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期刊信息/Journal information
中华妇产科杂志
中华医学会杂志社
中华妇产科杂志

中华医学会杂志社

郎景和

月刊

0529-567X

cjog@cma.org.cn

010-85158215

100710

北京市东城区东四西大街42号

中华妇产科杂志/Journal Chinese Journal of Obstetrics and GynecologyCSCD北大核心CSTPCD
查看更多>>1953年4月创刊，中华医学会主办。本刊是我国妇产科学界学术水平最高、影响力最大的专业期刊。以广大妇产科医师为主要读者对象，致力于刊登妇产科学及其相关学科在临床及基础研究中具有创新性的优秀论文。近年来，在中国科技期刊统计源期刊中，本刊的影响因子一直在本学科领域中名列前茅。2006至2011年本刊连续获得中国科协精品期刊工程项目资助。2005年在第三届国家期刊奖评比中，本刊荣获“百种重点期刊”称号。自1992年以来多次荣获新闻出版总署、国家科技部及中国科协优秀科技期刊奖。本刊一直被美国国立医学图书馆医学索引(Medline)、中国科学引文数据库等国内外30余个重要的检索系统收录。
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    论妇产科学之“四性”

    郎景和沈平虎
    1-4页
    查看更多>>摘要：医学不是纯自然科学，也不是纯社会科学，是自然科学与社会科学，特别是与人文科学的综合。哲学起源于医学，医学归隐于哲学。作为技术科学的医学，其实践性尤为突出。现代科技的发展，使医学更具多元性。因而，医学的人文性、哲学性、实践性、多元性对于医学、对于妇产科学的临床实践与基础研究及其发展至关重要，并具有决定性意义。
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    闭经诊断与治疗指南（2023版）

    陈子江田秦杰沈平虎
    5-13页
    查看更多>>摘要：闭经是临床常见的症状，包括生理性与病理性闭经，本指南根据近年来国内外闭经的研究进展，针对病理性闭经的定义、分类、发病机制、诊断、鉴别诊断与治疗进行了更新和补充，以便与国际标准接轨，并协助医生和患者更好地认识闭经，强调对闭经病因进行精准诊断，根据患者年龄、存在的问题和需求提供恰当的治疗方案，达到维持女性生殖健康及全身健康，促进第二性征发育，恢复月经，帮助有生育意愿的女性实现生育目标，并预防疾病发展与诊治过程中可能出现的并发症。
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    剖宫产手术专家共识（2023）

    赵扬玉漆洪波张楠
    14-21页
    查看更多>>摘要：剖宫产率在全球范围内持续上升，且存在明显的地区间和地区内差异。我国剖宫产率在全球范围内长期居高位，因此，合理优化剖宫产术已成为妇幼卫生领域的优先事项之一。为了更好地规范和指导我国剖宫产术的临床实践和管理工作，国家产科专业医疗质量控制中心和中华医学会围产医学分会专家经共同讨论，制定了本专家共识。经过深入分析国内外循证医学证据，专家组结合我国的具体情况，确定了一系列临床和管理问题，并给出推荐意见，包括剖宫产术的近远期母儿影响、手术医学指征、紧急剖宫产术管理、麻醉方式和抗菌药物的使用等临床和围手术期管理方案，以期为全国范围内剖宫产术的围产期规范管理提供指导。
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    子宫内膜癌多学科团队协作诊疗临床实践中国专家共识

