电视腹腔镜下卵巢良性畸胎瘤手术21例报告

目的探讨电视腹腔镜行卵巢良性畸胎瘤手术的适应症,预防和减少肿瘤破裂发生.方法对21例卵巢良性畸胎瘤病人在电视腹腔镜下行囊肿剥出术18例,附件切除术3例.结果发生肿瘤破裂12例,占66.67%,平均手术时间90min,平均术中出血80ml,1例出现皮下气肿,无术后出血、脏器损伤及化学性腹膜炎或肉芽肿.结论电视腹腔镜下行卵巢良性畸胎瘤的手术是完全可行的.     

卵巢良性畸胎瘤腹腔镜手术患者的护理

目的:探讨卵巢良性畸胎瘤腹腔镜手术患者围手术期的护理重点。方法:对31例卵巢良性畸胎瘤采用腹腔镜手术治疗的患者进行手术前后的护理。结果:患者全部康复出院,无术后并发症。结论:腹腔镜手术术前充分评估、做好术前准备和术后严密观察病情,其对患者术后的康复起重要作用。     

骶尾部畸胎瘤术后17年复发1例及文献综述

卵巢畸胎瘤为女性常见生殖细胞肿瘤,而发生于卵巢外的骶尾部畸胎瘤(sacrococcygeal teratoma,SCT)较少见,术后复发率及恶变率较高[1].本例患者骶尾部畸胎瘤术后17年复发且未见恶变实属少见.现报道如下并复习了相关文献.     

卵巢畸胎瘤598例临床病理分析

目的探讨卵巢畸胎瘤的临床特点及处理方法。方法收集我院妇产科1990年1月～2003年9月间收治卵巢畸胎瘤598例，建立数据库后对其临床特点及处理原则进行分析。结果卵巢畸胎瘤中成熟性囊性畸胎瘤占93．6％，合并其他卵巢良性肿瘤21例，合并其他卵巢恶性肿瘤4例。61．9％患者是在妇检及，或超声检查时发现，儿童及未婚妇女往往在出现并发症时才发现，超声检查符合率达90．8％，妊娠合并畸胎瘤直径≤6cm发生蒂扭转等并发症。结论①要加强对儿童及未婚妇女的妇科检查；②成熟性囊性畸胎瘤可合并其他卵巢良性和恶性肿瘤，术中快速冰冻切片是决定手术方式的重要依据；③妊娠合并卵巢畸胎瘤若直径≤6cm，可考虑保守期待。     

卵巢畸胎瘤复发相关因素及处理

卵巢畸胎瘤多发生于育龄期妇女,8%～15%为双侧生长,1.01%为多发畸胎瘤,双侧与多发呈正相关,术后复发值得关注。术前评估中,肿瘤≥8 cm、双侧、多发或有分隔等因素≥2个,复发率明显升高。手术残留或肿瘤再发为主要复发原因。术前充分评估复发风险,恰当选择手术方式与途径,可以减少复发概率及有效监测。     

腹腔镜手术中卵巢良性畸胎瘤破裂临床分析

目的分析腹腔镜下卵巢良性畸胎瘤手术时囊肿破裂的相关因素和对患者预后的影响.方法回顾性分析1999年～2002年间接受腹腔镜下卵巢良性畸胎瘤剥除术121例临床资料,并使用SPSS统计软件处理数据.结果术中发生囊肿破例48例,未破裂73例.两组比较,破裂组手术时间长于未破裂组,术中囊肿破裂与左侧肿瘤和盆腔粘连有关,而与患者年龄、孕产次、肿瘤大小、出血量、术后月经改变、腹痛以及术后妊娠无明显关系.结论手术者熟练的腹腔镜技术,术中使用取物袋,可能减少囊肿破裂,如发生破裂,及时、大量生理盐水冲洗盆腹腔可以减少术后病率发生,不会影响妊娠.     

