肉眼和电镜观察聚-DL-乳酸可吸收生物膜联合丹参预防硬膜外粘连的效果

目的观察聚-DL-乳酸（PDLLA）可吸收生物膜联合丹参预防腰椎术后硬膜外粘连的效果。方法将60只新西兰白兔随机均分成5组,施以L5—L7全椎板切除术,A组放置明胶海绵片,B组明胶海绵片＋丹参注射液,C组PDLLA可吸收膜．D组明胶海绵片＋丹参注射液＋PDLLA可吸收膜,E组空白对照组不作特殊处理,于术后2周、4周、8周、12周分别行肉眼大体观察、电镜观察瘢痕生长及硬膜外粘连情况。结果B组、C组和D组有非常明显防粘连效果,与E组及A组之间存在显著性差异（P〈0．05）,虽然B组,C组和D组之间在防粘连效果方面无显著差异（P〉0．05）,但D组的防粘连效果更为突出,直到12周时电镜下成纤维细胞和胶原纤维仍呈现生长缓慢,排列紊乱和结构疏松的镜像。结论丹参＋PDLLA可吸收膜有很好的三维防粘连效果．可作为理想的预防硬膜外粘连材料。     

补肾活血法联合优思明预防人工流产后宫腔粘连临床研究

目的：探讨补肾活血法联合优思明对于人工流产术后宫腔粘连的预防效果。方法随机选择100例在我院人流的自愿患者（纳入标准）,随机分为两组：试验组和对照组,两组孕周、孕次、年龄等方面都无明显差异性,对照组在人工流产后第1d开始给予优思明口服,每天1次,每次1片,共21d。月经来潮后,月经第5d开始继续服用,持续服用3个月,如果无月经来潮,则停药第7d开始下一个疗程,也持续服用3个月.试验组在对照组基础上加上补肾活血方。随访观察两组患者人流术后各项指标：首次月经复潮的时间、有无周期性的腹痛、有无经量减少、有无宫腔积血（通过B超检查）、有无宫腔粘连及其宫腔粘连的程度（宫腔镜检查）。结果试验组人流术后首次月经复潮的时间为（27±2）d,周期性腹痛0例,经量减少2例,无宫腔积血患者出现,轻度宫腔粘连患者2例,中度宫腔粘连患者2例,重度宫腔粘连患者0例,对照组人流术后月经复潮时间（28±3）d,周期性腹痛2例,经量减少4例,宫腔积血患者2例,轻度宫腔粘连患者3例,中度宫腔粘连患者4例,重度宫腔粘连患者1例。试验组与对照组比较：人流术后月经首次复潮时间无明显的差异性,P>0.05;月经量减少有明显的差异性, P<0.05;宫腔积血的发生率有明显差异性,P<0.05;轻、中、重度宫腔粘连发生率有明显的差异性,P<0.05,宫腔粘连的总发生率有明显的差异性,P<0.05,结论补肾活血法联合优思明应用于人工流产术后对于宫腔粘连的预防疗效好,预防范围广,安全性强,值得在临床中推广应用。     

去氧孕烯炔雌醇片在人工流产术后预防官腔粘连的效果分析

目的研究去氧孕烯炔雌醇片在人工流产术后预防官腔粘连的效果。方法选择2009年3月～2013年3月本院接诊的100例行人工流产术的患者,随机均分为观察组和对照组。观察组患者在术后即给予患者去氧孕烯炔雌醇片口服,对照组患者采用常规的抗生素及益母草颗粒治疗,治疗后对两组患者的宫腔粘连发生情况及两组患者的阴道出血时间、月经复潮时间及阴道出血量进行比较分析。结果观察组患者官腔粘连发生率（4．0％）明显低于对照组（16．0％）,两组比较差异有统计学意义（X2=-4．0000,P=-O．0455）。观察组患者的阴道出血时间、月经复潮时间明显短于对照组,阴道出血量明显少于对照组,两组比较差异有统计学意义（P〈O．01）。结论去氧孕烯炔雌醇片在人工流产术后预防宫腔粘连的疗效显著,可降低宫腔粘连发生率,缩短阴道出血时间及月经复潮时间,减少阴道出血量。     