    向阳张国楠姚红萍
    22-40页
    查看更多>>摘要：子宫内膜癌的发病率居中国妇科恶性肿瘤第2位，随着分子病理学的发展，子宫内膜癌的诊疗迎来了新的机遇和挑战。多学科团队（MDT）协作模式是当代肿瘤临床诊疗工作的大势所趋。本共识旨在从MDT协作的角度对子宫内膜癌临床诊疗中疑难、棘手的问题进行循证分析，形成共识和推荐意见。本共识专家组成员经讨论后设定了6个主题：（1）子宫内膜癌的分子分型和分子病理；（2）初治子宫内膜癌的危险程度分层；（3）晚期、复发的难治性子宫内膜癌的治疗；（4）特殊病理类型子宫内膜癌的临床综合管理；（5）保留生育功能的治疗；（6）Lynch综合征的诊治。以临床实践问题为切入点，针对6个不同主题设立的各工作小组对文献进行预选和整理；专家组成员经过两次专题讨论会，整合不同学科的意见，结合国内外研究证据，并最终投票产生共识。本共识以高水平研究证据为基础，结合临床MDT协作相关的实际问题，对以上6个主题内容进行临床实践的建议和推荐，以期服务于临床，进一步改善子宫内膜癌患者的预后和生命质量。
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    双胎妊娠孕妇妊娠晚期引产102例临床分析

    郭晓玥原鹏波魏瑗赵扬玉...
    41-48页
    查看更多>>摘要：目的 探讨双胎妊娠孕妇引产的临床特点和引产失败的相关因素。 方法 回顾性分析2016年1月至2022年12月在北京大学第三医院引产的双胎妊娠孕妇的临床资料，根据是否临产分为成功组（引产临产者，72例）和失败组（引产未临产者，30例），比较两组孕妇的临床特征差异，采用logistic回归分析双胎妊娠孕妇引产失败的相关因素。 结果 失败组双胎妊娠引产孕妇的产次、子宫颈Bishop评分显著低于成功组，而双绒毛膜双羊膜囊双胎占比、辅助生殖技术助孕和子宫颈Bishop评分<6分的比例，产后住院时间、总住院时间均显著高于成功组（P均<0.05）。成功组孕妇人工破膜±缩宫素静脉滴注引产的比例为72.2%（52/72），显著高于失败组（46.7%，14/30；P=0.030）。成功组与失败组孕妇的分娩孕周，严重产后出血、输血的发生率，产后出血量、两胎儿的新生儿出生体重、新生儿窒息的发生率、新生儿入住新生儿重症监护病房的比例分别比较，差异均无统计学意义（P均>0.05）。所有引产孕妇均无严重会阴裂伤、均未切除子宫。多因素logistic回归分析结果显示，初产妇（OR=3.064，95%CI为1.112~8.443；P=0.030）和子宫颈Bishop评分<6分（OR=5.208，95%CI为2.008~13.508；P=0.001）是影响双胎妊娠孕妇引产失败的独立危险因素。 结论 双胎妊娠孕妇择期引产是安全可行的；严格把握终止妊娠时机和指征，根据子宫颈条件选择合适的引产方法，积极促使子宫颈成熟，有利于提高引产成功率。 Objective To investigate the clinical characteristics of induced labor in twin pregnancy and the related factors of induced labor failure. Methods The clinical data of twin pregnant women who underwent induced labor in Peking University Third Hospital from January 2016 to December 2022 were retrospectively analyzed. According to whether they had labor or not after induction, pregnant women were divided into the success group (pregnant women who had labor after induction, 72 cases) and the failure group (pregnant women who did not have labor after induction, 30 cases). Logistic regression was used to analyze the related factors of induction failure in twin pregnant women. Results The parity and cervical Bishop score in the failure group were significantly lower than those in the success group, while the proportion of dichorionic diamniotic twins, assisted reproductive technology pregnancy and cervical Bishop score <6, postpartum hospital stay and total hospital stay in the failure group were significantly higher than those in the success group (all P<0.05). The proportion of induced labor by artificial rupture of membranes ± oxytocin intravenous infusion in the success group was 72.2% (52/72), which was significantly higher than that in the failure group (46.7%, 14/30 P=0.030). There were no significant differences between the two groups in the gestational age at delivery, the incidence of severe postpartum hemorrhage and blood transfusion, the amount of postpartum hemorrhage, the neonatal weight of two fetuses, the incidence of neonatal asphyxia, and the proportion of neonates admitted to the neonatal intensive care unit (all P>0.05). There were no severe perineal laceration and hysterectomy in all pregnant women. Multivariate logistic regression analysis showed that primipara (OR=3.064, 95%CI: 1.112-8.443 P=0.030) and cervical Bishop score <6 ( OR=5.208, 95%CI: 2.008-13.508 P=0.001) were the independent risk factors for induction failure in twin pregnancy. Conclusions . Elective induction of labor in twin pregnancy is safe and feasible. It is helpful to improve the success rate of induction of labor by strictly grasping the timing and indications of termination of pregnancy, choosing the appropriate method of induction according to the condition of the cervix, and actively promoting cervical ripening

