目的 探讨血清CC趋化因子配体20(CCL20)及白介素-17(IL-17)水平与子痫前期的相关性及其对子痫前期的诊断效能.方法 选择2021年1月至2022年12月陕西省人民医院产科收治的150例子痫前期孕妇为子痫前期组,另选取同期90例健康妊娠妇女为对照组.采用酶联免疫吸附法(ELISA)检测血清CCL20及IL-17的表达水平,采用Pearson相关法分析血清CCL20及IL-17与子痫前期患者临床参数的相关性;采用受试者工作特征曲线(ROC)分析血清CCL20及IL-17对子痫前期的诊断价值.结果 子痫前期组孕妇血清CCL20及IL-17水平均显著高于对照组(P＜0.001).子痫前期组孕妇血清CCL20及IL-17的表达均与收缩压(分别为r=0.463、r=0.545)、舒张压(分别为r=0.475、r=0.467)及尿蛋白(分别为r=0.302、r=0.342)呈显著正相关(P＜0.001),而与终止妊娠孕周(分别为r=-0.281、r=-0.188)、新生儿出生体重(分别为r=-0.299、r=-0.200)及1 min Apgar评分(分别为r=-0.215、r=-0.194)呈显著负相关(P＜0.05).子痫前期组孕妇血清CCL20与IL-17水平呈显著正相关(r=0.615,P＜0.001).血清CCL20及IL-17诊断子痫前期的临界值分别为50.025 pg/ml及48.825 pg/ml,血清CCL20+IL-17联合诊断子痫前期的曲线下面积最大,灵敏度及特异度分别为87.3％及94.4％.结论 子痫前期孕妇血清CCL20及IL-17的水平显著高于健康孕妇,且CCL20及IL-17水平与患者的血压、尿蛋白、妊娠结局及新生儿情况均存在显著相关性,两指标联合应用对子痫前期有一定的诊断价值.

目的:观察自拟更年安方治疗更年期综合征的临床疗效.方法:将80例患者随机分为治疗组和对照组,每组40例.对照组用更年乐胶囊,治疗组采用自拟更年安方治疗.对比两组临床疗效.结果:治疗组有效率高于对照组(P<0.05).治疗组患者治疗后促卵泡生成激素及促黄体激素水平均显著低于对照组(P<0.05),雌二醇水平高于对照组(P<0.05).结论:更年安方能显著改善更年期综合征患者的临床症状,疗效理想.

目的:对比子宫动脉化疗栓塞与单子宫动脉栓塞在瘢痕妊娠治疗中的有效性.方法:选择2016年1月-2018年12月在我院诊治的瘢痕妊娠患者96例,根据手术方式不同分为两组,各48例,其中,对照组采用单子宫动脉栓塞治疗,研究组采用子宫动脉化疗栓塞治疗,记录并对比两组术中出血量、手术时间、住院时间、人绒毛膜促性腺激素β亚单位(human chorionic gonadotrop (h)in-beta subunit,β-HCG)下降至正常范围时间、宫腔异常包块消失时间、月经恢复正常时间、首次肛门排气时间等指标;记录并对比两组患者治疗前后的卵泡刺激素(follicle stimulating hormone,FSH)、黄体生成素(luteinizing hormone,LH)、雌二醇(estradiol,E2)、抑制素B(inhibinB,IHB)等卵巢功能指标变化;记录并对比两组的膀胱损伤、阴道流血、感染等术后并发症的发生情况.结果:研究组的术中出血量、手术时间、住院时间均显著少于(短于)对照组(P＜0.05);研究组的β-HCG下降至正常范围时间、宫腔异常包块消失时间、月经恢复正常时间、首次肛门排气时间均显著短于对照组(P＜0.05);治疗前,两组的FSH、LH、E2、INHB等卵巢功能指标对比均无显著性差异(P＞0.05);治疗后,两组的FSH水平均升高,LH、E2、INHB水平均降低,且研究组更优(P＜0.05);研究组的并发症发生率显著低于对照组(6.25％vs.20.83％,P＜ 0.05).结论:相比于单子宫动脉栓塞,子宫动脉化疗栓塞有利于改善瘢痕妊娠患者的手术相关指标及术后恢复情况,对患者卵巢功能的恢复较好,且安全性较高,值得推荐至临床广泛应用.

