Planned second-look laparoscopy in the management of acute mesenteric ischemia

AIM： To investigate the role of second-look laparoscopy in patients with acute mesenteric ischemia （AMI）. METHODS： Between January 2000 and November 2005, 71 patients were operated for the treatment of AMI. The indications for a second-look were low flow state, bowel resection and anastomosis or mesenteric thromboembolectomy performed during the first operation. Regardless of the clinical course of patients, the second-look laparoscopic examination was performed 72 h post-operatively at the bed side in the ICU or operating room. RESULTS： The average time of admission to the hospital after the initation of syrnptoms was 3 d （range, 5 h-9 d）. In 14 patients, laparotomy was performed. In 11 patients, small and/or large bowel necrosis was detected and initial resection and anastomosis were conducted. A low flow state was observed in two patients and superior mesenteric artery thromboembolectomy with small bowel resection was performed in one patient. In 13 patients, a second-look laparoscopic examination revealed normal bowel viability, but in one patient, intestinal necrosis was detected. In two of the patients, a third operation was necessary to correct anastomotic leakage. The overall complication rate was 42.8%, and in-hospital mortality rate was 57.1% （n = 6）. CONCLUSION： Second-look laparoscopy is a minimally invasive, technically simple procedure that is performed for diagnostic as well as therapeutic purposes. The simplicity and ease of this method may encourage wider application to benefit more patients. However, the timing of a second-look procedure is unclear particularly in a patient with anastomosis.

Second-look endoscopy with prophylactic hemostasis is still effective after endoscopic submucosal dissection for gastric neoplasm

AIM: The clinical value of second-look endoscopy(SLE) after endoscopic submucosal dissection(ESD) has been doubted continuously. The aim of this study was to assess the effectiveness of SLE based on the risk of delayed bleeding after ESD. METHODS: A total of 310 lesions of gastric epithelial neoplasms treated by ESD were reviewed. The lesions were divided into two groups based on the risk of postprocedural bleeding estimated by Forrest classification. The high risk of rebleeding group(Forrest?Ⅰa,?Ⅰb and Ⅱa) required endoscopic treatment, while the low risk of rebleeding group(Forrest Ⅱb, Ⅱc and Ⅲ) did not. Delayed bleeding after ESD was investigated. RESULTS: Sixty-six lesions were included in the high risk of rebleeding group and 244 lesions in the low risk of rebleeding group. There were no significant differences in delayed bleeding between the high risk group(1/66) and the low risk group(1/244)(P = 0.38). The high risk of rebleeding group tended to be located more often in the mid-third and had higher appearance of flat or depressed shape than the low risk group(P = 0.004 and P = 0.006, respectively). CONCLUSION: SLE with pre-emptive prophylactic endoscopic treatment is still effective in preventing delayed bleeding after ESD.

Second-look surgery plus hyperthermic intraperitoneal chemotherapy for patients with colorectal cancer at high risk of peritoneal carcinomatosis:Does it really save lives?

The treatment of peritoneal carcinomatosis (PC) of colorectal origin with cytoreductive surgery(CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) has a 5-year recurrence-free or cure rate of at least 16%, so it is no longer labeled as a fatal disease, and offers prolonged survival for patients with a low peritoneal carcinomatosis index. Metachronous PC of colorectal origin is so predictable that there is a model which has been used to successfully determine the individual risk of each patient. Patients at risk are clearly identified; those with the highest risk have small peritoneal nodules present in the first surgery (70% probability of developing PC), ovarian metastases(60%), perforated tumor onset or intraoperative tumor rupture(50%). Current clinical, biological and imaging techniques still lack sufficient sensitivity to diagnose PC in its initial stages, when CRS plus HIPEC has a greater impact and a higher cure rate. Second-look surgery with HIPEC or prophylactic HIPEC at the time of the first intervention have been proposed as means of preventing and/or anticipating clinical or radiological relapse in at-risk patients. Both techniques have shown a significant decrease in peritoneal relapses and should be considered essential weapons in the management of colorectal cancer.