    妊娠,双胎妊娠末期引产影响因素分析

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    残角子宫妊娠12例临床分析并文献复习

    林明媚葛逸盟杨硕杨蕊...
    49-55页
    查看更多>>摘要：目的 探讨残角子宫妊娠的临床特点、治疗方案选择及手术治疗后生育力恢复情况。 方法 回顾性收集2010年1月1日至2022年12月31日北京大学第三医院诊治的12例残角子宫妊娠患者的临床资料，统计分析所有残角子宫妊娠患者的一般临床资料、诊治经过及手术后妊娠情况。 结果 12例残角子宫妊娠患者的年龄中位数为29岁（范围：24~37岁）；8例残角子宫妊娠发生于Ⅰ型残角子宫，4例残角子宫发生于Ⅱ型残角子宫；其中5例术前超声检查误诊。所有患者均行残角子宫切除术，手术过程顺利；术后9例患者有妊娠需求，5例成功受孕。5例再次妊娠者中，3例自然妊娠，2例通过辅助生殖技术成功妊娠；4例剖宫产术活产分娩，1例孕早期自然流产；均未发生子宫破裂或异位妊娠。 结论 残角子宫妊娠患者可通过超声检查进行早期诊断，但超声检查存在一定的误诊率，临床医师需根据病史、查体及辅助检查综合判断并决策，一旦确诊积极手术治疗，必要时宫腹腔镜联合手术探查。对手术后不孕的患者可积极行辅助生殖技术治疗，并警惕子宫破裂等妊娠并发症的发生，选择剖宫产术终止妊娠较为安全。 Objective To investigate the clinical characteristics, treatments and fertility recovery of rudimentary horn pregnancy (RHP). Methods The clinical data of 12 cases with RHP diagnosed and treated in Peking University Third Hospital from January 1, 2010 to December 31, 2022 were retrospectively analyzed. Clinical informations, diagnosis and treatments of RHP and the pregnancy status after surgery were analyzed. Results The median age of 12 RHP patients was 29 years (range: 24-37 years). Eight cases of pregnancy in residual horn of uterus occurred in type Ⅰ residual horn of uterus, 4 cases occurred in type Ⅱ residual horn of uterus among which 5 cases were misdiagnosed by ultrasound before surgery. All patients underwent excision of residual horn of uterus and affected salpingectomy. After surgery, 9 patients expected future pregnancy, and 3 cases of natural pregnancy, 2 cases of successful pregnancy through assisted reproductive technology. Four pregnancies resulted in live birth with cesarean section, and 1 case resulted in spontaneous abortion during the first trimester of pregnancy. No uterine rupture or ectopic pregnancy occurred in subsequent pregnancies. Conclusions Ultrasonography could aid early diagnosis of RHP while misdiagnosis occurred in certain cases. Thus, a comprehensive judgment and decision ought to be made based on medical history, physical examination and assisted examination. Surgical exploration is necessary for diagnosis and treatment of RHP. For infertile patients, assisted reproductive technology should be applied when necessary. Caution to prevent the occurrence of pregnancy complications such as uterine rupture, and application of cesarean section to terminate pregnancy are recommended.

