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中国计划生育和妇产科

中国计划生育和妇产科

CSTPCD

Chinese Journal Of Family Planning & Gynecotokology
医学文献检索刊物。旨在为计划生育和妇产科学临床、科研和教学服务，用于国际医学情报交流。报道我国有关计划生育和妇产科学动态和新理论、新经验、新技术、新方法。
  • 发文量：3275
  • 被引量：2155
  • H指数：1
  • 开始收录时间：1994(1)
  • CNKI综合因子：0.952
  • 维普期刊影响因子： 2.35
  • 万方期刊影响因子：2.46
  • 创刊时间：1982
  • 国内刊号/CN：51-1708/R
    国际刊号/ISSN：1674-4020
  • 发行周期：双月刊
    邮发代号：62-10
  • 主管单位：中华人民共和国卫生部
    主办单位：中国医师协会 四川省医学情报研究所
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  • 电话：028-86137409
  • 邮箱：bjbqbs@sina.com
  • 地址：四川成都市上汪家拐街39号
  • 邮编：610041
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中国计划生育和妇产科 >2023年第2期

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  • 摘要：Objective To study the reference value range of serum thyroid hormone in pregnancy in Lanzhou, Gansu.Methods 562 healthy pregnant women of single pregnancy from October 2015 to June 2016 in Obstetrics and Gynecology Clinic of Second Hospital of Lanzhou University were selected, in which 238 cases were in first trimester (T1),192 cases were in second trimester (T2), and 132 cases were in third trimester (T3).52 cases of non-pregnant women of childbearing age were selected as control group.Detected thyroid-stimulating hormone(TSH) and free thyroxine(FT4) and free triiodothyronine(FT3) by Siemens ADVIA Centaur XP detector,and the results were statistically analyzed to establish the medical reference range of thyroid hormone during pregnancy in the area.Results TSH reference range during pregnancy in the first, second and third trimester of pregnancy were 0.05 ～ 5.58 mU / L, 0.26 ～ 4.80 mU / L, 0.21 ～ 5.11 mU / L;FT4 were 10.73 ～ 19.15 pmol / L, 10.26 ～ 18.06 pmol / L, 9.94 ～ 16.35pmol / L ,respectively.TSH was the lowest, FT4 the highest in early pregnancy, and the reference range was different in different pregnant periods.There was a difference in the reference range between pregnancy and non-pregnancy.Conclusion It is very important and necessary to build the reference ranges of thyroid hormones during pregnancy in Lanzhou, Gansu Province.%目的 研究甘肃兰州地区妇女妊娠各期血清甲状腺激素医学参考值范围.方法 收集2015年10月至2016年6月在兰州大学第二医院妇产科门诊产检的单胎妊娠健康孕妇562例,其中孕早期(T1)238例,孕中期(T2)192例,孕晚期(T3)132例;选取52例非妊娠健康育龄期妇女作为对照组.用Siemens ADVIA Centaur XP检测仪化学发光法检测甲状腺激素(thyroid-stimulating hormone,TSH)、游离甲状腺素(free thyroxine,FT4)和游离三碘甲状腺原氨酸(free triiodothyronine,FT3),并对结果进行统计分析,建立该地区妊娠期甲状腺激素医学参考值范围.结果 甘肃兰州地区妊娠期TSH参考值范围在孕早、中、晚期分别为0.05～5.58 mU/L、0.26～4.80 mU/L、0.21～5.11 mU/L;FT4在孕早、中、晚期分别为10.73～19.15 pmol/L、10.26～18.06 pmol/L、9.94～16.35 pmol/L.TSH在孕早期最低,FT4最高,妊娠各期参考范围有差异,孕期与非孕期参考范围存在差异.结论 建立甘肃兰州地区妊娠期甲状腺激素参考值范围十分重要与必要.
  • 摘要：Objective To analyze the effects of different time and location of omphalotomy on mother and infant in cesarean section.Methods The data of 1 200 maternal underwent cesarean section delivery in Futian Women and Children Health Care Hospital from May 2015 to May 2016 were retrospectively analyzed.Randomized sampling method was used to divide them into four groups:A, B, C, D, with 300 cases in each group.A group of fetuses after delivery first clamp the uterus cut edge then cut off the umbilicus, the location as close as possible to the placenta, with umbilical cord length>30cm;B group of fetus after delivery first clamp the uterus cut edge then cut off the umbilicus, cut position from the umbilical wheel <10 cm;C group of fetus after cleaning the respiratory tract immediately cut the umbilical cord, the position as close as possible to the placenta, with umbilical cord length>30cm,and then clamp the uterine incision.Compared outcomes of the four groups of mother and child.Results There were no significant differences in Apgar score and bilirubin peak between the four groups (P>0.05).Postpartum hemorrhage, placental blood residue, postpartum 24h hemoglobin, hematocrit differences were statistically significant(P<0.05).The amount of postpartum hemorrhage and the placental blood residue of group C and group D were significantly higher than those of group A and group B.The 24h hemoglobin and hematocrit were significantly higher in group A and group C than those in group B and group D (P<0.05).Conclusion Cesarean section when at first clamp the uterine incision, can reduce the amount of maternal postpartum hemorrhage, delay omphalotomy and as close as possible to the placenta umbilical can improve neonatal hemoglobin and improve the prognosis.%目的 分析剖宫产不同断脐时机及位置对母儿的影响.方法 选取2015年5月至2016年5月于深圳市福田区妇幼保健院行剖宫产分娩的1 200例产妇,用随机抽样法分为A、B、C、D 4组,每组各300例.A组胎儿娩出后先钳夹子宫切缘后断脐,位置尽可能靠近胎盘,脐带长度>30 cm;B组胎儿娩出后先钳夹子宫切缘后断脐,断脐位置距脐轮<10 cm;C组清理呼吸道后即刻断脐,位置尽可能靠近胎盘,脐带长度>30 cm,后钳夹子宫切口;D组清理呼吸道后即刻断脐,断脐位置距脐轮<10 cm,再钳夹子宫切口,对比4组母儿结局.结果 4组新生儿Apgar评分、胆红素峰值比较差异无统计学意义(P>0.05),产后出血量、胎盘残血量、产后24 h血红蛋白、红细胞压积比较差异有统计学意义(P<0.05).其中C组与D组产后出血量、胎盘残血量显著高于A组、B组,A组与C组产后24 h血红蛋白水平、红细胞压积显著高于B组、D组,差异均有统计学意义(P<0.05).结论 剖宫产时先钳夹子宫切口,可减少母体产后出血量,延迟断脐并尽可能接近胎盘断脐可提高新生儿血红蛋白,改善预后.
  • 摘要：Objective To investigate the effect of nursing intervention based on plan-do-check-action (PDCA) on the prognosis of abnormal head position maternal.Methods 124 abnormal head position maternal hospitalized in the 309th Hospital of Chinese People's Liberation Army from August 2012 to September 2015 were divided into observation group and control group according to the random number table methods,each group with 62 cases.The control group was given routine care and special position intervention.On the basis of control group, the observation group was treated with psychological guidance, guidance of coordination technique and breathing method in the process and special position intervention carried out by PDCA cycle management.Observed the prognosis of the two groups.Results The incidence of vaginal delivery in the observation group was higher than that in the control group, and the poor prognosis of maternal epilepsy, postpartum hemorrhage, placental abruption and neonatal asphyxia were significantly lower than that of the control group.Master rate of childbirth health knowledge and the nursing satisfaction scores in the observation group were significantly higher than the control group, the differences were statistically significant (P<0.05).Conclusion Nursing intervention based on PDCA cycle management can help to increase the childbirth knowledge of maternal, improve the vaginal delivery rate, improve the prognosis of mother and child, and make the relationship between doctors and patients more harmonious.%目的 探讨基于计划-实施-检查-处理(plan-do-check-action,PDCA)循环管理的护理干预对头位异常产妇预后的影响.方法 根据随机数字表法将2012年8月至2015年9月在解放军第309医院进行建档分娩的头位异常产妇124例分为观察组与对照组,每组各62例.对照组给予常规护理和特殊体位干预,观察组在对照组护理的基础上,对心理疏导、配合技巧和产程中呼吸方法指导、特殊体位干预进行PDCA循环管理,观察两组预后情况.结果 观察组阴道分娩率高于对照组,产妇子痫、产后出血、胎盘早剥与新生儿窒息等不良预后情况明显少于对照组,观察组分娩健康知识掌握良好率和对护理的满意度评分明显高于对照组,差异均有统计学意义(P<0.05).结论 基于PDCA循环管理的护理干预有助于增加头位异常产妇对分娩期的知识掌握,提高阴道分娩率,改善母婴预后,使医患关系更加和谐.