Objective: To explore the risk factors and treatment of acute lower limb ischemia with catheter-directed thrombolysis combined with endovascular interventions. Methods: Totally 191 patients (191 lower limbs) with acute lower limb ischemia in department of vascular surgery of the First Affiliated Hospital of Chongqing Medical University from June 2012 to June 2017 who underwent catheter-directed thrombolysis combined with endovascular interventions were collected. According to imaging findings and clinical characteristics, the patients were divided into acute arterial embolism group (n=36) and acute arterial thrombosis group (n=155). The treatment effect, long-term follow-up and the risk factors closely related to primary patency were analyzed. Results: Among the 191 patients, the immediate success rate of surgery was 100%, the amputation rate within 30 days was 8.4% (16/191), and the mortality rate within 30 days was 2.6% (5/191). The mean follow-up was 31.0 (1.0-60.0) months. The 1-year overall survival rate was 92.1% and the 5-year was 79.5%. The primary patency rate was 74.3% within 1 year and 61.5% within 5 years. Primary vascular patency rate within 1 year and 5 years was mainly affected by occlusion segment (OR=3.5, 2.9, P<0.05), outflow tract (OR=3.2, 2.8, P<0.05) and ischemia degree (OR=3.4, 3.6, P<0.05). Conclusion: Catheter-directed thrombolysis combined with endovascular interventions for acute lower limb ischemia is a safe and effective method. Risk factors for primary patency at 1 and 5 years are occlusion segment, outflow tract and ischemia degree.

目的 探讨超声引导下泡沫硬化治疗老年下肢静脉曲张的疗效.方法 老年下肢静脉曲张患者316例(365条下肢),采用进口聚多卡醇注射液在超声引导下泡沫硬化治疗.随访12个月.结果 365条下肢均在门诊成功完成治疗,11例出现一过性全身不良反应;术后6个月随访率73％,复发率1％;术后12个月随访率52％,复发率6％.结论 超声引导下泡沫硬化治疗下肢静脉曲张简便、无创、高效、安全,适合于在老年人群中开展.

目的 探讨羊水过少与胎儿窘迫以及胎盘组织水通道蛋白9 (AQP9)和凋亡蛋白Caspase7(Caspase7)表达水平的关系,为临床诊治提供参考依据.方法 选取2013年2月-2016年2月在陕西省人民医院分娩的足月孕产妇187例,其中羊水量过少产妇31例(羊水过少组),羊水量正常156例(羊水正常组),观察两组胎儿窘迫发生情况,同时采用免疫组化染色SP法检测胎盘组织AQP9和Caspase7蛋白表达.结果 羊水过少组胎儿窘迫发生率为38.71％,明显高于羊水正常组7.05％,差异有统计学意义(p＜0.05);羊水过少组AQP9蛋白表达为(3.34±1.06)分,明显低于羊水正常组(5.05±1.13)分,差异有统计学意义(P＜0.05),而Caspase7蛋白表达为(3.61±1.01)分,明显高于羊水正常组(2.68±0.89)分,差异有统计学意义(P＜0.05);胎儿窘迫组与胎儿正常组胎盘组织AQP9和Caspase7蛋白表达比较差异无统计学意义(P＞0.05);羊水过少组胎盘组织AQP9和Caspase7蛋白表达呈负相关(r=-0.416,P＜0.05);羊水正常组胎盘组织AQP9和Caspase7蛋白表达无相关性(r=-0.037,P＞0.05).结论 羊水过少与胎儿窘迫以及胎盘组织AQP9和Caspase7表达有一定联系,在一定程度上解释了羊水过少的发生机制.

目的 研究超声引导下泡沫硬化治疗小隐静脉的技术及效果.方法 选取重庆医科大学附属第一医院血管外科2016年8月～2017年1月收治的32例小隐静脉曲张患者作为研究对象,31例为单侧下肢;其中1例为双侧下肢.采用超声引导下泡沫硬化剂(聚多卡醇)一次性硬化栓塞小隐静脉主干及曲张静脉,并对患者术后3个月定期随访,了解小隐静脉闭塞情况及术后并发症情况.结果 32例下肢均成功注射泡沫硬化剂,随访3个月,31例下肢小隐静脉主干达到完全闭塞,无一例深静脉血栓、肺栓塞、腓肠神经损伤等严重并发症的发生.结论 泡沫硬化治疗下肢小隐静脉曲张,疗效显著,安全性高.