    妊娠,异位早期诊断妇科外科手术腹腔镜检查宫腔镜检查残角子宫

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    外阴硬化性苔藓345例临床病理分析及维持治疗频率的初步探讨

    孙小怡肖银平孙一鑫张祺...
    56-63页
    查看更多>>摘要：目的 探讨外阴硬化性苔藓（VLS）的临床病理特征及治疗，并初步探讨其维持治疗频率。 方法 收集2018年至2021年于复旦大学附属妇产科医院诊断为VLS的患者共345例，回顾性分析其临床病理特征、治疗方法及效果，对病情稳定的患者进行维持治疗并定期随访，探究维持治疗的最低用药频率。 结果 （1）一般情况：345例VLS患者的确诊年龄为（50.4±14.7）岁（范围：8~84岁），其中50~59岁年龄段的占比最高（30.1%，104/345）。177例有合并疾病和相关家族史记录的患者中，18.6%（33/177）合并自身免疫性疾病，24.3%（43/177）合并过敏性皮肤疾病，5.6%（10/177）患者的女性直系亲属有长期外阴瘙痒或皮肤色素减退病史。（2）临床特征：204例有症状记录的患者中，最常见的症状为外阴瘙痒（96.1%，196/204）；214例有体征记录的患者中，最常见体征为外阴色素减退（96.3%，206/214）；202例有病变累及部位记录的患者中，常见累及部位依次为小阴唇（70.3%，142/202）、大阴唇（67.8%，137/202）、阴唇沟（59.4%，120/202）。62例外阴萎缩患者的病变累及部位数［（2.7±1.1）个］显著多于152例非萎缩患者［（2.2±1.0）个；t=3.48，P=0.001］；外阴萎缩患者的病程为（9.3±8.5）年，显著长于非萎缩患者［（6.6±5.6）年；t=2.04，P=0.046］。（3）病理特征：286例有电子病理图片的患者中，表皮层中最常见的病理特征为上皮钉突钝化（71.3%，204/286），真皮层中常见的病理特征依次为间质胶原化（84.6%，242/286）、炎细胞浸润（73.8%，211/286）。（4）治疗：177例患者在确诊后进行了规范治疗并在本院定期随访。初始治疗阶段，26.0%（46/177）患者使用0.05%丙酸氯倍他索乳膏，74.0%（131/177）患者使用0.1%糠酸莫米松软膏治疗；两种药物的完全缓解率分别为80.4%（37/46）、74.0%（97/131），两者比较，差异无统计学意义（χ²=0.76，P=0.385）。维持治疗期间，27.1%（48/177）的患者每周2次用药，35.0%（62/177）每周1次用药，37.9%（67/177）每10天1次用药；维持治疗6个月后随访，无瘙痒复发或外阴体征进展患者。 结论 绝大多数VLS患者有外阴瘙痒、色素减退、大小阴唇受累、进行性外阴萎缩、表皮层和真皮层炎症浸润后改变，初始治疗局部使用糠酸莫米松和丙酸氯倍他索治疗均具有良好的疗效，个体化的维持治疗频率在保证患者病情稳定的情况下可最大程度减少副反应的发生。 Objective To analyze and summarize the clinical and pathological characteristics, management, and efficacy of patients with vulvar lichen sclerosus (VLS) through a single center large sample study, and preliminarily to explore the frequency of maintenance treatment medication for VLS. Methods The clinical data of VLS patients in Obstetrics and Gynecology Hospital of Fudan University from 2018 to 2021 were retrospectively collected. The clinicopathological characteristics (patients′ age, course of disease, complicated disease history, family history, symptoms, signs and pathology), treatment and effects were retrospectively analyzed. The patients in the maintenance treatment stage were followed up regularly to explore the minimum frequency of individual medication to maintain the stability of the disease. Results (1) General situation: a total of 345 patients with VLS were included in this study. The average age was (50.4±14.7) years (ranged from 8 to 84 years old), prevalence was highest in the 50-59 years group (30.1%, 104/345). Immune diseases occurred in 18.6% (33/177) of patients, 24.3% (43/177) of patients had allergic