RESULTS OF SECOND-LOOK LAPAROTOMY WITH EXTENSIVE DISSECTION OF RETROPERITONEAL LYMPH NODE IN OVARIAN CANCER PATIENTS

Objective: To evaluate retrospectively the results of extensive lymphadenectomy during second-look laparotomy on patients with ovarian cancer. Methods: A total of 63 patients with ovarian malignancies received second-look laparotomy (SLL). Retroperitoneal lymph nodes, including pelvic and para-aortic lymph nodes below the level of left renal vein, were extensively dissected. Results: Of the 63 patients, residual tumor was found in 24 (38.0%) on SLL. The frequency of residual tumor was positively correlated with the clinical stage and with the amount of tumor left after initial debulking but not with degree of differentiation of tumor cells. Lymph node metastasis(LNM) was pathologically confirmed in 19 cases (30.2%), of which no residual tumor was found in 8 patients. Tumor recurred in only 4 of the 39 patients (10.3%) with negative SLL. The overall 3- and 5-year survival rate were 75.0% and 68.0%, respectively. Conclusion: Extensive retroperitoneal lymph node dissection was recommended during SLL. It favored a decrease in recurrence rate in ovarian cancer patients negative on SLL.

Effects of higher femoral tunnels on clinical outcomes,MRI,and second-look findings in double-bundle anterior cruciate ligament reconstruction with a minimal 5-year follow-up

Background:To perform anatomical anterior cruciate ligament reconstruction(ACLR),tunnels should be placed relatively higher in the femoral anterior cruciate ligament(ACL)footprint based on the findings of direct and indirect femoral insertion.But the clinical results of higher femoral tunnels(HFT)in double-bundle ACLR(DB-ACLR)remain unclear.The purpose was to investigate the clinical results of HFT and lower femoral tunnels(LFT)in DB-ACLR.Methods:From September 2014 to February 2016,83 patients who underwent DB-ACLR and met the inclusion and exclusion criteria were divided into HFT-ACLR(group 1,n=37)and LFT-ACLR(group 2,n=46)according to the position of femoral tunnels.Preoperatively and at the final follow-up,clinical scores were evaluated with International Knee Documentation Committee(IKDC),Tegner activity,and Lysholm score.The stability of the knee was evaluated with KT-2000,Lachman test,and pivot-shift test.Cartilage degeneration grades of the International Cartilage Repair Society(ICRS)were evaluated on magnetic resonance imaging(MRI).Graft tension,continuity,and synovialization were evaluated by second-look arthroscopy.Return-to-sports was assessed at the final follow-up.Results:Significantly better improvement were found for KT-2000,Lachman test,and pivot-shift test postoperatively in group 1(P>0.05).Posterolateral bundles(PL)showed significantly better results in second-look arthroscopy regarding graft tension,continuity,and synovialization(P<0.05),but not in anteromedial bundles in group 1.At the final follow-up,cartilage worsening was observed in groups 1 and 2,but it did not reach a stastistically significant difference(P>0.05).No statistically significant differences were found in IKDC subjective score,Tegner activity,and Lysholm score between the two groups.Higher return-to-sports rate was found in group 1 with 86.8%(32/37)vs.65.2%(30/46)in group 2(P=0.027).Conclusion:The HFT-ACLR group showed better stability results,better PL,and higher return-to-sports rate compared to the LFT-ACLR group.

Second-look arthroscopic evaluation of the articular cartilage after primary single-bundle and double-bundle anterior cruciate ligament reconstructions

