晚期产后出血问题的探讨(附52例临床分析)

本文对52例晚期产后出血病例进行了分析,结果认为晚期产后出血与感染密切有关;在处理上诊断性刮宫仍是重要措施之一,并提出对存在感染因素的产妇,术前、产前应用抗菌素预防感染.在剖宫产过程中,可用含抗生素的溶液冲洗宫腔,以达到预防感染的目的。     

Caesarean scar pregnancy

Caesarean scar pregnancy is one of the rarest forms of ectopic pregnancy. Little is known about its incidence and natural history. With increasing incidence of caesarean section worldwide, more and more cases are diagnosed and reported. Transvaginal ultrasound and colour flow Doppler provides a high diagnostic accuracy with very few false positives. A delay in diagnosis and/or treatment can lead to uterine rupture, major haemorrhage, hysterectomy and serious maternal morbidity. Early diagnosis can offer treatment options of avoiding uterine rupture and haemorrhage, thus preserving the uterus and future fertility. Management plan should be individually tailored. Available data suggest that termination of pregnancy is the treatment of choice in the first trimester soon after the diagnosis. Expectant treatment has a poor prognosis because of risk of rupture. There are no reliable scientific data on the risk of recurrence of the condition in future pregnancy, role of the interval between the previous caesarean delivery and occurrence of caesarean scar pregnancy, and effect of caesarean wound closure technique on caesarean scar pregnancy. In this article, we aim to find the demography, pathophysiology, clinical presentation, most appropriate methods of diagnosis and management, with their implications in clinical practice for this condition.     

胃肠富集kruppel因子GKLF在宫颈鳞癌中的表达及意义

目的　探讨胃肠富集kruppel因子 (GKLF)在宫颈鳞癌组织及正常宫颈组织中的表达及意义。方法　应用半定量的逆转录聚合酶链式反应 (RT -PCR)方法检测 32例宫颈鳞癌组织 (研究组 )中GKLFmRNA的表达强度 ,以 10例正常宫颈组织作为对照 (对照组 )。结果　GKLFmRNA在正常宫颈组织中的表达强度为 0 .76± 0 .15 ,而在宫颈鳞癌中的相对表达强度为 0 .4 2± 0 .19,与正常宫颈组织相比较 ,宫颈鳞癌组织中GKLFmRNA的表达丰度较低 (P <0 .0 5 )。而且临床分期愈晚 ,GKLFmRNA的表达强度愈低 ,差异有显著性 (P <0 .0 5 )。随着病理分级增高 ,GKLFmRNA的表达强度逐渐降低 ,差异有显著性 (P <0 .0 5 )。结论　宫颈鳞癌组织中GKLF表达下调 ,而且GKLFmRNA的表达与宫颈癌的临床分期和病理分级呈负相关 ,提示GKLF可能参与了宫颈癌的发生或进展过程     

分娩时子宫下段MMP-9及其组织抑制剂TIMP-1的变化

目的:探讨基质金属蛋白酶(MMP)及其组织抑制剂(TIMP)在分娩发动、宫颈成熟和扩张中的作用和机制.方法:采用ELISA方法测定子宫下段组织中MMP-9和TIMP-1的浓度.有宫缩剖宫产组56例,其中第一产程组44例,第二产程组12例.以无宫缩剖宫产组16例为对照组.结果:有宫缩剖宫产组子宫下段组织中MMP-9和TIMP-1的浓度分别明显高于无宫缩剖宫产组(P<0.05,P<0.05).第一产程组中随宫口开大,MMP-9和TIMP-1的浓度各组间无显著性差异.第二产程组MMP-9和TIMP-1的浓度分别明显高于第一产程组(P<0.01,P<0.05).结论:MMPs和TIMPs的动态变化是分娩发动、宫颈成熟和扩张过程中的重要中间环节.     

经阴道超声诊断子宫内膜癌

目的 探讨应用经阴道超声（TVS）诊断绝经前后出血妇女子宫内膜癌的价值。方法 采用彩色多普勒超声诊断仪检测74例阴道异常出血的妇女，其中绝经前28例，绝经后46例，所有患者均取子宫内膜组织行病理对照。结果 TVS检测子宫内膜癌的敏感性、特异性、假阳性率、假阴性率、阳性预测值和阴性预测值，绝经前妇女依次为61．5％，50．0％，14．3％，23．8％，94．1％和54．5％，绝经后妇女依次为97．3％，55．6％，44．4％，2．7％，90．0％和83．0％。结论 TVS检测可作为子宫内膜癌首选的筛查方法，尤其对于绝经后妇女价值更大。     

