米非氏酮促宫颈成熟的临床病理研究

在中晚孕引产中,宫颈成熟与否是引产成败的关键。宫颈成熟度,一般指宫颈的大体形态变化,包括软化、松弛、扩张和收缩等。而大体变化又有赖于组织学的改变,研究其大体及镜下改变,可加深对宫颈成熟度的认识。目前认为,宫颈扩张不单是被动牵拉的结果,也有其自身主动变化,在分娩、引产及催产中     

普贝生用于足月妊娠促宫颈成熟的临床观察

目的探讨普贝生用于足月妊娠促宫颈成熟的安全性及有效性。方法对160例符合促宫颈成熟指征,元引产及用药禁忌症的足月妊娠孕妇随机分为2组：催产素组静脉点滴催产素,普贝生组阴道后穹窿放置普贝生。结果普贝生组与催产素组比较,促宫颈成熟率、用药至临产时间及分娩结局均有显著差异,P〈0．05;2组间副反应及新生儿结局差异无显著性。结论阴道后穹窿放置普贝生是一种安全、有效、方便的妊娠晚期促宫颈成熟方法,值得临床应用。     

普贝生用于足月妊娠促宫颈成熟的临床观察

目的 评价普贝生促宫颈成熟的有效性和安全性.方法 采用病例对照研究,将180例足月妊娠、有引产指征的初产妇随机分为两组,研究组80例以普贝生引产,对照组100例以缩宫素引产,比较两组孕妇用药前后的宫颈 Bishop评分、临产情况、分娩情况、产后出血、对新生儿的影响.结果 研究组孕妇用药后6h、12 h宫颈Bishop评分分别为 (5.9±1.1)分和 (7.0±1.5)分,明显高于对照组 (4.0±1.3)分和 (4.0±1.4)分.研究组用药至胎儿娩出时间为 (14.4±5.5)h,对照组为(23.0±6.0)h.结论 普贝生能够有效地促进宫颈成熟.     

控释地诺前列酮栓用于晚期妊娠引产的临床分析

妊娠晚期要求中止妊娠者既往常用的方法是在宫腔内注射依沙吖啶(亦称利凡诺)50-100mg 以诱发宫缩,但属于介入性操作,需时较长,临床上需要一种针对晚期妊娠,安全、有效的引产方法.阴道放置控释地诺前列酮可通过局部作用促进宫颈成熟,诱发临产,本研究拟通过比较控释地诺前列酮与依沙吖啶用于晚期妊娠引产的效果,探讨控释地诺前列酮用于中晚期妊娠引产的有效性与安全性.     

促宫颈成熟终止晚期妊娠的研究

目前随着医疗条件的改善，社会因素的影响及手术安全性的提高，部分医院剖宫产率达50%以上[1]，在剖宫产率居高不下，医疗费用持续攀升的今天，找出一种安全、有效、经济的引产方法非常有意义，宫颈成熟度是晚期妊娠引产能否成功的关键体征，同时也是影响引产效果的关键因素。在产科临床工作中，对于宫颈不成熟需要引产的孕妇，应先采用促宫颈成熟方法促使宫颈成熟。宫颈成熟是自然临产前的生理过程，通过宫颈变软，缩短，抗张能力下降等变化，使分娩顺利完成，因此促宫颈成熟是引产成功的前提条件[2]。该文对孕晚期促宫颈成熟的方法进行综述。     

催产助生汤促大鼠宫颈成熟中宫颈组织及血管的改变

目的 通过实验研究观察催产助生汤促大鼠宫颈成熟的效果及其作用机理。方法以受孕SD大鼠为实验对象，测定大鼠血液PGE2α水平并观察妊娠晚期大鼠宫颈胶原纤维和血管的变化。结果 中药催产助生汤能改变大鼠宫颈组织胶原纤维含量和排列，使血管扩张充血，间质中出现大量白细胞。与催产素组比较无显著性差异（P〈0．05），说明中药催产助生汤有明显的促宫颈成熟的作用，其作用机制可能是通过改变PGE2α水平，血管扩张充血，胶原纤维破坏、断裂，排列紊乱，宫颈组织密度降低。组织疏松变软。使宫颈成熟。结论 中药催产助生汤通过改变宫颈组织结构和血管血流的作用，促宫颈成熟。     

