电针阴部神经刺激疗法联合Kegel盆底康复训练对产后压力性尿失禁患者盆底肌力、尿流动力学和生活质量的影响

摘要 目的：探讨电针阴部神经刺激疗法联合Kegel盆底康复训练对产后压力性尿失禁（SUI）患者盆底肌力、尿流动力学和生活质量的影响。方法：选取2019年6月~2021年11月期间于我院就诊的产后SUI患者109例,按照入院就诊奇偶顺序分为两组,其中对照组54例,接受Kegel盆底康复训练,研究组55例,接受电针阴部神经刺激疗法联合Kegel盆底康复训练。对比两组疗效、漏尿量、尿失禁程度、盆底肌力、尿流动力学和生活质量。结果：研究组的临床总有效率高于对照组（P<0.05）。两组治疗后盆底肌肌力各指标（手测肌力和Ⅰ类肌纤维最大值、Ⅱ类肌纤维平均值）均升高,且研究组高于对照组（P<0.05）。两组治疗后漏尿量、尿失禁程度评分均下降,且研究组低于对照组（P<0.05）。两组治疗后尿流动力学相关指标[腹压漏尿点压（AL-PP）、最大尿流率（Qmax）和最大尿道闭合压力（MUCP）]均升高,且研究组高于对照组（P<0.05）。两组治疗后尿失禁生活质量量表（I-QOL）各维度（限制性行为、心理影响、社交活动受限）评分及总分均升高,且研究组高于对照组（P<0.05）。结论：电针阴部神经刺激疗法联合Kegel盆底康复训练可有效改善产后SUI患者的盆底肌肌力和尿失禁情况,减少漏尿量,同时可促进尿流动力学恢复,进而提高患者的生活质量。     

P物质在子宫内膜异位症中的表达及其意义

目的:探讨P物质(substance P,SP)在子宫内膜异位症(endometriosis,EM)中的表达及其意义。方法:采用免疫组织化学法检测2012年10月至2013年4月在哈尔滨医科大学附属第一医院经腹腔镜及病理证实的EM患者异位子宫内膜组织20例,与其配对的在位子宫内膜组织10例以及因非EM(子宫肌瘤)行腹腔镜下子宫全切术或肌瘤核除患者的正常子宫内膜组织20例中SP的表达情况,并分析和比较术中盆腔粘连发生情况。结果:SP在EM患者的异位子宫内膜、在位子宫内膜及非EM患者的正常子宫内膜的阳性表达率分别为75%、80%、20%,异位子宫内膜和在位子宫内膜比较无显著性差别(P=1.0),但均高于非EM患者的正常子宫内膜,差异均有统计学意义(P=0.002,P=0.004);EM组盆腔粘连的阳性率高于非EM组,EM患者异位子宫内膜中SP阳性组盆腔粘连阳性率高于SP阴性组,差异均有统计学意义(P=0.001,P=0.032),非EM患者正常子宫内膜中SP阳性组盆腔粘连阳性率与SP阴性组相比,差异不具有统计学意义(P=0.061)。结论:SP在EM的异位子宫内膜和在位子宫内膜中的表达上调,并与EM合并盆腔粘连有关,其具体机制尚有待进一步的研究。     

Investigating micronucleus assay applicability for prediction of normal tissue intrinsic radiosensitivity in gynecological cancer patients

BackgroundPelvic organs morbidity after irradiation of cancer patients remains a major problem although new technologies have been developed and implemented. A relatively simple and suitable method for routine clinical practice is needed for preliminary assessment of normal tissue intrinsic radiosensitivity. The micronucleus test (MNT) determines the frequency of the radiation induced micronuclei (MN) in peripheral blood lymphocytes, which could serve as an indicator of intrinsic cell radiosensitivity.AimTo investigate a possible use of the micronucleus test (MNT) for acute radiation morbidity prediction in gynecological cancer patients.Materials and methodsForty gynecological cancer patients received 50 Gy conventional external pelvic irradiation after radical surgery. A four-field “box” technique was applied with 2D planning. The control group included 10 healthy females.Acute normal tissue reactions were graded according to NCI CTCAE v.3.0. From all reaction scores, the highest score named “summarized clinical radiosensitivity” was selected for a statistical analysis.MNT was performed before and after in vitro irradiation with 1.5 Gy. The mean radiation induced frequency of micronuclei per 1000 binucleated cells (MN/1000) and lymphocytes containing micronuclei per 1000 binucleated cells (cells with MN/1000) were evaluated for both patients and controls.An arbitrary cut off value was created to pick up a radiosensitive individual: the mean value of spontaneous frequency of cells with MN/1000 ± 2SD, found in the control group.ResultsBoth mean spontaneous frequency of cells with MN/1000 and MN/1000 were registered to be significantly higher in cancer patients compared to the control group (t = 2.46, p = 0.02 and t = 2.51, p = 0.02). No statistical difference was registered when comparing radiation induced MN frequencies between those groups.Eighty percent (32) of patients developed grade 2 summarized clinical radiosensitivity, with great variations in MNT parameters. Only three patients with grade 2 “summarized clinical radiosensitivity” had values of cells with MN/1000 above the chosen radiosensitivity threshold.ConclusionThe present study was not able to confirm in vitro MNT applicability for radiosensitivity prediction in pelvic irradiation.     