后路肿瘤摘除固定融合一期手术治疗颈椎椎管内肿瘤

目的探讨经后路全椎板切除摘除椎管内肿瘤,同时行颈椎侧块或椎弓根内固定植骨融合治疗颈椎椎管内肿瘤的临床疗效. 方法采用该手术方法治疗颈椎椎管内肿瘤8例. 结果所有患者术后早期(3周以内)可下床活动,无一例出现眩晕、颈痛、头痛等颈椎不稳的表现.随访6个月～2年未见后凸畸形发生,颈椎活动不受限制,内固定物无松动断裂. 结论经后路全椎板切除同时行经颈椎侧块或椎弓根内固定植骨融合治疗颈椎管内肿瘤,能够维持手术后颈椎的稳定性,防止远期后凸畸形的发生.     

脊髓型颈椎病的非手术治疗

目的阐述早期、中期脊髓型颈椎病(CSM)可首选非手术治疗。方法研究1990年2001年共收治的CSM病人426例，执行严格的诊断、纳入标准，采用颈牵、推拿、药物等综合治疗。结果426例CSM患者的近期疗效的优良率为67．11％，好转率为97．67％，并对其中的169例进行1年至7年11个月的随访，平均随访2年8个月，优良率78．70％，好转率98．22％，在随访患者中有30例治疗前后颈椎MRI对比，显示15例患者颈椎间盘达到部分还纳，其余15例无明显变化，426例CSM患者中未出现1例并发症。结论非手术治疗早、中期CSM安全，有效，患者痛苦小。     

宫颈上皮内瘤变108例临床分析

目的通过总结108例宫颈上皮内瘤变（CIN）的临床与预后，探讨分析CIN的诊断与治疗。方法归纳总结共108例各级CIN的临床特点及治疗方法，术前肉眼多点活检及阴道镜下活检与术后病理诊断的符合率，分析其预后。结果所有病人均有性生活史。除45／108（417％）无症状外，63／108（58．3％）有分泌物增多，或同房出血或阴道不规则流血。术前阴道镜下活检与术后病理诊断的符合率高于肉眼多．最活检符合率，但统计学差异无显著性，（P〉0．05）。根据病人要求、CIN级别及病变部位、范围采取不同的手术方式，其中14例随访超过5a，全部病人无1例复发，3、5a存活率均为100％。结论临床上对有性生活史的生育年龄妇女要警惕CIN，肉眼多点活检或阴道镜下活检可作为确诊手段，对不同的病人，依据病灶的性质，采用不同的手术方式，可避免复发，获100％的治愈率。     

A retrospective study on estrogen or contraceptives in the treatment of dysfunctional uterine bleeding in adolescent patients

Objective: To investigate the clinical efficacy of estrogen or contraceptives in the treatment of acute bleeding of dysfunctional uterine bleeding (DUB) in adolescent patients and the optimal starting dosage of drugs.Methods: The clinical records of 106 girls who with DUB and moderate or severe anemia from February 1990 to July 2005 were analyzed retrospectively.Results: All 106 patients received hormonal therapy. 56 patients were treated with estradiol benzoate(E2), 30 patients with conjugated equine estrogen(CEE) and 20 patients with combined oral contraceptives (COCs). The rates for rapidly controlling bleeding and for rapidly stopping bleeding in E2 group were higher than those in CEE group ,but similar to those in COCs group. The days for controlling and completely stopping bleeding were not significantly different between the starting dosages (≤8 mg/d and >8 mg/d) of E2 groups, and also there were no statistical difference between the starting dosages (<7.5 mg/d and ≥7.5 mg/d) of CEE groups, but during the treatment the rate of increasing the dosage in <7.5 mg/d group was higher than that of ≥7.5 mg/d group(40% vs. 5%),while there were no statistical difference between the starting dosages (≤3 pills/d and >3 pills/d) of COCs groups. Conclusions: The clinical efficiency of E2 treatment on DUB in adolescent patients is similar to that of COCs. And the efficacies of treatment of DUB with E2, CEE and COCs in the different dosages are similar.     

颈椎前路减压术治疗脊髓型颈椎病

目的探讨脊髓型颈椎病的手术疗效。方法对诊断明确症状较重的12例脊髓型颈椎病患者采用前路减压、植骨融合、钛板内固定。结果所有病例随访6~18个月,术后3个月椎间植骨达骨性融合,症状消失或明显改善,除1例钢板松动术后第5天再次手术外,未见食道损伤、喉返神经损伤等并发症。结论颈椎前路手术治疗脊髓型颈椎病具有减压彻底、融合率高、内固定牢靠的优点,虽手术风险较大,但如操作细致,仍可避免一些并发症的发生。