目的:探讨人乳头瘤状病毒(HPV)16/18感染患者瑞琳他抗/高强度聚焦超声(HIFU)治疗后未转阴的预警因素及其对临床治疗决策的指导价值.方法:选取2020年5月至2021年12月我院110例HPV16/18感染的低级别鳞状上皮内病变(LSIL)及以下患者进行回顾性研究,根据瑞琳他抗/HIFU治疗后HPV16/18感染转阴情况分为转阴组、非转阴组,对非转阴情况进行单因素及多因素Logistic回归分析.结果:年龄41～50岁患者非转阴的风险是＜25岁的12.762倍,HPV16/18双重感染患者非转阴的风险是HPV 16(+)或18(+)患者的22.231倍,HPV-mRNA E6/E7(+)患者非转阴的风险是(-)患者的37.722倍,伴阴道炎患者非转阴风险是无阴道炎患者的9.463倍,采用HIFU治疗患者非转阴的风险是药物治疗患者的0.430倍,性伴数量≥2个患者非转阴的风险是性伴=1个患者的12.731倍,尿液1-羟基芘浓度亦与转阴情况相关(P＜0.05).多因素 Logistic 回归方程:Logit(P)=-11.054+2.546 × 年龄 41～50 岁+3.101 × HPV16/18双重感染+3.630 × HPV-mRNA E6/E7(+)+2.247 × 阴道炎-0.843 × HIFU 治疗+2.544 × 性伴数量≥2个+2.702 ×尿液1-羟基芘浓度;该模型预测瑞琳他抗/HIFU治疗后转阴的受试者工作特征(ROC)曲线下面积(AUC)为 0.901(95％CI0.830～0.949),敏感度为 86.11％,特异度为 82.93％.结论:年龄、HPV16/18双重感染、HPV-mRNA E6/E7(+)、阴道炎、性伴数量、尿液1-羟基芘浓度均是HPV16/18感染患者瑞琳他抗/HIFU治疗后未转阴的预警因素,通过对以上预警因素的评价可为临床选取非手术治疗或外科手术治疗决策提供参考,既避免持续感染贻误病情,又可避免过度治疗增加患者负担.

目的 探讨超短聚焦超声技术对宫颈感染HPV16、18转阴治疗的可行性.方法 选取我院门诊自,HPV-DNA检测示有16和(或)18(+),病理提示低级别鳞状上皮内病变(LSIL)及以下者共110例,随机分入HIFU(聚焦超声)组(n=41)、LEEP组(n=39)、药物组(n=30)进行治疗,观察治疗后并发症的情况及治疗后6、12个月HPV转阴情况.结果 HIFU组和LEEP组转阴率高于药物组,差异有统计学意义(P<0.05).HIFU组和LEEP组间差异无统计学意义(P=0.065>0.05).Normal组和宫颈炎组转阴率高于LSIL组,差异有统计学意义(P<0.001),Normal和宫颈炎组转阴率比较,差异无统计学意义(P>0.05).HPV-mRNA阳性组无论采取哪种治疗方式,转阴率均低于阴性组,差异有统计学意义(P<0.01).HIFU组治疗后并发症发生明显低于LEEP组,创面愈合时间短于LEEP组(P<0.05).结论 利于病毒清除HPV转阴,同时自内向外的治疗,保留了组织完整,并发症低,对于育龄女性尤其有生育要求的女性,作为高危HPV感染的治疗方式更值得推荐.

目的 研究两种不同入路胸腔镜胸腺切除术对重症肌无力(MG)患者血气、氧合指数、脉搏氧饱和度、肺内分流率、气道压、肺动态顺应性的影响.方法 回顾性分析2017至2018年行胸腔镜胸腺切除MG患者60例,其中右胸入路胸腔镜胸腺切除术30例(Y组),剑突下入路胸腔镜胸腺切除术30例(J组).分别于全麻插管后,通气5 min(T1),通气30 min(T2),通气60 min(T3),关胸后即刻(T4),抽取动脉血进行血气分析,计算氧合指数(OI)、肺内分流率(Qs/Qt),同时监测记录脉搏氧饱和度(SpO2)、气道峰压(Pmax)并根据公式计算肺动态顺应性(Cdyn).结果 T1、T4时点Y组与J组比较,pH值、PaO2、OI、SpO2、Qs/Qt差异无统计学意义(P>0.05);T2、T3时点,Y组与J组比较,pH值、PaO2、OI、SpO2明显降低,Qs/Qt明显升高,差异有统计学意义(P<0.05).T1～T4时点,Y组与J组比较,PaCO2差异无统计学意义(P>0.05),与T1比较,T2、T3时点2组PaCO2都有升高,但均在正常范围.T2、T3时点,Y组与J组比较,Pmax显著增高,Cdyn明显下降,差异有统计学意义(P<0.05).T1、T4时点,2组Pmax、Cdyn比较差异无统计学意义(P>0.05).结论 与右胸入路胸腔镜胸腺切除术相比,剑突下入路胸腔镜胸腺切除术对患者血气、OI、SpO2、Qs/Qt、Pmax、Cdyn的影响较小,氧合更好.

