盆腔炎方内服结合盆腔灌注治疗盆腔炎性疾病72例

目的:观察中药口服结合盆腔灌注对盆腔炎性疾病的治疗效果。方法:选取盆腔炎性疾病病例144例,随机分为治疗组及对照组各72例。治疗组口服中药结合西药盆腔灌注;对照组单纯西药盆腔灌注,疗程结束后评价疗效。结果:两组总有效率无显著差异(P>0.05),但治疗组痊愈率高于对照组,有显著性差异(P<0.05);症状及体征改善与对照组比较,有显著性差异(P<0.01)。结论:本方法治疗盆腔炎性疾病有明显效果。

薄氏腹针治疗慢性盆腔疼痛48例

目的:观察薄氏腹针治疗慢性盆腔疼痛的疗效。方法:针刺中脘、下脘、气海等穴治疗本病48例。结果:总有效率89.6%。结论:薄氏腹针是通过刺激腹部穴位,调理脏腑功能来治疗多种慢性病、疑难病,尤其适用于疼痛性疾病治疗。

盆腔炎方对苯酚胶浆致大鼠慢性盆腔炎模型的影响

目的:探讨盆腔炎方对慢性盆腔炎的治疗作用。方法:采用苯酚胶浆制备大鼠慢性盆腔炎模型,观察本品对慢性盆腔炎大鼠的影响。结果:盆腔炎方3g/kg、1.5g/kg剂量组均可明显降低大鼠子宫卵巢脏体比(P<0.01或P<0.05);0.63g/kg可降低子宫上皮组织变性坏死程度,降低炎性浸润,降低充血水肿程度,降低卵巢充血水肿程度(P<0.01或P<0.05);0.32g/kg可降低子宫充血水肿程度,降低卵巢充血水肿程度(P<0.05)。结论:盆腔炎方功能清热利湿,理气和血,调经止痛,用于下焦湿热所致的慢性盆腔炎。

盆腔子宫内膜异位症40例术后辅助用药疗效观察

目的:观察盆腔子宫内膜异位症术后辅助孕三烯酮或米非司酮治疗效果。方法:81例患者采取腹腔镜手术或剖腹手术,其中,41例未辅助用药,40例术后给予孕三烯酮或米非司酮辅助治疗。结果:术后辅助用药6个月后完全缓解率62.5%,显著高于单纯手术组46.3%;复发率25%,显著低于单纯手术组(39%)。辅助用药12个月后完全缓解率52.5%,显著高于单纯手术组36.3%;复发率40%,显著低于单纯手术组51.2%。结论:子宫内膜异位症治疗方式,应根据不同的临床特点采取相应手术,术后辅以药物孕三烯酮或米非司酮治疗效果较好。

温经汤配合蠲痛散敷脐治疗盆腔瘀血综合征76例

目的:观察经典经方温经汤合蠲痛散敷脐治疗盆腔瘀血综合征的临床疗效。方法:治疗组76例采用经方温经汤合合蠲痛散(细辛、红花、艾叶、肉桂、丹参等)敷脐盆治疗。对照组72例用玉液金丹等治疗。结果:治疗组总有效率88.2%。对照组的65.3%(两组相比P<0.05有显著性差异。结论:口服温经汤有温经祛瘀、理气止痛的功效,蠲痛散敷脐盆有促进局部循环,活血化瘀的功效,两者结合治疗盆腔瘀血综合征疗效显著。

保留盆腔自主神经的直肠癌根治术对男性性功能的保护研究

目的:探讨在全直肠系膜切除(TME)的基础上行保留盆腔自主神经(PANP)的根治性切除术对男性直肠癌患者性功能(术后3个月)的影响。方法:对28例直肠癌男性患者行TME+PANP手术,对26例直肠癌男性患者仅行TME非保留盆腔自主神经根治术,术后3个月患者性功能(包括勃起功能和射精功能)通过勃起功能障碍国际指数问卷调查表(Internationalindex of erectile function,IIEF)评分了解。结果:患者术后勃起功能:保留盆腔自主神经组得分高于非保留组,两组具有显著性差异(P<0.05)。射精功能优于非保留组,两组具有显著性差异(P<0.05)。结论:进展期直肠癌患者实施保留盆腔自主神经的根治术,可以较好地保留患者的性功能。