旋转恒定磁场治疗盆腔子宫内膜异位症初步疗效观察

目的:探讨旋转恒定磁场治疗盆腔子宫内膜异位症的效果.方法:选择山东省立医院2008年1月-2009年1月妇科确诊及收治的72例患者.采用双旋磁治疗机对照治疗观察,在月经周期前10天,每天1小时,共3个周期,观察痛经的缓解情况.结果:研究发现治疗组36例患者中完全缓解率为94％,部分缓解率为2.6％,复发率为2.7％,完全缓解率明显高于对照组.结论:旋转磁场治疗盆腔子宫内膜异位症具有安全简便、无痛苦、患者易接受和效果显著的特点,有一定的应用价值.     

Novel instrumented probe for measuring 3D pressure distribution along the vaginal canal

We developed an intravaginal instrumented probe (covered with a 10 × 10 matrix of capacitive sensors) for assessing the three-dimensional (3D) spatiotemporal pressure profile of the vaginal canal. The pressure profile was compared to the pelvic floor (PF) digital assessment, and the reliability of the instrument and repeatability of the protocol was tested. We also tested its ability to characterize and differentiate two tasks: PF maximum contraction and Valsalva maneuver (maximum intra-abdominal effort with downward movement of the PF). Peak pressures were calculated for the total matrix, for three major sub-regions, and for 5 planes and 10 rings throughout the vaginal canal. Intraclass correlation coefficients indicated excellent inter- and intra-rater reliability and intra-trial repeatability for the total and medial areas, with moderate reliability for the cranial and caudal areas. There was a moderate correlation between peak pressure and PF digital palpation [Spearman’s coefficient r = 0.55 (p < 0.001)]. Spatiotemporal profiles were completely different between tasks (2-way ANOVAs for repeated measures) with notably higher pressures (above 30 kPa) for the maximum contraction task compared to Valsalva (below 15 kPa). At maximum contraction, higher pressures occurred in the mid-antero-posterior zone, with earlier peak pressure onsets and more variable along the vaginal depth (from rings 3 to 10-caudal). During Valsalva, the highest pressures were observed in rings 4–6, with peak pressure onsets more synchronized between rings. With this protocol and novel instrument, we obtained a high-resolution and highly reliable innovative 3D pressure distribution map of the PF capable of distinguishing vaginal sub-regions, planes, rings and tasks.     

基于经会阴实时三维超声评估生物反馈电刺激联合盆底肌锻炼治疗产后盆底功能障碍的临床疗效

摘要 目的：探讨经会阴实时三维超声评估生物反馈电刺激联合盆底肌锻炼治疗产后盆底功能障碍的临床疗效。方法：选择2020年9月至2022年9月我院收治的96例产后盆底功能障碍患者,根据随机数字表法将患者分为两组,对照组（48例）采用盆底肌锻炼治疗,研究组（48例）采用生物反馈电刺激联合盆底肌锻炼治疗。治疗前后采用经会阴实时三维超声检查,对比两组治疗前后的盆底功能障碍调查表（PFDI-20）、盆底障碍影响简易问卷7（PFIQ-7）评分、静息和Valsalva动作状态下的肛提肌超声参数。分析肛提肌超声参数与PFDI-20、PFIQ-7评分的相关性。结果：两组治疗后PFDI-20、PFIQ-7评分,静息和Valsalva动作状态下肛提肌裂孔前后径、肛提肌裂孔左右径、肛提肌裂孔面积较治疗前降低（P＜0.05）,静息时肛提肌厚度较治疗前增加（P＜0.05）。研究组治疗后PFDI-20、PFIQ-7评分,静息和Valsalva动作状态下肛提肌裂孔前后径、肛提肌裂孔左右径、肛提肌裂孔面积低于对照组（P＜0.05）,静息时肛提肌厚度大于对照组（P＜0.05）。静息和Valsalva状态下肛提肌裂孔前后径、肛提肌裂孔左右径、肛提肌裂孔面积与PFDI-20、PFIQ-7评分呈正相关（P＜0.05）,静息状态肛提肌厚度与PFDI-20、PFIQ-7评分呈负相关（P＜0.05）。结论：经生物反馈电刺激联合盆底肌锻炼治疗后肛提肌裂孔大小较治疗前降低,肛提肌厚度较治疗前增加,且与PFDI-20、PFIQ-7评分改善有关,经会阴实时三维超声可客观、有效评价产后盆底功能障碍患者的治疗效果。     

