女性盆腔积液与盆腔炎的关系

目的探讨盆腔积液与盆腔炎的因果关系。方法回顾性分析2007年5月至2008年5月我院B超提示盆腔积液的125例女性的临床资料。结果形成盆腔积液的原因多，非均为盆腔炎症所致。结论盆腔炎症可有盆腔积液，但盆腔积液不等于有盆腔炎症。     

The laparoscopic approach to control intractable pelvic neuralgia: from laparoscopic pelvic neurosurgery to the LION procedure

OBJECTIVE: To present different aspects and advantages of the laparoscopic approach to the pelvic nerves aimed at treating intractable pelvic neuralgia. METHODS: We report on a nonconsecutive series of 7 patients with different types and etiologies of chronic pelvic neuralgia, all of whom underwent laparoscopy. In all 7 cases, the neuralgia was refractory to medical management and had profound socioeconomic consequences for the patients. RESULTS: Techniques of laparoscopic transperitoneal neurolysis of several pelvic somatic nerves are described but also our technique of laparoscopic implantation of neuroprothesis for neuromodulation on somatic pelvic nerves or on autonomic pelvic nerves as the superior hypogastric plexus. DISCUSSION: Laparoscopic approach to the pelvic nerves opens new possibilities for the diagnosis and treatment of pelvic neuralgia, and offers new curative surgical techniques.     

正常女性盆底解剖、形态的动态MRI研究

目的　采用静息与最大盆腔用力时盆腔动态MRI评价正常盆腔器官的位置、运动和盆底形态 ,为动态MRI在盆底功能性疾病诊断上的临床应用建立盆腔器官运动程度和盆底形态学的正常标准。方法　对 3 0例健康女性志愿者进行静息与最大盆腔用力时盆腔动态MRI检查。采集的MR影像用于观测盆腔器官的位置、运动和盆底形态。结果　最大盆腔用力时正常盆底在形态上变化不明显 ,盆腔器官的平均下降值是膀胱颈 ( 15 .3± 4.3 )mm ,子宫颈 ( 10 .7± 3 .4)mm ,肛直肠连接 ( 19.2± 6.8)mm ,盆隔裂孔的平均增大百分比是 ( 12 .2± 6.4) %。盆腔器官运动的范围是膀胱颈不超过耻尾线下1cm ,子宫颈不超过耻尾线以下 ,肛直肠连接不超过耻尾线以下 2 .5cm。结论　MRI是研究活体盆底解剖与形态学的有效方法。正常妇女盆腔动态MR影像上 ,最大盆腔用力时盆腔器官有一定程度的运动 ,但无脱垂 ,盆底形态上变化不明显。     

Contribution of pelvic floor muscles to stiffness of the pelvic ring

STUDY DESIGN: A biomechanical study in embalmed specimens, on the relation between applied tension in the pelvic floor muscles, stiffness of the pelvic ring and generation of movement in the sacroiliac joints. OBJECTIVE: To gain insight into the effect of tension in the pelvic floor muscles on stiffness of the pelvic ring. Background. According to a model on selfbracing pelvic floor muscles have the capacity to stiffen the sacroiliac joints. However, this capacity has not been demonstrated in vitro yet. METHODS: In 18 embalmed specimens an incremental moment was applied to the sacroiliac joints to induce rotation of the innominate bones in the sagittal plane. After assessment of the relationship between rotation angle and moment, springs were applied to the pelvis to simulate tension in the pelvic floor muscles. During the simulated tension the measurements were repeated. Differences in stiffness before and after applying springs were tested for significance. RESULTS: In females, simulated tension in the pelvic floor muscles stiffened the sacroiliac joints with 8.5% (P < 0.05). In males no significant changes occurred. In both sexes a backward rotation of the sacrum occurred due to simulated tension in the pelvic floor muscles (P < 0.05). The sacroiliac joints of female specimens were more mobile in comparison to male specimens (P < 0.05). CONCLUSIONS: In females, pelvic floor muscles have the capacity to increase stiffness of the pelvic ring. In addition, these muscles can generate a backward rotation of the sacrum in both sexes. RELEVANCE: The ability of pelvic floor muscles to increase stiffness of the pelvic ring is of importance in patients with impairment of pelvic stability, especially in pelvic pain patients. Increased activity of these pelvic floor muscles might compensate for loss of pelvic stability by stiffening the pelvic ring and restoring proper load transfer through the lumbopelvic region.     

