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Introducción: Está demostrada la importancia de la cirugía de mínimo acceso en las urgencias pediátricas a cualquier edad, por lo que constituye el enfoque actual tanto diagnóstico como terapéutico. Objetivo: Resaltar la utilidad de la laparoscopia para la cirugía de urgencia en las adolescentes. Presentación de casos: Tres adolescentes femeninas entre 14 y 18 años de edad, intervenidas por abdomen agudo quirúrgico por vía laparoscópica, se encontraron los siguientes hallazgos: Paciente 1: hemoperitoneo por quiste de cuerpo lúteo de ovario izquierdo, tratamiento por cirugía de mínimo acceso. Paciente 2: apendicitis aguda no complicada y quiste simple de ovario izquierdo no complicado, tratado por cirugía de mínimo acceso y la apendicectomía asistida. Paciente 3: torsión de quiste paraovárico de la trompa de Falopio derecha, tratamiento convencional a través de una minilaparotomía. Conclusiones: La laparoscopia de urgencia en estas adolescentes le facilitó al cirujano pediátrico un diagnóstico certero, con hallazgos ginecológicos transoperatorio y tratamiento quirúrgico variado a través de una cirugía mínimamente invasiva con múltiples ventajas para las pacientes(AU)
Introduction: The importance of minimal access surgery in pediatric emergencies at any age has been demonstrated, being the current diagnostic and therapeutic approach. Objective: To highlight the utility of laparoscopy for emergency surgery in adolescents. Case presentation: Three female adolescents between 14 and 18 years of age underwent laparoscopic surgery for acute abdomen. The main findings were: Patient 1: Hemoperitoneum due to corpus luteum of the left ovary, treated by minimal access surgery. Patient 2: Acute uncomplicated appendicitis and simple uncomplicated left ovary cyst, treated by minimal access surgery and assisted appendectomy. Patient 3: Torsion of the paraovarian cyst of the right fallopian tube, treated by conventional minilaparotomy. Conclusions: Emergency laparoscopy in these adolescents provided the pediatric surgeon an accurate diagnosis with intraoperative gynecological findings and varied surgical treatment through minimally invasive surgery, with multiple advantages for patients(AU)
Subject(s)
Humans , Female , Adolescent , Minimally Invasive Surgical Procedures , Emergencies , Laparoscopy/methodsABSTRACT
Objective To compare the changes in cardiac output (CO) and other hemodynamic parameters in patients undergoing gynecological laparoscopic surgery in head-down lithotomy position and Trendelenburg position. Methods Sixty patients were divided into head-down lithotomy group and Trendelenburg group. CO was recorded as baseline by a noninvasive cardiac output monitor NICOM? system after the placement of patients. These measurements were also acquired when the patients were placed in the 30° head-down tilt(T0)following pneumoperitoneum establishment.Stroke volume(SV), heart rate(HR)and CO were monitored at 1-minute intervals thereafter for a total of 10 minutes(T1-T10),and mean arterial pressure(MAP)and total peripheral resistance(TPR)were monitored every 5 minutes. Results The reduction of CO in head-down lithotomy group was greater than that in Trendelenburg group(T0:-31％±19％ vs.-9％±34％;T1:-32％±18％ vs.-16％±38％;T2:-33％± 19％vs.-16％±26％;T3:-32％±22％vs.-16％±28％;T4:-31％±18％vs.-12％±38％;T5:-30％± 17％vs.-14％±37％;T6:-31％±17％ vs.-14％±33％,all P<0.05)during the first 6 minutes. MAP at baseline in head-down lithotomy group was significantly higher than that in Trendelenburg group[(97±11) mmHg vs.(85±6)mmHg,P<0.05].MAP decreased in head-down lithotomy group at T0(-8％±16％) and increased in Trendelenburg group at T5 and T10(T5:9％±15％,T10:12％±18％). Conclusion CO reduction was greater in patients in head-down lithotomy position than that in Trendelenburg position group during the first 10 minutes after adjusting the position following pneumoperitoneum establishment.
