Objective To assess the relationship between increment of nuchalskinfold thickness and chromosomally abnormal fetuses by ultrasonography. Methods Nuchalkinfold thickness(NT) of pregnant women(10~22 weeks) collected by prenatal ultrasonic B in in the People's Hospital Peking University from Feb.2007 to Dec. 2009.Those with increment of NT were suggestted to perform amniocentesis and cordocentesis chromosomal karyotypes analysis and were under followed-up. Results There were totally 78 cases with increment of NT,3 cases were chromosomally abnormal and all of the 3 cases were Down syndrome. The incidence of Down syndrome was 3.85% these were tatally.There were 6 cases with bad pregnant results,incluing 5 cases with abnomal fetuses which included right hydrencephaly and liquorrhea,polycystic kidney,teratic heart,rubella virus infection and hydrosarca. Conclusions Increment of NT measured by ultrasound may play an important guiding role in diagnosising Down syndrome.It is one of the main markers at early and middle stage pregnancy.

Objective To investigate the serum AMH level in domestic healthy reproductive age women, and to discuss the clinical application for AMH . Methods A total of 100 healthy reproductive age women participated in this study. All the subjects were grouped by menstrual cycle and age. Serum AMH concentration were measured by ELISA. Results AMH levels in follicular phase and luteal phase had no statistically differences. The average AMH level was (2.85 ± 1.66) ng / ml in reproductive age women. AMH level was negatively correlated to age(r=-0.667,P<0.001).It was (4.25±1.23)ng/ml in 18 to 25 year-old female, then declined with age increasing, and dropped significantly in 41 to 47 years old with the average level of (1.12±0.98) ng/ml. Conclusions Serum AMH level has no significantly difference in the follicular phase and luteal phase of the menstrual cycle. AMH detection is not limited to the follicular phase. Age is an important factor affecting the level of AMH, the clinical application of AMH should combine with age and need comprehensive judgment.

目的 探讨在临床中开展双侧阴部神经阻滞麻醉配合无保护会阴接生法的效果观察,以达到减轻产妇第二产程会阴部疼痛,缩短第二产程,减少会阴损伤,提高无保护会阴接生率,促进自然分娩的目的。方法 选取北京市昌平区妇幼保健院2012年10月至2013年11月189例产妇为研究对象,分为单纯无保护会阴接生组和双侧阴部神经阻滞麻醉配合无保护会阴接生组,对二程时间、新生儿体重、会阴损伤、会阴侧切、产后出血、新生儿窒息、无保护会阴接生成功率进行分析。结果 观察组无保护分娩成功率显著高于对照组(92.9% vs83.5% ,χ2=4.0026,P <0.05);新生儿体重显著大于对照组体重(t=2.7372,P <0.01);第二产程时间显著短于对照组,统计学均有显著性差异(t=4.1691,P <0.001)。会阴损伤、产后出血、新生儿窒息差异无统计学意义(P >0.05)。结论 第二产程进行双侧阴部神经阻滞麻醉可使阴部组织松弛,缩短第二产程时间,减轻第二产程的会阴部疼痛,提高无保护会阴接生成功率,促进自然分娩。

Objective To discuss the role of age and HR-HPV in evaluation of cervical lesions with negative Liquid-Based Cytology. Methods 906 women with positive HPV DNA and negative cytology results were included. The sampling methods were standardized. All cases underwent colposcopic indicated biopsy and pathological diagnosis. Analysis were based on the final results. Results The average age was (36.69±9.06 )years old. Pathological results showed 3 invasive cancer (2 micro-invasive cancer included), 1 adenocarcinoma, 29 cases of CIN3, 50 of CIN2, 155 of CIN1,2 of VAIN1 and 666 of normal. The odds ratio of ≥CIN3 between 30~49 years and <30 years was 3.4(1.02~11.40) while HR-HPV DNA load between ≥100 and <10 was 12.44 (2.89~53.5). Prevalence rate of ≥CIN3 in low, median, high HR-HPV load group 30~49 age group was 1.0%,4.0%,8.8%(χ² =14.978,P=0.001) while the prevalence rate of ≥CIN2 was 4.3%,7.5% and 19.1%(χ² =27.270,P=0.000)respectively. The average HR-HPV load of non-CIN patients in <30 years group and ≥30 years group were 244.04±547.20 and 149.59±328.39 (P<0.050). Conclusions Increased HR-HPV load are generally associated with an increasing risk of high-grade CIN. Women who are in the high risk age group should be assessed by HR-HPV load and be performed colposcopy to minimize the missed diagnostic cases of high grade lesions.

