音乐疗法在泌尿腔镜手术中的应用

目的 探讨音乐疗法在泌尿腔镜手术中的应用效果.方法 将202例拟行泌尿腔镜手术的患者随机分为音乐组102例,对照组100例.通过术前访视护士了解患者对音乐的喜好,音乐组患者在进入手术室后戴上耳机倾听轻松柔美的音乐,对照组则采用常规手术室护理.观察2组患者术中血压、心率、疼痛程度及术后恢复情况.结果 音乐组患者术中血压、心率、疼痛程度及紧张焦虑情况,与对照组相比较好,具有统计学差异(p<0.05).结论 音乐疗法作为术中护理干预措施,能有效降低手术患者的紧张、焦虑情绪,减轻患者术中疼痛,有利于手术顺利进行.     

乳癖舒胶囊治疗乳腺增生病

近年来,笔者采用千禾药业有限责任公司生产的乳癖舒胶囊治疗乳腺增生病60例,获效满意,现报告如下: 一般资料:本组60例患者,年龄最大48岁,最小27岁,均为已婚患者.其中27～30岁10人,41岁～48岁50人.病程最长者为3年以上,病程最短者为半年.在临床上均能在乳腺内触到肿块,均有乳房胀痛或刺痛,均为单纯乳腺上皮增生症.     

乳癖汤治疗妇科乳腺增生186例

乳腺增生是妇科常见病之一,随着生活节奏不断加快,女性所承受的精神压力也不断加大,该病近年呈多发趋势.笔者自2000年1月-2011年5月,以自拟乳癖汤治疗本病,收到较好疗效,报道如下.     

30例腔镜下甲状腺手术术前及术后的护理

甲状腺疾病常见于女性,传统的甲状腺手术由于颈部留有手术瘢痕,切断皮神经而导致术后颈部不适、感觉异常等,给女性患者造成很大的心理负担.近年随着微创外科技术的推广应用,腔镜下甲状腺切除术解决了这一难题,由于其具有创伤小、痛苦小、以及在颈部等暴露位置不会留下手术瘢痕的特点[1],而深为患者所接受.2009年2月~2011年7月对本科的30例腔镜下甲状腺手术患者进行了有效的护理干预,为手术的成功提供重要保证[2],现报道如下.     

腔镜设备及器械的管理体会

目的:为保证腔镜手术的质量,加强腔镜设备及器械的管理.方法:总结腔镜设备及器械的管理和经验.结果:无人为造成仪器设备损坏,手术配合顺利.     

腔镜下甲状腺切除术的术中护理配合

总结了35例腔镜下甲状腺切除术的术中护理配合要点和经验.包括术前准备和术中配合2个方面,认为充分的术前准备和积极主动的术中医护默契配合,是确保腔镜下甲状腺切除术顺利进行的关键.     

32例腔镜下乳腺癌改良根治术加腋窝淋巴结清扫治疗乳腺癌的手术配合

总结了32例腔镜下乳腺癌改良根治术加腋窝淋巴结清扫治疗乳腺癌的手术配合,主要包括术前准备、术中配合、术后处理.手术时间平均为62min,术中出血小于50ml,无皮下气肿、血肿及感染发生.术后疼痛轻微.术后8～10d出院,患者对美容效果较满意.提示腔镜下乳腺癌改良根治术加腋窝淋巴结清扫治疗乳腺癌具有创伤小、术后并发症少、美容效果肯定、术后疼痛轻、恢复快等优点,良好的心理护理和充分的术前准备、熟练的术中配合是保证手术成功的重要环节.     

门诊乳腺疾病患者的心理反应及护理

总结了门诊乳腺病患者的心理反应,并有针对性地制定出护理对策.待诊患者的心理反应主要包括侥幸、焦虑与抑郁、悲观与绝望、恐惧、害羞等等.主要措施是运用各种宣教方法,针对不同时期的心理反应,制定相应的护理对策,解除患者的心理问题,患者的心理障碍消除,积极地配合治疗.认为心理护理能提高患者的生存质量,使更多的乳腺患者身心和谐、完满、健康地回归社会.     

经皮肾镜取石法治疗肾结石的临床效果观察

目的:对经皮肾镜取石治疗肾结石的临床效果及并发症等进行记录观察.方法:选取30例经皮肾镜治疗肾结石的患者,分析结石取尽率、手术时间、出血量、并发症及住院时间的情况.结果:一次性结石取尽26例,二次结石取尽4例,次结石取尽率为86.7%.手术时间平均为85min,术中出血量平均为130ml,未出现严重的并发症,术后平均住院时间为8d.结论:经皮肾镜取石法治疗肾结石,疗效确切,创伤较小,恢复较快,是临床值得推广的一种方法.     

