细菌性阴道病阴道乳酸杆菌的生态学特征

细菌性阴道病（ｂａｃｔｅｒｉａｌｖａｇｉｎｏｓｉｓ，ＢＶ）系阴道内菌群生理生态内环境改变所致，尤与阴道内乳酸杆菌（ｌａｃｔｉｃａｃｉｄｂａｃｉｌ－ｌｕｓ，ＬＡＢ）与加特纳杆菌（Ｇａｒｔｎｅｒ＇ｓｂａｃｉｌ－ｌａｓ，ＧＢ）或混合性厌氧菌群失调有关。阴道...     

胎儿吸引器的应用与评价

介绍不是用于中、晚期妊娠（ｓｅｃｏｎｄａｎｄｔｈｉｒｄｔｒｉｍｅｔｅｒｐｒｅｇｎａｎｃｉｅｓ）引产（ｉｎｄｕｃｅｄｄｅｌｉｖｅｒｙ）的胎儿吸引器（（ｆｅｔａｌａｓｐｉ－ｒａｔｉｖｅａｐｐａｒａｔｕｓ，ＦＡＡ），而是用于经阴道助产术（ｔｒａｎｓｖａｇｉ...     

女性软下疳的诊断与治疗

女性软下疳的诊断与治疗西安医科大学第二附属医院（７１０００４）刘辅仁软下疳（ｃｈａｎｃｒｏｉｄ，ｓａｆｔｃｈａｎｃｔｅ，ｕｌｃｕｓｍｏｌｅ）是由一种杜克雷嗜血杆菌（ｈａｅｍｏｐｈｉｌｕｓＤｕｃｒｅｙｉ）引起的，通过性接触感染的急性局限性溃疡性疾病，一...     

游离脐带穿刺术36例分析

游离脐带穿刺术３６例分析张彦平，叶国玲，刘琪，席梅英，雷小莹脐带穿刺术（ｃｏｒｄｏｃｅｎｔｅｓｉｓ）又称经腹脐静脉穿刺术（Ｐｅｒｃｕｔａｎｅｏｕｓｆｅｔａｌｕｍｂｉｌｉｃａｌｂｌｏｏｄｓａｍｐｌｉｎｇ，ＰＵＢｓ），是采集胎血的新技术，自１９８３年以来...     

细菌性阴道病的诊断与治疗

细菌性阴道病的诊断与治疗中山医科大学孙逸仙纪念医院（５１０１２０）冯华英邝健全细菌性阴道病（ｂａｃｔｅｒｉａｌｖａｇｉｎｏｓｉｓ，ＢＶ）是由阴道加德纳菌（Ｇａｒｄｎｅｒｅｌａ）与某些厌氧菌混合感染引起的，曾称非特异性阴道炎（ｎｏｎｓｐｅｃｉｆｉｃｖａ...     

盆腔炎患者衣原体的检测及治疗

盆腔炎患者衣原体的检测及治疗唐家龄黄晓军林至君黄子健黄舒娥（广州市妇婴医院）沙眼衣原体（ｃｈｌａｍｙｄｉａｔｒａｃｈｏｍａｔｉｓ，ＣＴ）是性传播疾病（ｓｅｘｕａｌｙｔｒａｎｓｍｉｔｔｅｄｄｉｓｅａｓｅ，ＳＴＤ）中最常见的病原体。我院用聚合酶链反应（Ｐ...     

子宫切除途径的选择趋势

传统的子宫切除途径有经腹（ｔｒａｎｓ－ａｂｄｏｍｉｎａｌｈｙｓｔｅｒｅｃｔｏｍｙ，ＴＡＨ）和经阴道（ｔｒａｎｓｖａｇｉｎａｌｈｙｓｔｅｒｅｃｔｏｍｙ，ＴＶＨ）两种。最近１０年随着内镜技术的发展，又出现了腹腔镜辅助的阴道子宫切除术（ｌａ－ｐａｒｏｓｃｏ...     

