目的 探讨人工流产后立即放置宫内节育器的临床效果.方法 回顾性分析2008年1月-2010年1月400例停经6～8周因施行人工流产术且需要采取避孕措施的临床资料,根据选择放置宫内节育器的时间不同分为两组:A组200例,人工流产后立即放置宫内节育器;B组200例,人工流产后6月内延迟放置宫内节育器.比较两组人工流产术后1、3及6月的妊娠率、节育器脱落率、因症取出率、盆腔感染及子宫穿孔情况.结果 A组人工流产后无妊娠发生,B组有5例妊娠,且均为人工流产后未使用节育器的女性,妊娠率为2.5％;A组与B组节育器脱落率分别为2.5％(5/200)和1.5％(3/200);因症取出率分别为3.5％(7/200)和2.5％(5/200);盆腔感染率分别为0.5％(1/200)和1％(2/200);无子宫穿孔发生,两组比较差异均无统计学意义.结论 人工流产后立即放置宫内节育器具有安全性、可行性,值得临床推广.
Objective To discuss the effect of laparoscopy for tubal pregnancy with different surgical methods on subsequent pregnancy.Methods Retrospective analysis was carried out on 150 patients who received laparoscopic surgery from January 2001 to January 2007 in our hospital.All the patients had fallopian pregnancy and hoped to conserve fertility.We divided the patients into two groups according to surgical methods: group A(72 cases) received oviduct window surgery for removing the embryo and group B(78 cases) underwent salpingectomy,and then compared their effect on repregnancy after the surgery.Results The two groups were followed up for 2 years,during which groups A and B showed intrauterine pregnancy rates of 43.1%(31/72) and 35.9%(28/78),respectively without significant difference(χ2=0.804,P=0.370),and ectopic pregnancy rates of 20.8%(15/72) and 7.6%(6/78) with significant difference(χ2=5.370,P=0.020). Conclusion Though laparoscopic surgery with conservation of affected fallopian tube achieves slightly higher intrauterine pregnancy rate than salpingectomy(without statistical significance),the rate of recurrent ectopic pregnancy is increased by this approach and thus it should be carefully used.
目的探讨产程中产妇采取同侧侧俯卧位纠正枕后位的临床效果。方法选择2008年1月至2009年8月在我院住院待产的单胎初产妇,产程进入活跃期后出现产程停滞,经阴道检查确诊为枕后位的100例为研究对象,采用同侧侧俯卧位法纠正胎方位,观察阴道分娩率、有效转位与胎儿体重的关系。结果(1)有85例有效转位(其中枕前位80例,枕横位5例),阴道分娩数80例,其中阴道助产5例,阴道分娩率80%。(2)胎儿体重<3500g,转位有效率93%;胎儿体重>3500g,转位有效率67%。结论产程中指导产妇取同侧侧俯卧位纠正枕后位,是降低难产发生率,提高阴道分娩率的有效方法。
Objective To discuss the clinical efficacy of LigaSure for vaginal hysterectomy. Methods Totally 200 patients underwent vaginal hysterectomy with LigaSure from January 2007 to January 2008 in our hospital. Among the patients, 86 cases with uterine myoma had the uterus enlarged to 8- to 11-week gestation; 10 patients showed cervical intraepithelial neoplasia (CIN Ⅲ); 15 patients had Ⅱ to Ⅲ degree uterine prolapse; 6 patients were diagnosed with atypical endometrial hyperplasia; and 10 had dysfunctional uterine bleeding. During the operation, the uterosacral ligament, cardinal ligament, uterine vessels, round ligament, oviduct, and ovarian ligament were cut after clamp and electronic coagulation by LigaSure. Results The operation was completed successfully in all the 200 cases in 20 to 50 minutes, the intraoperative blood loss ranged from 15 to 150 ml. The patients were discharged from hospital in 3 to 5 days after the surgery without serious complications. Re-examination was carried out in 3 days postoperation, showing the surgical wounds healed well without stitches or granulation tissue in the vaginal stump. ConclusionVaginal hysterectomy by using LigaSure is a simple surgical procedure with less surgical difficulty, short operation time and a few blood loss.
目的探讨足月妊娠胎膜早破终止妊娠的时机及方式。方法对200例足月妊娠胎膜早破的产妇进行回顾性研究,将产妇分为两组,其中100例在期待治疗12小时后进行引产,另外100例在24小时后引产,两组进行比较分析。结果12小时组引产率47%,24小时引产率17%(p<0.05),12小时组阴道分娩率52%,24小时组阴道分娩率75%(p<0.05)。结论胎膜早破期待治疗24小时是适宜可行的,可减少人为干预,降低围生期母儿的并发症.对于经过期待治疗后仍未临产者或有感染征象而破膜未达到24小时的孕妇,需要引产以终止妊娠。
