腔镜辅助阴式手术在早期子宫内膜样腺癌中的应用以及预防感染措施

目的 对比分析腹腔镜与阴式手术和开腹手术治疗早期子宫内膜样腺癌在术中及术后的临床疗效,为临床医师治疗提供参考.方法 选取江西省妇幼保健院2009年5月-2012年5月收治的早期子宫内膜腺癌患者共90例,将其随机分为两组,开腹组45例为传统开腹手术组,腹腔镜组45例为腹腔镜辅助阴式手术组,比较两组间各项指标的差异.结果 腹腔镜组手术时间、术中出血量分别为(153.39±34.58) min、(92.66±73.62)ml,开腹组为(206.87±40.80)min、(187.56士101.7)ml,两组差异均有统计学意义(P＜0.01)；腹腔镜组术后切除淋巴结为(20.1±7.9)个、开腹组切除淋巴结为(23.4±9.8)个,两组差异无统计学意义；腹腔镜组术后住院时间、术后补充治疗间隔时间分别为(8.77士6.89)d、(26.00±14.80)d、开腹组为(9.42±2.25)d、(33.0±20.5)d,两组差异均有统计学意义(P＜0.05)；腹腔镜组随访期间未发现腹壁转移,术后出现阴道残端转移1例,开腹组在术后死亡1例.结论 腹腔镜作为早期子宫内膜样腺癌的治疗术式,术后切口无感染,其临床疗效优于开腹组.     

腹腔镜与开腹手术治疗早期宫颈癌的临床疗效比较

目的 比较腹腔镜与开腹手术治疗早期宫颈癌的临床疗效,探讨腹腔镜治疗宫颈癌的手术技巧和并发症的防治.方法 选择70例早期宫颈癌患者行腹腔镜(腹腔镜组,40例)和开腹(开腹组,30例)广泛全子宫切除术及盆腔淋巴结清扫术.观察两组患者手术时间、术中出血量、切除盆腔淋巴结数量、术后肛门排气时间、术后住院时间和并发症等情况.结果 腹腔镜组术中出血量(315.7±57.9)ml少于开腹组的(387.6±80.5)ml,术中切除盆腔淋巴结(26.7±5.3)个多于开腹组的(20.5±3.8)个,术后肛门排气时间(58.2±9.8)h早于开腹组的(70.5±10.4)h,术后住院时间(10.5±2.6)d短于开腹组的(13.6±3.4)d,并发症发生率17.5%(7/40)低于开腹组的40.0%(12/30),差异均有统计学意义(P<0.05);但腹腔镜组手术时间(284.5±80.5)min长于开腹组的(158.5±75.9)min(P<0.01).术后病理学检查均未发现切缘有残余病灶.所有患者均随访1～41个月,无肿瘤复发和穿刺点转移.结论 腹腔镜下广泛全子宫切除术及盆腔淋巴结清扫术,能完全达到开腹手术的要求,手术创伤小、恢复快,临床疗效明显优于开腹手术,是一种治疗早期宫颈癌的理想方法.     

腹腔镜治疗恶性子宫肿瘤的临床效果及对盆底、性功能的影响

目的:探讨腹腔镜下广泛性子宫切除术和盆腔淋巴结清扫术(TLRH+LPL)治疗子宫恶性肿瘤的临床效果及对患者盆底、性功能的影响作用。方法:选取2013年1月-2015年6月本院妇产科收治的97例子宫恶性肿瘤患者进行回顾性分析,其中53例采用腹腔镜下TLRH+LPL手术治疗(腹腔镜组),44例采取传统开腹手术治疗(开腹组),对比两种方法的围手术期指标及术后盆底、性功能指标差异。结果:腹腔镜组的手术时间、出血量、术后排气时间、术后住院时间均低于开腹组患者(t=12.88,t=19.96,t=8.31,t=5.19,P0.05),两组患者的淋巴结清扫数目、导尿管留置时间差异无统计学意义(t=1.32,t=0.88,P0.05);腹腔镜组的手术并发症发生率(9.3%)低于开腹组(25.0%)(χ~2=4.23,P0.05);腹腔镜组的压力性尿失禁发生率(1.9%)低于开腹组(13.6%)(χ~2=4.96,P0.05);腹腔镜组的性生活满意率(42.2%)高于开腹组(24.3%)(Z=-2.30,P0.05)。结论:腹腔镜下TLRH+LPL治疗子宫恶性肿瘤较传统开腹手术除具有创伤小、恢复快的优势外,同时具有对患者盆底功能及性生活质量影响较小的优势。     