盆腔炎1号方对湿热瘀结型慢性盆腔炎患者的临床观察

目的:探讨盆腔炎1号方对湿热瘀结型慢性盆腔炎患者临床疗效以及生活质量的影响。方法:收集湿热瘀结型慢性盆腔炎患者120例作为研究对象,根据就诊序列号进行随机分组,其中对照组60例使用常规方法治疗,治疗组60例在对照组基础上联合盆腔炎1号方治疗,比较两组患者的临床治疗效果及生活质量情况。结果:两组治疗前IL-2、TNF-a、疼痛值无显著性差异,P>0.05,治疗后两组均有好转,但治疗组数据和对照组有显著性差异,P<0.05,有统计学意义;治疗组疗效优良率、生活质量评价LSR、LSI、LSIB分数显著高于对照组,且均具有显著性差异。结论:给予湿热瘀结型慢性盆腔炎患者在常规治疗基础上联合盆腔炎1号方治疗可显著改善临床症状、降低疼痛感,对于提高临床疗效和生活质量具有积极意义。

腹腔镜手术联合红藤汤治疗盆腔脓肿58例临床观察

急性盆腔炎是妇产科常见急腹症之一，近年有上升趋势，急性期炎性病变继续发展，脓液积聚可形成盆腔脓肿，包括输卵管积脓、输卵管卵巢脓肿以及由盆腔腹膜炎、盆腔蜂窝织炎脓液积聚于盆腔腹膜外或盆底最低处所形成的阔韧带内脓肿及子宫直肠窝脓肿。传统的中西医结合保守治疗和开腹治疗因其疗程长、并发症多达不到医患双方共同满意的效果，近年来随着微创技术的发展，腹腔镜手术联合中药治疗在盆腔脓肿中的应用逐年增多并凸显优势。我院自2007年7月至20013年7月应用腹腔镜技术联合红藤汤治疗盆腔脓肿58例，取得较好的疗效，现将结果报道如下。

盆腔炎汤保留灌肠配合小剂量氟罗沙星治疗慢性盆腔炎疗效观察

目的:探讨小剂量氟罗沙星联合盆腔炎汤保留灌肠治疗慢性盆腔炎的临床效果。方法:选择患者200例,按照随机数字法分为两组各100例,对照组采用氟罗沙星口服每次0.4g,每天1次,治疗组采用盆腔炎汤(煅龙骨、牡蛎、乌贼骨、白果、淮山药、炒白术、炒芡实、红藤、代赭石、菟丝子、白头翁等)灌肠,每天1次,联合使用氟罗沙星片每次0.2g,每天1次,比较两组患者治疗后临床症状改善时间,并统计两组治疗后不良反应。结果:治疗组治疗后下腹腰骶疼痛,带下量多、气臭色黄及神疲乏力缓解时间均显著快于对照组(P<0.05),治疗组存在食欲不振、失眠及癫痫样发作的比例显著低于对照组(P<0.05)。结论:采用盆腔炎汤保留灌肠联系小剂量氟罗沙星治疗慢性盆腔炎临床效果显著,不良反应少。

盆腔治疗仪辅助药物保守治疗异位妊娠26例

异位妊娠是妇科常见的急腹症之一,其中以输卵管妊娠最为常见。近年来随着人工流产、药物流产的增加以及相应的盆腔炎的增加,异位妊娠发病率有上升趋势。血β-HCG测定和B超检查的普遍应用及检测水平的提高,使异位妊娠能够得到早期诊断,为采用保守治疗提供了有利条件。

盆腔包块125例彩色多普勒超声诊断分析

本文回顾性分析我院近4年来彩色多普勒超声诊断125例盆腔包块病例，明确排除子宫疾病，诊断率高达95．5％，为临床医生提供了明确的诊断依据。

盆腔消症灌肠液对模型动物血浆血栓素和6-酮前列腺素的影响

目的:盆腔消症灌肠液对模型动物血浆TXB2和6-keto-PGF1α的影响。方法:采用苯酚胶浆制作致炎模型,分别设空白对照组、模型对照组、阳性药物对照组(相当于生药0.405g/kg体重)、盆腔消症灌肠液高剂量组(相当于生药1.171g/kg体重)、盆腔消症灌肠液低剂量组(相当于生药0.585g/kg体重),造模2周后,连续灌肠给药14d,心脏取血,采用放射免疫法测定血浆中TXB2、6-keto-PGF1α的含量。结果:模型组大鼠血浆TXB2含量及TXB2/6-keto-PGF1α比值显著高于空白组(P<0.01)、6-keto-PGF1α含量显著低于空白组(P<0.01);盆腔消症灌肠液高剂量组大鼠血浆TXB2含量及TXB/6-keto-PGF1α比值显著低于模型组(P<0.01)、6-keto-PGF1α含量显著高于模型组(P<0.01)。结论:盆腔消症灌肠液可以通过降低模型大鼠血浆TXB2含量及TXB2/6-keto-PGF1α比值、提高模型大鼠6-keto-PGF1α含量,显著改善模型大鼠的血瘀状态。

