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91.
92.
目的探讨瘢痕子宫(前次剖宫产史)对再次妊娠的分娩方式和结局的影响。方法回顾性分析2012-01至2014-03于北京军区总医院妇产科初诊建档、定期产检,并于该院分娩的瘢痕子宫妊娠病例322例(瘢痕组),随机抽取同期非瘢痕子宫妊娠病例328例(非瘢痕组),比较两组的分娩方式和妊娠结局。结果瘢痕组和非瘢痕组孕妇年龄、分娩孕周、孕次、产次、分娩前体重指数比较,差异均无统计学意义。瘢痕组剖宫产261例,占81.1%;非瘢痕组剖宫产173例,占52.7%;两组差异有统计学意义(χ^2=58.70,P〈0.01)。瘢痕组的前置胎盘、胎盘粘连(植入)的发生率为13.7%、9.0%,均高于非瘢痕组的0.9%、0.6%(χ^2分别为39.38、25.22,P均〈0.01);而瘢痕组和非瘢痕组的胎盘早剥发生率比较,差异无统计学意义(χ^2=2.76,P〉0.05)。瘢痕组子宫破裂(1.6%)、产后出血(10.9%)、产褥发热(11.5%)等发生率均高于非瘢痕组(分别是0、2.7%和5.5%),差异有统计学意义(χ^2分别为5.13、17.00、7.56,P均〈0.01)。结论瘢痕子宫妊娠的并发症发生率高于非瘢痕子宫妊娠,其前置胎盘、胎盘粘连(植入)、产后出血的风险性明显升高。瘢痕子宫孕妇再次妊娠的分娩方式仍以剖宫产为主。 相似文献
93.
Yating Wei Yan Wang Ming Zhang Gang Yan Shixue Wu Wenjun Liu Gang Ji Cecilia W.P. Li-Tsang 《Burns : journal of the International Society for Burn Injuries》2018,44(2):453-461
Introduction
Deep facial burns leave conspicuous scar to the patients and affect their quality of life. Transparent facemask has been adopted for the prevention and treatment of facial hypertrophic scars for decades. Recently, with the advancement of 3D printing, the transparent facemask could facilitate the fitting of the facial contour. However, the effectiveness of the device and its biomechanical characteristics on pressure management of hypertrophic scar would need more objective evaluation.Method
A biomechanical model of the transparent 3D-printed facemask was established through finite element analysis. Ten patients with extensive deep facial burns within 6 months were recruited for clinical study using 3D-printed facemask designed according to biomechanical model, and the interface pressure was measured on each patient. The patients in the treatment group (n = 5) was provided with the 3D-printed transparent face mask soon after initial scar assessment, while the delayed treatment group (n = 5) began the treatment one month after the initial scar assessment. The scar assessment was performed one month post intervention for both groups.Results
The biomechanical modeling showed that the 3D, computer-generated facemask resulted in unbalanced pressure if design modifications were not incorporated to address these issues. The interface pressure between the facemask and patient’s face was optimized through individualized design adjustments and the addition of silicone lining. After optimization of pressure through additional lining, the mean thickness and hardness of the scars of all 10 patients were decreased significantly after 1-month of intervention. In the delayed treatment group, the mean thickness of the scars was increased within the month without intervention, but it was also decreased after intervention.Conclusion
Facemask design and the silicone lining are important to ensure adequate compression pressure of 3D-printed transparent facemask. The intervention using the 3D-printed facemask appeared to show its efficacy to control the thickness and hardness of the facial hypertrophic scars. 相似文献94.
目的对近年TGF-β1/Smad3信号转导通路与创伤后瘢痕形成的相关研究作一综述。方法广泛查阅国内外近年有关TGF-β1/Smad3信号转导通路及与创伤后瘢痕形成的文献,并进行综述。结果 TGF-β1是纤维化疾病的重要影响因子,通过TGF-β1/Smad3信号通路转导产生其生物学效应。该途径受多种因子调控并在细胞及分子水平与其他信号通路串话。该途径参与创伤后早期炎性反应、创面愈合及后期病理性瘢痕的形成。在分子水平干预转导途径的各个环节,可以影响纤维化及细胞外基质沉着的进程。结论 TGF-β1/Smad3信号转导途径是影响创伤后瘢痕形成及细胞外基质沉着的重要途径。对该途径进行深入研究,可为临床促进创面的愈合及病理性瘢痕的防治奠定理论基础。 相似文献
95.
