目的 探讨给予米非司酮、米索前列醇术前预处理联合宫腔镜下妊娠物清除术在Ⅱ型剖宫产瘢痕妊娠(cesareanscar pregnancy,CSP)中的治疗效果.方法 回顾性分析2017年1月—2018年12月无锡市妇幼保健院收治的CSP患者临床资料.依据中华医学会妇产科学分会2016年制定的CSP分型标准,将其中初始治疗采用米非司酮、米索前列醇术前预处理联合宫腔镜下妊娠物清除术的Ⅰ、Ⅱ型CSP患者共118例分为2组:Ⅰ型(61例)、Ⅱ型(57例).收集患者一般资料及手术治疗相关指标(包括手术时间、术中出血量、住院天数、中转进腹率、单次手术成功率、总治愈率),评价治疗效果,并比较2组患者治疗效果有无差异.结果 2组间一般资料、手术时间、出血量、住院天数相比差异无统计学意义.Ⅰ、Ⅱ型CSP中转进腹手术率分别为4.9％和5.3％,单次宫腔镜手术成功率分别为91.8％和89.5％,无二次手术及子宫切除病例,总治愈率均为100％,2组相比差异无统计学意义.Ⅱ型组术中放置球囊压迫止血例数较Ⅰ型组增加,2组间比较差异有统计学意义(P＜0.05).结论 米非司酮、米索前列醇术前预处理联合宫腔镜下妊娠物清除术可同样安全有效地应用于Ⅱ型CSP患者,但围手术期需做好应对瘢痕部位大出血中转进腹行妊娠病灶清除及子宫瘢痕修补术的准备.

目的 探讨不同手术途径全子宫切除术治疗宫颈上皮内瘤变3级(cervical intraepithelial neoplasia 3,CIN3)采用宫颈环形电切术(loop electrosurgical excision procedure,LEEP)术后患者的手术并发症差异.方法 分析宫颈上皮内瘤变3级LEEP术后患者162例,根据子宫切除术手术途径不同分为3组,A组66例为腹腔镜下全子宫切除术治疗,B组79例经腹全子宫切除术治疗,C组17例采用经阴道子宫切除术治疗,比较3组患者的围手术期相关数据(手术时间、术中出血及并发症情况).结果 A组手术中出血量、术后肛门排气时间明显比B组和C组短,B组手术并发症发生率高于A组和C组(P<0.05).结论 宫颈上皮内瘤变3级锥切术后补充全子宫切除手术并发症总体比较低,经腹手术并发症以感染多见,腹腔镜手术及经阴道全子宫切除术手术并发症以尿潴留为主,但恢复较快.

目的 探讨腹腔镜全子宫切除手术的同时行机会性双侧输卵管切除术对卵巢功能的影响.方法 选取因子宫良性疾病行腹腔镜下全子宫切除术的90例患者,随机分为两组,每组45例.切除组同时行机会性双侧输卵管切除,保留组术中保留输卵管.检测术前及术后3、6个月时的血清抗苗勒氏管激素(AMH)水平.比较两组手术相关资料.结果 两组手术时间、出血量、并发症发生率和住院天数均无统计学差异(P＞0.05).切除组和保留组术前AMH水平相仿[(1.32±0.12) ng/ml vs.(1.23±0.25) ng/ml](P＞0.05].90例患者术后3和6个月的血清AMH分别为(0.92±0.21) ng/ml和(0.90±0.19)ng/ml,低于术前的(1.29±0.31) ng/ml(P＜0.05).术后3和6个月时,切除组AMH下降率分别为21.5％和21.8％,与保留组的19.8％和20.1％相仿(P＞0.05).结论 因子宫良性疾病行腹腔镜全子宫切除手术对卵巢功能有一定影响,但同时行机会性双侧输卵管切除对近期卵巢功能并不产生额外的不良影响.如因子宫良性疾病需行腹腔镜切除子宫时可考虑同时切除双侧输卵管.

