非脱垂子宫经腹、阴式全切除术临床比较

目的 探讨非脱垂子宫经阴道与经腹全切术的临床比较。方法 2000年5月～2001年1月对阴式子宫全切术 (TVH)28例及腹式子宫全切术 (TAH)35例分为两组进行手术 ,对临床指标进行观察比较。结果 28例TVH手术均成功。平均重量255g(120～510g)。与TAH手术比较 ,其术后病率、肛门排气时间及术后住院天数有显著性差异 ( p<0.001及 p<0.05) ,但其手术时间及术中出血量无显著性差异 ( p>0.05)。结论 随着微创手术的开展 ,利用阴道天然孔道 ,经阴道切除较大的子宫是有效和安全的 ,手术的成功与术者经验、技术及子宫活动度有关 ,有合适器械也是手术成功的因素。     

Motor blockade associated with continuous epidural infusion after abdominal hysterectomy: a randomized controlled trial comparing 0.1% ropivacaine-plus-fentanyl versus 0.2% ropivacaine-alone

We compared rates of motor blockade, analgesia, adverse effects and patient satisfaction of 0.1% ropivacaine+fentanyl versus 0.2% ropivacaine-alone in a randomized, controlled trial. Fifty-four women who had undergone abdominal hysterectomy were randomly allocated into two groups to receive an epidural block at L_1–2 or L_2–3: group R received 0.2% ropivacaine-alone and group RF received 0.1% ropivacaine plus 2 μg fentanyl/ml, both at 8 ml/h. Rescue analgesia was provided via a morphine-loaded PCA device. Motor blockade (using a modified Bromage scale), pain intensity (visual analogue scale (VAS)), morphine consumption, level of sensory blockade and adverse effects, were measured at 4, 8 and 21 h after infusion. Patient satisfaction with pain management was assessed at the end of the study. The rates of motor blockade were not different at 8 h after infusion but at 21 h, group RF had significantly less motor blockade than group R. There were no differences in VAS, level of sensory blockade, adverse effects and patient satisfaction. Morphine consumption at each measurement was comparable but the total amount used by group RF was less than group R (12 mg versus 20 mg, P=0.049). Therefore, 0.1% ropivacaine with fentanyl 2 μg/ml appears to offer advantages over 0.2% ropivacaine-alone.     

Minilaparotomy for type II and III radical hysterectomy: technique, feasibility, and complications

The objective was to assess the feasibility, the operative and postoperative outcome, and complications in the use of minilaparotomy for type II and III radical hysterectomy (RH) and pelvic lymphadenectomy (PLN) in early-stage cervical/endometrial cancer. A pilot study on 91 consecutive patients submitted to type II and III RH and PLN for early-stage cervical/endometrial cancer was performed between March 2002 and May 2003 in the Division of Gynecologic Oncology (UCSC, Rome). Thirty-two of 91 cases (35.2%) were eligible for minilaparotomy. The mean operative time was 156.7 min, whereas the mean intraoperative estimate of blood loss was 303.7 ml. A mean number of 32.7 pelvic lymph nodes and 6.2 common iliac nodes were removed. Ileus and removal of bladder catheter were on mean postoperative day 2.4 and 3.4, respectively. The mean number of postoperative days spent in the hospital was 3.7. Intra- and postoperative parameters were compared to laparotomy controls and literature data on laparoscopy and Pfannenstiel incision, showing substantially comparable results. Minilaparotomy is acceptable for selected patients undergoing radical abdominal hysterectomy (RAH) and PLN and does not compromise the adequacy of the procedure. It can be considered as an alternative to the classic midline vertical incision or even to the Pfannenstiel incisions and laparoscopy.     

子宫切除术对生存质量的影响

目的：研究子宫切除术对生存质量的影响。方法：对108例因良性疾病而行腹式子宫切除术者进行前瞻性队列研究，术前及术后3，6，12个月进行调查问卷，观察症状、泌尿及胃肠功能、性功能、心理状况、社会生活状态的变化。结果：子宫切除术后3个月症状、压抑、焦虑程度减轻，社会生活状态显著提高，泌尿及胃肠功能、性功能无改变，这些改善持续至术后12个月。结论：子宫切除术可有效缓解妇科良性疾病所产生的症状，症状的缓解有利于改善生存质量。大多数因妇科良性疾病而行腹式子宫切除术的妇女，在术后1年，生存质量提高。     

A mild case of nesidioblastosis with diagnostic and therapeutic difficulty

A female infant with nesidioblastosis who showed mild clinical symptoms is reported. In this patient, insulin levels and insulin to glucose ratios (IRI/G) were often normal. Regular milk feedings supplemented with continuous glucose infusion (0.7-2 mg/kg per min) or oral glucose feedings (4.5 mg/kg per min) prevented hypoglycemia. As leucine-sensitivity was diagnosed at 2 months of age, she was started on diazoxide. This was, however, ineffective, and adverse effects appeared. Subtotal pancreatectomy (95%) was therefore attempted at 5 months of age, and persistent normoglycemia as well as normal growth and development followed up to 3 years after the operation. The pancreas showed characteristic signs of nesidioblastosis. The above clinical observation suggests that a patient with nesidioblastosis whose blood glucose level is easily controllable may develop an unexpected episode of hypoglycemia in the presence of a leucine sensitivity. In such a patient, diazoxide or, when it is of no avail, surgical intervention should promptly be instituted to prevent possible neurologic sequelae induced by hypoglycemia.     