Immunological and side effects of low sc recombinant interleukin-2 dose in addition to conventional treatment in relapsed breast and colorectal cancer patients

Thirteen relapsed cancer patients, four of them operated for colorectal and the nine remaining for breast cancer, were cyclically given low subcutaneous (sc) recombinant interleukin-2 (rIL-2) doses in addition to chemo- or hormone therapy. Cycle intervals were 2 or 6 weeks in length, and the number of cycles ranged from one to 14 and from one to six respectively. Tolerance assessed by clinical and laboratory data, eosinophils, lymphocytes (total number), T subpopulations, B lymphocytes and NK cells were the evaluated parameters. One (7.6%) of the 13 studied patients interrupted the first low dose sc rIL-2 cycle due to a hypersensitive reaction. This case showed relapse from breast cancer. During further cycles, three patients (25%), one operated on for colorectal and two others for breast cancer of the 12 remaining cases who completed all rIL-2 cycles showed an increase in glutamic oxaloacetic transaminase (GOT), glutamic pyruvic transaminase (GPT), gamma-gt, and creatininemia without any clinical symptoms. A slight influenza-like syndrome and 10-20 mmHg decrease in blood pressure sporadically occurred in all patients under rIL-2 therapy. In both cancer types, a significant (P < 0.05 - P < 0.001) increase in lymphocytes, eosinophils. T4 and T3 subpopulations but not in T8 subpopulations and NK cells occurred at the end of the rIL-2 cycles. In 11 of the 13 patients responsive to conventional therapy, a highly significant increase (P < 0.001) in all parameters apart from B lymphocytes and T4/T8 ratio was observed, while in three cases which were no longer responsive and in another case which had never been responsive to conventional therapy, a slightly significant increase in eosinophils only occurred (P < 0.05). Three colorectal cancer patients showed a partial response and the last a complete response to conventional therapy. In these four patients, time to progression during rIL-2 cycles ranged from 2.5-5 months and the duration of response ranged from 8-19 months. In seven of the eight breast cancer patients who completed all rIL-2 cycles, the response ranged from 3-51+ months and in the last case, which was not responsive to conventional therapy, the disease progressed in spite of the addition of rIL-2. These data suggest that: a) rIL-2 is likely to constitute a well-tolerated and suitable home therapy even when cyclically given for a prolonged period; b) following rIL-2 administration, eosinophils and lymphocytes increase in addition to the T subpopulations.     

Results of conventional and hysteroscopic surgery

Müllerian anomalies usually come to medical attention when they become problematic and require treatment. Most of these complications require surgical correction. The most commonly presenting anomaly is the double uterus which can be the source of recurrent abortion and preterm deliveries. The Strassman, Jones and Tompkins metroplasties have been shown to greatly improve the rate of successful deliveries in these patients. Hysteroscopic metroplasty, using either scissors, resectoscope or laser is now the recommended treatment for most septate uteri due to its relative simplicity, low morbidity and excellent reproductive outcome.     

强脉冲光联合药物治疗面部皮炎的临床疗效评价

目的:探讨强脉冲光联合药物治疗面部皮炎的效果,阐明强脉冲光联合药物治疗面部皮炎的可行性及安全性.方法:将门诊确诊的90例面部皮炎患者随机分为脉冲光联合药物组和单纯药物组,每组45例.脉冲光联合药物组采用强脉冲光联合雷公藤多甙和羟氯喹治疗,单纯药物组采用雷公藤多甙和羟氯喹治疗;6个月后随访,以面部潮红范围、丘疹数目、干燥脱屑改变情况及患者刺痒、刺痛、灼热等自觉症状改善情况作为临床观察指标判定疗效.结果:脉冲光联合药物组和单纯药物组有效率分别为93.3%和77.8%,接受治疗的患者自我评价的满意度分别为91.1%和75.6%,2组患者均未见不良反应发生,脉冲光联合药物组患者有效率及患者自我评价的满意度高于单纯药物组(P<0.05).脉冲光联合药物组随访31例,复发2例,复发率为4.5%(2/31); 单纯药物组随访29例,复发7例,复发率24.1%(7/29),脉冲光联合药物组患者复发率明显低于单纯药物组(P<0.05).结论:强脉冲光联合雷公藤多甙和羟氯喹治疗面部皮炎安全有效且复发率较低.     

子宫内膜异位症不孕腹腔镜手术配合药物治疗的疗效观察

目的:探讨子宫内膜异位症不孕患者行腹腔镜手术配合药物的疗效观察.方法:对32例子宫内膜异位症不孕的患者行腹腔镜手术治疗加药物治疗的情况进行系统回顾分析.结果:手术后按时服药,一年内的受孕率约达50%,2年内的受孕率明显降低,2年后的复发率一半以上.结论:子宫内膜异位症不孕的患者行腹腔镜手术配合药物治疗的方法安全有效,明显减轻患者临床症状,给要求生育者带来希望.     