腹腔镜下卵巢良性畸胎瘤手术65例分析

目的 探讨腹腔镜下卵巢良性畸胎瘤手术的可行性及临床应用价值。方法 采用德国WOLF电视腹腔镜对65例卵巢良性畸胎瘤行腹腔镜手术，与同期剖腹卵巢良性畸胎瘤手术63例进行对比分析。结果 腹腔镜组除手术时间长于剖腹组（P〈0．05）外，术中出血、拔尿管时间、肛门排气时间、住院时间及下床活动时间均少于剖腹组（P〈0．05）。结论 腹腔镜下卵巢良性畸胎瘤手术具有肠道干扰少、术中出血少、术后疼痛轻、进食早、恢复快、住院日短等优点，在临床中应用安全可行。     

复发性卵巢未成熟畸胎瘤34例分析

目的 总结复发性卵巢未成熟畸胎瘤的特点，以及复发后手术和化疗的经验。方法 对1949～2001年北京协和医院34例复发性卵巢未成熟畸胎瘤进行回顾性分析。结果 去除5例复发后仅行活检者，其余29例随访中位数时间84个月(1l-286个月)，28例存活(96．7％)。复发后手术病理级别为0级共23例次，17例次未再复发，未复发的患者中9例次术后未化疗，其余8例次接受1～8个疗程化疗。复发后手术病理级别为1～3级共17例次。9例次未再复发，均接受方案为VAC(长春新碱、环磷酰胺、阿霉素)≥4个疗程或顺铂(DDP)为主的联合化疗≥3个疗程。结论 复发性卵巢未成熟畸胎瘤的治疗效果是很好的。理想的再次肿瘤细胞减灭术非常重要，复发后病理级别未转为0级者应辅以规范有效的化疗(DDP为主的联合化疗至少3个疗程)。0级畸胎瘤可以不化疗，但仍有增长可能，应密切随诊，延长随诊时间，积极手术。     

糖抗原199在卵巢成熟畸胎瘤诊断中的临床意义

目的探讨糖抗原199(CA199)在卵巢成熟畸胎瘤诊断中的临床意义。方法选取2004年1月至2008年10月在北京协和医院妇产科进行手术并且术前进行包括CA199在内的4种肿瘤标志物检查的卵巢畸胎瘤患者263例进行分析。结果在4种肿瘤标志物中,CA199的阳性率最高,为38.4%。4例有畸胎瘤剔除史患者的CA199水平均高于正常。畸胎瘤的最大径线平均大小为(7.07±3.22)cm。CA199、CA125升高组肿瘤大于正常组(P<0.001)。当肿瘤为多房表现时,血清CA199、CA125水平较单房者明显升高(P<0.05);当肿瘤发生于双侧卵巢时,CA199显著升高(P<0.05)。结论 CA199在卵巢成熟畸胎瘤的诊断与鉴别诊断中具有一定的意义。当血清CA199水平升高时,无论对侧卵巢外观是否正常,手术时均应仔细检查对侧卵巢。CA199是否可作为临床检测卵巢畸胎瘤复发的指标有待于进一步的研究证实。     

卵巢畸胎瘤继续生长综合征

卵巢畸胎瘤继续生长综合征(GTS)是描述起源于卵巢的恶性生殖细胞肿瘤在化疗中或化疗后,逆转为成熟畸胎瘤并持续存在或继续增长的现象。卵巢GTS发生率极低,发病机制仍有待研究,但学者们已对GTS诊断标准达成共识。GTS易与化疗逆转(CR)混淆,二者区别尚存在争论。复习相关文献,对GTS的发病机制、临床特点、影像学诊断、治疗方法以及GTS与CR、腹膜神经胶质瘤病(PG)的关系等进行了总结,从而加深对GTS的认识,提高临床诊断和治疗GTS的水平。GTS预后良好,但仍有产生严重并发症及继发恶性肿瘤的风险,故随访很重要,长期影像学与肿瘤标志物监测是主要的随访手段。     

