医用几丁糖预防宫腔再粘连的临床分析

目的 探讨医用几丁糖在宫腔粘连分离术后预防宫腔再粘连的临床效果.方法 2011年3月-2013年4月宫腔镜下宫腔粘连分离术112例,根据术后防粘连的方法不同分为研究组和对照组：研究组61例,术后宫腔内放置医用几丁糖2.5 ml及元宫环1枚,术后联合人工周期治疗（戊酸雌二醇3 mg每12 h口服1次,共21 d,最后10 d加用安宫黄体酮6 mg,1次/d,口服）;对照组51例,术后宫腔内放置元宫环1枚,术后用药同研究组.比较2组术后再粘连发生率.结果 2组轻度粘连患者术后均未见宫腔粘连复发.中度宫腔粘连患者分离术后复发率研究组13.9%（5/36）显著低于对照组36.7%（11/30）（Z=-2.134,P=0.033）.重度宫腔粘连患者分离术后复发率研究组66.7%（6/9）与对照组88.9%（8/9）无统计学差异（Z=-1.102,P=0.270）.重度粘连患者二次宫腔镜下粘连分离术后宫腔镜检查,研究组2例存在粘连,对照组7例,有统计学差异（Z=-2.017,P=0.044）.结论医用几丁糖能有效预防中、重度宫腔粘连患者的术后复发.     

预防重度宫腔粘连电切术后再粘连方法的效果观察

目的探讨重度宫腔粘连术后多次宫腔镜下分离+人工周期治疗+几丁糖预防再粘连的有效性。方法选取2012-01—2013-05间行重度宫腔粘连电切术的63例患者,术中宫腔涂抹几丁糖2 m L,术后人工周期治疗。术后1个月复查宫腔镜,出现粘连者镜下分离后宫腔涂抹几丁糖,再次人工周期治疗,重复以上步骤直至宫腔无粘连,宫腔形态恢复。结果至术后3个月宫腔镜检查时宫腔形态恢复率87.30%(55/63)。结论多次宫腔镜下分离+人工周期治疗+几丁糖预防重度宫腔粘连宫腔镜电切术后宫腔再粘连,方法可靠,值得临床推广。     

重度宫腔粘连术后应用麒麟丸联合人工周期治疗临床疗效观察

目的观察重度宫腔粘连患者粘连分离术后应用麒麟丸联合戊酸雌二醇的临床疗效。方法选取2016年10月至2017年12月于我院行宫腔粘连分离术治疗的100例重度宫腔粘连患者为研究对象,随机分为研究组(50例)及对照组(50例)。研究组自术后当日给予麒麟丸联合戊酸雌二醇片促进内膜修复,对照组仅给予戊酸雌二醇片促进内膜修复。比较两组患者治疗后的子宫内膜厚度、宫腔镜复查次数及恢复时间。结果两组患者治疗3个周期后子宫内膜厚度均有显著改善(P0.05),且研究组子宫内膜厚度显著优于对照组[(0.77±0.13)cm vs.(0.66±0.12)cm,P0.05];研究组术后恢复至正常宫腔所需时长较对照组显著缩短[(3.22±0.89)个月vs.(3.64±0.96)个月,P0.05],粘连复发率亦显著低于对照组(16.0%vs.20.0%,P0.05);自术后宫腔恢复正常后继续随访12个月,研究组辅助生殖治疗临床妊娠率显著高于对照组(38.0%vs.32.0%,P0.05)。结论重度宫腔粘连分离术后应用麒麟丸联合戊酸雌二醇辅助治疗,可改善子宫内膜厚度,缩短术后恢复至正常宫腔所需时间,提高术后临床妊娠率,降低宫腔粘连复发几率。     