Prolift生物网片材料盆底重建与传统手术治疗盆底功能障碍的Meta分析

背景：近年来,Prolift 生物网片材料在盆底重建手术中广泛应用,学者们一直在探索 Prolift 生物网片材料与传统手术治疗盆底功能障碍性疾病的利弊。 目的：系统评价Prolift生物网片材料盆底重建术与传统手术治疗盆底功能障碍性疾病的临床疗效。 方法：通过检索1996至2014年万方数据库、维普、PubMed、Medline等数据库,纳入Prolift生物网片材料盆底重建手术与传统手术治疗盆底功能障碍的随机对照研究,从符合要求的文献中收集数据资料,应用RevMan5.2软件对两种治疗方法进行Meta分析。 结果与结论：纳入9个随机对照研究,共计780例患者,其中Prolift生物网片重建组398例,传统手术组382例。Prolift生物网片重建组手术时间、术中出血量、住院时间、术后排气时间、术后最高体温、及术后18个月治愈率方面显著优于传统手术组（P ＜0.05）,两组在术后残余尿量、术后6个月、12个月治愈率、术后1年性生活质量、术后复发率方面差异无显著性意义（P＞0.05）。表明Prolift生物网片材料盆底重建治疗盆底功能障碍性疾病的近期疗效某些方面优于传统手术,对 Prolift 生物网片材料盆底重建远期疗效的最终判断有待于更好的循证证据。     

绝经后妇女良恶性盆腔包块超声诊断价值的 ROC 曲线研究简

目的 研究超声鉴别诊断绝经后妇女恶性盆腔包块的效能,探讨超声在绝经后妇女盆腔包块诊断中的价值.方法 选取2011年1月至2013年1月有明确的病理以及临床诊断的120例绝经后盆腔包块患者作为研究对象,回顾性分析患者的临床资料以及超声声像图的特点.结果 120例绝经后盆腔包块患者中良性盆腔包块87例（72.5%）,恶性包块33例（27.5%）.超声诊断绝经后妇女恶性盆腔包块的敏感度为93.9%,特异度为93.1%;其中良性盆腔包块的诊断符合率为97.4%,恶性盆腔包块的诊断符合率为81.1%,超声误诊10例（8.33%）.超声诊断绝经后妇女恶性盆腔包块受试者工作特征曲线（ROC曲线）下面积为0.870.结论 超声在鉴别诊断绝经后妇女盆腔包块方面,具有无创、快速、灵敏度高等特点,具有较高的诊断价值,可以作为诊断绝经后妇女盆腔包块性质的首选检查方法.     

