Sex Sent Me to the ER: Case Series on Postcoital Laceration

Background: Sexual intercourse may be associated with serious complications and morbidities which may not be commonly experienced in clinical practice. One such complication is severe vaginal bleeding. Aim: To report a case series of postcoital vaginal lacerations in three women of various age groups with no prior surgical history who complained of acute onset, severe vaginal pain and bleeding after consensual intercourse. Case presentation: This case series describes the clinical features and management of women who required an examination under anaesthesia and surgical repair of vaginal injuries following consensual intercourse. The Post-operative recovery period was uneventful. Conclusion: A postcoital laceration is a rare emergency that may be complicated by excessive blood loss, which is increased if there is a delay in seeking care and or diagnosis. Prompt treatment should be instituted in such cases to minimise complications.

Old canalicular laceration repair:a retrospective study of the curative effects and prognostic factors

AIM： To investigate the epidemiology and surgical outcomes of old canalicular laceration and analyze the variables impacting on the prognosis of reparation. METHODS： A retrospective review of all old canalicular laceration repairs from Jan. 1, 2008 to Dec. 30, 2015 was performed. Analyzed data included demographics, mechanisms of injury, the time from injury to repair, causes for delayed repair, old associated injuries, the types of surgery, and the effects of repair using canaliculus anastomosis combined with bicanalicular stent intubation. RESULTS： Totally 148 patients with old canalicular laceration received surgical repair and were enrolled. The mean age at presentation was 32.52 years old （ranged from 3 to 63 years old）. The 110 patients （74.32%） were male and 127 patients （85.81%） were adults （__.18 years old）. The old upper, lower, and bicanalicular lacerations were found in 5 （3.38%）, 39 （26.35%）, and 104 patients （70.27%）, respectively. The mechanism of old injury was primarily due to motor vehicle accidents （n=53, 35.81%）. The mean time from injury to repair was 43.61mo （ranged from 1 to 360mo）. Associated old ocular and orbit injuries were found in 65 patients （43.92%）, and chronic dacryocystitis in 18 patients （12.16%）. The main cause of delayed repair was that doctors or patients didn＇t pay attention to the canalicular laceration because of the concurrent severe injuries （n=71, 47.97%）. Totally 136 patients （91.89%） with old canalicular laceration underwent canaliculus anastomosis combined with bicanalicular stent intubation. In all of them, 20 patients （13.51%） were combined with dacryocystorhinostomy. In these cases, 132 patients （97.06%） attained anatomic success, 121 patients （88.97%）reported no epiphora （functional success）, 11 patients （8.09%） reported significant epiphora anesis （functional improvement）, and 4 （2.94%） reported no significant anesis （functional failure）. Rates of anatomic success and functional success were significantly correlated with different canaliculus involved. However, rates of anatomic success and functional success were not significantly affected by the time from injury to repair. CONCLUSION： The canalicular anastomosis combined with bicanalicular stent intubation could act as an effective therapeutics for old canalicular laceration.

One-stitch anastomosis through the skin with bicanalicular intubation:a modified approach for repair of bicanalicular laceration

AIM:To evaluate the efficacy and safety of one-stitch anastomosis through the skin with bicanalicular silicone tube intubation in repairing of bicanalicular laceration.METHODS:The clinical data of 15 consecutive patients with both superior and inferior canalicular laceration in one eye who underwent surgical repair using one-stitch anastomosis through the skin and bicanalicular stent were retrospective studied.All the operations were performed under surgical microscope,5-0 silk sutures were used and were with bicanalicular silicone tube(diameter was 8mm) intubation,for one lacerated canaliculi one-stitch anastomosis through the skin.The stents were left in place for 3 months postoperatively and then removed.The follow-up period was 3-36 months(average 14 months). RESULTS:In 15 patients,13 patients were cured entirely,1 patient was meliorated,1 patient with no effects.All patients had got good recovery of eyelid laceration with no traumatic deformity in eyelid and canthus.Complication was seen in one case,for not followed the doctor’s guidance to come back to hospital to had the suture removed on the 7thday after operation,when he came at the 15thday,the inferior canalicular wall and eyelid skin were corroded by the suture caused 2mm wound,and the inside silicone tube was exposed,a promptly repair with 10-0 nylon suture was done,the wound healed in a week.There were no early tube protrusions and punctal slits in the patients.CONCLUSION:One-stitch anastomosis through the skin with bicanalicular silicone tube intubation is a good method in repair of bicanalicular laceration in one eye,the cut ends can be anastomosed directly,and with excellent cosmetic results,it is acceptable for the patients.For there is no suture remained in the wound permanently,so there is no suture-related granuloma which may cause obstruction or stenosis of canaliculi.It is simple,economical,effective and safe.

