宫颈妊娠的诊治进展

宫颈妊娠是一种罕见的异位妊娠,其诊断技术的进步使保留子宫及生育功能的保守治疗成为可能,该文就其诊断及治疗进展作以综述,并总结了特殊的宫颈妊娠如官腔妊娠合并宫颈妊娠及剖宫产疤痕部位妊娠的保守性治疗方法.     

雅培CD1700自动血液分析仪常见故障分析及排除

雅培CD1700自动血液分析仪是一种新型血液分析仪.仪器采用电阻法体积测定,装有特殊的防返流装置,正负向加压冲洗,红宝石镶嵌特殊工艺,易于取下清洗 ,有保护式针内外壁自动擦净设计.该仪器常见故障及排除介绍如下:     

消息

由江苏省南通县无线电仪器厂和上海医疗器械研究所共同研制的EYⅡ-M型固有荧光诊断仪,日前在沪通过部级鉴定。本仪器采用氮分子激光激发被照射组织后,由于各种不同组织具有特殊的吸收带,因而能呈现一幅癌与非癌以及癌浸润的图象,用目测法即能清晰地辨认。本仪器经中国医学科学院肿瘤医院、上海医科大学附属肿瘤医院、妇产科医院等临床使用1000余例,证明对诊断皮肤、口腔、肛管、阴道、宫颈等早期癌症诊断,符合率达90％以上,且对癌前病变也有较高的检测率。仪器性能良好,操作简便,易学易懂,可长期连续使用,是一种适于普查癌症的有效手段。     

原发性宫颈小细胞癌临床病理分析

目的 探讨原发性宫颈小细胞癌的临床病理特征、免疫表型和生物学行为.方法 采用光镜、免疫组化对5例宫颈小细胞癌进行观察、随访,并复习相关文献.结果 5例宫颈小细胞癌中单纯小细胞癌3例,合并腺癌或鳞癌2例.临床表现为不同程度的阴道不规则出血伴宫颈肿物.组织学显示肿瘤细胞小而圆,胞质少,核染色质深染,核仁不明显,分裂相活跃.免疫组化:5例肿瘤细胞CK和Syn+,3例CgA+,3例HPV+,4例NSE+.随访3例死亡.结论 宫颈小细胞癌是一种罕见的高度恶性肿瘤,具有独特的病理形态特征.其发生可能与HPV感染有关,CK、CgA和Syn是较为特殊的免疫标记物.     

宫颈脱落细胞特殊染色技术筛查宫颈病变效果

目的：探讨宫颈病变筛查的宫颈脱落细胞特殊染色技术的临床应用效果。方法：选择2021年3月-2022年6月在本院及多家医疗中心行宫颈病变筛查的女性共1176例。进行宫颈癌筛查两项，即人乳头瘤病毒(HPV)+液基薄层细胞(TCT)和宫颈脱落细胞特殊染色实验检测，对筛查出的宫颈病变阳性病例，以阴道镜下宫颈活检病理结果为金标准，对宫颈病变筛查中HPV、TCT和宫颈脱落细胞特殊染色实验的临床应用效果对比分析。结果：3种宫颈癌筛查方式检出的阳性病例与病理学检查的一致率TCT检测(40.1%)>宫颈脱落细胞特殊染色实验(28.8%)>HPV检测(19.6%(P<0.05)。宫颈脱落细胞特殊染色实验的灵敏度(62.1%)、准确度(80.1%)与TCT检测(53.8%、89.8%)无差异(P>0.05)。结论：宫颈脱落细胞特殊染色试验在宫颈病变筛查中灵敏度、准确度与TCT检测效果相当，且具有便携性高、操作简单、检测快速和经济实用等特点，适合基层宫颈癌筛查。     

宫颈妊娠的诊治进展

宫颈妊娠是一种罕见的异位妊娠,其诊断技术的进步使保留子宫及生育功能的保守治疗成为可能,该文就其诊断及治疗进展作以综述,并总结了特殊的宫颈妊娠如宫腔妊娠合并宫颈妊娠及剖宫产疤痕部位妊娠的保守性治疗方法。     

巨大宫颈肌瘤24例手术治疗临床分析

宫颈肌瘤是子宫肌瘤的一种特殊类型,由于缺少临床症状及生长部位的特殊性,较小时不易被诊断,发现时肌瘤常较大,直径达10cm以上,嵌顿于盆腔或阴道内,给手术带来困难。而宫颈周围解剖关系复杂,术中易造成膀胱、输尿管或直肠的损伤。为避免术中的副损伤,对于巨大宫颈肌瘤(直径≥10     

