输卵管妊娠术后生殖状况及其影响因素分析

目的分析引起输卵管妊娠手术治疗后不同生殖状况的相关因素,探讨改善生殖状况,提高宫内妊娠率的方法.方法对自1999-01-2003-12在中山大学附属第一医院等两家医院的424例输卵管妊娠患者经腹腔镜或剖腹手术治疗后患者生殖状况及其相关影响因素进行多重Logistic回归分析及x2分析,找出引起术后不孕及重复性异位妊娠的原因.结果424例患者术后宫内妊娠177例,占41.7%;出现重复性异位妊娠102例,占24.1%;有145例患者术后仍然未孕,占34.2%.多重Logistic回归分析提示,盆腔炎、不孕、异位妊娠、输卵管手术、输卵管粘连、输卵管伞端闭锁是输卵管妊娠术后不孕及重复性异位妊娠的危险因素.结论积极预防盆腔病变,治疗不孕症是改善输卵管妊娠术后生殖状况的重要手段.     

米非司酮和子宫动脉栓塞术治疗子宫肌瘤的疗效比较

目的 观察米非司酮和子宫动脉栓塞术治疗子宫肌瘤的，临床疗效。方法 子宫肌瘤患者84例，随机分为A、B两组，A组口服米非司酮治疗3个月，B组行子宫动脉栓塞术，观察治疗前后症状、体征、B超下子宫肌瘤大小的变化和不良反应。结果 两组临床症状均得到显著改善，子宫肌瘤体积明显缩小，但B组与A组比，其子宫及肌瘤体积缩小更显著（P〈0．01），副作用小。结论 米非司酮和子宫动脉栓塞术均为治疗子宫肌瘤的有效方法。在缩小子宫及子宫肌瘤体积方面，子宫动脉栓塞术优于米非司酮。     

远志增强大鼠子宫平滑肌峰电活动实验研究

目的:探讨远志对未孕大鼠子宫平滑肌电活动的影响及其机制.方法:用Biolap410生物机能仪进行记录,分别进行5种阻断剂使用前后,远志水煎醇沉液(以下简称远志)对子宫平滑肌电活动的影响.结果:远志可使未孕大鼠子宫平滑肌的电活动频率加快,持续时间延长,峰面积加大.酚妥拉明、苯海拉明、异博定、消炎痛等能全部或部分阻断其兴奋作用,但阿托品无明显影响.结论:远志对大鼠子宫平滑肌电活动增强作用主要通过H1受体、L型钙通道、α受体发挥作用,也与前列腺素的合成与释放有关,而与M受体无关.     

中医诊治妇科病的经验

重点论述妇女月经周期的生理变化及施治用药规律，介绍崩漏、痛经、闭经的临床诊治用药经验，有一定的参考价值。     

口服米索前列醇联合宫腔吸引管在剖宫产术后无痛人流的应用

分析口服米索前列醇联合宫腔吸引管治疗剖宫产术后无痛人流的临床效果及机制。120例患者随机分为对照组(n=60)和观察组(n=60)。对照组患者接受宫腔吸引管处理,观察组患者口服米索前列醇(0.6 mg)后接受宫腔吸引管。结果显示观察组患者的手术时间和苏醒时间明显缩短(P<0.05),术中出血量和异丙酚用量明显减少(P<0.05);观察组患者的宫颈扩张效果总有效率明显升高(P<0.05)而不良反应发生率明显降低(P<0.05);两组患者治疗后血清中白细胞介素1β(IL-1β)和IL-2水平明显升高,且对照组患者的上述白细胞介素水平升高更显著(P<0.05)而雌激素促黄体生成素(Luteotropic hormone,LH)、促卵泡激素(Follicle stimulating horman,FSH)和雌二醇(Estradiol,E2)水平无明显变化(P>0.05)。实验表明口服米索前列醇联合宫腔吸引管治疗剖宫产术后无痛人流临床效果明显,且不引起白细胞介素和雌激素水平的剧烈变化。     

