微管微创人工流产术终止妊娠的临床观察

目的观察微管微创人工流产术终止妊娠的疗效。方法将本院2010年1月至2013年9月收治的行人工流产术的孕妇120例根据人工流产方式不同分为传统手术组和微管微创手术组,每组各60例。微管微创手术组孕妇行微管微创人工流产术,传统手术组孕妇行传统负压吸宫术。观察两组孕妇术后疼痛情况、手术时间、术中出血量、疗效及阴道流血时间。结果微管微创手术组孕妇1级疼痛者多于传统手术组,2、3级疼痛者较传统手术组少,手术时间、术中出血量均明显少于传统手术组,差异均具有显著性(P<0.05)。两组孕妇均完全流产,微管微创手术组孕妇术后阴道出血时间为(4.3±2.9)分钟,传统手术组为(7.8±2.9)分钟,两组比较差异具有显著性(t=18.61,P<0.05)。结论微管微创人工流产术较传统负压吸宫术,孕妇痛苦小,出血量少,流产成功率高,是终止早期妊娠的理想选择方案。     

剖宫产合并子宫肌瘤切除术40例临床分析

目的探讨剖宫产时行子宫肌瘤切除术的安全性及可行性。方法 40例妊娠合并子宫肌瘤患者(治疗组)行剖宫产合并子宫肌瘤切除术;对42例妊娠无子宫肌瘤患者(对照组)行剖宫产术。比较2组手术时间及术中出血情况。结果治疗组手术时间为(59.12±6.29)min长于对照组的(31.24±5.21)min,差异有统计学意义(P<0.05);2组术中出血量比较差异无统计学意义(P>0.05)。结论对于经验丰富的医师,恰当把握适应证,对于妊娠合并子宫肌瘤患者在剖宫产术时行子宫肌瘤切除术是安全可行的。     

曲马多配伍安定在瘢痕子宫妊娠引产中的应用

目的探讨曲马多配伍安定在瘢痕子宫妊娠引产中镇痛及缩短产程的作用。方法选择2009~2011年自愿要求终止妊娠的瘢痕子宫患者112例,采用完全随机分组方法,分为观察组和对照组各56例,观察组引产中给予安定10 mg,盐酸曲马多100 mg,对照组引产中不另给药。观察两组产程时间和镇痛效果。结果观察组产程时间、镇痛效果均优于对照组(P0.05)。结论瘢痕子宫引产中使用曲马多配伍安定,能缩短产程,减轻患者疼痛,适合基层医院应用推广。     

2014-2018年某院剖宫产率及剖宫产指征的变化情况分析

目的分析我院2014-2018年剖宫产率及剖宫产指征的变化,探讨降低剖宫产率的策略和措施。方法回顾性分析2014年1月至2018年12月于我院行剖宫产分娩的42385例产妇的临床资料,分析其剖宫产率及主要剖宫产指征。结果2016年的剖宫产率均低于2014年、2015年、2017年、2018年,差异具有统计学意义(P<0.05)。瘢痕子宫在二胎政策开放后所占比例明显增加;羊水过少及相对头盆不称所占比例呈现逐年下降的趋势。2014-2018年,母体因素所占比例均最高,胎儿因素及头盆因素所占比例逐年下降。另外,社会因素在二胎生育政策开放后仍呈上升趋势。结论2016年剖宫产率明显下降,瘢痕子宫在二胎政策开放后所占比例明显增加。临床需提高剖宫产术后再次妊娠阴道试产的比例、提高助产技术水平、发挥营养门诊及助产士门诊的作用、提高产科医生对胎心监护的正确解读以降低剖宫产率。     

Detection and Characterization of Hyperlipoproteinaemia in Middle-aged Men

Serum lipoprotein (LP) concentrations were determined and LP patterns were classified in 261 middle-aged men, recruited from a health examination survey, with serum lipid values above the 80th percentile of the same population. Individuals with hyperlipoproteinaemia (HLP) and normolipidaemic controls were characterized also regarding family history of cardiovascular disease, socio-economic factors and clinical and laboratory variables. Subjects with HLP type IV–V and IIB were overweight and showed hyperuricaemia and hyperinsulinaemia compared with normolipidaemic controls and subjects with HLP type IIA. The latter showed elevated erythrocyte sedimentation rate. In spite of being overweight, subjects with HLP type III showed normal fasting values of insulin and uric acid in serum and normal early insulin response to intravenous glucose. The glucose tolerance did not differ significantly between the groups. Men with HLP types IV–V had predominantly sedentary occupations, in contrast to those with type IIA. There were significantly more smokers in the groups with HLP type IIB and IV–V than in the control group. Thus, individuals with different types of HLP tend to show different metabolic profiles but also different socioeconomic and clinical patterns, suggesting that exogenous factors are of importance in the expression of the LP abnormalities.     