目的 研究长期口服华法林患者下肢静脉曲张的泡沫硬化治疗方法及疗效.方法 回顾性分析2014年1月—2017年1月该院门诊治疗的长期口服华法林伴有下肢静脉曲张的患者21例,23条下肢,1％或3％浓度的聚多卡醇注射液超声引导下泡沫硬化治疗.随访12个月,观察治疗效果、复发率等.结果 23条下肢一次性门诊治疗的成功率为74％,二次治疗的成功率为100％,治疗过程中无明显不良反应,12个月随访复发率为13％.结论 超声引导下泡沫硬化治疗适合于长期口服华法林抗凝的患者在不停药情况下治疗下肢静脉曲张.

Objective To investigate the effect of minimally invasive surgery on stage Ⅰ - Ⅱ ovarian epithelial cancer .Methods A total of 98 cases of stage Ⅰ - Ⅱ ovarian epithelial cancer were selected from January 2014 to January 2010 in Shaanxi Provincial People's Hospital .The patients were divided into control group (49 cases) and observation group (49 cases) according to random number table .The patients in the control group were treated with laparotomy ,while the patients in the observation group were treated with laparoscopic surgery .Comparison was made between two groups in terms of intraoperative and postoperative conditions and complications .Results The operation duration ,surgical incision diameter and intraoperative blood loss in the observation group were significantly less than those in the control group (t value was 2 .037 ,2 .517 and 2 .389 ,respectively ,all P < 0 .05) .There was no significant difference in number of abdominal aortic and pelvic lymph node dissection between two groups (t value was 1 .619 and 1 .924 ,respectively ,both P > 0 .05) .The postoperative anal exhaust time ,out of bed time ,length of hospital stay ,and VAS scores in the observation group were significantly less than in the control group (t value was 2 .504 ,2 .917 ,2 .557 and 2 .001 , respectively ,all P < 0 .05) .But there was no significant difference in urinary tube indwelling time between two groups (t = 1 .669 ,P > 0 .05) .The total incidence of postoperative complications of the observation group was 10 .20％ ,which was significantly lower than that in the control group (20 .40％ ) (χ2 = 6 .883 , P < 0 .05) .Conclusion Laparoscopic surgery for patients with stage Ⅰ - Ⅱovarian epithelial cancer has the characteristics of mild trauma ,rapid postoperative recovery and low incidence of complications ,so it can be further popularized and used clinically .

Objective To study the clinical effects of Cesarean section through placental edge incision for the patients with central placenta praevia and its influence to the maternal and infant health.Methods According to random number table,there were 84 cases in our hospital divided into the observation group (42 cases) and the control group(42 cases) from March 2011 to August 2015.The patients in the observation group received Cesarean section through placental edge incision,while the control group received cesarean section through lower uterine segment incision.Results Operative time,intraoperative blood loss and the blood transfusion rate of the observation group were (25.5 ± 8.5)min,(380 ± 150)ml and 4.67％ respectively,which were significantly lower than (42.5 ± 12.5)min,(680 ± 160)ml and 16.67％ in the control group (all P ＜ 0.05).Neonatal asphyxia rate of the observation group was 4.67 ％ (2/42),which was significantly lower than 19.05％ (8/42) of the control group (P ＜ 0.05).The neonatal Apgar score of the observation group was 8.1 ± 1.0,which was significantly higher than 7.0 ± 0.3 of the control group (P ＜ 0.05).The maternal satisfaction rate of the observation group was 95.24％ (40/42),which was significantly higher than 80.95％ (34/42) of the control group (P ＜ 0.05).Conclusion It is effective of the Cesarean section through placental edge incision for the patients of central placenta praevia,which can effectively reduce the incidence of adverse pregnancy outcomes and improve the newborn health.

Objective To investigate the efficacy and safety of different applications of oxytocin during caesarean delivery in the patients with severe preeclampsia.Methods Clinical data of 124 patients with severe preeclampsia in Shanxi Provincial People's Hospital from March 2012 to May 2014 were selected.All cases were divided into study group and control group with 62 patients in each group according to different treatments.The patients in control group were injected oxytocin in corpus alone, The patients in observation group were received intravenous infusion combined with oxytocin injection in corpus.Intra-operative and postoperative&nbsp;bleeding amount, hospital stays, anus exhaust time, activity time and adverse reactions were compared between two groups.Results The bleeding amount of intra-operative, 2 h after and 24 h postoperative in the study group [(368 ±35.7) mL,(112 ±18.7) mL, (467 ±50.4) mL] were lower than that in control group [(445 ±34.5) mL,(174 ±20.5) mL,(610 ±75.3) mL] (P<0.05).The incidence of adverse reactions in the the study group (14.5 %) was lower than that in control group (46.8 %), (P<0.05).The hospital stay in the control group was ( 7.8 ±1.35 ) d and ( 5.6 ±0.96 ) d in the study group.The mean anus exhaust time were [(42.2 ±4.85) h and(30.4 ±4.57) h respectively].Postoperative activity out of bed days were(31.5 ±2.68)h and(23.8 ±2.57) h, the differences were statistically significant ( P <0.05 ) .Conclusion Oxytocin intravenous infusion combined with oxytocin injection in corpus can effectively reduced intra-operative or postoperative bleeding amount and incidence of adverse reactions, also improve clinical indexes.