skin diseases, and 5.6% (10/177) of the patients′ immediate family members had chronic vulvar pruritus or vulvar hypopigmentation. (2) Clinical features: the most common symptom was vulvar pruritus (96.1%, 196/204) among 204 patients with recorded symptoms. The most common sign was hypopigmentation of the vulva (96.3%, 206/214). The most common involved sites were labia minora (70.3%, 142/202), labia majora (67.8%, 137/202), and labial sulcus (59.4%, 120/202). The cumulative number of sites involved in 62 vulvar atrophy patients (2.7±1.1) was significantly higher than that in 152 non-atrophy patients (2.2±1.0 t=3.48, P=0.001). The course of vulvar atrophy was (9.3±8.5) years, which was significantly longer than that of non-atrophy patients [(6.6±5.6) years t=2.04, P=0.046]. (3) Pathological features: among the 286 patients with electronic pathological sections, the most common pathological feature in the epidermis was epithelial nail process passivation (71.3%, 204/286). The common pathological features in the dermis were interstitial collagenization (84.6%, 242/286), and inflammatory cell infiltration (73.8%, 211/286). (4) Treatment: 177 patients received standardized treatment after diagnosis and were followed up regularly in our hospital. In the initial treatment stage, 26.0% (46/177) of the patients were treated with 0.05% clobetasol propionate cream, and 74.0% (131/177) of the patients were treated with 0.1% mometasone furoate ointment. The complete remission rates of the two methods were respectively 80.4% (37/46) and 74.0% (97/131), and there was no statistically significant difference (χ²=0.76, P=0.385). During maintenance treatment, 27.1% (48/177) of the patients took the medication twice a week, 35.0% (62/177) took the medication once a week, and 37.9% (67/177) took the medication once every 10 days. During follow-up after 6 months of maintenance treatment, there were no patients with recurrence of pruritus or progression of vulvar signs. Conclusions The majority of VLS patients have itching, hypopigmentation, involvement of labia minora and labia majora, progressive atrophy, and inflammatory infiltration of dermis. Local treatments of mometasone furoate and clobetasol propionate have good initial therapeutic effects. The frequency exploration of individualized maintenance treatment could minimize the occurrence of adverse reactions when ensuring the stability of the patients′ condition.

