Objective To explore the effect of probiotics combined with prebiotics on clinical hypothyroidism during pregnancy combined with small intestinal bacterial overgrowth. Methods (1) In total, 441 pregnant women were included in this study. A total of 231 patients with clinical hypothyroidism during the second trimester of pregnancy and 210 normal pregnant women were enrolled in the lactulose methane-hydrogen breath test. The positive rate of intestinal bacterial overgrowth (SIBO), gastrointestinal symptoms, thyroid function and inflammatory factors were compared between the two groups by chi-square test and two independent sample t-test. (2) SIBO-positive patients in the clinical hypothyroidism group during pregnancy (n=112) were treated with probiotics combined with prebiotics based on conventional levothyroxine sodium tablets treatment. The changes in the methane-hydrogen breath test, gastrointestinal symptoms, thyroid function and inflammatory factors were compared before treatment (G0) and 21 days after treatment (G21) by chi-square test and paired sample t test. Results (1) The positive rates of SIBO in pregnant women in the clinical hypothyroidism group and control group were 48.5% and 24.8%, respectively. (2) The incidence of abdominal distention and constipation in the clinical hypothyroidism group was significantly higher than that in the control group, and the risk of abdominal distention and constipation in SIBO-positive pregnant women was higher than that in SIBO-negative pregnant women. (3) The serum levels of hypersensitive C-reactive protein (hsCRP), IL-10, IL-6, TNF-α, low-density lipoprotein (LDL), total cholesterol (TC), free fatty acids (FFAs) and apolipoprotein B (ApoB) in the hypothyroidism group during pregnancy were higher than those in the control group. (4) After 21 days of probiotics combined with prebiotics, the incidence of pure methane positivity in the methane-hydrogen breath test in the G21 group was significantly reduced, and the average abundance of hydrogen and methane at each time point in the G21 group was lower than that in the G0 group. (5) The incidence of constipation in the G21 group was significantly lower than before treatment. (6) The levels of serum TSH, hsCRP, IL-6, TNF-α, TC and LDL in pregnant women after probiotics combined with prebiotics were lower than those before treatment. Conclusion Probiotics combined with prebiotics are effective in the treatment of pregnant patients with clinical hypothyroidism complicated with SIBO, providing a new idea to treat pregnant patients with clinical hypothyroidism complicated with SIBO.
早发性卵巢功能不全(POI)对女性最大的危害是生殖功能提前衰退和过早出现的低雌激素状态.临床上多数POI患者的生育愿望难以顺利实现,常常需要借助供卵体外受精-胚胎移植(IVF-ET)治疗完成.但是POI患者除生殖以外的卵巢内分泌功能完全可以通过激素补充治疗(HRT)实现,从而有效改善低雌激素状态,预防远期并发症,提高患者生活质量.尤其是对于青春期女性诱发第二性征,维护正常性心理、促进性健康和骨健康等尤为重要.POI患者只要排除了禁忌证,应尽早开始HRT,并坚持长期使用,直至妇女平均绝经年龄(50岁),再按绝经激素治疗(MHT)流程判断是否可以继续采用绝经激素治疗.
腹腔镜下全子宫切除术为妇科良性疾病常见的手术方式.随着腹腔镜技术日益成熟,其适应证不断扩大.在临床实践中,应严格掌握手术适应证,术前精准评估和讨论,加强腹腔镜培训和技术水平提高,熟悉能量器械的使用,掌握腹腔镜手术技巧,规范术后监测,让腹腔镜技术在妇科良性疾病中的优势发挥到最大.