Objective To analysis the diagnosis, treatment and outcome of malignant tumor in pregnancy, in order to improve the outcome of mother and fetal. Methods Data of 9 pregnant patients with malignant tumor who were treated in Shanghai Jiaotong University No. 6 People's Hospital from 2007 to 2010 were reviewed. The patients include 2 lung cancer, 2 gastric carcinoma, 1 hepatocellular carcinoma,1 Nasopharyngeal carcinoma,1 brain neurogliocytoma,1 breast adenocarcinoma and 1 ovarian cancer. Results Of the 9 patients, only 4 had regular prenatal examination; 2 patients were diagnosed before pregnancy,the other 7 were diagnosed during pregnancy;7 patients were diagnosed by pathology and 2 patients were diagnosed by clinical imageology. 7 patients were in advanced stage, the other 2 were in early stage.Pregnant outcomes included 1 early induced abortion, 2 middle induced abortion, 2 vaginal delievery and 4 cesarean section delievery. As for the fetus outcome, there were 5 preterm infant and 2 term infant;6 newborn infants had good outcome,1 preterm fetal dead in uterus; 5 patients received treatment after delivery, other 4 didn't received any treatment after delivery;6 patients died during the first year's follow-up. Conclusions The deficient of the recognition of malignant tumor, lack of full-scale perinatal monitoring, short of perfect analyses of history, symptoms and sign of malignant disease and the delayed treatment for malignant tumor being considering the adverse effect on fetal were the main causes of the delay diagnosis and treatment of malignant disease in pregnancy. The pregnancy with malignant tumor was associated with poor maternal outcome but no unnormal fetal development was found.

Objective To detect the values of serum tumor markers including CA₁₂₅,CA199,AFP and CEA and to assess their value in the diagnosis of mature cystic teratoma (MCT). Methods Data of 512 patients with cystic teratoma of ovary diagnosed by postoperative pathology who treated in our hospital were analyzed retrospectively. Results 492 cases were tested for serum CA₁₂₅. Among these 492 patients, 44 had elevated CA₁₂₅ levels (>35U/ml). If we excluded the 24 cases who suffered from other diseases which could cause increased CA₁₂₅ levels, the positive rate was 4.27%. 101 patients were tested for serum CA199 and the mean level was 47.10 U/ml. 41 had the CA199 levels above 37 U/ml with the positive rate of 40.59%.149 patiens were detected AFP and no abnormal AFP was found. 93 cases were tested for CEA.Only one was abnormal and the positive rate was 1.08%. The mean diameter of the CA199 positive group ((8.32±3.19)cm) was bigger than that of the negative group ((6.43±3.12)cm,P< 0.05)).But the elevated level of CA199 had no correlation with tumor location, age,and nerve tissue in the tumor. Conclusions CA199 is the only tumor marker which has clinical significance and the highest positive rate for MCT. The diameter of the tumor with positive CA199 may be bigger than those with negative CA199.