盆底重建替代材料生物补片在妇产科临床中的应用特点

背景:近几年,随着大量生物技术替代材料的应用,盆底缺陷修复和重建有了较大进步,替代材料补片是重要的盆底组织替代物,能够替代薄弱受损的盆底筋膜组织,在盆底重建中的应用越来越广泛.目的:探讨盆底重建生物材料补片在女性盆底重建中应用的可行性、有效性及临床应用价值.方法:由第一作者检索1990/2008PubMed数据库(http://www.ncbi.nlm.nih.gov/PubMed)及万方数据库(http://www.wanfangdata.com.cn)有关盆底功能障碍、盆底重建以及补片植入物材料应用等方面的文献,英文检索词为"reconstruction of whole pelvic floor,mesh,synthetic mesh implants",中文检索词为"补片,生物材料补片,替代材料,盆底重建".排除重复性研究.计算机初检得到54篇文献,根据纳入标准保留17篇进一步归纳总结.结果与结论:女性盆底障碍性疾病,表现最为突出的是盆腔器官膨出.盆腔脏器膨出是由于盆底支持结构缺陷、损伤及功能障碍所致.传统的手术解决不了根本问题.目前用于盆底修复及重建的替代材料,大致包括生物材料补片、人工合成材料补片两类,其中生物材料补片分为3种:自身替代材料,同种替代材料,异种替代材料.由于它们能替代薄弱受损的盆底筋膜组织,是重要的盆底组织替代材料,在盆底重建中的应用越来越广泛.应用补片进行盆底重建,真正完成解剖结构的恢复从而达到功能的恢复,方法简单,操作容易,不延长手术时间,不增加手术并发症,患者耐受性好,安全可靠,近期疗效明显,远期疗效有待大量的临床实验和进一步观察.对不同脱垂部位患者均行改良全盆底重建是值得推广的临床经验.     

产后盆底肌肉松弛症的康复治疗之影响

目的评估产后盆底肌肉松弛症患者的治疗情况并探讨其对预防女性尿失禁的作用。方法回顾性分析157例产后42 d检测为盆底肌肉松弛的产妇使用生物反馈电刺激治疗后盆底肌肉收缩力及盆底肌力的变化情况。结果治疗1个疗程后,75%的患者盆底肌肉平均收缩力或盆底肌力都有所增强。结论产后尽早进行盆底肌肉松弛症的康复治疗,加强盆底肌肉收缩训练,可增强盆底肌肉的收缩力度,达到改善尿道括约肌和肛提肌功能的目的,并起到预防女性尿失禁的作用。     

Comparison of pelvic ultrasonography and pneumography for ovarian size

Thirty-two females undergoing pelvic pneumography or gynecography for question of ovarian size, fertility, or pelvic mass also had pelvic ultrasonography. The latter examinations were compared, predominantly retrospectively, with the radiographs in an attempt to establish criteria for locating ovaries and evaluating their size. Almost equal groups of normal, Stein-Levinthal syndrome, and miscellaneous pelvic lesions were established. The author concludes that pelvic echography can usually visualize normal ovaries, is a reliable diagnostic technique for polycystic ovaries (Stein-Levinthal syndrome), and is useful for confirming the presence of a pelvic mass. Other investigative techniques such as anemography, culdoscopy, laparoscope's, or exploratory surgery are more uncomfortable, hazardous, and expensive. It is suggested that pelvic ethnography should be the primary diagnostic approach in these cases.     

Restoring pelvic floor function in men: review of RCTs

The male pelvic floor muscles support the abdominal contents, are active during breathing, maintain urinary and faecal continence, increase local blood supply and are active during sexual intercourse. It was hypothesized that weak pelvic floor muscles would compromise these functions in men and lead to urinary and faecal incontinence and sexual dysfunction and that pelvic floor muscle strengthening would restore normal function. After a literature search of randomized controlled trials was undertaken, it was found that weak pelvic floor muscles compromised normal pelvic floor function and led to urinary incontinence and erectile dysfunction. Strengthening the pelvic floor muscles was shown to significantly improve post-prostatectomy urinary continence, post-micturition dribble and erectile function. It would be prudent for all men to exercise their pelvic floor muscles to maintain normal pelvic floor function.     

