临床路径用于腰椎间盘突出症患者健康教育的研究

目的探讨腰椎间盘突出症患者应用临床护理路径进行健康教育的效果。方法将160例患者分为观察组和对照组，每组各80例。观察组按制定好的临床护理路径对患者进行健康教育；对照组实施整体护理，观察两组的护理效果。结果观察组患者对疾病相关知识和健康教育内容的掌握程度及服务满意度明显高于对照组（P〈0．01；P〈0、005）。结论实行临床路径服务可以使医疗及护理工作进一步规范，能增强病人的自我护理能力，缩短住院时间，降低住院费用，促进护理人员与病人的沟通和互动，提高满意度。     

产后盆底肌训练对盆底功能的恢复效果观察

目的观察产后盆底肌训练对提高盆底肌力、改善尿失禁及盆腔脏器脱垂的效果。方法选取94例产后盆底功能障碍性疾病患者,随机分为两组,各47人。观察组采用标准的盆底肌训练,每周进行2次,5周为1个疗程;对照组完成相关健康教育和练习产后操。两组患者治疗前后均进行盆底肌力测定以及评价压力性尿失禁和盆腔脏器脱垂的发生情况。结果观察组与对照组盆底肌力治疗有效率分别为66.0%和89.4%,压力性尿失禁治疗有效率分别为59.6%和78.7%,盆腔脏器脱垂治疗有效率分别为57.4%和74.5%,差异均有统计学意义(P<0.05)。结论产后盆底肌训练对提高盆底肌力、改善尿失禁及盆腔脏器脱垂效果较好,值得推广应用。     

联合术式治疗直肠脱垂102例疗效分析

目的：探讨联合术式治疗直肠脱垂的临床效果,并对其治疗作用进行分析及评价。方法回顾性分析2014年1-8月该院收治直肠脱垂患者共102例,随机分为观察组和对照组,各51例,对照组采用经腹直肠悬吊固定术治疗,观察组采用经腹、肛门联合术式方法治疗,比较两组患者的治疗效果并分析评价。结果对照组的治疗有效率为80.3%,观察组的治疗有效率为94.1%,两组比较差异有统计学意义(P<0.05);观察组患者的住院天数为(11.57±3.54)d,对照组患者的住院天数为(21.61±6.23)d,两组比较差异有统计学意义(P<0.05);对照组患者术后并发症的发生率为33.3%,过程组患者术后并发症的发生率为13.7%,两组比较差异有统计学意义(P<0.05)。结论经腹、肛门联合术式治疗直肠脱垂有效提高治愈率,缩短患者住院时间,减少患者的住院花销,同时也有利于减少患者术后并发症的发生,是值得临床推广的治疗直肠脱垂的手术的方法。     

女性膀胱脱垂亚型患者的二维超声声像图特征分析

目的 分析经会阴二维超声对女性膀胱脱垂亚型的声像图特征,为超声诊断女性膀胱脱垂提供参考.方法 选择2013年7月至2016年6月海南省妇幼保健院收治的88例经盆腔器官脱垂定量评估系统进行检测初步确诊为阴道前壁膨出、膀胱脱垂的患者作为观察组,另选择88例健康体检者作为对照组.对所有入选者膀胱所处位置超声检查,并测定其膀胱尿道后角静息期和张力时期的倾斜角,分析声像图特征.结果 在静息状态以及最大Valsalva动作时,观察组患者的尿道前角为(121.34±28.74)°,对照组为(123.62±13.71)°,差异无统计学意义(P>0.05),但是观察组患者的前角缩小率为(15.60±0.14)%、明显大于对照组的(9.02±0.07)%,差异有统计学意义(P<0.05);在静息状态以及最大Valsalva动作时,观察组患者和对照组的尿道后角分别为(113.25±12.01)°、(113.29±14.37)°,后角缩小率分别为(3.75±0.16)%、(3.81±0.26)%,差异均无统计学意义(P>0.05);静息状态下,观察组患者和对照组的的会阴长度分别为(5.40±2.03)cm、(5.39±2.51)cm,厚度分别为(7.11±1.36)mm和(6.82±1.29)mm,差异均有统计学意义(P>0.05);观察组患者中直肠膨出2例,膨出物深度为(16.15±5.24)mm,会阴运动过度10例,膨出物深度为(10.15±1.17)mm.结论 经会阴二维超声技术可以获得膀胱脱垂亚型的超声特征,为临床诊断提供参考.     