阴道镜诊断宫颈腺癌的临床应用价值

目的:评价阴道镜诊断宫颈腺癌的临床应用价值。方法:回顾性分析2008年1月～2012年12月因TCT结果异常而行阴道镜检查及经宫颈组织病理学检测诊断为宫颈癌的225例患者的资料,比较宫颈腺癌与宫颈鳞癌的临床表现和阴道镜图像的差异。结果:阴道镜下宫颈腺癌的宫颈腺体肥大,开口粗大,开口处可见异常分泌物。宫颈腺癌多见点状血管或镶嵌等复杂图形,且多为III型转化区。结论:宫颈腺癌的诊断除病史、症状和体征外,其阴道镜图像有别于鳞癌,病理组织学诊断对于宫颈腺癌的诊断具有重要意义。     

宫颈妊娠的早期诊断

宫颈妊娠是一种罕见的异位妊娠,随着现代诊疗技术的发展,极大提高了宫颈妊娠的诊断符合率,改善了预后.本文回顾分析宫颈妊娠的发病原因,并总结了近年来宫颈妊娠的诊断方法.     

妊娠期宫颈细胞学与阴道镜检查的特征与处理

妊娠期作为女性的一个特殊生理期,宫颈细胞学及阴道镜的表现有其特殊性。妊娠期宫颈特殊的生理改变容易导致诊断误差。近年来宫颈癌的发病率呈上升趋势,正确把握妊娠期宫颈细胞学及阴道镜检查的特征及处理,早诊断早治疗,具有十分重要的意义。本文主要从妊娠期宫颈细胞学的特点、阴道镜检查的宫颈特征、妊娠期宫颈病变的诊断及处理几个方面来阐述。     

米索前列醇3种给药途径用于人工流产术前扩宫效果的观察

目的:探讨无痛人工流产术前应用米索前列醇扩张宫颈的给药途径。方法:将300例自愿要求行无痛人工流产术终止妊娠的早孕妇女随机分为3组,每组100例,分别于术前3h舌下含服、口服、阴道后穹窿放置米索前列醇400μg,观察3组宫颈扩张程度、手术时间、术中出血量及用药后副作用。结果:3组宫颈扩张程度、手术时间、术中出血量差异无显著性意义(P>0.05),舌下含服组、阴道用药组恶心、呕吐、腹泻发生率明显低于口服用药组,差异有显著性意义(P<0.05),舌下含服组、口服用药组腹痛发生率低于阴道用药组,但差异无显著性意义(P>0.05)。3组术前出现阴道流血差异无显著性意义(P>0.05)。结论:无痛人工流产术前3h舌下含服、口服、阴道后穹窿放置米索前列醇400μg对于有效扩张宫颈疗效相似,舌下含服用药消化道副作用发生率低,阴道用药适合于妊娠反应重、胃肠功能差的受术者。     

间歇式颈椎治疗仪的研制

目的：研制一种实用、有效的颈椎治疗仪。方法：把生物力学、人体工程学、电子技术相结合，以间歇式加热、间歇式自动充放气牵引的方式．由555芯片构成无稳态间歇振荡电路。结果：该产品可有效治疗颈椎病，并能缓解部分不良症状。结论：颈椎治疗仪采用间歇式效果更佳，便携式的颈椎治疗仪在牵引的功能上增加热疗效果更好。     

Cervical preparation for second-trimester surgical abortion prior to 20 weeks' gestation

For a dilation and evacuation (D&E) procedure, the cervix must be dilated sufficiently to allow passage of operative instruments and products of conception without injuring the uterus or cervical canal. Preoperative preparation of the cervix reduces the risk of cervical laceration and uterine perforation. The cervix may be prepared with osmotic dilators, pharmacologic agents or both. Dilapan-S™ and laminaria are the two osmotic dilators currently available in the United States. Laminaria tents, made from dehydrated seaweed, require 12–24 h to achieve maximum dilation. Dilapan-S™, made of synthetic hydrogel, achieves significant dilation within 4 h and is thus preferable for same-day procedures. A single set of one to several dilators is usually adequate for D&E before 20 weeks' gestation. Misoprostol, a prostaglandin E₁ analogue, is sometimes used instead of osmotic dilators. It is generally regarded as safe and effective; however, misoprostol achieves less dilation than overnight osmotic tents. The literature supports same-day cervical preparation with misoprostol or Dilapan-S™ up to 18 weeks' gestation. As the evidence regarding alternative regimens increases, highly experienced D&E providers may consider same-day regimens at later gestations utilizing serial doses of misoprostol or a combination of osmotic and pharmacologic agents. Misoprostol use as an adjunct to overnight osmotic dilation is not significantly beneficial before 19 weeks' gestation. Limited data demonstrate the safety of misoprostol before D&E in patients with a prior cesarean delivery. Mifepristone, a progesterone receptor antagonist, is also effective for cervical preparation prior to D&E, although data to support its use are limited. The Society of Family Planning recommends preoperative cervical preparation to decrease the risk of complications when performing a D&E. Since no single protocol has been found to be superior in all situations, clinical judgment is warranted when selecting a method of cervical preparation.     

