目的 分析颅内动脉瘤弹簧圈栓塞治疗术中出血的原因和防治对策。 方法 回顾性分析2003年3月－2012年8月358例颅内动脉瘤采用弹簧圈栓塞治疗患者，7例弹簧圈栓塞过程中出血，并继续栓塞止血。2例为弹簧圈栓塞中造影仅见血流明显变慢，术后CT证实的出血。术后对症治疗6例，开颅引流减压3例。 结果 9例术中破裂者中8例致密栓塞，1例部分栓塞。5例恢复好，1例一过性动眼神经麻痹，3例死于颅内高压 结论 术中出血与手中操作、动脉瘤形态和患者血管条件、血压变化有关，继续填塞及合理术中与后续治疗可以挽救大部分患者生命。
【摘要】 目的 探讨减少输卵管间质部妊娠腹腔镜术中失血的方法。 方法 选择2007年1月-2010年6月49例诊断为输卵管间质部妊娠的患者随机分成观察组（24例）和对照组（25例）。观察组在腹腔镜切开异位妊娠病灶前于宫角注射垂体后叶素6 U，待子宫收缩后手术；对照组直接切开异位妊娠病灶进行手术。比较两组手术时间、术中出血量、血压、术后肛门排气时间、体温等方面的差异以及随访患者月经恢复时间。 结果 观察组和对照组手术时间分别为（34.29±7.96）、（53.68±10.48） min，术中出血量为（48.04±9.49）、（85.52±15.24） mL，差异有统计学意义（Plt;0.05）；两组在术后肛门排气时间、术后体温、术前血压、妊娠病灶切开后5 min的血压以及观察组使用垂体后叶素前后的血压差异均无统计学意义（Pgt;0.05）。两组患者在术后30～41 d月经复潮。 结论 输卵管间质部妊娠腹腔镜术中使用垂体后叶素能明显缩短手术时间和减少术中出血量，不增加持续性宫外孕的发生。【Abstract】 Objective To explore the method of reducing bleeding in laparoscopy for interstitial pregnancy. Methods Forty-nine patients diagnosed to have interstitial pregnancy between January 2007 and June 2010 were randomly divided into observation group (24 cases) and control group (25 cases). Patients in the observation group were given an injection of 6 U pituitrin in the horn of uterus before the incision of lesions in laparoscopy, and operation was performed after uterine contraction; while the lesions of patients in the control group were directly incised. The differences between the two groups in operation time, blood loss during the operation, blood pressure, exhaust time and temperature were studied and the recovery time of menstrual period was followed up. Results The operation time of the observation group and the control group was (34.29±7.96) minutes and (53.68±10.48) minutes; the blood loss was (48.04±9.49) mL and (85.52±15.24) mL, respectively. The difference in the operation time and blood loss between the two groups was significant (Plt;0.05). The difference in other indexes between the two groups such as the exhaust time, postoperative body temperature, the blood pressure before operation and within five minutes after the incision of the lesion was not statistical (Pgt;0.05). The recovery time of menstrual period in the two groups was 30 to 41 days. Conclusion Using pituitrin in laparoscopy for interstitial pregnancy can significantly shorten operation time and reduce blood loss, and will not increase the incidence rate of persistent ectopic pregnancy.
目的:评估宫腔内水囊压迫治疗剖宫产术中大出血的可行性。方法:选择2005年2月至2009年3月北戴河医院及秦皇岛市妇幼保健院行子宫下段剖宫产,术中发生大出血病例106例,,常规方法处理无效后,应用宫腔内水囊压迫止血。结果:106例患者在12小时后取出水囊,阴道流血量明显减少,均无再次大出血发生。止血效率100%。结论:宫腔内水囊压迫治疗剖宫产术中大出血效果佳、操作简便、止血迅速,留置时间短、可作为治疗剖宫产术中大出血的一种简便、可行、有效的止血方法。
Objective To investigate the preventive measures for bleeding in laparoscopic hepatectomy. Methods The candidates for laparoscopic hepatectomy were 22 patients with live lesions， including 5 patients with primary liver cancer， 16 patients with liver hemangioma， and 1 patient with metastatic liver cancer. The tumors locatedthe left lateral lobe in 15 cases， caudate lobe in 1 case， segmentⅣin 2 cases， and segmentⅥ in 4 cases. The meandiameter of tumors was 4cm （2-10cm）. The surgical approaches included the left lateral lobectomy （15 cases）， leftlateral lobectomy of caudate （1 case）， and nonanatomic and wedge resection were performed in 6 cases. Results Twenty-two cases underwent laparoscopic liver resection， there were no conversion to open and operative death. The mean operative time was 115min （65-142min）， the mean blood loss was 450mL （270-780mL）， the mean length of hospital stay after operation was 6.5 days （3-11 days）. Conclusion Control liver section hemorrhage is a key technique in laparoscopic hepatectomy.
