太宁栓加痔血胶囊治疗内痔出血96例临床观察

目的:观察太宁栓加痔血胶囊治疗Ⅰ、Ⅱ期内痔出血的临床效果。方法:将278例Ⅰ、Ⅱ期内痔出血的患者随机分为治疗组和对照Ⅰ组、对照Ⅱ组。治疗组96例,对照Ⅰ组90例,对照Ⅱ组92例,其中治疗组用太宁栓塞肛,每次1粒,每日2次,口服痔血胶囊每次2粒,每天3次;对照Ⅰ组用太宁栓塞肛,每次1粒,每日2次;对照Ⅱ组口服痔血胶囊每次2粒,每天3次;每组均以7 d为1疗程,疗程结束后判定疗效。结果:治疗组和对照Ⅰ组、对照Ⅱ组的便血症状治愈显效率均有显著性差异(P<0.01)。结论:外用太宁栓加口服痔血胶囊联合治疗Ⅰ、Ⅱ期内痔出血有显著的临床效果,明显优于单用太宁栓或痔血胶囊。     

微波子宫内膜去除术前刮宫内膜预处理的临床及实验研究

目的探讨刮宫子宫内膜预处理在微波子宫内膜去除术(microwave endometrial ablation,MEA)中的应用价值。方法2001年6月～2005年6月对126例子宫异常出血行MEA之前刮宫预处理子宫内膜。同期12例因异常子宫出血行子宫切除术,先刮宫处理子宫内膜后行MEA,再切除子宫,取材进行组织病理学和酶组织化学检测子宫壁组织热损伤深度。结果126例术中无并发症发生,术后闭经78例(61.9%),正常月经46例(36.5%),少量不规则阴道出血2例(1.6%),治疗满意率98.4%(126/128)。术后10例子宫内膜炎,2例宫腔积血,2例术后因痛经行子宫切除术。126例术后随访6～28个月,(22±4)月,其中116例随访到术后2年以上,疗效稳定。MEA作用后子宫底的损伤深度为4.2～4.9mm,前壁的损伤深度为4.1～5.7mm,后壁的损伤深度为4.7～6.6mm,宫角的损伤深度为4.0～4.7mm。结论MEA术前全面刮宫预处理内膜,可以充分完整破坏子宫内膜全层,临床疗效好、满意率高,不增加组织过度损伤的危险。     

肾移植术后异常子宫出血的手术治疗

目的探讨肾移植术后异常子宫出血(abnormal uterine bleeding,AUB)的原因及手术治疗效果。方法收集2003年11月至2010年3月在中山大学附属第一医院因肾移植术后AUB接受手术治疗的6例患者资料,进行回顾性分析。所有患者均签署知情同意书,符合医学伦理学规定。6例患者AUB发生在肾移植术后6个月至12年,临床表现以月经量增多、经期延长为主。6例患者的临床诊断分别为子宫肌瘤2例,子宫腺肌病2例,子宫肌瘤合并子宫内膜增殖症1例,子宫内膜息肉合并子宫内膜增殖症1例。3例行子宫切除术,2例行子宫内膜诊断性刮宫(诊刮)术,1例行腹式子宫肌瘤剔除术。结果所有患者手术顺利,AUB得到控制,贫血改善。手术操作对移植肾未造成不良反应,未发生术后并发症。随访至投稿日,复查血红蛋白及肾功能正常。结论肾移植术后AUB发生原因复杂,合并子宫器质性病变为常见原因之一。对于药物保守治疗效果不佳或合并子宫器质性病变者应尽早手术治疗,手术治疗安全有效。     

甲氨蝶呤、明胶海绵动脉化疗栓塞治疗宫颈妊娠

目的探讨甲氨蝶呤(MTX)、明胶海绵子宫动脉化疗栓塞治疗宫颈妊娠的临床效果。方法 11例宫颈妊娠,4例刮宫后大出血急诊栓塞,7例刮宫前预防性化疗栓塞,选择性子宫动脉插管,用MTX灌注化疗并用医用明胶海绵颗粒及条块栓塞。所有患者术后联合刮宫术,复查血β-hCG及宫颈B超。结果 4例大出血立即停止,所有患者术后5~10 d行刮宫术,出血60~100 ml。术后1个月血β-hCG均降至正常范围,B超提示宫颈恢复正常大小,于45~60天月经复潮。未出现严重并发症。结论 MTX、明胶海绵子宫动脉化疗栓塞既能终止妊娠,又能防治大出血,是治疗宫颈妊娠一种安全有效的方法。     

