结直肠癌术后肝脏介入造影、化疗70例体会

目的：探讨结直肠癌术后预防肝转移及早期发现肝转移的有效措施。方法：结直肠癌术后采用肝脏动脉介入化疗代替全身静脉化疗，采用肝动脉介入造影检查肝脏有无转移及发现肝脏转移后给予栓塞转移灶并介入化疗。结果：肝介入化疗局部动脉血药浓度是全身静脉化疗血药浓度的10～30倍，局部疗效增强而全身副作用轻，肝介入造影较彩超及CT早发现肝脏转移。结论：结直肠癌术后肝脏介入化疗预防肝脏转移疗效确切，介入造影能及早发现肝脏转移。     

孕前保健门诊病例1055例分析

孕前保健是降低出生缺陷和其他不良妊娠结局的一级预防措施，是婚前保健的后续以及孕产期保健的前移。如国外的一些研究表明：孕前保健显著地降低了自然流产率。上海同济大学附属第一妇婴保健院于2007年5月底成立了女性孕前保健门诊，实施孕前疾病筛查、孕前优生咨询与指导。为了进一步规范和改进孕前保健服务，对2007年5月至2008年5月的就诊者进行回顾性分析。     

妊娠合并主动脉夹层的诊治

妊娠合并主动脉夹层病情凶险,容易误诊、漏诊,母儿不良结局风险极高,且与夹层分型密切相关,病因主要与原发高血压、先天性和遗传性血管性疾病相关,妊娠是其好发因素。胸痛为主要临床表现,诊断主要依靠影像学检查。治疗包括支持治疗、药物治疗、传统手术治疗、主动脉瘤腔内修复术等,治疗方式、分娩时机、分娩方式根据主动脉夹层累及范围与类型、孕周、患者及家属意愿和医疗条件综合决定。加强孕前与孕期保健、多学科评估与救治是降低不良母胎结局的关键。     

加强孕前保健,改善母儿结局

正孕前保健是通过评估和改善计划妊娠夫妇的健康状况,减少或消除导致出生缺陷等不良妊娠结局的风险因素,预防出生缺陷的发生,提高出生人口素质的重要措施。通过孕前优生指导配合规范化的孕前保健和检查,能够及早防治妊娠合并症及并发症,评估孕妇及胎儿的安危,改善母儿结局。     

外阴阴道上皮性血管内皮瘤1例报道

上皮性血管内皮瘤(epithelioid hemangioen-domethlioma,EHE)是一种少见的血管内皮肿瘤。文献检索未见有生殖道上皮性血管内皮瘤的报道。我院收治1例外阴阴道的上皮性血管内皮瘤,现报道如下。1病例报告患者28岁,G2P1,因反复外阴肿物5年,肿物渐大伴疼痛1年入院。患者5年前行外阴前庭大腺囊肿切开术,术后留一黄豆大小硬结。1年多前(孕5月)自觉外阴切口处疼痛,不伴下肢疼痛,自觉肿块渐渐增大。孕足月因为外阴肿块而行剖宫产,术后外阴肿物约花生米大小,1月前伴疼痛加剧,分泌物较多,就诊北京某医院,予抗感染(具体不详)后略好转。半月前当地医院…     

胎盘植入子宫次全切除术后盆腔迟发性出血2例

回顾性分析两例胎盘植入孕妇术后盆腔迟发性出血的发生及诊治经过, 结合文献探讨胎盘植入的术前评估及围手术期处理经验。两例孕妇均行胎盘植入术前超声评估, 考虑为穿透性胎盘植入, 术中二次评估后行胎盘在位子宫次全切除术, 术后病理证实为胎盘植入。术后2～3 d出现腹痛或肉眼血尿, 超声检查提示手术区域血肿形成, 并伴有血肿内活动性出血。急诊行子宫动脉栓塞术, 术后病灶逐渐缩小。胎盘植入于子宫前壁下段, 子宫下段与膀胱及腹膜与子宫颈的间隙可能有复杂的新生血管及吻合系统, 子宫切除术后, 仍有可能出现迟发性出血。胎盘植入术前除了进行严重程度的评估之外, 还应重视胎盘局部状态及植入部位解剖学的评估, 术后迟发性出血时可应用介入血管栓塞术治疗。     

