腹压和子宫重量对子宫韧带影响的有限元仿真研究

目的 应用有限元法分析不同子宫载荷(腹压和子宫重量)时子宫韧带的应力分布和变形情况,获得各韧带对子宫载荷变化的敏感度。方法 建立后位子宫及其附属韧带的三维模型并导入ABAQUS软件,设置载荷和约束,并计算子宫韧带的应力和变形。结果 腹压和子宫重量单独或同时变化会引起子宫韧带的拉伸变形,变形和应力随载荷的增加而增大,且主要分布于各韧带中下段或与子宫的连接处,最大应力和最大位移集中于各韧带与子宫或盆壁的连接处,并且子宫重量比腹压对各韧带的影响程度大。腹压单独或与子宫重量同时变化时,各韧带所受应力及对载荷变化的敏感度从大到小依次是骶、阔、主、圆韧带,子宫重量单独变化时排序从大到小依次是骶、主、圆、阔韧带,而各韧带变形及对载荷变化的敏感度排序保持不变,且从大到小依次是阔、圆、骶、主韧带。结论 通过有限元分析研究各子宫韧带对子宫载荷变化的敏感度,研究结果与临床资料相符,可为临床手术方案优化和发病机制探索提供指导。     

经阴道广泛性子宫切除术中自宫颈支持韧带的应用解剖

目的为经阴道广泛性子宫切除术提供应用解剖学基础。方法经阴道逆行解剖观测8例(16侧)常规防腐女性盆腔尸体标本。结果 (1)膀胱宫颈韧带位于膀胱、子宫颈和阴道之间,可分为宫颈部(2.10±0.85)cm、阴道部(1.70±0.61)cm;膀胱宫颈韧带长度为(4.10±1.05)cm,输尿管膝部距离子宫动脉跨越处(2.14±0.40)cm。(2)输尿管穿过子宫主韧带,距子宫颈(1.71±0.22)cm,其上方有子宫动脉和静脉。(3)子宫骶韧带的颈部、中间部、骶骨部距离输尿管的长度为(0.82±0.50)cm、(2.42±0.81)cm和(4.00±0.71)cm。结论经阴道广泛性子宫切除术中对起自宫颈的三对韧带的应用解剖了解非常重要,可避免损伤输尿管和子宫动脉等重要结构。     

经阴道广泛性子宫切除术中膀胱宫颈韧带的应用解剖

目的:为经阴道广泛性子宫切除术提供应用解剖学基础。方法:经阴道逆行解剖观测8例(16侧)常规防腐女性盆腔尸体标本。结果:(1)膀胱宫颈韧带位于膀胱、子宫颈和阴道之间,可分为宫颈部(2.07±1.06)cm、阴道部(1.75±0.58)cm;(2)膀胱宫颈韧带长度为(4.12±1.02)cm,阴道部起始端宽为(0.69±0.23)cm;(3)输尿管膝部距离阴道部起始端(2.14±0.47)cm;(4)输尿管膝部距离子宫动脉跨越处(2.16±0.36)cm。结论:经阴道广泛性子宫切除术中对膀胱宫颈韧带的解剖至关重要,可避免损伤输尿管和子宫动脉等重要结构。     

子宫变异1例报道

子宫是孕育胎儿和产生月经的中空性肌性器官,呈上宽下窄、前后略扁的倒置梨形.子宫一般位于小骨盆中央,前面紧邻膀胱,后面紧贴直肠,呈前倾前屈位.子宫有四类韧带,分别是起于子宫两侧的子宫阔韧带,连于子宫角下部的子宫圆韧带,连于子宫颈的子宫主韧带和骶子宫韧带,以上韧带均对子宫的位置具有固定作用.先天性子宫畸形是由于在胚胎发育时...     

筋膜内子宫全切除术的护理

子宫及子宫颈良性疾病是筋膜内子宫全切除术的手术指征。它兼有子宫次全切除术及子宫全切除术的两种优点:即不切断主韧带和骶韧带,防止术后阴道壁脱垂;另外,手术范围小,术后并发症少;同时切除宫颈,有效防止宫颈癌的发生;且阴道不缩短,对性生活无影响,副损伤小。我院从1998年3月至10月共收治子宫肌瘤及卵巢良性肿瘤病人行筋膜内子宫全切除术32例,未发生一例护理并发症,现将护理体会介绍如下。     

改进的筋膜内子宫切除术83例临床分析

经腹筋膜内子宫切除术(intrafascial hysterectomy)是相对于通常经腹筋膜外子宫切除而言,是指在筋膜内进行手术.传统的筋膜内子宫切除术是紧贴宫颈环切至阴道穹隆,切除子宫;而改进的筋膜内子宫切除术是于官颈外口外环切宫颈,将子宫切除.实际上就是将子宫颈在筋膜内挖出,故又称"子宫颈挖出的子宫切除术"[1].该术式手术简洁,损伤小,术后并发症少.现报道如下.     

