妊娠晚期女性盆膈裂孔结构及大小的三维超声观察

Objective To study the variation of the urogenital hiatus dimension in late pregnancy women by three-dimensional(3D) pelvic floor ultrasonography,to provide imaging evidence in the study of the relationship between pregnancy and pelvic floor dysfunction diseases.Methods Twenty nulliparas and forty late pregnancy women were examined by 3D pelvic floor ultrasonography to obtain the image of urogenital hiatus in which anteroposterior diameter of urogenital hiatus (AP),left to right diameter of urogenital hiatus (LR) and area of urogenital hiatus (HA) were measured and compared.AP,LR and HA were also compared between the late pregnancy women with stress urinary incontinence symptom and those without stress urinary incontinence symptom.Results AP,LR and HA in late pregnancy women were greater than those in nulliparas(all P ＜0.05) and had no difference between the late pregnancy women with stress urinary incontinence symptom and those without stress urinary incontinence symptom(all P ＞0.05).Conclusions 3D pelvic floor ultrasonography is an effective imaging method to observe pelvic support in pregnancy women.     

心理干预改善老年女性压力性尿失禁患者负性情绪和生活质量的研究

Objective To evaluate the mental intervention to improve negative emotion and quality of life of elder women with stress urinary incontinence.Methods A total of 88 cases of older women with stress urinary incontinence were divided randomly into test group and control group,two groups were given symptomatic treatment and routine care,the test group was also given specific mental intervention.The mental state and quality of life were evaluated by GDS,SAS,I-QOL Results After a period of one month,there was significant difference between the scores of the two groups (both P ＜ 0.05),the negative emotion and quality of life of test group were improved markedly.Conclusions The targeted mental intervention can improve the patient s ' negative emotions,elevate quality of life and promote patients'quality of life.     

Correction of scoliosis by three—dimensional instrumentation

AIM:To observe the clinical effects of three-dimensional instrumentation in the correction of frontal,sagittal and axial plane deformity of scoliosis.METHODS:From June 1996 to June 2001,52 cases of scoliosis were corrected with three-dimensional instrumentation.Among them,36cases were treated with CD system,5 cases were treated with TSRH,6 cases were treated with China Greatwall and 5 cases were treated with Scofix.RESULTS:All the patients were followed-up for an average of 2 years(ranging from 1 to 4 years).The averaged frontal curve was 25.5&;#176;（ranging from 10&;#176; to 46&;#176;),the average correction rate was 63.6%.The average sagittal curve was 27&;#176;(ranging from 20&;#176; to 35&;#176;).CONCLUSION:Three-dimensional instrumentation is effective in three-dimensional correction and is an excellent tool for scoliosis correction.The fixation isreliable and the complications rarely occurred.     

Effect of rehabilitation exercises on urinary function of incontinence after per urethra prostate opertation

Background:Urinay incontience is complication following benign hyperlasia of prostate undergo endoscopic removal.Due to internal imbalance of micturition mechanism mainly,such as incompetence of posterior urethra or unstable detrusor.Urinary incontinence causes not only physiological,psychological disorder,but also family and social problems.Objective:To observe effect of rehabilitation exercises on urinary function of urinary incontinence patients following per urethrakprostate operation.Unit:South-west Hospital,Third Military Medical University.Subjects:1525 male patients,aged 62-95 years old.Perurethra prostate electric technique,prostate holmium laser were done under peridural or general anesthesia.Urinary catheter was removed at 3-5 days after operation.There were 78 cases urinary incontinence after urinary catheter was taken out.After urodynamic study and culture of midstream urine,78 urinary incontinence were divided into:imminent urinary incontinence 48 cases,compression urinary incontinence 26 cases,real urinary incontinence 4 cases.Intervention:(1)To imminent urinary incontinence caused by infection,first strengthening anti-infection treatment,sensitive antibiotic was used.Sitz bath in potassium permanganate warm water patients were encouraged to drink more water and get liquid 1500-2000ml/d in case of no venous inflow,drink water once every 2-3h.Urinary mechanical douche was kept so as to lighten urinary irritation.Water intake should be reduced at night and in winter.(2) To precipitant urinary incontinence caused by unstable bladder.Patients should be guided whten they had urination consciousness,horizontal and genuflex position,deep breathed,relaxed abdominal muscle,constracted pelvic muscle and sphincter of anus,time of urination was delayed as for as possible.After urgent feeling decrease,went to toilet.With improvement of self-controlled ability of urination,went of toilet at fixed time.Patients were warned to tried their best to micturite once each hour.They should micturite at fixed time as far as possible,the time was prolonged to once every 3-4h.According to rehabilitation state of patients later finally biofeedback model was formed.Results: 14 urinary incontinence caused by inflammatory stimulus,remitted after 7-21d,normal micturition recovered after 1 month,9 cases.In 25 cases of urgent urinary incontinence,12 cases could control micturition,after 2 weeks,7 cases could control micturition after 1 month,other 6 cases could control micturition partly.In compression urinary incontinence patients,16 cases couldf control micturition after 1 month.10 Cases kept exercises after discharge,in those 8 cases could control micturition after 2-3 months,2 cases could control micturition at daytime.Two real urinary incontinence patients symptom was improvement.Conclusion: Rehabilitation exercises of urinary incontinence patients after per urethra prostate operation can improve their micturition function effectively.     