宫腔粘连(intrauterineadhesions,IUA)在临床上主要表现为闭经、月经过少、经期下腹痛、不孕等严重影响广大妇女的日常生活。IUA的治疗原则主要为手术分离粘连,术后辅助治疗促进子宫内膜的修复,而IUA术后预防再复发是IUA治疗中的重中之重,目前IUA分离术后再粘连的预防越来越得到学者们的关注。现将IUA的病因、诊治方法、治疗特别是预防IUA分离术后再粘连的方法的最新研究进展做一综述,以期指导临床。

【摘要】 目的 评价高危型人乳头瘤病毒（HR-HPV）感染子宫颈上皮内瘤变(CIN)患者的阴道微生态状况。方法 将2015年2月至2016年8月在天津医科大学总医院宫颈病变中心诊治的241例HR-HPV阳性的CIN患者设为研究组，健康查体HPV阴性且宫颈细胞学无异常168例女性设为对照组，比较两组阴道微生态状况的差异。结果 241例HR-HPV阳性CIN患者中，最常见的HPV型别分别为HPV16（30.1%）、HPV52（19.5%）、HPV58（19.1%）、HPV18（10.0%）和HPV33（9.1%）。其中，细菌性阴道病(BV)、需氧菌性阴道炎(AV)、混合感染、乳杆菌异常和阴道pH值升高检出率分别为20.7%（50/241）、12.4%（30/241）、9.1%(22/241)、34.4%（83/241）和23.2%（56/241），与对照组比较，差异有统计学意义（P＜0.05）。外阴阴道假丝酵母菌病(VVC)和滴虫性阴道炎(TV) 和WBC>10个/HPF检出率分别为10.0%（24/241）、1.7%（4/241）和30.7%（74/241），与对照组比较，差异无统计学意义（P>0.05）。HPV16/18阳性CIN与非HPV16/18阳性组比较，混合感染更常见（P＜0.05）。结论 HR-HPV阳性CIN中，最常见的阴道微生态异常为BV和AV，混合感染、乳杆菌异常及阴道白细胞增多也是重要的阴道微生态失调类型。HPV16/18阳性CIN更易合并混合感染。

【摘要】 目的 了解不同方法治疗非特异性阴道炎治疗的效果。方法 采用随机对照研究方法，在5家医院收集133例非特异性阴道炎病例，随机分为保妇康栓组（1组），臭氧液阴道冲洗组（2组）和硼酸冲洗组（3组）进行治疗，所有病例在完成疗后（3±2）d进行随访评价其治疗效果，随访内容包括症状、体征和阴道微生态改善情况。使用SPSS 22.0版统计进行F检验和χ2检验，P<0.05差异有统计学意义。结果 三种方法临床总有效率达40%以上，其中以2组有效率最高，达59%，其次为1组，有效率为57.8%，最后为3组，有效率为45.7%。但三组间比较，差异无统计学意义（χ2=2.158，P=0.363）。入组病例中经阴道微生态检测发现67例AV患者经治疗后三组间AV评分小于3分的比例分别为2组34.4%，1组为35.0%，3组35.7%，三组比例差异无统计学意义（χ2=0.092，P=1.000）。经阴道微生态检测发现69例乳杆菌异常患者经治疗后，三组间乳杆菌恢复正常的比例分别为2组78.1%，1组为63.2%，3组76.9%，三组比例差异无统计学意义（χ2=1.472，P=0.494）。结论 三种方法治疗非特异性阴道炎的临床疗效没有差异。