活跃期分娩镇痛对经阴道分娩产妇产后认知功能的影响

目的：分析活跃期分娩镇痛与非分娩镇痛的产妇产后认知功能障碍的发生情况及其影响因素。方法：选择2016年1月—2018年12月南通市通州区二甲人民医院经阴道分娩的产妇217例,按照自愿选择的原则分为分娩镇痛组（82例）和非分娩镇痛组（135例）,比较2组孕妇产程不同时间的疼痛评分以及产后第1天、第42天认知功能障碍的发生率,并分析其影响因素。结果：分娩镇痛组孕妇宫口开6 cm及10 cm时视觉模拟评分（VAS）显著低于非分娩镇痛组（P＜0.001）,2组宫口开3 cm时VAS 评分差异无统计学意义（P＞0.05）;分娩镇痛组孕妇产后第1天蒙特利尔认知评估量表（MoCA）及符号数字转换测验（SDMT90）得分均高于非分娩镇痛组,认知功能障碍发生率低于非分娩镇痛组（P＜0.05）,2组孕妇产后第42天MoCA、SDMT90得分及认知功能障碍发生率差异无统计学意义（P＞0.05）;未使用分娩镇痛、宫口开3 cm、6 cm、10 cm时VAS＞5分是产后第1天认知功能障碍的影响因素（P＜0.05）,年龄≥35岁、高中及以下学历与产后第1天认知功能障碍无相关性（P＞0.05）。结论：分娩镇痛可以通过有效地缓解产程中疼痛来降低经阴道分娩产妇产后第1天认知功能障碍的发生风险,非分娩镇痛及产程中疼痛是产后认知功能障碍的独立危险因素。     

宫内节育器对大鼠子宫去甲肾上腺素及肾上腺素含量的影响

为了研究宫内节育器对大鼠子宫组织中肾上腺素能神经末梢的影响,本文用改良荧光分光光度法测定了置器大鼠子宫组织中的去甲肾上腺素(NE)和肾上腺素(E)含量。结果发现放置不锈钢IUD置器侧和放置铜IUD置器侧子宫NE含量均较对照侧显著下降(P<0.01)。而子宫组织中E含量在各组置器侧与对照侧比较差异均无显著意义(P>0.05)。本研究结果提示,IUD作为异物非但使大鼠子宫肌层和内膜呈现明显的形态学变化,而且对子宫组织中肾上腺素能神经末梢的功能也产生明显影响。     

Suture péritonéale ou non au cours de la césarienne en 2008 ?

Non closure of the peritoneum at cesarean is still debatable, despite the national and international guidelines. This review aims at exposing risks and benefits of non closure of the peritoneum, focusing on the peritoneum adhesions. Many studies demonstrated no benefits at peritoneum closure in the duration of surgery, the immediate postoperative period and the short-term complications. Data about pelvic adhesion risk are more inconsistent. Different criteria were considered in the studies: adhesions incidence and density during subsequent cesareans or pelvic surgeries, duration of surgery and the delay between incision and birth during the subsequent cesarean and fertility known to be impaired by thick-pelvic adhesions. Most of the studies are exhibiting serious bias, leading to weak conclusions. However, two randomised controlled trials compared pelvic adhesion in the subsequent c-section, in step with closure or non closure of the parietal and visceral peritoneum at first caesarean. The results showed that non closure of the peritoneum does not increase or even reduce the adhesions risk. These results are consistent with results from three studies reporting no modification of patient fertility. As a conclusion, current data are supporting the national and international medical society recommendations about the benefits of the non closure of the peritoneum at caesarean section.     

