宫颈环形电切术对保留生育功能宫颈上皮内瘤变患者术后宫颈修复和宫颈狭窄及并发症的影响

目的探究宫颈环形电切术(LEEP)对保留生育功能宫颈上皮内瘤变(CIN)患者术后宫颈修复、宫颈狭窄及并发症的影响。方法选取2019年1月至2021年1月吉安市中心人民医院收治的72例CIN患者作为研究对象,采用随机数字表法分为A组与B组,每组36例。A组实施冷刀锥切术(CKC)治疗,B组实施LEEP治疗。比较两组手术相关指标、宫颈愈合情况、宫颈狭窄情况及并发症发生率、复发率、残留率。结果B组手术时间短于A组,术中出血量少于A组,锥切组织面积小于A组,锥高低于A组,差异有统计学意义(P<0.05)。两组浅度锥切后宫颈完全愈合率比较差异无统计学意义;B组深度锥切后宫颈完全愈合率高于A组,差异有统计学意义(P<0.05)。两组浅度锥切宫颈狭窄发生率比较差异无统计学意义;B组深度锥切宫颈狭窄发生率、宫颈狭窄总发生率均低于A组,差异有统计学意义(P<0.05)。B组并发症发生率低于A组,差异有统计学意义(P<0.05);两组复发率、残留率比较差异无统计学意义。结论LEEP治疗保留生育功能CIN患者,可提升其宫颈愈合率,降低宫颈狭窄发生率。

绝经后妇女的CO_2激光宫颈锥形切除术:发生宫颈狭窄及不满意随访的危险性

Objective. To assess chances of adequate cyto- colposcopic follow- up after laser conization performed in postmenopausal screening population by the evaluation of postoperative cervical stenosis and unsatisfactory colposcopy rates. Patients and methods. One thousand two hundred eighteen patients were submitted to laser CO2 conization for cervical intraepithelial neoplasia (CIN). Incidence and risk factors for cervical stenosis and unsatisfactory follow- up were retrospectively evaluated comparing fertile with postmenopausal patients. Results. Global incidences of postoperative unsatisfactory colposcopy and cervical stenosis were 46.2% and 7.1% . These rates were higher in postmenopausal patients compared with fertile ones, revealing a statistical correlation between unsatisfactory follow- up and postmenopausal status at the time of conization. Association between CIN relapse and cervical stenosis was significantly higher in postmenopausal group (66.7% vs. 8.6% ; P < 0.05), where two cases of recurrence were detected only after hysterectomy, because of an insurmountable cervical stenosis. Univariate and multivariate analysis revealed HRT use as the only significant factor in influencing postoperative cervical stenosis. Conclusion. Conization is still considered as the standard treatment for CIN at any woman’ s age, when excisional management is indicated, but all postmenopausal patients should be counseled about the possibility of postoperative stenosis that could exclude an adequate follow- up, configuring a failure of the conservative treatment. HRT use is associated with a low risk of stenotic complications; therefore, if possible, users should be encouraged to continue therapy at least 1 year after laser conization.

超声引导经阴道内膜活检:一项针对宫颈狭窄患者的实用技术

BACKGROUND: In patients with failed dilatation and curettage due to stenotic cervix, options for endometrial sampling are limited. We propose the ultrasonography-guided transvaginal endometrial biopsy. CASES: Two postmenopausal women presented with bleeding and failed dilatation and curettage due to a stenotic cervix. Under direct transvaginal ultrasound guidance, a 20- gauge needle was inserted through the vaginal vault and anterior uterine wall into the endometrium. The endometrium was aspirated, and specimen was submitted to cytology. One patient had endometrial adenocarcinoma and underwent a staging procedure. The other patient had a benign cytology and was followed up clinically. CONCLUSION: The ultrasonography-guided endometrial biopsy is a viable option for endometrial sampling in the presence of stenotic cervix.

宫颈狭窄及宫腔高位患者子宫输卵管造影成功体会

目的：探讨宫颈狭窄及宫腔高位患者子宫输卵管造影临床应用及子宫输卵管造影在治疗不孕症的应用价值。方法：研究分析已婚不孕妇女行子宫输卵管造影,采用76%泛影葡胺20ml或碘海醇50ml,GE800ma,数字化胃肠机进行透视观察、摄片,选取我院近20年来已婚育龄妇女不孕症患者,月经干净3-7天,做子宫输卵管造影时,放置子宫造影气囊导管总结体会。结果：放置情况所选500例置管较难患者,353例能基本顺利置入导管,137例因宫颈狭长及宫颈手术后,仅10例患者未能成功。结论：正确判断输卵管功能是治疗输卵管性不孕的关键,子宫输卵管造影是诊断输卵管通畅性的准确率为90%-93%,并能了解子宫输卵管的内部情况,以及盆腔疾病的部分信息。而X线子宫输卵管造影是操作简便,易于掌握,无需麻醉,无需住院,费用低廉,是判断不孕症的安全、有效、简便、经济实用的检查方法。