目的 探讨平谷地区妊娠特异性甲状腺功能参考范围在评估妊娠期妇女甲状腺功能中的作用。方法 采集2011年6月至2012年12月在北京市平谷区医院正常产检的951例妊娠小于等于20周妇女的血清,应用直接化学发光法测定血清TSH、FT4和TPOAb。分别以平谷地区妊娠特异性和非妊娠人群甲状腺功能参考范围及指南参考标准,筛查妊娠甲状腺功能异常的患病率。结果 采用妊娠特异性甲状腺功能的参考范围,临床甲减、亚临床甲减和低甲状腺素(T4)血症患病率(例)分别为0.74% (7)、5.04% (48)、2.1% (20);采用非妊娠人群的参考范围,患病率分别为0.53% (5)、1.79% (17)、1.58% (15);以指南的标准,患病率分别为0.84% (8)、11.04% (105)、2.0% (19),三种诊断标准获得的临床甲减、亚临床甲减和低甲状腺素(T4)血症的总患病率分别为:7.88% (75)、3.89% (37)、13.88% (132),两两比较差异均有统计学意义(P<0.001);采用非妊娠人群的参考范围作为标准,临床甲减、亚临床甲减和低T4血症的漏诊率分别为0.21%、3.25%、0.52%,总漏诊率为3.98%;采用指南的标准,临床甲减及亚临床甲减的过度诊断率分别为0.10%、5.99% ,总过度诊断率为6.09%。结论 采用妊娠特异性甲状腺功能指标的参考范围诊断妊娠期甲状腺功能异常,可以明显降低漏诊率及过度诊断率。

【摘要】 目的 分析瘢痕子宫产妇再次分娩的指证以及选择不同分娩方式的优势。方法 选取2013年1月至2015年12月于安徽省六安市人民医院分娩的瘢痕子宫产妇共计166例，详细记录其分娩方式以及产后24 h出血情况、发热情况、是否存在产褥病例。记录新生儿出生健康情况指标、是否有新生儿窒息。统计不同分娩方式产妇住院总需时间以及医疗相关费用。回顾性分析并比较不同分娩方式上述结果差异，总结不同分娩方式的选择优势。结果 阴道试分娩产妇共计90例，阴道试产成功率75.56%；剖宫产孕妇共计76(45.78%)例。瘢痕子宫产妇行剖宫产与阴道分娩相比，其24 h出血量以及产后发热情况明显增多(P﹤0.05)，新生儿窒息比例明显增多（P﹤0.05）。行剖宫产孕妇其住院总需时间以及花费均明显高于阴道分娩产妇（P﹤0.05）。其余指标均未见明显差异（P﹥0.05）。结论 相对剖宫产的分娩方式，阴道分娩对于再次分娩瘢痕子宫产妇及新生儿的不良影响较小，具有明显选择优势，临床应首先选择阴道分娩。

目的 探讨腹腔镜手术及开腹手术治疗I期子宫内膜癌的临床效果和并发症的处理及预防对策。方法 回顾分析中国医科大学附属盛京医院自2010年8月至2012年8月I期子宫内膜癌54例,其中腹腔镜手术22例,开腹手术32例。比较两组手术时间、术中出血量、淋巴结切除数量、手术并发症、术后肠道功能恢复时间等以评价二者差异。结果 两组患者术前临床资料,如年龄,体重,婚育史,内科合并症,深静脉血栓风险评估均无显著性差异。术中出血量、术后排气时间、术后住院时间三方面有显著性差异(P <0.05)。手术时间,淋巴结切除数量,腹主动脉淋巴结切除或取样完成的病例数,腹腔引流量等术中及术后资料无显著性差异(P >0.05)。结论 对于子宫内膜癌患者术前应注意重视相关风险评估,给予全面的预防措施以降低术中及术后并发症的发生,腹腔镜手术为早期子宫内膜癌的较优治疗方式。

Objective To explore the effect of mucosal flap suspension of the anterior vaginal wall in treating pelvic organ prolapse (POP)characterized by anterior vaginal prolapse (AVP). Methods Data of 52 POP patients characterized by AVP accepted mucosal flap suspension of the anterior vaginal wall in The Second Affiliated Hospital of Zhengzhou University from Jan 2005 to Jan 2010 were analyzed retrospectively. The comitant surgical approach included hysterectomy, oophorectomy, vaginal wall repair, sacral spine ligament suspension surgery, repair of old perineal laceration and mid-urethral suspension surgery. Results The average operative time was (43.47±5.18)min and the estimated blood loss was (50.7±2.5) ml. No hematoma, urethra, bladder or rectum damage occurred. There were 4 postoperative urinary retention and returned to normal by appropriate treatment. Patients were followed up for 12 to 60 months. The objective cure rate was 90.4% and the subjective cure rate was 100% on 28.4 months fellow-up . Conclusions Mucosal flap suspension of the anterior vaginal wall combined with other defection repair surgery is a less trauma, low cost operation with high cure rate, and low recurrence rate for AVP patients, it is worth to be applied in clinic.