目的 比较剑突下入路胸腔镜与传统开胸胸腺切除术式对重症肌无力(MG)患者血气、肺内分流率、气道压、肺动态顺应性的影响.方法 回顾性分析2015年1月至2018年12月行全胸腺切除MG患者60例,其中传统开胸胸腺切除术30例(K组),剑突下入路胸腔镜胸腺切除术30例(J组).分别于全麻插管后、通气5 min(T1)、通气30 min(T2)、通气60 min(T3),关胸后即刻(T4)抽取动脉血进行血气分析,计算肺内分流率(Qs/Qt),同时监测记录气道峰压(Pmax)并根据公式计算肺动态顺应性(Cdyn).结果 T1、T4时点J组与K组比较,pH值、PaO2、PCO2、BE值差异无统计学意义(P>0.05);T2、T3时点,J组与K组比较,pH值、PaO2、BE值明显降低,PCO2明显升高,差异有统计学意义(P<0.05).T1、T4时点,J组与K组比较,Qs/Qt差异无统计学意义(P>0.05),T2、T3时点,J组与K组比较,Qs/Qt显著增高,差异有统计学意义(P<0.05).T1、T4时点,J组与K组比较,Pmax、Cdyn差异无统计学意义(P>0.05),T2、T3时点,J组与K组比较,Pmax显著增高,Cdyn明显下降,差异有统计学意义(P<0.05).结论 传统开胸胸腺切除术和剑突下入路胸腔镜胸腺切除术对患者血气、肺内分流率、气道峰压、肺动态顺应性均会产生一定的影响,与传统开胸胸腺切除术相比,剑突下入路胸腔镜胸腺切除术对患者血气、肺内分流率、气道峰压、肺动态顺应性的影响较大.

目的 分析CO2气胸对剑突下入路胸腔镜胸腺切除术患者血气、肺内分流率、气道压及肺动态顺应性的影响.方法 选择行剑突下入路胸腔镜胸腺切除术的重症肌无力(MG)患者40例,术中均行单腔气管导管通气和CO2气胸.分别于CO2气胸前(T1),CO2气胸30 min(T2),CO2气胸60 min(T3),关胸结束即刻(T4),抽取动脉血进行血气分析,根据肺泡-动脉氧分压差P(A-a)O2值,计算肺内分流率(Qs/Qt),同时监测记录气道峰压(Pmax)并根据公式计算肺动态顺应性(Cdyn).结果 CO2气胸期间(T2～T3)与T1比较PaCO2、肺泡-动脉氧分压差P(A-a)O2、肺内分流率(Qs/Qt)、Pmax均明显升高(P<0.05),PaO2、BE(B)、Cdyn均明显降低(P<0.05).CO2人工气胸期间HCO3-、pH值虽然都在正常范围内,但是HCO3-有升高趋势,pH值有下降趋势.T1与T4比较,各项指标差异无统计学意义(P>0.05).结论 CO2人工气胸对剑突下入路胸腔镜胸腺切除术患者的血气、肺内分流率、气道峰压及肺动态顺应性,有明显影响.术中需加强监测与管理,减小对患者的不利影响.

目的 分析肺保护通气策略在右胸入路胸腔镜胸腺切除术中的应用效果.方法 选择2017年1～6月行右胸入路胸腔镜胸腺切除术的重症肌无力(MG)患者40例,患者随机分为肺保护组(PV组)和常规通气组(CV组),每组20例.2组患者术中均插入双腔气管导管,PV组患者单肺通气(OLV)时采用肺保护通气策略干预,潮气量(VT)6 ml/kg+呼气末正压通气(PEEP)5 cm H2O+手法肺复张+限制气道平台压(Pplat)≤30 cm H2O.CV组患者术中采用标准潮气量(VT)10 ml/kg,术中根据患者呼末二氧化碳和血气数值调整呼吸频率.分别于TLV通气5 min(T1),OLV通气30 min(T2)、OLV通气60 min(T3)、OLV结束后10 min(T4),抽取动脉血进行血气分析,根据肺泡-动脉氧分压差(A-aDO2)数值,用公式计算呼吸指数(RI),监测记录气道峰压(Pmax),并根据公式计算出肺动态顺应性(Cdyn),同时记录计算低氧血症(SpO2≤92％)的例数及发生率.结果 T1、T4时点,2组pH值、PaCO2、PO2、A-aDO2和RI比较差异无统计学意义(P>0.05).T2、T3时点,与CV组比较,2组pH值均降低,PV组略低于CV组(P>0.05).PV组PaCO2、PO2均高于CV组(P<0.05),A-aDO2、RI均低于CV组(P<0.05).PV组Pmax低于CV组,Cdyn高于CV组,呼吸频率(f)高于CV组,PET CO2高于CV组,低氧血症的例数及发生率低于CV组,2组比较差异有统计学意义(P<0.05).结论 在右胸入路胸腔镜胸腺切除术中应用肺保护通气策略,可提升脉搏血氧饱和度,减轻肺内分流,改善肺动态顺应性,同时避免气道压力过高造成肺损伤.