COOK宫颈扩张球囊与缩宫素促宫颈成熟引产的临床观察

目的 比较COOK宫颈扩张球囊与缩宫素促宫颈成熟的相关指标差异。方法 选取本院2016年12月~2017年12月的190例产妇作为研究对象,有引产指征且宫颈Bishop评分＜6分的产妇,有禁忌症的除外,评分数相同的平均分成两组,每组95例。观察组为COOK宫颈扩张球囊组,对照组为缩宫素组,分别比较两组产妇的宫颈Bishop评分、第一产程、第二产程、剖宫产率、新生儿出生体重、产后出血量及新生儿窒息率。结果 观察组产妇宫颈Bishop评分（8.8±2.4）分,高于对照组(6.3±1.30)分,差异有统计学意义（P＜0.05）;观察组产妇第一产程(6.71±1.90)h、第二产程（0.52±0.10）h,短于对照组第一产程（8.60±2.13）h、第二产程（0.67±0.16）h,差异有统计学意义（P＜0.05）;观察组产妇剖宫产率为11.57%,低于对照组的26.31%,差异有统计学意义（P＜0.05）;观察组产妇产后出血量、新生儿出生体重、新生儿窒息率与对照组比较,差异无统计学意义（P＞0.05）。结论 应用COOK宫颈扩张球囊后产妇的宫颈Bishop评分显著提高、缩短了产程,未增加分娩并发症。     

米非司酮配伍米索前列醇混悬液用于晚期妊娠促宫颈成熟疗效分析

目的 观察米非司酮配伍米索前列醇混悬液用于晚期妊娠促宫颈成熟的临床效果.方法 137例有引产指征的足月孕妇分为两组,A组77例应用米非司酮150mg治疗1天后给予口服米索混悬液,B组60例静滴催产素引产作为对照组.结果 两组引产成功率分别为98.8%和81.7%(P＜0.05).A组从用药至分娩的平均时间较B组明显缩短(P＜0.05).A组剖宫产率显著低于B组(P＜0.05).结论 米非司酮配伍米索混悬液用于晚期妊娠引产是一种安全、有效、方便的方法且效果优于催产素.     

米索前列醇用于瘢痕子宫无痛人工流产术前宫颈准备的临床研究

无痛人工流产术避免了疼痛给受术者带来的恐惧,但术前宫颈条件是操作顺利与否的重要前提.尤其是瘢痕子宫妇女,为提高手术成功率减少并发症的发生,我院观察无痛人工流产术前宫颈准备的临床效果,报告如下.     

应用普贝生促宫颈成熟后对阴道分娩、围产儿结局的影响

目的探讨应用普贝生促宫颈成熟后对各个产程、产后出血及围产儿结局的影响。方法将有指证终止妊娠的200例宫颈未成熟足月妊娠孕妇随机分为2组,研究组采用普贝生置阴道促宫颈成熟,24h后如未临产予催产素引产。对照组直接采用催产素引产。比较有完整产程产妇的各个产程时间,产后出血情况及两组的新生儿结局情况。结果研究组的第一产程平均（6.86±3.02h）明显短于对照组的（11.38±2.47h）,两者有显著性差异（P〈0.05）。而两组间总产程、第二、第三产程时间及产后出血量无明显差异（P〉0.05）。研究组新生儿的的高胆红素血症率明显低于对照组,两者有显著性差异（P〈0.05）,而两组间胎窘率、新生儿窒息率、转科率均无明显统计学意义（P〉0.05）。结论应用普贝生促宫颈成熟后临产后能有效缩短第一产程,降低新生儿的高胆红素血症发生率,而对产妇产后出血发生率及其他围产儿结局等并无影响。     

Dehydroepiandrosterone sulphate promotes hyaluronic acid-induced cervical ripening in rabbits.

Hyaluronic acid (HA) stimulates the synthesis of interleukin (IL) 8, while dehydroepiandrosterone sulphate (DHEA-S) induces the expression of IL-8 and its receptor in the human cervical fibroblast. This has led us to investigate the effect of DHEA-S on HA-induced cervical ripening. Experiments were performed in pregnant rabbits using vaginal suppositories containing 1 mg HA, 30 mg DHEA-S, 30 mg DHEA-S + 0.1 mg HA, 30 mg DHEA-S + 1 mg HA, and 500 microl Witepsol-50 base (control). The effects were evaluated by measuring collagenase, gelatinase and elastase activities, water content, neutrophil infiltration, relative collagen concentration and histological assessment. The activities of collagenase, gelatinase and elastase were significantly increased in rabbits treated with DHEA-S + 1 mg HA compared with rabbits treated with DHEA-S + 0.1 mg HA (P < 0.009, P < 0.001, P < 0.009 respectively). Water content was markedly increased in rabbits treated with DHEA-S + 1 mg HA compared with DHEA-S + 0.1 mg HA treatment (P < 0.05). Neutrophil infiltration was markedly increased, while relative collagen concentration was significantly decreased with DHEA-S + 1 mg HA compared with the DHEA-S + 0.1 mg HA approach (P < 0.001, P < 0.002). The histology of cervices treated with DHEA-S + 1 mg HA showed the density of collagen to be markedly decreased, and collagen fibres irregularly separated. Increased vascularity with massive dilatation of blood vessels was also observed in these rabbits. We conclude that DHEA-S upregulates the HA-induced cervical ripening process.     