胰岛素样生长因子I,生长抑素在新生儿缺氧缺血性脑病血液？…

目的 观察胰岛素样生长因子Ｉ（ｉｎｓｕｌｉｎ－ｌｉｋｅ ｇｒｏｗｔｈ ｆａｃｔｏｒ－Ｉ，ＩＧＦ－Ｉ）、生长抑素（ｓｏｍａｔｏｓｔａｔｉｎ，ＳＳ）在新生儿缺氧缺血性脑病（ ｈｙｐｏｘｉｃ－ｉｓｃｈｅｍｉｃ ｅｎｃｅｐｈａｌｏｐａｔｈｙ，ＨＩＥ）极其和恢复期血液中的变化；探讨ＩＧＦ－Ｉ、ＳＳ在ＨＩＥ发病机制中的作用。方法 （１）用放射免疫分析法（ＲＩ）测定正常对照组、ＨＩＥ极期、恢复期血浆ＳＳ的水平。     

彩色多普勒超声在产科的应用进展

彩色多普勒超声亦称多普勒彩色血流显像，简称彩超。它在二维和Ｍ型超声基础上同时显示血流的方向和相对速度，提供大血管内血流的时间和空间信息，不仅可显示血管的形态和分布，而且能分析血流速度波形（ｆｌｏｗｖｅｌｏｃｉｔｙｗａｖｅｆｏｒｍｓ，ＦＶＷＳ）即血流图。常用的参数有：１、收缩期的峰值速度（ｍａｘｉｍｕｍｓｙｓｔｏｌｉｃｖｅｌｏｃｉｔｙ，Ｖｍａｘ）。２、舒张末期的最大频移速度（ｅｎｄ－ｄｉｓｔｏｌｉｃｖｅｌｏｃｉｔｙ，Ｖｍｉｎ）。３、平均血流速度（ｔｈｅｍｅａｎｆｌｏｗｖｅｌｏｃｉｔｙ，Ｖ）。４、Ｓ／Ｄ值，即Ｖｍａｘ与Ｖｍｉｎ的比值。５、搏动指数（ｐｕｌｓｉｔｉｖｅｉｎｄｅｘ，ＰＩ）。６、阻力指数（ｒｅｓｉｓｔｅｎｔｉｎｄｅｘ，ＲＩ），ＰＩ和ＲＩ反映血流阻力情况。１９７８年Ｍａｃａｌａｎ首次用彩超检查胎儿脐动脉（ｆｅｔａｌｕｍｂｉｌｉｃａｌａｒｔｅｒｙ；ｆＵＡ），此后，彩超逐渐应用于检查子宫动脉（ｕｔｅｒｉｎｅａｒｔｅｒｙ，ＵｔＡ），胎儿肾动脉（ｆｅｔａｌｒｅｎａｌａｒｔｅｒｙ，ｆＲＡ），胎儿大脑中动脉（ｆｅｔａｌｍｉｄｄｌｅｃｅｒｅｂｒａｌａｒｔｅｒｙ，ｆＭＣＡ）等，从而监测胎盘功能、胎儿宫内状况和诊断胎儿畸?     

氧氟沙星栓治疗细菌性阴道炎临床效果评价

氧氟沙星栓（ｏｆｌｏｘａｃｉｎｓｕｐｐｏｓｉｔｏｒｙＯＦＳ）是新喹诺酮（ｎｅｗｑｕｉｎｏｋｅｔｏｎｅ）类广谱抗菌药，正式药名为氟嗪酸（ｎｏｒｆｌｏｐａｃｉｎ），该药抗菌谱广，抗菌作用强，抗革兰氏阳性菌的活性大于氟哌酸（ｎｏｒｆｌｏｘａｃｉｎ）４～８倍...     

