目的 比较使用TiLOOP网片的协和式前盆底重建术与自体组织修复术的临床疗效及对患者生活质量的影响.方法 盆腔器官脱垂(POP)62例患者,随机分为TiLOOP网片组32例,自体组织修复组30例,比较两组围术期参数、临床疗效及生活质量的影响.结果 两组围术期参数中的手术时间及出血量比较差异有统计学意义(P<0.05),术后两组前中盆腔相关的Ba、Bp、C点值及生活质量问卷评分较术前均显著改善(P<0.05,P<0.001),术后两组盆底功能障碍问卷(PFDI-20)、盆镀功能影响问卷(PFIQ-7)评分比较差异有统计学意义(P<0.05).结论 使用TiLOOP网片可提高经阴道前盆腔重建手术成功率,表明TiLOOP网片在植入盆底修复POP方面是安全有效的.

Objective To investigate the effect of menopausal hormone treatment on patients with uterine fibroids during peri-menopausal period.Methods 193 patients with uterine fibroids during peri-menopausal period treated in Wuxi Maternal and Child Health-Care Hospital Affiliated to Nanjing Medical University from January 2010 to September 2014 were selected.All patients received estrogen progesterone cycle sequential therapy.The Kupperman score was used to evaluate the symptoms of perimenopausal syndrome before medication and 3,6,9,12,24 months after medica-tion.Uterine volume,fibroid volume and endometrial thickness were monitored by vaginal ultrasound.The levels of serum follicle stimulating hormone,luteinizing hormone and estradiol were measured by chemiluminescent immunoassay.Results After medication the total score and item scores of Kupperman were significantly lower than before medication (P ＜ 0.05).9,12,24 months after medication the uterine volumes were significantly smaller than before medication (P ＜ 0.05),however,there were no significant differences in endometrial thickness and fibroid volume among before and after medication (P ＞ 0.05).After medication the levels of follicle-stimulating hormone were significantly lower than before medication (P ＜ 0.05),however,there were no significant differences in luteinizing hormone and estradiol levels among before and after medication (P ＞ 0.05).Conclusion Menopausal hormone treatment for patients with uterine fibroids during peri-menopausal period can effectively improve peri-menopausal symptoms,but has no obvious effect on the uterine fibroids.

目的 探讨宫颈环形电切术(LEEP)治疗宫颈鳞癌Ⅰa1期的可行性和安全性.方法 行宫颈LEEP术后病理诊断为宫颈鳞癌Ⅰa1期患者78例,接受经阴道根治性宫颈切除或全子宫切除术,结合其临床病理特征,分析LEEP术后病灶残留相关因素.结果 78例患者中,36例行经阴道根治性宫颈切除,42例行全子宫切除术.术后病理结果提示有病灶残留11例,残留率14.10％.其中,宫颈鳞状上皮不典型增生(CIN)Ⅱ级2例,CINⅢ级6例,早期癌3例.切缘阳性组患者病灶残留率22.86％(8/35),高于切缘阴性组的6.98％(3/43) (P＜0.05).年龄≤45岁的宫颈病灶残留率21.43％(9/42),高于年龄＞45岁者的5.56％ (2/36)(P＜0.05).患者的宫颈细胞学结果、宫颈活组织病理检查和高危型HPV等与LEEP术后病灶残留均无明显相关性(P＞0.05).结论 LEEP术后切缘阳性是影响宫颈病灶残留的独立危险因素,需要密切阴道镜随访,或选择再次行LEEP治疗.

目的 利用自身阴道粘膜、筋膜和韧带修补中重度盆腔脏器脱垂患者盆底支持结构的多部位缺陷,探讨自体组织修补术的临床疗效和安全性.方法 对2011年10月至2014年5月南京医科大学附属无锡妇幼保健院诊治的60例盆腔器官脱垂定量分期法(POP-Q)诊断为子宫或膀胱脱垂Ⅲ度及以上患者行自体组织修补术,手术前后采用POP-Q、盆底功能障碍问卷(PFDI-20)、性生活质量问卷(PISQ-12)对各项指标进行分析.结果 随访55例,平均手术时间(71.63±21.02) min,术中平均出血(55.75±48.16)mL,术后中位随访时间24个月.解剖治愈率83.64％,主观治愈率89.09％;12例术前有性生活,术后性生活质量改善(t=4.71,P＜0.05),PFDI-20评分显著改善(t=9.43,P＜0.01);4例新发压力性尿失禁,1例复发压力性尿失禁,无脏器损伤、血肿、感染、阴道挛缩等其他并发症.结论 自体组织修补术是治疗中重度盆腔脏器脱垂的安全经济术式,近期疗效肯定,长期疗效待进一步随访.

