宫颈残端病变57例临床分析

子宫次全切除术是妇科常用的手术之一,该术式操作简单、手术时间短、损伤小、且保留了宫颈的生理机能,利于术后性生活的维持,曾经是许多患者及妇科医生的选择。但目前研究发现,子宫次全切除术并没有给患者远期带来好处,也没有降低围手术期发病率,却使宫颈残端病变的发生率增加,患者不得不面临再次手术所带来的创伤和压力。而宫颈残端切除术,手术难度及风险亦增加。现对温州医科大学附属第二医院及温州市人民医院近10年收治57例宫颈残端病变患者进行临床分析,探讨其治疗方法及预防措施。     

加巴喷丁对布托啡诺术后镇痛及镇静程度的影响

抗癫痫药物加巴喷丁已被广泛应用于神经病理性疼痛的治疗,近年来对加巴喷丁围手术期应用的研究表明,加巴喷丁对加强术中和术后镇痛有效[1-2].患者自控镇痛（patient control analgesia,PCA）常用药物布托啡诺的主要副作用是在获得满意镇痛的情况下,常出现镇静过度或嗜睡现象[3].本研究将加巴喷丁应用于腹腔镜子宫切除术,探讨其对布托啡诺术后镇痛及镇静的影响,为术后镇痛提高安全性和有效性提供依据.     

子宫切除术后卵巢功能的变化

为了解子宫切除后保留卵巢的功能变化 ,对此类患者 1 60例进行 1～ 3年追踪观察。观察指标包括更年期症状、性欲、阴道涂片、性激素、骨密度以及心血管疾病发生情况等。发现 :切除子宫者的卵巢比有子宫者的卵巢功能低下且衰退得早 ;术后第 3年子宫切除者的卵巢功能明显下降 ,雌激素浓度甚至低于同龄人早卵泡期的浓度。结果提示 :对子宫切除并保留卵巢的患者术后要严密监测卵巢功能并要适时补充雌激素     

腹腔镜下全子宫切除术的临床评估

目的：对腹腔腔镜下全宫切除的临床价值进行评估。方法：对４３ 例因诊断为子宫肌瘤（３３ 例） 、子宫腺肌症（６例） 及子宫内膜增殖症（４ 例） 的患者行腹腔镜下全子宫切除术,对同时期１２１ 例具有同样适应症的患者行腹式全子宫切除手术。比较两组病人术中术后情况。结果：两组病人的手术时间、术中出血量无显著性差异,腹腔镜下全子宫切除术的手术时间与子宫增大有关,术中出血量与手术时间及子宫大小无关;行腹腔镜下全子宫切除术的病人手术损伤及术后阴道残端出血发生率无增高,术后疼痛的发生率明显减少,术后使用抗菌素时间、术后住院时间及术后恢复正常活动的时间缩短。结论：腹腔镜下全子宫切除术虽不能完全代替腹式全宫切除术,却是一种安全、可靠,适于临床广泛开展的手术方式。     

筋膜内子宫切除术86例临床分析

目的：报告筋膜内子宫全切术的方法及优点。方法：统计分析８６例筋膜内子宫全切与同期８０例子宫全切两组病人手术时间、术中出血、术后性功能、阴道脱垂情况进行对照。结果：筋膜内子宫全切术的手术时间及术中出血量均较子宫全切术明显减少,前者由于保留了宫颈外口及阴道的完整性,术后无１例阴道脱垂且性生活影响较小,结论：提倡对每例患者行子宫切除宫颈去留都应权衡利弊,以提高手术满意度和术后生活质量。     

Estrogen affects post-menopausal women differently than estrogen plus progestin replacement therapy

BACKGROUND: In the Women's Health Initiative Randomized Controlled Trial (WHI RCT), estrogen-only treatment compared with combined estrogen-progestin treatment resulted in less coronary artery disease, no increase in breast cancer and no reduction in colorectal cancer. Since we previously reasonably replicated the combined estrogen-progestin WHI RCT using the UK General Practice Research Database (GPRD), estrogen-only treatment was investigated using a similar methodology. METHODS: This GPRD study simulated the estrogen-only WHI RCT of women who had undergone a hysterectomy except for randomization. The primary analysis examined 11 572 unexposed and 6890 Exposed women (aged 55-79) treated with conjugated equine estrogen and was compared with the combined estrogen-progestin GPRD study. RESULTS: At baseline, women with a hysterectomy exhibited more cardiovascular disease than those with an intact uterus. In the estrogen-only GPRD study, adjusted hazard ratios (HRs) were 0.50 (0.38-0.67) for myocardial infarction (MI), 1.13 (0.91-1.41) for breast cancer, and 1.18 (0.72-1.92) for colorectal cancer. Compared to the HRs in the estrogen-progestin GPRD study, the estrogen-only results are significantly lower for MI and breast cancer and higher for colon cancer, a pattern similar to the WHI RCT study comparisons. CONCLUSIONS: This study confirms that post-menopausal women in the overall population respond differently to estrogen-only treatment compared with estrogen-progestin treatment, due to different hormone regimens and/or increased cardiovascular disease in hysterectomized women.