腹腔镜辅助阴式子宫切除术与经腹子宫切除术的前瞻性随机对照研究

目的　比较评估腹腔镜辅助阴道子宫切除术与经腹子宫切除术两种手术的临床效果。方法　 12 0例妇科良性疾病患者需行子宫切除术 ,但有经阴道子宫切除术的相对禁忌证、子宫不超过孕 16周 ,随机分成两组 ,甲组 (6 0例 )行腹腔镜辅助阴式子宫切除术 ,乙组 (6 0例 )行经腹子宫切除术。结果　两组患者年龄、产次、术前血红蛋白水平、子宫平均重量、术中失血、手术时间的差异无显著性 (P >0 .0 5 )。甲组术后疼痛程度、术后住院时间明显少于乙组 (P <0 .0 1) ,两组均未出现严重手术并发症。结论　腹腔镜辅助阴式子宫切除术具有创伤小、恢复快、住院时间短等优点 ,妇科医师经过良好的腹腔镜手术操作技能培训 ,能对大部分原不宜行阴式子宫切除术而需行经腹子宫切除术的患者行腹腔镜辅助阴式子宫切除术。     

腹腔镜下子宫切除术

目的：探讨腹腔镜下子宫切除术的临床应用价值；方法：2002年1月--12月我院对腹腔镜下子宫切除术30例患者进行回顾性分析；结果：其中腹腔镜辅助下的阴式子宫全切术(LAVH)2例，鞘膜内子宫切除术(CISH)8例，腹腔镜下子宫次全切除术(LSH)20例，手术均获成功；结论：腹腔镜下子宫次全切除术是目前妇科最常见的术式之一，从保留器官的功能出发，LSH术式更优于CISH。腹腔镜手术因其创伤小、恢复快、住院时间短等优点，深受患者的认同。     

子宫体三角形切除术的临床应用

目的:探讨子宫体三角形切除术的临床价值。 方法 :对子宫体三角形切除术组、子宫次全切除术组各6 4例进行回顾性分析。结果:两组的手术时间、出血量、术后排气时间等比较 ,差异无统计学意义 (P >0 .0 5 ) ,但子宫体三角形切除术组术后有少量月经。两组在性生活质量及更年期症状方面差异有统计学意义 (P <0 .0 1)。子宫体三角形切除术组的血清性激素水平手术前 FSH(7.0 5± 1.10 ) IU/ L、E2 (5 6 .4 0± 1.12 ) pm ol/ L,手术后 FSH(6 .88± 1.12 ) IU/ L、E2 (5 6 .2 8± 1.15 ) pm ol/ L,手术前后比较差异无统计学意义 (P >0 .0 5 )。子宫次全切除术组血清性激素水平手术前 FSH(5 .98± 1.15 ) IU/ L、E2 (5 6 .2 2± 1.10 ) pmol/ L,手术后 FSH(10 .6 6± 1.18) IU/ L、E2(47.4 5± 1.2 0 ) pmol/ L,手术前后比较差异有统计学意义 (P<0 .0 5 )。 结论:子宫体三角形切除术术式具有操作简单、易于掌握、不影响卵巢功能、术后恢复快等优点 ,能满足患者既去除疾病又保留子宫的生理和心理需要     

大鼠肝抑素样提取物的生物效应初探

从大鼠肝分离出小分子蛋白质,注入肝大部切除的大鼠体内。术后24h制备肝细胞悬液及骨髓细胞悬液,用流式细胞计测定细胞DNA含量。结果:①实验组大鼠每克体重注入肝提取物10～300μg,一致呈现4n肝细胞DNA复制受阻于G_1期,各类肝细胞数与正常大鼠的相似;②对照组大鼠,4n肝细胞由正常的68.1％降至30.9％,8n肝细胞由6.3％骤增至25.3％,并出现16.8％的4n～8n间8期肝细胞;③两组大鼠的骨髓细胞DNA含量均无变化。表明肝提取物中含有肝抑素样物质,它特异性地使再生肝的4n肝细胞增殖周期阻滞于G_1期及S早期。     

Effects of epidural bupivacaine and epidural morphine on bowel function and pain after hysterectomy

A comparison was made of the effects of continuous epidural analgesia with bupivacaine and intermittent epidural morphine on bowel function after abdominal hysterectomy. The duration of postoperative ileus was assessed as the time from the end of operation to the first postoperative passage of flatus and feces. Twenty-two patients were randomly allocated to two equal groups. An "epidural morphine" group received general anesthesia and epidural morphine for postoperative pain relief, and an "epidural bupivacaine" group was given combined general anesthesia and epidural anesthesia with 0.5% bupivacaine intraoperatively and epidural analgesia with 0.25% bupivacaine postoperatively. Epidural morphine or bupivacaine was given for 42 h postoperatively. Pain intensity (visual analog scale) was low in both groups, but lower (P less than 0.05) in the epidural bupivacaine group. The time to first passage of flatus was 22 +/- 16 h in the epidural bupivacaine group and 56 +/- 22 h in the epidural morphine group (P less than 0.001). The time to first postoperative passage of feces was shorter (P less than 0.05) in the former than in the latter 57 +/- 44 h vs 92 +/- 22 h). The patients of the epidural bupivacaine group started intake of oral fluids earlier (P less than 0.01) and to a greater extent (P less than 0.05) than those in the epidural morphine group. It is concluded that the duration of postoperative ileus after hysterectomy is shorter when epidural bupivacaine is given for postoperative pain relief than when this is achieved by epidural morphine.