Background Several reports have shown the progression of articular cartilage degeneration after anterior cruciate ligament （ACL） reconstruction. No report has been published about the cartilage comparing changes after single-bundle （SB） and double-bundle （DI3） ACL reconstructions. The purpose of this study was to evaluate the articular cartilage changes after SB and DB ACL reconstructions by second-look arthroscopy. Methods Ninety-nine patients who received arthroscopic ACL reconstruction were retrospectively reviewed at an average of 14 months after reconstruction, 58 patients underwent SB ACL reconstruction and 41 patients underwent DB ACL reconstruction. Hamstring tendon autografts were used in all patients. Second-look arthroscopy was done in conjunction with the tibial staple fixation removal at least one year after the initial ACL reconstruction. Arthroscopic evaluation and grading of the articular cartilage degeneration for all patients were performed at the initial ACL reconstruction, and at the second-look arthroscopy. Results The average cartilage degeneration at the patellofemoral joint （PFJ） was found significantly worsened after both SB and DB ACL reconstructions. This worsening were not seen at medial tibiofemoral joint （TFJ） and lateral TFJ. Grade II cartilage damage was the most common. At second-look arthroscopy, the average patellar cartilage degeneration was 1.14±0.14 （at first look 0.52±0.11） for the SB group, and 1.22±0.15 （at first look 0.56±0.12） for the DB group. The average trochlear cartilage degeneration was 1.05±0.16 （at fist look 0.10±0.06） and 0.66±0.17 （at fist look 0.17±0.09）, respectively. The average patellar cartilage degeneration showed no significant difference in both groups. However, the average trochlea cartilage degeneration in DB group was significantly less than in SB group. Conclusions Patellofemoral cartilage degeneration continued to aggravate after ACL reconstruction. DB ACL reconstruction could significantly decrease the trochlea cartilage degeneration compared with SB ACL reconstruction.

Endobutton袢钢板与Rigidfix横穿钉股骨端固定自体腘绳肌腱重建前交叉韧带的转归

背景:固定方式的选择是影响前交叉韧带重建预后的重要因素,Endobutton袢钢板和Rigidfix横穿钉作为目前应用较为广泛的2种股骨端悬挂固定装置,它们的优点是固定强度大,肌腱与骨隧道接触面积大,有利于腱-骨愈合等。但这2种固定方法本身在临床疗效、骨隧道扩大等方面是否存在差异还有争议。目的:探讨Endobutton袢钢板与Rigidfix横穿钉股骨端固定自体腘绳肌腱重建前交叉韧带术后的转归。方法:回顾性分析2015年6月至2017年12月开展前交叉韧带重建并进行了第2次关节镜探查的270例病例。所有患者对治疗方案均知情同意,且得到医院伦理委员会批准。根据股骨端固定方式将患者分成2组,Endobutton组150例采用Endobutton袢钢板行自体腘绳肌腱股骨端固定重建前交叉韧带;Rigidfix组120例采用Rigidfix横穿钉行自体腘绳肌腱股骨端固定重建前交叉韧带,2组胫骨端均采用Bioabsorbable Interference Screw+AO空心钉固定。采用MRI测量2组骨隧道扩大情况,采用Lysholm评分、国际膝关节文献委员会评分、Tenger评分表及抽屉试验、Lachman试验、轴移试验、KT-1000关节测量仪评价膝评价膝关节功能恢复情况及稳定性;术后1年二次关节镜探查时观察移植物连续性、移植物滑膜覆盖情况以及关节内是否有异常结构。结果与结论:①所有患者均获得随访,随访时间14-44个月;②术后1年Endobutton组股骨端和胫骨端骨隧道扩大均较Rigidfix组明显(P <0.05);③术后1年2组患者术后Lysholm评分、Tegner评分、国际膝关节文献委员会评分均较术前改善(P <0.05),2组间术后评分差异无显著性意义(P> 0.05);④术后1年2组膝关节活动度对比差异无显著性意义(P>0.05);⑤二次探查前2组患者前抽屉试验、Lachman试验、轴移试验情况对比差异无显著性意义(P> 0.05);Endobutton组KT-1000侧-侧差值为(1.12±1.20) mm,Rigidfix组KT-1000侧-侧差值为(1.23±0.91)mm,2组对比差异无显著性意义(P>0.05);⑥二次关节镜探查示Endobutton组患者移植物完全吸收1例、移植物磨损11例;Rigidfix组患者移植物完全吸收2例,移植物磨损15例,2组差异无显著性意义(P> 0.05);⑦二次探查时移植物滑膜覆盖程度Endobutton组优59例,良61例,差30例;Rigidfix组优47例,良49例,差24例,2组差异无显著性意义(P> 0.05);⑧Endobutton组术后并发症的发生率为2.6%,Rigidfix组为6.6%,2组差异无显著性意义(P>0.05);⑨结果表明,Endobutton袢钢板与Rigidfix横穿钉股骨端固定自体腘绳肌腱重建前交叉韧带效果相当,二次探查移植物滑膜覆盖及连续性无明显差异;但与Rigidfix横穿钉系统相比,股骨端采用Endobutton固定更易引起骨隧道扩大。

