目的 评估阴道病灶切除术在高级别阴道上皮内病变(HG-VaIN)治疗中的价值.方法 回顾性分析38例诊断为HG-VaIN行阴道病灶切除术的患者临床病历及随访资料.结果 21例患者纳入研究,初治者18例,复发者3例.13/15例患者HPV阳性,其中有HPV分型检测患者中70％为HPV16型.20例采用经阴道途径,1例复发者采用机器人辅助腹腔镜手术.手术时长平均(46.0±26.2) min,术中出血量平均(38.2±66.0) ml.经阴道途径手术时长平均(42.4±20.4) min,术中出血量平均(39.1±67.9) ml.1例机器人阴道残端切除术,手术时长120 min,术中出血20 ml.所有21例手术未出现术后出血、感染、脏器损伤等并发症.术后平均术后住院天数为2.7 d.术后病理发现阴道鳞癌4例,术后复发率16.7％.结论 HPV16型是HG-VaIN中最常见的感染型别.阴道病灶切除术安全有效,住院时间短,有利于发现浸润性病变.机器人途径适用于经阴道手术困难者,但需要更多的临床实践.

Objective To explore the clinical value of low molecular weight heparin(LMWH) plus low dose aspirin(LDA) in preventing twin pregnancy with preeclampsia high risk factors.Methods From January 2013 to December 2017,the twin pregnancy cases with preeclampsia high risk factors who were diagnosed in Shanxi Rongjun Hospital were randomly divided into two groups according to the order of the treatment .The observation group(n=53) used LMWH plus LDA to prevent preeclampsia ,while the control group ( n=53) used LDA alone.The incidence of preeclampsia and pregnancy outcome were compared between the two groups .Results The incidence of severe preeclampsia in the observation group(5.7％) was lower than that in the control group (18.9％)(χ2 =4.296,P<0.05),and there was statistically significant difference in the delivery time between the two groups (χ2 =7.993,P<0.05).While the incidence of preeclampsia ,placental abruption,postpartum hemorrhage and FGR between the two groups had no statistically significant differences (all P >0.05).The proportion of NICU transferred fetus in the observation group(18.3％) was lower than that in the control group (30.7％)(χ2 =4.289,P<0.05).There were no statistically significant differences in perinatal mortality and neonatal asphyxia ( all P >0.05 ).Conclusion Compared with using the LDA alone , LMWH plus LDA prevention can effectively reduce the incidence of severe preeclampsia in twin pregnancies;at the same time,it also can delay the delivery time and reduce the rate of NICU transferred.

目的探讨加速康复外科(enhanced recovery after surgery,ERAS)围术期管理在腹腔镜子宫切除患者中的临床应用价值.方法选取我院妇产科2014年1月—2017年1月诊治的妇科疾病患者作为研究对象,筛选出实施腹腔镜子宫切除手术患者,随机分为2组,试验组采用ERAS围术期管理方法,对照组采取常规围术期管理方法.记录并比较2组患者的手术以及术后康复相关指标.结果试验组术后排气时间、下地活动时间、留置尿管时间、平均住院日以及平均诊疗费用均少于对照组,差异有统计学意义(P<0.05).2组平均手术用时和术中出血量比较差异无统计学意义(P>0.05).结论加速康复外科管理措施在保证腹腔镜子宫切除手术安全、 有效实施的同时,能够加快患者的术后康复进程,同时能缩短住院时间,并减轻患者的经济负担,具有重要意义.

目的:探讨高龄孕产妇的妊娠结局和对母儿的影响.方法:用回顾性分析年龄≥35岁的高龄孕产妇156例作为观察组,同期非高龄孕产妇(＜35岁)的156例作为对照组.结果:观察组中妊娠期高血压疾病,妊娠期糖尿病,剖宫产率,产后出血均明显高于对照组;观察组胎儿宫内窘迫,胎儿生长受限明显高于对照组;观察组巨大儿、新生儿窒息与对照组无明显差异.结论:年龄大于35岁的高龄孕产妇容易出现各种合并症和并发症,是不良妊娠的独立危险因素,建立和完善预防保健及临床处理,发现异常,及时对症,加强高龄孕妇孕期及产时保健,确保母婴健康安全.

目的 探讨规范化疼痛评估在癌痛护理中的临床应用效果.方法 选取我院2015年4月～2017年4月收治的癌痛患者63例作为研究对象,并随机分为观察组和对照组,对照组给予常规护理,观察组在对照组的基础上给予规范化疼痛评估.结果 护理后,观察组的BPI评分显著低于对照组,组间差异显著,差异有统计学意义(P<0.05),而护理前,两组的BPI评分比较无显著差异;差异有统计学意义(P<0.05).结论 对癌症晚期患者实施规范化疼痛评估能更好的评估患者的病情,制订相应的护理干预措施,提升癌症患者的预后质量,值得广泛推广和应用.

Objective To investigate the ideal termination method of mid-pregnancy in cicatricial uterine.Methods The mid-pregnant women with scar uterine asking for abortion were randomly divided into two groups.36 cases received abortion by mifepristonum combined with rivanol(the observation group) and 36 cases received abortion by simple amniotic cavity injection of rivanol(control group).The abortion effects,starting time of uterine contraction after injection,total production time,post-partum 24 h bleeding.Results The complete abortion rate was 95% in the observation group,which was significantly higher than 73% in the control group,showing statistical difference(P0.05).The time from injection to uterine contraction and the total production time in the observation group were shorter than those in the control group(P0.01).The amount of post-partum 24 h bleeding in the observation group was less than that in the control group with statistical significance(P0.05).Conclusion Mifepristonum combined with rivanol for terminating mid-pregnancy in scar uterine is safe,effective and worthy of being widely applied.

<正>霉菌性阴道炎由真菌感染引起,主要是白色念珠菌属,阴道感染80%~90%系白色念珠菌,余为其他念珠菌和球拟酵母菌属,故又称念珠菌性阴道炎或念珠菌病[1]。念珠菌阴道炎是妇产科门诊的常见病与多发病。妇女在妊娠期间罹患念珠菌阴道炎又是常见的妊娠合并症之一,白色念

<正>糖尿病是一种伴有遗传倾向的代谢障碍引起的内分泌疾病。它是对糖类耐受性降低而引起的糖、蛋白质及脂肪等代谢紊乱,以高血糖、糖尿、多饮、多食、多尿及乏力等为主要临床特征的综合征。自人工胰岛素问世以来,糖尿病得到了有效的控制,使很多糖尿病育龄妇女恢复了生殖功能。由于妊娠本身是一个致糖尿病因素,随着妊娠进展,易造成胰岛素分泌相对不足而出现或发现糖尿病,称之为妊娠期糖尿病(gestational diabetes mellitus,GDM)。