Blunt abdominal injury with rupture of giant hepatic cavernous hemangioma and laceration of the spleen

A 41-year-old woman with blunt abdominal trauma due to a motor vehicle accident presented to our emergency department. The patient had a history of a giant hepatic cavernous hemangioma. Emergency exploratory laparotomy was performed for suspected intra-abdominal bleeding with abdominal compartment syndrome, and more than 4 liters of blood and blood clots were removed. An active bleeding laceration （5 cm） of a hepatic cavernous hemangioma was detected in segment III of the liver. The bleeding was controlled by sutures, Teflon patches and tamponade. The abdomen was closed temporarily using the vacuum-assisted method. Because of the presence of persistent fresh blood through abdominal drainage at a rate of 〉1 L/h, splenectomy was performed to control the bleeding again by sutures and Teflon patches. Finally, the abdomen was closed using a biologic mesh. The patient was discharged home 30 days after trauma. Bleeding of trauma-caused hepatic hemangioma is rare, but splenic injury due to blunt abdominal trauma is common. An in-depth investigation is necessary to avoid second intervention.

The risk of wound infection after simple hand laceration

BACKGROUND: This prospective observational study aimed to determine the infection rate of simple hand laceration(SHL), and to compare infection rates between patients who were prescribed antibiotics and those who were not.METHODS: The study was performed at two urban hospitals enrolling 125 emergency department(ED) patients with SHL. Exclusion criteria included patients with lacerations for more than 12 hours, immunocompromized patients, patients given antibiotics, and patients with gross contamination, bites or crush injuries. Wound infection was defined as clinical infection at a follow-up visit(10–14 days) or wound was treated with antibiotics. Patient satisfaction was also measured using a visual analogue scale 1–10, asking the patients about wound appearance. Demographic data and wound characteristics were compared between the infected and non-infected wounds. The infection rates were also compared between patients who received prophylactic antibiotics and those who did not. The results were presented with medians and quartiles or percentages with 95% confidence intervals(CI).RESULTS: In the 125 patients with SHL [median age: 28(18, 43); range: 1–102 years old; 36% female], 44(35%, 95% CI: 27%–44%) were given antibiotics in the ED. Wound infection was reported in 6 patients(4.8%, 95% CI: 2%–10%). Age, gender, history of diabetes and wound closure were not associated with wound infection(P>0.05). The infection rate was not significantly different between patients with or without antibiotic prophylaxis [7%(3/44), 95% CI: 2%–10% vs. 4%(3/81), 95% CI: 1%–11%, P=0.66]. Patient's satisfaction with appearance ofinfected and non-infected wounds were significantly different [7.5(6, 8) vs. 9(8, 10), P=0.01].CONCLUSION: Approximately 5% of simple hand lacerations become infected. Age, gender, diabetes, prophylactic antibiotics and closure technique do not affect the risk ofinfection.

Endoscopic variceal ligation caused massive bleeding due to laceration of an esophageal varicose vein with tissue glue emboli

Endoscopic variceal obturation of gastric varices with tissue glue is considered the first choice for management of gastric varices, and is usually safe and effective. However, there is still a low incidence of complications and some are even fatal. Here, we present a case in which endoscopic variceal ligation caused laceration of the esophageal varicose vein with tissue glue emboli and massive bleeding after 3 mo. Cessation of bleeding was achieved via variceal sclerotherapy using a cap-fitted gastroscope. Methods of recognizing an esophageal varicose vein with tissue glue plug are discussed.