Objective To assess the prediction value of first trimester serum secreted frizzle-related protein-5(Sfrp-5) levels for gestational diabetes mellitus (GDM).Methods Three hundred and twenty pregnant women were enrolled in this study and divided to two groups based on glucose tolerance screening:GDM group(n=28) and non-GDM group(n=288).Serum Sfrp-5 levels were measured on first and second trimester of pregnancy.All enrolled pregnant women were receiving insulin resistance(HOMA-IR) and beta cell function evaluation (HOMA-β,INSAUC,PGAUC,INSAUC/PGAUC and △l30/△G30).ROC analysis was used for evaluate the early prediction value of Sfrp-5 for GDM.Pearson correlation was used to analyze the association between GDM and Sfrp-5.Logistic regression was used to determinate the risk factors for GDM.Reaulta The serum Sfrp-5 level,HOMA-β,INSAUC/PGAUC and △I30/△G30 in GDM group were lower than those in non-GDM group on both first and second trimester of pregnancy,while HOMA-IR were higher than those in non-GDM group(all P＜0.05).Correlation analysis showed that contents of Sfrp-5 were negatively associated with GDM on both first and second trimester of pregnancy.ROC analysis suggested that AUC of Sfrp-5 on first trimester of pregnancy was 0.788,the sensitivity and specificity were 82％ and 78％ when 10.5ng/ml was taken as Cut-off value.Logistic analysis indicated that serum Sfrp-5 on first (＜10.5ng/ml) and second trimester (＜6.8ng/ml) of pregnancy were independent risk factors for GDM (OR=1.55 and 1.22,both P＜0.05).Conclusion The reduction of serum Sfrp-5 level on first trimester of pregnancy may be an important warning marker for GDM.

目的:探讨阴道上皮内瘤变(vaginal intraepithelial neoplasia,VaIN)的临床特征,以及评价CO2激光气化治疗VaIN的有效性及安全性.方法:收集2006年1月至2015年1月期间在无锡市妇幼保健院宫颈疾病诊疗中心行CO2激光气化治疗的108例VaIN患者临床资料,回顾性分析其临床特征及治疗效果.结果:患者平均年龄(41.2±9.5)岁,平均随访时间(37.0±12.7)月.108例患者中有71例(65.7％)同时或先前诊断为外阴上皮内瘤样病变或宫颈上皮内瘤样病变以及宫颈癌.阴道镜下病灶中位数为3,病变呈多灶性分布的临床特点.其中接受高危型人乳头状瘤病毒(human papilloma virus,HPV)检查的患者86人,治疗前HPV阳性率为75.6％(65/86).经初始治疗后病灶残留率为14.8％(16/108)、初始治愈率为85.2％.随访期间病变复发9例,复发率为8.3％.病灶残留及复发患者均接受重复激光气化治疗.有2例因阴道鳞状细胞癌转至肿瘤专科医师处治疗,其余均治愈,累计治愈率为98.1％.术后发生阴道粘膜溃疡伴感染1例,性生活满意度下降3例.术后HPV转阴率为76.9％,平均转阴时间为(13.2±3.1)月.结论:VaIN的发生与外阴、宫颈上皮内瘤样病变以及宫颈癌密切相关,阴道镜下病变呈多灶性分布的临床特点.采用CO2激光气化治疗VaIN安全有效,初始治疗后有一定的病变残留率及复发率,但重复治疗效果好,可作为VaIN安全有效的治疗方案,术后应注意严密随访.

本研究旨在分析无锡地区妊娠期妇女的碘营养状况及其与甲状腺功能关系,为实施该地区孕妇的碘营养状况监测和孕期甲状腺功能筛查提供依据。研究随机选取2010-2012年间无锡市妇幼保健院门诊定期产检的孕妇共计379例,测定尿碘浓度、血清促甲状腺素(TSH)、总甲状腺素(TT3、TT4)、游离甲状腺素(FT3、FT4)。研究对象的尿碘中位数(MUI)为211μg/L,59.1%尿碘值在150~250μg/L之间。尿碘>250μg/L,占16.6%,尿碘<150μg/L占研究对象的24.3%。碘缺乏、碘适量、碘超足量三组的甲状腺功能减退患病率分别为10.9%、3.6%、3.2%,碘缺乏组甲状腺功能减退发生率明显高于其他两组。因此,本地区妊娠期妇女总体碘营养处于适宜水平,但仍有部分孕妇存在碘缺乏及碘过量。

Objective To study whether hormone replacement therapy of estradiol valerate and norethisterone have any effect on the pulsatility index(PI) of the internal carotid and uterine arteries in early postmenopausal women.Methods A group of 48 healthy postmenopausal women with no history of hormone therapy(HT) were randomly divided into two groups: HT treatment group(n = 25) and placebo group(n = 23).Doppler ultrasound test was used to measure the pulsatility index(PI) of internal carotid and uterine arteries before and 4months after the treatment.Results There was no significant difference in pulsatility index and pulsatility index ratio of the internal carotid and the uterine arteries 4 months after HT treatment(P > 0.05).Conclusion This HT regimen showed no significant negative impact on vascular resistance in early postmenopausal women.Results are compatible with the updated recommendations on HT stating that there is little cerebrovascular risk when HT is initiated within a few years of the menopause.