Role of Minimally Invasive Surgery in Ovarian Cancer

The standard treatment of ovarian cancer includes upfront surgery with intent to accurately diagnose and stage the disease and to perform maximal cytoreduction, followed by chemotherapy in most cases. Surgical staging of ovarian cancer traditionally has included exploratory laparotomy with peritoneal washings, hysterectomy, salpingo-oophorectomy, omentectomy, multiple peritoneal biopsies, and possible pelvic and para-aortic lymphadenectomy. In the early 1990s, pioneers in laparoscopic surgery used minimally invasive techniques to treat gynecologic cancers, including laparoscopic staging of early ovarian cancer and primary and secondary cytoreduction in advanced and recurrent disease in selected cases. Since then, the role of minimally invasive surgery in gynecologic oncology has been continually expanding, and today advanced laparoscopic and robotic-assisted laparoscopic techniques are used to evaluate and treat cervical and endometrial cancer. However, the important question about the place of the minimally invasive approach in surgical treatment of ovarian cancer remains to be evaluated and answered. Overall, the potential role of minimally invasive surgery in treatment of ovarian cancer is as follows: i) laparoscopic evaluation, diagnosis, and staging of apparent early ovarian cancer; ii) laparoscopic assessment of feasibility of upfront surgical cytoreduction to no visible disease; iii) laparoscopic debulking of advanced ovarian cancer; iv) laparoscopic reassessment in patients with complete remission after primary treatment; and v) laparoscopic assessment and cytoreduction of recurrent disease. The accurate diagnosis of suspect adnexal masses, the safety and feasibility of this surgical approach in early ovarian cancer, the promise of laparoscopy as the most accurate tool for triaging patients with advanced disease for surgery vs upfront chemotherapy or neoadjuvant chemotherapy, and its potential in treatment of advanced cancer have been documented and therefore should be incorporated in the surgical methods of every gynecologic oncology unit and in the training programs in gynecologic oncology.     

腹腔镜在妇科恶性肿瘤诊治中的应用与规范化问题

腹腔镜在妇科恶性肿瘤诊治中的应用日益广泛,除肿瘤细胞减灭术外,几乎所有妇科恶性肿瘤开腹手术都有相对应的腹腔镜手术。腹腔镜技术与经阴道手术等其他的手术技术相结合,产生了一些新的手术方式。严格遵循妇科恶性肿瘤手术治疗原则的腹腔镜手术效果与相应的开腹手术相当或者更佳。机器人腹腔镜手术可能是妇科恶性肿瘤手术未来的发展方向。     

腹腔镜治疗妇科肿瘤适应证的初步探讨

目的 :探讨腹腔镜手术治疗妇科肿瘤的适应证。方法 :腹腔镜下行附件切除或囊肿剥除 ,子宫切除 ,妇科恶性肿瘤盆腔淋巴切除、卵巢动静脉高位结扎或大网膜切除。并以相应开腹手术作对照。结果 :腹腔镜手术进腹与缝合腹壁时间短、恒定 ,而开腹手术却受手术的大小和患者肥胖程度的影响。腹腔镜对小于 10cm的卵巢囊性肿瘤或子宫小于3月妊娠大小的子宫肿瘤患者 ,手术时间及过程与开腹手术比较没有显著区别。但对于更大囊性肿瘤或子宫肿瘤 ,腹腔镜手术难度加大 ,时间显著延长 ,开腹手术优于腔镜手术。合并盆腔脏器粘连者 ,两者处理过程相似。腹腔镜下处理妇科恶性肿瘤需较高的操作技巧和相应的手术器械 ,手术效果可与开腹手术相类似。结论 :腹腔镜手术适应于较小的卵巢囊性肿瘤或子宫肿瘤 ,对于子宫内膜癌等恶性肿瘤需处理淋巴结或探查上腹部者 ,腹腔镜手术效果和预后亦可与开腹手术相类似。因腹壁创伤小、腹腔干扰小 ,术后恢复明显优于开腹手术。     