妊娠晚期女性盆膈裂孔结构及大小的三维超声观察

目的 应用盆底三维超声观察妊娠晚期女性盆膈裂孔大小变化情况,为研究妊娠与盆底功能障碍性疾病之间的关系提供影像学依据.方法 对20例正常未育女性及40例晚孕女性进行盆底三维超声检查,获得盆膈裂孔声像图,测量盆膈裂孔前后径、左右径和面积并进行两组对比,比较晚孕尿失禁组和晚孕无尿失禁组的盆膈裂孔前后径、左右径和面积.结果 晚孕组盆膈裂孔前后径、左右径、面积均较正常未育组大(均P＜0.05).晚孕尿失禁组和晚孕无尿失禁组间盆膈裂孔前后径、左右径、面积无明显差别(均P＞0.05).结论 盆底三维超声是一种有效的观察妊娠期女性盆底支持系统的影像学方法.

Abstract：

Objective To study the variation of the urogenital hiatus dimension in late pregnancy women by three-dimensional(3D) pelvic floor ultrasonography,to provide imaging evidence in the study of the relationship between pregnancy and pelvic floor dysfunction diseases.Methods Twenty nulliparas and forty late pregnancy women were examined by 3D pelvic floor ultrasonography to obtain the image of urogenital hiatus in which anteroposterior diameter of urogenital hiatus (AP),left to right diameter of urogenital hiatus (LR) and area of urogenital hiatus (HA) were measured and compared.AP,LR and HA were also compared between the late pregnancy women with stress urinary incontinence symptom and those without stress urinary incontinence symptom.Results AP,LR and HA in late pregnancy women were greater than those in nulliparas(all P ＜0.05) and had no difference between the late pregnancy women with stress urinary incontinence symptom and those without stress urinary incontinence symptom(all P ＞0.05).Conclusions 3D pelvic floor ultrasonography is an effective imaging method to observe pelvic support in pregnancy women.     

The life-saving emergency thoracic endovascular aorta repair management on suspected aortoesophageal foreign body injury

BACKGROUND:Fatal aortic rupture caused by esophageal foreign body(EFB),is associated with a high mortality,but can be prevented by thoracic endovascular aorta repair(TEVAR)that performed increasingly as technology improves.This study aims to investigate the cause,management and prognosis of suspected penetrating aortoesophageal foreign body injury.METHODS:Twelve cases who met the criteria were enrolled in this study.The demographic and clinical data were reviewed for evaluating the characteristics of EFB.RESULTS:Among 12 cases enrolled,7 were males and 5 were females,with an age 27–86 years.The distance of EFB from aorta(DFA)of 7 cases were less than or equal to 0 mm,5 cases were 0–2 mm.Eleven cases were managed with TEVAR,only one case was with open surgery standby but finally treated by flexible endoscopy(FE)successfully,without TEVAR.In group with TEVAR,EFB of 7 cases were successfully removed by rigid endoscopy(RE),and one of them was failed at the first RE treatment.EFB of 2 cases were successfully removed by open surgery with TEVAR,and other 9 cases were managed by endoscopies with TEVAR.The mean length of stay of hospitalization(LOS)and length of ICU stay of patients treated by open surgery with TEVAR(18.50±2.12 days and 5.50±0.71 days)was significantly longer than those of patients treated by endoscopy with TEVAR(7.00±2.74 days and 1.33±1.12 days,P<0.001 and P=0.001,respectively).Five cases had severe complications.CONCLUSION:Rational application of TEVAR can be a life-saving management for aortoesophageal foreign body injury,and jointed with endoscopy is safe and effective with a shorter length of ICU or total hospital stay.     