疤痕子宫经阴道分娩的护理体会

目的总结疤痕子宫再妊娠经阴道分娩产妇的护理体会。方法选取2015年8月-2016年1月疤痕子宫再妊娠经阴道分娩产妇39例,采取严密监护及加强心理护理。结果 39例疤痕子宫再次妊娠经阴道分娩的产妇中,足月产37例,早产2例,均顺利阴道分娩,新生儿平均体重(3.2±0.62)kg,无产后出血,无子宫破裂,产后恢复良好,母婴安全,结局满意。结论在疤痕子宫产妇行阴道试产过程中加强产程护理和心理护理,有助于提高阴道试产成功率,提升护理工作质量。     

腹腔镜下子宫肌瘤剥除术的临床体会及效果分析

目的探讨采用腹腔镜手术剥除子宫肌瘤的临床效果.方法 搜集来我院就诊的采取腹腔镜手术的子宫肌瘤患者38例,对其病例资料做回顾性分析.结果 全部患者手术成功,术中术后均无并发症,术后随访3个月症状全部缓解.结论 腹腔镜子宫肌瘤剥除术创伤小,疼痛轻,术中出血少,术后并发症少,恢复快,是可以广泛应用到临床的微创手术方式.     

Clinicopathologic features and clinical outcomes of intravenous leiomyomatosis of the uterus: A case series

Rationale:Intravenous leiomyomatosis (IVL) is a rare and special type of smooth muscle tumor originating in the uterus. It is classified as a benign disease according to its histological features but shows the behavioral characteristics of a malignant tumor. It is easily misdiagnosed and recurrent. The purpose of this study was to retrospectively analyze clinicopathological data of 25 cases of IVL in order to enhance clinicians’ understanding of this rare disease.Patient concerns:We screened and identified 25 cases of IVL at our hospital from October 2013 to January 2020. Five patients had tumors.Diagnoses:The diagnosis in each case was pathologically confirmed after surgical treatment.Interventions:All patients were managed surgically. Although the surgical procedures were different, the surgical approach was geared towards achieving complete excision. Three patients received hormonal therapy with gonadotropinreleasing hormone agonists after surgery.Outcomes:We retrospectively reviewed all medical records and analyzed the clinicopathologic features and clinical outcomes of this disease as well as the correlations between the clinical features and risk of recurrence. Neither the symptoms nor the preoperative imaging results were suggestive of IVL in any of the cases. Except for two patients who were lost to follow-up, twenty-three patients who were followed up are still alive. Three patients experienced a recurrence.Lessons:The clinical manifestations and ultrasound images of IVL in the early stages are not typical; thus, IVL is easily misdiagnosed as uterine leiomyoma. Radiologists, pathologists, and surgeons should have a thorough understanding of IVL and a high index of vigilance for IVL in clinical practice. Surgery should always be aimed at achieving complete tumor excision. Patients with large lesions (≥7 cm) and lesions extending to the broad ligament may have an increased risk of recurrence. Early detection, diagnosis, and treatment are very important; once the diagnosis is confirmed, regular follow-ups are crucial.     

Transcervical Foley’s catheter versus Cook balloon for cervical ripening in stillbirth with a scarred uterus: a randomized controlled trial

Objective: To compare the efficacy and safety of the use of transcervical Foley’s catheter versus Cook cervical ripening balloon in pregnant women with stillbirth, unfavorable cervix and scarred uterus.

Design: Randomized controlled study.

Setting: El Minia University Hospital, El Minia, Egypt.

Patients and methods: Two-hundred pregnant women with stillbirth, unfavorable cervix and scarred uterus were recruited into this study. They were randomized into two groups. In group I (n?=?100), cervical ripening was done using Foley’s catheter. In group II (n?=?100), cervical ripening was done using Cook cervical ripening balloon.

Main outcome measures: Balloon insertion to delivery interval, successful ripening rate, cesarean delivery rate, maternal adverse events and maternal satisfaction.

Results: Time from balloon insertion to expulsion and from balloon insertion to delivery was significantly shorter in Foley’s catheter group. However, the difference between the two groups regarding time from balloon insertion to active labor, time from balloon expulsion to delivery, cervical ripening, cesarean section, instrumental delivery, pain score, need for analgesia, hospital stay and maternal satisfaction was not statistically significant.

Conclusions: Foley’s catheter and Cook cervical ripening balloon are comparable regarding efficacy and safety profile when used to ripen the cervix in pregnant women with stillbirth, unfavorable cervix and scarred uterus. However, Foley’s catheter has a shorter induction to delivery interval and is relatively cheaper device.     

郭霞珍教授活血化瘀法治疗青春期崩漏经验

郭霞珍教授认为肝脾肾三脏的功能失调与青春期崩漏的发生关系密切,如肝郁血热、脾虚失摄、肾精不足等。无论何种原因导致的崩漏,血出日久,或过用固涩药物止血,最终均可发展为血瘀。故临床治疗应以活血化瘀以澄其源,同时针对"瘀"形成的不同原因,佐以疏肝清热、健脾益气或补肾填精,方能取得预期疗效。