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妊娠高血压综合征剖宫产后双眼视网膜中央动脉阻塞

ANALYSIS OF FACTORS INFLUENCING PROGNOSIS OF BREAST CANCER ASSOCIATED WITH PREGNANCY AND LACTATION

The authors studied retrospectively clinical data of seventy cases with breast cancer during pregnancy and lactation.They were treated and diagnosed by operation and pathology.Primary factors influencing prognosis were analyzed.It was demonstrated that 5year survival rate of the patients were significantly influenced by clinical stage , month of pregnancy and lactation, time of symptoms, type of operation, type of pathology, histological grade of malignancy, recurrence and metastasis, and estrogen receptor status (Ｐ＜0.05).Age and termination of pregnancy had no beneficial effect on survival (Ｐ＞0.05).The prognosis of pregnant and lactating breast cancer was poorer than ordinary breast cancer.Their 5year survival rate were 55.7% and 74.3%, respectively. After they were matched for stage and for age, no difference in survival was found.Early diagnosis and radical operation combined with radiotherapy, chemotherapy and hormonal therapy have better prognosis.The method can shorten time of treatment and improve survival rate.Termination of pregnancy has not been shown to improve survival and shall not be advised routinely.Future pregnancy may be detrimental and shall be discouraged.

CLINICAL APPLICATION OF TUBAL RECONSTRUCTION AFTER LAPAROSCOPIC TUBAL PREGNANCY OPERATION

ObjectiveTo investigate the effectiveness of the tubal reconstruction after laparoscopic tubal pregnancy operation by comparing with simple laparoscopic tubal pregnancy operation. MethodsBetween May 2007 and May 2010, 63 patients with tubal pregnancy underwent laparoscopic tubal pregnancy operation and tubal reconstruction in 30 cases (trial group) or simple laparoscopic tubal pregnancy operation in 33 cases (control group). There was no significant difference in age, pregnancy time, and position between 2 groups (P gt; 0.05). The tube patency test and hysterosalpingography (HSG) were carried out to evaluate the efficacy. ResultsThe operation was successfully completed in 29 cases of trial group; 1 case had too severe adhesion to receive re-anastomosis and was excluded. The tube patency test showed that the tube was patency in 26 cases of trial group and in 2 cases of control group during operation, showing significant difference (Z=5.86, P=0.00); it was patency in 25 cases of trial group and in 26 cases of control group at 1 month after operation, showing no significant difference (Z=0.48, P=0.63). HSG examination showed tube was patency in 25 cases of trial group and in 2 cases of control group at 2 months after operation, showing significant difference (Z=5.35, P=0.00). After 24 months, intrauterine pregnancy of trial group (n=25, 86.20%) was significantly higher than that of control group (n=19, 57.58%) (χ2=7.72, P=0.01). ConclusionThe reconstruction after laparoscopic tubal pregnancy operation can significantly increase the intrauterine pregnancy rate, and it is better than simple laparoscopic tubal pregnancy operation.

The Relationship between the Implantation of Ovarian Stimulated Embryos and the Expression of Leukemia Inhibitory Factor Protein in Mice Metrium

观察受体鼠妊娠和胚胎着床情况,并检测胚胎移植时小鼠子宫内膜中白血病抑制因子(Lif)表达水平,探讨超排卵对小鼠胚胎着床潜能的影响。方法:建立超排周期胚胎和自然周期胚胎移植小鼠模型,比较妊娠率、胚胎着床率的差异及其与Lif蛋白的表达水平之间的关系。结果:超排卵周期受体组的妊娠率(20.00%)和胚胎着床率(8.33%)显著低于自然周期组的妊娠率(55.00%)和胚胎着床率(35.00%)(P＜0.05)。自然周期胚胎和超排周期胚胎受体组内膜中Lif蛋白的表达水平相似(P＞0.05),妊娠受体组Lif蛋白的表达水平显著高于未孕受体组(P＜0.05),但单胎妊娠和多胎妊娠受体组内膜中Lif蛋白的表达水平相似(P＞0.05)。结论:超排卵可能降低胚胎的着床潜能,Lif蛋白的表达水平与胚胎着床有关,但与着床胚胎的数目无比例关系。

异位妊娠的误诊原因分析与防治对策

目的 探讨异位妊娠误诊的原因及防治措施。 方法 对我院自2006年1月-2009年11月收治的52例异位妊娠患者的临床资料进行回顾性分析，并探讨其误诊原因及减少误诊的对策。 结果 忽略必要的病史及体检是误诊的主要原因； 过分依赖辅助检查，尤以依靠B 型超声波检查为多见；提高对异位妊娠的警惕性是减少误诊的关键。 结论 加强对异位妊娠的认识，早发现，早治疗，避免因误诊导致死亡和严重并发症的发生。

