经直肠超声检查在妇科疾病中的初步应用

目的 探讨经直肠法妇科超声检查的适应证及其诊断价值.方法 对39例不宜行经阴道超声检查的患者行经直肠法妇科超声检查,分析其声像图特征.结果 24例阴道异常大量出血患者经直肠超声可清晰显示子宫内膜回声和厚度;6例宫颈癌患者经直肠超声可清晰显示宫颈异常回声和血流表现,其中2例可见低回声占位,边界不清;8例无性生活史者和1例先天性阴道闭锁患者经直肠超声可清晰显示子宫体、宫颈、内膜、双侧卵巢及盆腔情况.结论 经直肠法妇科超声检查是一种安全、无创且可行性强的超声检查方法,对不宜行经阴道超声检查的患者,经直肠法可作为良好的替代方式,有较高的临床应用价值.     

Expression of the Ets transcription factor EHF in serous ovarian carcinoma effusions is a marker of poor survival

The EHF (Ets homologous factor) gene was previously shown to be overexpressed in ovarian/primary peritoneal serous carcinoma compared to malignant mesothelioma using gene expression arrays. The objective of this study was to validate this finding at the mRNA level in a larger series. We analyzed the diagnostic role of EHF in 98 ovarian serous carcinoma effusions, 23 malignant mesothelioma specimens (20 effusions, 3 surgical specimens), and 28 primary ovarian serous carcinomas using quantitative real-time polymerase chain reaction. Expression levels of EHF in ovarian carcinoma were additionally investigated for association with clinicopathologic parameters and survival. Quantitative real-time polymerase chain reaction analysis showed significantly higher expression of EHF mRNA in ovarian carcinoma effusions and in primary ovarian carcinoma compared to malignant mesothelioma effusions (P < .001 for both). EHF mRNA expression was additionally higher in primary ovarian carcinomas compared to effusions of this cancer (P < .001). In univariate analysis for all patients with effusions, higher EHF mRNA levels were associated with a trend for shorter progression-free survival (P = .066), which became significant in analysis of 45 patients with primary diagnosis pre-chemotherapy effusions (P = .01). In Cox multivariate analysis, EHF mRNA expression was an independent predictor of poor progression-free survival for all patients and patients with primary diagnosis pre-chemotherapy effusions (P = .033 and P = .009, respectively). EHF mRNA levels differentiate ovarian carcinoma from malignant mesothelioma and may thus be of diagnostic value in this setting. EHF may be a novel prognostic marker in ovarian carcinoma.     

围手术期心理暗示对妇科椎管内麻醉手术患者心理因素的影响

目的 用SCL - 90量表评价围手术期心理暗示对妇科椎管内麻醉手术患者心理因素的影响.方法 采用随机抽样的方法,将276例需椎管内麻醉的妇科患者分为对照组和实验组,对照组接受传统术前、术中、术后护理,实验组除传统护理外给予心理暗示,用SCL - 90量表测量两组病人心理状态.结果 实验组在躯体化、人际关系、抑郁、焦虑、恐惧等方面心理状态明显好于对照组.结论 对妇科椎管内麻醉患者围手术期实施心理暗示疗法能减轻患者抑郁、恐惧、焦虑等心理症状,增强了患者安全度过手术期的信心.     

妇科恶性肿瘤与血小板增多的关系

恶性肿瘤患者常伴有血小板增多,此现象在妇科恶性肿瘤中亦常见,其发生率与恶性肿瘤的类型及分期有关。随着恶性肿瘤患者分期级别的升高,血小板增多的发生率也随着升高,且预后较差。妇科恶性肿瘤可引起血小板增多,血小板增多亦可促进恶性肿瘤的疾病进展与浸润转移,两者形成恶性循环,其机制尚未完全阐明。血小板增多在妇科恶性肿瘤中已被认为是一个独立的预后因素。应用抑制血小板药物可作为抑制恶性肿瘤复发和转移的新手段。     

单孔腹腔镜在妇科的发展现状及展望

随着"无瘢痕手术"设想的提出,自然腔道内镜手术的兴起,减少医源性创伤,使手术方式越来越微创是每位外科医师的愿望。经脐单孔腹腔镜技术不仅具有传统腹腔镜手术的优点,而且还可隐藏手术瘢痕,该技术自被引入微创外科领域以来,越来越受到人们的重视。现回顾单孔腹腔镜称谓的由来;国内外,尤其是在妇科的发展过程及应用现状;介绍单孔腹腔镜的特点及在技术上的改进,并对单孔腹腔镜的未来进行展望。     