ObjectiveTo investigate the influencing factor of intraoperative hypothermia during laparotomy.MethodsA total of 81 patients underwent laparotomy in our hospital from October 1, 2018 to January 1, 2019 were enrolled. The difference of preoperative baseline data and surgical data between the hypothermia and non-hypothermia groups was compared, and the influencing factor of intraoperative hypothermia during laparotomy was explored.ResultsOf the 81 patients, 32 patients occurred hypothermia during operation. There were no significant differences in gender, age, BMI, HGB, WBC count, PLT count, TB, AST, ALT, ALB, PT, operation time, postoperative hospital stay, and Clavien-Dindo grade between the hypothermia group and the non-hypothermia group (P>0.05), but there were significant differences in intraoperative infusion volume, intraoperative blood loss, and surgical mode (P<0.05). The intraoperative infusion volume and intraoperative blood loss in the hypothermia group were higher than those in the non-hypothermia operation group, and the proportion of hepatectomy was higher than that in the non-hypothermia group. The multivariate analysis show that the intraoperative blood loss, intraoperative infusion volume, and kind of operation were the risk factors for the hypothermia during laparotomy (P<0.05).ConclusionsIntraoperative hypothermia is related to intraoperative bleeding volume, intraoperative fluid infusion volume, and the kind of operation. Therefore, for patients with less bleeding, the intraoperative hypothermia can be reduced by limiting the volume of intraoperative fluid infusion. For those patients with more intraoperative bleeding, warming fluid infusion may reduce the incidence of intraoperative hypothermia.
ObjectiveTo review the advances in the application of tranexamic acid (TXA) in adolescent spinal corrective surgery.MethodsThe mechanism of action and pharmacokinetic, effectiveness, dosage, safety as well as methods of administration were comprehensively summarized by consulting domestic and overseas related literature about the application of TXA in adolescent spinal corrective surgery in recent years.ResultsTXA efficaciously reduce intraoperative blood loss, transfusion rate and volume, postoperative drainage volume in adolescent spinal corrective surgery. At present, the most common method of administration in adolescent spinal corrective surgery is that a loading dose is given intravenously before skin incision or induction of anesthesia, followed by a maintenance dose until the end of the surgery. The range of loading dose and maintenance dose is 10-100 mg/kg and 1-10 mg/(kg·h), respectively. No drug related adverse event has been reported in this range.ConclusionThe effectiveness and safety of TXA in adolescent spinal surgery have been basically confirmed. However, further studies are needed to determine the optimal dosage, method of administration as well as whether it could reduce blood loss after surgery.
ObjectiveTo investigate the effect of the round ligament fissure approach in re-hepatectomy.MethodsA total of 40 patients with recurrence of hepatocellular carcinoma (HCC) who underwent re-hepatectomy in the Department of Hepatopancreatobiliary Surgery of Leshan People’s Hospital from June 2017 to August 2020 were collected and divided into two groups according to different surgical approaches: study group (transhepatic round ligament fissure approach) and control group (conventional surgical approach), 20 cases in each group. The perioperative general indicators, peripheral blood laboratory indicators, and complications of the two groups were compared.ResultsCompared with the control group, the operation time, postoperative drainage tube removal time, and postoperative hospital stay of study group were shortened, and intraoperative blood loss was reduced (P<0.05). Compared with preoperatively in the same group, postoperative TBIL and ALT levels of the two groups decreased, and HGF levels increased (P<0.05). There was no significant difference in the levels of TBIL, ALT, and HGF between the two groups before surgery (P>0.05); at 1 month after surgery, there was no significant difference in the levels of TBIL and ALT between the two groups (P>0.05), but the HGF level of the study group was higher than that of the control group at1 month after operation, the difference was statistically significant (P<0.05). The changes before and after operation of TBIL and ALT were similar between the two groups (P>0.05), but the rising value of HGF in the study group was higher than that of the control group (P<0.001). There was no death in the two groups during the perioperative period, and the total postoperative complications were not statistically different (P=0.677). There was no statistically significant difference in the postoperative follow-up results between the two groups in recurrence, metastasis, and death (P>0.05).ConclusionRe-hepatectomy through the round ligament fissure approach can reduce the amount of intraoperative blood loss, shorten the operation time, and reduce the damage to the residual liver, which has high safety.
ObjectiveTo investigate the clinical value of laparoscopic cholecystectomy following “A-B-D” approach applied in the operation of acute suppurative or gangrenous cholecystitis.MethodsWe sought out 45 patients diagnosed as acute suppurative or gangrenous cholecystitis and treated by laparoscopic cholecystectomy following the “A-B-D” approach in People’s Hospital of Leshan from Sep. 2019 to Dec. 2020 as the observation group (ABD observation group), and sought out 50 patients with the same diseases but treated by conventional laparoscopic cholecystectomy from Jun. 2018 to Aug. 2019 as the matched group (conventional matched group). We analyzed and compared the parameters related to safety and efficacy of the two groups retrospectively.ResultsA total of 95 patients were included, including 45 patients in the ABD observation group (26 cases of acute suppurative cholecystitis, 19 cases of acute gangrenous cholecystitis) and 50 patients in the conventional matched group (24 cases of acute suppurative cholecystitis, 26 cases of acute gangrenous cholecystitis). There were no significant differences in age, gender, body mass index, disease composition, gallbladder condition, and preoperative complications between the two groups (P>0.05). There was no bile duct injury case in the ABD observation group (0), while there were 4 cases (8.0%) in the conventional matched group, but the statistical results showed no statistical significance between the two groups (P=0.054). One case (2.2%) in the ABD observation group converted to laparotomy, which was significantly lower than the 10 cases (20.0%) in the conventional matched group, and the difference was statistically significant (P=0.017). In addition, there were no significant differences for other parameters including operative time, postoperative hospital stay, incidences of intraoperative bleeding and postoperative bleeding between the two groups (P>0.05).ConclusionsThe laparoscopic cholecystectomy following the “A-B-D” approach can help distinguish the anatomical structure of cystic duct and extrahepatic bile duct clearly, and it can help prevent biliary tract injury effectively and reduce the probability of conversion to laparotomy. It is worthy of clinical application and promotion, especially in the majority of county hospitals.