优美特宫颈扩张棒用于置(取)宫内节育器及人工流产术前扩张宫颈的临床效果观察

目的:观察优美特宫颈扩张棒用于置(取)宫内节育器(IUD)及人工流产术前扩张宫颈的临床效果和不良反应。方法:将要求置或取宫内节育器,妊娠10周负压吸引人工流产术需扩张宫颈的妇女275例随机分为两组,观察组(137例)为应用优美特宫颈扩张棒,对照组(138例)为应用宫术宁胶棒,观察两组术中宫颈软化扩张情况、镇痛效果、综合反应程度,术后20d随访。结果:观察组和对照组置或取IUD扩张宫颈效果分别为100%、96%,无统计学差异(P0.05),人工流产和绝经期取IUD扩张效果观察组优于对照组(P0.05),置入时疼痛发生率(4%、25%)有差异(P0.05);留置时疼痛发生率均较低,两组无统计学差异(P0.05),术后随访两组均无与产品相关的不良记载。结论:优美特宫颈扩张棒扩张效果可靠、安全,适用于置(取)IUD、妊娠10周内负压吸引人工流产术术前扩张宫颈。     

应用球囊扩张宫颈促宫颈成熟的临床效果观察

目的:探讨应用球囊扩张宫颈促宫颈成熟的效果。方法:于2018年1月~2019年1月,选自本院应用球囊扩张宫颈促宫颈成熟的临床效果观察孕妇共50例,随机分为观察组和对照组,每组为25例,对照组采用传统引产方法,静脉滴注2.5U缩宫素;观察组采用子宫颈扩张球囊方法进行引产。比较两组患者宫颈成熟度和剖宫产率。结果:观察组治疗后宫颈成熟度明显增加,与治疗前对比,P<0.05;观察组治疗后宫颈成熟度明显更高,剖宫产率明显更低,与对照组对比,P<0.05。结论:子宫颈扩张球囊在促宫颈成熟中的应用效果确切,能够有效地提高自然分娩的成功率。     

小针刀加手法整脊及颈前筋膜扩张术治疗80例神经根型颈椎病

目的探讨小针加手法整脊及颈前筋膜扩张术治疗神经根型劲椎病的临床效果。方法选取2012年1月—2013年12月在我院进行治疗的80例神经根型颈椎病,随机分为对照组和治疗组,对照组采用小针刀加手法整脊进行治疗,治疗组在对照组的基础上采用颈前筋膜扩张术进行治疗,治疗后,比较两组患者的临床效果。结果治疗组的总有效率为92.50%,明显高于对照组的82.50%,两者相比具有显著性差异（P〈0.05）。结论小针刀加手法整脊及颈前筋膜扩张术治疗神经根型劲椎病,疗效确切,优于单纯使用颈前筋膜扩张术,值得在临床上推广使用。     

Cervical dilation before first-trimester surgical abortion (<14 weeks' gestation). SFP Guideline 20071