卵巢子宫内膜异位症的手术方式及术后处理

目的:比较开腹与腹腔镜下卵巢子宫内膜异位囊肿剥除术及术后处理方法,探讨腹腔镜在子宫内膜异位症治疗中的作用。方法:回顾性分析2001年1月～2005年12月的卵巢子宫内膜异位囊肿剥除术188例,其中92例行腹腔镜手术(腔镜组),96例行开腹手术(开腹组)。术后随访12～36个月,对两组的围手术期情况、术后症状缓解、复发率及妊娠率进行比较。选择腔镜组2005年6～12月手术的56例患者,比较其术后不同处理方法的复发、妊娠结局及用药副作用情况。结果:术中出血量腔镜组为(110.5±82.8)ml,明显少于开腹组的(189.5±96.8)ml,P0.05。手术时间腔镜组为(136.5±80.4)min,与开腹组的(148.5±86.8)min相近,P0.05。术后病率腔镜组(4.3%)明显低于开腹组(12.5%),P0.05。腔镜组术后下床活动及肛门排气时间明显缩短,P0.05。术后两组妊娠率差异有统计学意义(P0.05),复发情况差异无统计学意义(P0.05),腔镜组妊娠及复发率在不同的术后处理方法之间差异无统计学意义(P0.05)。结论:腹腔镜在子宫内膜异位囊肿治疗中具有安全、有效、微创的特点;对于有生育要求者,术者若能彻底清除盆腔内膜异位病灶,术后可不用药。     

开腹与腹腔镜行子宫全切除术的临床效果对比分析

目的：比较开腹子宫全切术与腹腔镜子宫全切术的临床效果。方法：回顾分析2008年1月至2009年6月采用开腹或腹腔镜行子宫全切术92例,其中,腹腔镜子宫全切术54例（腹腔镜组）,开腹子宫全切术38例（开腹组）,比较两组手术时间、术中出血量、住院时间、术后恢复情况。结果：两组手术时间、术中出血量比较差异无显著性意义（P〉0．05）,术后镇痛药使用率（1．14％对88．3％）及术后病率（2．3％对19．04％）,腹腔镜组明显少于开腹组,两组比较差异有显著性意义（P〈0．05）,腹腔镜组术后排气（25．31±6．89）h、住院时间（4．83±0．81）d,与开腹组术后排气（34．15±7．46）h及住院时间（7．30±1．28）d相比,差异有显著性意义（均P〈0．05）。结论：腹腔镜子宫全切术术后恢复明显优于开腹子宫全切术术后恢复,随着腹腔镜技术和设备的不断发展与改进,腹腔镜妇科手术将逐渐取代传统的开腹手术。     

结肠癌腹腔镜与开腹手术近远期疗效临床对照研究

目的结肠癌主要由遗传及不良饮食习惯等因素引起,是常见的消化系统恶性肿瘤,腹腔镜结肠癌根治术以其微创性被广泛应用于临床。本研究对比分析腹腔镜结肠癌根治术与开传统腹手术治疗结肠癌近远期疗效。方法回顾性分析2012-03-01-2013-02-28郑州市第六人民医院收治的252例结肠癌患者的临床资料,根据手术方式不同分为腹腔镜组和开腹组,每组126例。腹腔镜组给予腹腔镜结肠癌根治术,开腹组采用传统开腹手术治疗,比较两组近期疗效和远期疗效。结果腹腔镜组手术时间为(199.37±14.29)min,低于开腹组的(173.76±15.29)min,t=13.736,P=0.034;腹腔镜组术中出血量为(93.28±11.35)mL,低于开腹组的(204.75±18.94)mL,t=56.668,P=0.017;腹腔镜组术后排气时间为(2.15±0.36)d,短于开腹组的(3.37±0.98)d,t=13.117,P=0.036;腹腔镜组下床活动时间为(80.37±8.45)h,短于开腹组的(107.62±11.38)h,t=21.580,P=0.024;腹腔镜组住院时间(8.62±1.34)d,短于开腹组的(11.78±2.56)d,t=12.276,P=0.038。腹腔镜组和开腹组术后并发症发生率为3.17%和4.76%,差异无统计学意义,χ2=0.417,P=0.519;腹腔镜组和开腹组局部复发率为1.59%和2.38%,差异无统计学意义,χ2=0.204,P=0.651;腹腔镜组和开腹组远处转移率为5.56%和4.76%,差异无统计学意义,χ2=0.081,P=0.776;腹腔镜组和开腹组转移复发率为7.94%和8.73,差异无统计学意义,χ2=0.052,P=0.820;腹腔镜组和开腹组3年生存率为42.63%和43.65%,差异无统计学意义,χ2=0.065,P=0.799;腹腔镜组和开腹组5年生存率为14.29%和15.08%,差异无统计学意义,χ2=0.032,P=0.859。结论腹腔镜结肠癌根治术可达到与开腹手术相当的近远期疗效,且具有创伤小、恢复快等优势。     

