剖宫产后2年内宫内足月妊娠时子宫前壁下段的超声表现

目的探讨剖宫产后2年内宫内足月妊娠时子宫前壁下段的超声表现。方法回顾性分析102例剖宫产术后2年内再次妊娠女性孕晚期的子宫前壁下段超声表现,并分析再次剖宫产患者术中切开瘢痕情况,探讨两者的相关性。结果超声各观察指标：子宫前壁下段厚度≥3 mm、子宫前壁下段各层结构分界清晰、子宫前壁下段肌层回声连续、肌层最薄处的厚度≥2 mm及子宫前壁下段出现点状血流评价瘢痕愈合良好灵敏度分别为89.1%、83.6%、75.6%、67.5%和94.5%,其中子宫前壁下段肌层最薄处厚度≥2 mm的特异度最高,达80.0%。结论超声能较准确地反映瘢痕情况,可为剖宫产术后2年内再次宫内足月妊娠女性分娩方式选择提供重要依据。     

Sonographic evaluation of the lower uterine segment in patients with previous cesarean delivery.

OBJECTIVE: To evaluate the appearance of the lower uterine segment (LUS) in pregnant women with previous cesarean delivery and to compare the LUS thickness with that in women with unscarred uteri. METHODS: In a prospective study, sonographic examination was performed on 53 pregnant women with previous cesarean delivery (cesarean group), 40 nulliparas (nullip-control), and 40 women who had 1 or more childbirths with unscarred uteri (multip-control) between 36 and 38 weeks' gestation to assess the appearance and compare the thickness of the LUS. In the cesarean group, the sonographic findings were correlated with the delivery outcome and the intraoperative LUS appearance. RESULTS: In the cesarean group, 44 patients (83.0%) had a normal-appearing LUS indistinguishable from that of control groups; 2 patients (3.8%) had an LUS defect suggestive of dehiscence; and 7 patients (13.2%) had thickened areas of increased echogenicity with or without myometrial thinning. Although the cesarean group had a thinner LUS (1.9 +/- 1.4 mm) when compared with both the nullip-control group (2.3 +/- 1.1 mm; P > .05) and the multip-control group (3.4 +/- 2.2 mm; P < .001), only the latter difference achieved statistical significance. One of the 2 patients who had a sonographically suspected LUS defect had confirmed uterine dehiscence during surgery. An intraoperatively diagnosed paper-thin LUS, when compared with an LUS of normal thickness, had significantly smaller sonographic LUS measurements (1.1 +/- 0.6 versus 2.0 +/- 0.8 mm, respectively; P = .004). CONCLUSIONS: Prior cesarean delivery is associated with a sonographically thinner LUS when compared with those with prior vaginal delivery. Prenatal sonographic examination is potentially capable of diagnosing a uterine defect and determining the degree of LUS thinning in patients with previous cesarean delivery.     

超声下不同部位下肢静脉血栓与肺栓塞发生的关联性分析

目的：通过下肢静脉超声检查结果来分析不同部位下肢静脉血栓与肺栓塞之间的关系,为肺栓塞患者的病情评估以及治疗方案提供帮助。方法：回顾性分析2018年1月初至2019年12月底上海交通大学附属胸科医院心内科收治的312例患者,所有患者均行CT肺动脉造影及下肢静脉超声检查,按照检查结果分为肺栓塞组和非肺栓塞组,根据超声检查结果以及病史资料的差别作单因素和多因素相关性分析。结果：两组患者的性别构成比、年龄、肺癌合并情况、下肢静脉血栓发生率及发生部位均存在显著差异（P＜0.05）。肺栓塞组肌间静脉、股静脉、腘静脉、胫后静脉和腓静脉血栓发生率均显著高于非肺栓塞组（P＜0.05）。多因素Logistic回归分析结果表明,存在下肢静脉血栓与肺栓塞的发生存在显著关联（OR= 8.344,95%CI: 4.867- 14.304）,其中存在肌间静脉血栓（OR=2.996,95%CI: 1.630-5.509）、腘静脉血栓（OR=5.536,95%CI: 1.646-18.623）、胫后静脉血栓（OR=6.685,95%CI: 1.789-24.990）均与更高的肺栓塞发生率显著相关。结论：下肢静脉血栓患者的肺栓塞风险显著增加,存在肌间静脉血栓、腘静脉血栓、胫后静脉血栓均为肺栓塞的独立危险因素。     

宫缩抑制剂用于胎膜早破性早产

目的：了解产前运用宫缩抑制荆对胎膜早破早产新生儿结局的影响。方法：回顾性分析118例小于35孕周胎膜早破性早产（PPROM）的临床资料。结果：33～34“周孕龄组新生儿1 min Apgar评分〈7分的发生率、缺血缺氧性脑病（HIE）发生率及新生儿呼吸窘迫综合症（NRDS）发生率明显低于对照组。两组间比较有显著差异（P〈O．05）。28-32“周孕龄组新生儿的各项指标在治疗组与对照组间比较无显著差异（P〉0．05）。结论：33-34“周胎膜早破性早产孕妇产前用宫缩抑制剂能显著改善新生儿结局。对〈33孕周的胎膜旱玻性早产，宫缩抑制荆的治疗效果还有待进一步探讨。     

