目的 研究超声追踪技术联合超声心动图在妊娠期高血压(HIP)孕妇心功能中的应用价值.方法 前瞻性选择2018年1～12月北京市平谷区医院妇产科接受治疗的70例HIP孕妇作为研究组,同期健康体检者60例作为对照组.采用超声心动图及超声追踪技术2种方法检查患者左心室功能,比较2组心脏形态指标、左心室收缩和舒张功能指标、左心室旋转指标、左心室运动情况.结果 研究组左心室舒张末期内径(LVDd),左心室收缩末期内径(LAD)、左心室后壁舒张期厚度(LVPWTd)、室间隔舒张末期厚度(IVSTd)、左心室重量指数(LVMI)及相对室壁厚度(RWT)值均显著高于对照组,差异有统计学意义(P<0.05).研究组舒张早期最大流速/舒张晚期最大速度比值(E/A)、舒张早期快速充盈分数(RFF)及心脏指数(CI)值显著小于对照组,左心室射血分数(LVEF)值显著高于对照组,差异有统计学意义(P<0.05);2组心输出量(CO)值比较差异无统计学意义(P>0.05).研究组心底水平旋转角度峰值(Prot-MV)、心底水平旋转角度达峰时间(Pti-MV)值显著低于对照组,心尖水平旋转角度峰值(Prot-AP)、心尖水平旋转角度达峰时间(Pti-AP)、心底水平旋转角度达峰时间百分比(Perc-Pti-MV)值显著高于对照组,差异有统计学意义(P<0.05);2组心尖水平旋转角度达峰时间百分比(Perc-Pti-AP)值比较差异无统计学意义(P>0.05).研究组舒张早期左心室侧壁速度(ELV)和位移(ELD)值显著小于对照组,舒张晚期左心室侧壁速度(ALV)和位移(ALD)值显著高于对照组,差异有统计学意义(P<0.05).结论 超声追踪技术联合超声心动图能准确评价HIP孕妇高血压孕妇心功能.

目的 探讨腹腔血与静脉血HCG比值(RPHCG/VHCG)诊断异位妊娠的临床价值.方法 回顾性分析我院2019年6月至2020年7月收治的50例异位妊娠腹腔内出血患者的临床资料,进行HCG定性、定量检测,分析RPHCG/VHCG诊断异位妊娠的临床价值.结果 腹腔血β-HCG定量检测值显著高于静脉血(P<0.05),RPHCG/VHCG为2.5.RPHCG/VHCG>1诊断异位妊娠的敏感度与特异度分别为97.78％、100.00％.结论 RPHCG/VHCG诊断异位妊娠具有较高的临床价值.

目的 探讨阴道镜下检查联合人乳头瘤病毒(HPV)、液基薄层细胞学(TCT)检查对宫颈癌(CC)筛查的临床作用.方法 选取2017年7月～2018年7月我院门诊938例CC筛查的受试者作为研究对象,所有受试者均分别采用HPV、TCT检查、阴道镜下检查等方式检查,并以病理学检查结果作为金标准,统计HPV、TCT及两者联合阴道镜下活检三种检查方式诊断CC和不同程度癌前病变的符合率.结果 938例受试者中经病理学检查诊断,817例无上皮内病变,121例为CC及癌前病变阳性,其中CC11例,CIN Ⅰ级病变30例,CINⅡ级病变39例,CINⅢ级病变41例.HPV检查的总体符合率为87.60％(106/121).TCT检查的总体符合率为85.12％(103/121),而HPV+TCT+阴道镜检查的总体符合率为97.52％(118/121).TCT和HPV检查两种检查方式对CC和癌前病变的检出符合率比较,差异无统计学意义(P＞0.05),而HPV+TCT+阴道镜检查的检出符合率要显著高于HPV、TCT单独诊断,差异有统计学意义(P＜0.05).结论 阴道镜下联合HPV、TCT检查应用于CC的临床筛查,能及早发现癌前病变,改善CC诊断的检出率,减少漏诊,应用价值良好.

