绝经后骨质疏松症(Postmenopapsal Osteoporosis,PMOP)是一种好发于绝经后妇女,由破骨细胞介导,属于高转换型的快速型的骨吸收形式的原发性骨质疏松症.追溯其中医范畴,应属“骨痿”.周蜻教授为云南省名中医,云南中医学院第一附属医院妇科主任医师、教授,师从国家级名中医、全国第二批名中医专家学术经验继承指导老师易修珍医师,为易修珍名医工作室主要负责人,从事妇科临床工作30余年,在治疗PMOP疾病中有着丰富的临床经验,作者通过跟诊抄方,现予初步探讨并总结,以为临床提供新思路.

总结周蜻教授治疗薄型子宫内膜的经验.近年来,子宫内膜菲薄逐渐成为影响女性月经量及胚胎种植的常见原因,周蜻教授对本病具有丰富的临床经验,擅于从“辨病与辨证相结合、按月经周期选方,运用专药,针药结合”等4个方面治疗本病,临床病例证实具有较好的临床疗效.

目的 研究改良胃管固定方法 在临床应用过程当中所配合的有效护理方案,以方便为临床干预工作提供可行依据.方法92例行留置胃管的患者,按照随机分组的方法分为常规护理组和针对性护理组,每组46例.两组患者均采用改良胃管固定方法进行胃管的留置,常规护理组患者采用常规护理,针对性护理组患者采用针对性护理.比较两组患者的胃管移位和胃管脱出发生情况、舒适度、护理满意度.结果 针对性护理组中存在胃管移位患者4例,胃管脱出患者1例,占比分别为8.70％和2.17％;常规护理组中存在胃管移位患者18例,胃管脱出患者7例,占比分别为39.13％和15.22％;两组患者的胃管移位和胃管脱出发生率比较,差异具有统计学意义(P<0.05).常规护理组患者的舒适度为30.43％(14/46),针对性护理组为91.30％(42/46),比较差异具有统计学意义(P<0.05).常规护理组患者的护理满意度为43.48％(20/46),针对性护理组为97.83％(45/46),比较差异具有统计学意义(P<0.05).结论 临床对于留置胃管的患者应用改良胃管固定方法时,为患者配合针对性护理方法进行干预可在一定程度上降低胃管移位和胃管脱出发生率,同时能够提高患者的舒适度,提升患者护理满意度,值得推广.

目的 分析临床护理路径在大隐静脉曲张患者干预过程中的有效性,为临床提供可行的依据.方法 50例进行手术治疗的下肢大隐静脉曲张患者,随机分为常规护理组和临床护理路径组,每组25例.常规护理组采用常规护理方法,临床护理路径组采用临床护理路径方法.比较两组患者的并发症发生情况、护理满意度及生活质量评分.结果 常规护理组并发症发生率为36.00％(9/25),临床护理路径组并发症发生率为12.00％(3/25),临床护理路径组并发症发生率低于常规护理组,差异具有统计学意义(χ2=3.947,P<0.05).常规护理组护理满意19例、不满意6例,护理满意度为76.00％(19/25);临床护理路径组护理满意24例、不满意1例,护理满意度为96.00％(24/25).临床护理路径组护理满意度高于常规护理组,差异具有统计学意义(χ2=4.153,P<0.05).常规护理组生活质量评分为(75.2±13.5)分,临床护理路径组生活质量评分为(91.5±4.3)分,临床护理路径组生活质量评分高于常规护理组,差异具有统计学意义(t=5.752,P<0.05).结论 大隐静脉曲张患者选择临床护理路径方法进行护理,能够降低并发症的发生率,提高护理满意度,还能有效提升患者的生活质量,值得推广.