    外阴硬化性苔癣外阴瘙痒症色素沉着不足上皮萎缩糠酸莫米松氯倍他索回顾性研究

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    Swyer综合征合并性腺非无性细胞瘤的恶性生殖细胞肿瘤15例临床分析

    梁欢黎思健杨佳欣吴鸣...
    64-69页
    查看更多>>摘要：目的 探讨Swyer综合征合并性腺非无性细胞瘤的恶性生殖细胞肿瘤（MGCT-NDG）的发生率、治疗和生存结局。 方法 回顾性分析2011年1月至2022年12月中国医学科学院北京协和医学院北京协和医院收治的15例Swyer综合征合并MGCT-NDG患者的临床病理资料。 结果 2011年1月至2022年12月本院共收治MGCT-NDG患者307例，其中发现Swyer综合征15例，Swyer综合征合并MGCT-NDG的发生率为4.9%（15/307）；确诊MGCT-NDG和Swyer综合征的年龄分别为（16.8±6.7）和（16.7±6.6）岁。初次手术方式：术前确诊Swyer综合征6例，其中4例行双侧性腺切除±子宫切除术、2例分别行性腺肿瘤剔除术及单侧性腺切除+子宫切除术；初次手术后确诊Swyer综合征9例，其中6例初次手术行单侧性腺切除术、2例行性腺肿瘤剔除术、1例行单侧性腺切除+子宫切除术。病理类型：混合性恶性生殖细胞肿瘤（MGCT）10例、卵黄囊瘤4例、未成熟畸胎瘤1例。国际妇产科联盟（FIGO）分期：Ⅰ期6例、Ⅱ期3例、Ⅲ期5例和Ⅳ期1例。11例患者在延迟（7.9±6.2）个月后再次接受残存性腺切除术，其中MGCT-NDG 8例，性腺母细胞瘤1例，另2例残存性腺未见肿瘤累及。15例患者中，10例患者经历了至少1次复发或疾病进展，其中2例在初始治疗时仅接受了手术治疗，中位无事件生存时间为9个月（5，30个月），所有复发或疾病进展的患者均接受了再次手术并联合术后化疗。15例患者的中位随访时间为25个月（15，42个月）；随访期内10例无病生存、3例死于本肿瘤、1例死于白血病骨髓移植后并发症、1例带病生存。 结论 Swyer综合征合并MGCT-NDG的发生率为4.9%，应强调及时诊断并行双侧性腺切除术，以降低再次手术和第二次癌变的风险。 Objective To evaluate the incidence, treatment, and survival outcomes of Swyer syndrome with gonadal non-dysgerminoma malignant germ cell tumor (MGCT-NDG). Methods A retrospective study was performed on Swyer syndrome patients with MGCT-NDG between January 2011 and December 2022 in Peking Union Medical College Hospital to investigate their characteristics and outcomes. Results A total of 15 patients (4.9%, 15/307) with Swyer syndrome were identified in 307 MGCT-NDG patients. The average age at diagnosis of MGCT-NDG and Swyer syndrome were (16.8±6.7) and (16.7±6.6) years, respectively. Six cases were preoperatively diagnosed as Swyer syndrome, of which 4 cases received bilateral gonadectomy with or without hysterectomy, while the other 2 cases underwent removal of gonadal tumor and unilateral gonadectomy with hysterectomy, respectively. Of the 9 patients postoperatively diagnosed as Swyer syndrome, unilateral gonadectomy, removal of gonadal tumor, and unilateral gonadectomy with hysterectomy were performed in 6 patients, 2 patients, and 1 patient, respectively. Mixed malignant germ cell tumor (MGCT 10 cases), yolk sac tumor (4 cases), and immature teratoma (1 case) were the pathological subtypes, in the descending order. There were International Federation of Gynecology and Obstetrics (FIGO) stage Ⅰ in 6 cases, stage Ⅱ in 3 cases, stage Ⅲ in 5 cases, and stage Ⅳ in 1 case, respectively. Eleven patients received reoperation for residual gonadectomy after a average delay of (7.9±6.2) months, including 8 MGCT-NDG patients and 1 gonadoblastoma patient, no tumor involved was seen in the remaining gonads in the other 2 cases. Ten patients experienced at least one recurrence, with a median event free survival of 9 months (5, 30 months), of which 2 patients received surgery only at the time of initial treatment. All patients with recurrence received surgery and combined with postoperative chemotherapy. After a median follow-up of 25 months (15, 42 months), 10 patients were disease-free, 3 patients died of the tumor, 1 died of side effects of leukemia chemotherapy, and 1 survived with disease. Conclusion The incidence rate of Swyer syndrome in patients with MGCT-NDG is about 4.9% timely diagnosis and bilateral gonadectomy should be emphasized to reduce the risk of reoperation and second carcinogenesis in this population.

