Obstetric Fistula: Epidemiological, Social and Therapeutic Aspects: Prospective Study of 196 Patients Admitted to the ZINDER Mother and Child Health Centre (CSME)

Introduction: Obstetric fistula (OF) is an abnormal communication between the genital and urinary tracts and/or associated with a recto-vaginal communication resulting from prolonged dystocic delivery. It is a frequent pathology in underdeveloped countries. In Zinder no study has been carried out on obstetric fistula. The aim of this study was to evaluate the epidemiological, social impact and therapeutic aspects of obstetric fistula at the CSME of Zinder. Patient and Method: This was a descriptive cross-sectional study of obstetric fistula care at CSME during the period of (January 2018 to June 2020). Results: A total of 196 cases were collected over 30 months. This represents an annual incidence of 78.4 fistulas. The median age of the patients was 18.63 years, and more than 65% were over 20 years old. One hundred and ninety-one patients (97.45%) did not attend school, and 56.12% (n = 110) lived in polygamous households. One hundred and fifty-one women (n = 151), 77.04% had full assistance from their husband during the first four (4) months of the pathology. Twenty-four (12.24%) had been notified of repudiation. Obstetrical risk of dystocia was found in 39.79% (n = 78) of the patients, of whom 24.49% (n = 48) had a focused antenatal consultation (CPNR). The labour lasted more than 24 hours in 100%. The majority of women are multiparous and 60% had at least 2 pregnancies. vesicovaginal fistula is the main pathological type with 86.23%. Fistulas were closed in 83.16% and 68.87% exited without urine loss. Conclusion: Obstetric fistula is a devastating disease affecting girls and young women in Niger, as in other countries in Africa and Asia. It is a major concern worldwide and is a social tragedy because it is disabling and depressing.

鼻内镜下综合治疗慢性泪囊炎

目的:观察鼻内镜下三种不同方法治疗慢性泪囊炎所需的手术时间、出血量及效果。方法:98例慢性泪囊炎分为三组,A组28例(31眼)在鼻内镜下应用膨胀海绵行鼻腔泪囊吻合造口术(置管),B组33例(35眼)鼻内镜下应用银夹、膨胀海绵行鼻腔泪囊造口术(不置管),C组37例(40眼)在鼻内镜下联合应用眼光导纤维、电刀、丝裂霉素C(mitomycin C,MMC)、耳脑胶及明胶海绵行鼻腔泪囊造口术(不置管),三组所需的手术时间、出血量及疗效进行对比分析。结果:平均手术时间、平均出血量及有效率(6个月、12个月)分别是A组、B组、C组。结论:鼻内镜下联合应用内光导纤维引导,电刀、丝裂霉素c和耳脑胶及明胶海绵行鼻腔泪囊造口术,能减少手术时间,出血少,疗效好、复发率低,是一种操作简单、安全可靠、经济、快速、实用、疗效好的方法。

西部非洲巨大甲状腺肿的诊治研究

目的:探讨简陋条件下西非巨大甲状腺肿诊断、手术麻醉、解剖方法、手术技巧,减少出血、术后颈部不适和瘢痕。预防和减少喉上神经、喉返神经和甲状旁腺的损伤及术后呼吸困难。方法:回顾性分析2008年11月-2011年11月75例巨大甲状腺肿手术切除患者的临床资料。结果:3年来共治疗巨大甲状腺肿75例,74例治愈,死亡1例。住院5～14d,切口Ⅰ/甲71例,Ⅰ/乙4例,无一例出现术后出血需再手术。抽搐、甲亢危象4例,呼吸困难4例,声嘶4例,呛咳2例。3例发生术后暂时性声嘶,术后1～3个月恢复正常。结论:西非巨大甲状腺肿物采用手术治疗可行。详细询问病史、细致的体格检查及常规的超声检查对巨大甲状腺肿物的性质鉴别仍是简单可行的诊断措施。全麻加气管插管、不断颈前肌群、先摘除瘤体、囊内切除腺体、靠下极结扎甲状腺上动脉、不解剖喉返神经、囊内结扎甲状腺下血管等方法在西非是治疗巨大甲状腺肿较好的方式,具有损伤率低、并发症少、出血少、手术时间短及住院天数少等优点。