腹壁会阴切口子宫内膜异位症30例临床分析

目的探讨腹壁子宫内膜异位症(内异症)的发病机制、诊断和治疗。方法回顾性分析我院1987年-2003年收治的30例腹壁会阴切口内异症的临床特点、治疗方法。结果30例患者中,腹壁内异症患者22例,均有剖宫产手术史,会阴EP切口内异症8例。均有典型周期性腹痛,肿块,手术切除均取得良好效果,未有复发。结论子宫内膜异位种植是本症的主要发病机制。根据典型的症状、体征,结合B超可正确诊断。彻底手术是唯一确实有效的治疗方法。     

会阴部瘢痕挛缩畸形45例整复治疗

目的　讨论、总结会阴部瘢痕挛缩畸形整复治疗的经验。方法　我科自 1989年以来对 4 5例会阴部瘢痕挛缩畸形患者进行了整复治疗。术前强调肠道清洁和局部瘢痕清洗 ;术中根据瘢痕挛缩畸形的具体情况 ,联合采用局部皮瓣及中厚皮片移植 31例 ,全厚皮片移植 8例 ,单纯用局部皮瓣移植 6例 ;术后注意保持创面的清洁干燥和进行及时有效的功能锻炼。结果　患者在接受整复治疗后形态、功能均获得良好恢复 ,总优良率达 95 .5 %。结论　根据会阴部瘢痕挛缩畸形的特殊性 ,重视术前准备及术后处理 ,合理设计、选择手术方法 ,才能够获得满意的治疗效果     

探讨无保护会阴接生法与传统接生法对会阴裂伤程度的效果比较

目的探讨无保护会阴接生法与传统接生法对会阴裂伤程度的效果比较。方法选取我院2013年11月~2014年3月间接收的516例临产妇作为观察对象,随机分为观察组和对照组各258例,观察组采取无保护会阴接生法,对照组采用传统接生法,比较两组产妇会阴裂伤程度。结果对照组产妇的会阴裂伤程度明显比观察组严重,比较有明显差异,P0.05。结论无保护会阴接生法相对于传统接生法能够明显降低产妇的会阴撕裂程度。     

品管圈在促进会阴伤口愈合中的临床应用

【】目的 探讨品管圈(QCC)活动在促进阴道分娩产妇会阴伤口愈合中的临床效果。方法 成立QCC小组,找出影响阴道分娩产妇会阴伤口愈合的相关因素,针对出现的问题进行分析,找出原因,提出整改措施,制定规范的操作流程,再进行PDCA循环,在临床中检测方法的有效性,从而不断提高助产质量,提高产妇的生活质量。结果 观察组产后会阴伤口愈合不良的发生率明显低于对照组,两组比较,差异有统计学意义(X₂=6.3421, p<0.05)。结论 通过QCC,可有效提高阴道分娩产妇伤口愈合率,减轻产妇的痛苦,提高了产妇的生活质量。     

Bacteriostasis evaluation of the different soaking solutions in perineal skin preparation before the male urethral open operation: a randomized controlled trial

Perineal soaking is of crucial importance for skin preparation before the male urethral open operation; however, soaking solutions vary across the world. The aim of this research was to explore the bacteriostasis efficacy of the different soaking solutions in perineal skin preparation before the operation. Thirty‐six patients were randomly divided into three groups. In Group A, 0·1% povidone iodine was used to soak the 12 patients' perineum to reduce the bacterial load of the skin preparation before the operation. Similarly, combination of 0·1% povidone iodine and 1·6% saline for Group B and 1·6% saline for Group C was used. Bacteria samples were collected in four sites of the patients' perineum, before soaking, 1 d after soaking and 2 d after soaking, respectively. No serious adverse reactions were observed. There was a significant lower bacteria load in Group C after soaking (P = 0·032). For penoscrotal junction, there were significant lower bacteria loads after soaking in both Group A and Group B compared with Group C (P = 0·009), and there was significant lower bacteria load after soaking in Group A (P = 0·001) and Group B (P = 0·017). Similar with penoscrotal junction, bacteria load at the bottom of the scrotum decreased significantly in Group A (P = 0·001) and Group B (P = 0·002) and there were significant lower bacteria loads after soaking in both Group A and Group B compared with Group C (P = 0·041). In the middle of the penis, still, there were significant lower bacteria loads after soaking in both Group A and Group B compared with Group C (P = 0·019), and there was significant lower bacteria load after soaking in Group A (P = 0·012) and Group B (P = 0·006). In conclusion, combination of 0·1% povidone iodine and 1·6% saline solution for the preoperative skin preparation of male open urethral operation is safe and efficient.     

