Clinical outcomes of patients treated for cervical pregnancy with or without methotrexate

The objective of this study is to describe the clinical outcomes of patients treated for cervical pregnancy with or without methotrexate (MTX) and to evaluate the effects of MTX in the treatment of cervical pregnancy. Between January 1993 and February 2000, 31 patients were diagnosed with cervical pregnancy. Twenty-two patients were treated with MTX chemotherapy and nine patients were treated with surgical procedures without MTX treatment. In the non-MTX treatment group, three patients underwent total abdominal hysterectomy, five required adjuvant procedures to control the bleeding during dilatation and curettage (D&C) and only one patient was treated with a simple D&C. In the MTX treatment group, fourteen (63.6%) patients were treated with only MTX and eight (36.4%) cases underwent concomitant procedures (simple curettage, curettage and Foley catheter tamponade, cervical cerclage, ligation of the descending branches of uterine arteries, or ligation of hypogastric arteries). The uterus was preserved in all cases and three women delivered healthy babies in their subsequent pregnancy. In conclusion, early diagnosis, appropriate MTX regimen in combination of necessary adjuvant conservative procedures could contribute to successful treatment with preservation of the uterus and future reproductive ability.     

Hipertiroidismo como manifestación de la enfermedad trofoblástica gestacional: a propósito de un caso

Gestational trophoblastic disease (GTD) is a group of tumours caused by the hyperproliferation of trophoblast cells and is noted for its overproduction of hCG. Among its manifestations, there may be hyperthyroidism, due to the stimulating activity of hCG on TSH receptors. In most cases it is only a biochemical hyperthyroidism, with its presentation as symptomatic hyperthyroidism being much less frequent. We report the case of a patient with GTD, who at diagnosis presented with symptomatic hyperthyroidism. Treatment included surgical evacuation of the hydatidiform mole, as well as a beta-blocker and antithyroid drug treatment to relieve the symptoms.     

Treatment effect analysis of curettage for jaw cysts based on volumetric assessment and image registration

The study was conducted to develop a visual and intuitive quantitative evaluation method for maxillary cystic lesions after curettage. Mimics 16.0 and Geomagic Studio 2013 were used to form a precise reconstruction of the cystic lesion morphology of 60 cases; the average reduction rates and 95% confidence interval were calculated. Computed tomography (CT) registration was performed before and after surgery to observe morphology features of the bone regeneration of the cystic area. The average reduction rates (RR) of the cysts after curettage were (43.56 ± 16.79)%, (54.33 ± 17.15)% and (68.53 ± 15.99)% at 3 months, 6 months and 12 months after surgery, respectively. The average monthly reduction rates (MRR) were (12.07 ± 4.35)%, (8.16 ± 2.84)% and (5.35 ± 1.52)% at 3 months, 6 months and 12 months after surgery, respectively. Correlation analysis by comparing with each group showed that the effect of sex and age in the 3-month group and the initial size in the 12-month group on RR and MRR were statistically significant. Within the limitations of the study it seems that the chosen approach for quantitative evaluation of the therapeutic effect of curettage for jaw cystic lesions might facilitate visual and quantitative follow-up of cyst curettage and timely detection of recurrence.     

药物流产不全清宫后服用屈螺酮炔雌醇片的临床疗效评价

目的探讨药物流产不全清官术后即日口服屈螺酮炔雌醇片的临床疗效。方法将64例药物流产不全清宫后患者随机分为两组,观察组32例．在预防感染及促进子宫收缩的基础上于清宫后即日口服屈螺酮炔雌醇片,连续服用21d;对照组32例,仅术后口服同剂量同种抗生素预防感染及促进子宫收缩3d。结果观察组子宫内膜恢复明显优于对照组（P〈0．05）,出血量明显减少,出血时间明显缩短,月经恢复快,宫颈管粘连及官腔粘连的发生率低。结论药物流产不全清宫后即日口服屈螺酮炔雌醇片可以促进子宫内膜修复,月经复潮快,可降低药物流产不全清宫后并发症的发生率,可作药物流产清宫后的常规用药。     