腹腔镜与开腹手术治疗子宫内膜癌临床疗效对比分析

目的:探究腹腔镜手术治疗子宫内膜癌的安全性、可行性及应用价值。方法:回顾分析2000年1月~2013年10月该院子宫内膜癌患者210例的病例资料,其中腹腔镜组(LH)160例,开腹组(AH)50例,对子宫内膜癌两种手术治疗方式的手术持续时间、术中出血量、清扫淋巴结个数、尿管保留时间、引流管保留时间、术后肛门排气时间、体温升高天数、拆线时间、术后住院时间等以及手术近期、远期并发症、复发率及死亡率做归纳总结和统计分析。结果:腹腔镜组手术时间为(162.0±42.0)min,开腹组为(195.2±47.9)min,两组差异有统计学意义(P<0.05)。腹腔镜组术中出血量为(172.4±105.3)ml,开腹组为(365.0±185.9)ml,腹腔镜组术中出血量明显少于开腹组(P<0.05)。腹腔镜组淋巴结清除个数为(19.15±8.13)个,开腹组为(13.03±6.75)个,两组具有明显差异(P<0.05)。腹腔镜组肛门排气时间分别为(2.0±0.6)天,开腹组为(2.5±0.5)天,腹腔镜组术后肛门排气时间短于开腹组(P<0.05)。腹腔镜组输尿管损伤、术中输血、肠梗阻、切口裂开、泌尿系感染等发生率明显低于开腹组,差异有统计学意义(P<0.05)。两组其他并发症发生率差异无统计学意义(P>0.05),两组复发率及死亡率差异无统计学意义(P>0.05)。结论:腹腔镜手术治疗子宫内膜癌优于开腹手术,可作为一种安全可行的治疗手段应用于临床。     

Self-reported health problems among Swedish miners one year after unemployment

Unemployment is considered to be a public health concern sincedeterioration in the health of the unemployed is often anticipated.However, for some groups, such as miners, unemployment mightimprove health due to a cessation of potentially harmful occupationalexposures. This study evaluates the health of 79 miners in oneSwedish iron-ore mine, and 226 age-matched controls from thegeneral population, during one year after the closure of themine. The participants received a questionnaire regarding medicalhistory and subjective symptoms at the beginning of the studyperiod, and after one year. Statistically significant negativeeffects on self-reported health attributable to unemploymentwere not found, although neuropsychiatric symptoms were morecommon among the unemployed miners. The miners reported a statisticallysignificant improvement in grip force (p=0.031). They had asignificantly higher prevalence of symptoms associated withmining related exposures when compared with the population controls;pain in the upper extremities [relative risk (RR)=2.27, 95%confidence interval (Cl)=1.44–3.59), back pain (RR=1.84;Cl=1.237–2.75), vasospastic disease of the fingers (RR=2.05;Cl=1.18–3.57) and obstructive respiratory symptoms (attacksof dyspnea and wheezing: RR=3.67; Cl=1.167–11.6).     

Excès de cas humains et animaux de tularémie en France au cours de l’hiver 2007–2008 : émergence ou phénomène isolé ?

Context

Tularemia is a zoonosis affecting humans and hares in France. We describe the results of surveillance in both species, in 2007 and 2008.

Methods

Human tularemia cases are mandatorily notifiable in France since 2003. In hares, surveillance relies on volunteer hunter associations in all districts of the country. Data from mandatory reports and volunteer surveillance in 2007/2008 were analyzed and compared with previous results.

Results

In 2007/2008, 144 cases were reported in humans and 117 cases in hares. This was a 100% increase compared to previous years. Human cases differed from those of previous years only by the frequency of contact with breeding animals. Human cases without any documented risk exposure were also more frequent.

Conclusion

An increase of tularemia cases occurred in 2007/2008 in both species. Complementary studies are needed to identify the species reservoir in France to understand the causes of this peak of cases.     

Occupational health hazards in mining: an overview

This review article outlines the physical, chemical, biological, ergonomic and psychosocial occupational health hazards of mining and associated metallurgical processes. Mining remains an important industrial sector in many parts of the world and although substantial progress has been made in the control of occupational health hazards, there remains room for further risk reduction. This applies particularly to traumatic injury hazards, ergonomic hazards and noise. Vigilance is also required to ensure exposures to coal dust and crystalline silica remain effectively controlled.     

