目的 分析不同严重程度子痫前期(PE)患者血浆内可溶性内皮细胞蛋白C受体(sEPCR)、凝血酶激活纤溶抑制物(TAFI)、活化蛋白C(APC)的表达水平及临床意义.方法 收集2014年4月-2016年4月医院收治的64例PE患者的临床资料,其中轻度PE(mPE组)34例,重度PE(sPE组)30例,同时选取同期于医院就诊无妊娠合并症及并发症的30例健康孕妇作为对照组,均于入院24h留取外周静脉血样,测定sEPCR、TAFI水平及APC比率(APCr),并有明确的凝血指标检查结果,包括凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(Fib)及D-二聚体(D-D)水平.结果 mPE组与sPE组血浆sEPCR水平均高于对照组,sPE组sEPCR水平又高于mPE组,差异均有统计学意义(P<0.05);sPE组血浆TAFI高于对照组与mPE组,APCr低于对照组和mPE组,差异均有统计学意义(P<0.05),但对照组与mPE组的TAFI、APCr组间比较差异无统计学意义(P>0.05).3组PT、APTT比较差异无统计学意义(P>0.05),mPE、sPE组Fib、D-D均高于对照组(P<0.05),sPE组Fib、D-D又高于mPE组(P<0.05).PE患者血浆sEPCR、TAFI水平均与Fib、D-D呈正相关(P<0.05),其血浆APCr与Fib、D-D呈负相关(P<0.05).结论 PE患者其血浆sEPCR、TAFI表达上调,APCr降低;随PE严重程度的增加,其sEPCR、TAFI表达逐渐上升,APCr逐渐降低,三者均与PE发病及病情进展有关.

目的 分析超敏C反应蛋白(hs-CRP)、活化蛋白C抵抗(APCR)与子痫前期的关系.方法 选取2015年1-12月医院妇产科收治因妊娠高血压引发子痫前期患者220例作为观察组,另选220例健康产妇作为对照组.比较2组hs-CRP水平、APCR阳性表达情况.结果 观察组患者的hs-CRP水平为(7.54±2.24)mg/L,明显高于对照组的(2.18±0.29)mg/L,差异有统计学意义(P<0.05);其中,重度子痫前期患者hs-CRP水平(8.02±2.23)mg/L,高于轻度子痫前期患者的(6.18±1.92)mg/L,差异有统计学意义(P<0.05).观察组患者APCR阳性率为38.18％(84/220),明显高于对照组的2.27％(5/220),差异有统计学意义(P<0.05);重度子痫前期患者APCR阳性率为46.38％(64/138),高于轻度子痫前期患者的24.39％(20/82),差异有统计学意义(P<0.05).结论 子痫前期发生与hs-CRP及APCR密切相关,并且随着子痫前期病情的加重,hs-CRP水平及APCR阳性率显著升高,对两者水平的检测,具有重要的预防及诊断价值.

Objective To explore the feasibility and influence factors of cervical conization for CIN Ⅲ patients with posi-tive cervical excision margin.Methods 148 cases of CINⅢ patients with positive cervical excision margin were divided into the conservative group(n =72) and non-conservative group(n =76),histopathological results of the 2 group s were compared.The non-conservative group was divided into the LEEPgroup and CKC group ,bleeding volume in surgery,operative time,postoperation bleeding,postoperative infiltrating carcinoma were compared .Results There had no significant difference in recurrence rate be -tween the 2 group s,bleeding volume in surgery,operative time,postoperative bleeding between the LEEPgroup and CKC group had statistically significant difference ,menopausal status,scope of lesions,positive cutting edge,cervical tube involvement ,preop-erative HPV loads were associated with cervical cone cutting postoperative residual lesions (P <0.005);Age,gland involvement were not associated with postoperative residual lesions of cervical conization (P >0.05).Conclusion Cervical conization for CINⅢ patients with positive cervical excision margin is feasible ,and CKC method is more reliable compared with LEEP ,menopa-usal status,scope of lesions,positive cutting edge,cervical involvement are the main influence factors of the operation .

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.

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.

宫颈高频电圈切除术(LEEP)已广泛用于宫颈上皮内瘤形成(CIN)的诊断及治疗,但对宫颈原位癌的诊治报道甚少.我们于1999年8月至2003年4月对宫颈原位癌实施LEEP的病理标本及切除子宫的宫颈残存病灶进行回顾性分析,报告如下.