盆底肌功能锻炼对会阴切口及盆底肌张力的影响

目的探讨盆底肌功能锻炼对会阴切口的愈合及盆底肌张力恢复的影响。方法将67例经阴道分娩产妇随机分为观察组（37例）和对照组（30例）。观察组采用一对一盆底肌功能锻炼指导，对照组采用常规会阴护理。结果观察组产后第3天会阴切口肿胀及产后第5天疼痛情况显著优于对照组（P〈0．01，P〈0．05），观察组产后第42天盆底肌张力恢复率显著高于对照组（P〈0．05）。结论孕产妇坚持盆底肌功能锻炼，可促进会阴切口的愈合，促进盆底肌张力的恢复。     

产后系统指导盆底肌功能锻炼效果观察

将187例初产妇随机分为两组,观察组90例由专人负责进行产前、产后盆底肌功能锻炼指导;对照组97例产后采用一般健康教育方式进行盆底肌功能锻炼指导.于产后第5天、第42天分别评价盆底肌功能锻炼指导效果.结果观察组效果显著优于对照组(均P＜0.05).提示专人系统指导盆底肌功能锻炼可促进产后盆底肌功能的恢复.     

盆底康复操锻炼对产妇产后盆底肌力及心理状态的影响

目的探讨盆底康复操锻炼对减少产后并发症、改善产妇心理状态及盆底肌力的作用。方法将自然分娩的初产妇按住院号奇偶数分为对照组54例和干预组55例。对照组采取常规护理模式,干预组在常规护理基础上于产后采取盆底康复操锻炼方案,比较两组产后14周内并发症发生情况、盆底肌力及心理变化。结果干预组产后尿失禁、子宫复旧不全及产后失眠等并发症发生率显著低于对照组(均P0.05);干预组在产后6周及14周时盆底肌力显著优于对照组(均P0.01);产后14周干预组SAS、SDS评分显著低于对照组(均P0.01)。结论产后盆底康复操的应用,可规范引导产妇进行有效的盆底功能锻炼,促进产后盆底肌功能恢复,减少产后并发症的发生,改善产妇的心理状态。     

会阴侧切术后T形裂伤解剖复位缝合法效果探讨

目的探讨会阴侧切术后T形裂伤的缝合对伤口愈合的影响,提高复杂裂伤的愈合效果。方法将102例会阴侧切术后T形裂伤的足月初产妇随机分为观察组(51例)和对照组(51例)。两组均采用可吸收肠线,对照组按照常规行皮内缝合,观察组采用改进的缝合方法,即将T形裂伤中的d、e、f三点按正确解剖关系串缝在一起,使裂伤皮肤对合更紧密。结果观察组伤口疼痛程度、伤口愈合、产妇分娩后住院时间、盆底肌肉张力显著优于对照组(P0.05,P0.01)。结论观察组采用的解剖复位缝合方法具有对合良好,伤口甲级愈合率高,缩短住院时间,有利于产后盆底肌肉张力恢复等优点。     

生物反馈盆底肌肉锻炼在产妇产后盆底功能康复治疗中的应用

目的探讨生物反馈盆底肌肉锻炼在产妇产后盆底功能康复治疗中的应用效果。方法选取2017-02—2018-02间郑州大学第一附属医院收治的100例分娩产妇,根据产后盆底功能康复治疗方法的差异分为2组,每组50例。对照组产妇给予常规盆底肌肉锻炼,观察组产妇在对照组基础上应用生物反馈仪进行康复治疗。结果盆底功能康复治疗2个月,产后102 d时,观察组产妇盆底肌力分级明显高于对照组,盆底肌最大肌电压及盆底肌持续收缩60 s的肌电压均明显高于对照组,产妇的尿道膀胱后角和尿道膀胱连接部的移动度小于对照组,膀胱颈到耻骨联合下缘距离高于对照组。以上指标的差异均有统计学意义(P0.05)。结论对产妇使用生物反馈治疗仪康复治疗,有助于促进产妇产后盆底功能恢复,预防盆底功能障碍性疾病的发生,可显著改善产妇产后的生活质量。     