Serial Study of Liver Function Variables of Normal Pregnancy

目的:了解正常妊娠妇女血清中常用肝功能指标测定结果及变化。方法:分别在早孕（孕10～14周）、中孕（孕20～24周）、晚孕（孕30～34周）及产后（产后12周）四个时期序贯性测定120例正常妊娠妇女血清谷丙转氨酶（ALT）、谷草转氨酶（AST）、γ谷氨酰转移酶（GGT）、乳酸脱氢酶（LDH）、总胆红素（TBIL）、直接胆红素（DBIL）、总蛋白（TP）、白蛋白（ALB）、前白蛋白（PA）的水平并进行比较。结果:ALT、AST在早、中、晚孕及产后各期相对于正常对照均升高（P＜0.01）；TBIL和DBIL在早、中、晚孕均降低（P＜0.01）；TP、ALB随孕期增加逐渐下降,产后回升,到产后12周上升到正常水平（早、中、晚孕P＜0.01,产后P＞0.05）；GGT在孕期中逐渐升高,于晚孕期达最高峰（P＜0.01）,产后稍有下降；LDH在孕早中期无明显变化（P＞0.05）,孕晚期上升,到产后12周仍呈一上升趋势（P＜0.01）；PA在孕早期低于正常对照（P＜0.01）,后随孕期上升,到中孕期后上升到正常（P＞0.05）。结论:本次实验观察到在妊娠期肝功指标ALT、AST、GGT、LDH升高,可能因为孕妇肝脏负荷增加、基础代谢和能量消耗增多、甾体激素水平增高引起。胆红素代谢指标及营养性指标TBIL、DBIL、TP、ALB、PA降低,可能是妊娠期血浆稀释引起。临床诊断妊娠合并肝功能损害时应考虑上述变化。

Clinical Analysis of 21 Patients with Cardiac Surgery by Cardiopulmonary Bypass during Pregnancy

目的探讨妊娠期体外循环手术的围术期处理方法及母婴安全性。 方法回顾性分析2006年1月至2014年3月福建省立医院心外科21例妊娠期行体外循环手术患者的临床资料，年龄（26.2±3.4）岁。 结果母亲19例生存，2例死于多器官功能衰竭。婴儿6例引产，2例死亡，生存13例。随访13例存活新生儿8个月至8年，并对4例年龄大于6岁的儿童进行韦氏儿童智力量表第4版（WISC-IV）测试，得分分别为92分、104分、106分、90分，平均98分，与正常儿童无明显差异[（100±15）分]。 结论体外循环下心脏手术对于妊娠期合并严重心脏病患者是可行的，手术的危险性主要取决于手术方式、手术时间、孕周、体外转流时间、是否深低温等，应采取多学科合作，根据患者具体情况制定个体化方案。

暴露于新型抗癫痫发作药物后儿童神经发育结果的系统综述

由于孕期暴露于某些传统的抗癫痫发作药物（Anti-seizure medications，ASMs）与儿童较差的神经发育有关，因此在整个妊娠期间使用新型ASMs的情况有所增加。本研究旨在阐明子宫内暴露于这些新型ASMs对儿童神经发育的影响。对MEDLINE、Embase、Web of Science、Cumulative Index to Nursing and Allied Health Literature Plus和PsycINFO进行了系统检索，结果仅限于2000年后发表的英文文章。调查宫内暴露于新型ASMs后神经发育结果的研究，纳入评价的药物包括：艾司利卡西平、加巴喷丁、拉考沙胺、拉莫三嗪、左乙拉西坦、奥卡西平、吡仑帕奈、托吡酯和唑尼沙胺，最终确定了35份发表的相关研究，并进行了描述性整合。方法学质量不统一，其不同的优势/劣势归因于研究设计。大多数研究观察了暴露于拉莫三嗪后其对儿童神经发育的并没有显著影响。左乙拉西坦的高质量研究相对较少，迄今为止未得到结论。托吡酯、加巴喷丁和奥卡西平的数据非常有限，无法得出确切的结论。令人担忧的是，尚无关于艾司利卡西平、拉考沙胺、吡仑帕奈或唑尼沙胺的研究。到目前为止，暴露于某些新型ASMs（如拉莫三嗪和左乙拉西坦）似乎并未影响神经发育的特定方面，但需要在不同的神经发育方面和剂量水平上进行进一步的研究。由于缺乏数据，无法确定新型ASMs的安全性，这些尚待进一步研究。

The Clinical Value of Ultrasound in the Diagnosis of Ectopic Pregnancy

目的:探讨超声在异位妊娠中的诊断及鉴别诊断价值。方法:回顾性分析我院超声诊断45例异位妊娠,并与手术及病理检查结果进行对照。结果:经超声诊断异位妊娠正确率达88.9%(40/45)。结论:超声对异位妊娠的诊断和鉴别诊断均具有较好的临床价值。

经阴道腔内彩色多普勒超声诊断子宫切口瘢痕妊娠的价值评估

【摘要】　目的　评估经阴道彩色多普勒超声对子宫切口瘢痕妊娠的诊断价值。　方法　对2004年9月－2011年2月经阴道彩色多普勒超声检查后并通过临床及病理确诊为子宫切口瘢痕妊娠的20例患者进行回顾性分析。　结果　20例患者中阴道彩色多普勒超声正确诊断17例（85.0%），误诊3例（15.0%）。　结论　阴道彩色多普勒超声检查对子宫切口部瘢痕妊娠的诊断有重要的价值，对临床选择正确的治疗方案有指导意义。