Misoprostol for cervical ripening in non-pregnant women: a randomized double-blind controlled trial of oral versus vaginal regimens

BACKGROUND: The objective was to compare the efficacy of oral versus vaginal misoprostol for cervical ripening in non-pregnant women. METHODS: Sixty non-pregnant women scheduled for diagnostic hysteroscopy were randomized by computerized randomization schedule to 400 microg of misoprostol orally (n = 30) or 200 microg vaginally (n = 30) administered 12 h prior to surgery. The diameter of the cervical canal measured with a Hegar dilator, adverse events and any complications were recorded and compared between the two groups. RESULTS: The mean pre- and post-medication cervical canal diameter and cervical diameter difference were 2.00 +/- 1.93 versus 2.37 +/- 1.83 mm (P = 0.453), 5.10 +/- 1.75 versus 5.60 +/- 1.69 mm (P = 0.265) and 3.10 +/- 1.79 versus 3.23 +/- 1.74 mm (P = 0.771) in the oral and vaginal group, respectively. Seven patients in the oral group and one patient in the vaginal group experienced diarrhoea within 24 h of administration of the misoprostol. CONCLUSION: Oral misoprostol 400 microg had similar efficacy in cervical ripening to 200 microg of vaginal misoprostol.     

Value of vaginal cervical position in estimating uterine anatomy

The anatomy of the uterus is defined with the angles of the vagina, cervix and uterine corpus. Hereunder there are angles of version and flexion. The cervical position observed during the vaginal speculum examination, may give information about the uterine anatomy. In this study, we investigated the place of the cervical position in the estimation of the uterine anatomy observed during the cervical examination. We enrolled 240 patients in our study, who applied to our routine gynecology outpatient clinic with various complaints. We divided these patients into two groups according to the cervical position (anterior cervical position and posterior cervical position) observed during the speculum examination. We recorded the uterine anatomy also with the transvaginal ultrasonography. During the speculum examination, we determined that 90% of the cases with posterior fornix position were anteverted and 10% retroverted; 64.2% of the cases with anterior fornix position were anteverted and 35.8% retroverted. According to these findings, cervical position observed during the speculum examination might be useful in the estimation of the uterine anatomy regarding the angles of the version. However, the ultrasonographic examination is essential for a definitive determination of the uterine anatomy. Clin. Anat. 30:404–408, 2017. © 2017 The Authors. Clinical Anatomy published by Wiley Periodicals, Inc. on behalf of American Association of Clinical Anatomists.     

Anatomic morphology and clinical significance of intraforaminal ligaments of the cervical spine

The cause of cervical spondylotic radiculopathy could be related to the intraforaminal ligaments (IFLs) of the cervical spine. The aim of this study is to identify and describe the IFLs and assess their clinical significance. Six intact cervical spine specimens from adult embalmed cadavers were dissected to expose the cervical nerve roots and their surrounding intraforaminal tissues fully. From the C1‐C2 to the C7‐T1 intervertebral foramina (IVF), the connective structures between each nerve root and its surrounding foraminal wall were examined under a surgical microscope. The morphology, number, and attachment points of the IFLs of each segment were documented, and the length, width, or diameter and thickness of the ligaments were measured with a vernier caliper. IFLs were observed in all 84 IVFs of the cervical spine. According to their locations, they can be divided into two categories: the first is entrance‐zone IFLs, which are radially distributed around the nerve root; the second is mid‐zone IFLs, which are thin, strip‐shaped fibrous tissues intertwined around the nerve roots, the number of ligaments being considerable but difficult to quantify. Ligament structures have been identified in the IVF of the cervical spine. Under physiological conditions, they could be protective in maintaining the position, shape, and function of nerve roots. However, under pathological conditions, the IFLs of the cervical spine could aggravate the symptoms of cervical nerve root radicular pain associated with other types of compression. Clin. Anat. 32:654–660, 2019. © 2019 Wiley Periodicals, Inc.     