Effect of perineal massage on the incidence of episiotomy and perineal laceration

Background: Perineal traumas particularly caused by following vaginal delivery are associated with short and long term morbidity for women. Therefore, interventions that increase the probability of intact perineum are necessary. The aim of study was to determine the effect of perineal massage with a sterile lubricant on the incidence of episiotomy and perinea laceration. Materials: This clinical trial study was performed on 145 nulliparous women who referred to Amol Emam Ali teaching center for normal delivery. They were randomly participating in interventional group (massage with lubricant) (45 cases) or control group (100 cases). In massage group when they progressed to full dilatation of the cervix, the midwife inserted two fingers inside vagina and using a sweeping motion gently stretched the perineum with lubricant 5 up to 10 minutes, in and between mother’s pushing in the second stage of labour. In control group just Ritgen Maneuver was applied. At last, we compared the rate of intact perineum, episiotomy and laceration, mean duration of the second stage of labor and Apgar score in 1 and 5 minutes between two groups. Statistical analyses were performed using t-test, Chi Square to determine potentially significant associations, and a p value less than 0.05 was considered significant. Results: The incidences of intact perineum, episiotomy and laceration were 22.2% (10), 44.4% (20), 33.3% (15) respectively in interventional group. In control group, intact perineum, episiotomy and laceration were: 20.2% (20), 49.3% (71), 28.3% (28) respectively. This difference was not statis- tically significant. Rate of first-degree laceration was 33.3% (15) in massage group, while this percent was 28.3% (28) in control group. This difference was not statistically significant. In massage and control groups, second, third and fourth-degree lacerations did not occur. Conclusion: The results showed that massage with a sterile lubricant provides no apparent and significant advantage or disadvantage in reducing perineal trauma. Therefore, the use of massage as technique for perineal control is safe based on labour criteria and woman’s preference during delivery.

Unexplained liver laceration after metastasis radiofrequency ablation

Many studies have established the role of radiofrequency (RF) ablation as a minimally invasive treatment for liver metastases. Although relatively safe, several complications have been reported with the increased use of RF ablation. We describe here a case of unexplained liver laceration after a RF procedure. A woman who presented a solitary metachronous liver metastasis underwent RF ablation treatment for this lesion. Six hours later the patient displayed fatigue and pallor. Emergency blood tests showed a haemoglobin level of < 7 g/dL and markedly elevated transaminase levels. A computed tomography examination revealed two areas of liver laceration with haematoma, one of them following the path of the needle and the other leading away from the f irst. Following a blood transfusion, the patient was haemodynamically stable and completely recovered 24 h later. The patient remained in bed for 1 wk. No surgical intervention was required, and she was discharged 1 wk later.

Comparing lignocaine-adrenaline-tetracaine gel with lignocaine infiltration for anesthesia during repair of lacerations:A randomized trial

BACKGROUND:This study aimed to compare the topical anesthetic lignocaine,adrenaline,and tetracaine(LAT)(4%lignocaine,1:2 000 adrenaline,1%tetracaine) with the conventional lignocaine infiltration(LI) for repair of minor lacerations,for the comfort of anesthetic administration,efficacy,adverse effects and cost.METHODS:This was a prospective randomized clinical trial.Forty Asian patients who required toilet and suture for minor lacerations in the emergency department of the Singapore General Hospital over a 4-month period.The patients were assigned randomly to 2 arms of treatment.The first was the LAT gel group who had LAT gel applied to the laceration prior to suturing.The second was the control group in whom the anesthetic administered was lignocaine infiltration(LI) via a syringe.The pain of the process of administering anesthetic and efficacy of anesthesia were scored using the visual pain scale included within.The efficacy of LAT vs.lignocaine infiltration as an anesthetic prior to the toilet and suture of minor lacerations and complications of therapy.RESULTS:Twenty patients were randomized to LAT gel and 16 to LI on an intention to treat analysis.The mean pain score by patients in the LAT gel group was 2.5(0.52 SE),and 2.5(0.58 SE)in the LI group.The pain score for pain during application of the anesthetic was 1.5(0.40) in the LAT gel group,and 3.5(0.46) in the LI group.There was no difference in complications between the LAT and LI groups.CONCLUSION:LAT gel prior to the toilet and suture of minor lacerations is proven to be as efficacious as LI in terms of patient comfort and effectiveness of anesthesia.The complications are also comparable to those treated with LI.

