腹腔镜手术治疗异位妊娠的护理

异位妊娠是妇产科常见的急腹症之一,若不及时诊断和积极抢救,可危及患者生命,异位妊娠近年来有上升趋势,其中以输卵管最常见,随着医学不断发展,腹腔镜手术治疗异位妊娠具有创伤小,术后恢复快,痕疤小,早出院等特点,逐渐被患者接受,我科2008年以来异位妊娠采用腹腔镜手术治疗122例,手术均成功,现将护理体会介绍如下.     

药物联合治疗异位妊娠临床分析

目的:观察异位妊娠采用甲氨蝶蛉联合米非司酮治疗的临床效果.方法:选择异位妊娠病人62例,随机分为对照组与观察组各31例,观察组给予甲氨蝶蛉联合米非司酮联合治疗,对照组仅仅采用甲氨蝶蛉治疗;观察两组治疗后的临床情况并进行统计学分析.结果:一疗程后,两组的血β-HCG值、包块大小及住院时间各项指标比较,观察组明显小于对照组(P<0.05);观察组的有效率为93.5%明显高于对照组的80.6%,两组比较差异有显著性(p<0.05).结论:甲氨蝶蛉联合米非司酮治疗异位妊娠疗效明显高于单独的甲氨蝶蛉治疗,值得在临床中推广应用.     

2 cases of simultaneous intra- and extrauterine pregnancy

A comparative study of the effectiveness of Watson's and Cairns's trabeculectomy in a Black South African population with open-angle glaucoma is presented. The eventual success rate of 91-6% is comparable with that found in Whites, and the results were similar with both methods.     

Laparoscopically assisted vaginal hysterectomy

OBJECTIVE: To report our experience with laparoscopically assisted vaginal hysterectomy (LAVH) and evaluate the advantages of LAVH. STUDY DESIGN: From January 1991 to August 1992, 176 LAVHs were performed at the Department of Obstetrics and Gynecology, College of Medicine, Chung-Ang University, Seoul, Korea. The indications for LAVH, based on the preoperative diagnosis, were uterine myomas, dysmenorrhea, chronic pelvic inflammatory disease or pelvic pain, dysfunctional uterine bleeding and cervical intraepithelial neoplasia (in order of frequency). RESULTS: Patients had concomitant procedures, including incidental appendectomy, posterior wall repair, pelvic adhesiolysis and salpingo-oophorectomy. Bipolar forceps were used to compress and desiccate vessels. The Nd-YAG laser, scissors and/or unipolar electrode were used for tissue division, excision of adhesions and cutting. The intraoperative complications were bladder perforation, massive hemorrhage and inferior epigastric vessel injury (one case each). The postoperative complications were infection, voiding difficulty, febrile morbidity, pelvic abscess, incisional hernia, vaginal vault bleeding and peroneal nerve palsy (one case each). CONCLUSION: Hysterectomy can be safely performed vaginally assisted by operative laparoscopy by well-trained laparoscopists, resulting in reduced surgical morbidity, blood loss, postoperative discomfort, recovery time and hospitalization.     

Wound closure of the fallopian tube with fibrin glue: endoscopic organ preserving therapy of extrauterine pregnancy

Families in transition (FIT), a joint program between Beth Israel Medical Center (BIMC) and National Development and Research Institutes, Inc., uses indigenous neighborhood women, Compa?eras (companions), to conduct street outreach in a New York City neighborhood where HIV infection is rampant. The outreach workers inform people that, not only will they be assisted in talking about HIV and guardianship for their children, but that they will be provided information concerning access to food stamps, housing, health care, and other basic needs. Through community participation, the Compa?eras empower themselves through knowledge making and sharing and, in the process, create conditions in which other women can began to effect changes in their individual lives and families. The ultimate goal of the project is to support HIV-infected women in finding their voices so that they can talk with their children and plan for their futures.     

Laparoscopically guided peritoneal insertion in ventriculoperitoneal shunts

A technique of laparoscopically guided insertion of the peritoneal end of ventriculoperitoneal shunts is described. Eleven consecutive cases were done in this manner. There were no failures in inserting the peritoneal end of the ventriculoperitoneal shunt catheter. By way of comparison, 11 previous cases were reviewed. These were done through standard open methods. There were two failures in the open technique group. One of the failures was the result of insertion of the peritoneal end into the subcutaneous layer in an extremely obese patient. It is our belief that this technique deserves consideration when a ventriculoperitoneal shunt is contemplated in adults.     

Laparoscopically assisted colpopoesis using sigmoid colon]

Presentation of one case of scrotal vesical hernia in a 66-year old patient who presented with scrotal mass, micturition difficulty and two-phase micturition that improved when pressure was exerted on the scrotum. Diagnosis was established by physical examination and CUMS. The patient underwent surgery during which a direct inguinal hernia due to paraperitoneal vesical sliding was found. Right herniorrhaphy was performed with Shouldice's technique. Postoperative radiological monitoring showed normal vesical morphology. The pathogeny, classification and treatment, as well as the differential diagnosis uncommonly reported by the authors consulted, are commented.     

Transition from fetal to extrauterine circulation

In utero, there is increased pulmonary vascular resistance favoring minimal pulmonary blood flow and right-to-left shunting of blood through the ductus arteriosus and foramen ovale. Delivery initiates a series of complex biochemical and structural changes whereby the neonate assumes those processes critical to survival. This article reviews fetal circulation, the characteristics of the fetal cardiopulmonary system, and the transition from fetal to neonatal circulation. It also discusses the consequences of disrupted transition to extrauterine life and the relationship between fetal cardiopulmonary anatomy and congenital heart disease.     

