The Clitoris—An Appraisal of its Reproductive Function During the Fertile Years: Why Was It,and Still Is,Overlooked in Accounts of Female Sexual Arousal

Stimulating the clitoris activates the brain to instigate changes in the female genital tract, namely, the enhancement of vaginal blood flow that increases vaginal luminal pO₂, vaginal transudate (lubrication) facilitating painless penile penetration and partial neutralization of the basal luminal acidic pH, vaginal tenting, and ballooning delaying sperm transport and allowing semen de-coagulation and capacitation (sperm activation) factors to act until arousal ends (often by orgasm induction). All these genital changes taken together are of major importance in facilitating the possibility of reproductive success (and thus gene propagation) no matter how or when the clitoris is stimulated—they reveal its overlooked reproductive function. Of course, also commensurate with these changes, is its activation of sexual pleasure. The clitoris thus has both procreative (reproductive) and recreative (pleasure) functions of equal importance. Clitoridectomy creates not only sexual disability but also a reproductive disability. Clin. Anat. 32:136–145, 2019. © 2019 Wiley Periodicals, Inc.     

经阴道三维超声评价未破裂卵泡黄素化综合征患者卵巢储备功能分析

目的 分析经阴道三维超声对于未破裂卵泡黄素化综合征患者卵巢储备功能评价的价值。 方法 选择不孕症患者100例作为研究对象，根据相关评价标准将确诊为未破裂卵泡黄素化综合征者200例作为研究组，其他正常排卵不孕者80例作为对照组，对比2组各卵泡期子宫内膜厚度、血清性激素6项水平、各卵泡期优势侧卵巢血流参数及围排卵期成熟卵泡血流分级情况。 结果 2组血管化指数、血流指数及血管化血流指数在组间、时点间及组间·时点间交互作用差异均有统计学意义（P＜0.01）。对照组围排卵期成熟卵泡血流多为3~4级，研究组多为1~2级，差异有统计学意义（P＜0.01）。 结论 血流量低、成熟卵泡新生血管数量少是未破裂卵泡黄素化综合征的血流灌注特点，经阴道三维超声检查，更利于早期评价卵巢储备功能，指导临床识别、预测卵泡发育不良及早期排卵障碍。     

Comparing the effects of Calendula officinalis and clotrimazole on vaginal Candidiasis: A randomized controlled trial

This triple-blind trial examined the effects of Calendula officinalis vaginal cream on the treatment of vaginal Candidiasis (primary outcome) and sexual function (secondary outcome). Married women aged 18–45 years with vaginal Candidiasis (n = 150) were recruited from April to October 2014 and randomized into Calendula and clotrimazole groups, using 5-g vaginal cream every night for seven nights. Clinical and laboratory assessments were conducted at 10–15 and 30–35 days after intervention and the female sexual function index was assessed at 30–35 days. Six women were lost to follow-up. The frequency of testing negative for Candidiasis in the Calendula group was significantly lower at the first (49% vs. 74%; odds ratio (OR) 0.32; 95% confidence interval (CI) 0.16–0.67) but higher at the second (77% vs. 34%; OR 3.1; 95% CI 1.5–6.2) follow-up compared to the clotrimazole group. The frequency of most signs and symptoms were almost equal in the two groups at the first follow-up, but were significantly lower in the Calendula group at the second follow-up. Sexual function had almost equal significant improvement in both groups. Calendula vaginal cream appears to have been effective in the treatment of vaginal Candidiasis and to have a delayed but greater long-term effect compared to clotrimazole.     

局部麻醉下经腹膜前无张力疝修补术20例的疗效

目的:探讨局麻下腹膜前腹股沟疝修补术的技术要点和临床疗效。方法:对20例局部麻醉下行腹膜前腹股沟疝修补术患者的资料进行回顾性分析。结果:20例患者术后恢复快,随访时间6～14个月,无复发。结论:局麻下腹膜前腹股沟疝修补术是一种操作较简便,术后复发率低的一种疝修补术,尤其适合于合并多种慢性疾病的老年患者,为腹股沟疝患者提供了一种理想的治疗方法。     

球体替代纽扣改良腹腔镜Vecchietti阴道成形手术12例临床分析

目的：探讨用球体替代纽扣实施腹腔镜Vecchietti阴道成形手术的可行性和临床效果的优越性。方法：选取2003年至2012年在山东大学齐鲁医院妇科行腹腔镜Vecchietti阴道成形术的20例先天性无阴道患者,其中行传统腹腔镜Vecchietti阴道成形手术者8例（纽扣组）,用球体替代纽扣实施改良腹腔镜Vecchietti阴道成形手术者12例（球体组）。比较两组的手术时间、术中出血量、术后提拉疼痛评分,以及术后3月及6月的阴道长度（cm）和宽度（cm）。结果：球体组的手术时间、术中出血量、术后疼痛评分（VAS）均显著低于纽扣组（P〈0.05）。术后3月及6月复查,两组患者的阴道长度及宽度均无显著差异（P〉0.05）。结论：应用球体替代纽扣改良腹腔镜Vecchietti阴道成形手术与传统腹腔镜Vecchietti阴道成形手术相比较,缩短了手术时间,减少术中出血量,明显缓解患者术后提拉疼痛,同时又保留传统手术方式的优点,是一种创伤更小、更加简约可行的手术方式。     