α1-receptor blockers combined with acupuncture treatment efficacy analysis of elderly patients with acute urinary retention

Objective To explore acupuncture and al-receptor blocker treatment efficacy of elderly patients with acute urinary retention. Methods Use of forward-looking monitoring and retrospective survey methodology, Choose January 1,2006 to January 1,2009 of acute urinary retention in 82 cases of elderly inpatients,Chronological order according to treatment group,39 cases were divided into control group,43 cases; Transurethral catheterization in both groups, stay catheter. The control group was treated with α1-receptor blocker hytrin (terazosin) and the application of antibiotics; the treatment group based on the above plus acupuncture therapy. Results The treatment group was 94.87% in the control group response rate was 76.74%, the two groups,P<0.05, the difference was significant. Conclusion al-receptor blockers combined with acupuncture treatment of elderly patients with acute urinary retention al-receptor blocker than simply good effects, synergistic effect, shortening the indwelling catheter time, avoid repeated urinary catheterization and reduce hospital infection, worthy to be popularized.     

α1-receptor blockers combined with acupuncture treatment efficacy analysis of elderly patients with acute urinary retention

Objective To explore acupuncture and al-receptor blocker treatment efficacy of elderly patients with acute urinary retention. Methods Use of forward-looking monitoring and retrospective survey methodology, Choose January 1,2006 to January 1,2009 of acute urinary retention in 82 cases of elderly inpatients,Chronological order according to treatment group,39 cases were divided into control group,43 cases; Transurethral catheterization in both groups, stay catheter. The control group was treated with α1-receptor blocker hytrin (terazosin) and the application of antibiotics; the treatment group based on the above plus acupuncture therapy. Results The treatment group was 94.87% in the control group response rate was 76.74%, the two groups,P<0.05, the difference was significant. Conclusion al-receptor blockers combined with acupuncture treatment of elderly patients with acute urinary retention al-receptor blocker than simply good effects, synergistic effect, shortening the indwelling catheter time, avoid repeated urinary catheterization and reduce hospital infection, worthy to be popularized.     

健康教育对尿失禁妇女的护理效果评价

目的 探讨健康教育对尿失禁妇女护理效果的影响作用.方法 于2010年1月～12月对在我院参加妇科普查的1 943名成年妇女进行尿失禁知识健康教育及定期随访,分别于健康教育前、6个月回访时进行问卷调查,以评价健康教育前后尿失禁妇女的护理效果.结果 在1 943名妇女中,健康教育后参加盆底肌训练及坚持训练的人数明显高于健康教育前,健康教育后到医院咨询及治疗人数明显高于健康教育前,健康教育后SUI患病人数及中重度比例亦明显低于健康教育前(P＜0.001).结论 对妇女进行尿失禁知识健康教育,推广盆底肌训练和膀胱功能训练,能显著提高妇女对尿失禁的认知,降低尿失禁的发病率,减低中重度比例,是保障妇女生殖健康的重要措施.

Abstract：

Objective To discuss nursing effect of health education on women with urinary incontinence. Methods From January to december in 2010, 1 943 adult women who received gynecology general survey in our hospital were treated with health education for urinary incontinence and were followed up regularly. They were investigated by questionnaire survey before health education and 6 months later after health education respectively. The effect of nursing for women with urinary incontinence were assessed. Results In these women patients,after health education, there were more women who participated in pelvic floor muscle training and adhered to training than before health education, the number of patients who received consultation and treatment increased significantly more than before. Afterf health education, the incidence of SUI, the proportion of moderate and severe symptoms were also significantly lower than before (P ＜0. 001 ). The differences was statistically significant. Conclusions Making health education on women with urinary incontinence and promoting pelvic floor muscle training (PFMT) and bladder functional training can significantly improve women's awareness of urinary incontinence, reduce the incidence of urinary incontinence, reduce the proportion of moderate and severe symptoms. These measures are important to protect women's reproductive health.     

经后路椎间盘镜手术患者的综合康复护理探讨

Objective To study the clinical effect of comprehensive rehabilitation nursing of postopera-tive patients treated by micrecndoscopic discectomy through posterior approach. Methods Fifty - four patients with Inmhar disc herniation were performed to remove nucleus pulposus with microendoscopic discectomy. A retro-spective analysis of 51 patients was made, and the therapeutic effect of the comprehensive rehabilitation nursing was evaluated. Results After operation, the patients could walk in 2±1 days, resumed their daily activities in 11±5 days and went back to work in 28±9 days. Excellent results were achieved in cases 44 (86.3% ), good in cases 3 (5.9%) and improved in cases 4 (7. 8% ) according to the Nakni scale. The excellent and good results were 92.2%. Conclusions Comprehensive rehabilitation nursing is effective in the postoperative patients treated by micrcendoscopic discectomy through posterior approach.     