Delayed Lumbar Artery Laceration and Symptomatic Retroperitoneal Hemorrhage Following IVC Filter Placement

Inferior vena cava filters are placed in selected patients to protect against potentially fatal pulmonary embolism. Generally, filter placement is regarded as a safe procedure although rare complications may arise. Recurrent thromboembolic events are the most common complications assoiated with inferior vena cava filters;however, there are multiple reports of filter fracture, migration, embolization, penetration and perforation. The aim of this report is to illustrate a serious potential complication of inferior vena cava filters. We report a rare case of symptomatic retroperitoneal hemorrhage occurring 3 weeks after filter placement treated successfully with selective arterial embolization of a lumbar artery laceration. This case serves to highlight the importance of retrieving filters when they are no longer beneficial.

Risk factors for persistent epiphora following successful canalicular laceration repair

AIM:To identify the risk factors of epiphora in patients with anatomical patency after surgical repair of canalicular laceration.METHODS:This retrospective case series included 178 cases of canalicular laceration repair from 2005 to 2012.Demographic data collected from each patient included age,sex,type of injury,distance from the distal lacerated end of the canaliculus to the punctum,the severity score for the structural abnormity of the medial canthus,the duration of stent placement,and the timing of surgery.The risk factors for epiphora were evaluated using Logistic regression models.RESULTS:Among the 178 cases,45(25.3%)with lacrimal patency after irrigation had symptomatic epiphora at the final follow-up.Patients'sex,age,type of injury,duration of stent placement,timing of surgery,and concurrent trauma were not found to be significantly associated with symptomatic epiphora after surgical repair of the lacerated canaliculus(P>0.05).A distance of more than 5 mm from the distal cut end to the punctum was closely and significantly associated with symptomatic epiphora after surgical repair of the lacerated canaliculus(P<0.01).Symptomatic epiphora was significantly more frequent in patients with higher severity scores for structural abnormities of the medial canthus(P<0.01).CONCLUSION:Our results indicate that the risk factors for postoperative symptomatic epiphora include a further distance between the distal cut end and the lacrimal punctum and a higher severity score for structural abnormities of the medial canthus.These findings could be used to prognosticate postoperative symptomatic epiphora.

Use of Silicone Tubes to Repair Canalicular Lacerations via a Novel Method

Purpose:To develop a novel method to repair canalicular lacerations using silicone tubes.Methods:A total of 47 adult patients(47 eyes)with canalicular lacerations were collected from the outpatient department from November 2010 to December 2012.The age ranged from16 to 53 years.Among the 47 eyes,37 had lower canalicular lacerations,6 had upper canalicular lacerations,and 4 had bicanalicular lacerations..A soft probe was made using a stainless steel acupuncture needle,which was inserted into the lumen of the proximal part of the catheter to increase its rigidity.The probe was then inserted into the lacrimal sac and nasolacrimal duct.After retrieval of the catheters,the two ends of the silicone tube were securely tied.(end to end).to the catheters..The silicon tube outside the nostril formed a Ushape.The catheters were then pulled upward until the silicone tube was completely located in the canalicular system.The catheters were cut off of the silicone tube near the site of the connection.The two ends of the silicone tube were cut short,~2mm out of the lacrimal punctum,and tied securely,end to end.The length of the tube between the upper and lower punctum was adjusted to ensure that no tension was present in the medial cathus,and the suture was removed through the nostril.The silicone tube was removed 3-10 months after this novel canalicular intubation procedure (NCI).Results:.All cases were anatomically rehabilitated after surgery..The silicone tube was removed after implanted in 3-10months (mean 4.5±1.3 months),the average follow-up time was 11.8 months after removal.In total,45 eyes in all 47eyes (95.74%)were free from obstruction.Among them,41eyes (91.11%) achieved complete success(completely disap-pearance of epiphora after tube removal),.4 eyes.(8.89%)achieved partial success.(irritation occurs under stimulation conditions,such as wind or cold conditions),4 eyes showed postoperative tearing,with three eyes having inferior lacrimal duct laceration,and one eye with superior canalicular laceration.Apart from two cases (4.26%) suffering inferior punctum splitting,no other associated issues occurred with the silicone tube or iatrogenic injury and lacrimal complications.Conclusion:For adult patients with canalicular laceration,the NCI was an effective,atraumatic surgery,which has fewer complications than traditional canalicular suture.

