泌尿生殖道瘘修补术83例效果分析

随着围产医学保健工作的加强及妇科手术技术的提高，女性泌尿生殖道瘘(尿瘘)的发生率逐年下降。据我院近13年的统计，平均年收治数为1.1例，比建国后的前31年(1950-1980年)的年收治数6．7例，呈大幅度下降，其中因产科因素发生的尿瘘发生率由75％下降至30％，而因妇科手术所致尿瘘的发生率由12％上升至46％。现就我院1978年后收治的83例尿瘘行修补术的效果及经验，报道如下。     

围产期泌尿生殖道感染与早产

泌尿生殖道感染是诱发早产的重要因素,无论何种泌尿生殖道感染,都有增加早产的风险。泌尿生殖道感染导致早产的机制尚不十分清楚,可能与免疫系统稳态的失衡、前列腺素分泌增加以及基因的多态性相关。早期筛查感染能否降低早产的发生率,不同的学者说法不一。但是,对早产高危人群,尽早进行泌尿生殖道感染的筛查对预防早产的益处是肯定的。     

女性医源性泌尿生殖道瘘诊治专家指导意见（2022年版）

医源性泌尿生殖道瘘 （iatrogenic genitourinary fistula,IGF） 是指与医疗操作相关的泌尿系统与生殖系统之间的异常通道,表现为阴道不自主漏尿或急腹症,严重影响患者术后身心健康,诱发医患矛盾［1］。根据瘘发生的部位可分为：膀胱阴道瘘、尿道阴道瘘、膀胱尿道阴道瘘、输尿管阴道瘘、膀胱输尿管阴道瘘、膀胱子宫瘘,输尿管子宫瘘等,其中以膀胱阴道瘘和输尿管阴道瘘最为常见。     

先天性生殖道畸形伴单肾1例

患者 14岁 ,因痛经 1年 ,加重 5天 ,于 2 0 0 0年 5月 15日入院。患者 12岁月经初潮 ,周期 2～ 4/ 30天 ,量、色基本正常 ,近一年来经期腹痛渐加重 ,伴肛门下坠感。本次入院前 5天开始出现下腹痛 ,为持续性钝痛 ,且渐加重。入院查体 :急性痛苦病容 ,女性第二性征发育正常 ,心肺听诊无异常。腹软 ,下腹偏左侧压痛 ( ) ,无反跳痛及肌紧张。外阴发育正常。肛查 :子宫中位偏右 ,左侧似有一包块 ,类椭圆形 ,囊实性 ,触痛明显。Ｂ超检查 :盆腔内可见两个子宫体 ,左侧宫体 3 6ｃｍ× 6 4ｃｍ× 2 6ｃｍ ,肌层回声均质 ,宫腔内见一液性暗区 ,内有…     

晚期妊娠合并生殖道畸形69例临床分析

综合１４年间晚期妊娠合并生殖道畸形的６９例病例，其发生率为０．２８％（６９／２４５１４）。异常生育史１６例，胎膜早破、早产、产后出血、妊高征及剖宫产率均较同期非生殖道畸形者高，差异有显著性（Ｐ＜０．０５）。围产儿病死率为５．８％，显著高于同期围产儿病死率（１．８６％，Ｐ＜０．０１）。新生儿出生体重（ｘ±ｓ）为（３００９±３６２．８５）ｇ，明显低于同期出生儿体重（ｘ±ｓ）（３２８６．６２±４０２．８３）ｇ。有３例新生儿畸形死亡，２例分娩畸形儿死亡史。妊娠前诊断生殖道畸形的母婴并发症明显低于产时、产后诊断者（Ｐ＜０．０５）。生殖道畸形的早期诊断是减少母婴并发症的关键，并总结了早期诊断的要点。强调了对生殖道畸形者进行遗传学检查的重要性。     

泌尿生殖道瘘的病因及类型

泌尿生殖道瘘指泌尿系统及生殖系统之间存在的异常通道。分娩、手术损伤、先天发育异常、盆腔炎症疾病及肿瘤是出现泌尿生殖道瘘的重要因素。膀胱阴道瘘、输尿管阴道瘘、尿道阴道瘘、膀胱子宫瘘均是泌尿生殖道瘘的常见类型,该文将概括介绍其发病原因、危险因素及诊断方法等。     