子宫动脉化疗栓塞在宫颈或剖宫产切口妊娠人工流产手术前的作用

目的 探讨子宫动脉化疗栓塞术在宫颈或剖宫产切口妊娠人工流产手术前的应用效果.方法 术前常规进行各项检查,待患者生命体征稳定后实施子宫动脉化疗栓塞术,待3～5天在B超引导下对其进行人工流产手术终止妊娠.结果 28例患者均顺利完成子宫动脉化疗栓塞及人工流产手术治疗,治愈率为100％.低热是子宫动脉化疗栓塞术后人工流产的常见不良反应,发生率高达75.00％,与其他不良反应发生率比较差异有统计学意义（P＜0.05）.结论 在宫颈或切口妊娠患者实施人工流产前给予子宫动脉化疗栓塞术治疗,可获得满意的临床疗效,安全性及有效性均较高.     

刮吸切割法在腹腔镜胆囊切除术治疗急性胆囊炎中的应用体会

目的:探讨腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)治疗急性胆囊炎的手术方法及刮吸切割法在术中的应用价值。方法:回顾分析2007年11月至2013年10月为64例急性胆囊炎患者行LC的临床资料,术中采用吸引器刮吸分离与超声刀切割相结合的方法完成操作。结果:62例(96.9%)手术获得成功,1例因术中出血、1例因术前怀疑Mirizzi综合征中转开腹。手术时间平均(127±31)min,术中出血量平均(115±34)ml,术后下床活动时间平均(17.2±3.8)h,术后胃肠功能恢复时间平均(23.5±8.2)h,手术后胆漏2例(3.2%),术中放置引流管引流46例(74.2%),引流时间平均(4.7±2.3)d,术后平均住院(6.6±2.3)d。术后平均随访(8.2±2.5)个月,无黄疸、膈下感染、"小胆囊"、肝外胆管狭窄等并发症发生。结论:刮吸切割法应用于急性胆囊炎LC术中是安全、可行的。手术成功的关键是术前对病情进行充分讨论与评估,术中使用吸引器刮吸分离与超声刀切割相结合的方法,可较好地解剖Calot三角,有效避免术中大出血、胆管损伤,降低术中并发症发生率及中转开腹率。     

米非司酮配合中药治疗药流不全临床疗效分析

目的探讨米非司酮配合益母草颗粒治疗药流不全的可行性。方法对152例宫内残留物平均经线≤15mm的药流不全病例的治疗方法进行回顾性分析,把用米非司酮配合益母草颗粒进行保守治疗组定为研究组,清宫术治疗组为对照组,研究两种方法治疗效果及并发症。结果米非司酮组与清宫术组宫腔残留物排净的成功率、并发感染率差异无统计学意义,P>0.05,两组血止所需的时间差异有统计学意义,P<0.05。结论药流后宫腔残留物平均经线≤15mm的病人,用米非司酮配合益母草颗粒治疗除阴道流血时间较长外,成功率、感染率与清宫术无显著性差异,故米非司酮配合中药治疗药流不全是可行的,可使患者免除痛苦,提高药流的成功率。     

Treatment of viable cesarean scar ectopic pregnancy with suction curettage.

OBJECTIVE: Pregnancy in previous cesarean scar is the rarest form of ectopic pregnancy. All reported cases in the literature that were treated with uterine curettage either become unsuccessful or complicated. We aimed to present a case of cesarean scar ectopic pregnancy that was successfully treated with suction curettage without any additional therapy. CASE: A 32-year-old asymptomatic woman, gravida 2, para 1 was referred to our hospital with the possible diagnosis of cervical ectopic pregnancy. Transvaginal and transabdominal sonographic examination revealed the diagnosis of viable ectopic pregnancy in a previous cesarean scar. Suction curettage with carman canulles was performed under transabdominal ultrasonographic guidance. beta-hCG decreased progressively postoperatively. CONCLUSION: Suction curettage under ultrasonography guidance can be used in termination of selected cases (early diagnosed, without symptoms that necessitates emergency intervention) of cesarean scar pregnancy.     

晚期产后出血114例临床分析

目的：探讨晚期产后出血的病因及防治措施。方法：回顾性分析114例晚期产后出血的病因及处理。结果：主要病因依次为胎盘、胎膜残留，子宫内膜炎和（或）蜕膜炎，子宫复旧不良，以及剖宫产术的子宫切口感染、裂开出血等。结论：治疗以清宫为主，对急性出血者可行经皮髂内动脉栓塞术或子宫切除术。