  • 摘要：目的 探讨腹腔镜下妇科手术并发症的发生情况及相关影响因素. 方法 对2012 年1月至2016年10月在山东临清市人民医院妇科采用腹腔镜手术551例患者的手术并发症发生情况和患者年龄、体质量指数(body mass index,BMI)、手术史、子宫大小、子宫内膜病史等并发症影响因素进行回顾性分析.结果 ① 551例腹腔镜手术患者中有50例发生并发症,发生率为9.07 ％.其中穿刺和气腹建立时的并发症5例,术中并发症32例,主要为大量失血(28例),术后并发症13例,主要为术后感染10例.Ⅰ(子宫附件手术)、Ⅱ(子宫肌瘤剔除术)、Ⅲ(子宫次切术和全子宫切除术)、Ⅳ(妇科恶性肿瘤根治术)类手术的并发症率依次为1.25 ％ (2/160) 、4.2 ％ (6/141)、11.3 ％ (17 /150)、25.0 ％(25 /100).② 根据单因素分析,未发生并发症和发生并发症患者在BMI、手术医师工作年限、手术类型、腹腔手术史和子宫内膜病史方面差异有统计学意义 (P>0.05) .③ 通过多因素Logistic回归分析发现3个影响并发症率的因素: 医师工作年限 (OR=7.796,P<0.05) 、腹腔手术史(OR=6.634,P<0.05) 、手术类型(OR=0.423,P<0.05).结论 腹腔镜下妇科手术中最常见的并发症是术中大量出血和术后感染.BMI、手术医师工作年限、手术类型、腹腔手术史和子宫内膜病史可能与并发症发生相关;而医师工作年限、腹腔手术史和手术复杂程度是并发症发生的危险因素.%Objective To investigate the complications of laparoscopic gynecological surgery and the related influencing factors.Methods 551 patients who underwent laparoscopic surgery in Shandong Linqing People's Hospital from January 2012 to October 2016 were selected, the incidence of complications, age, body mass index (BMI), surgery history, uterine enlargement, endometriosis and other influencing factors were retrospective analyzed.Results ① The overall complication incidence rate is 9.1 ％ (50/551) ,including 5 cases of pneumoperitoneum and puncture complications,32 cases of intraoperative complications, large blood loss mainly (28 cases),13 cases of postoperative complications, postoperative infection mainly.The complication occurrence rate of Ⅰ,Ⅱ,Ⅲ,Ⅳ operation were 1.25 ％ (2/160) , 4.2 ％ (6/141), 11.3 ％ (17 /150) , 25.0 ％(25 /100).② According to the single factor analysis,the differences of doctors' skill, operation type, BMI, history of abdominal surgery and endometriosis history between the patients with complications and patients without complications were statistically significant (P<0.05).③ According to the Logistic multifactor analysis,doctors' work experience (OR=7.796,P<0.05) ,history of abdominal surgery (OR=6.634,P<0.05) and the operation type(OR=0.423,P<0.05) were the influence factors of complication incidence rate.Conclusion Intraoperative bleeding and postoperative infection are the most common major complications of laparoscopic gynecological surgery.BMI index, physician experience, surgical type, history of abdominal surgery and endometriosis may be related to the occurrence of complications;and physician working years, history of abdominal surgery and surgical complexity are the risk factors of complications.
  • 摘要：子宫内膜不典型增生(atypical endometrial hyperplasia,AEH)属于子宫内膜癌的癌前病变.近年来,AEH发病率呈增长趋势,其发病年龄也趋于年轻化.治疗AEH的首选方法为手术治疗.由于越来越多的女性要求保留子宫,所以保守治疗受到越来越多的重视.本文对目前国内外这类患者保留生育功能的相关治疗方案,如口服孕激素、曼月乐、促性腺激素释放激素激动剂(gonadotropin-releasing hormone agonist,GnRHa)、GnRHa联合曼月乐进行综述.
  • 摘要：Objective To understand the status of receiving family planning and reproductive health counseling among floating population in Dongcheng district, Beijing.Methods The structured questionnaire survey was conducted among floating population aged 18 to 49 in factories,enterprises, construction sites and service/entertainment places.The contents included general demographic characteristics, history and attitude of marriage and fertility,status of receiving family planning and reproductive health counseling.The data was analyzed by SAS 9.1.Results A total of 2 099 migrants were surveyed, and 21.39 ％ of them received family planning and reproductive health counseling in the last year.The higher the education rate, the lower the proportion of migrants receiving reproductive health / reproductive health counseling services.41.31 ％ of them were willing to receive the counseling, and the way including paper and letter, professional internet and hot line.The proportion of willing to receive face to face counseling was 33.21 ％, and the places mainly included family planning service institute and Maternal and Child Health Care Hospital.Conclusion The status of receiving family planning and reproductive health counseling of floating population is not very good.It should be strengthened in current place of residence.%目的 了解北京市东城区流动人口接受计划生育/生殖健康咨询服务的情况,以及流动人口对咨询服务的需求,为完善流动人口计划生育/生殖健康管理和服务提供参考.方法 在北京市东城区流动人口集中的工厂、企业、建筑工地和服务/娱乐场所选择18～49岁的育龄流动人口进行结构式问卷调查,内容包括一般人口学特征,婚育史及婚育观念,接受计划生育/生殖健康咨询服务的情况等.采用SAS 9.1软件对收集到的资料进行统计分析.结果 本研究共调查2 099名流动人口,21.39 ％的流动人口在调查的近1年内接受过计划生育/生殖健康咨询,学历越高的流动人口接受计划生育/生殖健康咨询服务的比例越低.有41.31 ％的对象表示愿意接受咨询服务,咨询途径以"报刊专栏、信箱"、"专业网站咨询"、"电话热线咨询"的比例较高,"面对面"咨询的比例为33.21 ％,计划生育服务站、妇幼保健院是流动人口面对面咨询的主要地点.结论 流动人口在现居住地接受计划生育/生殖健康咨询服务的情况不理想.现居住地应加强对流动人口的计划生育/生殖健康咨询服务.