The nature of intrauterine adhesions following reproductive hysteroscopic surgery as determined by early and late follow-up hysteroscopy: clinical implications

Objective To evaluate the rate and characteristics of postoperative intrauterine adhesions (IUA) that might be formed following hysteroscopic reproductive surgery from both a gross and a histologic perspective as determined by early and late follow-up diagnostic hysteroscopy. Methods Retrospective analysis of 61 women wishing a pregnancy and suffering from a significant intrauterine pathology affecting their reproductive outcome were reviewed. All patients were treated hysteroscopically. Subsequently, they were randomly assigned to perform a follow-up diagnostic hysteroscopy at a variable intervals from their initial surgery. Multiple hysteroscopic-guided biopsies from IUA, when present, were obtained in several cases. Twenty patients were in the early group and had follow-up hysteroscopy performed 2–4 weeks after the initial operation. The late diagnostic group consisted of 41 patients with follow-up hysteroscopy at about 12 months (8–16 months). The two groups were similar to composition. Postoperatively, none of the early diagnostic group underwent hysterosalpingography (HSG) whereas all of the late group performed HSG 4 months following the initial surgery, which showed at least one-third of the cavity free of adhesions. When adhesions were present, no effort was made to lyse them. Results At follow-up hysteroscopy, 25% of both groups had no significant adhesions. Grade I adhesions (thin, filmy) occurred in 60% of the early hysteroscopy patients and in only 12% of the late group (P < 0.05). Grade II adhesions were present in 10% of the early group and in up to 41% in the late group (P < 0.05), whereas Grade III adhesions were present in only 5% of the early hysteroscopy group, but in 22% of the late one (P < 0.05). Correlation between hysteroscopic and histologic findings were good in most of cases in both groups. Follow-up to determine the subsequent reproductive outcome revealed similar conception rates in both groups. Conclusion The IUA that might be formed immediately following hysteroscopic reproductive surgery are histologically different from those appearing a longer time after the original operation. Routine early follow-up hysteroscopy can influence the prognosis resulting from the original surgery.     

Small bowel obstruction in pregnancy

Background Intestinal obstruction in pregnancy is rare. Symptoms are often unspecific and a high level of suspicion is essential for early diagnosis. Fetal and maternal mortality rates are higher during pregnancy due to delay in diagnosis. Case A 31-year-old primigravida with a history of abdominal surgery was admitted because of worsening abdominal pain, abdominal distension and elevated pancreatic enzymes. Ultrasound showed dilated small bowel loops. Explorative laparotomy revealed a small bowel obstruction with partial bowel necrosis caused by a single adhesion. A jejuno-jejunostomy was performed. Five days later, she developed peritonitis. A secondary laparotomy and caesarean section were done. Conclusion In spite of timely diagnosis and prompt surgical intervention, our case was still complicated by peritonitis and early delivery. This underlines the necessity of immediate clinical suspicion. Small bowel obstruction should be considered in differential diagnosis of pregnant patients with a history of abdominal surgery.     