剖宫产术后瘢痕妊娠17例临床分析

目的探讨剖宫产术后瘢痕妊娠（CSP）的临床特点及治疗方法。方法对我院2007年1月～2010年8月收治的17例剖宫产术后瘢痕妊娠患者的临床数据进行回顾性分析。结果 17例患者中12例停经后有不规则阴道流血,6例患者人工流产术中大出血,3例人工流产术后阴道淋漓出血,6例术前明确诊断,均通过彩超诊断瘢痕妊娠,14例予子宫动脉栓塞术联合刮宫术均治疗成功,1例予药流后行清宫术,2例吸宫术发生大出血致休克直接行子宫切除术。结论子宫动脉栓塞术联合刮宫术是治疗剖宫产术后瘢痕妊娠最快捷、最有效的方法。     

子宫动脉化疗灌注栓塞及刮宫术联合治疗宫颈妊娠

目的评价经子宫动脉化疗灌注、动脉栓塞、刮宫术联合治疗宫颈妊娠的疗效。方法24例宫颈妊娠患者，7例因发生大出血仅行子宫动脉栓塞和刮宫术，余17例行超选择性子宫动脉插管后灌注甲氨蝶呤（MTX）、明胶海绵颗粒栓塞后联合刮宫术进行治疗，所有患者术后均观察β-HCG值变化。结果24例患者双侧子宫动脉插管及栓塞成功率均为100％。17例行灌注化疗和栓塞术后刮宫及7例栓塞前刮宫大出血急诊行动脉栓塞患者，刮宫中胚胎组织易于剥离，出血仅为5-10ml。术后1周复查β-HCG下降，术后无严重并发症发生。结论子宫动脉药物灌注、动脉栓塞联合刮宫术治疗宫颈妊娠是一种微创、简便、安全有效的方法。     

云南白药胶囊在肛肠病术后的应用

我们采用云南白药胶囊口服预防肛肠病术后创口出血及促进创口愈合，取得满意疗效，现报告如下。临床资料：本组男45例，女33例；年龄15～75岁；病程1～30年。痔术后30例，肛裂术后19例，肛周脓肿术后15例，肛瘘术后11例，直肠息肉术后3例。方法及疗效：患者于肛肠病术后立即用温开水送服1粒云南白药胶囊中的保险子及2粒云南白药胶囊，以后每日口服3次云南白药胶囊，每次2粒。     

160例流产及刮宫术后宫腔粘连原因分析

目的总结流产及刮宫术后宫腔粘连的原因、治疗方法和预防措施。方法对160例流产及刮宫术后宫腔粘连的资料进行回顾性分析。结果治疗后,有97例(60.5%)患者下腹疼痛消失,9例并发了子宫内膜异位症,6例并发子宫腺肌病,2例行子宫切除手术。随访3个月后,157例(96.9%)患者恢复了月经周期,2例经半年综合性治疗后月经复潮但经量很少,1例治疗1年之后顺产一婴。结论刮宫术后宫腔粘连与手术操作有直接关系,扩宫时不用暴力、不要跳号、动作轻巧、不带负压进出宫口、尽量减少进出次数。负压吸引时负压控制在53.0kPa以内,术后抗感染治疗     

