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Resumen ANTECEDENTES: La evisceración por vía vaginal es una urgencia quirúrgica poco frecuente, con menos de 100 reportes en la bibliografía. Se asocia con múltiples factores, el más importante es la cirugía ginecológica por vía vaginal. La presentación clínica es variable y el tratamiento consiste en cirugía de urgencia para disminuir la morbilidad y mortalidad asociada con las complicaciones. CASO CLÍNICO: Paciente de 63 años, sin antecedentes quirúrgicos o procedimientos por vía vaginal, referida del segundo nivel al Hospital Regional de Alta Especialidad de Oaxaca, con diagnóstico de evisceración por vía vaginal, posterior a una maniobra de Valsalva cuando evacuaba, con posterior sensación de cuerpo extraño en el canal vaginal. Fue valorada en el servicio de Urgencias de un hospital de tercer nivel en donde se la encontró hemodinámicamente estable, con signos vitales en parámetros normales, taquicárdica, con 103 latidos por minuto. De inmediato fue intervenida y en el transoperatorio se evidenció la ruptura de la cúpula vaginal, con evisceración y necrosis de 100 cm de íleon terminal. Se le practicaron: resección, anastomosis y cierre primario del defecto vaginal. Se le tomó biopsia del cuello uterino; la colposcopia se reportó con malignidad negativa. El posoperatorio evolucionó sin contratiempos. CONCLUSIÓN: Hasta ahora, se encuentran menos de 100 reportes de esta complicación, que requiere de sospecha y tratamiento oportuno para disminuir la morbilidad y mortalidad asociada. Lo relevante de este caso es la ausencia de antecedentes quirúrgicos que pudieran ser la causa.
Abstract BACKGROUND: Vaginal evisceration is a rare entity, with less than 100 reports in the -literature, which is associated with multiple factors, the most important being the history of a gynecological surgical approach by vaginal approach. The clinical presentation is variable, and the treatment is based on emergency surgery to reduce the associated morbidity and mortality. CLINICAL CASE: The case of a 63-year-old female with no surgical history or vaginal procedures with a diagnosis of vaginal evisceration after performing a Valsalva maneuver when evacuating with a foreign body sensation in the vaginal canal, presenting a vaginal dome rupture, with evisceration and necrosis of the case is presented. 100 cm of terminal ileum who undergoes surgical time with resection, anastomosis as well as primary closure of vaginal defect, presents pathology report, cervical biopsy, as well as negative colposcopy of malignancy. CONCLUSION: So far, there are fewer than 100 reports of this complication, which requires suspicion and timely treatment to reduce the associated morbidity and mortality. What is relevant in this case is the absence of a surgical history that could be the cause.
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Objective To study the effect of remifentanil combined with propofol target-controlled infusion on anesthesia of gynecological laparoscopic surgery.Methods From August 2016 to August 2018,132 patients who needed to undergo gynecological laparoscopy in the Maternal and Child Health Care Hospital of Qujing were selected.The patients were randomly divided into two groups according to the principle of simple randomization,with 66 cases in each group.The observation group was given.remifentanil combined with propofol administered by target-controlled infusion for anesthesia.The control group were given fentanyl intravenous anesthesia.The clinical efficacy of the two groups was observed.Results The onset time of anesthesia [(1.3 ± 0.3) min],awake time [(5.2 ±1.5) min],anesthesia recovery time [(19.6 ± 5.3) min] and analgesic time [(23.6 ± 3.5) min] in the observation group were all shorter than those in the control group[(3.1 ± 0.6) min,(5.0 ± 3.5) min,(4.06 ± 4.8) min,(48.3 ±4.4) min] (t =12.742,15.102,11.265,12.354,all P ＜ 0.0).At 1 min after hemodynamic intubation,10 min after pneumoperitoneum,30 min after operation and 30min after operation,the heart rate,systolic blood pressure (SBP) and diastolic blood pressure (DBP) in the observation group were (82.38 ± 7.45) times/min,(85.65 ± 8.54) times/min,(77.58 ± 8.65) times/min,(80.12 ± 7.77) times/min,SBP:(136.25 ± 20.14) mmHg,(140.36 ± 18.02) mmHg,(129.14 ± 15.24) mmHg,(131.25 ± 16.19) mmHg,DBP:(986.45 ± 11.02) mmHg,(86.59 ± 10.11) mmHg,(80.17 ± 8.29)mmHg,(82.52 ± 8.17)mmHg,which were better than those in the control group[herat rate:(88.14 ± 10.01) times/min,(95.36 ± 8.48) times/min,(86.58 ± 7.33) times/min,(87.48 ± 8.47) times/min;SBP:(140.28 ±21.57) mmHg,(144.59 ± 21.35) mmHg,(137.33 ± 18.47) mmHg,(136.25 ± 18.47) mmHg;DBP:(90.0 ± 10.14) mmHg,(90.25 ± 11.24) mmHg,(84.25 ± 10.14) mmHg,(82.55 ± 8.84) mmHg] (F =1.320,1.245,1.365,all P ＜ 0.05).Conclusion Remifentanil combined with propofol target controlled infusion for patients undergoing gynecological laparoscopic surgery is helpful to enhance the anesthetic effect,and has a short pharmacodynamic effect,which is conducive to ensuring the quality of surgery.Therefore,it is worthy of popularizing in clinical practice.