正常双胎及单胎胎儿大脑中动脉搏动指数变化的比较

目的 探讨正常双胎妊娠期间胎儿大脑中动脉搏动指数的变化;并与正常单胎进行比较.方法 采用彩色多普勒超声对34例正常双胎及176例正常单胎胎儿从孕23周至孕35周进行大脑中动脉搏动指数测定.结果 正常双胎胎儿大脑中动脉搏动指数随孕周呈逐渐下降趋势,与正常单胎胎儿比较,孕29周前该值为低,以后较之略高.结论 孕29周后双胎胎儿大脑中动脉血流阻力比单胎其值为高.     

腹腔镜下子宫血管阻断治疗子宫肌瘤的最初经验及与子宫动脉栓塞治疗的比较

为了解腹腔镜下子宫血管阻断治疗有症状子宫肌瘤的价值．选择46例绝经期前，平均年龄43（34～51）岁，有临床症状的子宫肌瘤患者纳入研究。组其中（24例）采用放射介导子宫动脉栓塞治疗．组2（22例）采用腹腔镜下子宫血管阻断治疗．组2操作要点为近髂内动脉水平以腹腔镜内铗阻断子宫动脉．同时双极电凝处理卵巢固有韧带以阻断卵巢与子宫的交通血供。对两组术后子宫出血的改变情况．子宫及子宫肌瘤的体积变化情况及术后疼痛及镇痛药的使用情况进行评估分析。     

一氧化氮在妊高征发病及子宫-胎盘-胎儿循环中的调节作用

目的：探讨一氧化氮（ＮＯ）在妊高征发病及在子宫－胎盘－胎儿循环阻力中的调节作用和对胎儿生长发育的影响。方法：采用Ｇｒｅｉｓｓ法测定了４３例妊高征患者（妊高征组）分娩前后外周血及脐血血清ＮＯ的含量，以２５例正常晚孕妇（正常晚孕组）及１８例健康未孕妇（未孕组）作对照。应用彩色多普勒超声检测了部分病例子宫动脉及脐动脉血流阻力指标Ｓ／Ｄ值，并观察了部分病例胎盘绒毛血管的超微结构变化。结果：妊高征组产前外周血及脐血ＮＯ含量均低于正常晚孕组（Ｐ＜０．０１）。脐血ＮＯ含量高于母血（Ｐ＜０．０１）。妊高征组外周血及脐血血清ＮＯ含量均与脐动脉Ｓ／Ｄ值呈负相关（ｒ分别为－０．５２，Ｐ＜０．０５及－０．５８，Ｐ＜０．０１）。中、重度患者的胎盘绒毛血管均有不同程度的病变。结论：ＮＯ的合成减少可能是妊高征发病中的一个重要环节，妊高征患者ＮＯ合成减少与胎盘循环阻力增高及绒毛血管的超微结构改变可能互相影响、互为因果。     

甲状腺疾病妇女的孕前保健

甲状腺疾病是常见的内分泌疾病之一,妊娠后可造成母婴不良结局。因此,在受孕前需作好充分准备,接受孕前保健是十分必要的。孕前保健至少应在受孕前3~6个月开始,内容包括对夫妇双方的孕前医学检查(包括详细个人、家族史的采集,系统体格检查以及相关的实验室检查),孕前医学咨询及指导(包括对疾病的治疗及妊娠时机的建议,对生活行为、营养、运动的指导及对受孕知识的指导及个体化的咨询指导)等服务。1甲状腺功能的诊断程序2诊断标准[1]甲状腺疾病诊断标准①临床甲状腺功能减退症TSH>4·8 mU/L,FT4<10·3 pmol/L亚临床甲状腺功能减退症TSH>…     

The Effect of a Gynecologist–Interventional Radiologist Relationship on Selection of Treatment Modality for the Patient with Uterine Myoma

