卵巢子宫内膜异位囊肿粘连程度及相关因素分析

Objective To investigate the relationship between degree of endometrioma adhesions and clinical feature, surgical treatment and postoperative recurrence. Methods From Jan 2003 to Mar 2008, 662 patients with endometrioma undergoing laparoscopic ovarian endometrioma excision in Peking Union Medical College Hospital were studied retrospectively. All patients were classified into four groups according to the extent of adhesions: 31 cases in none adhesions group, 123 cases in mild adhesions group (filmy thickness, avascular, easily separated adhesions), 310 cases in moderate adhesions group (less than a half of ovary was adjacent to dense thickness adhesions which was difficult to separate, or above a half of ovary were adjacent to filmy thickness adhesions) and 198 cases in severe adhesions group (above a half of ovary was adjacent to dense thickness, well vascularized adhesions which was difficult to separate, and always involved the other pelvic organs, observed angiogenesis). The comparison of degree, characteristics, period of pain, lab test, surgical management and postoperative recurrence was performed among those above groups. In the mean time, risk factors and multinomial logistic regression were analyzed. Results (1)Clinical characteristics: The incidence of patients with dysmenorrhea, dyspareunia, straining feeling in anus, chronic pelvic pain and the level of CA125 (>35 kU/L) was remarkably higher in moderate-to-severe adhesion groups than in none-to-mild adhesions groups (P=0.000, 0.000, 0.001, 0.006 and 0.000, respectively). Infertility rate were significantly higher in severe adhesions group(15.7%,31/198) than none adhesions group(3.2%,1/31), mild adhesions group(11.4%,14/123) and moderate adhesions group(9.7%,30/310, OR=1.728, P<0.05).(2)Operating time and blood loss: Operating time of each groups was as followed: (37±15) min in none adhesions group, (42±19) min in mild adhesions group, (50±20) min in moderate adhesions group and (63±22) min in severe adhesion group. Blood loss was (23±12) ml in none adhesion group, (31±27) ml in mild adhesion group, (40±32) ml in moderate adhesion group and (70±67) ml in severe adhesions group. Thicker adhesions result in longer operation time and more blood loss. (3)Combined with other disease: The ratio of patients who combined with adenomyosis or deeply infiltrating endometriosis in moderate-to-severer adhesion groups was higher than patients in none-to-mild adhesions groups (OR=3.466, P=0.000). (4) Postoperative recurrence: It was categorized into recurrence of pain and cyst. Moderate-to-severe adhesions was related to higher recurrence rate of pain (OR=1.685,P=0.046), but was irrelevant to recurrence of cyst. Conclusion The more extent of endometrioma adhesions was related to severer pelvic pain symptoms, longer operating time and more blood loss. Postoperative pain recurrence rate was observed in moderate-to-severe adhesion group. Extent of adhesions was irrelevant to cyst recurrence.     

妊娠合并宫颈癌2例报告并文献复习

2004年我院妇科收治大月份妊娠合并宫颈癌2例，现结合文献复习报道如下。     

色素上皮源性因子

色素上皮源性因子(pigment epithelium-derived factor,PEDF)最初从视网膜色素上皮细胞分离,目前被认为是最强的血管增生抑制因子.现将PEDF的研究历史、结构、生理作用以及研究现状综述如下.     

初中生自我意识与父母养育方式的关系

自我意识是意识的核心内容，在初中阶段出现质的飞跃。它的发展标志着个体心理成熟的程度，到青春期渐趋成熟。如果在发育过程中受内外因素的影响，使儿童的自我意识出现不良倾向，则会对儿童的行为、学习和社会能力造成不良影响，自我意识对完善健全的人格具有重要作用。而家庭中父母对子女的教育是孩子心理健康成长的保证。为了解初中生自我意识与父母养育方式的关系，我们进行了本调查。结果报告如下。     

浅谈老年人的心理护理

老年人随着年龄的增加机体而逐渐衰老，各项功能呈直线下降，如食欲减退、失眠、视力下降、两耳失明、头发变白、免疫功能低下等等。这些都是老年人正常生理方面的改变，伴着健康状态和社会环境的改变，老年人的心理不同程度地发生变化，出现一些心理健康问题，社区护理针对老年人的这些特点，对老年人的心理护理加以指导，以提高老年人的心理健康水平和生存质量。     

