肝脏囊型包虫病腹腔镜与开腹根治性手术治疗的疗效比较

目的 评价和比较经腹腔镜与开腹根治性手术治疗肝脏囊型包虫病的临床疗效.方法 回顾性分析2006年5月至2013年1月收住并接受根治性手术治疗的肝脏囊型包虫病患者的临床资料,并对手术时间、术中出血量、中转开腹率、平均术后住院时间、术后并发症进行统计学分析.结果 本研究共纳入153例患者,其中41例行经腹腔镜手术(腹腔镜组)、112例行传统开腹手术(开腹组).腹腔镜组平均手术时间较开腹手术短,但差异无统计学意义(t=1.97,P＞0.05).腹腔镜组5例患者行中转开腹手术,中转开腹率为12.2％(5/41).2组术中出血量比较差异无统计学意义(t=2.00,P＞0.05).腹腔镜组平均术后住院时间为3～8 d,而开腹组为4～14d,差异有统计学意义(t=1.99,P＜0.05).腹腔镜组并发症发生率为4.9％(2/41)、开腹组并发症发生率16.0％(18/112),差异有统计学意义(x2=3.92,P＜0.05).结论 腹腔镜肝包虫根治性手术治疗较传统开腹肝脏囊型包虫病手术治疗具有术后住院时间短,并发症少,恢复快,复发率低的特点,在严格选择患者的条件下是安全和可行的.     

The prevalence of short cervix between 20 and 24 weeks of gestation and vaginal progesterone for prolonging of gestation

Objective: The objective of this study is to understand the prevalence of short cervical length between 20 and 24 weeks gestation in China and to evaluate the efficacy of micronized progesterone for prolonging gestation in nulliparous patients with a short cervix.

Methods: From May 2010 to May 2015, a total of 25?328 asymptomatic women with singleton pregnancies at Peking University First Hospital had their cervical length routinely measured between 20 and 24 weeks of gestation. A cervical length of 25?mm or less was defined as a shortened cervical length. The therapies prescribed include vaginal micronized progesterone capsules (200?mg each night) or bed rest from 20 to 34 weeks of gestation. The primary outcome was spontaneous delivery before 33 weeks.

Results: (1) One hundred fourteen women had a cervical length of?≤25?mm (0.45%). (2) Twenty-nine of which with previous spontaneous preterm delivery or late pregnancy loss had cervical cerclage, the remaining 85 women by the use of vaginal progesterone or simply resting activity restriction to prevent preterm birth. (3) In 85 nulliparous women treated by progesterone or bed rest, progesterone use in cervical length between 10 and 20?mm was associated with a statistically significant reduction in the incidence of preterm birth at <33 weeks of gestation (9.5% versus 45.5%, p?=?0.02) compared with bed rest. There were no significant differences in cervical length between 20 and 25?mm in their rates of spontaneous preterm delivery at <33 (5.3% versus 3.2%, p?=?0.72), <37 (33.3% versus 54.5%, p?=?0.25), or <35 weeks (14.3% versus 45.5, p?=?0.06) of gestation between vaginal progesterone and bed rest.

Conclusion: The rate of short cervical length was less than expected. Vaginal progesterone is efficacious for the prolonging of gestation in women with a cervical length of 10–20?mm in the mid-trimester for a singleton gestation and nulliparous women. For a cervical length of 20–25?mm in the mid trimester, vaginal progesterone compared with bed rest did not prolong pregnancy.     

早产预测的研究现状

早产的预测手段包括病史、宫颈长度和阴道分泌物中生物标志物检测等。建议针对早产高危人群进行宫颈长度的筛查和监测。生物标记物对无症状孕妇的早产预测价值尚不能肯定,但对于先兆早产孕妇有一定的预测价值,可以联合宫颈长度的超声检测提高预测的准确性。今后仍然需要进一步研究预测方法的有效性。     

胎儿脐动脉舒张末期血流缺失22例分析及妊娠结局

目的探讨妊娠期发生脐动脉舒张末期血流缺失（absentend—diastolic velocity,AEDV）的原因及与围生儿结局的关系。方法对2009年1月至2011年12月北京大学第一医院22例AEDV母儿的临床资料进行回顾性分析,并追踪妊娠结局。结果22例孕妇中,17例有合并症或并发症,5例无合并症或并发症。17例患者中,子痫前期13例,其中合并胎儿生长受限（FGR）5例,慢性高血压并发子痫前期1例,肾源性高血压并发子痫前期3例;单纯FGR者1例。慢性高血压合并妊娠1例;先天性心脏病（法洛四联症术后）1例;原发性抗磷脂综合征1例。双胎妊娠2例,其中选择性FGR1例,死胎1例;胎儿畸形3例,分别为尿道下裂、房间隔缺损及染色体异常（21-三体）,其中胎儿房间隔缺损孕妇合并重度子痫前期和FGR。结论以子痫前期为主的妊娠并发症是妊娠中晚期胎儿脐动脉血流缺失的主要病因。双胎妊娠中AEDV与选择性FGR有关。在无明确合并症或并发症的情况下出现AEDV应进一步寻找胎儿原因。