Unilateral Bone Window Cerebral Falx Incision of Bilateral Frontal Lobes Cerebral Contusion and Laceration under Neuroendoscopy and Literature Review

Background: Bilateral frontal lobes cerebral contusion and laceration is one unique brain injury in neurosurgery department. It is characteristic of recessive attacking and develops quickly. The unilateral cerebral falx incision is a new minimally invasive surgery that can solve bilateral frontal lobes cerebral contusion and laceration in one surgery. However, it has some limitations in removal of contralateral frontal hematoma and hemostasis due to the limited field of view under the microscope. The unilateral bone window cerebral falx incision of bilateral frontal lobes cerebral contusion and laceration under a neuroendoscopy can acquire a good illumination and field of view. This is beneficial to complete removal of contralateral hematoma, effective hemostasis and retaining brain tissue functions to the maximum extent. Case Presentation: The patient, a 55-year-old man, was hospitalized for “consciousness disorder by 12 h because of car accident”. Physical Examination: Coma, GCS score of E1V2M5, bilateral pupil diameter of 2 mm, presence of light response, contusion of scalp at the left top, peripheral dysphoria and bilateral Bartter syndrome negative. The patient has a history of non-traumatic cerebral stroke 3 years ago. Head CT: Longitudinal fracture of frontal parietal occipital bone, bilateral frontal lobes contusion and laceration, subarachnoid hemorrhage. Diagnosis: Bilateral frontal lobes contusion and laceration, longitudinal fracture of frontal parietal occipital bone, subarachnoid hemorrhage and hematoma of scalp. In emergency treatment, unilateral bone window cerebral falx incision of bilateral frontal lobes cerebral contusion and laceration under a neuroendoscopy was performed. The surgery has achieved satisfying effect. Discussion: This case realized the goal of removing contralateral frontal hematoma through unilateral craniotomy under a neuroendoscopy. Due to the clear field of view, it retained extracerebral layer structures of contralateral olfactory nerve protection frontotemporal completely. Moreover, this surgical technique is conducive to intraoperative recognition of pericallosal arteries and lateral fractured blood vessels. It also involves protection, which conforms to the minimally invasive philosophy. The proposed surgical technology can eliminate contralateral frontal hematoma under a good field of view. However, it is suggested not to manage with the further operation on patients who have brain swelling and difficulties in exposure of cerebral falx. These patients need to determine causes of brain swelling and choose bilateral craniectomy if necessary. Conclusions: Unilateral bone window cerebral falx incision of bilateral frontal lobes cerebral contusion and laceration under a neuroendoscopy is a new application of minimally invasive philosophy in craniocerebral injury operation. It still needs further clinical verifications and experience accumulation.