Laparoscopically assisted extracorporeal neosalpingostomy. A case report

Primary intestinal lymphangiectasia is characterized by dilated small bowel lymphatics and loss of lymph into the bowel lumen resulting in hypoproteinaemia and oedema. Some patients have a more generalized lymphatic abnormality associated with lymphoedema of the limbs and chylous pleural effusions. There is no specific treatment although enteric protein loss may decrease with a low-fat diet. This report describes a patient with severe primary intestinal lymphangiectasia, associated with limb oedema and recurrent pleural effusions, who responded to treatment with octreotide. Before starting octreotide she required weekly intravenous albumin infusions to maintain the serum albumin above 20 g/l. Bilateral pleural effusions repeatedly reaccumulated despite pleurectomy and subsequently tetracycline pleurodesis. Treatment with octreotide, 200 microg twice daily, resulted in a reduction in enteric protein loss from 16 to 4.1% in 5 days (normal less than 1%) and the serum albumin was maintained between 22 and 26 g/l without the need for albumin infusion. Oedema in the arms resolved completely and the pleural effusions did not reaccumulate. The mechanism of action of octreotide in this condition appears to be due to a reduction in gut protein loss and another, as yet unidentified, action.     

Laparoscopically assisted vaginal hysterectomy. A review of current issues

A review of 39 articles found no consensus on indication for laparoscopic assisted vaginal hysterectomy (LAVH) compared with traditional approaches. Since only three randomized trials comparing LAVH with traditional methods exist, the scientific basis for surgical choice is lacking. Uncontrolled studies indicated that outcomes following LAVH were not superior to vaginal hysterectomy and costs were significantly higher.     

Primary sclerosing cholangitis with itching treated during pregnancy with ursodeoxycholic acid

A 23-year old woman with primary sclerosing cholangitis was being treated with ursodeoxycholic acid (URSO). When pregnancy was diagnosed, she was already through the first trimester. The treatment was discontinued, but her symptoms including severe pruritus recurred immediately, and the biochemical markers of bile duct obstruction worsened. It was necessary to start URSO-treatment again, which relieved her symptoms and improved the biochemistry. The remaining part of the pregnancy was uncomplicated, there were no malformations and so far, the baby is doing fine. URSO may be a possible treatment for severe intrahepatic cholestasis and pruritus during pregnancy.     

Laparoscopically assisted abdominal aortic aneurysm repair: first 20 cases

PURPOSE: Laparoscopic surgery decreases postoperative pain, shortens hospital stay, and returns patients to full functional status more quickly than open surgery for a variety of surgical procedures. This study was undertaken to evaluate laparoscopic techniques for application to abdominal aortic aneurysm (AAA) repair. METHODS: Twenty patients who had AAAs that required a tube graft underwent laparoscopically assisted AAA repair. The procedure consisted of transperitoneal laparoscopic dissection of the aneurysm neck and iliac vessels. A standard endoaneurysmorrhaphy was then performed through a minilaparotomy using the port sites for the aortic and iliac clamps. Data included operative times, duration of nasogastric suction, intensive care unit days, and postoperative hospital days. Pulmonary artery catheters and transesophageal echocardiography were used in seven patients. For these patients data included heart rate, pulmonary artery systolic and diastolic pressures, mean arterial pressure, central venous pressure, pulmonary capillary wedge pressure, cardiac index, and end diastolic area. Data were obtained before induction, during and after insufflation, during aortic cross-clamp, and at the end of the procedure. RESULTS: Laparoscopically assisted AAA repair was completed in 18 of 20 patients. Laparoscopic and total operative times were 1.44 +/- 0.44 and 4.1 +/- 0.92 hours, respectively. Duration of nasogastric suction was 1.3 +/- 0.7 days. Intensive care unit stay was 2.2 +/- 0.9 days. The mean length of hospital stay was 5.8 days excluding three patients who underwent other procedures. There were two minor complications, one major complication (colectomy after colon ischemia), and no deaths. For the eight patients who had intraoperative transesophageal echocardiographic monitoring, no changes were noted in heart rate, pulmonary artery systolic pressure, pulmonary capillary wedge pressure, and cardiac index. Pulmonary artery diastolic pressure and central venous pressure were greatest during insufflation without changes in end-diastolic area. Volume status, as reflected by end-diastolic area and pulmonary capillary wedge pressure, did not change. CONCLUSIONS: Laparoscopically assisted AAA repair is technically challenging but feasible. Potential advantages may be early removal of nasogastric suction, shorter intensive care unit and hospital stays, and prompt return to full functional status. The hemodynamic data obtained from the pulmonary artery catheter and transesophageal echocardiogram during pneumoperitoneum suggest that transesophageal echocardiography may be sufficient for evaluation of volume status along with the added benefit of detection of regional wall motion abnormalities and aortic insufficiency. Further refinement in technique and instrumentation will make total laparoscopic AAA repair a reality.     

Serial sonographic changes in a case of isthmic pregnancy treated with methotrexate

A case report of a primary malignant fibrous histiocytoma (MFH) in the mandible of a young adult male is presented and relevant literature reviewed. The clinical presentation and course of the case is typical of MFH of the jaw as reported in the literature.