  • 摘要：目的 监测并比较妊娠期糖尿病孕妇在不同血糖控制情况下,其新生儿免疫球蛋白IgG、IgM、IgA与T淋巴细胞亚群CD 3+、CD 4+、CD 8+、CD 4+/CD 8+的值以及自然杀伤(natural killer,NK)细胞的含量值.方法 选取凉山彝族自治州第二人民医院210例经确诊为妊娠期糖尿病(gestational diabetes mellitus,GDM)患者分娩的新生儿作为研究组,以及同时期100例由正常孕妇分娩的新生儿作为对照组.根据血糖控制水平,将GDM患者分为血糖控制理想组(GDM-A组)115例患者和血糖控制不理想组(GDM-B组)95例患者.采用流式细胞仪监测外周血T细胞亚群和NK细胞的含量;采用散射比浊度法检测免疫球蛋白的含量.结果 经流式细胞仪检测, 对于GDM-B组的新生儿,外周血中CD 3+细胞[(52.35±11.17)％]、CD 8+细胞[(15.69±5.58)％]水平均低于对照组和GDM-A组,CD 4+/CD 8+比值[(1.58±0.39)％]高于对照组;而NK细胞(6.37±1.29)％水平明显低于对照组与GDM-A组,差异均有统计学意义(P<0.05).GDM-A组新生儿外周血中NK细胞水平为(8.44±2.05)％,低于对照组(11.19±1.74)％,差异有统计学意义(P<0.05).而其他外周血T淋巴细胞亚群水平与对照组相比,差异无统计学意义(P>0.05).经散射比浊法检测,GDM-B组新生儿外周血IgG水平为(6.45±1.25)g/L,低于对照组[(9.99±1.36) g/L]和GDM-A组[(9.47±1.58) g/L]水平,差异有统计学意义(P<0.05).其他数据3组比较差异无统计学意义(P>0.05).结论 GDM可能会影响新生儿非特异性免疫功能,若妊娠期间血糖控制不理想,则可能造成新生儿免疫功能低下.因此GDM孕妇应积极控制妊娠期间血糖水平.%Objective To observe and compare the levels of IgG, IgM, IgA, CD3+, CD4+, CD8+, CD4+/CD8+ and natural killer (NK) cell in the peripheral blood of newborns based on the different glycemic control level of the gestational diabetes mellitus (GDM).Methods 100 healthy puerperas as well as their normal full-month neonatus in Liangshan Yi Autonomous Prefecture Second People's Hospital were selected as the control group, and 210 newborns of GDM puerperas were selected as the study group.According to the glycemic control level, 115 cases were divided into the satisfactory group of glycemic control level (GDM-A Group) and 95 cases were divided into the unsatisfactory group of glycemic control level (GDM-B Group).The mount of IgG, IgM, IgA were detected by immunoassay, while the mount of CD3+, CD4+, CD8+, CD4+/CD8+, NK cell were measured by flow cytometry.Results According to the test results of flow cytometry, the mounts of CD3+ [(52.35±11.17) ％] and CD8+ [(15.69±5.58)％]of neonates in GDM-B Group were lower than those in control group and GDM-A Group, while the ratio of CD4+/CD8+ [(1.58±0.39) ％] was higher than that of the control group (P<0.05).The mount of NK cell[(6.37±1.29)％] of neonates in GDM-B group were obviously lower than that of the control group (P<0.01), and also lower than that of GDM-A Group (P<0.05).The mount of NK cell (8.44±2.05)％ of neonates in GDM-A Group were obviously lower than that of the control group (11.19±1.74)％ (P<0.05).According to the test results of immunoassay, the level of IgG in the neonatal peripheral blood was (6.45±1.25) g/L in GDM-B Group, which was lower than that of the control group [(9.99±1.36) g/L] and GDM-A Group [(9.47±1.58) g/L], and there were statistical differences(P<0.05).Conclusion The gestational diabetes mellitus could impact the non-specific immunity of the neonatus.Control mother's glycemic can improve the level of neonate's immunity.Therefore, in the gestation period, the GDM mothers should control the blood glucose in the satisfied level actively.
  • 摘要：Objective Assessing the efficacy of human papillomavirus (HPV) E6/E7 mRNA, hybrid capture Ⅱ (HCⅡ) and thinprep cytology test (TCT) screening for cervical intraepithelial neoplasia (CIN), and modified the screening program.Methods A case-control study was designed, including 80 patients with CINⅠ+ HCⅡ or TCT screening positive and histologically diagnosed, and 132 cases of negative control specimens including histological diagnosis of normal or inflammatory specimens;HC Ⅱ negative, TCT negative and HPV E6 / E7 mRNA were negative specimens.Every cervical cell sample was tested by all tests of the TCT, HCⅡ and b-DNA for HPV E6/E7 mRNA.Results The positive rate of HCⅡ detected (37.74％) was significantly higher than that of HPV E 6 / E 7 mRNA (25.94％) in 212 normal or cervicitis and CIN specimens (P <0.05), but was not significantly different from TCT positive rate (31.60％)(P>0.05).And the positive rate of TCT was not significant difference from HPV E6 / E7 mRNA (P>0.05).The concordance between HPV E6/E7 mRNA and HCⅡ was highest, and Kappa value was 0.733,P=0.000.The next was HCⅡ and TCT, Kappa value was 0.564, P=0.000.The concordance between HPV E6/E7 mRNA and TCT was lowest, and Kappa value was 0.519, P=0.000.Additionally, in 67 CINⅠ + cases with HCⅡ positive, HPV E6 / E7 mRNA or TCT test result was positive.Furthermore, in 13 CIN1 negative cases with HCⅡ positive, there were 7 (53.85％) cases with HPV E6 / E7 mRNA or TCT positive.Conclusion Screening for CINⅠ+, TCT and HPV E6/E7 mRNA tiage for HCⅡ positive could significantly decrease the false positive rate.%目的 分析人乳头瘤病毒(human papillomavirus, HPV) E 6/E 7 mRNA、第二代杂交捕获技术(hybrid Capture,HCⅡ)和薄层液基细胞学技术(thinprep cytology test,TCT)在宫颈上皮内瘤变(cervical intraepithelial neoplasia,CIN)筛查中的效能,选择适宜的分流筛查方案.方法 采用病例-对照研究设计,80例CINⅠ+的病例样本为HCⅡ或TCT筛查阳性并经组织学诊断;132例正常或炎症标本包括:组织学诊断正常或炎症的标本;HCⅡ阴性,TCT阴性且HPV E 6/E 7 mRNA均为阴性的标本.检测方法分别为:TCT进行细胞学检测、用b-DNA技术检测其HPV E 6/E 7 mRNA和用HCⅡ检测HPV DNA.结果 在212例正常或宫颈炎和CIN标本中,HCⅡ的阳性率(37.74 ％)显著高于HPV E 6/E 7 mRNA的阳性率(25.94 ％)(P<0.05);与TCT的阳性率(31.60 ％)比较差异无统计学意义(P>0.05).TCT的检出率高于HPV E 6/E 7 mRNA的检出率,但差异无统计学意义(P>0.05).HPV E 6/E 7 mRNA与HCⅡ的符合率最高,Kappa为0.733,P=0.000;其次为HC II和TCT的符合率,Kappa为0.564,P=0.000;HPV E 6/E 7 mRNA与TCT的符合率,Kappa仅为0.519,P=0.000.并且,在HCⅡ检测结果阳性的67例CINⅠ+样本中,HPV E 6/E 7 mRNA检测或TCT检测结果皆为阳性.而在HCⅡ阳性的13例正常或炎症样本中,HPVE 6/E 7 mRNA+或TCT结果阳性仅有7例(53.85％).结论 在CINⅠ+分流筛查方案中,HPV E 6/E 7 mRNA和TCT共同作为HCⅡ阳性分流筛查的方法,可有效降低HCⅡ的假阳性.
  • 摘要：多囊卵巢综合征(polycystic ovarian syndrome,PCOS)属于内分泌紊乱性疾病,是复发性流产(recurrent spontaneous abortion,RSA)的危险因素之一.本文综述PCOS引起RSA的因素分析和治疗现状.PCOS引起RSA的因素主要是高胰岛素血症/胰岛素抵抗、高雄激素水平和肥胖,此外,高黄体生成素水平、高同型半胱氨酸血症和血栓前状态与胰岛素抵抗、高雄激素水平、肥胖三者之间相辅相成,互相促进,共同作用导致RSA的发生.在治疗方面,孕前减轻体重至少5%、孕前乃至整个孕期服用二甲双胍是有效降低流产的治疗方案;抗凝治疗仍存在争议,尚缺乏有效的循证医学证据;口服避孕药等降低雄激素的治疗目前暂不推荐使用.
