腹腔镜手术联合药物治疗子宫内膜异位症的效果观察

目的观察腹腔镜手术联合药物治疗子宫内膜异位症的临床疗效。方法选取我院2013年4月~2014年7月收治的子宫内膜异位症患者84例,随机分为观察组和对照组各42例,对照组给予单纯腹腔镜手术治疗,观察组给予腹腔镜手术联合药物治疗,比较两组临床疗效。结果观察组的不良反应发生率为14.3%,对照组为9.5%,差异无统计学意义(P0.05);两组治疗后的雌二醇、CA125水平比较,观察组均明显低于对照组(均P0.05);治疗总有效率比较,观察组为95.24%明显优于对照组的73.81%,差异有统计学意义(P0.05)。经1年随访,观察组复发率为2.4%明显低于对照组的19.0%,差异亦有统计学意义(P0.05)。结论腹腔镜手术联合药物治疗子宫内膜异位症的疗效显著,可降低疾病复发风险,值得推广。     

腹腔镜手术联合药物治疗卵巢子宫内膜异位症疗效分析

目的探讨腹腔镜手术联合孕三烯酮治疗卵巢子宫内膜异位症的远期疗效及安全性。方法回顾性分析我院2008年8月-2009年12月收治的经腹腔镜手术的卵巢子宫内膜异位症患者78例,将术后给予孕三烯酮治疗的39例设为治疗组,单纯开腹手术治疗组39例设为对照组。所有患者随访1年以上,评价两组临床治疗效果。结果 LO组手术情况39例EM患者均成功完成手术。无一例转开腹手术。其手术时间、出血量、平均住院时间等与AO组相比差异有显著性（P〈0.05）,复发率分别为17.95%和20.51%,两者相比无统计学意义（P〉0.05）。结论腹腔镜术后联合孕三烯酮治疗卵巢子宫内膜异位症疗效确切,能降低复发率,提高受孕,且副反应小。     

腹腔镜诊断子宫内膜异位症并联合药物治疗不孕症157例分析

目的:探讨运用腹腔镜诊断子宫内膜异位症,并观察通过手术联合药物治疗子宫内膜异位症的临床疗效.方法:回顾性分析157例子宫内膜异位症患者腹腔镜手术联合药物治疗后的临床资料.结果:不同期别子宫内膜位异症患者术后联合用药后完全缓解率为84.7%,半年复发率为1.9%,半年妊娠率为59.2%.结论:子宫内膜异位症腹腔镜手术后联合用药可有效降低复发率,提高受孕率.     

子宫内膜异位症的药物治疗

子宫内膜异位症(EMS)是妇科常见病,近年来发病率逐年上升,仅次于子宫肌瘤。虽然为良性疾病,却表现为恶性行为,主要特征为疼痛、不孕及性交困难,导致生活质量下降。其治疗目的在于消除病灶、缓解疼痛和解决生育问题,降低术后复发也不可忽视,因此,药物治疗尤为重要,不同的药物有不同的作用机理、副作用及用药时间。不同的患者需要根据其治疗目的、身体情况及经济状况选择不同的治疗方案。所以药物治疗应注意个体化、阶梯化和规范化。本文就近年来内异症的药物治疗做一综述。     

戈舍瑞林联合内分泌药物对绝经前晚期乳腺癌患者疗效评估

目的:研究戈舍瑞林联合内分泌药物对绝经前晚期乳腺癌患者疾病进展的作用效果及生存率的影响作用。方法:回顾性分析绝经前晚期乳腺癌患者157例,其中78例住院期间服用戈舍瑞林作为对照组,79例采用戈舍瑞林联合内分泌药物治疗作为治疗组;对比两组患者住院期间的疾病进展状况及生存率情况。结果:两组患者标准治疗过程中数据资料比较不存在差异性(P0.05);治疗后,治疗组患者疾病进展情况明显高于对照组,在不同时间段内组间比较差异有统计学意义(P0.05);随访一年结果显示患者复发、生活质量及死亡例数情况组间对比,其中复发、生活质量为优及死亡例数情况组间比较差异均有统计学意义(P0.01)。结论:戈舍瑞林结合内分泌药物对于绝经前晚期乳腺癌患者的疾病进展具有良好的控制作用。     

