剖宫产瘢痕妊娠患者甲氨蝶呤胎囊注射联合B超监测下清宫术的疗效分析

目的 探究甲氨蝶呤胎囊注射联合B超监测下清宫术治疗剖宫产瘢痕妊娠患者的临床效果。方法 回顾性分析2014年10月至2017年10月安钢总医院收治的87例剖宫产瘢痕妊娠患者临床资料,按治疗方案不同分为对照组（n=43）与试验组（n=44）。对照组患者单纯采取甲氨蝶呤胎囊注射治疗,试验组患者采取甲氨蝶呤胎囊注射联合B超监测下清宫术治疗。对比两组患者的临床效果、月经恢复时间、包块消失时间、血人绒毛膜促性腺激素（HCG）转阴时间、阴道出血时间、住院时间及治疗前、治疗后2个月生活质量评分（SF-36）。结果 试验组治疗后总有效率（88.64%）高于对照组（67.44%）,差异有统计学意义（P<0.05）;与对照组相比,试验组包块消失时间、血HCG转阴时间、阴道出血时间、住院时间均较短,差异有统计学意义（P<0.05）;两组患者治疗后2个月SF-36评分均提高,且试验组提高水平高于对照组,差异有统计学意义（P<0.05）。结论 剖宫产瘢痕妊娠患者予以甲氨蝶呤胎囊注射联合B超监测下清宫术治疗可明显改善临床效果,缩短患者恢复时间,改善患者生活质量。     

Tumor Treated by Endoscopy

Background

This study was conducted to examine the clinical usefulness and efficacy of endoscopic curettage on benign bone tumor.

Methods

Thirty-two patients (20 men and 12 women) with benign bone tumor were included in the study. The patients were aged between five and 76 years; the mean follow-up period was 27.05 months (range, 9.6 to 39.9 months). The primary sites include simple bone cyst (9 cases), fibrous dysplasia (6 cases), enchondroma (5 cases), non-ossifying fibroma (4 cases), bone infarct (3 cases), aneurysmal bone cyst (1 case), chondroblastoma (1 case), osteoblastoma (1 case), intraosseous lipoma (1 case), and Brodie abscess (1 case). A plain radiography was performed to assess the radiological recovery. Radiological outcomes, including local recurrence and bone union, were evaluated as excellent, good, poor, and recurred.

Results

In our series, there were 27 cases (84.4%) of good or better outcomes, six cases (18.8%) of complications (4 local recurrence, 1 wound infection, and 1 pathologic fracture).

Conclusions

Our results showed that endoscopic curettage and bone graft had a lower rate of recurrence and a higher cure rate in cases of benign bone tumor. It can, therefore, be concluded that endoscopic curettage and bone graft might be good treatment modalities for benign bone tumors.     

伴放线放线杆菌在龈下菌斑和颊黏膜分布研究

目的:比较伴放线放线杆菌(actinobac illus actinomycetem com itans,A.a)在不同类型牙周炎患者龈下菌斑和颊黏膜中的分布。方法:通过聚合酶链反应(polym erase chain reaction,PCR)对侵袭性牙周炎患者(AgP)、慢性牙周炎患者(CP)、牙周健康者口腔龈下菌斑和颊黏膜中的A.a进行检测,分析该菌分别在两部位的相对含量。结果:AgP组菌斑和颊黏膜样本中A.a阳性检出率均为41.7%,分别高于CP组(菌斑16.7%、颊黏膜10.0%)和牙周健康组(菌斑和颊黏膜均为0%)。AgP组A.a在菌斑和颊黏膜的相对含量分别为38.5%和22.2%,高于CP组(菌斑19%、颊黏膜12.75%)。结论:A.a不仅存在于龈下菌斑中,也能够粘附于颊黏膜;A.a是AgP的主要优势菌也参与了CP的菌群组成。     

CGF联合根尖刮治术及单一根尖刮治术治疗慢性窦道型根尖周炎的比较

目的 探讨血小板浓缩生长因子(CGF)联合根尖刮治术及单一根尖刮治术治疗慢性窦道型根尖周炎的临床疗效.方法 选择80例慢性窦道型根尖周炎患者为研究对象,分成CGF组和对照组.对照组采取根尖刮治术治疗,CGF组在对照组基础上给予CGF覆盖根尖区创面治疗.结果 CGF组治疗后总有效率95.00％显著高于对照组77.50％....     

高强度聚焦超声联合甲氨蝶呤在瘢痕子宫妊娠行宫腔镜微创清宫术中的应用效果分析

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...     