慢性压迫性颈脊髓损害的超微结构观察

目的:对颈脊髓慢性压迫性损伤的超微结构进行观察研究,探讨其病理生理机制。方法:短毛豚鼠12只,8只用于模型制备,4只为正常对照。建立颈脊髓慢性压迫动物模型,分别于术后4周、8周对实验动物进行运动功能及电生理评价,并分批处死动物取样切片,以日本东芝H-600型透射电镜(每次动物4只),与正常组进行对照。结果:术后4周脊髓前角运动神经元胞体肿胀,胞浆内粗面内质网排列尚规则,核糖体仅部分脱落,部分线粒体肿胀,线粒体嵴清晰。白质前索呈原发性脱髓鞘改变,髓鞘变薄排列松散,胶质细胞水肿,部分有脱髓鞘改变,轴索结构基本正常。脊髓内毛细血管腔变细,内皮细胞肿胀。术后8周脊髓前角神经元胞体缩小或固缩,核内染色质成团块状,粗面内质网排列紊乱,线粒体广泛肿胀,嵴模糊。白质侧索髓鞘排列松散,出现原发性脱髓鞘改变,前索广泛脱髓鞘改变,部分轴索出现变性、坏死等改变。脊髓内毛细血管腔闭塞,内皮细胞凋亡变性。结论:来自前方的颈脊髓慢性压迫性损害,早期主要引起脊髓前索的原发性脱髓鞘改变。随着压迫程度的加重和时间的延长,逐渐出现脊髓内血供障碍、脊髓前角运动神经元退变、前索轴突变性等不可逆性改变。     

显微镜辅助下经颈椎前路椎间盘切除融合术治疗脊髓型颈椎病的疗效分析

目的 探讨在显微镜辅助下经颈椎前路椎间盘切除融合术(ACDF)治疗脊髓型颈椎病(CSM)的临床疗效。方法 回顾性分析2014年1月-2018年6月四川省广安市广安区人民医院骨科44例行ACDF的CSM患者的临床资料,其中男24例、女20例,年龄34~69(51.4±10.2)岁。按照手术方式不同分为:传统ACDF组20例,31个节段;显微ACDF组24例,38个节段。比较两组患者的基线资料、住院时间、手术时间、术中出血量、术后引流量,术后即刻以及随访3、6、12个月时的日本骨科学会颈椎病疗效评定标准(JOA)评分、颈椎功能障碍指数(NDI)评分、疼痛视觉模拟评分(VAS)、椎间隙高度、颈椎Cobb角、临床疗效和植骨融合情况。结果 两组患者的基线资料比较差异均无统计学意义(P值均＞0.05)。显微ACDF组和传统ACDF组手术时间分别为(91.2±8.2)、(85.1±7.8)min,出血量分别为(50.1±10.5)、(80.2±11.2)mL,引流量分别为(20.2±13.7)、(30.5±11.5)mL,差异均有统计学意义(t=-2.512、9.186、2.688, P值均＜0.05);两组患者住院时间差异无统计学意义(P＞0.05)。两组患者术后即刻及随访3、6、12个月的JOA 评分、NDI评分、VAS、椎间隙高度和颈椎Cobb角均较术前改善,差异均有统计学意义(F=60.435、419.723、21.037, P值均＜0.05),但两组间差异无统计学意义(P值均＞0.05)。术后随访12个月,传统ACDF组和显微ACDF组临床疗效评价优良以上的占比分别为95.00%(19/20)和95.83%(23/24)。末次随访两组患者植骨均融合,无明显并发症。结论 传统ACDF和在显微镜辅助下ACDF均能有效治疗CSM,但是同传统ACDF相比,显微镜辅助下ACDF的优势更明显,其手术视野清晰,术中止血彻底,术中出血量和术后引流量低。     

Intralaboratory quality assurance in cervical/vaginal cytology: Evaluation of intercytologist diagnostic reproducibility

Diagnostic reproducibility and accuracy in evaluating cervical/vaginal smears were the focus of this study concerning intralaboratory quality control. A set of 120 cytological samples was evaluated by 15 cytopathologists whose experience ranged from 3–29 yr. The study report form was based on the 1988 Bethesda System. Intercytologist reproducibility (with respect to sample adequacy, epithelial cell abnormalities, and presence of cellular changes associated with HPV, Human Papilloma virus) was evaluated using the Kappa statistic. Poor reproducibility in defining sample adequacy was observed (K = 0.24). The agreement on epithelial cell abnormality definition was good (K = 0.64); the lowest reproducibility was observed for High-grade squamous intraepithelial lesion/cervical intraepithelial neoplasia HSIL/CIN II (specific K = 0.37) and Atypical cells of undetermined significance ACUS (specific K − 0.44). The agreement in detecting cellular changes associated with HPV was fair (K = 0.49). Diagnostic accuracy for epithelial cell abnormalities, assessed by comparison with a consensus reference diagnosis, was good (K = 0.74). Diagn. Cytopathol. 16:87–92, 1997. © 1997 Wiley-Liss, Inc.