目的 评价Perigee系统治疗女性中重度前中盆腔联合缺陷的临床疗效和安全性.方法 对2011年10月至2014年1月该院50例盆腔器官脱垂定量(POP-Q)分期法诊断为子宫或膀胱脱垂Ⅲ度及以上患者行Perigee术式,手术前后采用POP-Q、盆底功能障碍问卷(PFDI-20)、性生活质量问卷(PISQ-12)对各项指标及网片相关并发症发生情况进行分析.结果 平均手术时间(70.31±15.86) min,术中平均出血(61.56±45.02) ml,术后随访4～27个月(中位随访时间21个月).客观治愈率93.5％,主观治愈率100.0％;PFDI-20评分较术前显著改善;有性生活患者6例,手术前后性生活质量无明显变化.术后发生网片暴露1例(2.2％);新发压力性尿失禁2例(4.3％);新发阴道后壁脱垂3例(6.5％);阴道挛缩1例(2.2％);无严重并发症发生.结论 Perigee系统是治疗中重度前中盆腔联合缺陷的安全、有效术式,长期疗效及并发症待进一步随访.

患者,女,26岁,因“停经36+3周,发现甘胆酸升高1d”入院.孕期多次查尿常规正常,尿蛋白阴性.既往体健,幼时有脊椎外伤史,无高血压病史,无癫痫病史.入院查血压、一般检查及产科检查无异常.实验室检查:ALT 364 IU/L,AST 152 IU/L,总胆汁酸23.1 μmol/L,血甘胆酸69.5 μmol/L,尿常规正常,尿蛋白阴性.入院诊断:G1P0,孕36+3周,左枕前位,妊娠期肝内胆汁淤积症(ICP).

盆底功能障碍性疾病是由于盆底支持系统的薄弱导致的盆腔脏器脱垂，从而引起一系列解剖和功能异常，它严重影响了患者的身心健康。治疗方式包括非手术治疗和手术治疗，目前手术治疗以各种盆底重建手术为主，现将常用的盆底重建术作一综述。

Objective To analyze the short-term outcomes and complications of treating pelvic organ prolapse(POP) with PROSIMA tension-free mesh.Methods PROSIMA pelvic floor repair system was used in 70 patients with POP stage Ⅱ-Ⅲ.The short-term outcomes were evaluated with PFIQ-7 and POP-Q.Results Postoperative residual urine volume was(18.01±27.91) ml.Positive result of bacterial culture of vaginal secretions was reported in 16 cases(22.9%) when vaginal support device was taken out.The follow-up showed recurrent anterior wall prolapse in one case(1.4%),vaginal fornix prolapsed in one case(1.4%),vaginal mesh erosion in 8 cases(11.4%) and much improved PFIQ-7 scores compared with before.Conclusion PROSIMA pelvic floor repair system is satisfied with the advantages of easy to master,microinvalsive,less intraoperative bleed loss and no postoperative pain.

目的探讨PROSIAM盆底重建术后阴道支撑装置(VSD)对阴道伤口康复的影响。方法 70例PROSIMA盆底重建术后患者应用VSD装置。术后随访1年,记录阴道伤口康复情况及术后并发症发生情况。结果术后3-4周阴道长度(6.77±0.48)cm。VSD放置期,9例有轻度不适感,1例麻木感。阴道分泌物均为淡黄色,31例阴道伤口有脓苔附着,36例有异味,16例细菌培养阳性;6例有网片暴露,无血肿发生。结论 PROSIAM盆底重建术后放置VSD可有效支撑阴道和固定网片位置,不影响生活质量;但术后网片暴露及细菌培养阳性率较高。

