直肠系膜全切除与阴道切除在女性低位直肠癌根治术中的应用体会

目的：探讨直肠系膜全切除与阴道切除在降低女性低位直肠癌局部复发中的价值。方法：回顾性总结43例女性Dukes B－C期低位直肠癌病例,其中22例按TME原则行直肠癌根治术（含阴道全部或后壁切除）,21例按传统直肠癌根治术（未切除阴道）。结果：TME组22例术后2年内局部复发率为4．55％（1／22）,阴道后壁肌层癌组织检出率50％（11／22）,直肠系膜有癌率63．64％（14／22）。传统组21例术后2年内局部复发率为23．67％（5／21）,直肠系膜有癌率38．10％（8／21）。结论：TME加阴道切除能降低女性Dukes B-C期低位直肠癌患者的局部复发率。     

Incidence of squamous neoplasia of the cervix and vagina in women exposed prenatally to diethylstilbestrol (United States)

Objectives: Women exposed prenatally to diethylstibestrol (DES) have an excess risk of clear-cell adenocarcinoma of the vagina and cervix, but the effect on the incidence of squamous neoplasia is uncertain. The purpose of the current study was to evaluate the long-term risk of developing high-grade squamous neoplasia of the genital tract among women exposed prenatally to DES. Methods: A cohort comprising 3899 DES-exposed and 1374 unexposed daughters was followed for 13 years (1982–1995) for pathology-confirmed diagnoses of high-grade squamous intraepithelial neoplasia (HSIL) of the genital tract. Poisson regression analysis was used to compute relative risks (RR) and 95% confidence intervals (95% CI), adjusting for age, calendar year, and other covariates. Results: The RR (95% CI) among DES-exposed versus unexposed, based on 111 cases of high-grade disease, was 2.1 (1.2–3.8). Adjustment for screening history estimated by the number of years since the last Pap smear had little effect. Risk estimates were higher with earlier intrauterine exposure; the RR (95% CI) for exposure within 7 weeks of the last menstrual period was 2.8 (1.4–5.5). Only two cases of invasive squamous cervical cancer occurred in total, precluding separate analysis. Conclusions: The findings support an association between in-utero DES exposure and high-grade squamous neoplasia, although a role for more intensive screening among DES-exposed women in the production of this excess could not be completely ruled out.     

经阴道三维超声诊断宫腔疾病

【目的】评价经阴道三维超声(3D-ITVUS)在宫腔病变中的应用价值。【方法】经阴道三维超声诊断宫腔内病变92例,并与宫腔镜检查结果及临床病理对照。【结果】正常位置宫内节育器(IuD)28例,移位IUD18例、子宫畸形19例,子宫内膜癌3例,子宫内膜息肉9例,黏膜下子宫肌瘤15例。【结论】与传统阴道超声比较．3DITVUS可清楚显示宫腔内病变,有助于宫腔病变的诊断,提高诊断准确率。     

The effects of delayed hormone replacement therapy on estrogen receptors of the cynomolgus monkey bladder and vagina

The aim of this study was to determine cytosolic estrogen receptor content of the cynomolgus monkey bladder and vagina after hormone replacement therapy. Animals maintained without hormone therapy for 2 years after surgical menopause were randomized to receive either no hormones (OVX), conjugated equine estrogens (CEE), or estrogen/medroxyprogesterone acetate (CEE + MPA) treatment for 30 months. Estrogen receptor content of bladder and vagina cytosolic extracts was determined using a commercial enzyme-linked immunosorbent assay. Estrogen receptors were uniformly present, although the vaginal concentration was 100-fold greater than in the bladder. Estrogen and combination therapy significantly decreased cytosolic receptor content in both sites compared with controls. The cynomolgus urogenital tract remains estrogen sensitive 2 years after surgical menopause. Prolonged exposure to estrogens decreases cytosolic estrogen receptor content in a manner similar to that described for short-term estrogen therapy. These results suggest that the effects of hormone replacement on the urinary tract can be identified even if initiated years after menopause. Neurourol. Urodynam. 17:241–247, 1998. © 1998 Wiley-Liss, Inc.     

Resection of Longitudinal Vaginal Septum Using a Surgical Stapler

BackgroundA longitudinal vaginal septum is a rare congenital anomaly that can cause dyspareunia, difficulty with tampon insertion, persistent vaginal bleeding, and dysmenorrhea. Various surgical techniques have been described.CaseWe present the case of a 14-year-old girl with obesity and diabetes mellitus with uterine didelphys and double vagina with a longitudinal vaginal septum. The patient presented with dysmenorrhea. Resection of the longitudinal vaginal septum using a GIA and EndoGIA (Medtronic, Inc, Doral Fl) stapler device was performed.Summary and ConclusionWe introduce a safe and effective technique for resecting a longitudinal vaginal septum using stapler technology. This technique eliminates the potential risk of thermal injury to nearby structures from currently described methods.     