Surgical management of early pregnancy failure: history, politics, and safe, cost-effective care

Early pregnancy failure and induced abortion are often managed differently, even though safe uterine evacuation is the goal in both. Early pregnancy failure is commonly treated by curettage in operating room settings in anesthetized patients. Induced abortion is most commonly managed by office vacuum aspiration in awake or sedated patients. Medical evidence does not support routine operating room management of early pregnancy failure. This commentary reviews historical origins of these different care standards, explores political factors responsible for their perpetuation, and uses experience at University of Michigan to dramatize the ways in which history, politics, and biomedicine intersect to produce patient care. The University of Michigan initiated office uterine evacuations for early pregnancy failure treatment. Patients previously went to the operating room. These changes required faculty, staff, and resident education. Our efforts blurred the lines between spontaneous and induced abortion management, improved patient care and better utilized hospital resources.     

Urinary catheter stent placement for treatment of cervical stenosis

BACKGROUND: Cervical stenosis is an uncommon condition that may result in significant distress in premenopausal women. Those affected may present with amenorrhoea and associated cyclical, monthly pain, infertility and haematotrachelos/haematometra. AIM: To describe a safe, easy and effective treatment method for cervical stenosis. Methods: The cervical canal is identified and dilated under ultrasound guidance. A urinary catheter stent is then placed in the cervical canal for two weeks. RESULTS: Of the five patients who underwent treatment for cervical stenosis, all had normal menstrual cycles restored. Four of these patients successfully became pregnant after treatment. Three of the four patients progressed to uncomplicated births at term (gestation). The fourth patient underwent a termination of pregnancy in the second trimester for a fetal abnormality. CONCLUSIONS: Cervical dilatation under ultrasound guidance with temporary urinary catheter stent placement appears to be both effective and safe in the treatment of cervical stenosis. Pregnancy outcomes after treatment were optimal in our case series.     

Angiographic uterine artery embolization followed by immediate curettage: an efficient treatment for controlling heavy bleeding and avoiding recurrent bleeding in cervical pregnancy

Two cases of cervical pregnancy with heavy bleeding successfully treated by uterine artery embolization (UAE) followed by immediate curettage are described in this report. Case 1 demonstrated intermittent bleeding after serious bleeding was successfully controlled by UAE. Serum beta human chorionic gonadotropin (beta-hCG) level rose remarkably after a short time decline. Transvaginal sonography consistently revealed a heterogeneous mass in the cervix. Repeated UAE followed by immediate curettage was performed and complete resolution was achieved. Case 2 was also successfully managed by UAE followed by immediate curettage after failure of medical treatment. This report suggests that UAE followed by immediate curettage is a safe and efficient procedure for controlling heavy bleeding and avoiding recurrent bleeding when fertility capacity is desired in cases of cervical pregnancy with fetal cardiac activity and high beta-hCG concentration.     

Comparison of D&C and hysteroscopy after UAE in the treatment of cesarean scar pregnancy: A case-control study

Cesarean scar pregnancy (CSP) stands for the severe complication secondary to cesarean section, and its incidence shows an increasing trend recently. However, no consensus has been reached about the CSP treatment. This study aims to explore the necessity of hysteroscopy (H/S) after preventive uterine artery embolization (UAE).A case-control report. The childbearing CSP patients with a cesarean section history were evaluated by ultrasonography, with a gestational age of less than 10 weeks. Thirty-four patients receiving dilation and curettage (D&C) after UAE were enrolled into the D&C group, whereas 46 undergoing H/S and curettage after UAE were enrolled into the H/S group.Differences in success rate and decrease in the β-hCG level in serum on the second day of surgery were not significantly different between D&C and H/S groups (P > .05). Also, differences in side effect rate (except for the anesthesia-related side effects), intraoperative blood loss amount, postoperative bleeding time, and total length of hospital stay were not significant between 2 groups (P > .05). Compared with D&C group, H/S group had decreased postoperative length of hospital stay (P < .05), increased hospitalization cost (P < .05), and significantly elevated time of CSP mass disappearance (P < .05). In addition, 8 (18.19%) patients in H/S group developed anesthesia-related side effects.This study reveals no obvious difference between UAE + D&C and UAE + H/S in terms of the clinical efficacy and safety, except for the time of CSP mass disappearance and anesthesia-related side effects. The hospitalization cost is more expensive for UAE + H/S, but the postoperative length of stay is shorter for UAE + H/S. UAE + H/S is associated with the risk of anesthesia-associated side effects.     

腹腔镜下妊娠病灶切除术对Ⅱ、Ⅲ型剖宫产瘢痕部位妊娠患者术后康复效果及卵巢内分泌功能的影响

目的 探讨腹腔镜下妊娠病灶切除术对Ⅱ、Ⅲ型剖宫产瘢痕部位妊娠(CSP)患者术后康复效果及卵巢内分泌功能的影响.方法 回顾性分析2019年3月至2021年2月就诊于我院的70例Ⅱ、Ⅲ型CSP患者的临床资料,根据不同治疗方式将其分为A组(n=35,腹腔镜下妊娠病灶切除术)与B组[n=35,双侧子宫动脉栓塞术(UAE)联合清...