Objective To evaluate the feasibility and safety of operative laparoscopy for ectopic pregnancy with hypovolemic shock. Methods Two hundred and fifteen women with ectopic pregnancy underwent operative laparoscopy. The...Objective To evaluate the feasibility and safety of operative laparoscopy for ectopic pregnancy with hypovolemic shock. Methods Two hundred and fifteen women with ectopic pregnancy underwent operative laparoscopy. These patients were divided into two groups. The study group included 21 patients with shock and intraperitoneal hemorrhage more than 1000 mL, and control group included 194 patients, hemodynamically stable, with blood loss less than 1000 mL. Clinical data of perio-perative periods in two groups were retrospectively analyzed. Results All patients were tubal pregnancies. The occurrence rate of tubal rupture was higher in study group than in control group (80.95% vs. 15.98%, P < 0.001). Intraabdominal blood loss was significantly higher in study group than in control group (1900 mL vs. 300 mL, P < 0.001), and autologous blood transfusions were given to 95.24% and 9.3% of patients in study and control group, respectively (P < 0.001). Laparoscopic salpingectomy was performed on 85.7 % and 50.5% of patients in study and control group (P < 0.001). The operative time was somewhat longer in study group than that in control group (60 minutes vs. 45 minutes), but with no significant difference. All patients had no perioperative complications. Conclusion Operative laparoscopy in patients with hopovolemic shock can be safely and effectively performed by experi-enced laparoscopists with the aid of optimal anesthesia, advanced cardiovascular monitoring, and autologous blood transfusion.展开更多
Objective:To study the prevalence and associated factors of recurrent ovarian endometrioma after ovarian cystectomy.Methods:This retrospective study analyzed 303 patients who underwent cystectomy for ovarian endometri...Objective:To study the prevalence and associated factors of recurrent ovarian endometrioma after ovarian cystectomy.Methods:This retrospective study analyzed 303 patients who underwent cystectomy for ovarian endometrioma and had at least a 2-year follow-up at Srinagarind Hospital from January 2013 to December 2018.The patients were divided into the recurrent and nonrecurrent groups according to the findings from postoperative transvaginal ultrasonography 6 months after undergoing surgery.Nineteen factors were collected for risk evaluation.The prevalence of recurrent ovarian endometrioma and its 95%confident interval(CI)were calculated.Univariate and multivariable logistic regression analyses were performed to determine the association between factors and recurrence.Results:Recurrent ovarian endometrioma occurred in 33%(95%CI 27.7%-38.3%)patients.The median duration of followup was 36 months.during the median follow-up period of 36 months.Preoperative history of parity,preoperative infertility history,endometriosis surgery,moderate to severe dysmenorrhea,dyspareunia,intraoperative stage 4 according to revised American Society for Reproductive Medicine classification,presence of adenomyosis,and postoperative pain relief were associated factors based on univariate analysis.In contrast,infertility[odds ratio(OR)2.22,95%CI 1.14-4.33],moderate to severe dysmenorrhea(OR 2.13,95%CI 1.09-4.15),and postoperative pelvic pain relief(OR 0.22,95%CI 0.12-0.42)were independently associated factors based on multivariable logistic regression analysis.Conclusions:In our setting,preoperative infertility history and moderate to severe dysmenorrhea were associated with a higher recurrent ovarian endometrioma risk.In contrast,postoperative pain relief was significantly associated with lower recurrence risk.展开更多
目的:总结加速康复外科(enhanced recovery after surgery,ERAS)理念在腹腔镜全子宫切除术患者围麻醉期管理中的应用效果,探讨其临床意义。方法:回顾性分析中国人民解放军总医院妇产科2016年1月—2017年1月诊治的腹腔镜全子宫切除术患...目的:总结加速康复外科(enhanced recovery after surgery,ERAS)理念在腹腔镜全子宫切除术患者围麻醉期管理中的应用效果,探讨其临床意义。方法:回顾性分析中国人民解放军总医院妇产科2016年1月—2017年1月诊治的腹腔镜全子宫切除术患者87例,根据康复管理方法分为观察组(42例,采用围麻醉期加速康复管理方法)和对照组(45例,采用常规康复管理方法)。2组患者年龄、体质量指数(BMI)、腹部手术史、手术时间、术中出血量和疾病构成情况比较,差异无统计学意义(均P>0.05)。记录2组患者康复相关指标和就医满意度。结果:观察组术后排气时间、留置尿管时间、下地活动时间、住院时间和住院费用均少于对照组,差异有统计学意义(均P<0.05)。2组患者并发症发生率比较差异无统计学意义(P>0.05)。观察组就医满意度高于对照组,差异有统计学意义(90.5%vs.73.3%,χ~2=4.254,P=0.039)。结论:对于腹腔镜全子宫切除术患者实施围麻醉期加速康复管理能够加快术后康复进程,同时提升就医满意度,具有重要意义。展开更多