目的 探讨高强度聚集超声消融术后抗生素应用的必要性.方法 选取2019年8～12月因病行高强度聚集超声消融治疗的患者共100例,其中子宫肌瘤60例,子宫腺肌病25例,肌瘤合并腺肌病10例,瘢痕妊娠5例,随机分为观察组和对照组,每组50例.观察组术后应用阿莫西林预防感染治疗3 d,对照组术后不用药.术前均常规检查血常规、生化(包括CRP),治疗后第1天晨复查血常规、CRP、监测体温,观察患者术后反应,术后3 d回访,通过对术后炎性反应的指标监测,应用与未应用抗生素组患者的症状调查,探讨术后应用抗生素的必要性.结果 通过术前检查、术后复查相关炎性指标及体温变化,发现高强度聚集超声消融后出现体温升高、炎性反应的患者发生率为3％,与患者术前存在高危因素(贫血、诊刮操作)有关,与投入能量大小、治疗时间有关,与肌瘤多少、操作时间长短、年龄无关(P>0.05),术前有诊刮及宫腔操作为高危因素者,术后感染风险增加(P<0.05),应预防应用抗生素,无高危因素者应用抗生素与否患者临床表现及检测指标无差别,不需要常规应用抗生素预防感染.结论 高强度聚集超声消融治疗是一种无创安全有效的治疗方法 ,通过对病灶产生高温,使病灶发生凝固性坏死而起到治疗作用,这种治疗方式无明显引起组织发生炎性感染的倾向,术后无诊刮高危因素者不需常规口服抗生素预防感染.

Objective To observe and compare the therapeutic effects of diffetent medication ways on missed abortion.Methods A total of 200 patients with missed abortion were enrolled in the study.According to the different doses of estradiol valerate combined with different doses of mifepristone and misoprostol by means of medication ways,these patients were divided into four groups: experimental group A, B,C groups and control group (mifepristone with misoprostol). The complete abortion rate,vaginal bleeding volume after abortion,vaginal bleeding time after abortion,abortion failure rate,the second time curettage rate and the second time pregnancy rate were observed and compared among the four groups.Results The complete abortion rate in three experimental groups were obviously higher than that in control group,however,the abortion failure rate and the second time curettage rate in three experimental groups were significantly higher than those in control group,moreover,the average vaginal bleeding volume,postpartum vaginal bleeding time, menstrual resurgence time in three experimental groups were significantly shorter than those in control group (P <0.05). However there were no significant differences in these indexes mentioned above among three experimental groups(P>0.05).In addition there was no significant difference in the second pregnancy rate between the three experimental groups and control group (P>0.05).Moreover there was no significant difference in the second time pregnancy rate among the three experimental groups(P>0.05).Conclusion The therapeutic effects of combination application of estradiol valerate with mifepristone and misoprostol on missed abortion are superior to those by simple mifepristone or simple misoprostol,however,there are no significant differences in different doses of estradiol valerate combined with mifepristone and misoprostol by means of different medication ways,and none of the four treatment modes has unique advantages on the second pregnancy.

Objective To investigate the risk factors of missed abortion to decrease the incidence of repeated abortions.Methods A questionnaire survey was performed for 200 patients with missed abortion who were treated firstly in our hospital from January 2013 to December 2014.The results were statistically analyzed by SPSS 11.0 software.Results The common cause of missed abortion was the infection factors,which accounted for 31.5％.The incidence of missed abortion was significantly increased in the age range of 26 ～ 30 years and 31 ～ 35 years.The more the number of times of artificial abortion,the higher the probability of incidence of missed abortion.Among 200 patients,the patients whose serum levels of calcium,iron,zinc and lithium were lower than the normal value accounted for 90％,and the difference was statistically significant (P ＜ 0.05).Among 200 patients,the patients with lower levels of progesterone who had missed abortion accounted for 48 ％,the patients with high levels of lactotropin accounted for 30％,and the patients with low levels of estrogens accounted for 30％,the difference was statistically significant (P ＜ 0.05).Conclusion Preventing genital tract infection,improving the immune status of pregnant women and avoiding high radiation environment can reduce the incidence rate of missed abortion in early pregnancy.The sufficient trace element concentration and sex hormone levels play an important role in embryo development and maintenance of pregnancy.It is suggested that the best child-bearing age should be 25 ～ 29 years,and it is important to cherish every chance of conception and reduce blindly induced abortion.