Single-Incision Mini-Slings Versus Standard Midurethral Slings in Surgical Management of Female Stress Urinary Incontinence: An Updated Systematic Review and Meta-analysis of Effectiveness and Complications

ContextAn updated systematic review and meta-analysis of randomised controlled trials (RCTs) comparing single-incision mini-slings (SIMS) versus standard midurethral slings (SMUS) in the surgical management of female stress urinary incontinence (SUI).ObjectiveTo evaluate the clinical efficacy, safety, and cost effectiveness of SIMS compared with SMUS in the treatment of female SUI.Evidence acquisitionA literature search was performed for all RCTs and quasi-RCTs comparing SIMS with either transobturator tension-free vaginal tape (TO-TVT) or retropubic tension-free vaginal tape (RP-TVT). The literature search had no language restrictions and was last updated on May 2, 2013. The primary outcomes were patient-reported and objective cure rates at 12 to 36 mo follow-up. Secondary outcomes included operative data; peri- and postoperative complications, and repeat continence surgery. Data were analysed using RevMan software. Meta-analyses of TVT-Secur versus SMUS are presented separately as the former was recently withdrawn from clinical practice.Evidence synthesisA total of 26 RCTs (n = 3308 women) were included. After excluding RCTs evaluating TVT-Secur, there was no evidence of significant differences between SIMS and SMUS in patient-reported cure rates (risk ratio [RR]: 0.94; 95% confidence interval [CI], 0.88–1.00) and objective cure rates (RR: 0.98; 95% CI, 0.94–1.01) at a mean follow-up of 18.6 mo. These results pertained on comparing SIMS versus TO-TVT and RP-TVT separately. SIMS had significantly lower postoperative pain scores (weighted means difference [WMD]: −2.94; 95% CI, −4.16 to −1.73) and earlier return to normal activities and to work (WMD: −5.08; 95% CI, −9.59 to −0.56 and WMD: −7.20; 95% CI, −12.43 to −1.98, respectively). SIMS had a nonsignificant trend towards higher rates of repeat continence surgery (RR: 2.00; 95% CI, 0.93–4.31).ConclusionsThis meta-analysis shows that, excluding TVT-Secur, there was no evidence of significant differences in patient-reported and objective cure between currently used SIMS and SMUS at midterm follow-up while associated with more favourable recovery time. Results should be interpreted with caution due to the heterogeneity of the trials included.     

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目的总结1997年11月至2011年12月复旦大学附属华东医院开展开放式腹股沟疝无张力修补术4438例的临床经验。方法根据各种不同类型的开放式腹股沟疝无张力修补术,对4438例腹股沟疝采用相对应的不同补片进行手术治疗,对不同术式的手术时间、术后疼痛、疝复发、血肿、血清肿、慢性疼痛、生殖系统并发症等及其他相关并发症进行观察、总结及数据分析。结果无手术死亡病例。术后平均随访33.7个月,术后血肿18例(0.40%),血清肿45例(1.01%),切口感染或愈合不良16例(0.40%),缺血性睾丸炎3例(0.07%)。复发14例(0.32%),慢性疼痛7例(0.60%),异常勃起1例(0.02%);3例睾丸疼痛(0.07%)。结论开放式无张力疝修补术治疗腹股沟疝安全有效,不同术式的疗效及并发症发生率情况接近,开展技术早期需特别注意预防手术并发症,对不同的病例宜采用个体化治疗方案,以期达到最佳的治疗效果。     

腹部超声联合阴道超声诊断异位妊娠的临床价值研究

目的 探讨腹部超声联合阴道超声在异位妊娠诊断中的临床价值.方法 回顾性分析2012年3月-2014年6月我院收治并经手术或病理确诊的146例异位妊娠患者的影像学资料.随机分为观察组和对照组,观察组采用腹部超声联合阴道超声检查,对照组采用单一腹部超声检查.比较两组诊断异位妊娠的准确率及显示孕囊时间等指标.结果 观察组诊断符合率为98.63％,对照组为75.34％,观察组诊断符合率明显高于对照组,差异有统计学意义（P＜0.05）.观察组平均显示孕囊（或包块）时间及手术时间比对照组分别早7～8d.结论 腹部超声联合阴道超声诊断异位妊娠有较高的临床价值,具有快捷、方便、无创及准确率高等优点,值得临床推广.