丹麦外科医生Kehlet对围手术期处理措施综合优化,于1997年首次提出加速康复外科(enhanced recovery after surgery,ERAS)理念,近年来该理念在欧美国家被广泛推广,并逐渐被国内采纳应用。ERAS从循证角度出发,力求降低对手术患者的生理及...丹麦外科医生Kehlet对围手术期处理措施综合优化,于1997年首次提出加速康复外科(enhanced recovery after surgery,ERAS)理念,近年来该理念在欧美国家被广泛推广,并逐渐被国内采纳应用。ERAS从循证角度出发,力求降低对手术患者的生理及心理创伤应激反应,通过外科、麻醉、护理、营养等科室紧密合作,采取多种干预措施,对围手术期临床路径优化,降低围手术期创伤应激反应及减少术后并发症的发生率,促进康复,缩短住院时间,减少医疗费用。这一理论体系自1997年正式提出以来相继在各外科领域推广应用,目前ERAS理念已应用于胸外科、普外科、结直肠外科、妇产科等的围手术期。近年来ERAS理念与妇产科围手术期管理模式相融合的成功案例众多,就目前ERAS理念在妇产科临床的应用进行综述。展开更多
文摘Objective To evaluate the feasibility and safety of operative laparoscopy for ectopic pregnancy with hypovolemic shock. Methods Two hundred and fifteen women with ectopic pregnancy underwent operative laparoscopy. These patients were divided into two groups. The study group included 21 patients with shock and intraperitoneal hemorrhage more than 1000 mL, and control group included 194 patients, hemodynamically stable, with blood loss less than 1000 mL. Clinical data of perio-perative periods in two groups were retrospectively analyzed. Results All patients were tubal pregnancies. The occurrence rate of tubal rupture was higher in study group than in control group (80.95% vs. 15.98%, P < 0.001). Intraabdominal blood loss was significantly higher in study group than in control group (1900 mL vs. 300 mL, P < 0.001), and autologous blood transfusions were given to 95.24% and 9.3% of patients in study and control group, respectively (P < 0.001). Laparoscopic salpingectomy was performed on 85.7 % and 50.5% of patients in study and control group (P < 0.001). The operative time was somewhat longer in study group than that in control group (60 minutes vs. 45 minutes), but with no significant difference. All patients had no perioperative complications. Conclusion Operative laparoscopy in patients with hopovolemic shock can be safely and effectively performed by experi-enced laparoscopists with the aid of optimal anesthesia, advanced cardiovascular monitoring, and autologous blood transfusion.
文摘Objective:To study the prevalence and associated factors of recurrent ovarian endometrioma after ovarian cystectomy.Methods:This retrospective study analyzed 303 patients who underwent cystectomy for ovarian endometrioma and had at least a 2-year follow-up at Srinagarind Hospital from January 2013 to December 2018.The patients were divided into the recurrent and nonrecurrent groups according to the findings from postoperative transvaginal ultrasonography 6 months after undergoing surgery.Nineteen factors were collected for risk evaluation.The prevalence of recurrent ovarian endometrioma and its 95%confident interval(CI)were calculated.Univariate and multivariable logistic regression analyses were performed to determine the association between factors and recurrence.Results:Recurrent ovarian endometrioma occurred in 33%(95%CI 27.7%-38.3%)patients.The median duration of followup was 36 months.during the median follow-up period of 36 months.Preoperative history of parity,preoperative infertility history,endometriosis surgery,moderate to severe dysmenorrhea,dyspareunia,intraoperative stage 4 according to revised American Society for Reproductive Medicine classification,presence of adenomyosis,and postoperative pain relief were associated factors based on univariate analysis.In contrast,infertility[odds ratio(OR)2.22,95%CI 1.14-4.33],moderate to severe dysmenorrhea(OR 2.13,95%CI 1.09-4.15),and postoperative pelvic pain relief(OR 0.22,95%CI 0.12-0.42)were independently associated factors based on multivariable logistic regression analysis.Conclusions:In our setting,preoperative infertility history and moderate to severe dysmenorrhea were associated with a higher recurrent ovarian endometrioma risk.In contrast,postoperative pain relief was significantly associated with lower recurrence risk.
文摘目的:总结加速康复外科(enhanced recovery after surgery,ERAS)理念在腹腔镜全子宫切除术患者围麻醉期管理中的应用效果,探讨其临床意义。方法:回顾性分析中国人民解放军总医院妇产科2016年1月—2017年1月诊治的腹腔镜全子宫切除术患者87例,根据康复管理方法分为观察组(42例,采用围麻醉期加速康复管理方法)和对照组(45例,采用常规康复管理方法)。2组患者年龄、体质量指数(BMI)、腹部手术史、手术时间、术中出血量和疾病构成情况比较,差异无统计学意义(均P>0.05)。记录2组患者康复相关指标和就医满意度。结果:观察组术后排气时间、留置尿管时间、下地活动时间、住院时间和住院费用均少于对照组,差异有统计学意义(均P<0.05)。2组患者并发症发生率比较差异无统计学意义(P>0.05)。观察组就医满意度高于对照组,差异有统计学意义(90.5%vs.73.3%,χ~2=4.254,P=0.039)。结论:对于腹腔镜全子宫切除术患者实施围麻醉期加速康复管理能够加快术后康复进程,同时提升就医满意度,具有重要意义。
文摘丹麦外科医生Kehlet对围手术期处理措施综合优化,于1997年首次提出加速康复外科(enhanced recovery after surgery,ERAS)理念,近年来该理念在欧美国家被广泛推广,并逐渐被国内采纳应用。ERAS从循证角度出发,力求降低对手术患者的生理及心理创伤应激反应,通过外科、麻醉、护理、营养等科室紧密合作,采取多种干预措施,对围手术期临床路径优化,降低围手术期创伤应激反应及减少术后并发症的发生率,促进康复,缩短住院时间,减少医疗费用。这一理论体系自1997年正式提出以来相继在各外科领域推广应用,目前ERAS理念已应用于胸外科、普外科、结直肠外科、妇产科等的围手术期。近年来ERAS理念与妇产科围手术期管理模式相融合的成功案例众多,就目前ERAS理念在妇产科临床的应用进行综述。