Comparison of conventional anterior surgery and laparoscopic surgery for inguinal-hernia repair

BACKGROUND: Inguinal hernias can be repaired by laparoscopic techniques, which have had better results than open surgery in several small studies. METHODS: We performed a randomized, multicenter trial in which 487 patients with inguinal hernias were treated by extraperitoneal laparoscopic repair and 507 patients were treated by conventional anterior repair. We recorded information about postoperative recovery and complications and examined the patients for recurrences one and six weeks, six months, and one and two years after surgery. RESULTS: Six patients in the open-surgery group but none in the laparoscopic-surgery group had wound abscesses (P=0.03), and the patients in the laparoscopic-surgery group had a more rapid recovery (median time to the resumption of normal daily activity, 6 vs. 10 days; time to the return to work, 14 vs. 21 days; and time to the resumption of athletic activities, 24 vs. 36 days; P<0.001 for all comparisons). With a median follow-up of 607 days, 31 patients (6 percent) in the open-surgery group had recurrences, as compared with 17 patients (3 percent) in the laparoscopic-surgery group (P=0.05). All but three of the recurrences in the latter group were within one year after surgery and were caused by surgeon-related errors. In the open-surgery group, 15 patients had recurrences during the first year, and 16 during the second year. Follow-up was complete for 97 percent of the patients. CONCLUSIONS: Patients with inguinal hernias who undergo laparoscopic repair recover more rapidly and have fewer recurrences than those who undergo open surgical repair.     

Radioimmunoguided surgery after primary treatment of locally advanced breast cancer

PURPOSE: To assess the role of radioimmunoguided surgery (RIGS) using a handheld intraoperative gamma-detecting probe (GDP) to identify neoplastic disease after primary chemotherapy in locally advanced breast cancer (LABC) patients injected with iodine 125-labeled monoclonal antibodies (MAbs). PATIENTS AND METHODS: Twenty-one patients with histologically documented LABC were treated with a combined modality approach. After three courses of primary chemotherapy and before modified radical mastectomy, the 125I-radiolabeled MAbs B72.3 (anti-TAG72) and FO23C5 (anti-carcinoembryonic antigen [CEA]) were administered to 11 patients (group A) and 10 patients (group B), respectively. At surgery, a GDP was used to locate the primary tumor and to assess possible tumor multicentricity and the presence of ipsilateral axillary metastases. Routine pathologic examination was performed in neoplastic and normal tissue specimens of all 21 patients. In addition, immunohistochemical assay for TAG72 and CEA expression was performed. RESULTS: In group A patients, RIGS identified primary tumor in seven of 11 patients (63.3%) and unpalpable multicentric tumor lesions were located in two of four (50%). Positive axillary lymph nodes were histologically documented in eight of 11 patients (72.7%) and RIGS identified three of eight (37.5%). In group B, RIGS located the primary tumor lesion in four of 10 patients (40%); in two cases, the tumor was not clinically evident. Multicentricity was observed in one of two patients and lymph node involvement in three of nine (33.3%). No false-positive results were observed in either group A or B. CONCLUSION: RIGS appears to be a safe and reliable technique. However, the MAbs used in this study are not sufficiently specific. RIGS represents a technique for which the full potential for intraoperative assessment of breast cancer lesions can be reached when more specific antibodies become readily available.     

Role of surgery in the treatment of brain metastases in patients with breast cancer

BACKGROUND: Patients whose brain metastases from breast cancer are treated nonsurgically have a median length of survival ranging from 2.5 to 7.5 months, and a median time to recurrence ranging from 2 to 5 months. Patients treated with radiotherapy have a median length of survival ranging from 3 to 4 months. Those treated with chemotherapy have a median length of survival ranging from 5.5 to 7.5 months. METHODS: We conducted a retrospective analysis on 63 patients treated over a 10-year period. Only patients who underwent surgery for nonrecurrent brain metastases were studied. Sixty-one patients (97%) underwent surgery within 2 weeks of diagnosis of the brain metastases. RESULTS: The median length of survival was 16 months (95% confidence interval [CI] 11 to 22 months), and the 5-year survival rate was 17% (CI 9% to 29%). Brain metastases recurred in 27 patients at a median interval of 15 months (CI 12 to 24 months). Eleven patients had local recurrence, 10 had distal recurrence, and seven developed leptomeningeal disease. Significant prognosticators of length of survival were age (p = 0.011), menopause status (p = 0.10), postoperative radiotherapy (p = 0.054), preoperative neurologic status (p = 0.011), and preoperative systemic disease status (p = 0.0003). Systemic disease status had a significant effect on the length of survival but not on the time to recurrence.