母犬宫颈狭窄引起子宫蓄脓病一例

生殖器官先天性发育异常主要包括:幼稚病、两性畸形、子宫颈缺陷或闭锁、阴道或阴门过于狭窄或闭锁等。有关母犬性器官发育异常的报道较少,我们在临床上收治一例京巴犬宫颈狭窄引起子宫蓄脓症的病例,现报告如下:1、主述情况该犬为一较富有的犬主所养宠物,年龄8岁,由于犬主宠爱。

垂体后叶素和苏肤凝胶预防宫颈环形电切术后宫颈狭窄的临床效果观察

子宫颈环形电切术（Loop electrosurgical excision procedure,LEEP）在宫颈上皮内瘤变的治疗效果上已经得到广泛的认可,是一种有效的治疗方法,近年来广泛应用于临床[1]。随此方法的广泛应用,出现了相应的并发症,常见的包括围手术出血、感染、宫颈管狭窄、黏连和宫颈机能不全等。

用二氧化碳激光治疗宫颈狭窄

破坏性疤痕会引起子宫颈内管狭窄,表现为宫颈外口针尖大小和鳞、柱状上皮连接的上移。这种情况通常由损伤、外科、热或冷烙术引起,常使宫颈切除产生并发症。据报导产生这种并发症的危险占1.3%～17.0%。为明确起见,当宫颈内管开口≤2mm直径时,则称为宫颈狭窄。宫颈狭窄并不常有宫颈粘膜减少和不育症发生,但常伴有痛经、子宫积血、子宫积脓和(或)子宫内膜炎。在宫颈狭窄合并妊娠的情况下,生产时宫颈不能扩张。

宫颈环形电切术不同宫颈切除深度对宫颈上皮内瘤变患者宫颈机能及生存质量的影响

目的评价宫颈环形电切术(LEEP)不同宫颈切除深度对宫颈上皮内瘤变患者宫颈机能及生存质量的影响。方法将408例行LEEP的宫颈上皮内瘤变(CIN)患者随机分为观察组和对照组各204例,两组术中宫颈切除深度分别为15~20 mm和21~25 mm。比较两组近期疗效及随访结果。结果观察组术中出血量、手术时间、CIN级别变化、治愈率、术后出血、术后感染情况与对照组比较均无统计学差异(P均>0.05)。术后3个月,观察组宫颈修复情况均明显优于对照组,宫颈狭窄程度亦较对照组减轻(P均<0.05)。术后1年,观察组宫颈裂伤、宫颈机能不全的发生率明显低于对照组(P均<0.05)。术后观察组生存质量各项评分皆高于对照组(P<0.05或<0.01)。结论 LEEP术中宫颈切除深度对女性术后宫颈修复及宫颈狭窄、宫颈裂伤、宫颈机能不全的发生影响较大。

宫颈环形电切术并发症及对分娩期宫颈机能的影响

目的探讨宫颈环形电切(LEEP)术对分娩期宫颈机能的影响。方法将204例女性分为观察组和对照组,观察组LEEP术中宫颈切除深度为10~20mm,对照组LEEP术中宫颈切除深度为21~25mm,比较两组术后的随访结果。结果观察组术后出血量、手术时间、术后出血情况、术后感染皆与时照组无显著性差异(P>0.05)。术后1月、2月时,观察组宫颈修复情况优于对照组(x^2值分别为0.542、10.264,均P<0.05)。观察组术后宫颈狭窄情况轻于对照组(x^2=15.711,P<0.01)。术后1年分娩时,观察组宫颈裂伤、宫颈机能不全发生率低于对照组(x^2值分别为6.423、6.655,均P<0.05)。结论 LEEP术中宫颈切除深度对女性术后宫颈修复、宫颈狭窄的发病率、分娩时宫颈裂伤、宫颈机能不全的发生率影响较大,而20mm以下的切除深度对女性术后宫颈生理及机能的影响较小。