基于有限元法研究顺产肛提肌损伤与盆底疾病的发生

目的 模拟阴道分娩及休息时骨盆韧带肌的生物力学特性，探讨阴道分娩时肛提肌损伤、盆腔器官脱垂及压力性尿失禁。方法 建立正常的骨盆-韧带-肌肉三维非线性有限元模型，计算不同腹压和载荷下肛提肌应力、应变分布及损伤情况；计算Ⅰ、Ⅱ、Ⅲ型压力性尿失禁以及盆腔脏器脱垂的应力、应变分布及损伤情况。结果腹压为1 kPa，载荷为3、5、8 kPa和腹压为1.5 kPa，载荷为3、5、8 kPa情况下，肛提肌最高等效应力分别为14、29、43、86、144、230 kPa；Ⅰ、Ⅱ、Ⅲ型压力性尿失禁以及盆腔脏器脱垂的应力为1.69、1.01、0.70、1.58 MPa。结论 阴道分娩造成肛提肌的耻骨直肠肌和耻骨尾骨肌中部受损，与盆底功能障碍肛提肌损伤部位一致。用科学方法找出盆底在阴道分娩时的精确损伤部位，为临床医生预防盆底疾病和制定产后康复训练提供参考依据。     

子宫圆韧带的形态学基础与临床应用进展

<正>子宫圆韧带是由子宫和输卵管相连的部位即子宫角发出的窄而略扁的束状带,它从子宫旁横过阔韧带由内向前外跨过髂外血管,沿盆腔侧壁经内环出腹部,与圆韧带动脉、腹股沟神经伴行穿腹股沟管终止于大阴唇,维持子宫前倾姿势。经典教材对子宫圆韧带的描述和记载并不详尽,国内外学术界对该结构及其应用进行了探索。随着腹腔镜、磁共振成像等技术的出现和发展,对子宫圆韧带系统全面的描述显得尤为重要,现就国内外相关研究文献进行综述。     

子宫的淋巴流向

观察了80例子宫的淋巴流向。实验分为两组:第一组(40例)由子宫注入普鲁士蓝氯仿溶液;第二组(40例)结扎卵巢悬韧带,然后再进行注射。在第一组,子宫底和子宫体上部的淋巴管都注入腰淋巴结;子宫颈和体下部的淋巴管多是直入髂外淋巴结、髂间淋巴结和髂内淋巴结,一部分先入宫颈旁淋巴结、闭孔淋巴结或骶淋巴结,然后再入髂淋巴结。在第二组,有25例(37侧),子宫底和体上部的淋巴管,沿子宫圆韧带走行,注入髂外淋巴结、闭孔淋巴结或腹股沟淋巴结。     

子宫骶韧带-阴道悬吊预防子宫切除术后盆底功能障碍性疾病的价值探讨

目的比较仅行腹腔镜子宫切除术患者与同时行腹腔镜子宫切除术及骶韧带-阴道悬吊术患者的术后发生盆底功能障碍(PFD)的状况,以探讨骶韧带-阴道悬吊术预防子宫切除术后PFD的价值。方法选择2017年7月至2018年2月在我院因子宫良性疾病行腹腔镜全子宫切除术的83例患者,根据有无同时行子宫骶韧带-阴道悬吊手术分为对照组41例及悬吊组42例,术后随访9~14个月,应用专科检查、妇科超声、问卷调查方法评估比较两组患者术后发生PFD的情况。结果与对照组相比,悬吊组术后发生下尿路症状(尿频、尿急、压力性尿失禁)的几率均明显下降,差异均有统计学意义(P<0.01),两组患者在术后便秘、阴道脱垂以及首次性生活时间方面的比较差异均无统计学意义(P>0.05)。结论腹腔镜全子宫切除术同时施行子宫骶韧带-阴道悬吊术可以有效减少子宫切除术后PFD尤其下尿路症状的发生。     

前韧带加强修复结合螺钉固定用于下胫腓不稳的生物力学特性分析

目的 建立踝关节骨折固定后遗留下胫腓前韧带损伤,用锚钉加强修复结合螺钉固定的有限元模型,比较其受力及变形情况.方法 选取1例正常男性青年志愿者踝关节CT图像,建立踝关节骨折固定后遗留下胫腓前联合损伤有限元模型,对损伤模型置入锚钉固定为实验组,使用螺钉固定为对照组.通过有限元分析计算,观察两组模型在各种载荷工况下的最大应...     