马铃薯片外敷促进会阴切口愈合的效果观察

目的观察新鲜马铃薯片外敷促进会阴切口愈合的临床效果。方法将住院行会阴侧切术的产妇196例随机分为对照组与观察组各98例。观察组每天采用0.1%碘伏擦洗切口后用新鲜马铃薯片外敷切口,每日2次;对照组每天采用0.1%碘伏擦洗切口2次。结果观察组会阴切口愈合情况显著优于对照组,会阴切口处肿胀及疼痛消退时间显著短于对照组(均P<0.01)。结论使用自制马铃薯薄片贴敷会阴切口能有效加速肿胀及疼痛消退,促进会阴切口愈合。     

会阴侧切皮下美容缝合联合综合护理干预对产后切口愈合的影响

目的:探讨会阴侧切皮下美容缝合术联合综合护理干预对产后切口愈合的影响。方法:选取2018年4月-2019年4月接诊的顺产会阴侧切初产妇60例,按照随机数字表法分成两组,对照组30例采用会阴侧切皮下美容缝合术联合常规护理配合,观察组30例在围术期联合综合护理干预,对比两组产妇总产程时间、产后48h会阴疼痛情况、切口愈合时间,记录两组产妇产后4周内线结反应,产后3个月、6个月时采用温哥华瘢痕评价量表(Vancouver scar scale,VSS)、患者瘢痕自我评分(Patient scar assessment scale,PSAS)评估侧切口的美观度。结果:观察组总产程、产后48h会阴疼痛程度优于对照组,差异有统计学意义(P0.05)。观察组会阴侧切口一期愈合率略高于对照组,组间比较差异无统计学意义(P0.05)。产后4周内观察组结线反应发生率显著低于对照组,差异有统计学意义(P0.05)。产后3个月、6个月时观察组VSS评分、PSAS评分均显著低于对照组,差异有统计学意义(P0.05)。结论:会阴侧切皮下美容缝合术联合综合护理能够有效缩短初产妇生产时间、缓解产后疼痛,切口愈合快,美观度和安全性较高。     

直肠癌Miles术后会阴切口一期缝合引流方法的选择

目的:探讨直肠癌Miles术后会阴切口一期缝合不同引流方法对会阴部切口愈合的影响。方法:将近3年来收治的100例行直肠癌Miles术的患者随机分成对照组和观察组,每组50例。对照组在Miles术后会阴切口一期缝合仅行骶前负压管经腹部切口引流,会阴部未置引流;观察组则除在骶前间隙采用经腹部切口引流外,还在会阴部行单管负压引流。比较两组的引流量、引流时间、一期愈合率、创口感染率、残腔消失时间以及皮肤切口愈合时间。结果:观察组的引流量显著多于对照组,且引流时间显著短于对照组(均P<0.05);观察组的一期愈合率显著高于对照组,而创口感染率显著低于对照组(均P<0.05);观察组的残腔消失时间和皮肤切口愈合时间均显著短于对照组(均P<0.05)。结论:直肠癌Miles术后会阴切口一期缝合采用骶前间隙单管引流和会阴部单管负压引流的方法对会阴部切口愈合效果优于仅行髋前负压管经腹部切口引流的方法。     

信息动机行为模型用于子宫切除术患者盆底肌功能锻炼

目的探讨信息-动机-行为模型(IMB)在子宫切除术后患者盆底肌功能锻炼的效果。方法将子宫切除术后患者120例,依据住院时间分为干预组(2016年7~12月)和对照组(2016年1~6月)各60例。对照组按照常规实施盆底功能锻炼;干预组实施基于IMB的盆底肌功能锻炼。结果干预3个月后,干预组患者功能锻炼依从性显著高于对照组,压力性尿失禁发生率显著低于对照组(均P0.01)。结论基于信息-动机-行为模型的功能锻炼能有效提高子宫切除术患者盆底肌功能锻炼依从性,有助于盆底功能的恢复。     