腹腔镜联合促性腺激素释放激素激动剂治疗子宫内膜异位症伴不孕症的疗效观察

目的:探讨腹腔镜联合促性腺激素释放激素激动剂治疗子宫内膜异位症伴不孕症的疗效。方法:将我院2013年2月~2014年2月收治的200例子宫内膜异位症伴不孕症患者随机分为2组各100例,对照组采用曲普瑞林治疗,观察组采用腹腔镜联合曲普瑞林治疗,检测患者治疗前后血清雌二醇(E2)、癌胚抗原125(CA125)及基质金属蛋白酶-1(MMP-1)水平,对比两组治疗后疼痛视觉评分(VAS)、盆腔包块和用药停止后月经恢复情况、随访1年记录两组复发率及妊娠率。结果:治疗后观察组VAS评分、盆腔包块和月经恢复情况均明显优于对照组,差异有统计学意义(P0.05);两组患者血清CA125、E2及MMP-1水平均显著下降,且观察组下降更明显,差异有统计学意义(P0.05);随访1年后,观察组妊娠率明显高于对照组,复发率明显低于对照组,差异有统计学意义(P0.05)。结论:腹腔镜联合促性腺激素释放激素激动剂治疗子宫内膜异位症的疗效显著,能有效降低复发率、提高妊娠率,值得临床推广应用。     

米非司酮治疗子宫内膜异位症疗效的临床研究

目的:研究米非司酮治疗子宫内膜异位症的疗效及副反应。方法:选择94例卵巢子宫内膜异位症患者,采用随机抽样的方法分为米非司酮组(简称米组)和内美通治疗组(简称内组),米组46例,内组48例。利用t检验和x~2检验。结果:米组有效率为91．42%,内组有效率为43．75%,二者比较,P＞0．05,差别无统计学差异;而副反应米组明显低于内组,体重增加米组为15．00%,内组为43．75%,二者比较,P＜0．01,说明存在统计学差异;谷丙转氨酶(ALT)异常米组为4．40%,内组为25．00%,二者比较,P＜0．05,存在统计学差异。结论:米非司酮治疗卵巢子宫内膜异位症与内美通具有相同的疗效,副反应明显低于内美通。     

腹腔镜手术联合孕三烯酮治疗卵巢子宫内膜异位症的临床观察-108例分析

目的:探讨腹腔镜手术联合孕三烯酮治疗卵巢子宫内膜异位症的远期疗效及安全性.方法:随机选择2003.08～2004.12我院经腹腔镜手术诊断的卵巢子宫内膜异位症患者108例(1例失访已除外),将术后给予孕三烯酮治疗的58例设为研究组,未给予的50例设为对照组.研究组于术后第一次月经后开始服用孕三烯酮2.5mg,每周两次,连用3-6个月.对照组不用药.所有患者随访6个月～3年观察疗效.结果:两组患者均通过腹腔镜完成手术,随访率99.08%,研究组与对照组的总有效率分别为86.21%和64.00%,两组相比差异有显著性(P＜0.01),复发率分别为10.34%和31.25%,两者相比有统计学意义(P＜0.01).34例不孕及要求妊娠者共有18例受孕.结论:腹腔镜术后联合孕三烯酮治疗卵巢子宫内膜异位症疗效确切,能降低复发率,提高受孕,且副反应小.     

腹腔镜联合促性腺激素释放激素激动剂治疗子宫内膜异位症伴不孕症的疗效观察

目的:探讨腹腔镜与促性腺激素释放激素激动剂(Gn RH-a)联合治疗子宫内膜异位症(EMS)伴不孕症的临床疗效。方法:选择2012年1月~2014年12月期间我院收治的108例EMS伴不孕症患者作为研究对象,随机分为研究组与对照组,每组各54例。对照组患者采用腹腔镜治疗,研究组在此基础上于术后应用达菲林治疗。两组均行宫腔镜检查,观察两组临床疗效,1年内的妊娠率、复发率及两组患者治疗前后血浆雌二醇(E2)及卵泡刺激素(FSH)水平变化。结果:研究组治疗总有效率为98.15%,显著高于对照组的85.19%(P0.05);两组1年内复发率对比差异无统计学意义(P0.05);研究组1年内妊娠率为55.56%,高于对照组的27.78%(P0.05)。研究组治疗后E2、FSH显著低于对照组及治疗前(P0.05)。结论:腹腔镜联合Gn RH-a治疗EMS伴不孕症应用效果显著,可以有效改善患者的临床症状,提高妊娠率。     