妊娠期糖尿病胎盘微绒毛形态计量学改变与围产儿并发症关系的探讨

目的:探讨妊娠期糖尿病胎盘绒毛变化与围产儿并发症的关系。方法:选择足月妊娠期糖尿病38例的胎盘为观察组,选择正常足月妊娠30例的胎盘为对照组,分娩时在胎盘母面取材,制成快速脱水、表面喷金镀膜标本,在扫描电镜下用VIDAS型图像分析仪对胎盘微绒毛进行组织形态计量学测定。称取胎盘重量、计算胎盘系数(胎盘重量与新生儿出生体重比值),记录新生儿Apgar评分、体重、脐血胆红素及新生儿出生后30min内血糖值。结果:糖尿病孕妇的胎盘合体滋养层细胞微绒毛面积、周长、长轴、短轴小于对照组,差异均有统计学意义(P<0.05);异形指数大于对照组,差异有统计学意义(P<0.05)。扫描电镜下观察组胎盘组织超微结构病理变化明显,表现为胎盘绒毛成熟不良、水肿,合体滋养层表面微绒毛排列紊乱,直径大小不一,局部缺损,呈葡萄状。观察组胎盘重量明显高于对照组,两组差异显著(P<0.05)。胎盘系数两组间差异非常显著(P<0,01);两组新生儿窒息、出生30min内血糖值、血胆红素均有显著差异(P<0.01)。结论:妊娠期糖尿病胎盘病理变化进一步加重了胎儿缺氧,增加了新生儿窒息率,导致新生儿发生更多的并发症。     

An immunohistochemical study of estrogen and progesterone receptors in adenocarcinoma of the endometrium and in the adjacent mucosa

The immunoperoxidase stain for estrogen and progesterone receptor content in endometrial adenocarcinoma was correlated with the grade and stage, level of myometrial invasion, age and survival of the patients. Anti-estrogen and anti-progesteone receptor monoclonal antibodies were applied to paraffin-embedded tissue from hysterectomy specimens of 100 patients with adenocarcinoma of the endometrium. In 34 of the cases the receptors were studied in the endometrium adjacent to the tumor and compared to the nuclear receptor content in the carcinoma. There was a high inverse correlation between the estrogen receptor status and the grade of tumor ( R = − 0.45, P = 0.006). The estrogen receptor measured in the endometrium near the tumor showed a negative correlation with the grade of the tumor ( R = −0.42, P = 0.013). The estrogen, but not the progesterone, receptor content, was positively related to the age of the patient ( P < 0.05). No significant correlation of the receptor status with the depth of myometrial invasion was found, despite the obvious interdependence between the grade and myometrial invasion. The progesterone receptor staining index appeared to be a distinct independent prognostic factor in endometrial cancer. The immunohistochemical analysis of the steroid hormone status in endometrial cancer therefore offers an alternative to the quantitative ligand-binding assay.     

瘢痕子宫再次妊娠分娩时机和分娩方式选择的影响因素分析

目的：探讨瘢痕子宫再次妊娠分娩时机和分娩方式选择的影响因素。方法：选取2015年1月-2017年12月于深圳市龙华区人民医院妇产科待产并选择阴道试产的瘢痕子宫再次妊娠孕妇228例为研究对象,根据最终分娩方式分为再次剖宫产组（121例）及阴道分娩组（107例）,收集并比较2组孕妇的临床资料。结果：228例孕妇中,107例顺利完成阴道分娩,成功率为46.93%,且所有孕妇均无子宫破裂发生;单因素分析发现,2组孕妇在年龄、文化程度、产前体质量指数（BMI）、距离上次剖宫产时间、阴道分娩史、定期产前检查、使用催产素、瘢痕厚度、现孕周、新生儿体质量等因素间差异有统计学意义（P＜0.05）;多因素分析发现,年龄、产前BMI、距离上次剖宫产时间、阴道分娩史、定期产前检查、瘢痕厚度、新生儿体质量是分娩方式选择的影响因素。结论：瘢痕子宫再次妊娠阴道分娩较为安全,对于35岁以下、BMI＜30 kg/m2、距离上次剖宫产时间超过2年、瘢痕厚度≥3 mm、预计新生儿体质量＜2 500 g且行定期产前检查的瘢痕子宫再次妊娠孕妇可选择阴道分娩。     