目的 探讨舒芬太尼复合罗哌卡因联合分娩镇痛对产程及阴道助产率的影响。方法 选择足月阴道分娩初产妇486例,分为分娩镇痛组362例,非无痛分娩组(对照组)124例,观察镇痛效果、镇痛药物不良反应、第一产程、第二产程时间,缩宫素使用、产钳助产、胎儿窘迫、新生儿窒息及产后出血等的发生情况。结果 舒芬太尼复合罗哌卡因分娩镇痛效果显著(P <0.01);镇痛组第一产程活跃期和第二产程时间略长于对照组,但两组比较差异无统计学意义(P >0.05);缩宫素的使用、产钳助产、胎儿窘迫、新生儿窒息及产后出血量两组比较差异无统计学意义(P >0.05)。镇痛组主要的不良反应为皮肤瘙痒,较对照组差异有统计学意义(11.6%vs2.4%,P <0.05);但呕吐及运动阻滞的不良反应两组间无显著差异(P >0.05);结论 舒芬太尼复合罗哌卡因用于分娩镇痛,效果好,略延长产程,但并不增加助产率

【摘要】 目的 探讨足月头位未衔接胎膜早破的初产妇临产前取自由体位的安全性与可行性。方法 经过评估的未临产足月头先露未衔接的胎膜早破初产妇230例，采用随机法分为两组，实验组102例，入院完成检查后送待产室进行体位管理,对照组128例按照常规护理要求绝对卧床直至分娩。比较两组的脐带脱垂及新生儿窒息的发生情况、婴儿体重、分娩方式，排尿情况、产程时间、破膜距离分娩时间、干预前后胎头位置等指标。结果 ① 两组均无显性及隐性脐带脱垂发生，两组婴儿体重比较差异无统计学意义（P>0.05）；② 实验组阴道分娩率高于对照组（P<0.05），枕横位及枕后位的发生率低于对照组（P<0.01）；③ 实验组产程时间、破膜距离分娩时间短于对照组，差异有统计学意义(P<0.01，P<0.01)；④ 实验组干预2.5 h后的胎头位置明显下降，差异有统计学意义（P<0.01）。结论 无头盆不称的足月、头位未衔接胎膜早破孕妇临产前经过干预后取自由体位可以提高自然分娩率，缩短产程。

目的 评估重度宫腔粘连分离术后应用7~8mm 宫腔镜定期监测在预防宫腔再粘连中所起的作用。方法 回顾性分析我院2009年6月至2012年5月宫腔镜下重度宫腔粘连分离术102例患者的临床资料,术后宫腔先放置充水球囊后放IUD者53例为球囊放环组;闭经者术后每2周实施1次7~8mm 宫腔镜监测,月结来潮者月经干净3~7d监测1次宫腔粘连情况共49例为宫腔镜监测组。观察宫腔再粘连情况,并跟踪月经改善及妊娠情况。结果 术后3个月宫腔镜探查再次粘连率球囊放环组为26.42%,宫腔镜监测组为6.12% (P<0.01);两组月经改善情况分别为81.13%和95.92% (P <0.05);球囊放环组妊娠率33.96%,宫腔镜监测组妊娠率38.78% (P >0.05)。结论 重度宫腔粘连分离术后应用7~8mm 宫腔镜定期监测可以有效预防再粘连,提高月经改善率,但未能显著提高妊娠率。