女性生殖道畸形的遗传学研究进展

本文就女性生殖道畸形的遗传学研究进展做一综述。     

绝经后反复泌尿生殖道感染

绝经后反复泌尿生殖道感染是老年人常见多发病，北京大学第一医院妇产科联合临床药理研究所就以下三个病例进行了临床讨论，现报告如下。     

女性生殖道畸形新分类

女性生殖道畸形是涉及子宫、宫颈、阴道、输卵管极其广泛的一大类先天性结构异常,且常合并生殖道以外的器官畸形。由于苗勒管（副中肾管）发育与午非管（中肾管）以及泌尿系发育在胚胎早期密切相关,其中以肾脏畸形最为常见。对不同生殖道畸形的分类目前主要取决于结构特征和临床表现,也力求与胚胎发育学相联系,最具代表性的分类法包括美国生育协会（AFS）分类法（1988）、阴道-宫颈-子宫-附件-相关畸形（VCUAM）分类法（2005）和欧洲人类生殖与胚胎学会和欧洲妇科内镜协会（ESHRE/ESGE）的女性生殖道先天异常分类法（2013）。文章将对各自的特点、优点以及局限性进行综述和评论。     

支原体在女性生殖道感染中的定位

支原体感染在临床上是热点问题,常见支原体为解脲支原体、人型支原体、生殖支原体。对于不同的疾病状态,不同的支原体意义并不相同。解脲支原体可导致尿道炎、绒毛膜羊膜炎,但正常女性阴道携带率非常高,临床意义经常被夸大。生殖支原体可导致宫颈炎、尿道炎、盆腔炎,但我国大部地区未能开展此项检查,故常常被忽视。人型支原体常见于细菌性阴道病及盆腔炎。对于不同的支原体检出,需要根据临床情况区别对待。     

Venous malformations of the female lower genital tract

Objectives

Vascular malformations are rarely located in the female lower genital tract. We present the specific clinicopathologic features of venous malformation in the lower genital tract and highlight the surgical management of these lesions.

Study design

Between the years 1998 and 2008, 8 of 646 female patients were retrospectively defined as venous malformation in the lower genital tract according to the classification of the International Society for the Study of Vascular Anomalies (ISSVA). Clinical and pathologic information was analyzed according to the medical records and archived pathological sections.

Results

Venous malformations were located in the vagina in three women, and in two of these cases extended to the cervix, and were found at the vulva in five patients. The age of the patients ranged from 15 to 85. The clinical presentations were abnormal vaginal bleeding or vaginal mass in cases with cervicovaginal lesions, and non-specific vulvar nodules in women with vulvar lesions. The abnormalities were found shortly after birth and increased in size gradually thereafter, or become significantly enlarged during or following pregnancy. Postmenopausal episodes could occur, although rarely. Doppler ultrasound, MRI and angiography were available to help define the type of vascular anomalies. The therapeutic approach consisted of interventional embolization and surgical excision. In rare cases of refractory and diffuse cervicovaginal lesions, hysterectomy might be ultimately inevitable.

Conclusion

Venous malformations in the lower female genital tract are rarely reported. Their clinical presentations mimic other genital tract neoplasms, including malignancies. Surgical excision is the curative procedure and is helpful to reach a definite pathological diagnosis.     

认识女性生殖道癌肉瘤

女性生殖道癌肉瘤是一类很少见、侵袭性强、易于复发转移、预后差的肿瘤。该类肿瘤包含癌和肉瘤两种恶性组织成分,目前的研究对此类肿瘤的起源更倾向于转化学说,即认为该类癌瘤为单克隆起源,其中肉瘤成分由癌细胞化生为肉瘤样成分。在治疗上,对癌肉瘤首选手术治疗,术后通常需采用辅助化疗和放疗等综合治疗。     

女性生殖道沙眼衣原体感染的诊治

生殖道沙眼衣原体感染是最常见的性传播疾病之一,明确诊断需依据实验室检测。由于患者早期症状多不明显,而女性持续或反复感染常导致严重并发症,因而早诊断、及时有效的规范化治疗并追踪随访对患者具有十分重要的意义。近年来核酸扩增等分子生物学技术的发展和标本取材方法的改进都极大地推动了沙眼衣原体感染的筛查,目前最好的公共健康干预手段是增加筛查率和积极治疗感染者,同时不能忽视性健康教育为基础的一级预防。     

Ligneous inflammation involving the female genital tract

Ligneous inflammation is a rare disease characterized by progressive growth of ligneous plaques on mucosal surfaces. Involvement of the female genital tract is an unusual condition. We present a patient with multifocal ligneous inflammation involving her genital tract, oral mucosa and conjunctiva. Plasminogen functional activity was 18% of normal (reference: 55-145%). Molecular analysis exhibited that her genetic status is homozygous for a combination of three polymorphisms. But no true mutation could be found in all 19 exons of the plasminogen gene. We did not observe any clinical changes, although plasminogen activity has improved in the course of 5 months of oral contraceptive therapy Most gynecologists are unfamiliar with this diagnosis and pathologists with wide experience in gynecology are unaware of this disease. However, the histology of lesions is characteristic and a diagnosis can be made quite easily once it has been considered.