OBJECTIVE:The purpose of this study was to evaluate the clinical efficacy of preoperative vaginal intracavitary irradiation for Stage Ib2 and IIa cervical cancer.MATERIALS AND METHODS:From June 2008 to June 2014, data from 78 Stage Ib2 and IIa cervical cancer patients (age ≤75 years) with a diameter of local lesions >4 cm were collected in our hospital. Before treatment, all cases were confirmed by biopsy. The patients' general state was good, Karnofsky Performance Score ≥90, heart and lung functioning was normal, and patients were able to tolerate the surgery. The 78 patients were randomly divided into two groups: neoadjuvant radiotherapy group (NRG) (n = 38) and radical surgery group (n = 40). Patients in NRG received 2000~3000 cGy192 Ir irradiation of preoperatively intracavitary brachytherapy (radioactive source at 1 cm distance). After a rest of 10-14 days, radical hysterectomy with pelvic lymphadenectomy was performed. Surgery alone group (SAG) (n = 40) underwent radical surgery directly. The treatment outcomes between these two groups were compared, and the effect of preoperative intracavitary brachytherapy and presence of postoperative complications were evaluated.RESULTS:The total clinical efficacy for intracavitary brachytherapy was 94.7% (36/38) with complete response 13 (34.2%), partial response 23 (60.5%), and stable disease 2 (5.3%). Moreover, no patients developed progression disease; for SAG patients, 32 cases successfully finished the extensive hysterectomy and pelvic lymphadenectomy. Operation time <240 min was found in 19 patients. Moreover, the positive complication for lymphatic cyst and urinary retention was 20.0% and 15.0%, respectively. For NAG group, 36 patients successfully finished the extensive hysterectomy and pelvic lymphadenectomy. Operation time <240 min was found in 22 patients. Moreover, the positive complication for lymphatic cyst and urinary retention was 15.8% and 13.2%, respectively. The median follow-up time for NRG and SAG was 28 and 30 months, respectively. Three cases lost to follow-up in the SAG with the follow-up rate of 92.5% (37/40). In the NRG group, 3 cases lost to follow-up with the follow-up rate of 92.1% (35/38). The locoregional control rate for 1, 3, and 5 years was 80.0%, 61.3%, and 52.6%, respectively, for SAG group and 89.5%, 82.9%, and 76.9%, respectively, for NRG group with significant statistical difference for 3 and 5 years.CONCLUSION:Preoperative intracavitary brachytherapy is an effective procedure for the treatment for Stage Ib2 and IIa cervical cancer and can significantly improve the locoregional control rate.

目的分析高危子宫内膜癌术后单纯放疗与联合放化疗的疗效及毒性作用。方法回顾性分析1999～2007年接受病理分期性手术及术后辅助治疗的172例高危子宫内膜癌患者的临床资料。结果 172例患者3年和5年的疾病特异性生存（DSS）率分别为87.09%和78.17%。联合放化疗与单纯放疗的DSS率和复发率比较差异有统计学意义（P=0.020、0.004）。化疗后放疗与单纯放疗的毒性作用比较差异无统计学意义（P=0.638）。结论高危子宫内膜癌联合放化疗可明显提高DSS率,减少复发率。联合方式中,化疗后放疗更为安全,可行性大。

<正>宫颈病变(cervical lesions)是一个尚未限定的、比较泛化的概念,系指在宫颈区域内的各种病变,包括宫颈炎症、损伤、畸形、子宫内膜异位症、宫颈癌前病变和宫颈肿瘤[1]。妊娠期间可能发生包括宫颈上皮内瘤变和子宫颈癌在内的各种宫颈病变,统称为妊娠相关宫颈病变。有研究结果显示,妊娠妇女宫颈感染性疾病的发病率明显高于非妊娠期妇女[2],因此对妊娠

目的:比较术前近距离腔内后装放疗和单纯手术治疗Ⅰ b2、Ⅱa期宫颈癌的疗效,以探讨Ⅰ b2、Ⅱa期宫颈癌术前适当剂量阴道腔内放疗的意义.方法:选取北京妇产医院1998年6月 2005年6月,Ⅰ b2、Ⅱa期且宫颈肿块均＞4cm的宫颈癌患者78例.患者随机分为两组:术前放疗组38例行术前192Ir近距离腔内放疗,阴道盒源旁1cm2000～3000cGv.分2～3次/2～3周完成,放疗后10～14天行宫颈癌根治术即广泛子宫切除+盆腔淋巴结清扫术;单纯手术组40例直接行宫颈癌根治术.评定两组的疗效和术前阴道腔内后装放疗对手术的影响及术后并发症的情况.结果:术前放疗组宫颈肿块均有不同程度的缩小,总有效率(CR+PR)94.7%(36/38),术前放疗组和单纯手术组相比未增加手术难度和术后并发症,两组局部控制率分剐为1年(89.5%和80.0%,P>0.05)、3年(82.9%和61.3%,P<0.05)、5年(76.9%和52.6%,P<0.05);两组1、3和5年生存率分别为(85.0%和92.1%,P>0.05)、(83.9%和87.9%,P＞0.05)和(78.3%和80.0%.P>0.05),差异无显著性.结论:术前近距离阴道腔内后装放疗可作为Ⅰ b2、Ⅱa期宫颈癌综合治疗的一种有效的治疗方法,时Ⅰb2、Ⅱa期宫颈癌有满意的局部控制率.

心脏双瓣膜置换术常规指二尖瓣加主动脉瓣置换术,是外科治疗心脏联合瓣膜病变所致心功能不全的重要手段[1].