Robot-assisted laparoscopic rectovaginopexy for rectal prolapse: a prospective cohort study on feasibility and safety

Robotic systems may be particularly supportive for procedures requiring careful pelvic dissection and suturing in the Douglas pouch, as in surgery for rectal prolapse. Studies reporting robot-assisted laparoscopic rectovaginopexy for rectal prolapse, however, are scarce. This prospective cohort study evaluated the outcome of this technique up to one year after surgery. From January 2005 to June 2006, 15 consecutive patients with a rectal prolapse, either with or without a concomitant rectocele or enterocele, underwent robot-assisted laparoscopic rectovaginopexy with support of the da Vinci robotic system. A prospective cohort study was performed on operating times, blood loss, intra-operative and post-operative complications, and outcome at a minimum of one year after surgery. Median age at time of operation was 62 years (33–72) and median body mass index 24.9 (20.9–33.9). Median robot set-up time was 10 min (3–15) and median skin-to-skin operating time was 160 min (120–180). No conversions to open surgery were necessary. No in-hospital complications occurred and there was no mortality. Median hospital stay was four days (2–9). During one year follow-up, two patients needed surgical reintervention. One patient was operated for recurrent enterocele and rectocele one week after surgery. In another patient an incisional hernia at the camera port occurred three months after surgery. At one year after surgery, 87% of patients claimed to be satisfied with their postoperative result. Robot-assisted laparoscopic rectovaginopexy proved to be an effective technique with favourable outcomes in most patients in this prospective series. The operating team experienced the support of the robotic system as beneficial, especially during the dissection of the rectovaginal plane and suturing in the Douglas pouch.     

Validation of the Pelvic Organ Prolapse Quantification Index (POP-Q-I): a novel interpretation of the POP-Q system for optimization of POP research

Even though very precise at describing pelvic organ position, our criticism to the Pelvic Organ Prolapse Quantification (POP-Q) system is its limited ability to quantify the prolapse itself, since it still classifies prolapse into four stages, almost the same way as Baden and Walker (Clin Obstet Gynecol 15(4):1070-1072, 1972) did in 1972. As a result, the same grade can include a wide prolapse intensity range. The objective of this study was to assess inter-observer reliability in the Pelvic Organ Prolapse Quantification Index (POP-Q-I; Lemos et al., Int Urogynecol J 18(6):609-611, 2007) on a prospective randomized trial. Fifty consecutive women were prospectively examined by two members of the urogynecology staff, blinded to each other's results. Spearman's rank correlation was used to assess inter-observer reliability. Excellent correlation coefficients were observed, with an overall coefficient of 96.5% (CI: 0.889-1.042; p < 0.0001). The POP-Q-I is a method that makes POP research more efficient by directly measuring prolapse as a continuous variable, which is statistically more powerful than the categorical variables proposed by the POP-Q system. This study suggests that the POP-Q-I is applicable to clinical POP research.     

17例巴洛综合征的外科治疗

目的 总结17例巴洛综合征的手术治疗,并对其诊断、病因、手术方法进行初步探讨.方法 2005年8月至2007年12月,17例经临床、心脏超声及术后病理确诊有巴洛综合征病人,行二尖瓣成形术或置换术,随访其术后心功能与预后情况,总结巴洛综合征二尖瓣成形术的特点.并对10例上海地区病人进行基因学测序研究,探讨该巴洛综合征病人是否存在FLNA基因的位点发生改变.结果 术后病人心功能均提高至Ⅰ级.12例二尖瓣成形者术后食管超声显示,6例轻微反流,1例轻度反流,5例未测及反流.5例二尖瓣置换术者术后心脏超声均未见反流.所有接受手术治疗者,左心房内径、左心室舒张末内径及左室收缩末内径均较术前明显缩小(P<0.05).基因学测序结果显示,10例病人中有2例在FLNA的EXON1的5'UTR区域G10A位点发生改变.结论 二尖瓣手术(成形术或置换术)是治疗巴洛综合征的有效手段.巴洛综合征的二尖瓣成形术修复较难,有其特殊性,要警惕SAM现象,不能勉强修复;二尖瓣置换术也是一种很好的选择.部分巴洛综合征病人在FLNA的EXON 1的5'URT区域G10A有基因位点改变.     

