会阴正中切口左侧切口缝合术临床效果分析

探讨会阴正中切口缝合术与会阴左侧切口缝合术的临床应用效果,根据产妇会阴体的条件,有无产科合并症胎儿的大小等情况,选择最佳的会阴切口方式,以减轻产妇的疼痛,减少切口出血量,分析比较两种切口方式术后并发症和后遗症的发生率。     

Endometriosis and the role of the integrins in the pathogenesis of the endometriosis

The endometriosis is gynecological disease what is characterized with the presence of endometrial lesions are composed of endometrial epithelial and stromal cells outside of the uterus. There are many theories for the development of the disease endometriosis. The most widely accepted theory is the theory what is postulated the endometriosis is a result of retrograde menstruation. The essential stage in the process of development of endometrial lesions is the process of adhesion of endometrial cells on the peritoneal surface and on the organs, are situated in the peritoneal cavity. The adhesion molecules (integrins) have the most essential role in this first stage. The integrins are cell surface receptors with glycoprotein structure. They have part in process of adhesion of the endometrial cells to the proteins from EC matrix outside the uterus. The integrins have part like signal molecules in the processes of proliferation and invasion of endometrial implants. They are very essential molecules what influence the viability of endometrial implants as well as the angiogenesis in the new forming endometrial implants. Improvement of the studies, related to the roles of the integrins in the pathogenesis of endometriosis would be give new possibilities to search more effective methods for therapy of the endometriosis.     

A study of the elasticity and tension of fetal membranes and of the relation of the area of the gestational sac to the area of the uterine cavity.

The surface area of the uterine cavity before delivery was compared with that of the gestational sac after delivery and experiments were carried out to test the elasticity of membranes and the tension on them during labour. The results indicated that after 28 weeks of pregnancy the intact fetal membranes were under tension and were not a passive lining to the uterine cavity and that there was a significant decrease in the elasticity of those membranes which ruptured before labour irrespective of the maturity of the pregnancy. The results failed to support the suggestion that there was a deficiency in the area of the gestational sac in those cases where the membranes ruptured before labour.     

两种保留子宫治疗子宫脱垂的手术方式的疗效分析

目的:探讨腹腔镜下子宫腹壁悬吊术及子宫骶骨岬悬吊术治疗要求保留子宫的女性盆腔脏器脱垂患者的可行性及临床疗效。方法:回顾分析2012年6月1日至2013年6月1日郑州大学第一附属医院收治的64例要求保留子宫的子宫脱垂患者的临床资料,其中34例行腹腔镜下子宫腹壁悬吊术(研究组),30例行子宫骶骨岬悬吊术(对照组)。比较两组患者的手术时间、术中出血量、住院天数及术后并发症,术后12个月测量患者POP-Q各点值评价术前术后盆底功能改善状况,以盆底不适调查表短表20(PFDI-20)评价手术前后患者的生活质量。结果:64例患者均经腹腔镜成功完成手术,术中无膀胱、输尿管、直肠损伤。研究组的手术时间、术中出血量、住院天数均少于对照组,差异均有统计学意义(P0.05)。术后随访12个月,两组患者均无子宫脱垂复发,POP-Q各点测量值差异无统计学意义(P0.05);两组的术前与术后生活质量调查表问卷得分比较,差异有统计学意义(P0.05)。研究组和对照组分别有3例(8.8%)和2例(6.7%)发生术后并发症。结论:腹腔镜下腹壁子宫悬吊术及子宫骶骨岬悬吊术治疗子宫脱垂安全有效;腹腔镜下腹壁子宫悬吊术具有手术时间短、术中出血量少、经济安全、术后并发症少等优点,有望临床推广。     

The influence of the progress of labor on the reliability of the transcutaneous PCO2 of the fetus

Transcutaneous PCO2 measurements were performed on 105 fetuses during labor. A modified Severinghaus electrode was calibrated with 5% and 10% carbon-dioxide gas at 33 and 66torr. This corresponds to a drop in the PCO2 levels measured transcutaneously of about 13% and to an adjustment to the blood gas level. The levels measured transcutaneously were compared with data compiled from the fetal blood analysis and values of blood gas analysis from the umbilical artery immediately after delivery. The object of the study was to find out to what extent the progress of labor influences the conformity between the PCO2 levels measured transcutaneously and measured in blood. Comparing the data of the transcutaneous measurement (pb PCO2) with the pb PCO2 of the peripheral blood (pb PCO2) in cases without a caput succedaneum, we found a correlation coefficient of r = 0.79 and a slope of 1.1. On the other hand with the development of a caput succedaneum the correlation coefficient was lowered to r = 0.72 and the slope to 0.85. An influence of the propulsion of the fetal head in the birth canal on the accuracy of the transcutaneous measurement was also obvious. When the position of the fetal head was either above or in the interspinal plane, the correlation coefficient amounted to r = 0.85. With the progression below the interspinal plane, the correlation coefficient was clearly lowered. While our results show a good overall conformity between PCO2 levels measured transcutaneously and those from peripheral blood, our analysis shows also to what extent the conformity can be influenced both by the existence of a caput succedaneum and by the propulsion of the presenting part.     

The effect of the duration of the second stage of labour on the acid-base state of the fetus

A prospective study was made in 153 patients with a second stage of labour lasting 1 to 120 min. Maternal venous, umbilical artery and vein blood were analysed for acid-base variables and lactate levels. Blood was obtained immediately at delivery. Fetal heart rate monitoring data and blood test results were related to the duration of the second stage of labour and clinical outcome. In primiparae and multiparae there was a steady rise in umbilical artery lactate levels, with duration of second stage of labour, P less than 0.025 and P = 0.023, respectively. The median umbilical artery pH decreased significantly from 7.31 in patients with a second stage of labour that lasted less than or equal to 15 min to a pH of 7.25 in patients with a second stage of labour that lasted more than 30 min. Changes in PO2 and PCO2 were not statistically significant.