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Objective@#To study the effect of remifentanil combined with propofol target-controlled infusion on anesthesia of gynecological laparoscopic surgery.@*Methods@#From August 2016 to August 2018, 132 patients who needed to undergo gynecological laparoscopy in the Maternal and Child Health Care Hospital of Qujing were selected.The patients were randomly divided into two groups according to the principle of simple randomization, with 66 cases in each group.The observation group was given.remifentanil combined with propofol administered by target-controlled infusion for anesthesia.The control group were given fentanyl intravenous anesthesia.The clinical efficacy of the two groups was observed.@*Results@#The onset time of anesthesia[(1.3±0.3)min], awake time[(5.2±1.5)min], anesthesia recovery time[(19.6±5.3)min]and analgesic time[(23.6±3.5)min]in the observation group were all shorter than those in the control group[(3.1±0.6)min, (5.0±3.5)min, (4.06±4.8)min, (48.3±4.4)min](t=12.742, 15.102, 11.265, 12.354, all P<0.0). At 1 min after hemodynamic intubation, 10 min after pneumoperitoneum, 30 min after operation and 30min after operation, the heart rate, systolic blood pressure (SBP) and diastolic blood pressure (DBP) in the observation group were (82.38±7.45)times/min, (85.65±8.54)times/min, (77.58±8.65)times/min, (80.12±7.77)times/min, SBP: (136.25±20.14)mmHg, (140.36±18.02)mmHg, (129.14±15.24)mmHg, (131.25±16.19)mmHg, DBP: (986.45±11.02)mmHg, (86.59±10.11)mmHg, (80.17±8.29)mmHg, (82.52±8.17)mmHg, which were better than those in the control group[herat rate: (88.14±10.01)times/min, (95.36±8.48)times/min, (86.58±7.33)times/min, (87.48±8.47)times/min; SBP: (140.28±21.57)mmHg, (144.59±21.35)mmHg, (137.33±18.47)mmHg, (136.25±18.47)mmHg; DBP: (90.0±10.14)mmHg, (90.25±11.24)mmHg, (84.25±10.14)mmHg, (82.55±8.84)mmHg](F=1.320, 1.245, 1.365, all P<0.05).@*Conclusion@#Remifentanil combined with propofol target controlled infusion for patients undergoing gynecological laparoscopic surgery is helpful to enhance the anesthetic effect, and has a short pharmacodynamic effect, which is conducive to ensuring the quality of surgery.Therefore, it is worthy of popularizing in clinical practice.
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Introduction Surgical site infections (SSIs) can affect body tissues, cavities, or organs manipulated in surgery and constitute 14% to 16% of all infections. This study aimed to determine the incidence of SSIs in women following their discharge from a gynecology outpatient clinic, to survey different types of SSIs among women, and to verify the association of SSIs with comorbidities and clinical conditions. Methods Data were collected via analytical observation with a cross-sectional design, and the study was conducted in 1,026 women who underwent gynecological surgery in a teaching hospital in the municipality of Teresina, in the northeast Brazilian State of Piauí, from June 2011 to March 2013. Results The incidence of SSIs after discharge was 5.8% among the women in the outpatient clinic. The most prevalent surgery among the patients was hysterectomy, while the most prevalent type of SSI was superficial incisional. Comorbidities in women with SSIs included cancer, diabetes mellitus, and hypertension. Conclusions Surveillance of SSIs during the post-discharge period is critical for infection prevention and control. It is worth reflecting on the planning of surgical procedures for patients who have risk factors for the development of SSIs. .
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Adult , Female , Humans , Middle Aged , Surgical Wound Infection/epidemiology , Cross-Sectional Studies , Incidence , Length of Stay , Risk Factors , Surgical Wound Infection/etiologyABSTRACT
Objective To evaluate the reliability of PainVision method for assessment of postoperative pain in patients undergoing gynaecological laparoscopy.Methods Twenty ASA physical status Ⅰ-Ⅱ patients,aged 30-45 yr,undergoing gynaecological laparoscopy under fentanyl-propofol-cisatracurium anesthesia,were studied.Pain intensity was simultaneously assessed using PainVision method and visual analog scale (VAS) at 12,24 and 48 h after surgery.PainVision was a new method for quantitative measurement of pain intensity using a painless electrical stimulation (PainVision PS-2100 device).Pain degree was calculated from two parameters,current perception threshold and pain compatible electrical current by using PainVision.The former parameter was defined by the lowest electrical current detected ; the latter parameter defined by the electrical current judged as being compatible with the intensity of ongoing pain.Results There was a significant positive correlation between pain degree calculated by PainVision method and VAS scores,and the correlation coefficient was 0.902 (P ＜ 0.01).Conclusion PainVision method can be applied for assessment of postoperative pain in patients undergoing gynaecological laparoscopy.