BackgroundOn the basis of consistent published scientific evidence, the American College of Obstetricians and Gynecologists has given uterine artery embolization (UAE) a level A recommendation as a viable alternative treatment for uterine myomas, describing it as a safe and effective option for appropriately selected women who wish to retain their uteri. Despite the growth of favorable clinical outcome information, many gynecologists do not routinely offer UAE as an alternative to abdominal hysterectomy or abdominal myomectomy. The percentage of laparoscopic hysterectomies in the United States remains less than 20%, reflecting the reluctance or inability of gynecologic surgeons to perform other minimally invasive procedures such as hysteroscopic myomectomy, laparoscopic myomectomy, laparoscopic hysterectomy, or even vaginal hysterectomy. Of great significance, many patients do not wish to have any kind of surgery, no matter how “minimally invasive.” As a result, patients seeking less invasive treatments may bypass the gynecologist and be referred directly to an interventional radiologist by their primary care physician, or they may self-refer. Little has been published on the referral relationship between gynecologists and the interventional radiologist who performs uterine artery embolization. The absence of a structured routine referral relationship causes some women to undergo treatments that potentially are not aligned with all of her treatment desires. This study was undertaken to gain insight into the interventional radiologist–gynecologist dynamic and the benefit to patients who are informed of all of their options for the treatment of myomas.Study ObjectivesInvestigate the course of myoma treatment in a cohort of patients either self-referred to an interventional radiologist or referred to the interventional radiologist by their gynecologist. Determine the effect of a cooperative referral network of interventional radiologists and gynecologists that informs patients about the options of UAE and minimally invasive surgical alternatives on the choice of myoma treatment.Study DesignProspective data acquisition of patient referral source, UAE evaluation, patient decision on treatment options, and continued follow-up with a network gynecologist.SettingHospital-based interventional radiologist and gynecologist both practicing in a large urban teaching setting.PatientsA total of 226 women, representing 73% of women presenting to an interventional radiologist in 2007 seeking UAE for symptomatic myomas. One hundred thirty-eight of these patients were referred to the interventional radiologist by a gynecologist, and 88 were self-referred. Patient outcome relative to referral was traced with 76 patients in the myoma surgery group treated from 2007–2008 by a gynecologist in the referral network.InterventionsEvaluation for suitability for UAE procedure, followed either by UAE procedure with return to referring gynecologist for follow-up, return to referring gynecologist for treatment, or referral to another gynecologist for minimally invasive surgical management when the primary gynecologist is unable to perform alternative treatment.Measurements and Main ResultsAll patients in the study initially evaluated by the interventional radiologist were referred to a gynecologist. Overall, 62% of patients were candidates for UAE, and 38% underwent the procedure during the study period. Patients who did not receive UAE were returned to the referring gynecologist for further evaluation and treatment. Patients who underwent UAE were referred to a gynecologist for ongoing care. In all, 70% of self-referred patients and 92% of gynecologist-referred patients expressed satisfaction with their original gynecologist and were referred back to that physician. Patients who did not have a gynecologist or who were dissatisfied with their original gynecologist were referred to a network gynecologist for continued gynecologic care. In our study 26 self-referred women were sent as new patients to gynecologists in the interventional radiologist's referral network, resulting in a 119% return on the original 138 gynecologist–to–interventional radiologist–referred patients. Among the 8% of gynecologist-referred women who switched to a different gynecologist within the referral network, the primary reasons for dissatisfaction were the gynecologist's failure to fully disclose treatment options or offer desired minimally invasive procedures. On follow-up with a network gynecologist, 8 newly referred patients underwent myoma surgery, and 8 newly referred patients continued to be seen by that gynecologist. Four patients referred to the gynecologist for treatment were originally referred by the gynecologist to the interventional radiologist for UAE evaluation. Ten patients switched from their named gynecologist to a different gynecologist willing to disclose all treatment options for uterine myomas and able to provide minimally invasive surgical treatment as medically indicated. Of the 10 women who switched to this network gynecologist, 8 underwent myoma surgery.ConclusionsEstablishing a referral relationship with an interventional radiologist for comprehensive uterine myoma treatment supports a trusting, collaborative, long-term, noncompetitive “win-win” relationship between the gynecologist and radiologist, meets the patient's desire for full disclosure of all myoma treatment options, improves the patient's overall medical care and physician/patient experience, and has been demonstrated to improve patient flow to a gynecologist practice. With the guidelines established in this study, no patients were inappropriately left to the gynecologist for post-UAE care. The authors acknowledge that this dynamic is dependent on the individual interventional radiologist and their relationships and open communication with the gynecologist. Finally, the study revealed that failure to fully disclose alternative treatment options, or offer minimally invasive surgical techniques may result in a loss of patients due to patient dissatisfaction.     