醋酸亮丙瑞林对子宫内膜异位症患者血清雌二醇、孕酮及黄体生成素水平的影响

目的:研究醋酸亮丙瑞林对子宫内膜异位症患者血清雌二醇、孕酮及黄体生成素水平的影响。方法:选取2016年10月至2017年9月我院收治的84例子宫内膜异位症患者,根据患者入院顺序分为观察组和对照组,每组42例。观察组使用醋酸亮丙瑞林治疗,对照组使用炔雌醇环丙孕酮片。比较两组患者的临床疗效,治疗前后痛经评分、血清雌二醇、孕酮、黄体生成素、TGF-β、IL-4、IL-10、IL-17水平的班花及不良反应的发生情况。结果:治疗后,观察组临床总有效率显著高于对照组[90.48%(38/42) vs.64.29%(27/42)](P0.05)。两组患者治疗后痛经评分、雌二醇、孕酮、黄体生成素、TGF-β、IL-4及IL-10水平均较治疗前显著降低(P0.05),且观察组以上指标均明显低于对照组(P0.05)。两组患者治疗后血清IL-17水平及不良反应发生率与治疗前相比均无明显差异(P0.05)。结论:与炔雌醇环丙孕酮片相比,醋酸亮丙瑞林能有效提高子宫内膜异位症患者的临床疗效,降低其血清雌二醇、孕酮及黄体生成素水平,改善患者的痛经情况,且安全性较高。     

子宫内膜异位症患者免疫调节Th17细胞及Treg细胞的表达意义

目的探究子宫内膜异位症患者免疫调节Th17细胞及Treg细胞的表达意义。 方法选取2017年1月至2018年12月青岛大学附属医院收治患有子宫内膜异位症的患者,为子宫内膜异位组（EMT组）,选取同一时期在医院因不孕不育进行腹腔镜检查的患者,为正常组（NM组）,两组分别56例。EMT组和NM组患者在一般资料上差异无统计学意义。通过流式细胞仪、HE染色法、qRT-PCR法、ELISA法分析EMT组和NM组患者Th17、Treg细胞所占比例、子宫内膜组织病变情况、ROR-γt、Foxp3 mRNA表达含量的差异性来探究子宫内膜异位症患者Th17细胞及Treg细胞变化。实验结果用 ±s表示,并采用独立样本t检验进行比较。 结果EMT组患者CD4⁺ T细胞中Th17所占比例为5.48±2.81,Treg所占比例为4.22±1.04,NM组Th17所占比例为2.34±1.01,Treg所占比例为6.14±1.52,差异均有统计学意义（t = 7.869,3.015,P = 0.014,0.026）。EMT组患者血清中IL-17水平为（256.38±34.15）?pg/ ml、IL-22为（67.48±10.89）?pg/ml,NM组患者血清中IL-17水平为（198.04±27.59）?pg/ml、IL-22为（43.78±6.92）?pg/ml,差异均有统计学意义（t = 9.944,4.689,P = 0.008,0.017）。EMT组患者血清中IL-10水平为（18.56±4.77）?pg/ml、TGF-β为（148.28±40.52） pg/ ml,NM组患者血清中IL-10水平为（28.35±6.07）pg/ml、TGF-β为（204.78±19.87）pg/ml,差异均有统计学意义（t = 9.491,2.849,P = 0.012,0.034）。EMT组患者子宫内膜组织形态不规则,多数细胞不完整,破损或缺失,且炎性细胞增多,在其周围聚集。NM组患者子宫内膜组织形态规则,细胞没有明显破损或缺失,未见细胞周围炎性因子增多。qRT-PCR检测结果显示,EMT组和NM组ROR-γ mRNA分别为2.89±0.76、1.71±0.26,EMT组和NM组Foxp3 mRNA分别为2.25±0.34、1.13±0.18,两组差异均有统计学意义（t = 10.996,6.759,P = 0.006,0.011）。 结论子宫内膜异位症患者外周血免疫调节细胞Th17/Treg平衡失调,免疫调节紊乱与子宫内膜异位发生、发展有密切关系。     

卵巢巧克力囊肿腹腔镜结合中药治疗的临床观察

目的:探讨卵巢巧克力囊肿患者行腹腔镜囊肿剥除手术后中药治疗的效果.方法:对90例卵巢巧克力囊肿患者随机分两组:第一组对照组,单纯腹腔镜治疗;第二组研究组,腹腔镜术后中药治疗.两组治疗后均随访临床症状、复发情况、监测血清CA125水平以及妊娠情况.结果:两组间比较,对照组症状消失或改善的总有效率为82.2%,囊肿复发率为40.O%,血清CA125的转阴率为55.3%,妊娠率32.13%;研究组症状消失或改善的总有效率为100%,囊肿复发率为13.3%,血清CA125的转阴率为95.1%,妊娠率72.7%.二组比较,研究组的术后治疗总有效率和复发率均明显低于对照组(P＜0.01),研究组血清中CA125转阴率明显高于对照组(p＜0.01),研究组治疗后的妊娠率高于对照组(p＜0.01).三项指标的差异均有显著性.结论:腹腔镜术后结合中药可有效治疗卵巢巧克力囊肿.     