未足月胎膜早破早期宫内感染预测指标的研究

目的探讨母血C反应蛋白(CRP)、羊水白细胞介素-6(IL-6)及葡萄糖含量三项指标预测未足月胎膜早破早期宫内感染的价值。方法收集未足月胎膜早破孕妇的羊水,测定IL-6、葡萄糖含量及沙眼衣原体IgM抗体、巨细胞病毒IgM抗体、解脲支原体,并作细胞培养。采集母血测定CRP。结果①IL-6预测早期宫内感染的敏感性最高;②三指标的参考值为CRP≥0.1g/L,IL-6≥6.0×10     

孕中晚期超声胎膜厚度联合血清IL-6、C反应蛋白预测早产发生的临床价值

目的  探讨孕中晚期超声胎膜厚度检测联合血清白介素-6(IL-6)、C反应蛋白(CRP)预测早产发生的临床价值。方法  收集2019年1月1日~2020年12月31日于我院建档进行产检和分娩的599例孕妇作为研究对象,根据分娩时间将孕妇分为早产组(n=86)和足月组(n=513),分析两组孕妇孕中、晚期血清IL-6、CRP及超声胎膜厚度,采用ROC曲线分析上述3项指标对孕妇早产的预测价值,并比较两组孕妇通过各指标诊断的阳性率。结果  在孕23~25周和孕32~34周,早产组孕妇血清IL-6、CRP水平高于足月组(P < 0.05),胎膜厚度低于足月组(P < 0.05);ROC曲线分析结果显示,超声胎膜厚度联合血清IL-6、CRP预测早产的ROC曲线下面积高于3项指标单独预测的ROC曲线下面积(P < 0.05);且联合预测的准确度、敏感度和特异性均较高。早产组孕妇血清IL-6、CRP和胎膜厚度单项诊断和联合诊断早产的阳性率均高于足月组(P < 0.05)。结论  与足月生产孕妇比较,早产孕妇中晚期的血清IL-6、CRP水平明显更高,胎膜厚度更高,联合检测血清IL-6、CRP和胎膜厚度对于预测孕妇早产具有较高的应用价值。     

Premature preterm rupture of the membrane diagnosis in early pregnancy: PAMG-1 and IGFBP-1 detection in amniotic fluid with biochemical tests

Objectives

Previable premature rupture of the membranes (pPROM), occurring before 24 WG, is associated with a 25% neonatal survival rate. This terrible prognosis may lead to elective pregnancy termination on parents' request. Therefore, certain diagnosis is essential but remains difficult in about 10% of patients. Bed-side biochemical tests developed to help in diagnosis had never been evaluated in early pregnancies. This study aimed to evaluate and compare the in vitro sensitivity, detection limit, reaction time and consistency of AmniSure detecting placental alpha microglobulin-1 (PAMG-1) and actim PROM detecting Insulin Growth Factor Binding Protein-1 (IGFBP-1) in amniotic fluid between 15 and 20 weeks of gestation (WG).

Design and methods

Samples of amniotic fluid were collected by amniocentesis performed between 15 and 20 completed WG in 55 patients. Dilution series were prepared and both tests were performed twice at each dilution. In vitro sensitivity, detection limit, and reaction time were evaluated and compared in serial dilution.

Results

A total of 460 AmniSure and 476 actim PROM tests were performed. Both tests' in vitro sensitivity was 100% at dilution 1:20 and remained up to 90% until dilution 1:80. In vitro sensitivities were not different at any dilution. Detection limit and consistency were similar for both tests at all dilution. Actim PROM reaction time was shorter than AmniSure at all dilutions, except 1:320 (p < 0.05).

Conclusions

PAMG-1 and IGFBP-1 can be detected in amniotic fluid between 15 and 20 completed WG, using respectively AmniSure and actim PROM.     

探测前哨淋巴结在乳腺癌、早期宫颈癌和头颈鳞癌中的应用

目的评价核素淋巴显像和γ探针定位在乳腺癌、宫颈癌和头颈鳞癌中确定前哨淋巴结(SLN)的应用价值。方法女性乳腺癌116例,体检腋窝未扪及肿块。应用99Tcm-DX37~74MBq(1~2mCi)经皮下注射,或术中注射专利兰1ml,术中用γ探针定位并行前哨淋巴结活检,与手术、病理对照。宫颈癌27例,体检盆腔未扪及肿块。应用99Tcm-DX74MBq(2mCi)在宫颈肿瘤周围2°或10°处或99Tcm-SC74MBq(2mCi)阴道镜直视下四点注射,行核素淋巴显像后,手术后的标本用γ探针行体外定位,并与病理的结果加以对照。N0头颈鳞癌10例,99Tcm-DX74MBq(2mCi)肿瘤周围成分下注射,术中用γ探针定位并行前哨淋巴结活检,与手术、病理对照。结果116例乳腺癌中活检SLN108例,灵敏度为92.6%(22/27例),特异性100%(81/81例)。27例宫颈癌中SLN的灵敏度为100%(6/6例),特异性100%(21/21例)。10例N0头颈鳞癌中SLN转移3例,NSLN转移1例。结论核素淋巴显像和γ探针定位应用于乳腺癌、宫颈癌和N0头颈鳞癌是切实可行和可能的,这是一种简便、安全、易被病人接受的探测前哨淋巴结的检查方法,对预测腋窝淋巴结、盆腔淋巴结等转移有很大的临床实用价值。