Good clinical practice guideline--guidelines of the health care chain cancer of the breast: stage 3 guideline "Early Recognition of Cancer of the Breast in Germany" Lecture: International Cancer of the Breast Symposium on the occasion of the retirement of Professor Dr. med K.-D. Schultz, 27.-29. September 2002 in Marburg

Breast cancer is the leading death of women with cancer worldwide and the focus of today major concern of gender specific, health care in Germany. Diagnosis of breast cancer at an early stage has a better prognosis and better chance to be cured combined with improved quality of life. Thus quality of health care in early detection of breast cancer should not be focussed on screening-mammography of women at a certain age-group alone anymore. The efficacy and effectiveness of an early detection of breast cancer programme depends on the concomitant quality assuring arrangements of the interdisciplinary diagnostic chain including risk evaluation, clinical examination, technical diagnostic procedures including interventional techniques and histo-pathological analysis in combination with excellent surgical and oncological treatment and follow-up. To establish a national effective, quality assured, interdisciplinary breast cancer early detection programme in Germany a multidisciplinary good clinical practice (GCP) guideline has been developed.     

Assessment of gestational trophoblastic disease by Doppler ultrasonography

OBJECTIVE: To evaluate the role of transvaginal color Doppler ultrasonography in the management of first-trimester spontaneous abortion, clinically thought to be complete. STUDY DESIGN: A prospective interventional non-randomized study was performed in a tertiary care University hospital. Sixty-two women with suspected first-trimester spontaneous abortion, clinically thought to be complete were included in the study. All women were evaluated on admission by transvaginal color Doppler ultrasonography. The amount of blood flow within the myometrium or in the endometrium-myometrium interface was assessed. Those women with suspected retained tissue on color Doppler were scheduled to undergo dilatation and curettage (D&C). Those patients with no suspected retained tissue on color Doppler were scheduled for expectant management. RESULTS: Eighteen women had suspected retained tissue and 44 women did not. A total of 16 out of 18 (88.9%) patients had retained trophoblastic tissue confirmed on histopathologic analysis. There were two false negative cases. Outcome of all patients managed expectantly was optimal with no complications. CONCLUSIONS: Transvaginal color Doppler ultrasonography is useful to detect or to rule out the presence of retained trophoblastic tissue after first-trimester spontaneous abortion and to select patients for expectant management.     

血管性介入治疗妇科恶性肿瘤与泌尿系统损伤的研究

目的探讨妇产科血管性介入治疗恶性肿瘤对泌尿系统损伤的类型、原因及处理。方法广州市第一人民医院1999年6月至2004年12月对89例妇科恶性肿瘤行血管性介入治疗的病例进行回顾性分析,探讨泌尿系统损伤的发生率、损伤类型、原因、治疗措施及结局。结果89例妇科恶性肿瘤介入治疗后发生的泌尿系统损伤共13例,包括膀胱、输尿管和肾脏的损伤,发生率为14.61%。13例中有5例只有1种损伤,其余8例均为2种或3种损伤并存,但肾脏的损伤不是直接的,而是继发于输尿管损伤。13例中子宫颈癌共5例,以输尿管损伤和继发肾脏损害为主者4例,占总发生率的30.77%(4/13),膀胱损伤仅有1例,占总发生率的7.70%(1/13);子宫体恶性肿瘤共8例,以膀胱损伤为主者7例,占总发生率的53.85%(7/13),输尿管损伤和继发肾损害仅有1例,占总发生率的7.70%(1/13)。13例中只有2例造成器官严重或不可逆的损伤,其余11例均在治疗后康复。结论血管性放射介入治疗存在对泌尿系统损伤的危险,采取恰当的措施可以预防损伤的发生。     

