目的 探讨双管喉罩与气管插管用于全身麻醉妇科腹腔镜手术的安全性和可行性。 方法 2009年1月-5月择期妇科腹腔镜手术患者60例，ASAⅠ～Ⅱ级，随机分为喉罩组（P组）和气管插管组（T组）。记录入室基础值（T0），置罩（管）前（T1），置罩（管）后即刻（T2），置罩（管）后5 min（T3 ），拔除罩（管）即刻（T4），拔除罩（管）后5 min（T5）的收缩压（systolic pressure, SBP），舒张压（diastolic pressure, DBP），心率（heart rate, HR）和脉搏血氧饱和度（pulse oxygen saturation, SpO2），喉罩和气管插管控制呼吸时气腹前后不同时段的气道峰压（airway. maximum pressure, Pmax），潮气量（vital volume, VT）和呼气末二氧化碳分压（end tidal CO2, PETCO2）。记录插罩（管）成功率，及相关并发症。 结果 T2时T组SBP，DBP和HR显著高于P组（P＜0.05），两组术中通气均满意；Pmax，VT和PETCO2组间比较各时点无差异（P＞0.05）。气腹后Pmax和PETCO2组内比较均高于气腹前，差异有统计学意义（P＜0.05）。置罩（管）成功率组间比较差异无统计学意义，拔罩（管）期及术后24 h并发症，喉罩组明显低于气管导管组，差异显著（P＜0.05）。 结论 双管喉罩用于全麻妇科腹腔镜手术通气效果满意，安全可行。
Objective To investigate patients in gynecological endocrinology clinic with the following three pieces of information: how did they provide their symptom information, how did they understand diagnostic and therapeutic information, and what was their attitude towards the visit, and to get to know about the situation and problems in doctor-patient communication, so as to aim directly at improving the efficiency of diagnosis and treatment. Methods A total of 403 patients, who visited Prof. HAN Zi-yan’s clinic in the hospital from April to August 2010, were evaluated using self-edited Assessment on Doctor-patient Communication in Gynecological Endocrinology Outpatient Clinic. Results a) As to the situation of patients providing symptom information as well as understanding diagnostic and therapeutic information, when doctor asked, only 29% (118/403) of patients could narrate their treatment history clearly, and 38% (152/403) could tell their examination history exactly. After doctors’ explanation, only 21% (86/403) understood their examination results correctly, and 27% (108/403) understood management and therapeutic advice. The result of correlation analysis showed the accuracy of patients in providing disease information and accepting diagnostic and therapeutic information was higher in patients aged from 21 to 40 rather than those younger than 20, in patients well- educated rather than those with little education at the primary school, and in patients who were also engaged in medical work, All differences were significant (all Plt;0.05); and b) As to patients’ attitude towards visit, 55% (222/403) of patients hoped to get more attention from doctor, and 37.5% (151/403) overly expected the visit. Conclusion In the professor’s gynecological endocrinology outpatient clinic, many patients can’t clearly provide their treatment and examination history, neither understand exam situation and therapeutic advice at that visit, which are influenced by their age, education and occupation. In addition, psychological needs of patients should be concerned, too
目的 探究妇科投诉纠纷发生的状况及原因，以改进工作方式减少投诉现象。 方法 对2005年1月－2010年12月妇科门诊和病房发生的投诉及医患纠纷资料进行收集，并对其原因进行分类统计分析，提出相关应对措施。 结果 6年间门诊及病房共发生投诉41例，纠纷8例。其医务人员技术水平不到位、服务态度差、沟通缺乏，就医环境差、收费不合理、患者自身因素等是投诉纠纷发生的主要原因。 结论 妇科是纠纷易发科室，但只要采用有效的控制措施，就能减少甚至避免医患纠纷的发生，提高患者满意度。
目的:比较不同麻醉方法在腹腔镜妇科不孕检查及治疗术中的效果和安全性。方法:选择不孕拟在腹腔镜下行检查及治疗术的患者60例,随机分为三组,每组20人,分别进行连续硬膜外麻醉(简称EA组);静吸复合全身麻醉(简称GA组);连续硬膜外麻醉加静吸复合全身麻醉(简称EGA组),观察比较三种麻醉方法对患者呼吸,循环及麻醉效果的影响。结果:三种麻醉方法均可保证手术完成,EA组术中管理较为麻烦,GA组循环波动大,EGA组麻醉效果更好,各种药物用量减少,患者血液动力学更稳定,恢复快,管理更轻松。结论:连续硬膜外麻醉加静吸复合全身麻醉(EGA)可避免其它两种麻醉方式不足,各取长处,更适用于腹腔镜妇科不孕检查及治疗术麻醉。
Objective To assess the safety and effectiveness of laparoscopic hysterectomy (LH) for women with benign gynecological diseases. Methods Such databases as CENTRAL (The Cochrane Library, Issue 5, 2012), MEDLINE, EMbase, CNKI, WanFang Data, VIP and CBM were searched from the date of their establishment to May 2012, meanwhile the relevant gray literature was also retrieved to identify the randomized controlled trials (RCTs) about LH versus abdominal hysterectomy (AH) for benign gynecological diseases. The literature was screened according to the inclusion and exclusion criteria by two reviewers independently, and the methodology quality was evaluated after extracting the data, then RevMan 5.1 software was used for meta-analysis. Results A total of 22 RCTs involving 3 304 patients were included. The results of meta-analysis showed that, compared with AH, LH was shorter in the time of both hospital stay (MD=–2.31, 95%CI –3.03 to –1.60, Plt;0.000 01) and postoperative recovery (MD=−13.86, 95%CI −17.70 to −10.03, Plt;0.000 01), and lower in the incidences of both postoperative fever and other nonspecific infections (OR=0.72, 95%CI 0.54 to 0.95, P=0.02), but it was higher in the incidence rate of intraoperative urinary systematic injuries (OR=2.41, 95%CI 1.21 to 4.82, P=0.012), and longer in the operation time (MD=20.27, 95%CI 3.95 to 36.59, P=0.03). There were no significant differences between the two groups in the incidence of complications such as intraoperative intestinal injuries, vessel injuries, postoperative fistulizaion, postoperative urethral dysfunction, postoperative vaginal infection, etc. (Pgt;0.05). Conclusion This systematic review shows when treating benign gynecological diseases, LH is superior to AH in shortening the time of hospital stay and postoperative recovery, and in decreasing the incidence of operative fever and other nonspecific infections, but it results in a higher incidence of intraoperative urinary systematic injuries and longer operative time. Because there is no result regarding to the postoperative long-term life quality, so it expects to be further proved by more high quality RCTs.