Dynamic pelvic floor imaging: MRI techniques and imaging parameters

Magnetic resonance imaging (MRI) is an excellent tool to understand the complex anatomy of the pelvic floor and to assess pelvic floor disorders. MRI enables static and dynamic imaging of the pelvic floor. Using static T2-weighted sequences the morphology of the pelvic floor can be visualized in great detail. A rapid half-Fourier T2-weighted, balanced steady state free precession, or gradient-recalled echo sequence are used to obtain sagittal images while the patient is at rest, during pelvic squeeze, during pelvic strain and to document the evacuation process. On these images the radiologist identifies the pubococcygeal line (PCL) (which represents the level of the pelvic floor). In normal findings, the base of the anterior and the middle compartment are above the PCL at rest, and the pelvic floor elevates during contraction. During straining the pelvic floor muscles should relax and the pelvic floor descends normally less than 3 cm below the PCL. Pelvic floor MRI based on the static and dynamic MRI sequences allows for the detection and characterization of a vast array of morphologic and functional pelvic floor disorders. In this review, we focus on technical aspects of static and dynamic pelvic floor MRI.     

非侵入式盆底肌康复疗法对产后盆底康复效果研究

目的:观察非侵入式盆底肌康复疗法对产后盆底肌康复的治疗效果。方法:将128例产后盆底功能障碍患者随机分为治疗组和对照组各64例。对照组只接受家庭自主的盆底肌训练治疗,每天不少于40分钟的训练。对照组使用非侵入盆底肌康复疗法治疗40分钟,每周3次。两组患者治疗前,治疗后6周、12周时分别进行疗效评价。观察两组患者的盆底功能障碍评分、盆底肌力Glazer评分,对比两组患者疗效差异。结果:两组患者盆底功能障碍评分、盆底肌力Glazer评分治疗6周后、12周均显著改善(P<0.01),但治疗组治疗6周后及12周后疗效明显优于对照组,差异有显著统计学意义(P<0.01)。结论:与患者自行盆底肌锻炼相比,非侵入式盆底肌康复疗法能更够显著地改善患者的盆底功能状态,提高患者生活质量,增强盆底肌力。非侵入式盆底肌康复疗法是产后盆底肌松弛的有效治疗方案,同时该疗法非侵入,无创、无痛更容易被广大患者接受。有益于促进中国妇女盆底功能障碍防治项目的进一步发展推广。     

Traumatic pelvic fractures

Pelvic fractures can be a big challenge in caring for the injured patient. Pelvic fractures are important as a cause for morbitidy and mortality. The mortality can be 30% with unstable pelvic ring injuries, and 10-12% of this percentage alone is due to blood loss. Multiple complications can occur during a pelvic fracture. This article will help nurses assess and manage patients with pelvic injuries. Topics covered in the article include basic anatomy of the pelvis, diagnostic tests performed after a pelvic fracture, types of pelvic fractures, management of pelvic fractures, and complications.     

盆底超声在不同分娩方式产妇盆底功能障碍诊断及盆底康复治疗效果评估中的作用

目的 探讨盆底超声在不同分娩方式产妇盆底功能障碍诊断及盆底康复治疗效果评估中的作用.方法 选取2019年1月至2021年2月我院妇产科70例阴道自然分娩产妇与70例剖宫产分娩产妇作为研究对象,分别设为阴道分娩组、剖宫产组,产后均实施盆底超声检查.比较阴道分娩组与剖宫产组的盆底超声检查指标、盆底功能障碍发生情况.以盆底肌...     

Development and testing of a pelvic goniometer designed to measure pelvic tilt and hip flexion

OBJECTIVE: To determine the reliability and validity of a pelvic goniometer designed to measure the pelvic tilt and hip flexion during seated posture. BACKGROUND: Assessment of the seated posture requires measurement of the pelvis and hip. Determining accurate pelvic tilt and hip flexion angles during sitting is often difficult using standard techniques. A pelvic goniometer has been designed to measure pelvic tilt and hip flexion angle of persons in a seated posture. METHODS: Validation of the pelvic goniometer was done radiographically. Ten male volunteers sat in three postures--erect, forward or anterior tilt, and posterior tilt. Pelvic tilt and hip angle were recorded using radiographs and the pelvic goniometer. Reliability of pelvic and conventional goniometers was done using seated nondisabled subjects with physical therapists performing measurements. RESULTS: Validation: the average differences and correlation between the pelvic goniometer and radiographic measures were as follows--pelvic tilt: -4.9 degrees, 0.93; hip angle 1.2 degrees, 0.81. Reliability: average range of hip angle across three measures was about 3 degrees for both goniometers. CONCLUSIONS: The data indicate that the pelvic goniometer has utility in measuring pelvic tilt and hip angle, especially within the seated posture. Because it measures both pelvic tilt and hip angle, the pelvic goniometer has an advantage over conventional goniometers that only measure the latter. RELEVANCE: A valid and reliable tool that measures pelvic tilt and hip angle of persons in a seated posture is needed for clinical research and practice. Its applications include wheelchair seating evaluations and ergonomic assessments of seated workers.     