妇科盆腔颗粒的制备及质量控制

目的:建立妇科盆腔颗粒的质控标准。方法:采用薄层色谱法对处方中黄柏、赤芍、金银花、丹参进行鉴别。结果:薄层色谱法,专属性强,阴性无干扰。结论:该方法简便、准确、重现性好,可作为妇科盆腔颗粒的质量控制标准。

Chronic proctalgia and chronic pelvic pain syndromes:New etiologic insights and treatment options

This systematic review addresses the pathophysiology, diagnostic evaluation, and treatment of several chronic pain syndromes affecting the pelvic organs:chronic proctalgia, coccygodynia, pudendal neuralgia, and chronic pelvic pain. Chronic or recurrent pain in the anal canal, rectum, or other pelvic organs occurs in 7% to 24% of the population and is associated with impaired quality of life and high health care costs. However, these pain syndromes are poorly understood, with little research evidence available to guide their diagnosis and treatment. This situation appears to be changing:A recently published large randomized,controlled trial by our group comparing biofeedback, electrogalvanic stimulation, and massage for the treatment of chronic proctalgia has shown success rates of 85% for biofeedback when patients are selected based on physical examination evidence of tenderness in response to traction on the levator ani muscle-a physical sign suggestive of striated muscle tension. Excessive tension (spasm) in the striated muscles of the pelvic floor appears to be common to most of the pelvic pain syndromes. This suggests the possibility that similar approaches to diagnostic assessment and treatment may improve outcomes in other pelvic pain disorders.

Neoadjuvant vs adjuvant pelvic radiotherapy for locally advanced rectal cancer: Which is superior?

The treatment of locally advanced rectal cancer including timing and dosage of radiotherapy, degree of sphincter preservation with neoadjuvant radiotherapy, and short and long term effects of radiotherapy are controversial topics. The MEDLINE, Cochrane Library databases, and meeting proceedings from the American Society of Clinical Oncology, were searched for reports of randomized controlled trials and meta-analyses comparing neoadjuvant and adjuvant radiotherapy with surgery to surgery alone for rectal cancer. Neoadjuvant radiotherapy shows superior results in terms of local control compared to adjuvant radiotherapy. Neither adjuvant or neoadjuvant radiotherapy impacts overall survival. Short course versus long course neoadjuvant radiotherapy remains controversial. There is insufficient data to conclude that neoadjuvant therapy improves rates of sphincter preserving surgery. Radiation significantly impacts anorectal and sexual function and includes both acute and long term toxicity. Data demonstrate that neoadjuvant radiation causes less toxicity compared to adjuvant radiotherapy, and specifically short course neoadjuvant radiation results in less toxicity than long course neoadjuvant radiation. Neoadjuvant radiotherapy is the preferred modality for administering radiation in locally advanced rectal cancer. There are significant side effects from radiation, including anorectal and sexual dysfunction, which may be less with short course neoadjuvant radiation.

Adjuvant Pelvic Radiotherapy vs.Sequential Chemoradiotherapy for High-Risk StageⅠ-ⅡEndometrial Carcinoma

Objective To explore if the addition of adjuvant chemotherapy with paclitaxel and carboplatin to radiotherapy confers an advantage for overall survival （OAS）, and progression free survival （PFS）; to assess the incidence of relapses over standard pelvic radiotherapy; and to evaluate the related toxicity in high-risk stage I-II endometrial carcinoma Methods Medical records were reviewed to identify high-risk stage I-1I endometrial carcinoma cases treated in the Clinical Oncology and Nuclear Medicine department between 2002 and 2008 with adjuvant radiotherapy alone （arm Ⅰ）（57 patients） or with sequential carboplatin （AUCS-6） and paclitaxel （135-175 mg/m^2） with radiotherapy （arm Ⅱ） （51 patients）. Radiotherapy was performed through the four-field box technique at doses of 45-50 Gy （1.8 Gy/day × 5 days/week）. Results The toxicity was manageable and predominantly hematologic with a grade 3 neutropenia and thrombocytopenia in 9.8% and 6% of the patients in arm Ⅰ and arm Ⅱ, respectively, without febrile neutropenia. All patients experienced hair loss. Chernoradiotherapy arm was associated with a lower incidence rate of relapse （9.8% vs. 22.7%）. After a median follow-up period of 48 months, the 5-year OAS and PFS rates for chemoradiotherapy-treated patients were significantly more favorable than those who did not receive chemotherapy （P=0.02 and 0.03, respectively）. In arm I, the OAS and PFS rates were 73.7% and 66.7% compared with those in arm II, whose rates were 90.2% and 84.3%. Conclusions Adjuvant chemoradiation with paclitaxel and carboplatin improved the survival rates and decreased the recurrence rates in patients with high-risk stage Ⅰ-Ⅱ endometrial carcinoma. Chemotherapy was associated with an acceptable rate of toxicity. However, a prospective study with a larger number of patients is needed to define a standard adjuvant treatment for high-risk stage Ⅰ-Ⅱ endometrial carcinoma.

