妇科腹腔镜手术后输尿管阴道瘘的诊治策略

探讨妇科腹腔镜手术后输尿管阴道瘘的诊治策略。选取笔者所在科室收治的17例妇科腹腔镜手术后输尿管阴道瘘患者,其中1例合并膀胱阴道瘘。其中行腹腔镜子宫切除3例,腹腔镜广泛子宫切除加盆腔淋巴结清扫13例,腹腔镜子宫阔韧带肿瘤切除1例。患者均表现为阴道有液体不自主流出,发生于术后6天~21天,平均10.8天。伴腹痛9例,发热3例。就诊时间为出现尿液漏出第3天~30天,平均13.3天。结果 8例行输尿管镜下留置双J管,治愈5例。12例行输尿管膀胱再植术,均治愈。妇科腹腔镜手术后输尿管阴道瘘一经诊断明确,需及时行输尿管镜探查,可选择合适患者行留置输尿管支架管治疗。     

逆行性肾盂造影联合输尿管软镜在诊断小肾盏癌中的价值

探讨逆行性肾盂造影联合输尿管软镜在诊断小肾盏癌中的价值。回顾分析5例小肾盏癌临床资料,术后病理检查结果均提示尿路上皮癌I级（Ta-G1）,术后定期行膀胱内灌注化疗药物,且均未出现肿瘤其他部位转移等并发症发生。对5例患者均进行随访,1年期间每3个月行尿常规及B超检查均正常,1年生存率达100％。患者出现血尿症状,虽然常规检查（尿常规、B超、IVU、CT或MRI等）诊断不明确者,都可行逆行性肾盂造影检查。一旦逆行性肾盂造影检查提示异常图像,均可提示肾盏癌,使误诊率及漏诊率降至最低程度,尽可能阻断早期肿瘤的发展。故逆行性肾孟造影联合输尿管软镜可提高早期小肾盏癌的术前诊断率。     

下肢深静脉血栓患者预防性置入下腔静脉滤器的临床决策

下肢深静脉血栓的患者,预防性置入下腔静脉滤器,可有效预防致命性肺栓塞。但致命性肺栓塞的发生率低,滤器置入是侵入性手术,术后需长期抗凝。下肢深静脉血栓患者是否常规置入滤器,临床上仍存在争议。本文对目前我国下腔静脉滤器置入现状进行分析,提出除一些特殊情况外,滤器置入不应作为一种常规,为临床决策提供参考。     

剖宫产术后盆腔血肿6例临床分析

本文探讨剖宫产术后盆腔血肿形成的原因、早期诊断、治疗及预防措施。对我院2010年3月～2011年4月1800例剖宫产术后发生盆腔血肿的6例患者资料进行回顾性分析,盆腔血肿发生率为0．33％,均通过B超检查确诊,3例保守治疗,3例在B超下穿刺治疗,均治愈。剖宫产后盆腔血肿的形成有多种原因,多在术后一周左右B超检查确诊。早...     

How anterior pelvic tilt affects the lower extremity kinematics during the late swing phase in soccer players while running: A time series analysis

Anterior pelvic tilt has been proposed to predispose the hamstring in soccer players to injury at the late swing phase during a sprint, however the mechanism on how the changes in the alignment would affect the kinematics are still unclear. Thirty-four male amateur soccer players were recruited for this study. Pelvic tilt was measured using the DIERS Formetric 4D. Lower extremity angles were recorded using an 8-camera Vicon motion capture system at 200 Hz while the athlete performed a high speed run on a motorised treadmill. Late swing phase was extracted from 5 running cycle which were later analysed using statistical parametric mapping (SPM). The results show that the increase of anterior pelvic tilt angle was significantly correlated with hip (r = −0.421 to −0.462, p = 0.015) and knee flexion (r = −0.424 to −0.472, p = 0.026) values. No other correlation was found between the anterior pelvic tilt and the angles at the coronal plane. By using time series analysis it was shown that the anterior pelvic tilt measured in a standing position would affect the adjacent segments’ kinematics while running as suggested in the kinetic chain theory; which would potentially predispose the soccer athletes to hamstring injury by maintaining knee extension.     

