目的 探讨官旁血管结扎术在中央性前置胎盘剖官产术中的应用.方法 回顾性分析2010年1月至2014年3月福建省妇幼保健院住院的中央性前置胎盘患者44例资料.病例分研究组和对照组各22例,每组均有8例凶险型前置胎盘.研究组在胎儿娩出后先行宫旁血管结扎,然后处理胎盘;对照组按传统方法先取出胎盘,再行官旁血管结扎,观察两组出血量.结果 研究组非凶险型中央性前置胎盘术中出血量(360.0±78.5) mL,少于对照组(509.3±155.8)mL;两组凶险型中央性前置胎盘术中出血量差异无统计学意义[研究组(1 275.0±911.4) mL,对照组(1 137.5士986.6)mL].结论 官旁血管结扎术在非凶险型中央性前置胎盘剖官产术中,先结扎后处理胎盘更为合理,能明显减少术中出血量,值得推荐应用.

目的 探讨子宫破裂发生的原因、临床特点及防治措施.方法 对福建省妇幼保健院2010年1月至2012年12月期间孕产妇发生子宫破裂的21例临床资料做回顾性分析.结果 瘢痕子宫是子宫破裂的首要原因(76.2％),其次是药物引产不当(9.5％)、多产次生产(9.5％)及残角子宫妊娠(9.5％).21例子宫破裂者均行剖腹探查术,其中18例(85.7％)行子宫修补术,2例(9.5％)行全子宫切除术,1例(4.8％)行残角子宫切除术.患者经积极抢救,未发生死亡,围产儿死亡5例,术后常规抗炎治疗后均痊愈出院.结论 子宫破裂是产科严重并发症,加强围产期保健,严格掌握剖宫产指征及宫腹腔镜下子宫肌瘤挖除术和宫角切除术手术指征,规范药物引产,是预防的根本措施.

目的 探讨剖宫产腹部切口脂肪液化的原因及防治措施.方法 对47例剖宫产术后腹部切口脂肪液化的临床资料做回顾性分析.结果 剖宫腹产术后切口脂肪液化率0.9％(47/5 021),主要原因是合并肥胖、糖尿病、妊娠水肿、贫血和产程停滞、术中使用电刀及术后咳嗽等.根据伤口渗出液量的多少将患者分两组:A组渗出液少;B组渗出液多.两组均采用局部挤压脂肪液,或拆开部分切口缝线引流、清除坏死组织等治疗,经局部处理后覆盖大片苯扎氯铵贴等措施,直至切口干燥无渗液.治疗结果:B组患者于剖宫产术后(8.2±1.2)d出院,切口愈合(13.4±2.6)d;A组分别仅需(5.8±0.8)d和(10.5±1.7)d.两组切口均无感染,愈合情况好,无需二期缝合,亦未发生医疗纠纷.结论 B组病人因渗出液多,所需的住院天数与切口愈合天数均较长.应重视腹部切口脂肪液化发生的各种高危因素,早期发现并积极处理会缩短切口愈合时间,明显缩短住院时间,避免发生医疗纠纷.

Objective To investigate the clinical features and the surgical procedure of endometriosis in the patients of different ages and to analyze the postoperative efficiency and prognosis.Methods A retrospective analysis for the clinical data from 179 operated patients,who were diagnosed as endometriosis in different ages and were followed up for 24～30months,was conducted.All the patients were categorized as groupsⅠ,Ⅱand Ⅲaccording to their ages.There were 85cases<30(groupⅠ),65cases within 30～40(groupⅡ),and 29cases>40(groupⅢ)years old.Results The patients' average age was(32.7±7.6)years.Out of the 179cases,167were fully followed up,138 were performed by conservative surgery with a recurrence rate of 11.6%,and 29 received radical or semi-radical conservative operation with no recurrence.In groupsⅠ,Ⅱ andⅢ,the patients' rates of postoperative palliation were 88.5%,91.4% and 83.3%,the recurrence rates were 10.3%,15.4%,and 0%,respectively,and statistic analysis showed no significant difference(P>0.05).The natural pregnancy rates in the patients between groupsⅠ(56.7%)andⅡ(10.0%)after conservative surgery were statistically significant different.Conclusions The rates of postoperative palliation and recurrence were not significantly different among the different age groups of conservative surgery.The younger infertile patients with endometriosis had a higher rate of natural pregnancy.

子宫切除术后发生的盆腔包块在临床并非罕见,其诊治难度大于初发的盆腔包块.对子宫切除术后出现盆腔包块的性质、处理方式等一直以来为妇科医师所关注.笔者回顾性分析40例子宫切除术后盆腔包块的特点和诊治情况,以期对其临床诊治提供有益的资料和借鉴.

胎盘早剥是妊娠晚期严重并发症,往往起病急,进展快,若处理不及时可危及母儿生命,围产儿死亡率高达35.5%～55%.本文对我院2002年5月～2004年5月住院治疗的胎盘早剥病例作一回顾性分析,以探讨胎盘早剥的早期诊断方法,提高诊断水平,以期改善母儿预后.