  • 摘要：Objective To investigate a better embryo transfer strategy for non-top quality embryos in in-vitro fertilization and embryo transfer(IVF-ET). Methods A retrospective analysis was performed for the clinical data of non-top quality embryos in 550 IVF-ET cycles,including 157 frozen-thawed embryo transfer(FET) cycles and 393 fresh embryo transfer(ET) cycles in Chengdu Women & Children's Central Hospital from January 2014 to December 2015. Results The clinical pregnancy rate of non-top quality embryos in FET cycle was significantly higher than in ET cycle [(43.31 % vs. 34.86 %),P<0.05];There were no significant differences in implantation rate and abortion rate between the two groups(P>0.05);For non-top quality embryos caused by embryo debris in FET cycle,the clinical pregnancy rate and embryo implantation rate were significantly higher than those of non-top quality embryos with abnormal developmental speed (P<0.05).Conclusion The use of FET can improve the clinical outcomes for non-top quality embryos,especial for those caused by embryo debris.%目的 探讨体外受精-胚胎移植中非优质胚胎的最佳移植策略.方法 回顾性分析成都市妇女儿童中心医院2014~2015年首次移植胚胎全部为非优质胚胎的周期资料共550例,其中冻融非优质胚胎移植组157例,新鲜非优质胚胎移植组393例,分析两组患者的临床结局.结果 冻融周期的临床妊娠率(43.31%)比新鲜周期(34.86%)更高(P<0.05);两组胚胎种植率、流产率比较差异均无统计学意义(P>0.05);胚胎碎片原因形成的非优质胚胎在冻融周期的临床妊娠率、胚胎种植率均显著高于发育速度异常的非优质胚胎(P<0.05).结论 冻融胚胎移植可改善非优质胚胎患者的临床结局,特别是以胚胎碎片原因形成的非优质胚胎.
  • 摘要：Objective To investigate the methods of diagnosis and treatment for interstitial tubal pregnancy(ITP). Methods The clinical data of 117 cases of ITP were analyzed retrospectively from July 2006 to June 2016 in Affiliated Hospital of North Sichuan Medical College. Results ①Diagnosis:13 cases of the conservative treatment group were diagnosed by transvaginal ultrasonography. For the 104 cases of surgical treatment group, 83 cases were diagnosed of ectopic pregnancy by B - scan ultrasonography before operation,of which 61 cases were confirmed with ITP,the accuracy rate was 73.5 % (61/83);21 cases were confirmed the diagnosis due to intraoperative hemorrhage within the emergency surgery,accounting for 20.2 % (21/104). ②Treatment:Laparoscopic surgery was shorter than laparotomy, with less bleeding and earlier postoperative activity, the differences were statistically significant(P <0.05). Time for the levels of serum β-hCG to reduce to normal in conservative treatment group,who were treated with 5 - Fu and MTX as chemotherapy,was longer than the surgical group,the differences were statistically significant (P<0.05). Conclusion ①ITP should be treated with"three earlys",that is,early medical advice,early diagnosis and early treatment. To determine the location of pregnancy,vaginal three-dimensional ultrasonography can be used as the preferred method of inspection; ② Surgery is still the main treatment for ITP,while laparoscopic surgery has advantages of shorter time, less bleeding, earlier postoperative recovery and so on;③ For patients with low blood β-hCG concentration,no internal bleeding,small lesions of early interstitial pregnancy or missed abortion patients,5-Fu and MTX conservative treatment can achieve satisfactory results.%目的 探讨输卵管间质部妊娠(interstitial tubal pregnancy,ITP)的诊治方法.方法 对川北医学院附属医院2006年7月至2016年6月收治的117例ITP病例的临床资料进行回顾性分析.结果 ①诊断:保守治疗组13例全部经阴道三维B超诊断.手术治疗组104例,术前B超拟诊异位妊娠83例,其中确诊ITP61例,准确率73.5%(61/83);21例因腹腔内出血急诊术中探查确诊,占20.2%(21/104).②治疗:腹腔镜手术较开腹手术时间短、出血少、术后活动时间早,差异有统计学意义(P<0.05);保守治疗组选用氟尿嘧啶(fluorouracil,5-FU)与甲氨蝶呤(Methotrexate,MTX)化疗,血清β-人绒毛膜促性腺激素(β-human choionic gonadotophin,β-hCG)降至正常时间较手术组长,差异有统计学意义(P<0.05).结论 ①对ITP需做到"三早",即早就诊、早诊断、早治疗.为明确妊娠部位,阴道三维B超可作为首选检查方法;②手术仍是ITP的主要治疗方法,腹腔镜较开腹手术具有时间短、出血少、术后恢复快等优势;③对于血β-hCG浓度低、无内出血、病灶小的早期间质部妊娠或稽留流产型患者选用5-Fu与MTX保守治疗可取得满意疗效.
  • 摘要：复发性流产(recurrent spontaneous abortion,RSA)是指连续发生2次或2次以上的胎儿丢失,本文综述了RSA与染色体相关因素的研究进展.RSA的病因复杂,主要有染色体异常、生殖道解剖异常、内分泌失调和自身免疫因素等.胎儿染色体异常是引起RSA的常见原因,夫妇染色体异常,精子染色体非整倍体异常和染色体多态性是近年来关注热点.RSA夫妇确诊为染色体异常,可选择个体化地进行产前诊断.
  • 摘要：目的 了解长沙市育龄妇女人工流产现状及其影响因素.方法 对在长沙市农村及城市医疗机构行人工流产的1718例育龄妇女进行计划生育的相关内容问卷调查,对结果进行统计分析.结果 长沙市农村及城市育龄妇女的重复人工流产率分别为69%和58%.行人工流产的原因主要是未避孕和避孕失败.Logistic回归分析显示,年龄、文化程度、户籍、收入均是育龄妇女人工流产的影响因素.结论 育龄妇女人工流产发生率较高,需针对不同人群的不同需求开展有效的干预措施以保障其生殖健康.%Objective To understand the current situation and influencing factors of artificial abortion among women of childbearing age in rural and urban area of Changsha city. Methods A random cluster sampling method was used to investigate 1 718 women of childbearing age by an anonymous questionnaire. Results The repeated artificial abortion rate among women of childbearing age in rural and urban area of Changsha city were 69 % and 58 %;The causes of artificial abortion included contraceptive failure and not taking contraceptive measures;The results of logistic regression analysis showed that age,educational level, household registration and income were the influencing factors of artificial abortion in women of childbearing age. Conclusion The incidence rate of artificial abortion among women of childbearing age is relatively high,effective interventional measures should be taken targeting to different requirements of different populations to ensure their reproductive health.
  • 摘要：低分子肝素(low molecular weight heparin,LMWH)为妊娠期首选抗凝药物,安全性高、不良反应少.复发性流产(recurrent spontaneous abortion,RSA)是一种常见的妊娠相关疾病,国内外研究认为其与血栓前状态(pre-thrombotic state,PTS)密切相关.对于PTS引起的RSA,抗凝治疗被认为是有效的治疗方法.近年研究发现,LMWH除了经典抗凝作用外,还具有促进滋养细胞增殖、分化和侵袭等重要作用,可降低再次妊娠丢失率,改善妊娠结局,但仍备受争议,需要更完善的循证医学证据来证实其有效性.本文旨在总结LMWH在RSA领域的应用现况,促进临床更合理用药.