目的:调查无锡地区妇产科护士工作倦怠感及自我效能感状况,探讨二者之间的关系,为矫治和预防妇产科护士职业倦怠提供必要性依据和实践指导.方法:对无锡市3家三级甲等医院的150名妇产科护士进行问卷调查.结果:妇产科护士工作倦怠感中情绪倦怠感得分为(24.60±10.28)分,工作冷漠感得分为(6.16±5.60)分,均为中度倦怠,个人成就感得分为(31.30±9.45)分,属于高度倦怠,自我效能感得分为(2.58±0.61)分.自我效能感得分与情绪倦怠感得分呈显著负相关(r=-0.232,P<0.01),自我效能感得分与个人成就感得分呈显著正相关(r=0.426,P<0.01).结论:应重视提高妇产科护士的自我效能感,以便更有效地降低护士的工作倦怠感.

目的:评价妊娠期糖尿病高危孕妇首次糖尿病筛查结果正常时再次筛查异常结果发生率及相关因素。方法:2005年4月～2007年4月期间在本院进行产前检查有患糖尿病高危因素的600例孕妇,且于孕24周前行50g糖筛查结果均小于7.8mmol/L。所有研究对象在孕28～32周再次接受糖筛查实验并进行随访。结果:600例孕24周前首次糖筛查结果正常的孕妇被纳入研究。513例接受了二次糖筛查实验,其中165例(32.2%,95%CI:28.2%～36.3%)在二次糖筛查中结果异常,20例(3.9%)被诊断为糖尿病。妊娠妇女年龄≥30岁或首次糖筛查结果≥7.2mmol/L者再次筛查的异常发生率较高。结论:有患糖尿病高危因素的孕妇于孕24周前糖筛查结果正常时,仍需建议在孕28～32周时再次接受筛查实验,再次筛查结果异常的高危因素为年龄≥30岁和50g糖筛查结果≥7.2mmol/L。

Objective:To expound the pathological mechanism of occurrence and development of fetal growth restriction from the standpoint of cell apoptosis and proliferation by detecting the apoptosis index and proliferation index of placental tissues in cases with fetal growth restriction.Methods:31 patients with fetal growth restriction and 30 normal term pregnant women delivered in the hospital from February 2007 to February 2009,their placental tissues were collected,the apoptosis index and proliferation index were detected by TUNEL method and SP method quantitatively.Results:Apoptosis occurred in placental tissues of both fetal growth restriction group and control group,especially in decidual cells and syncytiotrophoblast cells.The apoptosis indexes in placental tissues of fetal growth restriction group [syncytiotrophoblast cells(36.4±9.2)%,decidual cells(40.2±7.5)%] were significantly higher than those in control group [syncytiotrophoblast cells(23.3±5.0) %,decidual cells(28.4±8.2) %](P<0.01).The expression level of proliferating cell nuclear antigen in cytotrophoblastic cells of fetal growth restriction group [proliferation index of cytotrophoblastic cells(25.1±5.9) %] was significantly higher than that in control group [proliferation index of cytotrophoblastic cells(17.2±5.8) %](P<0.01).Conclusion:Apoptosis exists in placental tissues of patients with fetal growth restriction and normal women of late pregnancy;the apoptosis indexes in placental tissues(syncytiotrophoblast cells and decidual cells) of patients with fetal growth restriction are significantly higher than those in normal women of late pregnancy,and proliferation of cytotrophoblast cells in placental tissues is enhanced in patients with fetal growth restriction,which may probably play an important role in occurrence and development of fetal growth restriction.

碘是人体所必需的微量元素,是合成甲状腺素的重要原料.胎儿甲状腺的发育依赖于母体所提供的碘.如果妊娠期碘摄入量异常,可造成母体甲状腺功能异常,还会引起胎儿甲状腺功能异常及脑发育分化不良,导致一系列发育障碍.