目的 探讨咖啡对妇科恶性肿瘤经腹手术患者术后胃肠功能恢复的影响.方法 选取2020年8月至2021年8月中国医科大学附属盛京医院妇科收治的因恶性肿瘤住院行开腹手术的95例患者,随机分为观察组47例和对照组48例.对照组在术后第1天起8:00am、2:00pm 口服温水150mL,共3d.观察组在术后第1天起分别于8:00am、2:00pm咖啡粉1.8g加温水150mL 口服,共3d.其他治疗及护理与对照组相同.最终共有观察组45例和对照组46例参与分析.比较两组患者一般资料结果与手术变量、术后首次排气时间、首次排便时间、术后24h及术后48h自身疼痛评分;术后腹胀、恶心、呕吐、发生肠梗阻情况;术后住院时间及住院总费用.结果 两组患者的一般资料结果与手术变量无统计学意义(P＞0.05).观察组与对照组相比,术后首次排气时间缩短[(45.2±15.4)hvs.(52.9±13.5)h,P＜0.05)];首次排便时间缩短[(74.4±15.6)hvs.(83.8±13.9)h,P＜0.05];术后24h 自身疼痛评分降低[(5(2～8)分vs.5.5(3～9)分,P＜0.05];术后48h自身疼痛评分降低[2(1～5)分vs.3(2～5)分,P＜0.05].术后腹胀的发生率降低(36.6％vs.58.7％,P＜0.05).而观察组与对照组的术后住院时间、住院费用、术后恶心发生率、术后呕吐发生率、术后肠梗阻发生率比较差异无统计学意义.结论 术后饮用咖啡能缩短妇科恶性肿瘤患者经腹手术后首次排气时间、首次排便时间,促进妇科恶性肿瘤患者经腹手术后胃肠功能的恢复.
子宫颈缩短是指妊娠中期经阴道超声测量的子宫颈长度≤25mm,对于预测自发性早产和指导先兆早产临床决策具有重要意义.近些年,国内外学者开始关注子宫颈缩短的高危因素、筛查方案及治疗手段.文章从妊娠期子宫颈缩短的高危因素谈起,阐述孕酮尤其是阴道用孕酮治疗子宫颈缩短的机制、适应证及临床疗效,为防治早产提供参考依据.
With the aggravation of the aging society andthe further improvement of people’s life quality,theincidence of POP and the rate of consultation havegradually increased.Middle pelvic defect is a defect inthe apical support structure of the vagina.It is char-acterized by uterine or vaginal vault prolapse,entero-cele and vault herniation,and is a common type in POP.There are many surgical methods for the treatment ofpelvic defects,mainly including sacrocolpopexy（SC）、uterosacral ligament suspension（USLS）、sacrospinousligament fixation（SSLF）,Manchester-Fothergill pro-cedure（MF）,and transvaginal mesh surgery（TVM）,etc.This paper aims to make a comprehensive analysis andcomparison of various surgical methods for middlepelvic defects.
目的 探讨妇科门诊患者阴道微生态特征及其与人乳头瘤病毒(HPV)感染的相关性.方法 选取2019年1月至2020年12月于首都医科大学附属北京妇产医院妇科门诊就诊行阴道微生态及HPV检查的患者30 205例,对其检查结果进行分析.结果 (1)30205例患者中,阴道菌群正常者64.4％(19 460/30 205);菌群抑制2.0％(605/30 205);单纯性阴道炎21.7％(6543/30205),以外阴阴道假丝酵母菌病(VVC)和需氧性阴道炎(AV)为主(分别占单纯性阴道炎的48.2％和46.9％);混合性阴道炎11.9％(3597/30 205),其中AV+细菌性阴道炎(BV)占混合性阴道炎的62.5％.(2)阴道微生态正常的比例随着年龄的增长而降低,单纯性阴道炎及混合性阴道炎的比例随着年龄的增长而增加(均P＜0.001).(3)在阴道微生态指标中,pH值异常、菌群密集度异常、乳杆菌减少及白细胞酯酶计数异常均与HPV感染增加相关(均P＜0.001).(4)单纯性VVC、AV以及混合性阴道炎与HPV感染增加相关(均P＜0.05).结论 阴道微生态异常与HPV感染有关,阴道微生态特征分析为进一步管理HPV患者提供了理论依据.
目前,肿瘤是全球常见的疾病,其特征之一是不受控制的增殖.尽管在诊断、手术、化疗和放射治疗方面取得了进展,但恶性肿瘤的存活率仍然很低,在所有疾病中死亡率较高,晚期患者预后差,复发率高.肿瘤的治疗方式多样,包括传统的手术治疗以及各种放化疗.常规化疗药物的用药原则是不断增加化疗剂量,直到达到最大的体细胞毒性和最大的身体耐受剂量,此时虽然能对肿瘤细胞产生较大的杀伤作用,但也对正常细胞造成了较大范围的不可逆性损伤.时间化疗则是选择在化疗药物作用最佳的时间段给药,不但可提高药物的有效性,而且还可降低对正常细胞的毒性,尽快控制病情,延长患者的生存期.目前,时间化疗已经用于不同肿瘤的治疗,尤其是在妇科肿瘤方面,其作为一种可供选择的治疗手段在临床上得到了一定的应用.本文就生物钟节律的发生机制、肿瘤与生物钟节律的相关性、时间化疗药物的作用机制以及时间化疗在肿瘤治疗中的应用进行阐述.
