骶韧带高位悬吊术治疗子宫脱垂的效果及对生活质量的影响

目的 比较对于子宫脱垂患者分别应用骶韧带高位悬吊术与传统阴道前后壁修补术治疗疾病的价值。方法 选取收治的子宫脱垂患者60例,按手术方法不同分成悬吊组与传统组,每组各30例,传统组应用阴道前后壁修补术治疗,悬吊组应用骶韧带高位悬吊术治疗,评价2组患者的临床疗效。结果 悬吊组患者总有效率(93.33%)与传统组(90.00%)比较差异无统计学意义(P>0.05);悬吊组在手术时间、术后排尿时间、住院时间指标方面显著短于传统组(P<0.05),术中出血量指标显著少于传统组(P<0.05);2组在盆腔脏器脱垂/尿失禁性功能问卷(PISQ-12)与生活质量评分表(QOL)评分均显著提高(P<0.05),同时悬吊组术后各项评分高于传统组(P<0.05);悬吊组并发症总发生率6.67%显著低于传统组26.67%(P<0.05)。结论 子宫脱垂患者采取骶韧带高位悬吊术的手术方法在治疗效果上可媲美传统阴道前后壁修补术,同时悬吊手术方式还有创伤小、术后恢复快等优势,且可显著改善患者性功能并提高患者生活质量。     

盆底悬吊术与经阴道子宫切除治疗盆底障碍性疾病中的临床分析

目的比较盆底悬吊术与经阴道子宫切除治疗盆底障碍性疾病的临床效果。方法将我院住院治疗的盆底障碍性疾病患者70例分为悬吊组和切除组各35例。悬吊组采用盆底悬吊术治疗,切除组采用经阴道子宫切除治疗。结果悬吊组手术时间、术中出血量、术后排气时间、术后导尿时间、住院天数以及术后1年的复发率等均明显优于切除组。结论盆底悬吊术与经阴道子宫切除相比,在治疗盆底障碍性疾病疗效更加明显,值得临床推广。     

腹腔镜下宫颈或阴道残端腹壁网片悬吊术的临床探讨

目的 探析腹腔镜下宫颈或阴道残端腹壁悬吊术的临床效果.方法 选取34例不同程度的子宫及阴道壁脱垂患者,对其临床资料进行回顾性分析,并将其随机分为治疗组和对照组,各17例,治疗组采取腹腔镜下宫颈腹壁悬吊术或腹腔镜下全子宫切除并阴道残端腹壁悬吊术,对照组采取阴式子宫切除及前盆腔重建术,对比两组手术情况及术后患者情况.结果 治疗组患者的手术时间、术中出血量、术后拔除尿管时间分别为(119.1±35.8)min、(39±20.7)mL、(47.5±1.8)h,对照组患者的手术时间、术中出血量、术后拔除尿管时间分别为(96.4±19.3)min、(63.4±36.8)mL、(120.2±2.8)h,两组比较差异具有统计学意义(P<0.05);治疗组患者的局部不适发生率、拔除尿管后尿频和术后并发症几率分别为11.8％、5.3％、0％,对照组患者的局部不适发生率、拔除尿管后尿频和术后并发症几率分别为23.6％、17.6％、5.3％,均较治疗组高.结论 腹腔镜下宫颈或阴道残端腹壁悬吊术对周围脏器影响更小,临床效果更好,并发症更少,尤其对于年轻、对术后性生活要求较高及合并卵巢囊肿等需术中同时处理者等更为适宜.     

经阴道骶棘韧带悬吊术在盆腔器官脱垂治疗中的应用

目的:探讨经阴道骶棘韧带悬吊术(SSLF)治疗盆腔器官脱垂的可行性和临床疗效.方法:对41例盆腔器官脱垂患者实施经阴道骶棘韧带悬吊术的临床资料进行回顾性分析.结果:所有患者均成功进行该术式治疗,平均手术时间90.6分钟,术中平均失血量119.4ml,无1例发生术中出血或脏器损伤,治愈率100%.结论:对子宫脱垂或阴道顶端脱垂的患者施行经阴道骶棘韧带悬吊术矫治阴道穹隆膨出,是安全简单有效的方法.     