Prognosis in epithelial ovarian cancer: Clinical analysis of 287 pelvic and para-aortic lymphadenectomy

Objective: To evaluate the relationship between the pelvic and para-aortic lymphadenectomy and the prognosis of epithelial ovarian cancer. Methods: 287 patients suffering from primary epithelial ovarian cancer from 1995 to 2005 were analyzed retrospectively. Results: The 3-, 5-, 10-year survival with systematic lymphadenectomy (SL) were slightly higher than those without SL, but there were no statistically significance (P > 0.05). The 3-, 5-, 10-year survival of clinical stages without SL were lower than those with SL, but there were no significant difference either (P > 0.05). The 3-,5-, and 10-year survival rates with SL were higher than those without SL with no statistically differences (P > 0.05) among the subgroups such as absent, ≤ 2 cm and > 2 cm residual tumor. The survival rates of the groups without residual tumor and the group with ≤ 2 cm residual tumor were significantly higher than that of > 2 cm (P < 0.005). On multivariate analysis, patient staging (P = 0.01) and size of residual disease after primary cytoreductive surgery (P < 0.001 and = 0.002, respectively) retained prognostic significance. SL was not proved to be an independent prognostic factor (P = 0.69). Conclusion: Systematic pelvic and para-aortic lymphadenectomy can not improve and prolong the survival time significantly.

Pelvic arterial embolization in obstetric hemorrhage

AIM: To analyze safety and efficacy of pelvic arterial embolization(PAE) in preventing and treating obstetrical hemorrhage.METHODS: A consecutive study of eight cases undergoing pelvic artery embolization from January 2010 to October 2012 in Department of Obstetric and Gynecology of Maulana Azad Medical College for intractable obstetric hemorrhage was done. All embolization were carried out in cath lab of cardiology Department at associated GB Pant Hospital.RESULTS: Clinical success was defined as arrest of bleeding after PAE without need for repeat PAE or additional surgery which was 75% in our series. PAE was successful in controlling obstetrical hemorrhage in all except one who had mortality. Other had hysterectomy due to secondary hemorrhage. Five resumed menstruation. None of the women intended to conceive, hence are practicing contraception. CONCLUSION: PAE is minimally invasive procedure which should be offered early for hemostasis in intractable obstetrical haemorrhage unresponsive to uterotonic. It is a fertility sparing option with minor complications.

Current Situation of Transvaginal Mesh Repair for Pelvic Organ Prolapse

SURGICAL mesh is a metallic or polymeric screen intended to be implanted to reinforce soft tissue or bone where weakness exists. Surgical mesh has been used since the 1950s to repairabdominal hernias. In the using surgical mesh products 1970s, gynecologists began to indicate the repair of pelvic organ prolapse （POP）, and in the 1990s, gynecologists began using surgical mesh for POP. Then the U.S. Food andDrug Administration （FDA） approved the first surgical mesh product specifically for use in POP.

Metachronous penile metastasis from rectal cancer after total pelvic exenteration

Despite its abundant vascularization and extensive circulatory communication with neighboring organs, metastases to the penis are a rare event. A 57-yearold male, who had undergone total pelvic exenteration for rectal cancer sixteen months earlier, demonstrated an abnormal uptake within his penis by positron emission tomography/computed tomography. A single elastic nodule of the middle penis shaft was noted deep within Bucks fascia. No other obvious recurrent site was noted except the penile lesion. Total penectomy was performed as a curative resection based on a diagnosis of isolated penile metastasis from rectal cancer. A histopathological examination revealed an increase of well differentiated adenocarcinoma in the corpus spongiosum consistent with his primary rectal tumor. The immunohistochemistry of the tumor cells demonstrated positive staining for cytokeratin 20 and negative staining for cytokeratin 7, which strongly supported a diagnosis of penile metastasis from the rectum. The patient is alive more than two years without any recurrence.