透明质酸钠预防宫腔镜粘连分离术后再粘连发生的效果评价

目的对行宫腔镜粘连分离术的患者给予透明质酸钠治疗,评价其对宫腔镜术后预防再粘连的效果。方法选取2015年1月至2017年1月本院收治的中重度宫腔粘连患者72例,将其随机分为研究组(n=36)与对照组(n=36),对照组宫腔放置宫内节育器+口服戊酸雌二醇孕激素人工周期治疗,研究组术后1~2月内重复宫腔镜检查+宫腔注入透明质酸钠+口服戊酸雌二醇孕激素人工周期治疗,术后对两组月经量改善、子宫内膜厚度及再粘连发生情况等进行比较。结果在月经改善率及子宫内膜厚度方面,研究组与对照组比较均显著提高(P0.05);在宫腔再粘连发生率方面,研究组与对照组相比显著降低(P0.05)。结论对宫腔粘连患者术后进行透明质酸钠综合治疗能够使月经明显改善,使子宫内膜恢复时间明显缩短,且可降低再粘连率,值得临床推广应用。     

几丁糖在预防宫腔操作后粘连中的应用

目的评价医用几丁糖在宫腔操作术后预防宫腔粘连的效果。方法回顾性分析256例行宫腔操作患者的病例资料,根据是否应用几丁糖随机分为几丁糖组和常规组。术后定期随访,宫腔镜检查观察有无粘连及程度。结果几丁糖组120例仅有2例(1.67%)发生轻度宫腔粘连,2例(1.67%)发生了中度宫腔粘连,无1例(0%)发生重度宫腔粘连,总发生率为3.33%。常规组136例患者有16例(11.76%)发生轻度宫腔粘连,15例(11.03%)发生中度宫腔粘连,13例(9.56%)为重度宫腔粘连,总发生率为32.35%。2组间差异具有统计学意义。结论宫腔操作术后宫腔内应用几丁糖可以减少宫腔粘连发生,促进月经恢复。     

几丁糖防治输卵管疏通术后再阻塞效果观察

目的研究医用几丁糖预防输卵管疏通术后粘连阻塞的临床疗效。方法对54例因阻塞性输卵管不孕的患者行官腔镜一腹腔镜联合手术,患者被随机分为几丁糖组（20例）和对照组（25例）,对照组仅作单纯宫、腹腔镜联合术治疗,几丁糖组宫腹腔镜联合手术结合医用几丁糖防治输卵管疏通术后再阻塞。结果术后12个月内,几丁糖组妊娠率为65．0％（13／20）,对照组妊娠率44．0％（11／25）,两组术后妊娠率比较差异无显著性;几丁糖组术后输卵管通畅率97．5％（39／40）高于对照组82．0％（41／50）,两组比较差异有显著性意义（P〈0．05）。结论输卵管再通术后应用医用几丁糖能较有效地防止输卵管再次炎症阻塞。     

稽留流产围术期口服戊酸雌二醇临床疗效分析

目的分析稽留流产清宫术围术期口服戊酸雌二醇的临床疗效。方法回顾性分析2012年1月-2013年12月我院确诊的324例稽留流产行清宫术患者的临床资料。研究组（174例）于清宫术前3 d开始口服戊酸雌二醇2 mg,2次/d,连续4周;对照组（150例）于清宫术前3 d开始口服米非司酮25 mg,2次/d,连续3 d。所有病例均于手术当日术前服用米索前列醇600μg,均于超声引导下行清宫术。两组患者术后均获随诊,观察并比较术后阴道出血时间,术后第一次月经来潮后月经中期子宫内膜最厚的厚度,超声提示子宫最厚内膜≤7 mm或者内膜线中断则行宫腔镜检查。结果研究组与对照组清宫术后阴道流血时间分别为（4.24±1.51）d和（5.41±1.66）d,组间比较差异有统计学意义（P=0.000）;术后第一次月经来潮后子宫内膜最厚的厚度分别为（9.03±1.71）mm和（8.35±2.01）mm,组间比较差异有统计学意义（P=0.001）。研究组行宫腔镜检查22例,发现宫腔粘连5例（2.87%）,其中轻度4例,中度1例;对照组行宫腔镜检查28例,发现宫腔粘连14例（9.33%）,其中轻度9例,中度3例,重度2例。两组宫腔粘连发生率比较,差异具有统计学意义（χ^2=6.089,P=0.014）。结论稽留流产清宫术围术期口服戊酸雌二醇更利于子宫内膜的修复,在一定程度上可以减少术后宫腔粘连的发生。     