  • 摘要：Objective To explore the related risk factors of 77 intrauterine stillbirth. Methods The clinical data of 77 singleton intrauterine stillbirth in the First Affiliated Hospital of Tsinghua University from 2004 to 2013 as case group was retrospectively analyzed,and 200 singleton live births as control group were randomly selected. The risk factors of intrauterine stillbirth were analyzed by the multivariate logistic regression. Results The univariate analysis showed that the pregnant women with advanced age( >30), gestational hypertension,placental abruption,placenta previa,umbilical cord abnormalities,irregular checkups,fetal amniotic fluid abnormalities or abnormal fetal development were more likely to have intrauterine stillbirth(P <0.05). There were no statistical significant differences on incidence of intrauterine stillbirths among pregnant women with different gestational age, birth, abortion history and gestational diabetes mellitus(P>0.05).No statistical difference on intrauterine stillbirths between fetal sexes(P>0.5). The multivariate logistic regression analysis showed that advanced age,gestational hypertension,placental abruption,placental previa, umbilical cord abnormalities,amniotic fluid abnormalities and fetal development abnormalities were the independent risk factors of intrauterine stillbirth (OR=1.675、1.956、1.863、1.985、1.677、1.945、1.954,all P <0.05). Regular check -up was protective factor of intrauterine stillbirths (OR =0.542, P <0.05). Conclusion Advanced age( >30), hypertensive disorder complicating pregnancy, placental abruption, placenta previa, abnormal umbilical cord, amniotic fluid abnormalities and fetal development abnormalities are independent risk factors for intrauterine stillbirth.Clinical focus should be focused on high-risk groups and take targeted measures to intervene.%目的 探讨77例宫内死胎的相关危险因素.方法 回顾性分析2004~2013年清华大学第一附属医院收治的宫内死胎产妇的临床病历资料(病例组),并随机选取同期200例单胎活产分娩产妇病历资料(对照组),采用多因素Logistic回归分析宫内死胎的危险因素.结果 单因素结果显示,高龄(>30岁)、妊娠期高血压疾病、胎盘早剥、前置胎盘、脐带异常、无规律产检、羊水异常、胎儿发育异常的孕妇更易出现宫内死胎(P<0.05);不同孕次、产次、流产史、妊娠期糖尿病的孕妇宫内死胎的发生率比较差异无统计学意义(P>0.05);不同性别胎儿宫内死胎率比较差异无统计学意义(P>0.05).多因素Logistic回归分析结果显示,高龄(>30岁)、妊娠期高血压疾病、胎盘早剥、前置胎盘、脐带异常、羊水异常、胎儿发育异常是宫内死胎的独立危险因素(OR分别为1.675、1.956、1.863、1.985、1.677、1.945、1.954,P均<0.05);规律产检是保护因素(OR=0.542,P<0.05).结论 高龄(>30岁)、妊娠期高血压疾病、胎盘早剥、前置胎盘、脐带异常、羊水异常、胎儿发育异常是宫内死胎的独立危险因素,临床应重点关注高危人群,采取针对性措施进行干预.
  • 摘要：Objective To explore the success factors and maternal- fetal outcomes of vaginal delivery after cesarean section. Methods Retrospective analyzed 1 638 vaginal trial production of pregnant women in Shenzhen Longhua New District People's Hospital from January 2013 to December 2016, including 1 038 cases of successfull vaginal delivery after cesarean section group and 600 cases of vaginal trial failure group.Compared the deferences between the two groups to summarize the factors that affect the success of vaginal delivery after cesarean section. Compared the two groups of postpartum hemorrhage rate, uterine rupture rate and neonatal asphyxia rate,to sum up factors affecting maternal and child outcomes of vaginal delivery after cesarean section. Results Vaginal delivery situations have correlations with the maternal age,prenatal BMI,expansion of the cervix,last cesarean section time,the last time of cesarean section,whether it is an emergency admission and whether or not vaginal birth history(P <0.05). There were significant differences in postpartum hemorrhage rate, uterine rupture rate and neonatal asphyxia rate between the two groups of pregnant women(P<0.05). Conclusion Age≤35,prenatal BMI<30 kg/m2,<10 years from the last cesarean section operation, history of vaginal delivery,emergency admission and expansion of the cervix≥6 cm are correlated with successfull vaginal delivery after cesarean section.%目的 探讨影响剖宫产术后阴道分娩成功的因素以及母婴结局.方法 回顾性分析2013~2016年深圳市龙华新区人民医院收治的1638名剖宫产术后阴道试产孕妇,根据阴道试产成功与否分为阴道分娩成功组(1038名)和阴道试产失败组(600名).对比两组的产后出血率、子宫破裂率以及新生儿窒息率,总结影响剖宫产术后阴道分娩相关因素,影响母婴结局的相关因子.结果 孕妇剖宫产术后阴道分娩情况与年龄、产前体质量指数(body mass index,BMI)、入院宫口的扩张情况、上次剖宫产手术时间、是否紧急入院及有无阴道分娩史之间有关联;两组孕妇的产后出血率、子宫破裂率及新生儿窒息率比较差异均有统计学意义(P<0.05).结论 剖宫产术后阴道分娩成功与孕妇年龄≤35岁、产前BMI<30kg/m2、距离上次剖宫产手术时间<10年、有阴道分娩史、紧急入院以及入院时宫口扩张≥6cm密切相关.
  • 摘要：目的 观察产前、产后连续盆底肌锻炼干预对阴道分娩和剖宫产后盆底功能的影响及盆底功能障碍性疾病的预防效果.方法 选择2014年12月至2015年12月在南昌大学第四附属医院妇产科产检、分娩的孕产妇150例,根据分娩方式分为阴道分娩组(A组)106例与剖宫产组(B组)44例;根据产前、产后是否进行盆底功能障碍性疾病(pelvic floor dysfunction, PFD)防治将A组分为干预组(Aa组66例)与未干预组(Ab组40例),B组亦分为干预组(Ba组19例)与未干预组(Bb组25例).产后6周、12周对以上孕产妇进行问卷调查并检测盆底肌力、阴道静息压、阴道收缩压及阴道收缩持续时间,对结果进行比较和统计学分析.结果 ①产后6周盆底功能检测:Aa组盆底I类肌力、Ⅱ类肌力、阴道静息压、阴道收缩压、阴道收缩持续时间均显著高于Ab组(P<0.05);Ba组I类肌力、Ⅱ类肌力均显著高于Bb组(P<0.05),但两亚组患者阴道静息压、阴道收缩压、阴道收缩持续时间比较差异无统计学意义(P>0.05).②产后12周盆底功能检测:Aa组盆底I类肌力、Ⅱ类肌力、阴道静息压、阴道收缩压、阴道收缩持续时间均显著高于Ab组(P<0.05);Ba组I类肌力、Ⅱ类肌力、阴道静息压、阴道收缩压、阴道收缩持续时间均显著高于Bb组(P<0.05).③产后12周Aa组阴道前壁脱垂、后壁脱垂、尿失禁发生率显著低于Ab组(P<0.05);Ba组阴道前壁脱垂、尿失禁发生率显著低于Bb组(P<0.05).结论 围产期盆底肌锻炼联合生物反馈电刺激可不同程度地改善顺产和剖宫产后盆底肌功能,有助于预防产后盆底功能障碍性疾病的发生.%Objective To observe the effect of prenatal and postnatal continuous pelvic muscle training on pelvic floor dysfunction in natural delivery and uterine-incision delivery. Methods A total of 150 pregnant women were selected in The Fourth Affiliated Hospital of Nanchang University from December 2014 to December 2015, and were divided into two groups: the vaginal delivery group (group A,106 cases) and the cesarean section (group B,44 cases) according to the mode of delivery. According to whether received prenatal and postnatal continuous pelvic muscle training, A group were divided into Aa group(66 cases, received training) and Ab group(40 cases,without training),while B group were divided into Ba group(19 cases, received training) and Bb group(40 cases,without training). After 6 weeks, 12 weeks, all participants received pelvic floor dysfunction questionnaire, while pelvic floor muscle pressure,vaginal pressure and duration of vaginal contractions were observed and compared. Results ① Pelvic floor function detection after 6 weeks: type I and type II muscle strength, vaginal resting pressure,vaginal systolic pressure and the duration of vaginal contractions in Aa group were higher than that of the Ab group.The differences had statistical significance(P<0.05);Type I and type II muscle strength in Ba group were higher than Bb group, but vaginal resting pressure,vaginal systolic pressure and the duration of vaginal contractions in Ba group had no obvious difference compared to Bb group(P>0.05). ② Pelvic floor function detection after 12 weeks:type I and type II muscle strength, vaginal resting pressure,vaginal systolic pressure and the duration of vaginal contractions in Aa group were higher than Ab group.The differences were statistical significant(P<0.05);Type I and type II muscle strength,vaginal resting pressure,vaginal systolic pressure and the duration of vaginal contractions in Ba group were higher than Bb group,and the differences were statistical significant(P<0.05). ③After 12 weeks,the prolapse rates of the anterior vaginal wall and posterior vaginal wall,the rate of urinary incontinence in Aa group were lower than that of Ab group,and the prolapse rates of the anterior vaginal wall and the rate of urinary incontinence in Ba group were lower than that of Bb group(P <0.05). Conclusion The prenatal and postnatal continuous pelvic muscle training and biofeedback combined with electrical stimulation could improve the pelvic floor muscle strength with different degree in natural delivery and uterine-incision delivery,and the training could prevent the pelvic floor dysfunction effectively.