FasT-Fix和半月板箭修复半月板术后磁共振成像的信号特点

目的 比较FasT-Fix和可吸收半月板箭（Arrow）缝合半月板术后磁共振（MRI）的信号特点和差异.方法 2002年9月～ 2008年12月,112名患者（其中12例内外侧半月板均缝合,共124处半月板缝合）接受关节镜下半月板缝合术,FasT-Fix组73处,Arrow组51处.患者术前及术后接受MRI扫描,比较两种缝合方式的MRI信号特点和差异,并以二次关节镜探查的结果作为金标准计算MRI对两种缝合方式术后愈合情况的诊断价值.结果 二次关节镜探查证实FasT-Fix组和半月板箭组的愈合率分别为74.0％ （54/73）和88.2％ （45/51） （Х^2 =3.794,P=0.051）;MRI综合T2序列对Arrow组愈合情况诊断的准确性（80.4％,41/51）高于FasT-Fix修复组（65.8％,48/73）,但差异无显著性（Х^2=3.176,P=0.075）;在综合T2序列中,FasT-Fix组中未愈合半月板出现3度信号的比例[84.2％ （16/19） vs.50.0％ （3/6）,Х^2=26.142,P=0.000]和累及层面[中位数4（1～6） vs.1（0～3）,Z=3.060,P=0.002]均明显高于Arrow组.结论 MRI综合T2序列对半月板箭修复术后的愈合诊断更准确,FasT-Fix修复术后的半月板更易出现3度信号.

子宫纵隔电切术后二探的临床观察

目的探讨不同子宫纵隔长度和经宫颈子宫纵隔电切术后不同处理方式与二探时宫腔粘连及残存纵隔的关系。方法对107例纵隔子宫电切治疗患者进行分组,根据初次电切时纵隔长度分小纵隔组≤1.5cm和大纵隔组>1.5cm;根据术后处理方法分单纯放置宫内节育器组和节育器加用雌孕激素治疗组。术后3个月宫腔镜二探,观察对比纵隔长度和术后不同处理方式的子宫腔修复情况。结果 107例均无手术并发症发生。6例残余纵隔>0.5cm行二次电切;21例存在宫腔粘连。术后纵隔残存与原子宫纵隔长度显著相关(P<0.05);宫腔粘连与术后处理方式没有明确相关性。结论大纵隔手术后存在残留可能性大,宫腔镜二探可以弥补第一次手术不足,雌孕激素治疗对预防术后粘连尚无明确疗效。

血清CA125测定对卵巢癌的诊断和治疗的意义

从１９８５年５月～１９８９年５月，作者采用单克隆抗体ＯＣ１２５，以放射免疫固相测定法进行检测人血清ＣＡ１２５抗原。测定结果，确定在本文研究中的血清ＣＡ１２５正常值为６５Ｕ／ｍｌ，≤６５Ｕ／ｍｌ为阴性，＞６５Ｕ／ｍｌ为阳性。卵巢上皮性癌患者的血清ＣＡ１２５水平８１．５％（７５／９２）为阳性，明显高于对照人群的２．５％，其中浆液性癌阳性率高达９３．２％（４１／４４）．根据ＣＡ１２５数值的动态变化来观察对评定疗效、预示复发及指导选择二探术等方面的临床意义，ＣＡ１２５阳性的病例不需要接受二探术，ＣＡ１２５水平与肿瘤变化的符合率达９２．９％。这充分证明ＣＡ１２５＞６５Ｕ／ｍｌ水平，肿瘤病灶＞２ｃｍ者，对化疗的反应差，预后也差。