Uterine first pass effect in postmenopausal women

BACKGROUND: Vaginally administered drugs distribute preferentially to the uterus; counter-current transfer from the vaginal veins to the uterine artery probably plays a pivotal role. In each side, the ovarian and uterine arteries form arterial anastomoses and controversy exists regarding the origin of the arterial supply to the Fallopian tube and tubal part of the uterus, and consequently whether these tissues can be reached through vaginal administration. METHODS: A thermocatheter with four measurement points, each separated by 5 mm, was inserted under endoscopic control into the tubal corner of uterus in 10 conscious, menopausal women and the temperatures registered every 2 s. The vagina was then flushed for 15 min with 1.5 l of saline at room temperature, after which the probe position was re-assessed by the endoscope. RESULTS: The lowest measurement point (15 mm from the tip) cooled significantly more than the other points (P < 0.0001). At 15 min, mean temperature reduction at point 4 was significantly greater than at all other measurement points (P < 0.05) due to local transfer of cold from vaginal vein blood to the uterine arterial blood (but not the ovarian artery). CONCLUSIONS: The results support the theory that, at least in postmenopausal women, the uterine artery supplies most of the uterus while the corneal part of cavity (up to 5-10 mm from the ostium) receives the blood supply from the ovarian artery. This finding represents a rationale for vaginal administration of drugs when a local effect on the uterus (e.g. progestational or relaxation) in postmenopausal women is requested.     

Blood velocities in the uterine artery in humans during labour

Blood velocities in the uterine arteries were measured during labour in humans, by means of the pulsed ultrasound Doppler velocity meter (UNIDOP). The uterine arteries were approached through the abdominal wall at the lateral border of the uterus and through the lateral vaginal fornix. At a depth of 0.5-1.5 cm from the lateral vaginal fornix there were three different arteries in each woman. One of these arteries had similar velocity spectra to the uterine artery as measured through the abdominal wall higher up along the uterus, and the velocities were in the same range. The mean velocities were high and the velocities in diastole were high compared to those in systole. During uterine contractions the velocities were reduced during diastole, reducing mean velocities by 20-40% as measured through the vagina and by 50-60% when measured higher up through the abdominal wall. A second artery, which we believe is a branch of the uterine artery traversing the myometrium, had lower mean velocities and a greater difference between systole and diastole. During contractions the velocities were reduced by 100%. A third artery, which we believe is the descending branch of the uterine artery, supplying the cervix and vagina, had the lowest mean velocities, with backflow during diastole. During contractions the velocities increased 100-140%.     

Variations with age and serum cholesterol level in the topographic distribution of macroscopic aortic atherosclerotic lesions as assessed by image analysis methods

The topographic distribution of macroscopic atherosclerotic lesions in the aorta was studied by image analysis of aortas taken at autopsy from 155 males aged 10 to 54 yr. In both the thoracic and abdominal aorta, fatty streaks (FS) appear before raised lesions (RL) affecting preferential areas located longitudinally along the intercostal ostia, at the aorta bifurcation, and surrounding the points of origin of branches of the abdominal aorta. Later RL appear in the same areas of the aortic intima affected by FS at younger ages. As for the effect of serum total cholesterol (TC) in the progression of atherosclerosis, the prevalent involvement areas by FS and RL were similarly distributed as indicated by our analyses. However, areas showing frequent occurrence of FS and RL in each aortic segment were distributed more extensively at identical areas in the higher serum TC groups than in the lower TC level group. Thus, it can be concluded that FS are the precursor lesions of RL in the aorta and that the serum TC promotes the progression of atherosclerosis.     

Resistance training prevents liver fat accumulation in ovariectomized rats

BACKGROUND: Menopause is associated with increased lipid deposition in the liver and fat accumulation in the abdomen. OBJECTIVE: The purpose of the present study was to determine the effects of adding a resistance training program (RT) to a restrictive diet (RD) on liver lipid accumulation and abdominal fat depots in ovariectomized (Ovx) rats. METHODS: One group of sham-operated and three groups of Ovx rats were compared. Five weeks after surgery, Ovx rats were either submitted to an approximately 25% RD with or without RT for 3 or 8 weeks, while a third group of Ovx rats were fed ad libitum and remained sedentary. The RT program consisted of climbing a 6m vertical metal grill five times a week with an increasing load up to 75% of body weight attached to the tail. The number of repetitions increased from two to four sets of 10 repetitions. RESULTS: Ovariectomy resulted in significantly higher (P<0.01) body weight, energy intake, intra-abdominal fat depots, plasma leptin levels (P<0.05), and liver triacylglycerol concentrations. All of these responses were (P<0.01) reduced in Ovx rats following the RD with the exception of liver lipid infiltration. The addition of RT to the RD treatment synergistically reduced abdominal fat deposition and plasma-free fatty acid levels. Moreover, liver lipid infiltration was completely prevented by the addition of the RT program. Muscle mass relative to body weight was significantly increased in Ovx-RD-RT compared to all other groups. CONCLUSION: It is concluded that RT is an asset to minimize the deleterious effects of ovarian hormone withdrawal on liver lipid accumulation and abdominal fat accumulation in Ovx rats.     