五酯软胶囊在肾移植术后应用的临床研究（附60例报告）

目的探讨五酯软胶囊治疗肾移植术后因服用环孢素（CsA）致肝损害患者的效果及对CsA血药谷浓度的影响。方法将60例采用环孢素（CsA）＋麦考酚吗乙酯（MMF）＋泼尼松三联免疫抑制方案治疗3个月以上出现肝损害的肾移植术受者作为研究对象,加服五酯软胶囊（每粒0．5g含五味子甲素6mg）,每次0．5g、每日3次（A剂量）,用药15d后,调整五酯软胶囊用量为每次0．5g、每日2次（B剂量）,用药15d后再调整五酯软胶囊用量为每次0．5g、每日1次（C剂量）,再应用15d,停服五酯软胶囊5d。加服五酯软胶囊前1d,加服A剂量3d、5d、7d、10d、15d,加服B剂量15d,加服C剂量后15d和停服5d分别测定CsA血药谷浓度。同时监测60例肝损害患者的肝功能、肾功能、空腹血糖和24h尿量。结果与加服五酯软胶囊前比较,加服3d、5d、7d、10d、15d后,CsA血药谷浓度均明显升高（均为P〈0．01）。减量（加服B剂量与C剂量）及停服5d后,CsA血药谷浓度明显下降（均为P〈0．01）。与加服五酯软胶囊前比较,60例肾移植患者在加服五酯软胶囊后肝功能明显改善,而肾功能、空腹血糖无明显变化。结论。肾移植术后肝损害患者应用五酯软胶囊治疗,具有良好的护肝效果,且能明显提高CsA血药谷浓度,可相应减少CsA的服用剂量。     

子宫动脉化疗栓塞术联合刮宫术治疗剖宫产瘢痕妊娠的临床疗效

目的探讨子宫动脉化疗栓塞术联合刮宫术治疗剖宫产瘢痕妊娠(CSP)的可行性和安全性。方法将82例CSP患者分为2组:A组39例,行氨甲蝶呤+刮宫术;B组43例,行子宫动脉化疗栓塞术+刮宫术。比较2组刮宫术成功率、术中出血量、β-HCG下降至正常的时间、住院时间及术后6个月性激素水平和月经周期恢复时间等。结果 A组中4例因无法控制的急性阴道出血而终止刮宫术,对其中2例行子宫切除手术,2例行子宫动脉栓塞术止血。B组无子宫切除患者。刮宫术成功率、术中出血量、β-HCG下降至正常的时间、住院时间在两组间差异均有统计学意义(P均0.05),但术后6个月性激素水平和月经周期恢复时间组间差异无统计学意义(P均0.05)。结论子宫动脉化疗栓塞术联合刮宫术治疗CSP安全、有效,可明显降低子宫切除风险。     

High rate of endometrial hyperplasia in renal transplanted women

A high rate of endometrial hyperplasia, an estrogen-dependent premalignant lesion of the endometrium, has been observed among female kidney allograft recipients. The aim of the study was to evaluate the incidence of endometrial abnormalities among renal transplanted women with abnormal uterine bleedings. MATERIAL AND METHODS: A retrospective analysis compared 45 renal transplanted women who underwent dilatation and curettage for abnormal uterine bleeding between January 1999 and September 2004 with 90 consecutive, nontransplanted, control patients who underwent dilatation and curettage for the same reason in 2004. RESULTS: Thirty-one cases (69%) of endometrial hyperplasia and one case (2%) of endometrial cancer were detected among the renal allograft recipients. The majority of transplant patients (28 cases, 62%) developed endometrial hyperplasia without atypia successfully treated with progestagens. There were 29 cases (32%) of hyperplasia without atypia, 2 cases (1%) of atypical hyperplasia, and 4 cases (4%) of endometrial cancer in the control group. CONCLUSIONS: Renal transplanted women seem to have an extremely high risk of endometrial hyperplasia. The majority of cases may be successfully treated with progestagens. Immunocompromised renal graft recipients, however, show other risk factors for carcinogenesis. Thus, frequent clinical surveillance should be recommended in this group of patients, also because there is conflicting evidence with regard to the risk of progression to carcinoma among untreated patients.     