Objective: To compare the clinical effects of Mirena and Fukang Tablets in the treatment of simple endometrial hyperplasia and research the most suitable plan to treat it.Methods: Collect 102 patients with simple endometrial hyperplasia,they were divided into Fukang Tablets group(n=46 patients) and Mirena group(n=56 patients) Clinical effect,PBAC score,endometrial thickness,hemoglobin levels after three months' treatment,and the adverse reactions in the treatment process were compared.Results: There was a significant difference(P0.05) in the number of markedly and invalid cases,the PBAC score,endometrial thickness,hemoglobin levels after three months' treatment,the adverse reactions in the treatment process,the Mirena group was all better than that in the Fukang Tablets group.Conclusion: It could improve the clinical effect and the clinical symptoms,reduce the adverse of liver and kidney dysfunction by treating the simple endometrial hyperplasia with Mirena.

近年来,使用聚丙烯网片对盆底功能障碍疾病女性患者实施盆底重建术受到了人们很大的关注.本文针对无锡市妇幼保健院2007年5月-2010年6月接受协和前盆底重建术187例患者的中长期临床疗效及并发症进行回顾性分析.

目的:评价Perigee系统治疗女性前盆腔器官脱垂的安全性及临床疗效。方法 :对24例盆腔器官脱垂定量系统(pelvic organ prolapse-quantitation,POP-Q)诊断为Ⅱ度或以上的前盆腔器官脱垂患者行Perigee前盆底重建术,采用主观评价[盆底功能障碍影响问卷简版(PFIQ-7)、性生活质量问卷]和客观评价(POP-Q)对围手术期及术后近期各项指标的变化及并发症发生情况进行分析。结果:24例患者的平均手术时间(70.83±15.30)min,术中平均出血(80.92±40.39)ml,术后中位随访时间为4个月。以POP-Q评分作为客观疗效评价指标,治愈率为100%;PFIQ-7评分较术前有显著改善;术后1例有性生活,性生活质量无明显下降。术后发生网片暴露1例(4.2%);新发压力性尿失禁2例(8.4%);会阴部、臀部疼痛4例(16.7%);新发阴道后壁脱垂3例(12.6%);无严重并发症发生。结论:Perigee系统是治疗前盆腔脏器脱垂的安全、微创术式,近期疗效肯定,中远期疗效待进一步随访。

女性性功能障碍(female sexual dysfunction,FSD)是指女性个体不能参与她所期望的性行为,在性行为过程中不能或难以得到满足,并造成人际关系紧张,是一种与年龄相关的、渐进性发展的严重影响女性生活的常见和多发疾病。绝经期女性由于心理、身体、药物及激素水平改变的影响,绝经后女性比绝经前女性有着更多性功能障碍,目前对于雄激素与FSD之间的关系已受到越来越多的重视。现有证据表明女性中雄激素的缺乏可以导致FSD,而且性欲的降低是它的主要表现。并且最近的研究结果表明雄激素补充治疗不仅可以改善性功能障碍,还能改善情绪、血管舒缩症状。绝经期女性比非绝经期女性更容易发生雄激素缺乏,所以绝经期女性雄激素的使用受到了重视。目前雄激素的治疗方式很多,且雄激素使用的副作用也需要进一步的研究。

目的:调查无锡地区女性压力性尿失禁(SUI)发生的患病率及有关发病因素。方法:随机抽取无锡市新区鸿山镇17周岁以上的女性人群1 017例妇女问卷调查,进行一对一当面问卷。数据采用U、χ2检验。结果:压力性尿失禁患病率18.39%。SUI有随年龄及绝经后年限的增加而升高的趋势;工人、农民,高体重指数、高腹围、高血压,孕、产、流产次数、新生儿体重、阴道分娩、会阴裂伤、无会阴切开是压力性尿失禁的易患因素。结论:无锡地区女性压力性尿失禁患病率较高,影响因素很多,应引起广大医务人员及社会各界的重视,帮助患者早预防、早治疗,恢复其身心健康。

