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 Posted: Wed 14:03, 16 Mar 2011 Post subject: tory burch outlet Lappaconitine morphine analgesia |
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Lappaconitine morphine analgesia in the postoperative clinical observation
Discuss cases of 233 patients with fibroids, the implementation of myoma enucleation, are reported below. 1 Data and methods 1.1 General information: in our hospital in May 1999 and 2003 7 months, to retain fertility of 23 patients with uterine fibroids, aged 26 to 37 years, of which 6 cases over 30 years of age, 30 years of age in 17 cases, 5 cases with preoperative unmarried,[link widoczny dla zalogowanych], not pregnant and married the original 12 patients, spontaneous abortion 2 of 3 patients, 1 medical abortion in 1 case, producing a tire early in 2 patients. 23 patients were diagnosed with uterine fibroids and to report the need for surgical treatment, were made to retain the uterus, retained fertility. 23 patients, 8 patients had significantly increased menstrual flow, prolonged menstrual symptoms, 15 cases in the census or marriage, pregnancy did not found when B-ultrasound, no dysmenorrhea. 1.2 Preoperative preparation: Before 100ml with 0.5% metronidazole vaginal washing fluid, day 1, continuous treatment for 3 days to clean the vagina or the treatment of vaginitis may be the prevention of postoperative uterine infection. 1.3 and intraoperative surgical conditions: continuous epidural anesthesia in the enucleation of uterine fibroids. 4 cases of a single submucous myoma (17.4%), pedicle size, fibroids about 2.0 ~ 3.5cm, both vaginal evisceration. The remaining 19 cases were abdominal surgery, surgery in 8 cases see subserosal fibroids (42%), intramural fibroids in 11 patients (57.8%), fibroids in 14 cases for a single (73.6%) fibroids for more than one in 5 cases (26.3%), up by up to 5,[link widoczny dla zalogowanych], the largest myoma diameter 7 ~ 8cm, the smallest about 3 ~ 5cm. Enucleation surgery carefully one by one, and for the degree of the minimum cut 12I, 12I cut the anterior wall of the uterus as close as possible, enucleation muscle nuclear, complete hemostasis, the suture without leaving dead space to prevent the accumulation of blood, and finally cut the uterus completely pulp 12I membrane of. Check bilateral tubal surgery and bilateral ovarian situation. 2 results of 23 patients recovered well, were not any postoperative complications, average length of stay (8.5 ± 2.5) days, patients were followed up, after 13 cases of pregnancy and childbirth, two cases when the pregnancy in February spontaneous abortion, pregnancy in 3 cases, 2 cases without pregnancy,[link widoczny dla zalogowanych], 3 single. Postoperative pregnancy rate was 90%, time 2.2 years after the first pregnancy, the latest time was 3.5 years, newborns are healthy. Uterine fibroids are the most common gynecological benign tumor, a high incidence, occurs in the 4JD ~ 50-year-old women, the incidence rate on the rise. The patients in the oldest 37 years old,[link widoczny dla zalogowanych], 6 cases were older than 30 years, after all pregnancy. The group has multiple fibroids after evisceration successful pregnancy,[link widoczny dla zalogowanych], suggesting that the number of how many fibroids fibroid enucleation should not be a contraindication. Submucosal uterine fibroids on the best surgical approach is transvaginal enucleation, thus reducing the trauma of the uterus, uterine muscle wall and serosa to ensure the integrity and prevent uterine rupture during pregnancy. The subserosal and intramural fibroids, surgery should pay attention to the following questions: (1) incision: incisions as small as possible, with minimal incision enucleation fibroids, thus reducing the damage of the myometrium, the uterine scar small. (2) the best choice for longitudinal incision to prevent the entrance of tubal damage. If condition can also be cut into the palace chamber, check whether the lesions of the mucous layer in order to be processed, and cut bureaucratic does not increase postoperative complications and the incidence of pregnancy after uterine rupture. (3) surgery to completely stop the bleeding after myoma enucleation significantly if active bleeding or bleeding should be given to suture bleeding, if necessary, myometrial injection of oxytocin. (4) reconstruction of the uterus: multiple fibroids, such as enucleation, the myometrium many damaged, broken do not fix, some variants, when required by the trimmed catgut absorbable suture or interrupted suture 2 to 3 layers the tumor cavity large, could strengthen the suture must not stay dead space, so that the shape intact uterus, incision of the serosa to complete in order to reduce pelvic adhesion. Myomectomy should be out-patient follow-up after surgery for dealing with different problems in a timely manner, requiring patients to take contraceptive measures after 2 years, 2 years later to pregnancy. If possible after tubal infertility or tubal lipiodol angiography test. After pregnancy, prenatal care should be prepared, especially in late pregnancy should pay attention to miscarriage. Myomectomy has been reported up to full-term pregnancy, who after only 25% to 45%, and most of termination of pregnancy by cesarean section ..., the group of 13 cases of pregnancy and delivery in 3 patients a vaginal delivery, and the remaining 10 cases cesarean section to terminate pregnancy.
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