断乳后低钙膳食对高脂膳食大鼠肥胖影响

目的探讨断乳后低钙膳食对高脂膳食大鼠肥胖的影响。方法80只刚断乳雄性Wistar大鼠按体重随机分为2组,分别给予低钙或正常钙膳食3周,然后以正常饲料喂养3周。第6周末各组动物又随机分成2组,分别喂饲高脂饲料和基础饲料,观察肥胖发生情况。结果断乳后低钙膳食大鼠食用高脂饲料后体脂含量、血脂、瘦素水平显著升高,高密度脂蛋白（HDL）、游离三碘甲状腺原氨酸（FT3）水平显著降低。结论断乳后给予低钙膳食可能促进高脂膳食大鼠肥胖的发生。     

妇科微创手术适应证及方法选择的争议

随着人类文明的进步以及科学技术的飞速发展,医学进入一个日新月异的发展时代,其中最值得关注的就是微创外科学.[第一段]     

内蒙古医科大学附属医院细菌耐药性监测

目的: 分析2015 年内蒙古医科大学附属医院分离细菌对多种抗菌药物的耐药性。方法: 采用手工
药敏纸片扩散法和法国生物梅里埃全自动鉴定药敏仪器分析了多种抗菌药物的耐药性，参照了2015 年CLSI 判
定标准，分析了抗菌药物的药敏试验结果，采用WHONE 5．6软件统计分析。结果: 鉴定了全院临床分离的3788
株细菌，其中G－ 菌占74．2%( 2809 /3788) ，G+ 菌占25．8%( 979 /3788) 。前五位的临床分离菌株为大肠埃希菌、肺
炎克雷伯菌、金黄色葡萄球菌、鲍曼不动杆菌、铜绿假单胞杆菌。肠杆菌科细菌中产超光谱β 内酰胺酶的肺炎克
雷伯菌和大肠埃希菌的检出率为13．5%和51．1%，肠杆菌科细菌对碳青霉烯类抗菌药物耐药率较低，为2%。非
发酵革兰氏阴性杆菌所占比列为27．8%( 781 /1975) ，主要为铜绿假单胞杆菌和鲍曼不动杆菌，对亚胺培南的耐
药率分别为27．9%和46．1%。耐甲氧西林葡萄球菌和耐甲氧西林凝固酶阴性葡萄球菌分别为28．6%( 182 /446) 和
80．7%( 213 /265) ，未检出万古霉素和利奈唑胺耐药的葡萄球菌。肠球菌中屎肠球菌的耐药率远高于粪肠球菌，
未发现对万古霉素和利奈唑胺耐药的肠球菌。肺炎链球菌占革兰氏阳性球菌的6．3%( 62 /979) ，其中对红霉素、
四环素和复方新诺明的耐药率均高于90%。流感嗜血杆菌和卡他布兰汉菌产β－内酰胺酶的检出率分别为
48．7%( 19 /40) 和96．1%( 50 /52) 。结论: 细菌的耐药性问题仍然对临床抗感染治疗起着严重威胁，定期进行细菌
的耐药性监测能够指导临床合理使用抗菌药物，同时有助于了解医院细菌耐药性迁移特征，避免耐药株的扩散
传播。     

浅谈儿科护士的心理压力及应对策略

目的分析儿科护士的心理压力的来源及应对措施.方法对40名儿科护士进行问卷调查,了解造成儿科护士心理压力的主要因素.结果造成儿科护士的主要心理压力有患儿自身因素、技术方面、患儿家长方面、环境因素等.结论儿科护士普遍心理压力较大,因此,要给其营造一个轻松舒适的环境,使她们的压力得到释放,更好地发挥她们的潜能,投身到儿科护理事业.     

晚发性VitK缺乏所致颅内出血患儿的临床护理

晚发性VitK缺乏症是由于缺乏VitK导致凝血功能障碍性疾病。临床可表现为全身多部位出血，以自发性颅内出血或颅内血肿多见，其发生率约为80％，病死率为18％～50％，存活者遗有不同程度神经系统后遗症者占33％～50％^[1,2]，起病突然，病情来势迅猛，病死率高，后遗症严重，故早期诊断，及时救治和有效护理是提高治愈率的关键。我科于2005年1月-2007年6月收治晚发性VitK缺乏症患儿18例，经积极救治和精心护理，取得满意效果，现介绍如下：