生物网片材料在女性盆底重建中的应用

背景：与传统的全子宫切除＋阴道前后壁修补手术相比,应用网片材料进行盆底重建能更好修补缺陷,实现结构重建和组织替代。目的：评价生物补片材料在女性盆底器官脱垂手术中的应用情况、临床效果、并发症和不同手术方法对避免术后并发症的作用。方法：采用电子检索的方式在万方数据库中检索1999/2010有关生物补片用于盆底功能障碍性疾病手术治疗的研究,关键词为＂生物补片,盆腔重建＂。排除重复研究、普通综述或Meta分析类文章,筛选纳入30篇文献进行评价。结果与结论：目前用于盆底重建的材料有聚丙烯网片和Prolift专用网片,植入盆底后可显著加强盆底筋膜结构,重建阴道膀胱筋膜、直肠阴道筋膜及悬吊阴道穹窿部,恢复盆底脏器的解剖结构;且手术时间短,可迅速缓解患者症状,围手术期及术后随访无严重并发症,效果良好。用于盆底重建的材料选择很多,植入方法有多种,在实际操作中,应根据患者实际情况采取相应的措施,以达到最满意的效果。     

MRI-based registration of pelvic alignment affected by altered pelvic floor muscle characteristics

BACKGROUND: Pelvic floor muscles have potential to influence relative pelvic alignment. Side asymmetry in pelvic floor muscle tension is claimed to induce pelvic malalignment. However, its nature and amplitude are not clear. There is a need for non-invasive and reliable assessment method. An intervention experiment of unilateral pelvic floor muscle activation on healthy females was performed using image data for intra-subject comparison of normal and altered configuration of bony pelvis. METHODS: Sequent magnetic resonance imaging of 14 females in supine position was performed with 1.5 T static body coil in coronal orientation. The intervention, surface functional electrostimulation, was applied to activate pelvic floor muscles on the right side. Spatial coordinates of 23 pelvic landmarks were localized in each subject and registered by specially designed magnetic resonance image data processing tool (MPT2006), where individual error calculation; data registration, analysis and 3D visualization were interfaced. FINDINGS: The effect of intervention was large (Cohen's d=1.34). We found significant differences in quantity (P<0.01) and quality (P=0.02) of normal and induced pelvic displacements. After pelvic floor muscle activation on the right side, pelvic structures shifted most frequently to the right side in ventro-caudal direction. The right femoral head, the right innominate and the coccyx showed the largest displacements. INTERPRETATION: The consequences arising from the capacity of pelvic floor muscles to displace pelvic bony structures are important to consider not only in management of malalignment syndrome but also in treatment of incontinence. The study has demonstrated benefits associated with processing of magnetic resonance image data within pelvic region with high localization and registration reliability.     