奥马哈系统在女性压力性尿失禁患者护理中的应用效果

目的:探讨奥马哈系统在女性压力性尿失禁患者中的应用效果.方法:选取84例女性压力性尿失禁患者,随机分为观察组和对照组各42例.两组患者均在硬膜外麻醉下行经闭孔经阴道无张力尿道中段悬吊术(TVT-O).对照组患者给予常规护理,观察组患者在对照组基础上给予基于奥马哈系统的护理.观察两组患者术后早期并发症,并采用尿失禁生活质...     

改良TVT-O术治疗女性压力性尿失禁68例围术期护理

目的:探讨改良经闭孔无张力阴道吊带术(TVT-O)治疗女性压力性尿失禁(SUI)患者的围术期护理方法.方法:对68例SUI患者行改良TVT-O术治疗,并给予精心围术期护理,术前加强盆底肌力和紧张性训练,术后做好并发症护理,指导进行膀胱功能训练.结果:本组随访6个月～1年,4例于术后6个月再次出现尿失禁症状,经治疗后好转,其余症状均消失,无并发症发生.结论:改良TVT-O术治疗SUI效果满意,做好围术期护理是手术成功的关键.     

经闭孔无张力尿道中段悬吊术治疗女性压力性尿失禁

目的:评价经闭孔无张力尿道中段悬吊术(TVT-O)治疗女性压力性尿失禁(SUI)的疗效。方法:回顾性总结2006年4~10月采用TVT-O术式治疗女性SUI的临床资料11例。结果:11例病人均治愈,术中出血15~40mL,平均20mL,历时15~20min,平均18min。术中无并发症,无膀胱损伤。术后随访至今无并发症发生。结论:TVT-O术式操作简便快捷、创伤小、并发症少、不易损伤膀胱,是治疗女性SUI的安全有效方法。     

经会阴二维及三维超声检查观察压力性尿失禁患者TVT-O术后吊带

目的应用经会阴二维及三维超声检查观察压力性尿失禁患者TVT-O(经闭孔、阴道无张力吊带)术后吊带位置、形态及活动情况。方法收集在我院接受TVT-O手术治愈的压力性尿失禁患者32例,术后3个月对患者行经会阴二维及三维超声检查,观察吊带在静息和Valsalva时的位置、形态和活动情况。结果 TVT-O吊带多位于尿道中下1/3交界处;Valsaval时尿道长度和吊带近端与膀胱颈之间尿道的实际长度较静息时变长;从吊带到耻骨联合的距离来看,Valsaval时较静息时吊带向前下方移动,而吊带的成角变小,但差异均无统计学意义。结论经会阴二维及三维超声检查可用于TVT-O术后吊带位置、形态和活动情况的观察。Valsalva时吊带的位置和形态改变不明显,但可在尿道中段形成闭合效应,加强控尿机制。     

无张力阴道吊带术与经闭孔无张力阴道吊带术治疗女性压力性尿失禁的临床对比

目的对比研究无张力阴道吊带术（TVT）和经闭孔无张力阴道吊带术（TVT-O）治疗女性压力性尿失禁（SUI）的临床效果。方法回顾分析2003年3月一2013年4月女性SUI患者61例，其中行TVT33例，TVT-028例，术后随访1～62个月，平均22个月。以术后咳嗽、增加腹压无尿液溢出，且B型超声检查无剩余尿为治愈；术后咳嗽、增加腹压少许尿液溢出但较术前改善者为改善；术后咳嗽、增加腹压仍不能控制尿液溢出者为无效。结果两组患者的年龄及病程等临床资料相似，差异均无统计学意义（P〉0．05）。61例手术均顺利完成。TVT组手术时间26～45min，平均（35．5±4．3）min；TVT-O组15～20min，平均（17．2±3．1）min；两组的手术时间差异有统计学意义（P〈0．05）。两组术中出血量差异无统计学意义（P〉0．05）。TVT-O组的并发症发生率比TVT组低。两组的治愈率、改善率差异均无统计学意义（P〉0．05）。结论TVT和TVT-O都是治疗SUI安全有效的方法。相比TVT，TVT-O具有无需膀胱镜、手术时间更短、创伤小、并发症发生率更低等优点，是治疗女性SUI更理想的手术方法。     