Operative treatment of endometrial hyperplasia in kidney graft recipients: report of seven cases

OBJECTIVES: The high rate of abnormal uterine bleeding associated with endometrial hyperplasia has been observed in women after kidney transplantation. The great majority of these premalignant lesions regress after conservative treatment, mostly with progestagens. There are cases, however, of persistent or recurrent hyperplasia requiring operative treatment. MATERIALS AND METHODS: We report seven cases of endometrial hyperplasia in kidney graft recipients treated with hysterectomy after failure of conservative treatment. The presence of typical risk factors of endometrial hyperplasia and cancer were analyzed as well as their clinical courses and treatment methods. RESULTS: The age of the patients ranged from 35 to 50 years (mean, 42.7). Among typical risk factors, we observed obesity, diabetes, arterial hypertension, and nulliparity in the study group. All patients reported abnormal uterine bleeding and developed anemia. Women underwent two to four dilatation and curettage procedures. Progestagens (medroxyprogesterone or lynesterol) were administered for 3 to 9 months. The initial treatment was ineffective in two cases; in the remaining five cases endometrial hyperplasia recurred within 3 to 12 months. Pathologic findings after hysterectomy in all patients confirmed non-atypical endometrial hyperplasia. CONCLUSION: Hysterectomy is the treatment of last resort for premalignant endometrial lesions. It should be considered in all cases of recurrent or persistent endometrial hyperplasia. It may protect immunocompromised kidney graft recipients from heavy bleeding, severe anemia, and most of all, the of endometrial cancer development.     

Dysfunctional uterine bleeding

Dysfunctional uterine bleeding is defined as abnormal uterine bleeding in the absence of organic disease. It is the result of anovulation or the abnormal local production of prostaglandins, and in each case the primary fault is inappropriate hormone formation. There are two approaches to diagnosis. The traditional one is primarily concerned with the exclusion of cancer of the endometrium; this concern results in the frequent resort to uterine curettage. The second approach is to limit curettage to patients whose symptoms are not ameliorated by medical therapy. The aim of medical treatment is either to produce secretory change in the endometrium or to decrease the formation of uterine prostaglandins. Intermittent progesterone treatment is used to cause secretory changes in the endometrium. Decreased production of the prostaglandins is achieved indirectly by causing atrophy of the endometrium or directly through the use of prostaglandin synthetase inhibitors. Surgery in the form of dilatation and curettage has no long-term therapeutic effect; hysterectomy is definitive therapy.     

血管内介入治疗子宫特殊部位妊娠

目的探讨血管内介入治疗在子宫特殊部位异位妊娠治疗中的临床意义。方法对22例子宫特殊部位妊娠患者行双侧子宫动脉灌注氨甲蝶呤加栓塞术治疗,其中宫颈妊娠6例、子宫切口妊娠15例、宫角妊娠1例,分析其临床疗效。结果 20例经子宫动脉栓塞术后血β-HCG水平呈进行性显著下降,2～3周均降至正常。6例因仍有少量阴道出血及妊娠物残留,于术后5～19天行清宫术,无子宫破裂和大出血发生,随访2个月后月经周期均恢复正常。结论血管内介入治疗子宫特殊部位异位妊娠微创、安全有效、并发症少,可保留患者子宫及生育功能。     

Hydrothermal Endometrial Ablation Can Reduce the Need for Hysterectomy and Transfusion

Women seeking emergency care for severe uterine hemorrhage with profound anemia often undergo transfusion dilatation curettage and ultimately hysterectomy. The purpose of this article is to describe a modern conservative approach to treating persistent uterine hemorrhage unresponsive to medical therapy, avoiding transfusion and allowing for nonemergent future therapy without the potential complications of transfusion. Six patients with unremitting uterine bleeding were included in the study performed in the Department of Gynecology at an academically affiliated general hospital. Patients underwent successful hydrothermal endometrial ablation after failed medical therapy. This procedure is effective in controlling severe uterine bleeding in patients with large intrauterine fibroids; thus, the number of women being transfused can be significantly reduced.     