分娩相关会阴疼痛和损伤的系统化管理

目的探讨分娩相关性会阴疼痛和损伤的系统性护理管理效果。方法将定期产检、有意愿自然分娩、排除妊娠合并症和妊娠并发症的非高危产妇200例随机分为观察组和对照组各100例。对照组采用传统的护理模式,定期产检,分娩期根据产程进展情况进行护理;观察组接受系统而个性化的会阴疼痛与损伤管理。结果两组会阴裂伤、侧切率比较,差异有统计学意义(P<0.05,P<0.01),观察组在产后第1天、第2天会阴部疼痛程度显著轻于对照组,其对护理服务工作的满意度显著高于对照组(均P<0.01)。结论对产妇进行会阴疼痛和损伤管理,可以有效地预防和减轻会阴疼痛和损伤,提高产妇的生活质量和满意度。     

Emergency Stabilization of Pelvic Instabilities with the Pelvic C-Clamp

Abstract Objective: Emergency stabilization of translationally unstable injuries/fractures of the pelvic ring (type C injuries). Temporary, rarely definitive, restoration of form and function of the posterior pelvis. Indications: Emergency stabilization of sacroiliac disruptions and fractures of the sacrum in type C pelvic injuries. Type B injuries with clinically apparent instability (rotational instability) and type C injuries (disruption of sacroiliac joint, fractured sacrum) with associated circulatory instability. Contraindications: Pelvic type A fractures. Pelvic fractures involving the iliac wing(s). Rotational instability of the pelvis without associated circulatory instability (type B). Surgical Technique: Closed reduction applying traction, pressure and rotation to the affected hemipelvis. Stab incisions and bilateral percutaneous introduction of the pins. Compression of the C-clamp under fluoroscopic monitoring stabilizes the posterior pelvic ring. Depending upon the patients general condition, open reduction and internal fixation (ORIF) will often be performed at a later time. Results: 39 patients with type C pelvic injuries underwent primary stabilization with the pelvic C-clamp. The patients average age was 36 years (11–89 years), 29 were men, ten woman. With the exception of two, all patients had sustained either multiple injuries, or polytrauma. The mean Hannover Polytrauma Score (HPS) was 39.9 points (11–79 points). Ten patients had a disrupted sacroiliac joint, 29 an unstable fracture of the sacrum. On admission, all patients with the exception of four were considered hemodynamically unstable. The initial hemoglobin count was 6.7 g/dl (3.1–12.3 g/dl) on average, the average base excess amounted to –8.7 mmol/l (+2 to –28.0 mmol/l), average systolic blood pressure on admission was 82 mmHg (0–130 mmHg), corresponding to marked findings of shock. At the time of C-clamp application, the indication for the C-clamp was a pelvic instability in 13 patients alone, and in 26 patients the pelvic instability was associated with a circulatory instability. In 15 patients the circulatory situation stabilized after application of the C-clamp. Complications occurred in seven patients (excessive compression of sacral fractures in three patients, one pin malpositioning, two bleeders from pin channels, one perforation of the ilium). This reflects a steep learning curve.The following is a reprint from Operat Orthop Traumatol 2004;16:192–204 and continues the new series of articles at providing continuing education on operative techniques to the European trauma community.Reprint from: Operat Orthop Traumatol 2004;16:192–204 DOI 10.1007/s00064-004-1101-3.     

Pelvic exenteration

Pelvic exenterations are the most extensive surgeries performed for patients with gynecologic cancer, and the surgical team and patients have to be fully aware of the many issues that come into the discussion. This article discusses the history, indications, surgical techniques, and complications of pelvic exenteration.     

Pelvic hemangiopericytoma

An additional case of pelvic hemangiopericytoma is described, emphasizing the difficulty in diagnosis. If surgery is undertaken, excessive blood loss must be anticipated.     

Pelvic lipomatosis

A case of pelvic lipomatosis and review of the literature are presented. The diagnosis is usually made by careful review of the physical findings and radiologic examinations. Distortion and elevation of the bladder with elongation of the posterior urethra should arouse suspicion. Excision is the treatment of choice but is only effective in 10 to 35 per cent of cases. Conservative therapy using antibiotics and steroids is disappointing.