经阴道无张力尿道中段悬吊术治疗女性压力性尿失禁28例围术期护理体会

目的:探讨经阴道无张力尿道中段悬吊术(TVT)治疗女性压力性尿失禁的护理方法。方法:回顾性分析行TVT手术治疗的28例女性压力性尿失禁患者的护理资料,术前做好充分准备,术后加强对伤口的护理,密切观察病情变化,观察有无排尿困难、出血、感染等并发症。结果:本组24例术后排尿功能恢复良好,4例因膀胱不稳定或感染发生排尿困难,经持续导尿、膀胱训练及药物治疗后均恢复排尿功能。结论:对女性压力性尿失禁患者行TVT手术,并给予术前充分准备和术后严密观察护理,可减少术后并发症的发生,促进患者康复。     

Urinary incontinence and menopause: an evidence-based treatment approach

OBJECTIVE: To review the evidence on risk factors, evaluation, diagnosis, and treatments in postmenopausal women with incontinence. DATA SOURCES: Articles on urinary incontinence were located by searching Medline and the Cochrane Database of Systematic Reviews in March 2000. RESULTS: Urinary incontinence is common with aging. The relationship between urinary incontinence and menopause is not well understood. There are 3 major types of urinary incontinence: stress, urge, and mixed. The diagnosis can often be established with a good history. For a long time estrogen was thought to be of benefit in the treatment of incontinence, however, there is now evidence it may exacerbate urinary incontinence. There are multiple new agents shown to be effective in the treatment of incontinence. Surgical approaches for the treatment of stress incontinence have not been studied in large clinical trials, however, open abdominal retropubic suspension seems to be better than anterior vaginal repair. CONCLUSIONS: As the aging population grows, urinary incontinence will become an increasing public health problem. Increasing awareness is needed by women and their providers to identify, evaluate, and apply evidence-based treatment approaches to urinary incontinence.     

TVT-O治疗女性压力性尿失禁效果随访(附112例报告)

目的探讨经闭孔尿道中段无张力悬吊术(TVT-O)治疗女性压力性尿失禁(SUI)的手术效果及安全性。方法回顾性分析112例应用TVT-O治疗SUI患者术前及术后2个月、6个月及1年的尿流率及残余尿数据,并行ICI-Q-SF评分综合评价尿道中段悬吊术的效果以及安全性。结果112例患者均获得满意控尿效果,术中无膀胱及尿道损伤,无闭孔血管神经损伤等并发症发生;术后无阴道侵蚀及尿潴留发生;8例术前合并尿急患者中5例术后症状自行改善;6例患者术后新生尿急,口服托特罗定后症状缓解;1例患者于术后3周尿失禁复发,术后8周时再次行TVT-O手术,术后控尿正常,未复发SUI。全部患者术后随访2～20个月,平均12.6个月,无SUI复发,完全改善率94.64%(106/112),症状显著好转率5.36%(6/112),术后最大尿流率无下降(P>0.05),残余尿量无增加(P>0.05),生活质量评分明显改善(P<0.01)。结论TVT-O治疗SUI简单易行,操作安全,并发症发生率低,术后效果满意。     

改良TVT-O术治疗女性压力性尿失禁疗效分析

目的探讨经闭孔无张力尿道中段悬吊术（transobturator vaginal tape inside-out,TVT-O）治疗女性压力性尿失禁（stress urinary incontinence,SUI）的初步疗效和手术安全性。方法对压力性尿失禁患者21例行改良TVT-O术,并对手术效果和并发症进行初步的随访研究。结果平均手术时间30min,平均出血量35ml,平均住院天数5．2d。术后尿失禁症状均得到控制或减轻,1例患者出血局部血肿,经保守治疗后好转,随访6～12个月无复发。结论改良TVT-O术治疗女性压力性尿失禁疗效确切,具有手术时间短、创伤小、不损伤膀胱、费用低等优点。     

尿流动力学在女性压力性尿失禁TVT-O手术治疗中的临床价值

目的探讨尿流动力学在女性压力性尿失禁TVT-O手术治疗中的临床价值。方法采用TVT-O手术治疗26例女性压力性尿失禁患者。检测患者术前术后尿流动力学结果,并进行对比。根据患者主诉,排尿正常、完全自控、无尿失禁为治愈,尿失禁减少〉50%为改善。结果 26例患者手术后主观症状均明显改善。其中主观治愈24例,主观改善2例。尿流动力学检测指标中,最大尿流率在治疗前后无明显改变（P〉0.05）,最大尿道压和腹压漏尿点压力在治疗前后有明显改变（P〈0.05）,最大尿道闭合压（MUCP）在术前均为负值,术后均为正值。结论尿流动力学对于女性压力性尿失禁患者选择恰当的治疗方案,以及对TVT-O手术治疗效果的评估有着重要临床价值。