经阴道尿道悬吊术治疗压力性尿失禁的手术配合

目的探讨经阴道尿道悬吊术（IVS）治疗压力性尿失禁的手术配合要点。方法总结了12例经阴道尿道悬吊术的术前准备、术中护理配合及器械准备。结果本组手术顺利，术后随访无复发。结论手术护士在经阴道尿道悬吊术的术前准备、术中的手术配合是确保压力性尿失禁手术成功的重要环节。     

阴道穹隆吊带悬吊术治疗子宫及阴道穹隆脱垂的临床疗效分析

目的:探讨阴道穹隆吊带悬吊术在子宫及阴道穹隆脱垂治疗中的应用价值,为临床手术方式的选择提供参考。方法:选择我院妇科2008年5月～2010年4月收治的子宫及阴道穹隆脱垂患者68例,采用盆腔器官脱垂定量法进行临床分期,行阴道穹隆吊带悬吊术。术后随访1年,观察患者的临床疗效、术后并发症发生率和复发率。结果:患者手术时间(45.4±6.7)min;术中出血量(61.2±10.2)ml;术后发生吊带侵蚀1例、泌尿系感染1例、尿潴留2例,经对症处理后均痊愈,术后并发症发生率为5.88%;复发1例,予以子宫托治疗后好转,复发率为1.47%。结论:采用阴道穹隆吊带悬吊术治疗子宫及阴道穹隆脱垂,操作简单、手术创伤小、安全有效,值得临床合理推广。     

阴道残端悬吊术在子宫颈癌治疗中的应用

目的探讨阴道残端悬吊术在宫颈癌治疗中的应用。方法50例子宫颈癌患者随机分为治疗组22例和对照组28例。治疗组行子宫颈癌根治术加阴道残端悬吊术,对照组行子宫颈癌根治术。并观察2组术中及术后情况。结果治疗组的手术时间、术中出血量、肛门排气时间、留置导尿时间、术后病率和脏器损伤发生率与对照组比较差异均无统计学意义（均P〉0．05）。治疗组术后阴道长度显著长于对照组（P〈0．01）,而性生活时男方有阴道短小感、女方有不适感的发生率均明显低于对照组（均P〈0．01）。结论在子宫颈癌根治术中,采用阴道残端悬吊术可以防止手术后阴道残端的进一步短缩而又不增加手术难度,有利于改善术后性生活质量。     

经阴道后路悬吊术治疗子宫及阴道壁脱垂不良结局分析

目的 通过对经阴道后路悬吊术(PIVS)治疗子宫及阴道壁脱垂引起的不良结局进行分析,探讨PIVS的利弊以及提出可能解决问题的有效方法.方法 对行PIVS后出现不良结局的7例患者的临床资料进行回顾性分析.首次术式以PIVS为主,术后7例患者均出现阴道前壁Ⅲ度膨出;再次或第三次手术时加用前盆腔悬吊术.结果 随访24～36个月,平均30.5个月,患者无复发及其他并发症.结论 忽视盆底修补手术的受力点,在软组织间寻找修补手术的支撑是导致复发的重要原因;手术的关键受力点应在骨盆骨,而非盆底组织中已经受损的韧带或筋膜.     

经阴道骶棘韧带悬吊术治疗盆腔器官脱垂的疗效

目的:研究分析经阴道骶棘韧带悬吊术治疗盆腔器官脱垂的效果。方法:86例阴道骶棘韧带悬吊术治疗的盆腔器官脱垂患者设为观察组,84例同期接受阴式子宫切除术结合阴道前、后比修补术治疗的患者设为对照组,回顾两组患者的临床资料,并进行对比研究。结果:观察组86例患者在手术时间、术中失血量、住院时间等方面均远胜于对照组(P<0.05),差异有统计学意义。全部患者均没有发生术中出血、脏器损伤等症状。观察组86例患者均痊愈,治愈率100%;而对照组84例患者中,痊愈者72例,治愈率是85.71%。两组疗效比较差异有统计学意义(P<0.05)。结论:阴道骶棘韧带悬吊术应用于盆腔器官脱垂的治疗非常安全、有效,且治疗效果显著,可在临床中积极推广应用。     

经阴道后路悬吊术治疗子宫及阴道壁脱垂不良结局分析

目的通过对经阴道后路悬吊术（PIVS）治疗子宫及阴道壁脱垂引起的不良结局进行分析,探讨PIVS的利弊以及提出可能解决问题的有效方法。方法对行PIVS后出现不良结局的7例患者的临床资料进行回顾性分析。首次术式以PIVS为主,术后7例患者均出现阴道前壁Ⅲ度膨出;再次或第三次手术时加用前盆腔悬吊术。结果随访24～36个月,平均30．5个月,患者无复发及其他并发症。结论忽视盆底修补手术的受力点,在软组织间寻找修补手术的支撑是导致复发的重要原因;手术的关键受力点应在骨盆骨,而非盆底组织中已经受损的韧带或筋膜。     