目的：探讨中孕期产前筛查对出生缺陷的干预作用。方法：对1269例孕14～20＋6周的单胎妊娠孕妇，应用罗氏Cobas6000、Cobas601检测仪及配套的试剂、电化学发光方法检测血清中AFP、Freeβ-HCG浓度，通过罗氏配套软件评估胎儿患唐氏综合征（DS）、18-三体综合征（ES）和神经管缺陷（NTD）的风险值，设定每种疾病的风险截断值，对高风险孕妇进行遗传咨询，在知情选择后行产前诊断。结果：1269例孕妇中筛查出42例高危，占3．31％，其中包括DS高危35例，ES高危3例，NTD高危4例，最后确诊了DS 4例，ES 0例，NTD 2例。结论：中孕期二联产前筛查、产前诊断对预防和减少DS、ES、NTD这3种出生缺陷的发生有重要的临床和社会意义。

Objective To investigate the relationship between serum visfatin and glucose metabolism disorder in patients with polycystic ovary syndrome.Methods Seventy eight patients with polycystic ovary syndrome (PCOS) were selected,and,according to the results of glucose tolerance test and insulin release test (OGTT),were divided into normal OGTT without insulin resistance (NONIR) group (n =32 cases),OGTT normal with hyper insulinemia (HI) group (n =25 cases),and OGTT abnormalities that may be associated with hyper insulinemia (also known as abnormal glucose metabolism (AGM) group; n =21 cases).Sixteen cases of tubal infertility women were selected as control group in the same period.The relationship between serum visfatin and glucose metabolism was analyzed and related to various factors.The changes of relevant indicators of PCOS patients who were treated before and after treatment were observed in AGM group.Results In AGM Group,PCOS patient's menstrual cycle,testosterone (T),luteinizing hormone (LH)/follicle stimulating hormone (FSH),visfatin,triglyceride (TG),homeostasis model assessment of insulin resistance (HOMAIR) were higher than control group (P ＜ 0.05).The age at menarche,menstrual cycles,infertility time,waist-hip ratio (WHR),systolic blood pressure,T,estradiol (E2),and LH/FSH were no significant difference between AGM group versus NONIR group or HI group (P ＞0.05).However,the body mass index (BMI),waist circumference,diastolic blood pressure,HOMA-IR,and TG in AGM group were significantly higher than NONIR group,and older than HI group; visfatin in AGM group was higher than NONIR group or HI group (P ＜ 0.05).Visfatin was positively correlated with BMI,waist circumference,fasting insulin (FINS),fasting plasma glucose (FPG),HOMA-IR,and TG (r =0.423 ～ 0.847,P =0.01 ～ 0.04).After 3 months of treatment,8 cases AGM patients' serum visfatin,HOMA-IR,and blood pressure were significantly decreased (P ＜ 0.05).Conclusions High serum visfatin may be one predictor of glucose metabolism in patients with PCOS.Especially,the patients with obesity should be highly vigilant glucose metabolism disorder occurring and should be given positive joint programs treatment for weight control.

现将自1998年5月至2006年5月收治的55例妊娠期肝内胆汁淤积症(ICP)的治疗体会,报道如下. 临床资料 1 一般资料 55例患者年龄20～36岁,平均23.8岁.初产妇48例,经产妇7例;孕早期1例,孕中期45例,孕晚期9例.实验室检查:丙氨酸氨基转移酶(ALT):正常2例,升高低于3倍以下18例;总胆汁酸(TBA):15～92.5 μmo/L;血总胆红素(TBIL)全部超过正常,其中21例在80μmo/L以下;碱性磷酸酶(ALP)均超过正常范围.