宫颈电圈环切术中颈管黏膜环切预防宫颈柱状上皮外移效果分析

目的探讨宫颈电圈环切除术（LEEP）在治疗上皮内瘤样病变（CIN）时颈管黏膜环切对预防术后宫颈柱状上皮外移的作用。方法 156例CIN患者在行LEEP术前采用抽签方法分为两组,其中对照组78例选择Fisher电极行LEEP锥切;试验组78例在用Fisher电极切除宫颈病变后,再用小环形电极伸入颈管切除颈管黏膜0.5-0.8 cm。术后1、2、3及4周随访阴道流血、分泌物及创面恢复情况,术后3个月随访宫颈柱状上皮外移的发生率及宫颈粘连狭窄的发生率。比较两组手术时间、术中出血量、术后出血时间、术后宫颈柱状上皮外移的发生率及宫颈粘连狭窄的发生率。结果试验组术后4周及术后3个月宫颈柱状上皮外移的发生率分别为6.41%、2.56%,低于对照组24.36%、17.95%,差异有统计学意义（P〈0.05）;两组手术时间、术中出血量、术后出血时间和术后宫颈粘连狭窄发生率的差异均无统计学意义（P〉0.05）。结论 LEEP锥切术中颈管黏膜环切可有效预防术后宫颈柱状上皮外移的发生。

宫颈环形电切术对宫颈上皮内瘤变患者宫颈功能的影响评价

目的：探讨宫颈环形电切术（LEEp）对宫颈功能的影响。方法：将204例女性分为观察组和对照组。观察组102例，LEEp 术中宫颈切除深度为15-20 mm；对照组102例，LEEp 术中宫颈切除深度为21-25 mm。比较两组疗效及随访结果。结果：观察组术中出血量、宫颈上皮内瘤变（CIN）级别变化、治愈率与对照组比较，差异无统计学意义（P 〉0.05）。术后1，3个月时，观察组宫颈修复情况明显优于对照组，两组比较差异有统计学意义（ P 〈0.05）。观察组术后宫颈狭窄情况明显轻于对照组，两组比较差异有统计学意义（P 〈0.05）。术后1年时，观察组宫颈裂伤、宫颈功能不全情况明显好于对照组，差异有统计学意义（P 〈0.05）。结论：LEEp 术中宫颈切除深度对女性术后宫颈修复、宫颈狭窄的发病率、宫颈裂伤及宫颈功能不全的发生率影响较大。

子宫颈根治切除术后放置Malecot导管有助于胚胎移植

Objective: To describe the use of a Malecot catheter as a stent after radical trachelectomy (RT). Design: Case report. Setting: Assisted conception unit at a teaching hospital in the United Kingdom. Patient(s): A 36-year-old woman undergoing IVF after her cervix had been excised for cervical carcinoma. Previous attempts at embryo transfer (ET) had been very traumatic and required a transmyometrial transfer on one occasion. Intervention(s): A Malecot catheter was inserted into the uterine cavity after a dilatation procedure had been performed and removed before ovarian stimulation. Main Outcome Measure(s): Ease of ET. Result(s): The subsequent ET was much more straightforward. Conclusion(s): This technique can facilitate ET after RT if the passage is found to be stenosed.

治糜灵栓治疗宫颈糜烂90例疗效分析

宫颈糜烂是育龄妇女的常见病，多发病，严重困扰着妇女同志的身心健康。多年来，临床研究证明宫颈糜烂与宫颈癌的发病有密切联系。治疗宫颈糜烂的方法很多，包括物理疗法和药物疗法。物理治疗方法有激光疗、微波、Leep刀等，各种治疗方法大同小异，均有术后出血、宫颈管狭窄、不孕、感染等不良反应。我院自2008门诊应用通化金马药业集团股份有限公司生产的治糜灵栓治疗宫颈糜烂取得了良好的临床疗效，现总结如下：

200例宫颈上皮内瘤变临床诊治和疗效观察

目的：对比评价单纯宫颈环、锥形电切术（LEEP）治疗与宫颈环、锥形电切术（LEEP）术后伍用聚甲酚磺醛栓治疗宫颈病变疗效及术后并发症的发生.方法：回顾性对照分析近2年因宫颈病变在我院接受宫颈环、锥形电切术（LEEP）伍用聚甲酚磺醛栓治疗的妇女100例为治疗组,选同期单纯用宫颈环、锥形电切术（LEEP）术治疗的妇女100例为对照组,观察两组病人的术后创面愈合情况、脱痂期出血持续时间、宫颈内膜增生、宫颈管狭窄粘连的发生比率.结果：与对照组相比,治疗组的创面愈合时间、脱痂期出血持续时间明显缩短,宫颈内膜增生的发声明显减少,无宫颈管狭窄粘连的发生,差异有统计学意义.结论：对宫颈病变的治疗采用宫颈环、锥形电切术（LEEP）手术伍用聚甲酚磺醛栓可以减少手术并发症,减少术后脱痂期出血,加速手术创面愈合,值得临床推广.