Laparoscopic surgery for complex ovarian masses

STUDY OBJECTIVE: To assess the value of laparoscopy in managing complex ovarian masses. DESIGN: Retrospective, observational analysis (Canadian Task Force classification II-2). SETTING: University-based, tertiary level center for endoscopic surgery. PATIENTS: Two hundred eleven consecutive women. INTERVENTIONS: Laparoscopic surgery including ovary-preserving surgery, salpingo-oophorectomy, adhesiolysis, and pelvic lymphadenectomy. MEASUREMENTS AND MAIN RESULTS: Patients were selected on the basis of preoperative ultrasound findings. Intraoperative appearance of the tumors as well as results from frozen section examinations were compared with histologic results. Two hundred sixteen pelvic masses were benign. In 10 patients, early ovarian cancer, borderline tumors, tubal cancer, or secondary ovarian, nongynecologic pathology was managed primarily by laparoscopy and confirmed histologically. Three of these 10 women underwent standard radical open surgery within 1 week. The true nature of masses was not recognized at the time of laparoscopy in three patients with malignant findings. Patients with malignant tumors were followed for 5 years. CONCLUSION: Although most complex ovarian masses can be managed by laparoscopy, the possibility of overlooking malignancy remains, even with frozen section examination. Whether or not laparoscopy compromises clinical outcome compared with laparotomy is not fully understood. Prospective studies to address this important clinical question are urgently needed.     

Risk of malignancy in sonographically confirmed ovarian tumors

Ovarian cancer is the leading cause of gynecologic cancer death in the United States. Once an ovarian tumor is identified, a pelvic ultrasound is recommended, including tumor volume and tumor structure. Unilocular and simple septate tumors are unlikely to be malignant and when asymptomatic, can be safely followed conservatively without surgery. Complex ovarian tumors are at an increased risk for malignancy and secondary testing is recommended. Secondary testing may include CA125, OVA1, the RMI, ROMA, or the ACOG referral guidelines. When secondary testing indicates that an ovarian tumor is at high risk for malignancy, referral to a gynecologic oncologist is recommended.     

"Nongynecologic" surgical procedures performed on a gynecologic oncology service

One thousand fifty-eight patients had major surgery in a community-based, university-affiliated gynecologic oncology service. Of these, 233 underwent a total of 275 "nongynecologic" surgical procedures. Two hundred twenty patients suffered from gynecologic malignancies, whereas 13 had surgery for benign disorders. Eighty-two procedures were performed on the gastrointestinal tract, 44 on the urinary tract, and 149 on extrapelvic lymph nodes. Except for ovarian carcinoma and benign conditions the majority of gastrointestinal or urinary tract operations were preceded by radiation therapy. When the nongynecologic operation was necessitated at a time subsequent to initial therapy of the malignancy, a high incidence of recurrent disease was discovered. Of the 275 procedures, reoperation because of early or late complications was necessary in only 8 instances. Only one postoperative death was caused by complications of surgery. Other mild postoperative complications were transient and responded to routine noninvasive care. The complication rate and morbidity of nongynecologic surgical procedures performed on a gynecologic oncology service are low and should encourage gynecologic oncologists to continue their present comprehensive approach to patient care.     

Recurrence and prognostic factors in borderline ovarian tumors

OBJECTIVE: The purpose of this study was to evaluate the survival estimates and clinico-pathological variables in patients treated for borderline ovarian tumors. METHODS: The patients treated for borderline ovarian tumors were evaluated retrospectively. Data were obtained from hospital records and special gynecologic oncology forms. RESULTS: Overall, 100 patients were evaluated. The mean age at the time of diagnosis was 41.7 (range, 19-84). Seventy one (71%) patients underwent surgical staging including 49 (49%) of them with comprehensive surgical staging, 22 (22%) with fertility-sparing surgery. Only 30 (30%) patients were unstaged. The histopathological diagnosis was serous, mucinous, and the other types of borderline ovarian tumor in 54 (54%), 39 (39%), and 7 (7%) of the patients, respectively. Seventy patients had stage IA (70%), 10 had stage IB (10%), 9 had stage IC (9%), 3 had stage IIIA (3%), and 8 had stage IIIC (8%) disease. The stage of only four patients in which disease confined to ovary was upgraded as stage IIIC following surgical staging procedure. The recurrence rate was found 3% (3). The overall disease-free survival rates of BOT in surgically staged (comprehensive, fertility-sparing surgery) and unstaged patients were 97.92%, 95.00%, and 96.30%, respectively. But, the overall tumor-free survival was significantly found to be decreased in cases of young age (<30 years old), performing fertility-sparing surgery and presence of micropapillary architecture or peritoneal implants. Overall survival rates of BOT in surgically staged (comprehensive, fertility-sparing surgery) and unstaged patients were 97.9%, and 100% and 100%, respectively. CONCLUSION: Low malignant potential ovarian tumors have excellent survival, and the patients can be treated safely by conservative surgery.     