  • 摘要：Objective To investigate the clinical effect and recurrence rate of hysteroscopic electrocision in the treatment of endometrial polyps(EMP). Methods Data of 143 patients with EMP treated by hysteroscopic surgery in Guang'an People's Hospital were retrospectively analyzed. According to the ages and fertility requirements,all patients were divided into three groups:63 patients with transcervical resection of endometrial polyps(TCRP), 49 patients with TCRP + partial transcervical resection of endometrium (TCRE),and 31 patients with TCRP+ roller-boll endometrial ablation(REA). By followed up for 1 ~12 months, the menstrual conditions,recurrence and gestation of patients were observed. Results The mean operation time of patients in the TCRP group was shorter,and also with less blood loss in the surgery than the other two groups(P<0.05). All surgeries of patients were successfully completed without any surgical complications. After surgery,there were 2 cases in the TCRP group with postoperative mild dizziness;respectively 1 case with transient fever in TCRP + partial TCRE group and TCRP+REA group. Besides,the menstrual conditions of 99 patients with paramenia were improved. As a result of re-examination, the improvement rate of EMP patients with the clinical symptoms was relatively better. And after followed up for 1~12 months,there were 3 recurrences in the TCRP group and 1 recurrence in the TCRP + partial TCRE group. There were 13 patients with infertility in the TCRP group before treatment,of whom there were 7 cases(53.85 %) with intrauterine pregnancy within 1 year. There were no pregnancy in the other two groups. Conclusion The application of hysteroscopic electrocision in the treatment of endometrial polyps could effectively improve the clinical symptoms and decrease recurrence. According to the treatment requirements of various patients,the individual hysteroscopic electrocision plan should be selected,which would be recommended for the clinical used as an effective choice.%目的 探讨3种不同宫腔镜电切术治疗子宫内膜息肉(endometrial polyps,EMP)的临床疗效和复发率.方法 回顾性分析2015~2016年143例在广安市人民医院进行宫腔镜电切术治疗的EMP患者的临床资料,根据年龄和生育要求,分为宫腔镜子宫内膜息肉电切术(transcervical resection of endometrial polyps, TCRP)组(63例),TCRP+部分宫腔镜子宫内膜电切术(transcervical resection of endometrium,TCRE)组(49例)和TCRP+宫腔镜下滚球电极电凝去内膜术(roller-boll endometrial ablation,REA)组(31例).随访1~12个月,详细记录患者月经情况,复发情况以及妊娠情况.结果 与其他两组比较,TCRP组患者手术时间最短,术中失血量最少(P<0.05);所有患者顺利完成手术,术中未发生严重并发症.术后,TCRP组2例患者出现轻度头晕,其余两组各有1例患者发生一过性体温升高;99例月经紊乱患者术后月经情况得到显著改善;术后复查结果显示,3组患者术后症状改善率均较高,差异无统计学意义(P>0.05).TCRP组有3例(4.76%)患者复发;TCRP+部分TCRE组有1例患者复发,而TCRP+REA组无患者复发.术前,TCRP组有13例有生育要求的患者不孕,随访1年,有7例患者自然受孕,妊娠率为53.85%;另外两组患者无妊娠.结论 宫腔镜电切术可有效改善EMP患者的临床症状,复发率低,应根据患者病情和治疗要求,选择个体化电切术方案.
  • 摘要：正常妊娠依赖于母体内细胞因子参与的免疫调控以产生母胎免疫耐受.近年来研究发现复发性流产(recurrent spontaneous abortion,RSA)患者体内存在Th1/Th2型细胞因子失衡现象,正常妊娠是以Th2细胞免疫为主,RSA则以Th1细胞免疫为主.任何影响Th1/Th2细胞比例的因素均可导致流产.随着对细胞因子研究的进展,发现传统Th1/Th2细胞模式不能完全解释母胎免疫耐受机制,由此提出了Th1/Th2/Th17及调节性T细胞(regulatory T cell,Treg)模式.研究发现Th17/Treg比例失衡,影响母体外周血及子宫蜕膜局部细胞因子间的网络平衡,导致流产发生.针对细胞因子的免疫调节治疗(如淋巴细胞免疫治疗、IVIG、TNF-α抑制剂等)可调整T细胞亚群比例及其细胞因子的分泌水平.本文将对Th1/Th2/Th17及Treg模式与RSA的关系进行综述.
  • 摘要：目的 探讨影响剖宫产手术发生子宫切口裂伤的因素,以采取相应的预防对策.方法 收集2014~2015年成都市第二人民医院妇产科采取剖宫产分娩的1762例产妇的临床资料,分析影响剖宫产手术发生子宫切口裂伤的因素.结果 子宫切口裂伤81例,占4.60%.经Logistic回归分析,宫口扩张≥8cm、术前先露S≥+3、枕后位、子宫下段形成差、瘢痕子宫、新生儿体重≥4kg、胎位为臀位是影响剖宫产手术发生子宫切口裂伤的独立因素.在切口位置上,当切口距离膀胱子宫返折>3cm时,裂伤率高于<3cm时的距离(P<0.05);而在扩大子宫切口方式上,钝性切口裂伤率远高于采用钝性加锐性切口的裂伤发生率(P<0.05).结论 剖宫产手术切口裂伤发生与手术时机、先露位置、子宫手术史、胎儿体重、胎方位、切口位置、手术技巧相关,剖宫产术前应充分评估胎儿体重,产时及时纠正胎位不正及胎方位,把握手术时机,严格掌握剖宫产指征,提高手术技巧,以减少剖宫产术子宫切口裂伤的发生.%Objective To analyze the risk factors and preventive measures of uterine incisional dehiscence in cesarean section. Methods From January 2014 to December 2015, the clinical data of 1 762 patients with cesarean sections were retrospectively analyzed in Chengdu Second People's Hospital in order to find factors affecting the occurrence of uterine incision laceration in cesarean section.Results Uterine incision laceration occured in 81 cases, accounting for 4.60 %.The logistic regression analysis showed, cervix dilatation≥8 cm, preoperative presentation S≥+3, posterior occipital position, poor lower uterine segment formation, scar uterus,neonatal weight≥4 kg and fetal breech position were independent factors of uterine incision laceration. About the incision position,when the incision was more than 3 cm from the bladder uterus, the rate of laceration was higher than that of <3 cm(P<0.05). The rate of laceration of blunt incision was much higher than that of sharp incision(P<0.05). Conclusion Cesarean section incision laceration is related to surgical timing, presentation position, uterine surgery history, fetal weight, fetal position, incision location and surgical techniques. With fetus weight fully assessed, fetal position timely corrected, the timing of surgery grasped,cesarean section indications strictly controled,and surgical skills improved,the occurrence of uterine incision laceration of cesarean section will be reduced.
  • 摘要：Objective To study the expression and clinical significance of transforming growth factor -β1(TGF -β1) and matrix metalloproteinase-9 (MMP-9) in placenta of patients with severe preeclampsia. Methods The expression of TGF-β1and MMP-9 in placenta of 50 normal pregnant women and 60 cases of preeclampsia(25 cases were mild and 35 cases were severe) were analyzed by Western blot. Including 15 cases of early-onset mild preeclampsia,10 cases of late-onset mild preeclampsia;18 cases of early-onset severe preeclampsia and 17 cases of late -onset severe preeclampsia. Results The expression of TGF -β1was significantly increased in the stage of severe preeclampsia,and the expression of MMP-9 was significantly decreased.Compared with mild preeclampsia group and normal pregnancy group,the differences were statistically significant(P<0.05).The expression of TGF-β1in placental tissue was negatively correlated with the expression of MMP-9 (P<0.05). The expression of TGF-β1and MMP-9 in early-onset and late-onset group of patients with preeclampsia were compared and differences between the two were statistically significant(P <0.05). Conclusion The abnormal expression of TGF - β1and MMP -9 in placenta of patients with severe preeclampsia may be related to the occurrence of severe preeclampsia.%目的 研究转化生长因子-β1(transforming growth factor beta 1,TGF-β1)及基质金属蛋白酶-9(matrix metalloproteinase-9,MMP-9)在重度子痫前期患者胎盘组织的表达及其临床意义.方法 Western blot方法对50例正常妊娠组和60例子痫前期组(25例轻度和35例重度)胎盘组织中TGF-β1、MMP-9的表达进行分析.其中早发型轻度子痫前期组15例,晚发型轻度子痫前期组10例;早发型重度子痫前期组18例,晚发型重度子痫前期组17例.结果 在重度子痫前期组中TGF-β1的表达明显升高,MMP-9的表达明显降低,与轻度子痫前期组及正常妊娠组相比,差异有统计学意义(P<0.05).轻度子痫组与正常妊娠组之间比较差异无统计学意义(P>0.05);胎盘组织中TGF-β1的表达水平和MMP-9的表达水平呈负相关(P<0.05);TGF-β1、MMP-9在子痫前期患者早发型和晚发型组间的表达两两比较差异均有统计学意义(P<0.05).结论 重度子痫前期患者胎盘组织中TGF-β1和MMP-9表达异常,提示两者可能共同参与重度子痫前期的发生.