重度宫腔粘连分离术后5天二次宫腔镜探查预防宫腔粘连的临床疗效

目的探讨重度宫腔粘连分离术后5d二次宫腔镜探查在预防宫腔粘连中的临床疗效。方法选取2012年1月至2015年3月在我院就诊的重度宫腔粘连患者56例,就诊时按卫生统计学随机数字表分为实验组(27例)和对照组(29例),均住院行宫腔粘连电切术。对照组行宫腔粘连分离术后立即放置球囊尿管,同时口服雌激素预防宫腔粘连;实验组除放置球囊尿管及口服大剂量雌激素外,于术后5d再次行宫腔镜检查,如发现粘连行粘连分离并清除宫腔内的积血块、炎性渗出物。结果实验组平均子宫内膜厚度(9.0 mm vs.7.1 mm)及月经改善情况(92.6%vs.69.0%)均优于对照组(P0.05),且术后再次宫腔粘连的患者(2例)显著少于对照组(9例)(P0.05)。结论重度宫腔粘连分离术后放置球囊尿管及术后5d及时地再次给予宫腔镜检查结合补充大剂量的雌激素,是一项有效的预防宫腔粘连的方法     

GnRH-a治疗对中、重度宫腔粘连手术结局的影响

目的探讨促性腺激素释放激素激动剂（GnRH-a）对宫腔镜下宫腔粘连分离术（transcevical resection of adhesions,TCRA）后结局的影响。方法选取2008年1月～2013年6月我院妇科微创中心由同一医生施行TCRA的27例中、重宫腔粘连（中度19例,重度8例）合并Ⅲ-Ⅳ期子宫内膜异位症作为研究组,TCRA术后放置宫内节育器（IUD）,GnRH—a治疗3个周期;同期接受TCRA术后人工周期药物治疗3个周期,但未进行GnRH—a治疗的94例宫腔粘连（中度66例,重度28例）作为对照组。TCRA术后3个月宫腔镜检查评估术后效果,同时检测研究组GnRH-a治疗3个月后雌二醇（E2）水平和对照组人工周期3个月后月经第2天E2水平。结果研究组术后1个月内3例（11．1％）盆腔炎症,对照组5例（5．3％）,2组比较差异无统计学意义（χ2=0．395,P=0．530）,8例经抗炎治疗2周后治愈。TCRA术后3个月宫腔镜检查：研究组治疗有效率77．8％（中度16例,重度5例）,对照组治疗有效率75．5％（中度52例,重度19例）,2组比较无统计学差异（Z=-0．095,P：0．924）。研究组GnRH-a3个月后E2为（19．12±8．53）ps／ml,对照组E2为（163．72±77．69）ps／ml,2组比较有统计学差异（t=-9．626,P=0．000）。结论GnRH-a造成的低雌激素状态不影响TCRA的术后效果。     

宫、腹腔镜联合治疗重度宫腔粘连50例

目的探讨宫、腹腔镜联合下对重度宫腔粘连（intrauterine adhesions,IUA）行分离术的价值。方法2008年1月～2011年12月对50例宫腔镜检查确诊为重度IUA采用腹腔镜监视下宫腔镜下针状电极划开宫颈及宫腔粘连,环状电极切除及切取粘连组织,有盆腔病变者腹腔镜下处理并行美蓝通液,术后宫内放置O型环、粘停宁,口服戊酸雌二醇、黄体酮胶丸等预防复发,对术后月经、痛经、妊娠情况进行观察。结果除1例闭经为输卵管结核和子宫内膜结核,经2次宫腔镜分离术后患者放弃治疗外,其余患者均一次性手术成功。无并发症发生。49例随访1～5年,平均3年（1～2年30例,〉2～3年10例,〉3年9例）,39例闭经者术后月经恢复;10例经量少者,术后月经正常;10例腹痛者术后腹痛均缓解;7例妊娠,除1例合并卵巢巧克力囊肿行辅助生殖后妊娠,其余6例自然受孕。结论宫、腹腔镜联合治疗重度IUA可直视下进行粘连分离手术,安全可行。     