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PURPOSE: The purpose of this study was to investigate the effects of thermotherapy on gas pain, post-operative resilience, and body temperature discomfort among patients who received laparoscopic myomectomies. METHODS: The experimental group consisted of 62 patients with thermotherapy and the control group consisted of 60 patients. Thermotherapy was applied individually to the experimental group four hours after surgery. The collected data was analyzed using descriptive statistics, t-tests, χ²-tests, and repeated measures of analysis of variance, using IBM SPSS Statistics version 18. RESULTS: The results showed no significant interaction effect between the group and time of measurement in gas-related pain in the experimental group. For gas-related pain, there was significant difference in right shoulder pain at 24 hours (t=-4.222, p=.000), 48 hours (t=-3.688, p=.000), 72 hours (t=-2.250, p=.028), and left at 24 hours (t=-3.727, p=.000), 48 hours (t=-4.150, p=.000), and 72 hours (t=-2.482, p=.016) and both shoulders at 24 hours (t=-2.722, p=.009) and 48 hours (t=-2.525, p=.014). There was no significant difference in epigastric pain, excluding both epigastric pain at 48 hours (t=2.908, p=.005), 72 hours (t=3.010, p=.004), but there was a significant difference in objective body temperature discomfort (t=2.895, p=.008). CONCLUSION: Thermotherapy relieved shoulder gas-related pain and objective body temperature discomfort. It needs to be developed and applied to improve post-operative discomfort in patients with laparoscopic hysterectomies.
Subject(s)
Humans , Body Temperature , Hyperthermia, Induced , Hysterectomy , Shoulder , Shoulder PainABSTRACT
Objective To evaluate the efficacy of ultrasound-guided transversus abdominis plane (TAP) block for preventive analgesia in patients undergoing gynecological laparoscopy. Methods 60 ASA physical status I ~ II, aged 30 ~ 50 yr, weighting 50 ~ 65 kg patients scheduled for elective gynecological laparoscopy were randomly divided into 3 groups using a random number table (n = 20 each): control group (group I), preoperative TAP block group (group II) and postoperative TAP block group (group III). Ultrasound-guided bilateral TAP block was performed before induction of anesthesia or at the end of surgery in II and III groups, respectively. Patient-controlled intravenous analgesia (PCIA) with 1μg/ml sufentanil (background infusion 2 ml/h, bolus dose 2 ml, lockout interval 15 min) was used until 2 days after surgery and VAS score was maintained ≤ 3. When VAS score > 3, flurbiprofen axetil 50 mg was injected intravenously as rescue medication. The consumption of sufentanil per hour, requirement for rescue medication, and development of adverse reactions were recorded within 24 h after surgery. Sufentanil-sparing degree was calculated. Results Compared with group I, the consumption of sufentanil per hour, requirement for rescue medication and the incidence of nausea and vomiting were significantly lower within 24 h after surgery in II and III groups (P < 0.05). The consumption of sufentanil per hour, requirement for rescue medication and the incidence of nausea and vomiting were significantly lower in group II than in group III (P < 0.05). The consumption of sufentanil was decreased by 35.0% in group II as compared with group I, and decreased by 16.0% in group II as compared with group III. Conclusion Ultrasound-guided TAP block can provide good postoperative analgesia in patients undergoing gynecological laparoscopy, and effect of preoperative nerve block is better than that of postoperative nerve block.
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Objective:To explore the feasibility and efficacy of short peptide enteral nutrition in preoperative bowel preparation for patients with gynecological laparoscopy.Methods:A total of 100 patients with gynecological laparoscopy were randomized into the trial group (n =50) and the control group (n =50) by using the random number table method.Patients in the study group received short peptide enteral nutrition for three days before operation without mechanical bowel preparation.Patients in the control group received traditional liguid diet and mechanical bowel preparation.The satisfaction of bowel preparation,postoperative anal exhaust time,hospitalization time and nutritionrelated parameters were compared between the two groups.Results:Doctor's satisfaction of bowel preparation in the study group was significantly higher than the control group (90％ vs 64％) (P ＜ 0.01).Postoperative anal exhaust time and hospitalization time were shorter in the control group (both P ＜ 0.05).The levels of postoperative albumin and hemoglobin in study group were significantly higher than the control group (bothP ＜ 0.05).Conclusion:Short peptide EN in preoperative bowel preparation of gynecological laparoscopy reveals a better efficacy and safety,a better recovery in postoperative intestinal function and nutritional status,and a shorter postoperative hospitalization time.It is well worth clinical promotion.
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Objective To explore the effect of treatment and nursing of Butorphanol and Tramadol Hydrochloride on chills after gynecological laparoscopic surgery. Methods Retrospective analysis of 60 chills patients after gynecological laparoscopic surgery treated the Second Hospital of Jiaxing City from January 2015 to January 2017 were taken, 60 patients were randomly divided into the control groups and the observation group, 30 cases in the control group were given Tramadol Hydrochloride; 30 patients in the observation group were given Butorphanol, the two groups of patients were given clinical nursing, patients chills grading after 5 min, 10 min, 30 min, Prince-Henry score, Ramsay sedation score and adverse reactions of two groups were comprehensively evaluated. Results There was no significant difference in the chills grading between the control group and the control group. Ramsay sedation score in the observation group significantly higher than the control group at 4 h, 8 h and 12 h after treatment with statistical significance (P<0.05) , in the observation group, there were 3 cases of adverse reactions occurred, accounting for 10.0%, which was significantly lower than that (36.7%) of the control group with statistical significance (P<0.05). Conclusion Butorphanol has a significant effect on chills after gynecological laparoscopic surgery, sedative effect of which is better than Tramadol Hydrochloride, with less adverse reactions.