女性生育力是指女性产生卵母细胞、卵细胞并孕育胎儿的能力[1],与性激素和子宫内环境密切相关.早期妊娠手术流产(负压吸引术)是终止早期非意愿妊娠和病理妊娠的主要方法,是一种安全、操作简便、效果良好的终止妊娠的方法,若未发生手术并发症,则对随后的生育力影响较小[2];但若出现近、远期手术并发症,则可能导致女性内分泌及子宫内环境的改变,危害女性生育力[3].因此,采取有效措施减少手术流产的并发症,从而保护女性生育力,具有重要的临床和社会意义.手术流产围术期生育力保护涉及诸多方面,目前国内外尚无广泛认可的操作标准.
文章针对子宫切除术对卵巢功能的影响进行了文献检索以及相关观点的梳理.多项研究提示子宫切除术对卵巢功能有影响,但一般在术后2～3年出现卵巢功能下降,导致患者绝经时间提前.不同手术方式中,全子宫切除术与次全子宫切除术相比,以全子宫切除术影响更为显著,子宫切除术的同时切除双侧输卵管,则影.响更大.手术路径主要包括经腹子宫切除术、阴式子宫切除术、腹腔镜子宫切除术,以阴式路径影响最大,腹腔镜路径影响最小.鉴于卵巢功能是维持女性健康的重要因素,子宫切除术可造成卵巢功能下降,绝经时间提前2～3年.因此,建议临床工作中严格掌握子宫切除术的指征,避免卵巢功能下降危害女性健康.
《2020年全球癌症统计报告》显示,世界范围内子宫颈癌年新发病例604 127例,年死亡病例341 831例,其中我国子宫颈癌年新发病例109 741例,年死亡病例59 060例,发病率和病死率呈双上升趋势,严重威胁女性生命健康[1].同时,人口老龄化已成为全球普遍现象,我国人口老龄化具有规模大、程度深、速度快等特点.现有数据显示,我国绝经后(60岁以上)女性子宫颈癌发病率占同期子宫颈癌发病的29.8％[2].
子宫内膜间质肉瘤(endometrial stromal sarcoma,ESS)为少见的子宫恶性间叶组织源性肿瘤,在所有子宫肿瘤中占比不足1％[1].依据分化程度,ESS分为低级别子宫内膜间质肉瘤(low-grade endometrial stromal sarcoma,LGESS)和高级别子宫内膜间质肉瘤(high-grade endometrial stromal sarcoma,HGESS).目前,国内外指南对HGESS的诊疗关注相对较少,诊治方案未臻一致,高质量的临床研究不多,诊治策略尚缺乏一致性共识.为此,中国医师协会微无创医学专业委员会妇科肿瘤学组、中国医院协会妇产医院分会妇科肿瘤专业学组联合组织国内专家检索文献,结合现有的循证资料,集体讨论制订本共识,以期为我国HGESS的规范化诊治提供诊疗思路.
Acute abdomen in pregnancy（AAP）can be due to obstetric as well as non-obstetric causes. The diagnosis and treatment of AAP are often delayed due to lack of typical symptoms and signs. AAP develops rapidly,and can endanger the life safety of mothers and fetuses in severe cases. Early identification of AAP and early warning of the severity are of great significance to maintain the health of mothers and children.