Compression and texture in socks enhance football kicking performance

The purpose of this study was to observe effects of wearing textured insoles and clinical compression socks on organisation of lower limb interceptive actions in developing athletes of different skill levels in association football. Six advanced learners and six completely novice football players (15.4 ± 0.9 years) performed 20 instep kicks with maximum velocity, in four randomly organised insoles and socks conditions, (a) Smooth Socks with Smooth Insoles (SSSI); (b) Smooth Socks with Textured Insoles (SSTI); (c) Compression Socks with Smooth Insoles (CSSI) and (d), Compression Socks with Textured Insoles (CSTI). Reflective markers were placed on key anatomical locations and the ball to facilitate three-dimensional (3D) movement recording and analysis. Data on 3D kinematic variables and initial ball velocity were analysed using one-way mixed model ANOVAs. Results revealed that wearing textured and compression materials enhanced performance in key variables, such as the maximum velocity of the instep kick and increased initial ball velocity, among advanced learners compared to the use of non-textured and compression materials. Adding texture to football boot insoles appeared to interact with compression materials to improve kicking performance, captured by these important measures. This improvement in kicking performance is likely to have occurred through enhanced somatosensory system feedback utilised for foot placement and movement organisation of the lower limbs. Data suggested that advanced learners were better at harnessing the augmented feedback information from compression and texture to regulate emerging movement patterns compared to novices.     

后腹腔镜肾盂输尿管切开取石术34例临床体会

探讨后腹腔镜下肾孟、输尿管切开取石的技术要点和临床应用价值。回顾性分析34例后腹腔镜肾盂、输尿管切开取石术的临床质料。男22例,女12例,肾盂结石10例,输尿管结石24例。结果34例成功完成腹腔镜取石术,手术时间40min～90min,平均58min,术中出血10ml～30ml,术后1例漏尿3d,术后3d～5d拔除后腹...     

人工全髋关节置换术肢体长度调定方法的前瞻性研究

探讨人工全髋关节置换术预防双下肢不等长的方法。综合采用术前X线片模板测量股骨头运动中心指导选择假体颈长;术中根据股骨头运动中心是否与大粗隆尖端平齐、侧卧位测量双髌骨下缘是否在同一平面、牵拉患肢根据软组织张力调整患肢长度等方法来确定术中股骨颈假体的长度。本组44例患者分为2组：A组术前肢体等长（21例）;B组术前肢体不等...     

老年人肺栓塞临床特点及误诊原因分析

通过对38例临床表现、实验室检查、放射性核素肺灌注显像等方法确诊的老年肺栓塞患者进行回顾性分析,并比较老年患者和非老年患者在致病原因、临床表现及误诊方面的差异,证实下肢深静脉血栓的形成、恶性肿瘤、高血压动脉硬化等是老年人肺栓塞的主要危险因素。老年组肺栓塞的误诊率高达60.5%,高于非老年组(53.2%),最易误诊为肺炎,其次为心肌梗死。因此,老年人肺栓塞应引起临床医生高度重视。     

诺舒阻抗与宫腔镜两种子宫内膜切除术的比较研究

探讨诺舒阻抗子宫内膜切除术在月经过多患者中的临床应用及优越性。将我院2010年1月至2014年5月行诺舒阻抗子宫内膜切除术的57例患者,纳为治疗组。同期宫腔镜单极子宫内膜切除术的45例患者,纳为对照组,比较两组患者术中情况及术后随访各项指标。发现治疗组的手术时间、术中出血量、膨宫液吸收量、电解质紊乱、术后阴道出血时间、阴道排液时间、宫腔积血、宫腔粘连、药物辅助治疗、再次手术（全子宫切除术）均低于对照组,组间对比有统计学意义（P〈0．05）。诺舒阻抗子宫内膜切除术具有学习曲线短、手术易掌握、操作安全、疗效肯定的优点,是目前子宫内膜切除术的首选方法。     

简单非一致:以再认启发式使用为例

再认启发式理论认为人们仅依赖再认做出决策。以两项高低不同再认预测力(效度)的任务为材料,选取初中生(N=138,M=14.1岁)和成年大学生(N=136,M=19.3岁)被试,探讨再认启发式使用特征。使用层级多项式加工树模型对数据进行分析,结果显示:(1)初中生较大学生认识的材料数更少或运用知识比较的正确率更低;(2)再认启发式使用存在被试异质性;(3)初中生再认启发式的使用低于大学生。结论:知识表现出随年龄增长的趋势,再认启发式的使用存在较大的个体差异和群体差异,决策时初中生相比大学生会更少依赖再认线索。     

Dynamics of Pushing

A standing individual can use several strategies for modulating pushing force magnitude. Using a static model, researchers have shown that the efficacy of those strategies varies considerably. In the present article, the authors propose a human motor control dynamic model for analyzing transients that occur when an individual is asked to modulate force magnitude. According to the model, the impedances of both the upper and the lower limbs influence the time course of force variations and foot placement has a profound effect on pushing force dynamics. With a feet-together posture, the center of pressure has a limited range of motion and changes in force may be preceded by initial changes in the opposite direction; that is, to decrease force, an individual must first increase force. When the feet are placed apart, individuals can move the center of pressure over a much larger range, thereby modulating pushing force magnitude, without reversing behavior, over a larger range of force magnitudes. Therefore, the best way to control pushing force at the hand may be by using the foot.