湖北海棠总黄酮对卵巢早衰大鼠卵巢功能及骨代谢的影响

目的观察湖北海棠总黄酮对卵巢早衰大鼠卵巢功能及骨代谢的影响。方法将48只成年雌性大鼠随机分为空白组、模型组、戊酸雌二醇组及湖北海棠总黄酮高、中、低剂量组,每组8只。除空白组外,其余各组每天给予灌胃雷公藤多苷片(75 mg/kg),连续14 d,复制卵巢早衰模型。第15天起,戊酸雌二醇组给予灌胃戊酸雌二醇(1 mg/kg);湖北海棠总黄酮高、中、低剂量组分别给予灌胃湖北海棠总黄酮(160、80、40 mg/kg),每日1次,连续给药21 d。观察各组大鼠:动情周期;卵巢指数、子宫指数;血清中雌激素(E2)、孕激素(P)、卵泡刺激素(FSH)、黄体生成素(LH)水平变化;卵巢、子宫形态学变化;血清碱性磷酸酶(ALP)、骨碱性磷酸酶(BALP)活性、1,25(OH)_2D_3含量、超氧化物歧化酶(SOD)活力、丙二醛(MDA)含量,检测卵巢组织中ERα的表达。结果与空白组比较,模型组大鼠动情周期紊乱,卵巢指数、子宫指数降低,血清中E2、P水平降低,FSH水平升高(P0. 05,P0. 01)。与模型组比较,戊酸雌二醇组和湖北海棠总黄酮治疗组血清生殖激素水平得到明显改善(P0. 05),卵巢内生长卵泡数量增多,子宫内膜增厚,血清中ALP活力、BALP含量降低,1,25(OH)_2D_3含量升高(P0. 05,P0. 01);血清中SOD活力增强,MDA含量降低;卵巢组织中颗粒细胞、基质细胞ERα的表达增强。结论湖北海棠总黄酮对卵巢早衰大鼠卵巢及骨质疏松具有一定的治疗保护作用,其作用机制可能与体内抗氧化能力、增强颗粒细胞内雌激素受体的表达密切相关。     

早孕期补充戊酸雌二醇对雄性子代大鼠生殖系统发育的影响

目的:建立大鼠早孕期戊酸雌二醇用药模型,从肛门生殖器距离(AGD)、附睾、睾丸组织发育等方面评估戊酸雌二醇对雄性子代生殖系统发育的影响。方法:妊娠SD大鼠随机分对照组及低、中、高剂量组,孕6～15d每天分别给予戊酸雌二醇0、0.2、0.5、0.8mg/kg灌胃,分娩后正常喂养其雄性子代,出生3d、出生21d分别测量雄性子代AGD,出生60d测量附睾、睾丸的脏器系数(附睾、睾丸重量g/大鼠体重100g),进行睾丸组织学切片观察生精小管的形态学变化,测量生精小管直径和上皮高度。结果:对照组及各给药组雄性子代出生3d、出生21d的AGD比较,无明显差异(P>0.05);对照组及各给药组子代出生60d的附睾、睾丸脏器系数比较、睾丸生精小管直径及上皮高度比较,均无明显差异(P>0.05)。结论:早孕期大鼠补充一定剂量(0.2～0.8mg/kg)戊酸雌二醇,出生的雄性子代在生殖系统发育上未受明显影响,性成熟期的睾丸组织学未见明显改变。     

Safety of gentamicin bladder irrigations in complex urological cases

PURPOSE: Recurrent urinary tract infections are common in complex pediatric urological cases, particularly those requiring clean intermittent catheterization. At our institution gentamicin bladder irrigations have been used for antimicrobial prophylaxis and to treat symptomatic bacteriuria, particularly when the infection does not involve the upper urinary tract. The purpose of this study was to assess the safety of this therapy. MATERIALS AND METHODS: A retrospective study was performed of all children treated with gentamicin bladder irrigations from 1999 to 2004. The dose was 14 mg gentamicin in 30 ml saline instilled via catheter once or twice daily. Serum creatinine and random gentamicin levels were obtained according to a protocol based on risk of gentamicin toxicity. Patient demographics, laboratory results and outcomes were abstracted from the medical records. RESULTS: A total of 80 patients (38 males and 42 females) were identified. Median patient age was 10 years and median duration of treatment was 90 days. No patient had detectable serum gentamicin levels greater than 0.4 mg/dl. Small increases in serum creatinine were seen in 3 patients, all of whom had chronic renal insufficiency. A total of 21 patients (26%) had breakthrough UTIs, of which 5 (24%) were gentamicin resistant. No adverse events were documented. CONCLUSIONS: Gentamicin bladder irrigations are a helpful adjunct in the management of complex pediatric urological cases involving recurrent symptomatic bacteriuria. We no longer require intensive laboratory monitoring of low risk patients at our institution.     