Prevention of adhesion of rabbit knee joint with chitosan：an experimental study

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高超声速风洞进气道流量系数测量精度影响因素研究

目的 观察妇康口服液对大鼠实验性宫腔粘连模型宫腔组织形态学及对宫内膜转化生长因子-β1(TGF-β1)、纤溶酶原激活物抑制因子-1(PAI-1)和基质金属蛋白酶-9(MMP-9)表达的影响,探讨妇康口服液预防宫腔粘连的效果及机理.方法 将健康雌性未交配Wistar大鼠50只随机分为5组,分别为妇康口服液高剂量组(Hfuk,n=10),妇康口服液中剂量组(Mfuk,n=10),妇康口服液低剂量组(Lfuk,n=10),空白对照组(Bcon,n=10),模型对照组(Mcon,n=10).Hfuk、Mfuk、Lfuk和Mcon组制作宫腔粘连模型;Hfuk、Mfuk及Lfuk组于造模术后第1d开始分别灌胃给予妇康口服液4 mL/d、2 mL/d、1 mL/d,Bcon和Mcon组灌胃给予生理盐水2 mL/d,10 d后断颈处死所有大鼠.HE染色观察各组大鼠宫腔组织形态学变化,免疫组化检测宫内膜TGF-β1、PAI-及MMP-9的表达.结果 光镜下,Bcon组子宫腔及子宫壁组织结构清晰;Mcon组宫腔组织结构消失;Hfuk、Mfuk、Lfuk组各层结构基本保持正常排列,并随着妇康口服液剂量的增加,宫腔内形态表现越好.Hfuk、Mfuk、Lfuk组的TGF-β1、PAI-1蛋白表达少于Mcon组(P＜0.001),而MMP-9蛋白表达高于Mcon组(P＜0.001).结论 妇康口服液能预防大鼠发生宫腔粘连,其机制可能是通过调节宫内膜组织TGF-β1、PAI-1和MMP-9的表达,调节细胞外基质(ECM)的生成与降解,从而发挥其预防作用.     

常通口服液预防术后肠粘连的实验研究

目的 观察中药常通口服液用于术后腹腔肠粘连的效果。方法 选取54只SD雄性大鼠随机分为6组(n=9):正常对照组、模型对照组、四磨汤组、常通口服液低、中、高剂量组。除正常对照组外,其余大鼠均按Ellis法制备成肠粘连模型。正常及模型对照组予以蒸馏水灌胃(10ml/kg);四磨汤组以10ml/kg灌胃给药;常通口服液低、中、高剂量组分别按4.3、8.6、17.2g/kg灌胃给药。各组于术后第7天取血,测定白细胞(WBC)计数及纤维蛋白原(FIB)浓度;同时进行粘连程度肉眼分级。结果 常通口服液能明显减轻肠粘连程度,降低大鼠血浆中WBC计数及FIB浓度。结论 常通口服液能够预防腹腔术后肠粘连形成。     

Hysteroscopic observations in 348 consecutive cases of female genital tuberculosis: A prospective study

Study objectiveTo evaluate the hysteroscopic findings in female genital tuberculosis.DesignIt was a prospective study of hysteroscopic findings performed on 348 cases of female genital tuberculosis (FGTB).SettingIt was a prospective cross-sectional study in a tertiary referral centre.PatientsA total of 348 patients with infertility with FGTB on various tests.InterventionA total of 348 patients of infertility found to have FGTB on various investigations were enrolled in the study. A detailed history was taken. Clinical examination, endometrial sampling and diagnostic laparoscopy were performed was also performed in selected cases. All patients underwent hysteroscopy as part of evaluation for infertility and tuberculosis (TB) findings.Measurements and main resultsThe mean age, parity, body mass index and duration of infertility was 28.2 years, 0.31,23.1kg/m² and 3.44 years respectively. Infertility was primary in 81.03% and secondary in 18.96% cases. Diagnosis of FGTB was made by endometrial aspirate findings of positive AFB on microscopy (4.02%), positive culture (4.88%), positive PCR (83.90%), epithelioid granuloma (14.65%), positive AFB on microscopy or culture of peritoneal cytology (1.14%) or epithelioid granuloma on peritoneal biopsy (1.72%), definitive findings of TB on laparoscopy (41.95%) or probable findings of TB on laparoscopy (58.05%). Various hysteroscopic findings observed were normal findings (28.16%), pale endometrial cavity (54.31%), features of active TB (7.47%), features of chronic TB (19.54%), features of TB sequelae like obstructed ostia (both ostia in 13.79%, one ostia 14.94%, periostial fibrosis; (bilateral 4.59%, unilateral 5.17%), endometrial glands atrophy (12.35%), small shrunken cavity (6.32%), distorted cavity (5.17%), various grades of intrauterine adhesions (29.88%). Hysteroscopy in FGTB was associated with increased difficulties and complications like failed procedures, difficult visualisation, false passage and uterine perforation.ConclusionHysteroscopy is useful modality to detect endometrial TB but is associated with increased difficulty and complications.