食管癌剖胸探查原因分析

目的：探讨食管癌手术无法切除的原因。方法：回顾性分析我院1985～2003年216例行开胸探查而未能切除食管癌患者及2024例行根治性切除患者的临床资料，并与我院1954～1984年食管癌未切除手术248例和770例根治切除病例相比较。结果：1985～2003年资料显示，食管癌开胸探查率为9．6％（216／2240）；食管癌肿瘤外侵部位最常见者依次为主动脉、肺门、气管膜部、支气管、下肺静脉、椎体及心包等；主动脉受累率为42．6％（92／216），气管、支气管受累率为25．0％（54／216），远处转移率为21．8％（47／216）．1954～1984年资料显示。食管癌开胸探查率为32．2％（248／770），主动脉受累率为35．5％（88／248），气管、支气管受累率为26．6％（66／248），远处转移率为19．8％（49／248）；与1985～2003年比较，开胸探查率差异有统计学意义（P〈0．05），探查原因差异无统计学意义，P〉0．05。绪论：食管癌切除的可能性与病程、症状、病变长度、肿瘤部位、分期和大体病理类型有密切关系。由于先进诊断设备的应用，食管癌开胸探查率较以前明显下降，肿瘤外侵和转移仍然是影响手术切除的重要原因。综合各项检查，正确评估切除可能性，可降低开胸探查率。

三维超声在子宫中隔切开术预后评估中的价值

目的探讨经阴道三维超声成像(3-dimentional transvaginal ultrasound,3DTVU)对子宫中隔切开术后(transcervical incision of septum,TCIS)是否需要再次手术的预测价值。方法 2015年1月～2017年12月行子宫中隔切开术162例,年龄(30. 9±4. 6)岁,子宫完全中隔34例,不完全中隔128例。术后2个月行三维超声检查,记录残留中隔的长度及宫底内膜内陷的夹角,复查宫腔镜,记录宫腔修复、粘连情况及中隔残留长度,并与超声测量结果相比较。结果 (1)三维超声显示37例(22. 8%)宫腔形态正常,三维超声提示子宫内膜回声不均诊断宫腔粘连的灵敏度为100%(10/10),特异度92. 6%(25/27)。(2)其余125例超声检查见残留中隔,可测量到内膜凹陷长度和夹角。取120°为诊断角度,灵敏度92. 6%(63/68),特异度35. 1%(20/57)。内膜夹角> 120°的患者80. 0%(20/25)宫腔镜探查为弓形及正常宫腔形态(阴性预测值),无需宫腔镜手术;夹角≤120°的患者63. 0%(63/100)存在残隔及宫腔粘连(阳性预测值),需二次宫腔镜手术。结论三维超声提示宫腔形态正常且子宫内膜回声均匀可不行二次宫腔镜检查;若超声显示宫腔形态正常但回声欠均,或子宫内膜夹角≤120°,建议二次宫腔镜探查。

卵巢内胚窦瘤化疗的合理性探讨

1980～1988年收治22例卵巢内胚窦瘤,按术后残存肿瘤<1cm和>1cm分成两组,两组分别存活期各为46个月和15.5个月(P<0.01).又按术后予以联合化疗和单一化疗分成两组,两组存活期分别为28个月和10个月(P<0.05).术后首先应用腹腔联合化疗,越早越好.DDP和5—Fu联合腹腔化疗较合理,3次后每月1次VAC方案全身化疗效果较佳.少数病例在7～8个疗程后加全腹^(60)Co外照射.早期病例应行腹膜后淋巴清除术.连续测定AFP可作为治疗监护和评价预后.不宜行二次探查术.