生物补片材料在盆底功能重建中的应用

背景:盆底结构缺陷、损伤以及功能障碍可以导致盆腔脏器膨出,外科治疗是主要方法,随着盆底缺陷修复和功能重建技术的发展,生物补片材料成为重要的盆底筋膜组织替代物,在盆底功能重建中的应用越来越广泛。目的:对生物补片材料在盆底功能重建应用研究的文献资料趋势进行多层次探讨分析。方法:以电子检索方式对万方数据库2007-01/2011-12有关生物补片材料在盆底功能重建应用研究的文献进行分析,采用检索词为"补片(patch);盆底功能重建(pelvic functional reconstruction);盆腔脏器膨出(pelvic organ bulging);生物材料(biomaterial)",运用数据库中自带的分析功能和Excel软件绘制图表的功能,分析文献年度命中数、出版时间及数量、学科类别、基金资助、博硕士学位论文、会议论文和专利信息,以及不同补片材料临床应用效果比较。结果与结论:在万方数据库学术期刊收录的2007/2011文献中,共检索到30篇相关文献。5年来补片材料研究文献的年度命中数处于明显的上升趋势,生物补片材料在盆底功能重建应用研究的文献量处于平稳状态;《中国组织工程研究与临床康复》杂志在生物补片材料盆底功能重建应用研究领域发稿较多;文献的关键词主要有盆腔脏器脱垂、聚丙烯补片和生物相容性,可见生物补片材料在盆腔脏器脱垂疾病中的应用较多,以聚丙烯补片材料的研究为主,突出研究材料的生物相容性。通过文献计量学方法对万方数据库关于生物补片材料在盆底功能重建应用研究的文献分析,为中国从事生物补片材料在盆腔脏器膨出基础研究和临床医务工作者进一步确定科研思路提供有价值的参考。     

检测盆腔淋巴结HPV-DNA预测病理诊断淋巴结阴性宫颈癌的复发

目的探讨检测盆腔淋巴结的人乳头状瘤病毒DNA,以预测病理诊断淋巴结阴性宫颈癌的复发。方法对8例术后病理诊断淋巴结转移阳性患者的原发病灶和淋巴结转移病灶的石蜡包埋标本进行荧光定量PCR检测HPV-DNA,作为阳性对照。对20例病理诊断盆腔淋巴结转移阴性而临床上出现复发的患者进行荧光定量PCR检测其原发病灶和盆腔淋巴结石蜡包埋标本中的HPV-DNA。随机选择20例病理诊断无淋巴结转移临床上也无复发的患者,进行上述同样的原发灶和盆腔淋巴结的HPV-DNA检测。结果在8例病理诊断盆腔淋巴结转移阳性病灶中,均检测出与原发病灶型别完全相一致的HPV-DNA。在20例病理诊断无盆腔淋巴结转移而临床上复发的患者中,18例检测出与原发病灶型别完全相一致的HPV-DNA,占90％。在20例病理上无盆腔淋巴结转移、临床上也无复发者中,除了1个盆腔淋巴结检测出HPV—DNA外,其余19例均未检测出任何的HPV-DNA。结论在病理诊断盆腔淋巴结转移阴性的宫颈癌患者中,盆腔淋巴结HPV-DNA阳性提示可能存在早期微小淋巴结转移或同时存在不能发现的血性转移,因此,盆腔淋巴结HPV-DNA的检测结果可以作为一项诊断指标,以预测这部分宫颈癌患者的术后复发。     

胎儿盆腔肾的产前超声诊断

目的探讨胎儿盆腔肾的超声筛查方法和声像图特点。方法回顾性分析经产前超声诊断的8胎胎儿盆腔肾的声像图特征,并结合引产后尸体检查病理结果及出生后随访复查等进行分析。结果盆腔肾胎儿8胎,胎龄22～36周;左肾4胎,右肾3胎,交叉融合肾1胎。2胎盆腔肾形态结构正常,1胎交叉融合肾结构正常;2胎盆腔肾合并肾积水;3胎盆腔肾合并多囊性肾发育不良,2胎为同侧,1胎为双侧并多发畸形。8胎中,引产3胎,2胎经病理检查证实;4胎出生,其中3胎经出生后复查证实,1胎失访;1胎尚在孕期随访中。结论对于单侧肾窝肾缺失的胎儿,应注意寻找异位盆腔肾。彩超显示肾动脉对诊断胎儿盆腔肾有重要提示作用。