Forgetting hormonal contraceptive methods: expert opinion about their daily management in clinical routine practice

Many guidelines regarding the daily management of regular oral hormonal contraceptive methods have been proposed worldwide. Some of them may even appear to be conflicting. The search for the maximal contraceptive protection leads to a low acceptance of these guidelines, probably because of their complexity and their apparent discrepancy. We are deeply convinced that simplicity and pragmatism of guidelines should pave the way to both their better acceptance and compliance and, consequently, to their improved real-life effectiveness. We have considered physiology and pharmacodynamics before proposing the following rules for an effective management of hormonal contraceptive failures. We conclude that the risk of unwanted pregnancy is higher in case of a unique contraception misuse/a delayed start during the first week of the contraceptive cycle (or in case of multiple days of contraceptive misuses during the following weeks) for a combined contraception or at every cycle day for a non anti-ovulatory progestin only contraception. In such risky situations, we firmly recommend the restart of the regular contraceptive method and the use of condoms for the following 72 hours, provided no sexual intercourse has occurred during the past 5 days before the contraceptive failure. If sexual intercourse has occurred during the past 5 days before the contraceptive failure, we firmly recommend the intake of an emergency contraception, ulipristal acetate, the restart the regular contraceptive method and in this case, the use of condoms for, at least, the following 7 days.     

Screening for domestic violence during pregnancy

This experimental study was conducted to determine the specific problems experienced by couples participating in assisted reproductive techniques (ART) and to assess couples’ counseling needs. It was also intended to determine the effects of the counseling service model, developed and implemented by the researcher, on the success rate of ART, and to assess the couples’ anxiety, depression and life satisfaction levels.

Thirty couples for the experimental group and 30 couples for the control group were included in the study. The couples in the control group experienced the routine procedures that the treatment currently includes. Couples in the experimental group took part in the counseling service model, and were informed and supported throughout the steps of the ART. A guide developed for the couples and education material developed for the counseling service model were used during the study. Three psychological tests were given to the couples before (pretest) and after (post-test) each procedure. These tests included anxiety, depression and life satisfaction inventories. The difference means test and Student's t test were used for statistical analysis.

The results of the study showed that couples in the experimental group had lower anxiety and depression scores than the couples in the control group. Life satisfaction scores and pregnancy rates were higher for couples in the experimental group than for the couples in the control group. Statistical evaluation showed that the difference between the experimental group and the control group was significant (p < 0. 05).

This study demonstrates the importance of the counseling role of the nurse, and the development and application of counseling services in ART centers, in lowering the anxiety and depression levels of couples and ensuring success of the treatment     

The healers journey: a literature review

While much important research has gone into identifying the efficacy and importance that healing interventions can make to healthcare this paper seeks to synthesise some of the core themes of the processes that healers go through in their journey to becoming a healer. Through the process of a literature review of seminal texts and current literature the paper identifies the key themes of, healer as facilitator, connecting to sources of healing, an appreciation of the healee, an expanded sense of spirituality, an acknowledgement of the wider archetypal significance of the healer, the importance of the wound and the role that these can play in the process of personal transformation and also acceptance. In doing so it hopes to offer that the journey of the healer plays a crucial role in guiding the quality of the healing that healers share in a healing encounter.     

Behçet's disease in obstetrics and gynecology

Beh?et's disease is a multisystemic disease of unknown origin characterized by a recurrent bipolar aphtosis (oral and genital) associated with vascular, digestive or articular symptoms. Gynecologists can be faced to this disease at any time of the life of their patients, including during the pregnancy. Given that the first demonstrations of the disease can be genital, they are in the front line to evoke this diagnosis. They thus have to know the main characteristics of the disease to make the diagnosis and to organize a multidisciplinary management. During pregnancy, the treatment of the disease is to be adapted to avoid teratogenic drugs, and adapt the doses of the treatment.