腱索折叠与人工腱索矫治二尖瓣前瓣脱垂的比较分析

目的 评价腱索折叠和人工腱索两种成形术治疗二尖瓣前瓣脱垂(ALP)的效果.方法 回顾性分析1990年3月至2008年3月接受上述两种成形术治疗的50例ALP患者的临床资料.全组男性29例,女性21例;年龄(42.6±11.3)岁.其中腱索折叠组23例,人工腱索组27例.结果 围手术期腱索折叠组病死率13.0%(3/23),高于人工腱索组的3.7%(1/27)(P=0.199).随访时间为1个月～18年,总随访时间为278人年.两组晚期死亡各3例,5～8年生存率腱索折叠组为70.0%±18.2%,人工腱索组为86.8%±9.2%(χ2=8.17,P=0.046).再次手术腱索折叠组4例,人工腱索组1例,两次手术间隔时间为(26±17)个月;5年免除再次手术率分别为83.3%±15.2%和100%(χ2=12.06,P=0.007).多因素回归分析显示,腱索折叠术是ALP成形术晚期心脏事件的独立危险因素.结论 人工腱索成形术矫治ALP在远期生存上要优于腱索折叠术.     

COL1A1 Sp1-binding site polymorphism as a risk factor for genital prolapse

The objective of this study was to verify the possible association between the Sp1-binding site polymorphism and genital prolapse. A case–control study was conducted in 107 patients with stages III and IV genital prolapse. The control group included 209 women with stages 0 and I. The polymorphism of type I collagen Sp1-binding site was identified by amplification of the first intron of the COL1A1 gene. We did not find differences in the prevalence of the GT and TT genotypes between the groups (p = 0.34), even when we grouped patients with at least one polymorphic allele (GT and TT) and compared them with patients without the polymorphic allele (GG; p = 0.17) The presence of at least one vaginal delivery, family history for prolapse, and macrosomatic fetus were independent risk factors for prolapse. In conclusion, the COL1A1 Sp1-binding site was not significantly associated with genital prolapse among our study subjects.     

痔上黏膜环切钉合术与Milligan—Morgan术治疗Ⅲ、Ⅳ度内痔2年疗效比较

目的比较痔上黏膜环切钉合术（PPH）与Milligan—Morgan术（MMH）治疗Ⅲ、Ⅳ度内痔的远期疗效。方法按照完全随机分组原则将100例Ⅲ、Ⅳ度内痔患者分别采用PPH（PPH组，42例）和MMH（MMH组，58例）手术，观察并比较两组患者术后的远期疗效差异。结果PPH组与MMH组术后2年比较，在出现肛门溢液（2．38％比20．69％，P=0．007）、皮赘（9．52％比25．86％，P=0．040）和细便（2．38％比18．97％，P=0．027）方面PPH组术后少见，总的并发症发生率（9．52％比25．86％，P=0．040）和总排便功能异常（9．52％比29．31％，P=0．017）方面PPH组术后也少见，两组差异有统计学意义。在痔脱垂复发（14．29％比10．34％，P=0．549）、症状改善满意度（92．86％比87．93％，P=0．636）和总的症状复发（19．05％比25．86％，P=0．424）方面两组差异无统计学意义。结论PPH与Milligan-Morgan术治疗Ⅲ、Ⅳ度内痔的远期疗效无显著差异，但PPH安全、并发症少、对排便功能影响小。