Phytoestrogens and carcinogenesis-differential effects of genistein in experimental models of normal and malignant rat endometrium

The phytoestrogen genistein was studied in normal and malignant experimental uterine models in vivo. The action of genistein on the uterus and vagina of ovariectomized DA/Han rats after 3 day oral administration (25, 50 or 100 mg/kg/BW/d) was compared to ethinyl oestradiol (0.1 mg/kg/BW/d). Effects on uterine and vaginal morphology, uterine growth and uterine gene expression were studied. A dose dependent increase of the uterine wet weight and the uterine and vaginal epithelial height, a dose dependent up-regulation of complement C3, down-regulation of clusterin mRNA expression and a stimulation of the vaginal cornification was observed after administration of genistein. Uterine gene expression and vaginal epithelium respond to genistein at doses where no significant effects on uterine wet weight were detectable. In general the vagina was more sensitive to genistein than the uterus. To analyse the action of genistein in malignant uterine tissue, the impact of a 28 d treatment with 50 mg/kg/d of genistein on the in-vivo tumour growth of RUCA I endometrial adenocarcinoma cells, following subcutaneous inoculation into syngeneic DA/Han rats, was assessed. In contrast to ethinyl oestradiol (0.1 mg/kg/BW/d), a dose of 50 mg/kg/BW/d of genistein did not affect tumour growth. Nevertheless C3 and TRPM2 mRNA expression in the tumour were both significantly stimulated by ethinyl oestradiol and genistein. In comparison to ovariectomized animals genistein up-regulated uterine wet weight and uterine dependent gene expression in tumour bearing animals. In conclusion, four independent uterine and vaginal parameters indicate genistein is a weak oestrogen receptor agonist in the uterus and vagina of female DA/Han rats, and evidence is provided for a selective oestrogen receptor modulator (SERM)-like action of genistein in normal and malignant uterine tissue.     

Resetting the baroreflex during snoring: Role of resistive loading and intra-thoracic pressure

Baroreflex sensitivity (BRS) is reduced during snoring in humans and animal models. We utilised our rabbit model to examine the contribution of increased upper airway resistance to baroreflex resetting during snoring, by comparing BRS and baroreflex operating point (OP) values during IS to those obtained during tracheostomised breathing through an external resistive load (RL) titrated to match IS levels of peak inspiratory pleural pressure (Ppl). During both IS and RL, BRS decreased by 45% and 49%. There was a linear relationship between the change in Ppl and the decrease in BRS, which was similar for IS and RL. During both RL and IS, there was a shift in OP driven by ～16% increase in HR and no change in arterial pressure. Snoring related depression of BRS is likely mediated via a HR driven change in OP, which itself may be the outcome of negative intra-thoracic pressure mediated effects on right atrial wall stretch reflex control of heart rate.     

胃裸区的冠状断层解剖学研究

目的：为给胃底部和食管腹段疾病的现代影像学诊断和外科治疗提供实用的形态学依据。方法：用成人躯干部连续冠状断层标本30例,研究了胃裸区在连续冠状断层上的典型表现及胃裸区内的结构。结果：（1）胃膈韧带右层与小网膜的后层相续,左层与膈脾韧带右层及胃脾韧带后层相续,向下左、右层靠拢而续为胃胰襞左部。在冠状断层上寻找胃裸区的最佳层面在A11（下腔静脉前份层面（和A12（下腔静脉中份层）。（2）胃裸区居胃膈韧带的左、右层之间,其存在率为100％。胃裸区内除有迷走神经后干,血管、淋巴结外,左肾上腺、左肾上极及胰体上份亦可进入其内。结论：（1）胃为腹膜间位器官。（2）国膈韧带很短且两层间的距离较宽,加上胃裸区较大,胃底后壁的活动度较小,在施行胃底和食管腹段手术构解胃底后壁时,对胃裸区内的结构应给与足够的重视。