米非司酮、双炔失碳酯及宫内节育器用于紧急避孕临床效果观察

对８４名月经规律的正常妇女在避孕失败或无保护性交后要求紧急避孕者，按本人意愿分为３组：Ａ组（ｎ＝２４）于性交次日开始服米非司酮２５ｍｇ／１２ｈ、２天，共１００ｍｇ；Ｂ组（ｎ＝３０）性交次晨服双炔失碳酯７．５ｍｇ，１２小时后再服７．５ｍｇ，以后每晚服７．５ｍｇ，连服１０天，共９０ｍｇ；Ｃ组（ｎ＝３０）于性交后１２０小时内放置宫内节育器（ＩＵＤ）Ｍｕｌｔｉｌｏａｄ（ＭＩ）Ｃｕ３７５。结果：Ａ及Ｃ组无一例妊娠，成功率１００％，Ｂ组妊娠２例，成功率９３％。主要的副反应是恶心、呕吐等胃肠反应，均在Ｂ组出现，而月经改变以Ｂ及Ｃ组为多见。认为，米非司酮的效果优于双炔失碳酯；ＩＵＤ在排除了生殖道感染的妇女中使用，能取得满意的效果。     

辅助生殖患者宫腔粘连术后应用人工周期促内膜修复的疗效及对生育结局的影响

目的评价17-β雌二醇用于辅助生殖患者宫腔粘连术后促子宫内膜修复的效果及对生育结局的影响。方法 429例拟行体外受精-胚胎移植(IVF-ET)患者,因宫腔粘连经宫腔镜下行宫腔粘连分离术和放置宫内节育器术,215例术后应用17-β雌二醇+地屈孕酮行周期治疗(雌二醇2mg bid)2周期(实验组),214例不行周期治疗(对照组)。所有病例定期随诊,治疗结束后再行宫腔镜检查探查宫腔情况并取出宫内节育器,再行胚胎移植,随访治疗疗效及妊娠结局。结果实验组的宫腔镜治疗治愈率明显较对照组高,X2=-3.16,p=0.002,实验组术后胚胎移植临床妊娠率也明显较对照组高X2=-2.75,p=0.006。结论宫腔粘连术后采用17-β雌二醇周期治疗,不但有利于宫腔形态的恢复及内膜的修复,而且可以提高内膜的容受性,明显改善妊娠结局。     

Randomized controlled trial of the efficacy of isosorbide-SR addition to current treatment in medical expulsive therapy for ureteral calculi

It has been suggested that nitrates are potent smooth muscle relaxants that may reduce pain and facilitate ureteral stone passage; therefore it may be an option for medical expulsive therapy in ureteral stones. In a prospective randomized controlled clinical trial, we evaluated the efficacy of medical expulsive therapy with isosorbide-SR 40 mg in patients with ureteral stones (≤10 mm). The patients with ureteral stones in KUB or urinary tract ultrasonography were randomized to receive methylprednisolone plus celecoxib without (control group), and with isosorbide-SR 40 mg (treatment group) for 21 days. 66 patients [33(50%) in control, 33(50%) in treatment group] were entered randomly to our study. The stone expulsion rate was not significantly different between two groups (54.5 vs. 45.5%) (P = 0.497). The need for surgical procedures were more common in control group within 21 days (9.4 vs. 6.1%) and more common in treatment group after 21 days (33.3 vs. 21.9%) (P = 0.756).Patients in the treatment group experienced more intractable pain (27.3 vs. 6.1%), intractable vomiting (3 vs. 0%) (P = 0.046) and hospitalization (3 vs. 0%) (P = 0.314). Drug side effects including headache and dizziness were more common in treatment group (39.4 vs. 9.1%) (P = 0.004). In our study, the use of isosorbide-SR in treatment group did not improve the stone expulsion rate in patients with ureteral stones (≤10 mm) but developed more side effects. Then it may not an appropriate alternative for medical expulsive therapy. Of course, further trials are recommended.     