目的 探讨吲哚菁绿(ICG)在子宫内膜癌患者前哨淋巴结(SLN)示踪时间与SLN检出情况及淋巴引流通路识别的关系.方法 回顾性纳入北京大学人民医院自2016年3月至2021年11月行手术治疗并以ICG作为示踪剂、明确记录示踪时间、术前评估病灶局限于子宫体的子宫内膜癌患者104例.术中将ICG注射至患者子宫颈,观察荧光示踪的淋巴引流通路并切除示踪淋巴结,记录其位置及切除示踪淋巴结的数目及ICG示踪时间.术后石蜡病理检查判断淋巴结转移情况,以单侧盆腔为单位计算SLN的总检出率、SLN常见区域及淋巴引流通路的检出率,分析示踪时间是否影响SLN检出、淋巴引流通路的检出;按示踪时间四分位数分别将行系统性淋巴结切除术且有SLN检出的患者和单侧盆腔分组,分析示踪时间是否影响SLN检出的准确性.结果 (1)在208侧盆腔中,SLN总检出率为75.96％,上子宫颈旁、下子宫颈旁、骨盆-漏斗韧带3条通路的检出率分别为72.60％、10.10％和4.33％;上子宫颈旁伴下子宫颈旁通路的检出率为6.25％;仅1侧盆腔同时检出3条通路.以患者为单位分析,SLN检测的敏感度为50.00％,阴性预测值为94.74％;以单侧盆腔为单位进行分析,SLN检测的敏感度为66.67％,阴性预测值为97.80％.(2)二元logistic回归分析显示SLN示踪时间与SLN检出率、各淋巴引流通路的检出均无明显相关性.(3)Fisher精确概率检验结果显示,按示踪时间四分位数分组,以患者和单侧盆腔为单位分别进行分析,各组阴性预测值均无显著性差异.结论 以ICG作为示踪剂的示踪时长不会影响手术对SLN及淋巴引流通路的识别.
目的 探讨肿瘤标志物糖类抗原125(CA125)的血清动力学变化指标在行初次肿瘤细胞减灭术(PDS)的上皮性卵巢癌(EOC)患者治疗预后评估中的临床意义.方法 回顾性分析2013年1月至2021年2月苏州大学附属第一医院妇产科收治的239例行PDS的EOC患者的临床信息及随访资料,统计CA125的各项动力学变化,并分析其对EOC患者治疗预后的预测价值.结果 239例EOC患者的发病年龄(54.1±10.2)岁.其中PDS达到满意肿瘤细胞减灭术组214例(89.5％),未达到满意肿瘤细胞减灭术组25例(10.5％),满意PDS组患者的总生存期(OS)和无进展生存期(PFS)均显著高于不满意PDS组患者(P＜0.0001和P=0.001).单因素分析显示,腹水量、国际妇产科联盟(FIGO)分期、术后残余癌灶、术前CA125水平、血清CA125转阴所需化疗疗程数、血清CA125所达到最低值及血清CA125消除速率常数K(KELIM)值与患者的OS显著相关(P＜0.05);多因素分析显示:FIGO分期、术后残余癌灶及KELIM值是预测OS的独立因素.结论 血清CA125动力学变化指标中,KELIM值可以作为评估EOC患者预后的指标之一;术前血清CA125水平可作为判断能否实施满意PDS的一项重要指标.KELIM值算法较其他CA125相关变量纳入了更多的时间点,对EOC患者治疗预后更具预测价值.
Acute pancreatitis in pregnancy（APIP）is a serious disease in pregnancy and puerperium. In recent years,the incidence rate has increased significantly,with the characteristics of acute onset,atypical clinical symptoms,rapid progress,high mortality,and many adverse pregnancy outcomes. Due to the dramatic differences in the onset factors,severity and gestational weeks of APIP patients,appropriate medical decisions mainly depend on experiential individualized treatment. The problems of early diagnosis and timely intervention seriously threaten the health of mothers and children,and the lack of standardized management of treatment also plagues clinicians. This article will review the etiology,diagnosis,treatment,prevention and management of pregnancy complicated with acute pancreatitis.