妇产科学

超低剂量雌二醇经皮肤给药治疗绝经后妇女尿失禁的效果;脱垂患者阴道结缔组织的重构;肥胖妇女行腹腔镜可调节束胃带术后的分娩结局;重症妊娠期高血压疾病中—过性低甲状腺功能低下;胎儿纤连蛋白作为诱导宫颈成熟的初产妇女阴道分娩的预测指标;妊娠早期自然流产危险因素.     

Vaginal haemangioendothelioma: an unusual tumour

Vaginal tumours are uncommon and this is a particularly rare case of a vaginal haemangioendothelioma in a 38-year-old woman. Initial presentation consisted of symptoms similar to uterovaginal prolapse with “something coming down”. Examination under anaesthesia demonstrated a necrotic anterior vaginal wall tumour. Histology of the lesion revealed a haemangioendothelioma which had some features of haemangiopericytoma. While the natural history of vaginal haemangioendothelioma is uncertain, as a group, they have a propensity for local recurrence. To our knowledge this is the third reported case of a vaginal haemangioendothelioma. Management of this tumour is challenging given the paucity of literature on this tumour. There is a need to add rare tumours to our “knowledge bank” to guide management of these unusual tumours. The patient has given written informed consent to the publication of the article.     

瘢痕子宫再次妊娠经阴道分娩的可行性分析

目的分析瘢痕子宫再次妊娠经阴道分娩的可行性。方法选取我院妇产科收治的剖宫产后再次妊娠产妇112例,按照是否满足阴道分娩条件分为试产组51例和剖宫产组61例,同时按照1∶1比例随机抽取我院同期经阴道分娩初产妇与试产组比较分析其分娩结局;随机抽取同期剖宫产初产妇与剖宫产组比较分析其手术情况;同时比较试产组与剖宫产组间的母婴结局。结果试产组共51例,其中试产成功47例,成功率42.0%,与经阴道分娩初产妇相比,试产组在产程时间、产时出血量、住院时间、新生儿Apgar评分及新生儿窒息发生率等方面比较差异均无统计学意义（P〉0.05）;剖宫产组共65例,手术时间、术中出血量、术后血象异常率及住院时间均显著高于剖宫产初产妇组（P〈0.05）;在手术复杂性及风险性方面,剖宫产组胎盘异常（胎盘前置、粘连、植入）率21.54%显著高于剖宫产初产妇组（P〈0.05）,子宫破裂率3.08%,高于初产妇但比较差异无统计学意义（P〉0.05）;试产组分娩出血量、住院时间及新生儿体重均显著低于剖宫产组（P〈0.05）,二组新生儿Apgar评分、新生儿窒息率及产褥病率差异无统计学意义（P〉0.05）。结论瘢痕子宫再次妊娠在按照高危孕产妇管理,经仔细筛选符合试产条件和严密监测产程及时发现并采取处理措施的条件下可以进行经阴道分娩。     

Huge abdominal mass secondary to a transverse vaginal septum and cervical dysgenesis

Transverse vaginal septum is a rare occurrence. When it co-exists with cervical dysgenesis, it is even rarer. Primary amenorrhea with cyclic pain is one manifestation in post-pubertal women. A case of transverse vaginal septum with vaginal atresia and cervical dysgenesis is presented. Presentation as a huge abdominal mass and severe anaemia posed diagnostic challenges. A two-staged management is described as well as variation in management of the septum. The involvement of the patient in her follow up is also stressed.     

Breech presentation and delivery.

What constitutes proper management for the singleton baby who presents by the breech at term has remained one of the most contentious subjects in obstetric practice. Perinatal morbidity and mortality are much higher in breech than in cephalic presentation. Elective caesarean section has been increasingly used in an attempt to improve the perinatal outcome. But caesarean section has immediate and late maternal complications. Some of these complications can be catastrophic. External cephalic version (ECV) at term, under tocolysis if necessary, will reduce the incidence of vaginal breech delivery and the incidence of caesarean section. Where ECV fails, the use of a selective management protocol will allow trial of breech labour in suitable cases, thus further reducing the incidence of elective section. Symphysiotomy may save the life of the baby whose head is trapped by disproportion.     