First-trimester surgical abortion is a common, safe procedure with a major complication rate of less than 1%. Cervical dilation before suction aspiration is usually accomplished using tapered mechanical dilators. Risk factors for major complications in the first trimester are increasing gestational age and provider inexperience. Use of laminaria for cervical priming reduces the risk of cervical laceration and, to a lesser extent, uterine perforation. While pharmacological priming agents may potentially have the same effects, no published studies to date have been large enough to assess these outcomes. Given an experienced provider, the risk of these injuries during suction aspiration is very small. Cervical priming can be achieved with osmotic dilators or pharmacological agents. The advantages of osmotic dilators such as laminaria, Dilapan-S and Lamicel are their ability to produce wide cervical dilation, and for the synthetic types, their advantages include predictable effects and rapid onset of action. A disadvantage of osmotic dilators is that they require a speculum examination and a trained clinician to perform the insertion. When cervical priming is performed, misoprostol is the prostaglandin analogue most commonly used worldwide. Compared to laminaria, vaginal misoprostol requires a shorter period of time to achieve the same dilatation, is associated with less discomfort and is preferred by women. The sublingual route appears as effective as vaginal administration and requires less time for priming (2 h), but it is associated with more side effects. Oral administration can produce equivalent dilation to vaginal or sublingual administration, but higher doses and longer treatment periods (8 to 12 h) are required. Buccal administration of misoprostol appears to have a pharmacokinetic and physiologic profile similar to vaginal administration; however, there are no published studies of buccal misoprostol prior to first-trimester suction abortion. While extensive data demonstrate that a variety of agents are safe and effective at causing cervical softening and dilation preoperatively, there are not enough data to conclude that routine cervical priming is necessary to reduce complications of first-trimester surgical abortion. Cervical priming increases preoperative cervical dilation, making the procedure easier and quicker for the physician. However, in order to preoperatively dilate the cervix, the woman must receive the agent at least 3 to 4 h prior to her procedure. Besides the additional waiting, the woman might experience bleeding and cramping prior to the procedure. There are insufficient data evaluating how cervical priming affects women's quality of life in relation to abortion. Based on existing evidence, the Society of Family Planning does not recommend routine cervical priming for suction aspiration procedures. The Society of Family Planning further recommends that providers consider cervical priming only for women who may be at increased risk of complications from cervical dilation, including those late in the first trimester, adolescents and women in whom cervical dilation is expected to be difficult due to either patient factors or provider experience.     

妊娠期宫颈机能不全宫颈缝扎手术时机的探讨

目的:探讨妊娠期因宫颈机能不全行宫颈缝扎术的时机。方法:对我院2000年1月~2004年12月31例因妊娠期宫颈机能不全行宫颈缝扎术的病例的临床资料进行回顾性分析。结果:宫口开大≤2 cm者,手术成功率为81.82%;宫口开大>2 cm者,手术成功率为44.44%,两者间比较,有显著性差异(P<0.05)。孕周为12~18周者,手术成功率为83.33%;孕周>18周者,手术成功率为53.85%,两者差异无显著性(P>0.05)。结论:妊娠期宫颈机能不全缝扎时机与宫口开张有关,与孕周无关。     

Successful pregnancy following assisted reproduction and transmyometrial embryo transfer in a patient with anatomical distortion of the cervical canal

Abstract

Presented is the case report of a patient noted to have gross distortion of the internal cervical canal during her attempt at embryo transfer following an in vitro fertilization with intracytoplasmic sperm injection (IVF-ICSI) procedure. Multiple attempts at cervical dilation were unsuccessful and the patient was ultimately treated by transmyometrial embryo transfer also known as the Towako method. She successfully achieved a singleton pregnancy and delivered at 41 weeks by primary cesarean section because of arrest of cervical dilation. Transmyometrial embryo transfer represents a viable option for patients with cervical stenosis refractory to conventional methods of navigation or severe anatomical distortion of the internal cervical canal.     

米索前列醇对非妊娠妇女宫颈扩张效果的观察

目的:评价米索前列醇对非妊娠妇女宫颈扩张的效果。方法:将200例宫腔镜电切术病人随机分成3组:Ⅰ组80例,米索前列醇600μg分两次置入阴道后穹隆;Ⅱ组80例,米索前列醇400μg于术前日晚9时放置;Ⅲ组40例,米索前列醇600μg于手术日晨6时舌下含化。观察宫颈扩张情况、术者对手术操作的满意率、手术并发症以及药物的副作用。结果:I组病人全部无阻力通过9~11号Hegar氏扩张棒,术者操作的满意率为100.0%;Ⅱ组97.5%的病人可无阻力通过8.5~11号扩张棒,术者操作的满意率为97.5%;Ⅲ组75%的病人需扩张宫颈,术者操作的满意率为30.0%,与Ⅰ、Ⅱ组相比有显著性差异(P<0.01)。无一例并发症发生,药物的副作用主要为轻微恶心、呕吐、腹痛、阴道流血、发热等。结论:米索前列醇600μg分两次放置以及400μg于术前日晚一次放置均可有效地扩张宫颈,其中400μg于术前日晚一次放置是宫腔镜电切术所需的最低有效剂量和最佳给药途径。