The role of laparoscopy in ovarian tumors of low malignant potential and early-stage ovarian cancer

Although it is feasible today to perform laparoscopic surgical staging and treatment of ovarian low malignant potential tumors and early-stage ovarian cancer safely, it is still generally agreed that a patient with ovarian cancer should have a laparotomy. Concerns related to laparoscopy in managing gynecologic malignancy include the accuracy of intraoperative diagnosis, inadequate resection, significance of tumor spillage, improper or delay in surgical staging, delay in therapy, and the possibility of port-site metastasis. On the other hand, laparoscopy has the advantages of being a minimally invasive surgery, with shorter hospitalization, decreased postoperative pain, and quicker return to normal daily activities. We review the current literature discussing the consequences of laparoscopic surgery in ovarian tumors of low malignant potential and early-stage ovarian cancer. TARGET AUDIENCE: Obstetricians & Gynecologists, Family Physicians. LEARNING OBJECTIVES: After completion of this article, the reader should be able to list the concerns related to laparoscopic management of ovarian malignancies, to outline the accuracy of the diagnosis of low malignant potential (LMP) ovarian tumors on frozen section, and to summarize the data on the effect of capsule rupture on overall prognosis for patients with ovarian cancer.     

卵巢交界性肿瘤的诊疗现状

卵巢交界性肿瘤(borderline ovarian tumor,BOT)是指组织病理学特征和生物学行为介于良性肿瘤和恶性肿瘤之间的一组低度恶性潜能的卵巢肿瘤,具有发病年龄轻、早期发现、预后好的特点,但术前诊断困难,虽然血清肿瘤标志物、盆腔超声及术中快速冰冻病理切片可协助诊断,但准确率不高。手术是治疗BOT的主要方法,近年来,对BOT的手术治疗方式逐渐由根治性手术向保留生育功能的手术转变,术后一般不需辅助化疗。然而,关于其早期诊断、手术方式的选择、术后妊娠结局及预后等问题一直存在广泛争议,就BOT诊断、治疗、预后的研究现状进行综述,以期为今后BOT的临床诊疗及新的诊疗技术研究提供参考。     

Benign or malignant ovarian neoplasms and ovarian endometriomas

STUDY OBJECTIVE: To investigate clinical features and biologic behavior of ovarian cancer that might be closely related to endometrioma and/or endometriosis. DESIGN: Retrospective study (Canadian Task Force classification II-2). SETTING: University hospital. PATIENTS: All 324 women who were operated for endometriomas and/or ovarian tumors 5 cm or greater in diameter between January 1988 and December 1997. INTERVENTION: One hundred twelve women underwent laparoscopic surgery and 212 had laparotomy. MEASUREMENTS AND MAIN RESULTS: All tissues were evaluated histologically. Clinical examinations including ultrasound and serum tumor makers were performed in all patients preoperatively. No malignancies were found at laparoscopic surgery (76 endometriomas, 36 ovarian tumors). The frequency of endometriosis in benign, borderline malignant, and malignant tumors was 9.7%, 12.5%, and 11.4%, respectively. Endometriosis was present most frequently (40%) in women with endometrioid adenocarcinoma. It was present in 81 patients with endometriomas and 25 with ovarian neoplasms. Of these, nine women (8.5%) had malignant tumors, including borderline malignancy. Among patients with malignant tumors, those without endometriosis were significantly older (mean +/- SD age 54.9 +/- 16.2 yrs) than those with endometriosis elsewhere in the pelvis (45.9 +/- 8.9 yrs). CONCLUSION: Endometriosis may be closely related to ovarian tumors such as endometrioid adenocarcinoma. Surgeons should be aware of this possibility, and candidates for laparoscopic surgery should be carefully selected based on preoperative evaluations.