Retraction Note: Oxycodone versus morphine for analgesia after laparoscopic endometriosis resection

This case demonstrates the severe electrolyte derangements that may present after a common therapy such as a bowel preparation for an outpatient procedure and the rare yet potential detrimental outcomes of those abnormalities. It also highlights the implications of long QT syndrome regarding pharmacology and treatment. We present a case of 48 year-old female with severe electrolyte derangements and long QT syndrome (LQTS) leading to Torsades de Pointes (TdP), pulseless ventricular fibrillation, and unsynchronized defibrillation in the post anesthesia care unit (PACU) after uneventful upper and lower endoscopy. This led to an unanticipated intensive care unit admission for aggressive electrolyte repletion, cardiology consultation, and implantable cardioverter defibrillator (ICD) placement. This is a rare presentation after an outpatient procedure that would have had a detrimental outcome if not promptly diagnosed and treated appropriately. Therefore, we aim to provide further insight into the diagnosis and treatment of severe hypokalemia and long QT syndrome resulting in Torsades de Pointes and ventricular fibrillation.     

腹腔镜手术联合微生态制剂对结直肠癌患者肠道菌群和肠道屏障功能的影响

目的观察腹腔镜手术联合微生态制剂对结直肠癌患者肠道菌群和肠道屏障功能的影响,为临床治疗提供依据。方法选择我院2016年12至2018年12月收治的84例结直肠癌患者为研究对象。入选患者分为观察组和对照组。观察组患者采用腹腔镜手术联合口服益生菌治疗,对照组患者单纯采用腹腔镜手术治疗。比较两组患者术后恢复情况、并发症情况、肠道菌群变化和肠道屏障功能。结果观察组患者第1次完全进食时间、术后住院总时间(d)均短于对照组(9.54±0.52 vs 11.56±0.24、11.61±2.14 vs 14.94±3.65,P<0.05);观察组患者术后并发症总发生率低于对照组(9.5%vs 28.6%,P<0.05)。观察组患者术后第1次排便时肠道乳杆菌、双歧杆菌数量(lg CFU/g)大于对照组(7.21±0.35 vs 6.78±0.21、7.12±0.23 vs 6.84±0.25,P<0.05),大肠埃希菌、球杆菌数量低于对照组(8.12±0.56 vs 9.55±0.54、8.24±0.24 vs 8.85±0.25,P<0.05)。观察组患者术后第15天肠道乳杆菌、双歧杆菌数量大于对照组(9.51±0.56 vs 8.21±0.45、9.61±0.44 vs 7.85±0.23,P<0.05),大肠埃希菌、球杆菌数量低于对照组(7.22±0.36 vs 9.15±0.35、7.68±0.54 vs 8.25±0.55,P<0.05)。观察组患者术后第15天粪便sIgA水平(mg/g)大于对照组(1.21±0.13 vs 1.05±0.14,P<0.05);血清D-乳酸、尿L/M水平(μg/mL)低于对照组(5.48±0.85 vs 0.62±0.54、3.24±0.28 vs 2.68±0.54,P<0.05)。结论腹腔镜手术联合益生菌制剂可纠正并改善结直肠癌患者术后肠道微生态失调,修复并增强肠道屏障功能。     