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Objective To explore the effect of treatment and nursing of Butorphanol and Tramadol Hydrochloride on chills after gynecological laparoscopic surgery. Methods Retrospective analysis of 60 chills patients after gynecological laparoscopic surgery treated the Second Hospital of Jiaxing City from January 2015 to January 2017 were taken, 60 patients were randomly divided into the control groups and the observation group, 30 cases in the control group were given Tramadol Hydrochloride; 30 patients in the observation group were given Butorphanol, the two groups of patients were given clinical nursing, patients chills grading after 5 min, 10 min, 30 min, Prince-Henry score, Ramsay sedation score and adverse reactions of two groups were comprehensively evaluated. Results There was no significant difference in the chills grading between the control group and the control group. Ramsay sedation score in the observation group significantly higher than the control group at 4 h, 8 h and 12 h after treatment with statistical significance (P<0.05) , in the observation group, there were 3 cases of adverse reactions occurred, accounting for 10.0%, which was significantly lower than that (36.7%) of the control group with statistical significance (P<0.05). Conclusion Butorphanol has a significant effect on chills after gynecological laparoscopic surgery, sedative effect of which is better than Tramadol Hydrochloride, with less adverse reactions.
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Objective To study the effect of gradient pressure socks combined with intermittent pneumatic pressure pump on lower extremity deep venous thrombosis after gynecological laparoscopy.Methods Toally 45 patients to underwent gynecological laparoscopy during April 2013 to February 2015 were assigned as observation group and from April 2012 to March 2013 another 45 ones to undergo the same therapy were as control group.The latter was treated with routine nursing and the former with gradient pressure socks combined with intermittent pneumatic pressure pump apart from the routine nursing.The effective rate was conpared between two groups.Result The observation group was significantly more effective in the prevention of lower extremity deep venous thrombosis than that of the control group (P＜0.05).Conclusion The gradient pressure socks combined with intermittent pneumatic pressure pump can be effective in the prevention of lower extremity deep venous thrombosis after gynecological laparoscopy and thus deserves clinical popularization.
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Objective To observe the effect of integrative Chinese and western medicine fast-track rehabilitation in surgery (FTS) for patients during peri-operation period of gynecological laparoscopy. Methods A total of 226 patients receiving gynecological laparoscopic surgery were randomized into observation group and control group, 113 cases in each group. The observation group received integrative Chinese and western FTS treatment, and the control group received routine non-surgery treatment. After operation, time for the first post-operation anal gas evacuation, time for out-of-bed activity, hospitalization time, and incidence of post-operation complications were compared between the two groups. Results In the observation group, time for the first post-operation anal gas evacuation and time for out-of-bed activity were earlier, and hospitalization time was shorter than those in the control group (P<0.05). The incidence of post-operation complications was 0.9%, lower than 4.4% in the control group ( P<0.05). Conclusion Integrative Chinese and western medicine fast-track rehabilitation in surgery shows certain effect on promoting enterokinesia, shortening time for the anal gas evacuation, reducing post-operation complica-tions, promoting post-operation recovery of gastrointestinal function of patients receiving gynecological la-paroscopy .
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Objective To evaluate the effect of the electronic anti-nausea instrument on the postoperative nausea and vomiting of patients with gynecological laparoscopic surgery.Methods One hundred and eighty patients for gynecological laparoscopic surgery were enrolled and randomized into 2 groups with 90 patients in each.Patients in group T accepted patient-control transcutaneous elec-troacupoint stimulation at P6 (Neiguan)point from the time before the induction of anesthesia to 24 h after surgery.Patients in group C accepted the same device of electronic anti-nausea instrument with-out transcutaneous acupoint stimulation.Data were recorded of the nausea and vomiting in postopera-tive 2,6,12 and 24 h respectively.Results The incidence and severity of nausea at 6,12 and 24 h and vomiting at 6,24 h after operation in group T were both lower than those in group C(P < 0.05 ). Conclusion With patient-control transcutaneous acupoint stimulation at P6 point,the incidence of both early PONV and late PONV are reduced in patients with gynecological laparoscopic surgery.