Detecting accidental punctures and lacerations during cholecystectomy in large datasets: Two methods of analysis

Background: After the Institute of Medicine(IOM) report To Err Is Human highlighted the impact of medical errors, the Agency for Healthcare Research and Quality(AHRQ) developed Patient-Safety Indicators(PSI) to improve quality by identifying potential inpatient safety problems. PSI-15 was created to study accidental punctures and lacerations(APL), but PSI-15 may underestimate APLs in populations of patients. This study compares PSI-15 with a more inclusive approach using a novel composite of secondary diagnostic and procedural codes. Methods: We used Nationwide Inpatient Sample(NIS) data(20 0 0–2012) from AHRQ’s Healthcare Cost and Utilization Project(H-CUP). We analyzed PSI-15-positive and-negative cholecystectomies. Cross tabulations identified codes that were significantly more frequent among PSI-15-positive cases; these secondary diagnostic and procedural codes were selected as candidate members of a composite marker(CM) of APL. We chose cholecystectomy patients for study because this is one of the most common general operations, and the large size of NIS allows for meaningful analysis of infrequent occurrences such as APL rates. Results: CM identified 1.13 times more APLs than did PSI-15. Patients with CM-detected APLs were significantly older and had worse mortality, comorbidities, lengths of stay, and charges than those detected with PSI-15. Further comparison of these two approaches revealed that time-series analysis for both APL markers revealed parallel trends, with inflections in 2007, and lowest APL rates in July. Conclusions: Although CM may yield more false positives, it appears more inclusive, identifying more clinically significant APLs, than PSI-15. Both measures presented similar trends over time, arguing against inflation in PSI-15 reporting. While arguably less specific, CM may increase sensitivity for detecting APL events during cholecystectomies. These results may inform the interpretation of other large population studies of APLs following abdominal operations.

Impact of Selective vs Routine Midline Episiotomy and Lacerations of the Anal Sphincter

Introduction: Obstetric anal sphincter tear (OAST) is associated with anal incontinence. Episiotomy was proposed as a form of protection of the anal sphincter at delivery;however, several studies have shown that routine use of episiotomy does not reduce the risk of OAST. Objective: This study aims to analyse whether the reduction in the rate of episiotomy in a school hospital in Brazil was associated with an increase in the incidence of obstetric lacerations of the anal sphincter, in addition to associated factors. Methods: Observational, cross-sectional and retrospective study. We included all vaginal deliveries of single pregnancies, cephalic presentation, from 34 weeks of gestational age, performed in 2011-2012 (liberal episiotomy) and 2015-2016 (restricted episiotomy), and compared in relation to the rate of mediolateral episiotomy and OAST. Results: 4268 births were analysed (2043 in 2011-2012 and 2225 in 2015-2016). The episiotomy rate decreased from 59.4% to 44.2% (p ≤ 0.0001). In 2011-2012, there were 10 obstetric anal sphincter lacerations in 2043 births (0.48%), while in the period 2015-2016 there were 31 lacerations in 2225 births (1.39%). There was interaction when comparing the two periods in relation to the episiotomy and the occurrence of OAST (p ≤ 0.0001). Factors associated with OAST were labor induction and shoulder dystocia. Conclusion: There was an increase in the rate of lacerations of the anal sphincter with use of restrictive episiotomy. However, this increase occurred both in deliveries with and in deliveries without episiotomy.

Emergency department management of an occult renal laceration following a minor fall

We present a case of a pediatric patient with high grade renal injury following a minor fall,where clinical suspicion of occult injury resulted in diagnosis.Additionally,we review the management of high grade renal lacerations in children,including the role of ultrasound in managing these injuries.

改良垂直褥式缝合技术在急诊儿童面部裂伤中的应用研究

目的探究改良垂直褥式缝合技术在急诊儿童面部裂伤中的应用价值。方法选取2021年1月至2022年1月宜宾市第二人民医院收治的108例面部裂伤患儿作为研究对象,按照随机抽样法分为观察组与对照组,每组54例。观察组采用改良垂直褥式缝合术,对照组采用面部美容缝合术。比较两组围手术期相关指标、术后切口愈合情况、术后温哥华瘢痕量表(VSS)评分和患儿家长满意度。结果观察组缝合时间、愈合时间均短于对照组,差异有统计学意义(P<0.05)。术后3个月,两组术后切口愈合情况均优于术后1周,差异有统计学意义(P<0.05);术后1周、3个月,观察组术后切口愈合情况均优于对照组,差异有统计学意义(P<0.05)。术后3、6个月,两组VSS评分均低于前一时间点,且观察组低于对照组,差异有统计学意义(P<0.05)。观察组患儿家长满意度高于对照组,差异有统计学意义(P<0.05)。结论改良垂直褥式缝合技术用于急诊儿童面部裂伤可促进伤口愈合,短期愈合良好,远期瘢痕较小,有利于提高患儿家长的满意度,值得临床推广应用。