目的 探究采用高强度聚焦超声(HIFU)联合甲氨蝶呤(MTX)在瘢痕子宫妊娠行宫腔镜微创清宫术中的应用效果。方法 选择2018年5月—2019年5月在本院接受宫腔镜治疗的108例瘢痕子宫妊娠患者,依据随机数字表法分为研究组与对照组,每组各54例。对照组使用HIFU预处理,研究组则使用HIFU联合MTX的方式预处理,处理后两组均行宫腔镜辅助微创清宫术。通过随访分析比较两组的治疗效果及妊娠结局。结果 研究组术后7 d血清β-HCG水平为(28 598.38±2 176.52)U/L,低于对照组的(32 423.13±2 734.65)U/L,差异有统计学意义(t=8.042,P<0.001);研究组血清β-HCG转阴时间、月经恢复时间、住院时间分别为(21.33±3.78)d、(28.21±3.83)d、(6.53±2.12)d,分别短于对照组的(26.72±4.83)d、(33.82±4.91)d、(9.53±2.67)d,差异具有统计学意义(t=6.458、6.620、6.466,P均<0.001)。两组均随访≥24个月,宫内妊娠、未孕、流产、再次瘢痕子宫妊娠、异位妊娠比较... 相似文献
96.
【摘要】 目的 探讨经阴道子宫疤痕妊娠病灶清除术与子宫动脉介入栓塞治疗的临床应用价值。方法 收集2013年1月~2015年12月住院治疗的子宫疤痕妊娠患者46例。将其随机分成经阴道子宫疤痕妊娠病灶清除术组(研究组)26例和子宫动脉介入栓塞后清宫术(对照组)20例。分别对术中出血量、血促性腺激素(HCG)恢复时间、住院时间、住院费用以及副作用发生等进行对比。结果 经阴道子宫疤痕妊娠病灶清除术在血HCG恢复时间、住院时间、住院费用、副作用发生率等方面优于子宫动脉介入栓塞后清宫术组,差异具有显著性(P<005)。结论 经阴道子宫疤痕妊娠病灶清除术具有高效、可靠、副作用少、术后恢复快和费用相对较低等优点,是目前治疗剖宫产子宫疤痕妊娠新的、有效的治疗方法,可在临床推广应用。 相似文献
97.
《Journal of Clinical Orthopaedics and Trauma》2019,10(1):111-116
ObjectiveWith the trend towards accelerated rehabilitation, the method of skin closure has become increasingly important in orthopedic surgery. It is imperative to evaluate a technique that provides superior clinical and cosmetic results specifically for TKA, due to relatively thin skin anterior to the knee making poor wound healing an issue of concern. We conducted a prospective, single-arm audit evaluating the patient assessments of incision cosmesis for a novel technique in TKA wound closure called Concealed Cosmetic Closure (CCC).Methods570 knees were included in the study whose wound was closed with concealed cosmetic subcuticular interrupted sutures (CCCIS) between January 2014 and May 2016. A validated, ordinal questionnaire, Stony Brooks Scar Evaluation Scale (SBSES) designed to elicit a score evaluating scar satisfaction was interviewed by the investigators to patients 6 months to 3 years postoperatively.ResultsCCC is a simple and relatively rapid single-operator technique that takes about 7–10 min to close 11–17 cm knee incision. In our study, the mean score for Stony Brook Scar Evaluation Scale (SBSES) was 4.4 (SD of 0.73) (range 3–5). The scar was rated highly in terms of cosmesis, patient satisfaction and appearance of the wound.ConclusionCCC is an effective modality for skin closure in total knee arthroplasty providing superior cosmetic healing with minimal complications leading to improved long term patient satisfaction. 相似文献
98.
99.
100.
Alexandra Laberge Mays Merjaneh Syrine Arif Sbastien Larochelle Vronique J. Moulin 《Experimental dermatology》2021,30(1):112-120
Hypertrophic scars are a common complication of burn injuries and represent a major challenge in terms of prevention and treatment. These scars are characterized by a supraphysiological vascular density and by the presence of pathological myofibroblasts (Hmyos) displaying a low apoptosis propensity. However, the nature of the association between these two hallmarks of hypertrophic scarring remains largely unexplored. Here, we show that Hmyos produce signalling entities known as microvesicles that significantly increase the three cellular processes underlying blood vessel formation: endothelial cell proliferation, migration and assembly into capillary‐like structures. The release of microvesicles from Hmyos was dose‐dependently induced by the serum protein α‐2‐macroglobulin. Using flow cytometry, we revealed the presence of the α‐2‐macroglobulin receptor—low‐density lipoprotein receptor‐related protein 1—on the surface of Hmyos. The inhibition of the binding of α‐2‐macroglobulin to its receptor abolished the shedding of proangiogenic microvesicles from Hmyos. These findings suggest that the production of microvesicles by Hmyos contributes to the excessive vascularization of hypertrophic scars. α‐2‐Macroglobulin modulates the release of these microvesicles through interaction with low‐density lipoprotein receptor‐related protein 1. 相似文献