Anal sphincter reconstruction and perineal resurfacing with a gracilis myocutaneous flap

A 60-year-old woman with radiation proctitis and perineal radiodermatitis has been treated by one-stage transfer of a gracilis myocutaneous flap, utilizing the muscle to restore anal sphicter function and the skin for perineal resurfacing.     

经腹超声联合经会阴超声在前置胎盘诊断中的应用价值

目的 探讨经腹超声联合经会阴超声在前置胎盘诊断中的应用价值。方法 纳入2018年1月～2019年5月我院明确诊断为前置胎盘的80例患者进行研究,所有患者均同时接受经腹超声与经会阴超声检查。比较经腹超声检查、经会阴声检查以及经腹超声与经会阴声联合检查对前置胎盘的检出情况以及对前置胎盘分型的诊断结果。结果 经会阴超声检查与经腹超声检查对前置胎盘的检出率组间无统计学差异(P0.05);经腹超声与经会阴超声联合检查对前置胎盘的检出率显著高于经腹超声检查和经会阴超声检查,差异有统计学意义(P0.05);经会阴超声检查与经腹超声检查对前置胎盘各分型的诊断准确率组间无统计学差异(P0.05);经腹超声与经会阴超声联合检查对前置胎盘各分型的诊断准确率均显著高于经腹超声检查,差异有统计学意义(P0.05);经腹超声与经会阴声联合检查对低置胎盘的诊断准确率显著高于经会阴超声检查,差异有统计学意义(P0.05)。结论经腹超声联合经会阴超声对前置胎盘的诊断和分型准确率优于两种检查方式单独使用,值得临床推荐。     

女性会阴整形现状

综述国内外女性会阴整形的研究现状,对会阴部整形按照以功能重建、形态重塑与满足心理需求为目的进行分类,并对手术、微创与激光治疗方法进行了临床经验归纳。3种治疗方式各有适应证与禁忌证,手术方法包括阴道再造术、会阴成形术、小阴唇缩小术、处女膜修补术、阴道缩紧术、阴蒂肥大缩小整形术;微创技术方法包括激光、射频治疗阴道松弛和压力性尿失禁,以及应用自体脂肪组织、胶原蛋白、透明质酸、透明质酸联合PRP的注射填充治疗。会阴部整形因受传统文化的影响存在就诊、评价与整形治疗技术不规范,应尽快研究制订诊疗标准;激光和射频治疗因缺乏大样本研究,临床作用机制不详,应进行规范入组随机对照的临床观察;注射填充治疗多为非标签用药,未见文献报道对疾病的治疗作用,且存在后果严重的出血、栓塞等并发症的报道,因此应在伦理委员会的指导下谨慎实施。     

超声诊断会阴子宫内膜异位症

目的探讨超声诊断会阴子宫内膜异位症的价值。方法回顾性分析23例经手术和病理证实的会阴子宫内膜异位症患者的声像图表现。结果 23例中,经会阴超声检出24个内膜异位症病灶。91.67%(22/24)病灶超声表现为边界不清的结节状或条束状实性低回声或囊实性混合回声,CDFI于59.09%(13/22)的病灶内探及血流信号。本组5例接受激素治疗(GnRHa),用药后病灶明显缩小。经会阴超声判断肛门括约肌是否受累均与手术结果一致。结论经会阴超声检查能够发现并诊断会阴子宫内膜异位症,并评价肛门括约肌受累情况,对术前制定手术方案具有指导意义。