会阴裂伤修补术并盆底康复治疗陈旧性会阴撕裂效果

目的探究会阴裂伤修补术并盆底康复对Ⅲ/Ⅳ度会阴撕裂病人的临床疗效。方法选取2020年8月—2022年2月宁夏回族自治区人民医院收治的Ⅲ/Ⅳ度会阴撕裂病人106例,随机分为联合治疗组和单纯手术组,每组53例。单纯手术组仅接受会阴裂伤修补术,联合治疗组于会阴裂伤修补术后行盆底康复治疗。比较两组临床疗效、肛门功能、盆底肌损伤指标和生活质量。结果联合治疗组总有效率为92.45%,明显高于单纯手术组的81.13%,差异有显著性(Z=1.995,P<0.05)。两组病人治疗后Ⅰ类肌纤维活动持续时间、Ⅱ类肌纤维收缩次数以及盆底肌疲劳程度均显著改善(t=4.218~7.818,P<0.05),但联合治疗组的改善程度显著高于对照组(t=4.876~5.870,P<0.05)。联合治疗组的术后生活质量量表评分和肛门功能良好率均显著高于单纯手术组(t=14.552~21.348,Z=2.003,P<0.05)。结论会阴裂伤修补术并盆底康复治疗陈旧性Ⅲ/Ⅳ度会阴撕裂病人有较好疗效,能改善病人的盆底肌和肛门功能,提高病人生活质量。

149例疑似巨大儿经阴道分娩产妇会阴侧切的影响因素分析

目的:探讨疑似巨大儿产妇经阴道分娩伴会阴侧切的影响因素。方法:回顾性分析2022年1—7月于南京医科大学第一附属医院产科分娩的149例疑似巨大儿产妇的临床资料,根据是否行会阴侧切,将产妇分为会阴侧切组和自然裂伤组。分析疑似巨大儿产妇经阴道分娩的危险因素。结果:149例疑似巨大儿产妇中,40例(26.85%)行会阴侧切分娩,109例(73.15%)阴道分娩伴自然裂伤,其中93例为Ⅰ度裂伤,16例为Ⅱ度裂伤。会阴侧切组中初产妇、助产士工作年限<5年占比高于裂伤组(P<0.001,P=0.021);会阴侧切组中第2产程<47 min的比例显著高于会阴裂伤组(87.5%vs.39.4%,P<0.001)。此外,自然裂伤组羊水性质(清+Ⅰ度)比例显著高于会阴侧切组(87.2%vs.72.5%,P=0.034),而会阴侧切组产后出血率显著低于自然裂伤组(P=0.010)。初产妇、助产士工作年限<5年是疑似巨大儿产妇会阴侧切的独立危险因素(OR=2.708,P=0.021)。结论:初产妇、助产士工作年限<5年时,产妇疑似巨大儿经阴道分娩伴会阴侧切的发生率增高;同时,侧切组产后出血率显著降低。

脑挫裂伤患者预后影响因素的研究进展

脑挫裂伤是由直接暴力所致的一种常见的颅脑损伤类型,大多由交通事故、自然灾害、高空作业等引起,常常造成神经功能恶化、肢体功能障碍、昏迷甚至死亡等不良后果,严重影响患者预后转归。脑挫裂伤患者预后受众多因素影响,包括患者伤者特征与健康相关因素、损伤与伤情相关因素以及伤后救治相关因素等,其中炎症反应、神经元损伤程度、手术时机等备受关注。本文对脑挫裂伤患者预后影响因素进行综述,以期为改进脑挫裂伤患者的临床干预措施、改善患者预后提供参考。