PURPOSE: To document a previously unreported complication after vitrectomy with peeling of the internal limiting membrane (ILM) for idiopathic macular holes. Method: Retrospective review of notes of 232 consecutive pa...PURPOSE: To document a previously unreported complication after vitrectomy with peeling of the internal limiting membrane (ILM) for idiopathic macular holes. Method: Retrospective review of notes of 232 consecutive patients who underwent vitrectomy with peeling of the ILM for idiopathic macular holes from 1996 to 2001. Four patients were found to have eccentric iatrogenic macular holes postoperatively. Optical coherence tomography was used to evaluate these holes. Results: The idiopathic macular holes were graded from stages II to IV preoperatively with visual acuities from 6/18 to 6/60. All patients had surgery within 6 months of presentation. They underwent vitrectomy with complete separation of the posterior cortical vitreous, peeling of the ILM, injection of platelets (0.1ml), and gas tamponade with SF6 20%. Postoperatively the patients postured strictly face down for 10 days. Follow-up ranged from 8 months to 6 years. Iatrogenic eccentric macular holes were noted postoperatively. The holes were located between 3 and 6 o’clock in three patients and at 9 o’clock in the fourth patient, relative to the macula. Optical coherence tomography showed them to be full thickness and completely flat. No further intervention was necessary. No complications have arisen during follow-up. Comment: To our knowledge iatrogenic eccentric full thickness macular holes after macular hole surgery have never been reported. We believe that the location of the holes represents the initial site of ILM elevation. These holes are asymptomatic, have not required any treatment and have not caused any complications in up to 6 years of follow-up.展开更多
目的探讨经肛门痔上黏膜环切术(procedure for prolapse and hemorrhoids,PPH)偏心性切除吻合治疗直肠良性肿瘤伴抑郁的效果。方法选取2012年6月到2014年6月住院接受治疗的104例良性肿瘤伴抑郁患者为研究对象,随机数表法分为对照组(50例...目的探讨经肛门痔上黏膜环切术(procedure for prolapse and hemorrhoids,PPH)偏心性切除吻合治疗直肠良性肿瘤伴抑郁的效果。方法选取2012年6月到2014年6月住院接受治疗的104例良性肿瘤伴抑郁患者为研究对象,随机数表法分为对照组(50例)与观察组(54例),对照组行传统肛门手术治疗,观察组行经肛门PPH偏心性切除吻合术,比较两组患者的治疗有效率及术后并发症情况。结果治疗后3个月,两组患者病情均好转,观察组的总有效率为96.30%,显著高于对照组的84.0%(P<0.05);观察组患者的术后恢复时间(平均为6.32天)和术后疗效评分(平均为9.36分)均显著优于对照组患者(术后恢复时间平均为10.87天、术后疗效美分平均为7.13分)(P<0.05)。两组患者治疗前的抑郁自评量表(SDS)及焦虑自评量表(SAS)评分相似;其治疗后的SDS及SAS评分明显高于治疗前,且治疗后观察组患者SDS及SAS评分明显低于对照组(P<0.05)。结论对于直肠良性肿瘤伴抑郁患者,肛门PPH偏心性切除吻合治疗在其恢复速度、术后并发症及抑郁改善等方面明显优于传统的手术治疗,可能有重要的临床推广价值。展开更多
目的:探讨经阴道三维超声成像技术在宫角妊娠与输卵管间质部妊娠诊断及鉴别诊断中的价值。方法:回溯性收集2020年9月—2022年10月南京医科大学附属妇产医院临床疑诊为宫角妊娠或输卵管间质部妊娠的91例患者的经阴道二维和三维超声图像,...目的:探讨经阴道三维超声成像技术在宫角妊娠与输卵管间质部妊娠诊断及鉴别诊断中的价值。方法:回溯性收集2020年9月—2022年10月南京医科大学附属妇产医院临床疑诊为宫角妊娠或输卵管间质部妊娠的91例患者的经阴道二维和三维超声图像,分析经阴道三维超声中宫角妊娠和输卵管间质部妊娠的图像特征,以手术及随访结果为金标准,对比两种超声的诊断准确率。结果:经阴道三维超声诊断准确率高于经阴道二维超声[94.51%(86/91)vs 84.62%(77/91),χ^(2)=15.05,P<0.05]。经阴道三维超声与手术及随访结果诊断一致性优于经阴道二维超声(Kappa=0.899 vs Kappa=0.687,P<0.05)。宫角妊娠三维冠状面特征:两宫角不对称,一侧宫角膨大;孕囊或包块均与宫腔内膜相连;宫底轮廓对称或一侧膨隆。输卵管间质部妊娠三维冠状面特征:两宫角对称;孕囊或包块基本不与宫角内膜相连;孕囊或包块自一侧宫底向轮廓外凸起。宫角妊娠孕囊或包块周边肌层完整,平均厚度明显厚于输卵管间质部孕囊或包块周边肌层[(5.72±1.08)mm vs(1.73±0.84)mm,P<0.001]。结论:经阴道三维超声检查技术诊断准确率高,其冠状面声图像特征在鉴别宫角妊娠及输卵管间质部妊娠中有较高的应用价值。展开更多