Anesthetic implications of laparoscopic surgery

Minimally invasive therapy aims to minimize the trauma of any interventional process but still achieve a satisfactory therapeutic result. The development of "critical pathways," rapid mobilization and early feeding have contributed towards the goal of shorter hospital stay. This concept has been extended to include laparoscopic cholecystectomy and hernia repair. Reports have been published confirming the safety of same day discharge for the majority of patients. However, we would caution against overenthusiastic ambulatory laparoscopic cholecystectomy on the rational but unproven assumption that early discharge will lead to occasional delays in diagnosis and management of postoperative complications. Intraoperative complications of laparoscopic surgery are mostly due to traumatic injuries sustained during blind trocar insertion and physiologic changes associated with patient positioning and pneumoperitoneum creation. General anesthesia and controlled ventilation comprise the accepted anesthetic technique to reduce the increase in PaCO2. Investigators have recently documented the cardiorespiratory compromise associated with upper abdominal laparoscopic surgery, and particular emphasis is placed on careful perioperative monitoring of ASA III-IV patients during insufflation. Setting limits on the inflationary pressure is advised in these patients. Anesthesiologists must maintain a high index of suspicion for complications such as gas embolism, extraperitoneal insufflation and surgical emphysema, pneumothorax and pneumomediastinum. Postoperative nausea and vomiting are among the most common and distressing symptoms after laparoscopic surgery. A highly potent and selective 5-HT3 receptor antagonist, ondansetron, has proven to be an effective oral and IV prophylaxis against postoperative emesis in preliminary studies. Opioids remain an important component of the anesthesia technique, although the introduction of newer potent NSAIDs may diminish their use. A preoperative multimodal analgesic regimen involving skin infiltration with local anesthesia. NSAIDs to attenuate peripheral pain and opioids for central pain may reduce postoperative discomfort and expedite patient recovery/discharge. There is no conclusive evidence to demonstrate clinically significant effects of nitrous oxide on surgical conditions during laparoscopic cholecystectomy or on the incidence of postoperative emesis. Laparoscopic cholecystectomy has proven to be a major advance in the treatment of patients with symptomatic gallbladder disease.     

Teaching laparoscopic surgery: the need for guidelines.

There is a risk that minimally invasive surgery will fall into disrepute unless adequate steps are taken to reassure the public. Some form of accreditation after a recognised training scheme would go a long way towards allaying these fears. The cost of training surgeons must be addressed. Adequate training will probably pay dividends in reduced litigation. The royal colleges should be responsible for maintaining standards of teaching on recognised courses, setting criteria for accreditation, and supervising a national audit of all laparoscopic procedures.     

Hand-assisted laparoscopic surgery versus laparoscopic right colectomy: a meta-analysis

Objective

The objective of this study is to systematically assess the clinical efficacy of hand-assisted laparoscopic surgery (HALS) and laparoscopic right colectomy (LRC).

Methods

The randomized controlled trials (RCTs) and non-RCTs were collected by searching electronic databases (Pubmed, Embase, and the Cochrane Library). The outcomes included intraoperative outcomes, postoperative outcomes, postoperative morbidity, and oncologic outcomes. Meta-analysis was performed using of RevMan 5.3 software.

Results

A total of five studies involving 438 patients were finally included, with 202 cases in HALS group and 236 cases in LRC group. Results of meta-analysis showed that there was no statistical difference between HALS and LRC in terms of conversion rate, length of hospital stay, reoperation rate, postoperative morbidity, and oncologic outcomes. The operative time was 6.5 min shorter in HALS group; however, it was not a clinically significant difference. Although the incision length was longer in HALS, it did not influence the postoperative recovery.

Conclusions

HALS can be considered an alternative to LRC which combines the advantages of open as well as laparoscopic surgery.

     

瑞芬太尼与舒芬太尼复合异丙酚静脉麻醉在妇科腹腔镜手术的效果比较

目的:比较舒芬太尼、瑞芬太尼在妇科腹腔镜手术麻醉中的优越性.方法:60例行妇科腹腔镜手术的病人随机分成舒芬太尼组(S组):舒芬太尼+异丙酚,瑞芬太尼组(R组):瑞芬太尼+异丙酚.记录病人麻醉诱导前、麻醉诱导时、气管插管后即刻、气腹前、气腹(CO2压力达12cmH2O)后1、30、60min以及拔除气管导管后5min的SBP、DBP、HR、PErCO2;并观察记录病人术毕的清醒恢复时间及术后疼痛、恶心、呕吐的情况.结果:R组在麻醉诱导时、气管插管以及拔除气管导管后5min血液动力学变化较S组明显(p＜0.05或0.01),R组术后意识恢复时间和拔管时间明显早于S组(p＜0.05),S组术后疼痛的发生率明显少于R组(p＜0.05).恶心、呕吐的发生率无明显差异.结论:舒芬太尼在妇科腹腔镜手术麻醉中与瑞芬太尼比较在麻醉诱导时及术毕气管拔管时具有较高的血流动力学稳定性,在麻醉过程中的平稳性二者无显著差异,舒芬太尼在术后疼痛控制方面优于瑞芬太尼,而瑞芬太尼在术后意识恢复上优于舒芬太尼.