电针对去卵巢大鼠骨密度及生物力学的影响

目的研究电针对去卵巢骨质疏松模型大鼠骨密度(BMD)、生物力学的影响。方法选取60只雌性SD大鼠,随机分为空白组、模型组、假手术组、药物组、电针组,每组12只。空白组不做任何处理;假手术组只暴露双侧卵巢但不切除;其余3组行双侧切卵巢法建立骨质疏松模型大鼠。造模13周后开始治疗,电针组取"肾俞"、"脾俞"、"三阴交"、"足三里",每次电针刺激15 min(断续波,2 Hz,1.0m A)并灌服与药物组相同体积的蒸馏水,每日1次,连续治疗5 d,间隔2 d,20 d为1个疗程,共3个疗程;药物组大鼠以戊酸雌二醇水溶液(0.02 mg/mL,1 mL/100 g体质量)灌胃,疗程同电针组;空白组不予处理,常规饲养;模型组、假手术组大鼠灌服与药物组相同体积的蒸馏水,疗程同电针组。治疗结束后麻醉处死大鼠,分离股骨和第4腰椎,双能X射线骨密度检测仪检测股骨和腰椎BMD;三点弯曲法和压缩法检测股骨和腰椎生物力学。结果与假手术组相比,模型组大鼠股骨和第四腰椎离体BMD、股骨和第四腰椎的最大载荷及弹性模量均显著性降低(P0.01);与模型组相比,电针组、药物组大鼠股骨和第四腰椎离体BMD、股骨和第四腰椎的最大载荷及弹性模量均显著性升高(P0.01);电针组、药物组大鼠股骨和第四腰椎离体BMD、股骨和第四腰椎的最大载荷及弹性模量均显著性低于假手术组(P0.01)。结论针刺能有效增加大鼠骨密度,阻止骨量降低,减缓骨力学的退变,增强骨强度,对绝经后骨质疏松症具有一定的治疗作用。     

Comparative study of single-dose and three-day therapy for acute uncomplicated cystitis

To assess the efficacy and safety of a single-dose therapy for acute uncomplicated cystitis (AUC), we compared 4 treatment regimens in 120 women. Patients eligible for the study were randomly assigned to one of four treatment groups: Ciprofloxacin (CPFX) 200 mg in a single oral dose (group A); 200 mg once daily for 3 days (group B); 200 mg twice daily for 3 day (group C); and cefpodoxime-proxcetil (CPDX-PR) 200 mg once daily for 3 days (group D). The efficacy was evaluated 3 days after the single-dose therapy or at the end of a three-day therapy according to the criteria proposed by the Japanese UTI Committee. The overall clinical efficacy in a total of 107 patients was evaluated to be excellent, moderate, and poor in 72 (67.3%), 35 (31.8%), and 1 (0.9%), respectively. The causative organisms were eradicated in 88.0, 85.2, 85.2, and 82.1% of the patients in groups A, B, C, and D, respectively. Recurrence was identified in 3 (2 in group A and one in group D) of 16 patients who were followed at 2 to 3 weeks after the treatment. No adverse reactions related to the antibiotics were recognized in the study. There were no significant differences in the clinical efficacy or recurrence rate among these four treatment regimens. These results indicate that the single-dose therapy of CPFX is the treatment of choice in women with AUC.     

Indomethacin as prophylaxis against recurrent ureteral colic

In a prospective, randomized study, the prophylactic effect of indomethacin (150 mg daily) in regard to recurrence of ureteral colic was investigated in 78 patients. Severe recurrent attacks were experienced in 78 patients. Severe recurrent attacks were experienced by 4 of 37 patients in the test group and by 16 of the 41 controls without indomethacin. The mean duration of recurrent pain including the severe attacks was 5.6 +/- 1.1 hour/patient/week in the test group and 12.5 +/- 2.9 in the control group. Passage of stone within 7 days was not influenced by indomethacin (22/37 and 25/41 cases). Indomethacin administration for 7 days after an acute attack of ureteral colic thus reduced the frequency of severe attacks and the total duration of recurrent pain, without influencing the stone passage.