文摘PURPOSE: To document a previously unreported complication after vitrectomy with peeling of the internal limiting membrane (ILM) for idiopathic macular holes. Method: Retrospective review of notes of 232 consecutive patients who underwent vitrectomy with peeling of the ILM for idiopathic macular holes from 1996 to 2001. Four patients were found to have eccentric iatrogenic macular holes postoperatively. Optical coherence tomography was used to evaluate these holes. Results: The idiopathic macular holes were graded from stages II to IV preoperatively with visual acuities from 6/18 to 6/60. All patients had surgery within 6 months of presentation. They underwent vitrectomy with complete separation of the posterior cortical vitreous, peeling of the ILM, injection of platelets (0.1ml), and gas tamponade with SF6 20%. Postoperatively the patients postured strictly face down for 10 days. Follow-up ranged from 8 months to 6 years. Iatrogenic eccentric macular holes were noted postoperatively. The holes were located between 3 and 6 o’clock in three patients and at 9 o’clock in the fourth patient, relative to the macula. Optical coherence tomography showed them to be full thickness and completely flat. No further intervention was necessary. No complications have arisen during follow-up. Comment: To our knowledge iatrogenic eccentric full thickness macular holes after macular hole surgery have never been reported. We believe that the location of the holes represents the initial site of ILM elevation. These holes are asymptomatic, have not required any treatment and have not caused any complications in up to 6 years of follow-up.
文摘目的探讨经肛门痔上黏膜环切术(procedure for prolapse and hemorrhoids,PPH)偏心性切除吻合治疗直肠良性肿瘤伴抑郁的效果。方法选取2012年6月到2014年6月住院接受治疗的104例良性肿瘤伴抑郁患者为研究对象,随机数表法分为对照组(50例)与观察组(54例),对照组行传统肛门手术治疗,观察组行经肛门PPH偏心性切除吻合术,比较两组患者的治疗有效率及术后并发症情况。结果治疗后3个月,两组患者病情均好转,观察组的总有效率为96.30%,显著高于对照组的84.0%(P<0.05);观察组患者的术后恢复时间(平均为6.32天)和术后疗效评分(平均为9.36分)均显著优于对照组患者(术后恢复时间平均为10.87天、术后疗效美分平均为7.13分)(P<0.05)。两组患者治疗前的抑郁自评量表(SDS)及焦虑自评量表(SAS)评分相似;其治疗后的SDS及SAS评分明显高于治疗前,且治疗后观察组患者SDS及SAS评分明显低于对照组(P<0.05)。结论对于直肠良性肿瘤伴抑郁患者,肛门PPH偏心性切除吻合治疗在其恢复速度、术后并发症及抑郁改善等方面明显优于传统的手术治疗,可能有重要的临床推广价值。
文摘目的:探讨经阴道三维超声成像技术在宫角妊娠与输卵管间质部妊娠诊断及鉴别诊断中的价值。方法:回溯性收集2020年9月—2022年10月南京医科大学附属妇产医院临床疑诊为宫角妊娠或输卵管间质部妊娠的91例患者的经阴道二维和三维超声图像,分析经阴道三维超声中宫角妊娠和输卵管间质部妊娠的图像特征,以手术及随访结果为金标准,对比两种超声的诊断准确率。结果:经阴道三维超声诊断准确率高于经阴道二维超声[94.51%(86/91)vs 84.62%(77/91),χ^(2)=15.05,P<0.05]。经阴道三维超声与手术及随访结果诊断一致性优于经阴道二维超声(Kappa=0.899 vs Kappa=0.687,P<0.05)。宫角妊娠三维冠状面特征:两宫角不对称,一侧宫角膨大;孕囊或包块均与宫腔内膜相连;宫底轮廓对称或一侧膨隆。输卵管间质部妊娠三维冠状面特征:两宫角对称;孕囊或包块基本不与宫角内膜相连;孕囊或包块自一侧宫底向轮廓外凸起。宫角妊娠孕囊或包块周边肌层完整,平均厚度明显厚于输卵管间质部孕囊或包块周边肌层[(5.72±1.08)mm vs(1.73±0.84)mm,P<0.001]。结论:经阴道三维超声检查技术诊断准确率高,其冠状面声图像特征在鉴别宫角妊娠及输卵管间质部妊娠中有较高的应用价值。