乳腺“第二眼”超声对动态增强MRI额外检出ACR-BI-RADS 4类以上病灶的再评价

目的探讨乳腺"第二眼"超声对动态增强MRI BI-RADS 4类以上额外检出的病灶再评价的临床价值。方法对术前乳腺动态增强MRI额外发现的ACR BI-RADS 4类以上的病灶,应用"第二眼"超声再评价的80例病灶进行回顾性分析。结果动态增强MRI额外检出的80个病灶中,77个病灶被"第二眼"超声检出,检出率为98.25%。动态增强MRI诊断乳腺癌的灵敏度77.4%,特异度70.4%,总符合率:75%;"第二眼"超声诊断乳腺癌的灵敏度78.4%,特异性92.3%,总符合率83%。"第二眼"超声与病理的一致性较好(Kappa=0.65,P <0.001),与增强MRI的一致性中等(Kappa=0.44,P <0.001);动态增强MRI与病理的一致性中等(Kappa=0.46,P <0.001)。结论动态增强MRI导向"第二眼"超声对乳腺癌的检出率及特异性较高。

Role of endoscopy in acute gastrointestinal bleeding in real clinical practice:An evidence-based review

Although upper gastrointestinal bleeding is usually segregated from lower gastrointestinal bleeding, and guidelines for gastrointestinal bleeding are divided into two separate sections, they may not be distinguished from each other in clinical practice. Most patients are first observed with signs of bleeding such as hematemesis, melena, and hematochezia. When a patient with these symptoms presents to the emergency room, endoscopic diagnosis and treatment are considered together with appropriate initial resuscitation. Especially, in cases of variceal bleeding, it is important for the prognosis that the endoscopy is performed immediately after the patient stabilizes. In cases of suspected lower gastrointestinal bleeding, full colonoscopy after bowel preparation is effective in distinguishing the cause of the bleeding and treating with hemostasis. The therapeutic aspect of endoscopy, using the mechanical method alone or injection with a certain modality rather than injection alone, can increase the success rate of bleeding control. Therefore, it is important to consider the origin of bleeding and how to approach it. In this article, we aim to review the role of endoscopy in diagnosis, treatment, and prognosis in patients with acute gastrointestinal bleeding in a real clinical setting.

腹腔镜下卵巢上皮癌二次探查术的临床评价——附14例临床分析

目的探讨腹腔镜下卵巢上皮癌二次探查术的可行性、可靠性及并发症。方法14例均采用全身麻醉。6例取开放式切口,8例用闭合式腹腔镜进腹。按四孔法进行手术,生理盐水冲洗盆腹腔,冲洗液送细胞学检查;探查盆腹腔,分离粘连,在盆腹腔约20处多点活检。结果14例均按照手术前计划完成二次探查手术,手术时间(61.3±16.7)m in,出血(98.7±32.1)m l。手术发现4例(28.6%)阳性,其中肉眼阳性3例(21.4%),镜检阳性1例(7.1%);其余10例(71.4%)阴性。4例“二探术”阳性的卵巢癌患者,手术发现肿瘤位于盆腔腹膜、结肠旁沟腹膜;所有病例无腹腔脏器损伤,无中转开腹,仅有1例行开放式腹腔镜者脐部切口延迟愈合。10例二探术阴性者中有1例(10.0%)发生肿瘤复发,复发时间为48个月。结论进行腹腔镜下卵巢上皮癌二次探查术是可行的,具有创伤小、恢复快、病人易于接受等优点。

乳腺MRI导向性“第二眼”超声的临床应用

目的探讨乳腺MRI导向性＂第二眼＂超声对最初仅在MRI发现的乳腺病变的临床应用价值。方法对133例接受乳腺MRI导向性＂第二眼＂超声检查的患者,依据乳腺影像报告和数据系统（BI-RADS）标准进行影像分析。对超声或MRI诊断为BI-RADS 4或5类的病灶行穿刺活检或手术切除,对BI-RADS 2或3类病灶则进行定期随访。结果 133例患者中最初仅由MRI发现的病灶共147个,MRI导向性＂第二眼＂超声检出124个,检出率84.35%（124/147）。＂第二眼＂超声对肿块型和非肿块型病灶的检出率分别为89.87%（71/79）和77.94%（53/68）,差异有统计学意义（χ^2=3.942,P=0.047）。＂第二眼＂超声检出的124个病灶中94个有明确病理结果,未检出的23个病灶中9个有明确病理结果。＂第二眼＂超声对良、恶性病灶的检出率分别为93.75%（45/48）和89.09%（49/55）,差异无统计学意义（χ^2=0.698,P=0.498）。结论乳腺MRI导向性＂第二眼＂超声对最初仅由MRI发现的病灶具有较高检出率,且对肿块型病灶的检出率更高。