基于增强CT连续扫描数据的胎盘植入患者产后盆腔结构三维模型的构建及意义

目的:探讨基于增强CT扫描数据重建产后女性在体盆腔结构三维模型的方法及意义。方法:选择1例阴道分娩后疑为胎盘植入产妇,经双源CT血管成像(CTA)技术扫描盆腔,将Dicom 3.0原始二维断层图像数据集导入Mimics软件,分别对骨盆、盆腔动静脉、输尿管进行三维重建并配准融合。结果:获取的在体胎盘植入患者产后盆腔结构数字化模型可以清楚显示骨盆、泌尿系统、髂总动静脉、髂外动静脉、髂内动静脉、子宫动脉及其分支,并可进行任意缩放和任意角度旋转,显示不同结构间的毗邻关系和空间构象,适于三维距离和角度测量。结论:利用CTA数据集,在Mimics软件下可方便快捷地建立理想的产后女性在体骨盆血管网的数字化三维模型,为妇产科医生更好地了解产后女性盆腔解剖结构、做好产后介入手术术前评估提供了理想的物理化模型平台。     

Ultrasonographic assessment of pregnancy development after endometriosis treatment

Investigated group comprised pregnant women after sterility treatment, which underwent obstetrical care in Institute of Obstetrics and Gynaecology Medical Academy of ?ód? in years 1998-2000. In the first group were 25 pregnant women after endometriosis treatment, the second one 23 healthy pregnant women. At term were performed ultrasound examinations (biometry and estimated fetal weight) than were assessed neonatal weight in both groups. There were found the similar mean age in both groups, but in the group after treatment more women in age over 30 years were observed (not significant). The higher weights were observed in the group of healthy pregnant women in ultrasound fetal estimation before delivery (about 343.5 g) and neonatal weight after delivery (about 407 g) but without significance. There is possibility of the better vascular development in the feto-maternal circulation in the course of pregnancy in healthy women than after endometriosis treatment, but for the correct conclusions should be made further research on larger collectives. Ultrasound assessment is a useful method in prenatal diagnostic with possibility of precise analysis of the fetal development.     

Hawaiian-style "Talkstory": Psychosocial Assessment and Intervention During and After Pregnancy

Standard health care services generally limit the psychosocial assessment and management provided for women during and after pregnancy. Recommendations for improving prenatal care include the need for evaluating different approaches for addressing culturally sensitive care. In an innovative prenatal and postpartum program developed by public health nurses in Hawaii, the use of local "talkstory" has been integrated successfully as a caregiving strategy for participating women from Asian and Pacific Islander ethnic groups. This article describes the use of talkstory for delivering psychosocial care and its application in the design of health care services for pregnant women in the general population.     

子宫动静脉瘘引起晚期产后出血的诊疗进展

子宫动静脉瘘(uterine arteriovenous fistula,UAVF)是一种临床上较为罕见的子宫血管异常疾病,是导致女性晚期产后出血的原因之一.近年来随着我国二孩政策的放开以及人工流产率的增高,UAVF的发病率也随之上升,严重影响女性的生活质量,并增加了患者再次妊娠的难度和风险.由于UAVF病因和临床表现...     

Statins and menopausal health

Cardiovascular disease is associated with high morbidity and mortality. Cholesterol-lowering statins can reduce health risks both in men and women. While this benefit has thus far been attributed to the lipid-lowering effects of these drugs, the importance of their direct actions on vascular tissue is gaining more recognition. Furthermore, recent studies suggest that statins might also be effective in preventing osteoporosis and Alzheimer's disease. Equally interesting are experimental results showing that statins may inhibit growth of certain malignancies such as the breast. When statins are combined with hormone replacement therapy (HRT), even greater beneficial effects on the lipid profile can be obtained. To our knowledge we have investigated for the first time direct vascular effects by combining statins with HRT. We were able to identify significant beneficial effects on endothelial function and vascular smooth muscle proliferation. In the context of current discussions on the benefits and risks of HRT in treating patients with pre-existing cardiovascular disease, it appears particularly important that interventional studies should be conducted to evaluate the therapeutic relevance of statin/HRT combinations. At present, this is the most important conclusion drawn from the data collected thus far on the combination of these two drug types. There is some evidence suggesting drug-specific effects, particularly adverse reactions and statin interactions, which should be considered when using this combination therapy.