Objective To analyze the hemodynamics charateristics of patients with missed abortion and early pregnant women by color Doppler ultrasonography in order to provide the basis for early diagnosis of missed abortion.Methods The transvaginal color Doppler examination was performed in 200 cases of missed abortion and 200 cases of normal early pregnancy.The hemodynamic indexes of uterine artery and spiral artery including pulsatility index (PI),resistance index (RI),systolic/diastolic flow rate ratio (S/D) were detected and statistically analyzed.Results RI and PI in uterine arteries and spiral arteries in missed abortion group were significantly higher than those in normal early pregnancy group (P ＜ 0.05),and the S/D in uterine arteries and spiral arteries in missed abortion group was higher S/D than that in normal early pregnancy group,but there was no significant difference between two groups (P ＞ 0.05) Conclusion The monitoring of uterine artery hemodynamic parameters has important clinical significance in.diagnosis of missed abortion.

<正>围绝经期出血病因复杂,大多为卵巢功能逐渐衰退,引起激素水平波动所致的功能失调性子宫出血。可表现为三不规:月经周期长短不规;出血量多少不定;经期长短不一。近年内膜病变所致出血呈高发状态,但即使为恶性变,及早发现和治疗也会有好的预后,因此明确病因及早治疗,对患者身心健康,

<正>患者,23岁,未婚,有性生活史。主因反复发作右下腹疼痛1年加重3d入我院检查。既往曾于3岁时因先天巨结肠行部分结肠切除术,术后2+月因肠梗阻行肠管复位术。平素月经规律144-6/28d,量中,无明显痛经,末次月经2011年10月31日。患者于2011年1月曾人工流产1次,术后5d血止,此后月经正常来潮,术后2个月出现下腹隐痛,左侧偏重,间断性伴腰酸,曾于别院就诊,考虑盆腔炎,给予抗生素及中药治疗,症

Objective:Through the comparison of cervical ripening and induced labor effects and development of fetal fibronectin between 0.2% and 0.5% of oxytocin for delayed pregnancy by intravenous drip.Methods:120 41~41+6 weeks delayed first pregnancies were chosen and randomly divided into two groups,given intravenous dripped by two different percentage of oxytocin.Cervical ripening and induced labor effects was compared by development of fetal fibronectin and cervix bishop scores.Results:For rates of cervical ripening and rates of delivery and the positive rates of fetal fibronectin had no significant difference in two groups(P>0.05),while for pregnancy with cervix bishop scores equalled and was greater than seven.The rates of cervical ripening and the rates of delivery and the positive rates of fetal fibronectin had more difference than equals and under six.(P<0.05),which were conforming to the positive of fetal fibronectin.Conclusion:Low concentration of oxytocin will be effectively for induced labor.The positive of fetal fibronectin is a signal for cervical ripening and delivery..The pregnancy with cervix bishop scores equals and is under six,0.2% oxytocin will be of choice for cervical ripening and induced labor,while for pregnancy with cervix bishop scores equals and greater than seven and the positive of fetal fibronectin,0..5% oxytocin will be preferable.

目的分析产程中胎心监护图形,探讨提示脐带异常的情况。方法选取我院2010年1至6月分娩的单胎、头位、无产科合并症及阴道分娩禁忌证的产妇230例,产程中实行胎儿心电监测(NST),通过胎心率宫缩图(CTG)的分析,探讨提示脐带异常的情况。结果 230例中出现异常图形132例(57.4%),经分娩过程中及分娩后证实与脐带有关的57例,占异常图形的43.18%。不同产程胎心率图形异常表现不同。有脐带因素组中,羊水污染发生率高,手术产及新生儿窒息率高。结论产程中持续NST可提示脐带异常所致胎儿窘迫,可作为筛查胎儿缺氧的手段,对分娩方式的选择有很好的指导作用。

目的 探讨盐水灌注宫腔造影对诊断子宫内膜增殖症的价值.方法 选取2009年1月-2010年1月,因不规则阴道出血来院就诊的患者100例,均行经阴道超声、盐水灌注宫腔造影、诊断性刮宫检查,对其结果 进行回顾性分析.结果 100例患者病理诊断证实为子宫内膜增殖症患者51例,经阴道超声、盐水宫腔造影、诊断性刮宫检查的诊断符合率分别为80.4%、98.0%、100.0%.结论 盐水灌注宫腔造影可提高子宫内膜的成像质量和诊断的准确性,同时指导诊断性刮宫.