Manufacture and use of nanomaterials: current status in the UK and global trends

This paper provides an overview of the production and use of nanomaterials (NMs), particularly in the UK. Currently, relatively few companies in the UK are identifiable as NM manufacturers, the main emphasis being the bulk markets in metals and metal oxides, and some niche markets such as carbon nanotubes and quantum dots. NM manufacturing in the UK does not reflect the global emphasis on fullerenes, nanotubes and fibres. Some assumptions have been made about the types of NM that are likely to be imported into the UK, which currently include fullerenes, modified fullerenes and other carbon-based NMs including nanotubes. Many university departments, spin-offs and private companies have developed processes for the manufacture of NMs but may only be producing small quantities for research and development (R&D) purposes. However, some have the potential to scale up to produce large quantities. The nanotechnology industry in the UK has strong R&D backup from universities and related institutions. This review has covered R&D trends at such institutions, and appropriate information has been added to a searchable database. While several companies are including NMs in their products, only a few (e.g. manufacturers of paints, coatings, cosmetics, catalysts, polymer composites) are using nanoparticles (NPs) in any significant quantities. However, this situation is likely to change rapidly. There is a need to collect more information about exposure to NPs in both manufacturing and user scenarios. As the market grows, and as manufacturers switch from the micro- to the nanoscale, the potential for exposure will increase. More research is required to quantify any risks to workers and consumers.     

Investigating clusters in the workplace and beyond

Clusters of disease are common and occur in the workplace and in the general community. They often arouse considerable concern among the population. Investigations have sometimes lead to exciting new knowledge, but in general the investigation of clusters is difficult and often unrewarding, especially for community clusters. In the workplace, investigations are more likely to find associations and even new causes, but still many clusters remain enigmatic. Despite this, there are many reasons for investigating clusters, including allaying community concern and identifying uncontrolled exposures. A structure for investigating clusters in the workplace is suggested.     

Assessing occupational and environmental exposure

Exposure assessment is a poorly understood component of the science of epidemiology. The relationship between exposure to chemicals and ill-health outcomes is often calculated using crude exposure measures such as ever/never exposed or duration. When investigating subtle effects, exposures need to be characterized much more fully in terms of intensity, frequency, duration and route. While occupational exposures tend to be much greater than those experienced from the wider environment there is a need to remember that, for many chemicals, exposure can occur occupationally, environmentally and through consumer use of products containing the material of interest. Inhalation exposure has generally been the traditional focus for most epidemiological investigations but there is now growing awareness of the importance of the dermal and ingested routes of contact and internalization. Quantification of the exposure also needs to be related to a biological mechanism of action and exposure metrics need to be selected accordingly. Occupational exposures can generally be measured using simple well-validated techniques. Environmental exposures require much more sensitive instruments and are more difficult to assess. Exposure modelling, particularly for the environmental fate of chemicals has undergone many recent developments and Monte Carlo techniques can be used to characterize model uncertainty and variability. This approach to exposure assessment can now be used in the setting of the wider environment and will enable a far better understanding of the relationship between exposure and disease.     

Mercury toxicity due to the smelting of placer gold recovered by mercury amalgam

A 19-year-old man developed tremor in both hands and fatigue after starting work at a placer gold mine where he was exposed to mercury-gold amalgam. Examination revealed an intention tremor, dysdiadochokinesis and mild rigidity. The 24-h urinary mercury concentration reached a peak of 715 nmol/l (143 ug/l) shortly before the clinical examination, after which he was removed from working in the gold room [Mercury No. Adverse Effect Level: 250 nmol/l (50 ug/l)]. On review 7 weeks later his tremor had almost resolved and the dysdiadochokinesis and rigidity had gone. The 24-h urinary mercury concentration had fallen to 160 nmol/l (32 ug/l). The principal exposure to mercury was considered to be the smelting of retorted gold with previously unrecognized residual mercury in it. The peak air concentration of mercury vapour during gold smelting was 0.533 mg/m3 (Mercury Vapour ACGIH TLV: 0.05 mg/m3 TWA). Several engineering and procedural controls were instituted. This episode occurred at another mine site, unrelated to Mount Isa Mines Limited.     

How Adults with Acquired Brain Damage Perceive Computer Training as a Rehabilitation Tool: A Focus-group Study

The aim of this study was to explore and describe how adult outpatients with acquired brain damage and referred to occupational therapy perceive computer training with the RehaCom programs, in order to evaluate the method of treatment as a tool in the rehabilitation of persons with cognitive disorders. By using focus-group discussions as a qualitative method of research when analysing the result, five themes with corresponding categories emerged, describing a development of understanding and learning about capacities. Themes describing how the participants could apply strategies to overcome shortcomings in daily occupations and the therapeutic role of the occupational therapist were identified as well. The result shows that a computer training program such as RehaCom can be used as an educational tool, for example, to guide a person who is trying to adopt compensatory strategies to avoid overload by taking pauses. It was found that anything the participants learned was also applicable to occupational performance in daily life.