持续硬膜外麻醉镇痛分娩的临床分析

目的探讨持续硬膜外麻醉在无痛分娩中的应用。方法对130例产妇分娩时实施硬膜外麻醉并给予相应的助产措施(镇痛组),与70例未实施麻醉者(对照组)进行对比,比较两组产妇第一产程时间和新生儿Apgar评分。结果镇痛组效果优于对照组。镇痛组活跃期宫颈扩张速度较对照组明显加快,第一产程时间明显缩短,新生儿Apgar评分无显著性差异。结论硬膜外麻醉无痛分娩具有安全起效快、持续时间可控制、对产妇生理影响小,对胎儿无不良影响并能缩短产程等优点。配合相应的临床支持,值得推广和应用。     

浅议86例妇科腹腔镜手术的护理

目的探讨妇科腹腔镜手术的护理。方法随机选择妇科腹腔镜手术患者共86例。年龄19.8～64.6岁,平均34.4岁,其中输卵管异位妊娠31例,子宫肌瘤22例,卵巢囊肿14例,畸胎瘤手术8例,输卵管阻塞7例,慢性盆腔炎4例。对照组43例,常规护理:术前准备、肠道准备、阴道准备、饮食护理、预防感染护理、术后即时护理。观察组43例,常规护理措施同上,本组侧重围手术期心理、疼痛、皮肤护理。两组孕妇年龄、体重、疾病种类、手术时间无显著差异。比较两组病例相关并发症。数据处理使用SPSS 15.0软件。结果观察组患者术后表现为轻、中度疼痛,无重度疼痛,情绪稳定,P<0.01,差异有统计学意义。伤口愈合表现为甲级愈合,明显优于对照组,无压疮发生。结论常规护理以及侧重心理、疼痛、皮肤护理对于妇科腹腔镜手术病例康复有积极的临床意义。     

妇科腹腔镜手术中不同麻醉方法效果分析

目的探讨不同麻醉方式在妇科腹腔镜手术中的麻醉效果。方法将60例接受妇科腹腔镜手术的患者随机分为2组,采用气管内插管全麻和硬膜外复合静脉麻醉,观察比较2组麻醉情况。结果 2组气腹后20 m in和放气后20 min MAP、HR、SpO2等与麻醉前比较变化并不明显,差异无显著性（P〉0.05）,2组比较差异也无统计学意义（P〉0.05）。结论全麻和硬膜外复合静脉麻醉均能很好地满足手术的要求,硬膜外复合静脉麻醉有丙泊酚用量少、患者拔管时间短等优势。     

Medicinal plants used in Hmong women's healthcare in northern Thailand

Ethnopharmacological relevance

We studied traditional knowledge of medicinal plants used for women's healthcare in three Hmong villages in northern Thailand and determined how prevalent such knowledge is. We documented traditional medical practices and determined which of the species used are culturally important among the Hmong.

Materials and methods

We interviewed six key informants and 147 non-specialist informants about their traditional knowledge of medicinal plants used in Hmong women's healthcare. We selected nine species that were known in all three villages as the domain for questionnaire interviews with 181 additional and randomly selected non-specialist informants. We calculated the Cultural Importance index (CI) for each species and use category. We tested normality of the data, age correlations, and gender correlations with Kolmogorov-Smirnov tests, Spearman's rank correlation coefficient, Kruskal-Wallis test, and Mann-Whitney tests.

Results

We documented traditional knowledge of 79 medicinal plants used in women's healthcare. Of these, three species were culturally important to the Hmong. Our questionnaire interviews revealed significant difference in traditional medicinal plant knowledge between genders and age groups.

Conclusions

The Hmong people in northern Thailand possess large amounts of traditional knowledge related to women's healthcare and plants used for this purpose. However, this knowledge, even for the culturally important species, is not possessed by all Hmong and there were signs of knowledge erosion. Preservation of the Hmong intellectual heritage related to medicinal plants used in women's healthcare requires intensive traditional knowledge dissemination to the young Hmong generation.