Recurrent postmenopausal bleeding

Thirty-four patients with recurrent postmenopausal bleeding are reviewed. All had previously undergone dilatation and curettage after a first episode of postmenopausal bleeding, and no pathological cause had been found. When they presented with recurrence of bleeding, 32 of the 34 patients underwent total abdominal hysterectomy and bilateral salpingo-o?phorectomy and the excised organs were submitted for histological examination. In 2 patients clinical cervical carcinoma was found and they received radiotherapy. Hysterectomy was warranted in 5 patients with endometrial glandular hyperplasia and in 2 with uterine fibroids. Fibroids which distort the uterine cavity can result in an inadequate curettage. In 2 patients, failure to take adequate endocervical cytology smears resulted in a pre-operative diagnosis of endocervical carcinoma being missed. In recurrent postmenopausal bleeding, the taking of an adequate cervical smear and repear dilation and curettage are indicated as initial procedures. In obese patients, in whom palpable ovarian tumours may be overlooked, and in those with distortion of the endometrial cavity due to fibroids, total abdominal hysterectomy with bilateral salpingo-o?phorectomy is preferable, because underlying genital cancer can be missed in these cases.     

预防性子宫动脉栓塞对减少清宫术治疗瘢痕妊娠术中出血的效果及其影响因素

目的观察预防性子宫动脉栓塞(UAE)对减少清宫术治疗瘢痕妊娠(CSP)术中出血的效果,并探讨其影响因素。方法回顾性分析841例接受预防性UAE+清宫术的CSP患者,评估清宫术中出血量,将出血量≥200 ml判定为预防出血效果不佳,分析其影响因素,并统计术后60天内并发症发生情况。结果841例中,53例预防出血效果不佳,产次、栓塞剂直径(>1000μm)、多支血管供血及未完全栓塞是其独立危险因素(P均<0.05)。UAE术后60天内主要并发症包括腹部疼痛(599/841,71.22%)、低热(399/841,47.44%)、恶心呕吐(329/841,39.12%)及臀部疼痛(306/841,36.39%)。结论清宫术治疗CSP前预防性UAE可安全有效地减少术中出血,产次、栓塞剂直径、多支血管供血及栓塞不完全均为其影响因素。     

肝肾联合移植13例临床分析

目的 探讨肝肾联合移植的适应证、手术并发症及生存情况.方法 回顾性分析2003年10月至2008年12月施行的13例肝肾联合移植患者的临床资料,分析围手术期死亡率、并发症情况及生存情况.结果 13例肝肾联合移植患者围手术期死亡率30.8%(4/13).术中、术后腹腔出血4例(30.8%);肺部感染7例(53.8%);移植肾急性排斥反应1例(7.7%).本组随访4.4～60个月,中位数40个月.存活1年以上8例,2年以上6例,3年以上5例,4年以上3例,5年以上1例.肝肾联合移植前有1例患者经历肝移植(例2)和2例患者经历肾移植(例3、例4),例4患者于肝肾联合移植术后第29天死于肺部感染、多器官功能衰竭,例2和例3肝肾联合移植术后分别存活40 m、48 m.结论 肝肾联合移植是治疗终未期肝肾疾病的有效方法.肝/肾移植术后再行肝肾联合移植是可行的.

Abstract：

Objective To investigate the indications, complications and survival results of combined liver-kidney transplantation. Methods From Oct 2003 to Dec 2008, the clinical data of 13 patients who underwent combined liver-kidney transplantation (CLKTs) were retrosptiverly analyzed in our institution. The perioperative mortality rate, complications and the result of follow-up were analyzed.Results The perioperative mortality rate (within 30 days) was 30.8% (4/13). Postoperative complications included intrabdominal bleeding in 4 patients ( 30. 8% ); pulmonary infection in 7 patients (53.8%); acute renal rejection in one (7. 7% ). Survivors were followed up from 4.4 to 60 months, with the median time of 40 months. Eight patients have survived more than 1 year; six patients have survived more than 2 years; five of them have survived for more than 3 years; and three of them have survived for more than 4 years, with one surviving for more than 5 years. One patient had undergone liver transplantation ( case 2 ) and two patients had had kidney transplantations ( case 3 and case 4 ) before this CLKTs.Postoperatively case 4 died of pulmonary infection and multiple organ failure at day 29, while case 2 and case 4 survived respectively 40 m, 48 m after CLKTs. Conclusions CLKTs is an effective therapy for end-stage liver and kidney disease. CLKTs for patients with irreversible liver and renal insufficiency after initial liver transplantation or kidney transplantation was feasible.