  • 摘要：目的 探讨宫腔镜下子宫黏膜下肌瘤切除不同治疗模式的治疗效果.方法 回顾性分析2014年3月至2015年12月因子宫黏膜下肌瘤在海南省农垦三亚医院就诊的患者160例,其中日间手术组80例,住院手术组80例.对患者手术时间、术后不良反应、住院时间、医疗花费、患者满意度及术后1年复发情况进行对比分析.结果 两组治疗方式均能使患者月经紊乱情况得以改善,日间手术组比住院手术组住院时间短、医疗花费少、患者满意度高,差异有统计学意义(P<0.05).两组手术时间、术后不良反应、术后1年复发率及术后恢复率比较,差异无统计学意义(P>0.05).结论 日间手术在医疗花费与住院时间上优于住院手术,在临床上可优先考虑.%Objective To investigate the effect of two different treatment modes,day time surgery and hospital surgery on the therapeutic effect for transcervical resection of uterine submucous myoma. Methods A total of 160 patients diagnosed with uterine submucous myoma in Hainan Province Nongken Sanya Hospital from March 2014 to December 2015, including 80 patients in the daytime surgery group and 80 patients in the hospitalization surgery group,were selected in retrospective analysis. The operative time, postoperative adverse reactions, hospitalization time, medical expenses, patient satisfaction and 1 year recurrence rate after surgery were observed.Results Two groups of treatment improved the patients'menstrual disorders. Compared with the hospitalization surgry group,the hospitalization time was shorter,the medical expenses were less,the patients'satisfaction was higher in the daytime surgery group,the differences were statistically significant(P<0.05). There were no significant differences between the two groups in the operation time,postoperative adverse reactions and 1 year recurrence rate (P> 0.05). Conclusion Daytime surgery in medical expenses and hospitalization time is better than hospitalization surgery,but in during and postoperative recovery there are no significant differences. Daytime surgery is worthy in clinical promotion.
  • 摘要：Objective To study the psychological influence of traditional Chinese medicine nursing on postoperative gynecological tumor patients. Methods 120 patients with gynecological tumor who were treated in Affiliated Hospital of Jiangxi Traditional Chinese Medicine Research Institute from January 2016 to April 2017 were divided into control group and observation group according to the principle of randomization,with 60 patients in each group. The patients in the control group were given routine nursing care of gynecological tumor. The patients in the observation group were treated with Chinese medical care. The mental health and nursing satisfaction of the two groups were compared and analyzed. Results The scores of self-rating anxiety scale and self-rating depression scale were better in the observation group than that in the control group. The nursing satisfaction of the observation group was also significantly higher than that of the control group. The differences were statistically significant(P<0.05).Conclusion In the clinical nursing of gynecological tumor, taking traditional Chinese medicine care can significantly improve the degree of mental health after surgery and the patient's care satisfaction,thus it is worthy of clinical promotion.%目的 探讨中医护理对妇科肿瘤患者手术后心理的影响.方法 选取江西省中医药研究院附属医院2016年1月至2017年4月就诊的120例妇科肿瘤患者,按照随机数字表法分为对照组和观察组,每组60例患者,对照组患者给予妇科肿瘤的常规护理,观察组患者给予中医护理,对两组患者手术后的心理健康程度、护理满意度等进行比较和分析.结果 采取中医护理的观察组患者在焦虑自评量表和抑郁自评量表方面的评分(42.1±8.1、44.3±7.3)优于对照组患者(49.7±11.3、51.2±9.6),观察组的护理满意度(91.7%)也明显高于对照组(71.7%),差异有统计学意义(P<0.05).结论 在妇科肿瘤临床护理中,采取中医护理可以明显改善患者手术后的心理健康程度,并且可以提高患者的护理满意度.
  • 摘要：目的 对子宫切除术患者应用温馨关爱服务计划,观察对其术后疼痛、情绪及生活质量的影响.方法 选取2015年6月至2016年6月大连医科大学附属大连市中心医院124例拟行子宫切除的患者,按照随机数字表法分为对照组和关爱组,前者手术后实施常规护理,后者按温馨关爱服务计划实施护理.比较两组术后不同时间疼痛评分变化、情绪及生活质量改变及术后并发症发生情况.结果 关爱组术后不同时间疼痛评分均低于对照组(P<0.05);负性情绪、各维度生活质量评分两组本组内护理前、3月后比较和3月后两组间比较差异均有统计学意义(P<0.05);关爱组术后并发症发生率低于对照组(P<0.05).结论 温馨关爱服务计划在子宫切除术后应用可减轻患者主观疼痛感,有效改善情绪及生活质量,并发症少.%Objective Patients with hysterectomy were treated with a warm and caring service plan to observe their effects on postoperative pain,mood and quality of life. Methods A total of 124 patients who underwent hysterectomy were selected from June 2015 to June 2016 in Dalian Central Hospital Affiliated to Dalian Medical University. According to the random number table method, they were divided into the control group and the care group. The former was given routine care after operation, while the latter was given the nursing according to the established warm loving care program. The changes of pain score at different times,mood,quality of life and postoperative complications were observed. Results The pain scores in the postoperative care group were much lower than those in the control group(P<0.05). Negative emotion and quality of life scores were compared before and after 3 months within the group and the two groups after 3 months, the differences were statistically significant(P <0.05). The incidence of postoperative complications in the care group was much lower than that in the control group, and the difference was statistically significant(P <0.05). Conclusion The application of the warm loving care program can relieve the subjective pain of the patients after hysterectomy,and effectively improve the mood and quality of life,with less complications and ideal value.
  • 摘要：目的 分析原因不明自然流产(unexplained spontaneous abortion,USA)的相关因素.方法 选取2015年1月至2016年2月在西安第五人民医院就诊的孕早期妇女1045例为观察对象,统计其年龄、文化程度、既往孕产史等资料,进行单因素分析后经多因素Logistic回归分析USA的危险因素.结果 单因素研究分析发现年龄、文化程度、既往孕次、既往胎次、自然流产史、人工流产史、怀孕季节、产前体质量指数(body mass index,BMI)、围孕期服用叶酸、血清同型半胱氨酸(homocysteine,Hcy)水平、血清叶酸等对USA的发生有显著影响(P<0.05).多因素分析结果显示,自然流产史、人工流产史、既往胎次、孕前BMI偏低、文化程度、年龄及孕期服用叶酸、高Hcy血症、血清叶酸高水平与USA的发生有统计学关联(P<0.05),OR值分别为12.180、10.988、6.448、2.109、1.749、1.054、0.629、2.598、0.237.其中,围孕期服用叶酸和血清叶酸高水平是降低孕妇USA发生率的有利因素.结论 孕妇年龄>30岁,文化程度较低,有自然流产史,有人工流产史、孕前BMI过低,血清Hcy水平较高,血清叶酸水平较低易发生USA.%Objective To analyze related factors of unexplained spontaneous abortion(USA). Methods A total of 1 045 pregnant women were selected as observation object in Xi'an Fifth People's Hospital from January 2015 to February 2016. Statistics of their age,education level,history of previous pregnancy and other information were collected, risk factors of USA were analyzed by single factor analysis and multivariate logistic regression. Results The single factor analysis showed that pregnancy, history of spontaneous abortion and artificial abortion,prenatal BMI, gestational folic acid, serum Hcy and serum folic acid had a significant impact on the occurrence of USA(P<0.05). After analysis of multivariate analysis,the results showed that the history of spontaneous abortion and artificial abortion,previous parity,pre-pregnancy low body weight,education level,age and pregnancy taking folic acid, high Hcy hyperlipidemia,serum folic acid levels were statistically correlated with the incidence of USA (P<0.05). OR values were 12.180,10.988,6.448,2.109,1.749,1.054,0.629 and 2.598,0.237 respectively. Among them, the perinatal taking folic acid and high levels of serum folic acid were favorable factors in reducing the incidence of USA in pregnant women. Conclusion Pregnant women who are over 30 years of age,with low educational level,a history of spontaneous or artificial abortion,low prenatal BMI,high serum Hcy level and low serum folic acid level were prone to spontaneous abortion.