Objective To investigate the feasibility and safety of transvaginal natural orifice transluminal endoscopic surgery（vNOTES）for benign ovarian cystectomy.Methods This study was a subgroup analysis of “Efficacy and Safety Study of Transvaginal Single-port Laparoscopic Surgery（v NOTES）in Benign Gynecological Adnexal Surgery”（Clinical Trial Registry:ChiCTR2100052223）. A parallel study of1∶1 single-center non-inferior randomized controlled trial with a non-inferiority cut-off value of 10% was conducted in Beijing Hospital. Women who aged 18-50years undergoing surgery for benign lesions from 1August 2019 to 1 February 2022 were enrolled. This study used a stratified block randomized method. All of the included patients were grouped 1∶1 by random table method in each stratum based on the extent of surgical resection.The included subjects were allocated to the observation group receiving vNOTES and the control group receiving conventional laparoscopy for ovarian cystectomy. The primary outcome evaluation indicator was the rate of completion of ovarian cystectomy without switching to other procedures in the two groups. Secondary evaluation indicators were operation time,intraoperative blood loss,postoperative complications,visual analog pain scor（eVAS）within 24 hours and one week after operation,postoperative sexual function score and other related data.Results There were 94 patients in total,including 47 in the observation group and 47 in the control group. All patients successfully completed the operation according to the assigned operation method,and were not transferred to other surgical methods during the operation.Sensitivity analysis was performed on the surgical success rate,assuming that 1 case in the observation group was switched to other surgical methods during the operation,and all the operations in the control group were successful,the 95% upper limit of confidence for the difference in the two-sided proportions was estimated at 6%,which was below the10% noninferiority cut-off value. There were no significant differences in preoperative baseline conditions,operation time,intraoperative blood loss,health status score or sexual function evaluation between the two groups（P＞0.05）.The postoperative exhaust time in the observation group were lower than those in the control group[（18.9±7.7）h vs.（38.2±14.0）h],with significant differences（P＜0.05）.The VAS pain score of the observation group was significantly lower than that of the control group every day within 7 days after surgery, and the difference was statistically significant（P＜0.05）.The health condition scores at 3 and 6 months after operation in the observation group[（129.7±9.1）and（127.6±10.2）points,respectively]were higher than those in the control group[（119.4±9.8）and（119.7±10.8）points,respectively],and the sexual function evaluation scores[（23.2±8.4）and（23.2±7.5）points,respectively]were also higher than those in the control group[（11.1±10.7）and（10.3±10.7）scores,respectively],with statistically significant differences（P＜0.05）.Conclusion Transvaginal natural orifice transluminal endoscopic surgery for ovarian cystectomy is safe and feasible,with unique advantages such as less pain,less scarring,and faster recovery. It is a more minimally invasive surgical method and can be used as a treatment for benign ovarian tumors.
Mesenteric vascular occlusion（MVO）is a series of syndromes caused by mesenteric artery embolism or thrombosis,mesenteric vein thrombosis leading to acute intestinal ischemia（AMI）,which can lead to intestinal necrosis or even death. Pregnancy complicated with MVO is a rare surgical acute abdomen with high misdiagnosis and mortality rate due to atypical early symptoms and lack of specific tests. This article elaborates on the etiology,epidemiology,clinical manifestations,risk factors,diagnosis and treatment of the disease,aiming to improve the understanding of clinicians about this disease,assist the early diagnosis,and thus improve the survival rate and prognosis.
经脐单孔腹腔镜全子宫切除术与多孔腹腔镜于20世纪同期起步,受制于内镜技术及单一小切口手术通道的诸多因素,此项技术较多孔腹腔镜进展缓慢,多孔腹腔镜子宫切除术占据明显优势,良性疾病的子宫全切除术主要通过多孔腹腔镜完成.近10年来,随着单孔腹腔镜手术器械和手术经验不断优化和积淀,单孔腹腔镜子宫切除术在多孔腹腔镜的"夹缝"中重获新生,其优势逐渐凸显,不仅可与多孔腹腔镜子宫切除术相媲美,而且备受妇科医生和患者所青睐.文章重点阐述经脐单孔腹腔镜全子宫切除术手术特点、适应证以及优与劣的相关问题.
卵巢子宫内膜样癌(ovarian endometrioid carcinoma,OEC)是起源于卵巢、病理组织学与原发于子宫内膜的内膜样癌相似的卵巢上皮性恶性肿瘤,1964年由国际妇产科联盟(FIGO)正式命名[1].OEC发病率仅次于卵巢高级别浆液性癌(high grade serous ovarian cancer,HGSOC),约占卵巢上皮性恶性肿瘤的10％[2],常伴有子宫内膜病变[3].
