甲硝唑配伍糜蛋白酶侧穹窿注射结合体外射频治疗慢性盆腔炎的临床研究

目的:探讨治疗慢性盆腔炎更好的方法,研究甲硝唑配伍α-糜蛋白酶结合体外射频治疗慢性盆腔炎的治疗效果。方法:将确诊为慢性盆腔炎患者90例随机分为试验组45例(药物加体外射频治疗)和对照组45例(单用药物),试验组用甲硝唑配伍a-糜蛋白酶在阴道侧穹窿注射,接着用体外射频治疗仪照射下腹30min,隔日1次,连用5次为1疗程,对照组用甲硝唑配伍α-糜蛋白酶在阴道侧穹窿注射,隔日1次,连用5次为1疗程。结果:试验组的治愈率为75.5%。而对照组的治愈率只有25·5%。结论:甲硝唑配伍α-糜蛋白酶结合体外射频治疗慢性盆腔炎无损伤,局部用药安全可靠,疗效满意。     

肛肠、阴道、尿道环形牵开器

制作一种用于肛管直肠、阴道、尿道手术的环形牵开器.经临床使用证明暴露术野效果良好,省时省力,安全可靠,值得推广应用.     

产泰治疗药物流产后阴道流血的临床分析

目的 :观察产泰治疗药物流产后阴道流血的疗效。方法 :对比观察药物流产后口服产泰(治疗组 )与未服产泰 (对照组 )对阴道流血的影响。结果 :治疗组阴道流血量多者占 14 .3% ,明显低于对照组的 47.7% ( P <0 .0 1) ;治疗组阴道流血平均天数为 ( 10 .2± 2 .6 )天 ,显著短于对照组的 ( 17.5±3.4)天 ( P<0 .0 1) ;流产后 10天内阴道流血停止者治疗组占 77.8% ,明显高于对照组的 46 .2 % ( P<0 .0 5 ) ;治疗组月经恢复的时间平均为 ( 2 8.6± 6 .3)天 ,亦明显短于对照组的 ( 35 .4± 8.5 )天 ( P<0 .0 1)。结论 :产泰具有减少阴道流血量、缩短阴道流血时间及促进月经恢复的作用。     

白假丝酵母菌对人阴道上皮细胞TLR4mRNA表达的影响

目的探讨白假丝酵母菌对人阴道上皮细胞Toll样受体4（Toll-like receptor4，TLR4）mRNA表达的影响。方法用白假丝酵母菌热灭活孢子刺激体外培养的人阴道上皮细胞12h和24h，应用实时定量逆转录聚合酶链反应（QRT-PCR）检测细胞TLR4mRNA的表达水平。结果正常人阴道上皮组织和体外培养人阴道上皮细胞均表达TLR4mRNA。白假丝酵母菌热灭活孢子刺激12h，上皮细胞中TLR4 mRNA表达明显高于对照组和刺激24h组P〈0．05，刺激24h组与对照组比较，无明显差异P=0．50。结论人阴道上皮细胞构成性表达少量TLR4，白假丝酵母菌刺激12h时人阴道上皮细胞表达TLR4 mRNA增加，推测TLR4可能在人阴道上皮细胞识别白假丝酵母菌和启动防御感染的早期起一定作用。     

电子阴道镜检查在宫颈癌筛查中的临床价值

目的:评价电子阴道镜在宫颈癌筛查诊断中的价值及临床意义。方法:对860例妇科患者进行电子阴道镜检查,并在阴道镜下定点组织活检。结果:860例电子阴道镜检查结果中,发现异常90例,异常率为10.5%。其中50例为CIN I级,28例为CINII级~Ⅲ级,12例为宫颈癌。镜下定位活检送病理诊断确诊CIN I级45例,CINII级-Ⅲ级26例,宫颈癌12例,确诊率分别为90%、92.9%和100%。结论:电子阴道镜检查是提高宫颈癌筛查诊断率的重要手段。     

A new device for bone anchor fixation in laparoscopic sacrocolpopexy: The Franciscan laparoscopic bone anchor inserter

Background A laparoscopic modification of the sacrocolpopexy procedure with mesh and bone anchor fixation with the Franciscan laparoscopic bone anchor inserter was developed.Methods We developed a laparoscopic bone anchor inserter for the placement of a titanium bone anchor in sacral segment 3 as fixation for the mesh in laparoscopic sacrocolpopexy procedures performed in women with posthysterectomy vault prolapse.Results Surgery successfully corrected vaginal vault prolapse. Laparoscopic bone anchor insertion with this new and simple device took 2 minutes and provided a firm anchor for mesh fixation. MRI demonstrated an anatomically preferable vaginal axis toward the hollow of the sacrum.Conclusion Application of the newly developed Franciscan laparoscopic bone anchor inserter in laparoscopic sacrocolpopexy is an easy and safe procedure that provides firm fixation and excellent anatomical results.     