  • 摘要：目的 探讨糖化血红蛋白(glucosylated hemoglobin,HbAlc)水平在预测妊娠期糖尿病(gestational diabetes mellitus,GDM)孕妇生产结局中的价值.方法 将2014年6月至2015年12月在四川省眉山市妇幼保健院进行产前检查并在该院分娩的146例GDM孕妇,按照分娩前HbAlc水平控制情况将其分为控制组86例、未控制组60例,另外选取同期HbAlc水平正常的产妇60例作为对照组,对比分析3组产妇妊娠结局.结果 未控制组妊娠期高血压疾病、胎膜早破、羊水过多、剖宫产率、羊水粪染、早产、胎儿宫内窘迫、新生儿窒息和巨大儿发生率明显高于控制组和对照组(P<0.05),控制组和对照组比较差异无统计学意义(P>0.05).结论 HbAlc水平对GDM孕妇的妊娠结局有较好的预测作用,可将HbAlc水平作为孕妇血糖控制情况的重要监测指标.%Objective To investigate the value of glycosylated hemoglobin(HbAlc) level in predicting the outcomes of pregnant women with gestational diabetes mellitus(GDM). Methods 146 pregnant women diagnosed with GDM in Meishan Women and Children's Hospital from June 2014 to December 2015 were divided into control group(86 cases) and non-control group(60 cases). 60 women with normal HbAlc levels were selected as the matched group. The pregnancy outcomes of the three groups were analyzed. Results The proportion of pregnancy induced hypertension, premature rupture of membranes, polyhydramnios, cesarean section, meconium stained amniotic fluid, premature delivery, fetal distress, neonatal asphyxia and giant baby in non -control group were significantly higher than that of the control group and the matched group, the differences were statistically significant(P < 0.05). While the differences between the control group and the matched group had no statistical significance(P>0.05).Conclusion The level of HbAlc has a good predictive effect on the production of GDM pregnant women.It can be used as an important monitoring index of blood glucose control in pregnant women with GDM.
  • 摘要：目的 提高妊娠期急性脂肪肝(acute fatty liver of pregnancy,AFLP)早期检出诊断率,应用综合治疗措施,减少孕产妇及围产儿死亡.方法 我院收治的临床诊断为AFLP7例,对诊断标准的适用性,人工肝等综合治疗措施以及影响预后的关键因素进行分析.结果 7例临床诊断AFLP,对照Swansea诊断标准,全部符合.3例病情较轻者,2例短时间内阴道分娩,1例剖宫产分娩,产后第2d病情开始好转,肝功能2周内恢复正常,其发病至终止妊娠病程≤3d.4例早期肝功能衰竭患者均行剖宫产分娩,术后病情继续加重,行人工肝等综合治疗,死亡2例,存活2例,其发病至终止妊娠病程≥7d.结论 应用Swansea诊断标准可提高AFLP的早期检出诊断率.终止妊娠后病情仍可继续加重,出现肝功能衰竭征兆宜尽早应用人工肝治疗,可减少孕产妇死亡.加强孕期监测,及早就诊是改善AFLP预后的关键因素.
  • 摘要：目的 探讨阑尾周围脓肿误诊为妇科急腹症的原因及治疗体会,以期提高临床医生鉴别诊断的能力.方法 回顾性分析首都医科大学附属北京友谊医院近5年收治的术前考虑妇科急腹症,术中及术后证实为阑尾周围脓肿的10例患者的临床资料,分析临床表现及治疗方法.结果 10例患者主要临床表现为发热伴下腹痛,其中4例患者存在腹膜刺激征象,3例伴随消化道症状.10例患者中仅2例出现典型的转移性右下腹痛.妇科查体可扪及附件区压痛的包块.多数患者血白细胞升高,部分患者伴肿瘤标志物糖类抗原125及糖类抗原199轻度升高.10例患者中,术前诊断为卵巢癌破裂继发感染2例,急性盆腔炎2例,右输卵管卵巢脓肿2例,卵巢囊肿2例,卵巢囊肿蒂扭转1例,黄体破裂1例.10例患者中,9例行手术治疗,其中4例行腹腔镜探查+阑尾周围脓肿切除术,3例完整切除阑尾及周围脓肿,1例粘连严重术中仅行阑尾周围脓肿部分切除.2例患者行腹腔镜探查转开腹阑尾切除术,余3例患者行腹腔镜下粘连松解+脓液引流术.结论 阑尾周围脓肿是临床常见病,不典型的病例可能与妇科的急腹症相混淆,妇产科临床医生接诊急腹症患者时,需认真做好诊断和鉴别诊断,从而减少或避免阑尾周围脓肿的误诊误治,避免二次手术.%Objective To explore the reasons and treatment of appendicular abscess misdiagnosed as gynecological acute abdomen and to improve the ability of clinicians to differentiate and diagnose. Methods Retrospectively analyzed the clinical data of 10 patients in Beijing Friendship Hospital Affiliated to Capital Medical University in the past 5 years who were preoperative considerated gynecological acute abdomen and intraoperative and postoperative confirmed appendicular abscess,to analyze the clinical manifestation and treatment methods. Results The 10 patients were with major clinical manifestations of fever with abdominal pain, of which 4 patients with peritoneal irritation signs,3 cases with gastrointestinal symptoms. Of the 10 patients,only 2 had typical metastatic right lower abdominal pain. Gynecological examination can found in the attachment area tenderness of the mass. Most patients had elevated white blood cells,some patients with tumor markers CA125 and CA199 slightly elevated.Of the 10 cases,2 cases were preoperative diagnosed of ovarian cancer rupture secondary infection, 2 cases of acute pelvic inflammatory disease, 2 cases of right oviductal abscess,2 cases of ovarian cyst,1 case of ovarian cyst torsion and 1 case of rupture of corpus luteum. Of the 10 patients, 9 were treated surgically,of which 4 cases of laparoscopic exploration + appendiceal abscess resection,3 cases of complete removal of the appendix and surrounding abscess, only 1 case of partial resection of appendiceal abscess due to serious intraoperative adhesions. 2 patients underwent laparoscopic exploration of open appendectomy. The other 3 patients underwent laparoscopic adhesions release +pus drainage. Conclusion Appendicular abscess is a common clinical disease,atypical cases may be confused with the gynecological acute abdomen. Clinic doctors need to do a good job on diagnosis and differential diagnosis when receiving acute abdomen patients, therefore reducing or avoiding misdiagnosis and secondary surgery.
  • 摘要：妊娠对甲状腺功能产生影响,甲状腺功能异常在妊娠妇女中患病率较高.分析不同甲状腺功能状态对妊娠结局的影响,指导临床筛查甲状腺功能异常的妊娠妇女.

    中国计划生育和妇产科的期刊信息

    • 曾用名：中国医学文摘.计划生育和妇产科学;中国医学文摘-计划生育妇产科学;中国医学文摘：计划生育妇产科学;中国医学文摘.计划生育妇产科学;中国医学文摘:计划生育妇产科学
    • 创刊时间：1982
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