目的 探讨术后化疗对早期高危子宫内膜癌患者的临床意义.方法 选取2010年1月至2013年12月间北京市平谷区医院收治的100例早期高危子宫内膜癌患者,采用随机数表法分为治疗组和对照组,每组50例.治疗组患者手术后行化疗治疗,对照组患者术后未行化疗治疗,比较两组患者术后3年及5年的子宫内膜癌复发率及生存率.结果 治疗组患者复发率为10.0％(5例),对照组为18.0％(9例),两组比较,差异有统计学意义(P＜0.05).治疗组患者3年和5年生存率分别为94％和92％,均较对照组的83％和82％高,差异均有统计学意义(均P＜0.05).治疗组患者化疗过程中出现皮肤过敏2例、呕吐5例和腹泻1例,经对症治疗,均顺利完成化疗.结论 对早期高危子宫内膜癌患者行术后辅助化疗,可减少子宫内膜癌复发,有效提高患者5年生存率,值得临床推广.

Objective: To investigate the surgical techniques and safety of vessel sealing system( LigaSure) and bipolar electrosurgical generator in laparoscopic hysterectomy for enormous uterus. Methods: From Jan. 2008 to Dec. 2013,168 patients with uterine fibroids were selected for the study,all patients were treated with laparoscopic total hysterectomy. Surgical instruments were selected according to patientsu0027 wishes,and according to the surgical equipment used the 168 patients were divided into group A( n = 83,LigaSure and bipolar electric knife) and group B( n = 85,bipolar electrosurgical generator). Conversion to open surgery,operative time,blood loss,postoperative exhaust time,postoperative hospital stay,incidence of postoperative complications were compared between the two groups. Results: In group A the rate of conversion to laparotomy was 3. 6%,and 4. 7% in the group B,the difference was not statistically significant( P 0. 05). The operative time and blood loss of group A were less than those of group B( P 0. 05). The postoperative exhaust time and postoperative hospital stay of two groups was not statistically different( P 0. 05). In group A,1 patient with uterine adenomyosis was found mild extension of left fallopian tube,mild hydronephrosis of the left kidney within 1 week,after anti-inflammatory treatment of 2 weeks,this patient improved and was discharged. Patients in group B did not suffer from serious complications,the difference was not statistically significant( P 0. 05). Conclusions: Using LigaSure and bipolar electric knife in hysterectomy has shorter operative time,less blood loss,and the clinical efficacy is similar with simple use of bipolar electric knife,this procedure can promote the popularization of laparoscopic hysterectomy for enormous uterus.

<正>患者,47岁,主因"普查发现子宫肌瘤6～7年,阴道出血1年"于2013年2月1日入院。患者平素月经规律,5/24天,量多,痛经阳性,无进行性加重。6～7年前妇科普查发现子宫肌瘤,超声提示肌瘤直径1～2 cm,无临床症状,未定期复查。近1年阴道淋漓出血,2012年10月就诊于北京协和医院行分段诊刮术,术后病理回报子宫内膜单纯性增生,口服妇康片,8片/次,2次/d,持续至今;期间仍有间断阴道淋漓出血。2013年1月28日北京协和医院超声检查提示子宫肌瘤增至7.4 cm×5.8 cm×5.9 cm大,建议手术治疗,于2013年2月1日入我院。合并高血压病5年,17岁初潮,25岁结婚,孕2产2,初次分娩发现双子宫双宫颈。外阴已婚经产型,单阴道,少量暗红色血,双宫颈,左侧宫颈上唇见增生组织,未触及明显双宫体,子宫整体增大如孕12周,表面

<正>1临床资料患者28岁,因停经49d,无痛性阴道出血9d入院。停经47d查血β-HCG2605mIU/mL,B超:宫腔内见5cm×3cm胎囊样无回声,其内见4.0cm×2.7cm不均质中强回声,中强回声内见部分蜂窝样无回声,考虑葡萄胎(见图1)入院。既往患者有剖宫

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.

目的 探讨输卵管妊娠病人采取不同手术方式对于术后妊娠的影响.方法 回顾性总结2000～2005年间本院住院手术病人中行输卵管开窗术或者切除术有意愿再次妊娠患者并术中行卵管通液术证实对测卵管通畅135例进行3～4年随访.其中A组62例,行开窗术.B组73例行输卵管切除术.比较两组手术方式对于再次妊娠的影响.结果 比较术后3～4年内妊娠宫内妊娠率及再次异位妊娠发生率.宫内妊娠率:A组25例宫内妊娠.B组16例宫内妊娠,两组比较p＜0.05有显著差异;异位妊娠率:A组15例,B组8例,两组比较p＜0.05,差异有显著性.结论 对于采取输卵管开窗术应推荐.因为保留输卵管增加了总的妊娠率,增加了宫内妊娠率.尤其要求再生育者,保留输卵管应建议.对于无生育要求者建议切除患侧卵管,因为保留卵管同时增加了再次异位妊娠率.