宫腔镜检查在诊断异常子宫出血中的临床价值

目的:探讨宫腔镜检查在诊断异常子宫出血中的临床价值。方法:回顾性分析因异常子宫出血行宫腔镜检查,同时在宫腔镜下进行相应治疗和子宫内膜定位活检的287例患者资料。结果:287例异常子宫出血患者的宫腔镜诊断与病理组织学诊断总符合率为80.84%,其中子宫黏膜下肌瘤100.00%、子宫内膜息肉96.83%、子宫内膜增生68.42%、子宫内膜炎77.27%、萎缩性子宫内膜100.00%、子宫内膜癌100.00%。结论:宫腔镜能直接清晰地观察宫腔内及宫颈管的形态与结构,具有诊断性刮宫和超声检查不可比拟的优点,是诊断异常子宫出血的金标准。     

产力异常产妇62例临床护理

目的探讨产力异常产妇的临床护理。方法对62例产力异常产妇进行护理评估,并针对性采取护理措施。结果 62例产力异常产妇经过精心细致的治疗和护理,均成功分娩,无并发症发生。结论对产力异常产妇在围生期进行密切观测,并有针对性地采取护理干预措施,能够提高分娩成功率,保证产妇及胎儿安全度过分娩期。     

Hemoperitoneum associated with uterine fibroids: A case report

Introduction:Uterine fibroids, which are common benign tumors, rarely cause acute complications. We herein report a case of hemoperitoneum associated with uterine fibroid that could be diagnosed preoperatively with contrast-enhanced computerized tomography (CT).Patient concerns:A 48-year-old woman with uterine fibroid developed extremely severe lower abdominal pain on the first day of her menstrual period.Diagnosis:Ultrasonography and contrast-enhanced CT revealed a uterine fibroid and extravasation from the dilated vessels of the uterine fibroid.Intervention:Emergent abdominal hysterectomy was performed.Outcomes:The total amount of bleeding was 4,600 mL. Intraoperative blood salvage (1,357 mL), 6 units of red blood cells, 4 units of fresh frozen plasma, and 20 units of platelet concentrates were transfused. The postoperative course was uneventful. Pathological examination confirmed a benign uterine fibroid.Conclusion:CT could be useful to determine a diagnosis for bleeding from ruptured subserosal uterine fibroid.     

Human papillomavirus vaccination: Where are we now?

The development of efficacious prophylactic human papillomavirus vaccines provided an opportunity for the primary prevention of related infections and diseases. Certain oncogenic human papillomaviruses that preferentially infect the genital epithelium cause cervical cancer and a substantial proportion of anal, penile, vaginal, vulvar and oropharyngeal cancers. Following extensive clinical trials demonstrating their efficacy and safety, two vaccines have been in global use for over 6 years. This review summarises the accumulated evidence regarding their high level of efficacy, safety in population usage, reductions in genital warts, infections and cervical disease following their adoption, and facilitators and barriers to achieving high vaccination coverage. The review also discusses practical issues and frequently asked questions regarding duration of effect, vaccination of women treated for cervical disease and alternate vaccination schedules, as well as the need to review cervical screening strategies in the post‐ vaccination environment.     

Pelvic insufficiency fracture after definitive radiotherapy for uterine cervical cancer: retrospective analysis of risk factors

The purpose of this study is to determine the incidence, clinical characteristics and risk factors of postradiation pelvic insufficiency fracture (PIF) in women with uterine cervical cancer. We reviewed the medical records of 126 patients who received definitive radiotherapy (RT) for uterine cervical cancer between 2003 and 2009 at our institution. Among them, 99 patients who underwent at least one computed tomography (CT) or magnetic resonance imaging of the pelvis during their follow-up at more than 6 months were included in this analysis. The relationship between the incidence of PIF and several patient- and treatment-related factors was analyzed. The median follow-up period was 21 months. Of the 126 patients, 33 (with a total of 50 lesions) were diagnosed with PIF. The 2-year cumulative incidence was 32%. Univariate analysis showed that age ≥70 years (P= 0.0010), postmenopausal state (P = 0.0013), and lower CT density of bone and bone marrow (P= 0.020) significantly related to PIF. In a multivariate analysis, of the 59 patients whose CT densities were evaluable, lower CT density was the only significant factor associated with PIF (P = 0.0026). In conclusion, postradiation PIFs were detected in a considerable number of patients after definitive RT for cervical cancer. Predisposing factors were older age, postmenopausal state, and decreased density of bone and bone marrow on CT.