目的:分析经阴道和经腹腔镜2种方式治疗剖宫产术后子宫瘢痕妊娠(CSP)的临床效果和安全性。方法:选取2016年1月至2018年12月在徐州市贾汪区人民医院治疗的76例CSP患者,按手术方式的不同分为经阴道手术组(A组)与经腹腔镜手术组(B组),每组...目的:分析经阴道和经腹腔镜2种方式治疗剖宫产术后子宫瘢痕妊娠(CSP)的临床效果和安全性。方法:选取2016年1月至2018年12月在徐州市贾汪区人民医院治疗的76例CSP患者,按手术方式的不同分为经阴道手术组(A组)与经腹腔镜手术组(B组),每组各38例。A组采用经阴道子宫下段病灶切除术进行治疗,B组采用腹腔镜下病灶切除术进行治疗,比较2组患者的手术时间、出血量、住院时间、首次肛门排气时间、月经恢复时间、血清人绒毛膜促性腺激素(β-HCG)恢复时间、术后24 h VAS评分,记录膀胱损伤、阴道流血、感染等并发症发生情况。结果:A组的手术时间、出血量及住院时间均少于B组,差异有统计学意义(P<0.05),A组的首次肛门排气时间及术后24 h VAS均少于B组,差异有统计学意义(P<0.05),但2组的月经恢复时间及血清β-hCG恢复时间的差异无统计学意义(P>0.05),2组并发症发生情况差异无统计学意义(P>0.05)。结论:经阴道以及经腹腔镜2种方式对CSP患者均具有良好的临床效果和安全性。经阴道手术的优势在于创伤更小,术后患者恢复更快。展开更多
Background The infection risk of natural orifice transluminal endoscopic surgery （NOTES） is of concern. The aim of this study was to assess the safety of NOTES by investigating the intraperitoneal bacterial load dur...Background The infection risk of natural orifice transluminal endoscopic surgery （NOTES） is of concern. The aim of this study was to assess the safety of NOTES by investigating the intraperitoneal bacterial load during transgastric and transvaginal procedures with antiseptic or controling perioperative preparation.Methods Forty-five female pigs were randomly assigned to five equal groups： the transgastric （TG） control group （group A）, the TG middle volume gastric lavage group （group B）, the TG high volume lavage group （group C）, the transvaginal （TV） control group （group D） and the TV study group （group E）. The study groups received gastric or vaginal lavage and abdominal antimicrobial irrigation, while the control groups received neither. All animals were administered intravenous antibiotics, underwent NOTES peritoneoscopy and transumbilical laparoscopic cholecystectomy under NOTES view with sterile instruments. The viscerotomy was closed by laparoscopic suture. The animals were observed until necropsy was performed 14 days postoperatively. Quantitative bacteriologic cultures were taken from the gastric or vaginal aspirate before and after lavage; peritoneal fluid was collected before and after peritoneal irrigation and at necropsy. Results The surgical procedures were completed for all the pigs and all of them survived. The mean operative time of the TG group and the TV group was （81±27） minutes and （66±12） minutes, respectively. All animals survived for 14 days.At necropsy, significantly more peritoneal infections were noted in group A than in group D （5：9 vs. 0：9; P 〈0.05）. Nogross evidence of intra-peritoneal infection was found in groups B, C, D and E. Bacteriological evidence was seen in all pigs in group A, 7 pigs in group B, 6 pigs in group D, and none in groups C and E.Conclusions Without gastric or vaginal lavage and antibiotic peritoneal irrigation, the TG procedure has a higher infection rate than the TV access. After antiseptic preparation, the b展开更多
文摘目的:分析经阴道和经腹腔镜2种方式治疗剖宫产术后子宫瘢痕妊娠(CSP)的临床效果和安全性。方法:选取2016年1月至2018年12月在徐州市贾汪区人民医院治疗的76例CSP患者,按手术方式的不同分为经阴道手术组(A组)与经腹腔镜手术组(B组),每组各38例。A组采用经阴道子宫下段病灶切除术进行治疗,B组采用腹腔镜下病灶切除术进行治疗,比较2组患者的手术时间、出血量、住院时间、首次肛门排气时间、月经恢复时间、血清人绒毛膜促性腺激素(β-HCG)恢复时间、术后24 h VAS评分,记录膀胱损伤、阴道流血、感染等并发症发生情况。结果:A组的手术时间、出血量及住院时间均少于B组,差异有统计学意义(P<0.05),A组的首次肛门排气时间及术后24 h VAS均少于B组,差异有统计学意义(P<0.05),但2组的月经恢复时间及血清β-hCG恢复时间的差异无统计学意义(P>0.05),2组并发症发生情况差异无统计学意义(P>0.05)。结论:经阴道以及经腹腔镜2种方式对CSP患者均具有良好的临床效果和安全性。经阴道手术的优势在于创伤更小,术后患者恢复更快。
文摘Background The infection risk of natural orifice transluminal endoscopic surgery （NOTES） is of concern. The aim of this study was to assess the safety of NOTES by investigating the intraperitoneal bacterial load during transgastric and transvaginal procedures with antiseptic or controling perioperative preparation.Methods Forty-five female pigs were randomly assigned to five equal groups： the transgastric （TG） control group （group A）, the TG middle volume gastric lavage group （group B）, the TG high volume lavage group （group C）, the transvaginal （TV） control group （group D） and the TV study group （group E）. The study groups received gastric or vaginal lavage and abdominal antimicrobial irrigation, while the control groups received neither. All animals were administered intravenous antibiotics, underwent NOTES peritoneoscopy and transumbilical laparoscopic cholecystectomy under NOTES view with sterile instruments. The viscerotomy was closed by laparoscopic suture. The animals were observed until necropsy was performed 14 days postoperatively. Quantitative bacteriologic cultures were taken from the gastric or vaginal aspirate before and after lavage; peritoneal fluid was collected before and after peritoneal irrigation and at necropsy. Results The surgical procedures were completed for all the pigs and all of them survived. The mean operative time of the TG group and the TV group was （81±27） minutes and （66±12） minutes, respectively. All animals survived for 14 days.At necropsy, significantly more peritoneal infections were noted in group A than in group D （5：9 vs. 0：9; P 〈0.05）. Nogross evidence of intra-peritoneal infection was found in groups B, C, D and E. Bacteriological evidence was seen in all pigs in group A, 7 pigs in group B, 6 pigs in group D, and none in groups C and E.Conclusions Without gastric or vaginal lavage and antibiotic peritoneal irrigation, the TG procedure has a higher infection rate than the TV access. After antiseptic preparation, the b