Bowel vaginoplasty in children: a retrospective review

Background/purpose

There are numerous congenital genitourinary conditions that result in vaginal agenesis or atresia. Reconstruction presents a challenge to the surgeon who wishes long-term functional and cosmetic results with low morbidity. Historically, reconstruction has involved the use of skin grafts and nonoperative methods with less than ideal results. The preference of the authors is to use intestinal segments for creating the neovagina and herein review their experience with this procedure.

Methods

The authors identified 10 children who underwent vaginal construction with intestinal segments from 1996 to the present. Patient charts were reviewed for etiology, procedure performed, operative and postoperative complications, and follow-up.

Results

Average age at surgery was 10.9 years (1 to 29 years). Of the 10 children, 3 required vaginal construction for cloacal extrophy, and 7 had vaginal atresia of various etiology. Sigmoid colon was utilized in 6 cases, ileum in 2, and, in 2 patients with high imperforate anus, their mucous fistula segment was used to create the vagina. Mean follow-up was 24 months. Complications included a right ureteral injury necessitating placement of an indwelling ureteral stent and a girl presenting with cyclic pelvic pain who required reanastomosis of the neovagina to the uterus for an obstructed cervical os.

Conclusions

Intestinal segments can be used successfully for creation of a neovagina with exceptional cosmetic results and an acceptable complication rate. In appropriate patients, the mucous fistula can be used to create the vagina obviating the need for a bowel anastomosis.     

Short-term outcome analysis of total pelvic reconstruction with mesh: the vaginal approach

PURPOSE: We describe our experience with transvaginal total pelvic reconstruction using a mesh with 4-point fixation for patients with genitourinary prolapse with or without stress urinary incontinence. MATERIALS AND METHODS: A total of 29 consecutive patients who underwent sacrospinous fixation using mesh material since March 1999 for genitourinary prolapse were analyzed retrospectively. In all patients defect specific repair was done, including hysterectomy (in 13). For isolated vault prolapse a rectangular mesh was interposed between the peritoneum and vaginal vault, with each corner anchored to the sacrospinous ligament using a suture-capturing device. For vault prolapse associated with anterior vaginal wall prolapse an "H" shaped, 1-piece sling was used to support both entities. Additionally, posterior and perineal repairs were done through separate incisions if needed. RESULTS: Of the 29 patients 19 (65.5%), 7 (26.92%) and 11 (39.29%) had associated symptoms of stress urinary incontinence, urgency and frequency, respectively, and 79.31% had associated anterior and 44.8% had associated posterior prolapse. Average operative time was 175.6 minutes, blood loss was 340 cc and hospital stay was 2.46 days. Early adverse events following the procedure were perineal pain, vaginal discharge and irritative voiding symptoms. At 6 month followup (mean 25.14 months) mild constipation and dyspareunia were encountered in a small subset of patients. Two patients (6.89%) have genital prolapse recurrence and none has reported erosion or nonhealing to date. CONCLUSIONS: Transvaginal technique of 4-point vaginal vault fixation using mesh is a safe and effective procedure at 2 years.     

Efficacy of sildenafil in the treatment of female sexual dysfunction due to multiple sclerosis

PURPOSE: We assessed the tolerability, safety and efficacy of sildenafil for the treatment of women with sexual dysfunction secondary to multiple sclerosis, as well as the role of somatosensory evoked potential neurophysiological testing. MATERIALS AND METHODS: We performed a double-blind, randomized, placebo controlled, crossover study investigating the effects of sildenafil in women with multiple sclerosis and sexual dysfunction. Assessments were done by validated questionnaires. Pudendal and tibial evoked potentials were also recorded. RESULTS: A total of 19 women completed the 2 arms of the double-blind phase and 12 completed the optional open label extension phase. Statistically significant improvement following sildenafil was only reported in the lubrication domain of sexual function during the double-blind phase. There was no overall change in quality of life after sildenafil. There was a significant correlation between the latency of tibial and pudendal evoked potentials. CONCLUSIONS: Sildenafil only appeared to produce limited benefit in certain individuals with female sexual dysfunction. Some measure of the extent of neurological deficit in these patients could be ascertained from the latency of tibial evoked potentials, which correlated with pudendal evoked potentials. However, it could not predict the extent of sexual dysfunction. Sildenafil is unlikely to help all patients with neurogenic female sexual dysfunction.