上尿路腔内手术中降低肾盂压力机制与方法的研究进展

1983年,Wickham教授首先提出微创外科(minimally invasive surgery),此后,微创泌尿外科逐渐成外具有科学意义上的微创外科学的一个重要的分支学科。上尿路的腔内手术,包括PNL(Percutaneous nephrolithotomy)、URS(Ureteroscopic)、f-URS(Flexible ureteroscope)等。与传统手术相比,上尿路的腔内手术具有创伤小、时间短、恢复快、并发症少,并且可以直视下进行手术操作,临床应用较广泛。在腔内操作时,为保证术中手术视野的清晰度,手术多采用生理盐水(NS)进行灌注,进而导致肾盂压力升高,引起各项潜在的危害。因此如何在上尿路腔内手术中降低肾盂压力成为一个研究的热点。近些年,腔内器械的改进,包括镜体灌注通道入路与出路的分开设计、回流鞘的设计、压力泵的改进,在一定程度上降低了肾盂压力。灌注液体中加入相应浓度的药物,抑制上尿路平滑肌的蠕动与收缩,也在一定程度上降低了肾盂压力。本文介绍了上尿路腔内手术中肾盂压力的影响因素,回顾了肾盂压力升高后的危害,分析了肾盂压力升高机制,总结了肾盂压力降低的各种方案以及将来的应用前景。     

含蛋白转导域的SARA/SBD融合蛋白对腹膜透析大鼠

目的：探讨含蛋白转导域的SARA融合蛋白（PTD-SAR／SBD）对腹膜透析大鼠腹膜纤维化的抑制作用。方法：每日腹腔注射4．25％葡萄糖腹膜透析液（PDF）制备腹膜透析大鼠模型。28只Sprague-Dawley大鼠随机分为正常对照组（n=8）;腹膜透析模型组（n=10）;PTD-SARA／SBD蛋白干预组（n=10）。4周后行腹膜平衡试验,检测超滤量、葡萄糖吸收率;留取壁层腹膜组织行HE染色;免疫组织化学方法检测大鼠壁层腹膜间皮细胞转分化指标E-cadherin和Twist的表达;Westemblotting测定E-cadherin、twist,以及CollagenⅠ、TGF-β1、P-Smad3、t-Smad3的表达。结果：①与正常对照组比较,模型组大鼠壁层腹膜增厚,糖转运率增加,超滤量降低（P〈0．01）;免疫组织化学与westernblotting检测结果显示E-cadherin表达下调,Twist表达上调;CollagenⅠ、P-Smad3、TGF-β1表达增加。②与模型组比较,PTD-SARA／SBD蛋白干预组大鼠壁层腹膜糖转运率降低,超滤量增加（P〈0．05）;E-cadherin表达上调,Twist表达下调;CollagenⅠ、TGF-β1、P-Smad3表达减少,各组t-Smad3无明显变化。结论：PTD-SARA／SBD融合蛋白通过抑制TGF-WSmads信号通路部分逆转腹膜间皮细胞转分化从而改善腹膜结构和功能,为防治腹膜透析所致腹膜纤维化奠定基础。     

生殖道衣原体、支原体感染与盆腔炎症的相关性分析

目的:探讨女性生殖道衣原体、支原体感染发生与盆腔炎症的相关性,并为相应人群提出相应的预防和治疗措施。方法:对我院2012年1月到2013年5月诊治的盆腔炎患者280例及60名健康妇女进行了衣原体、支原体的培养,采用试剂盒进行检查,并进行药敏实验,分析比较两组生殖道衣原体和支原体感染情况。结果:盆腔炎症组中衣原体感染的检出率为58.5%,支原体感染率为26.2%,衣原体合并支原体感染率为12.4%。健康妇女组衣原体感染、支原体感染及衣原体合并衣原体感染的检出率分别为:9.1%,6.2%和4.9%。两组的差异有统计学意义(P0.05)。在盆腔炎症患者组中,30岁人群中单纯衣原体感染和单纯支原体感染检出率分别为51.3%和26.4%,均要明显高于30岁以上的人群,差异有统计学意义(P0.05)。结论:盆腔炎症与生殖道衣原体,支原体感染有密切的相关性,盆腔炎的发病可能与生殖道衣原体、支原体感染有关,针对临床上盆腔炎患者应密切关注生殖道支原体、衣原体的感染问题。     

DE-3L型妇产科电脑综合治疗仪用于产后的效果观察

目的探讨DE-3L型妇产科电脑综合治疗仪应用于产后泌乳与机体康复效果。方法将我院收治的231例顺产妇依据产后康复方式差异进行分组,治疗组采用DE-3L型妇产科电脑综合治疗仪治疗,对照组产后进行母乳喂养宣教联合盆底肌训练,比较两组产后泌乳、子宫复旧与恶露量及盆底组织康复情况。结果治疗组促泌乳、子宫复旧与恶露量减少及盆底肌肉肌力恢复情况均明显优于对照组(P0.05)。结论 DE-3L型妇产科电脑综合治疗仪可有效促进产妇产后泌乳、恶露排出与盆底组织的康复,值得临床应用。