化疗对卵巢癌腹膜后淋巴结转移的疗效观察

自1986年6月至1993年12月．32例卵巢癌行二探术并作了腹膜后淋巴结清除术．其中上皮性癌20例（62.5％）、生殖细胞瘤12例（37.5％）。Ⅰ期15例，Ⅱ期5剂，Ⅲ期11例，Ⅳ期1例。32例腹膜后淋巴结有转移的9例28.1％,其中上皮性癌淋巴结转移为30.3％（6／20）．生殖细胞瘤淋巴结转移为25.0％（3／12）．Ⅰ期15例均无淋巴结转移．Ⅱ期5例．淋巴结转移40％（2／5）．Ⅲ11例，淋巴结转移54．5％（6／11），Ⅳ期1例有淋巴结转移。本文复查9例腹膜后转移淋巴结的病理．从形态学所见该9例对化疗均无变化。32例二探术中有盆、腹腔残癌者13例（40.6％）．本文对卵巢癌腹膜后转移淋巴结对化疗敏感性问题以及二探术的指证进行了讨论．并提出了的意见。

24例剖宫产术后非计划再次手术病例临床特点分析

目的探讨剖宫产术后非计划再次手术的原因及临床特点。方法收集24例剖宫产术后非计划再次手术患者的临床资料,回顾性分析其临床处理过程及预后。结果24例患者剖宫产指征主要是瘢痕子宫(n=7,29.2%)和产程停滞(n=6,25.0%);非计划再次手术的指征主要是腹腔出血(n=13,54.2%)和严重产后出血(n=8,33.3%);术前并发失血性休克16例(66.7%),并发弥散性血管内凝血13例(54.2%);24 h内再次手术19例(79.1%),24~72 h内再次手术5例(20.9%);主要手术方式是止血(n=13,54.2%)和子宫切除(n=12,50.0%);出血量(4633.0±1983.3)mL,输红细胞(3395.8±1986.3)mL、输血浆(1427.0±893.5)mL;术后转重症监护病房治疗13例(54.2%),腹壁切口感染裂开6例(25.0%),肺部感染6例(25.0%);术后住院时间(15.6±7.4)d。所有患者均临床痊愈出院。结论大部分剖宫产术后非计划再次手术是可以避免的,术中需彻底止血;密切监测具有高危因素患者的术后情况,早期识别并及时处理可降低严重并发症的发生率。

卵巢癌二次探查手术前PET-CT检查的作用及临床意义

目的探讨卵巢癌二次探查前行PET-CT检查的作用及临床意义。方法回顾性分析2006年2月-2010年12月手术治疗的、符合纳入标准的37例卵巢癌(16例行PET-CT检查)病历随访资料,比较二次探查术与PET-CT检查用于指导患者手术治疗随访结果。结果二次探查手术阳性率为67%;PET-CT检查阳性率为75%。PET-CT检查指导手术治疗组(S组)手术时间缩短,与直接二次探查手术组(对照组)相比,差异有统计学意义(P<0.01);S组中位生存时间较对照组延长(P<0.05);PET-CT检查组(T组即PET-CT检查后的手术及非手术病例)中位生存时间与行传统检查后直接行二次探查手术组相比,差异无统计学意义(P>0.05)。结论 PET-CT在二次探查手术前进行检查,可准确定位复发或转移部位,可缩短手术时间,延长术后患者生存期。但单纯以PET-CT结果为依据,判定患者是否需要二次手术,效果并不优于传统检查后行二次探查手术。