孕期体质量管理对孕妇产程时间和分娩结局的影响

目的:探讨孕期体质量管理对孕妇产程和分娩结局的影响.方法:选取产妇100例作为研究对象,按照管理方法分为体质量管理组和对照组,各50例.对照组给予传统管理方法,体质量管理组给予孕期体质量管理.比较2组产妇分娩方式、会阴损伤情况、产程和妊娠不良事件发生率.结果:体质量管理组产妇的剖宫产率低于对照组,自然分娩率高于对照组(...     

Cesarean section: trends and morbidity.

A review of 1683 cesarean sections performed at one hospital in a 3-year period (1977-79) showed that the cesarean section rate had trebled since 1967-79, the rates being 16.9% and 5.8%. The main indications for cesarean section responsible for this rise were dystocia, breech presentation and a previous cesarean section. AFter the operation 23.3% of received antibiotics. If the cesarean section rate is to fall, the biggest impact can be made by planning vaginal delivery in selected patients with a previous cesarean section and by improving the management of nonprogressive labour.     

Validation of diagnostic algorithms for syndromic management of sexually transmitted diseases

Objective To validate our revised syndromic algorithms of the management of sexually transmitted diseases and determine their sensitivity,specificity,positive predictive value and cost-effectiveness.Methods Patients with either urethral discharge,vaginal discharge or genital ulcer,were selected during their first visits to three urban sexually transmitted disease clinics in Fujian Province,China,They were managed syndromically according to our revised flowcharts.The etiology of the syndromes was detected by laboratory testing.The data were analyzed using EPI INFO V6.0 software.Results A total of 736 patients were enrolled into the study.In male patients with urethral discharge,the sensitivities for gonococcal and chlamydial infections were 96.7% and 100%,respectively,using the syndromic approach.The total positive predictive value was 73%.In female patients with vaginal discharge,the sensitivity was 90.8%,specificity 46.9%,positive predictive value 50.9%,and negative predictive value 89.3% for the diagnosis of gonorrhea and/or chlamydial infection by syndromic approach.In patients with genital ulcer,the sensitivities were 78.3% and 75.8%,specificities of 83.6% and 42.9%,and positive predictive values of 60.0% and 41.0% for the diagnosis of syphilis and genital herpes, respectively,using the syndromic approach,Cost-effectiveness analysis indicated that the average cost of treatment for a patient with urethral discharge was RMB 46.03 yuan using syndromic management,in comparison with RMB 149.19 yuan by etiological management.Conclusions The syndromic management of urethral discharge was relatively effective and suited clinical application.The specificity and positive predictive value for syndromic management of vaginal discharge are not satisfactory.The revised flowchart of genital ulcer syndrome could be suitable for use in clinical settings.Further validation and revision are needed for syndromic approaches of vaginal discharge and genital ulcer.     

Opinion leaders vs audit and feedback to implement practice guidelines. Delivery after previous cesarean section

A randomized controlled trial with 76 physicians in 16 community hospitals evaluated audit and feedback and local opinion leader education as methods of encouraging compliance with a guideline for the management of women with a previous cesarean section. The guideline recommended clinical actions to increase trial of labor and vaginal birth rates. Charts for all 3552 cases in the study groups were audited. After 24 months the trial of labor and vaginal birth rates in the audit and feedback group were no different from those in the control group, but rates were 46% and 85% higher, respectively, among physicians educated by an opinion leader. Duration of hospital stay was lower in the opinion leader education group than in the other two groups. The overall cesarean section rate was reduced only in the opinion leader education group. There were no adverse clinical outcomes attributable to the interventions. The use of opinion leaders improved the quality of care.     

Systemic absorption and sustained effects of vaginal estrogen creams.

Systemic absorption and sustained effects of two estrogen vaginal cream preparations (Premarin and Estrace) were measured in 29 postmenopausal women receiving daily applications. With both preparations, vaginal absorption of estrogens into the systemic circulation was rapid, efficient, and sustained. It is apparent that estrogen vaginal cream preparations, as widely used in clinical practice for their local effects on the vaginal mucosa, actually result in sustained high estrogen levels in the systemic circulation. The vaginal route shows promise when systemic estrogen therapy is indicated, but is dangerous when estrogen is contraindicated.