腹腔镜下腹膜代阴道成形术的临床观察

目的:探讨腹腔镜下腹膜代阴道成形术的临床效果。方法:回顾性分析13例行腹腔镜下腹膜代阴道患者的临床资料,观察手术时间、术中出血、术后患者恢复情况及人工阴道生长情况,应用FSFI量表评估患者性功能。结果:13例患者手术均无并发症发生,手术时间(116.67±27.78)min,术中出血(45.42±7.71)m L,术后肛门排气时间(25.25±9.83)h,术后住院时间(12.92±1.90)d,随访人工阴道内表面均光滑,深约8~10cm,宽度约2~3指,MRKH组在性欲、性唤起、阴道润滑、性满意度、性交痛项目评分及FSFI总分与对照组相比,差异无统计学意义(P>0.05),男性满意度两组比较差异无统计学意义(P>0.05)。结论:腹腔镜下腹膜代阴道成形术是目前治疗先天性无阴道患者的理想的方法,值得临床推广。     

臭氧联合双唑泰阴道凝胶对于中老年念珠菌性阴道炎的临床疗效观察与分析

目的:本研究旨在探讨和分析臭氧治疗联合双唑泰阴道凝胶对于中老年妇女念珠菌性阴道炎的临床治疗效果。方法:选择2014年2月至2016年2月在我院妇产科门诊治疗的100例中老年妇女念珠菌性阴道炎患者,随机分为治疗组和对照组,每组各50例。治疗组的患者接受臭氧治疗联合双唑泰阴道凝胶治疗;对照组的患者接受双唑泰阴道凝胶治疗。观察和比较两组患者的临床效果。结果:治疗组患者的总有效率明显优于对照组,差异有统计学意义(P0.05)。另外,患者的外阴瘙痒、白带变化、排尿烧灼感、腰腹疼痛等临床症状改善的时间均明显短于对照组,差异有统计学意义(P值均0.05)。结论:臭氧治疗联合双唑泰阴道凝胶对于中老年妇女念珠菌性阴道炎临床疗效显著,且症状改善时间短,值得在临床大力推广。     

Innervation of the human vulvar vestibule: A comprehensive review

Pain of the vulvar vestibule, including provoked vestibulodynia, is prevalent among women, yet challenging to treat due to its multifactorial etiology. Recent evidence indicates a neuroproliferative subtype in which hypersensitivity of the vulvar vestibule is due, in part, to hyperinnervation. Detailed knowledge regarding the innervation of the vulvar vestibule is crucial to understanding and treating pain conditions impacting this region. The purpose of this review is to consolidate the current evidence regarding the innervation of the human vulvar vestibule and discuss the implications of this innervation for pathological conditions affecting this tissue. A comprehensive review of the literature was conducted using keywords including vulvar vestibule, innervation, and vestibulodynia to identify articles concerning the innervation of the vulvar vestibule. Fifteen studies published between 1998 and 2017 were reviewed. Evidence from immunohistochemical investigations support that the vulvar vestibule has nociceptive, mechanosensory, sympathetic, and parasympathetic innervation. In pathological samples, hyperinnervation supports the neuroproliferative etiology of provoked vestibulodynia. Additionally, there is some evidence supporting the role of the pudendal nerve in vulvar vestibule innervation, although no cadaveric studies have been reported to date. Progress has been made in our understanding of the innervation of the vulvar vestibule, though further research into the origin of sensory and autonomic innervation of this region is needed. Advancing the knowledge of vulvar vestibule innervation is crucial towards improving our understanding of the function of this tissue, in addition to informing the etiology and management of pain syndromes impacting this region.     

乳酸菌阴道胶囊对妊娠晚期合并细菌性阴道病患者不良妊娠结局的预防作用

目的:探讨乳酸菌阴道胶囊对妊娠晚期合并细菌性阴道病(BV)患者不良妊娠结局的预防作用。方法:将94例妊娠晚期合并BV患者,根据就诊的门诊号顺序将其分为联合组48例和对照组46例。联合组患者予以乳酸菌阴道胶囊和甲硝唑栓联合治疗,对照组予以单纯的甲硝唑栓治疗。观察两组治疗7d后的临床疗效,并比较其不良妊娠结局。结果:治疗7d后,在临床总有效率方面联合组患者(95.83%)明显高于对照组(80.43%)(χ~2=5.39,P0.05);联合组患者在早产、胎膜早破和新生儿黄疸等不良妊娠结局发生率明显低于对照组(P0.05)。两组在产褥感染、低体重儿等不良妊娠结局发生率方面比较差异无统计学意义(P0.05)。结论:乳酸菌阴道胶囊辅助治疗妊娠晚期合并BV患者的疗效较确切,对其不良妊娠结局具有良好的预防作用,可减少其早产、胎膜早破和新生儿黄疸发生率。