<正>改良前盆底重建术是国内学者根据中国女性骨盆较小的特点,将10cm×15cm聚丙烯纤维网片修剪成"蜻蜓"形治疗阴道前壁脱垂,文献报道临床效果良好[1],我院将该术式用于临床,与同期开展的"梯形"网片前盆底重建术(阴道旁网片修补术)进行前瞻性比较,分析了手术安全性和临床应用价值。现

目的 探讨盆底肌肉生物反馈电刺激治疗子宫脱垂效果.方法 选择我院32例子宫脱垂患者,予盆底肌肉生物反馈电刺激治疗.结果 32例子宫脱垂患者宫颈距处女膜缘的距离治疗前后比较,差异有统计学意义(P<0.05).治疗5次后,腰骶酸痛、下腹坠胀、剧烈咳嗽喷嚏有漏尿、外阴异物感总有效率分别92.86%,84.62%,87.50%,100%.治疗10次后,子宫脱垂伴随症状与治疗前比较,差异有统计学意义(P<0.05).结论 盆底肌肉生物反馈电刺激治疗对子宫脱垂有明显的治疗作用。

Objective To evaluate the outcomes of treating moderate pelvic organ prolapse with PROSIMA pelvic floor repaire system. Methods Reconstruction of pelvic floor was performed using PROSIMA pelvic floor repair system in 30 patients with moderate pelvic organ prolapse.The outcomes were evaluated by POP-Q and PFIQ-7 in 6 months after operation. Results According to POP-Q,30 patients were cured.Vaginal mesh erosion was discovered in two patients(6.67%) during postoperative follow-up.The VSD was taken out on the 21st day after operation and vaginal secretions cultures showed Escherichia coli positive in 6 cases,smooth Candida positive in 1 case,and Proteus mirabilis positive in 1 case. Sexual life was satisfactory after surgery. Conclusion Reconstruction of pelvic floor with PROSIMA pelvic floor repair system is safe and effective in the patients with moderate pelvic organ prolapse,but vaginal infection is worthy of attention.

Objective:To assess the clinical efficacy of modified pelvic floor reconstruction using polypropylene mesh. Methods:162 patients with anterior vaginal wall prolapse (AVWP) of stage Ⅱor greater which were clarified by the Pelvic Organ Prolapse Quantification (POP-Q) were treated by modified pelvic floor reconstruction.The subjective and objective parameters of them were evaluated.Results:In 162 patients, the mean operation time was 97.2 min (50 to 170 min), the mean amount of blooding was 86.3 ml (120 to 300 ml). After operation,the mean maximum temperature was 37.9℃(37.2 to 39.0℃). The mean hospitalization time was 6.2 days (5 to 10 days). The average catheter retention time was 3.2 days (2 to 10 days), of which 7 cases had residual urine more than 100ml. After treatment, all of them were recovered. The average follow-up time was 18 months. Consulted with POP-Q, the objective cure rate was 97.1%, the vaginal mesh erosion rate was 3.6% (5/140) and the emerging urge incontinence rates were 3.6% (5/140).Results:Modified pelvic floor reconstruction can improve anatomical and functional recovery of bladder. It is a safe and effective surgical mode to treat vaginal wall prolapse.

<正>临床上Ⅲ～Ⅳ期子宫内膜异位症约占内异症的37.5%～48.4%[1],卵巢是内异症最常见的部位。传统观念认为,对于中重度卵巢子宫内膜异位症,经腹手术更易清除盆腔病灶或保留卵巢功能。我们选择手术治疗的Ⅲ～Ⅳ期卵巢子宫内膜异位症患者,其中腹腔镜手术61例,经腹手术36例,对比分析了两种术式的临床疗效,现报道如下。

目的分析ProliftTM治疗女性重度盆腔脏器脱垂的安全性和临床疗效。方法回顾分析2008-01-2009-12无锡市妇幼保健院采用ProliftTM行全盆底重建术42例,分析围手术期情况、随访临床疗效和并发症。结果平均手术时间92min,术中出血量平均200ml。随访12～36个月,治愈41例,复发1例,发生网片侵蚀3例,排尿困难3例。结论 ProliftTM全盆底重建术是治疗女性重度盆腔脏器脱垂安全有效的术式,但长期疗效和远期并发症待进一步观察。