    性腺发育不全,46,XY生殖器肿瘤,女（雌）性肿瘤,生殖细胞和胚胎性发病率存活率

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    重症产科疾病继发急性肾损伤的临床分析

    巩雪敏甘泉张楠
    70-76页
    查看更多>>摘要：目的 探讨重症产科疾病继发急性肾损伤（AKI）孕妇的临床特点。 方法 收集2020年6月至2023年1月于湖北省妇幼保健院成人重症医学科住院的重症产科疾病孕妇249例，其中，重度子痫前期不伴溶血、肝酶升高和低血小板计数综合征（HELLP综合征）172例、HELLP综合征32例、无张力性产后出血（特指子宫收缩乏力所致的产后出血）18例，其他重症产科疾病27例（其中羊水栓塞4例、胎盘早剥7例、妊娠期肝内胆汁淤积症16例）。排除既往患有肾病者，入院第1天血肌酐>70.7 μmol/L且符合AKI诊断标准者定义为AKI孕妇，血肌酐≤70.7 μmol/L定义为非AKI孕妇。分别比较各种重度产科疾病AKI与非AKI孕妇的临床资料和新生儿结局。采用二分类logistic回归分析重症产科疾病孕妇发生AKI的影响因素。 结果 （1）重度子痫前期不伴HELLP综合征：172例重度子痫前期不伴HELLP综合征孕妇中，发生AKI者60例（34.9%），未发生AKI者112例（65.1%）。AKI孕妇的24 h尿蛋白定量、D-二聚体、丙氨酸转氨酶、天冬氨酸转氨酶、血清胆汁酸水平，合并甲状腺功能减退的比例均高于非AKI孕妇，血清白蛋白水平、新生儿出生体重均低于非AKI孕妇，分别比较，差异均有统计学意义（P均<0.05）。二分类logistic回归分析结果显示，24 h尿蛋白定量（OR=1.000，95%CI为1.000~1.000；P=0.006）和血清白蛋白（OR=0.883，95%CI为0.789~0.988；P=0.031）是AKI发生的影响因素，受试者操作特性曲线下面积分别为0.730和0.252。AKI孕妇与非AKI孕妇低出生体重儿占比、新生儿窒息的发生率分别比较，差异均无统计学意义（P均>0.05）。（2）HELLP综合征：32例HELLP综合征孕妇中，发生AKI者21例（65.6%），未发生AKI者11例（34.4%）。AKI孕妇的24 h尿蛋白定量显著高于非AKI孕妇（P=0.017）。24 h尿蛋白定量（OR=1.000，95%CI为1.000~1.001；P=0.095）不是AKI发生的影响因素。AKI孕妇与非AKI孕妇的活产率分别为71.4%（15/21）、11/11，二者比较，差异无统计学意义（P=0.071）。（3）无张力性产后出血：18例无张力性产后出血孕妇中，发生AKI者4例（4/18），非发生AKI者14例（14/18）。AKI孕妇与非AKI孕妇的发病孕周、剖宫产术分娩、住院时长、术中出血量、休克指数、D-二聚体、妊娠合并症或并发症等分别比较，差异均无统计学意义（P均>0.05）。（4）其他重症产科疾病：27例其他重症产科疾病孕妇中，发生AKI者12例（44.4%），未发生AKI者15例（55.6%）。AKI孕妇与非AKI孕妇分别活产10例（10/12）、11例（11/12），两组比较，差异无统计学意义（P=1.000）。AKI孕妇与非AKI孕妇的新生儿窒息率分别为4/7、0/9，两者比较，差异有统计学意义（P=0.019）。（5）各类重症产科疾病孕妇7日内肾功能恢复率的比较：重度子痫前期不伴HELLP综合征、HELLP综合征、无张力性产后出血、其他重症产科疾病继发AKI孕妇7 d内肾功能恢复率分别为85%（51/60）、42.9%（9/21）、2/4、11/12。4类疾病继发AKI孕妇7 d内肾功能恢复率进行比较，差异具有统计学意义（χ2=16.704，P=0.001）。 结论 重症产科疾病继发AKI孕妇的7 d内肾功能恢复率较低，低出生体重儿占比高，易出现新生儿窒息；低蛋白血症、尿蛋白定量为重度子痫前期不伴HELLP综合征孕妇并发AKI的预测因素，尿蛋白定量预测价值较好；尿蛋白定量与HELLP综合征孕妇继发AKI相关，但不是AKI发生的预测因素。
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    肠系膜静脉血栓孕产妇7例临床分析及文献复习

    叶湘云麻希洋贺芳张楠...
    77-82页
    查看更多>>摘要：目的 分析肠系膜静脉血栓（MVT）孕产妇的临床特点及诊疗方法。 方法 回顾性分析2018年1月至2023年5月广州医科大学附属第三医院收治的7例发生MVT孕产妇的临床资料，包括一般情况、既往史、高危因素、发病时间、初步诊断、临床表现、辅助检查及治疗措施。 结果 （1）发病时间：7例MVT孕产妇中，1例发生于孕39+4周剖宫产术后1 d，1例发生于孕25+4周依沙吖啶羊膜腔内注射引产术后30 d，5例发生于妊娠期（妊娠早期3例，妊娠中期1例，妊娠晚期1例）。（2）临床表现及高危因素：7例MVT孕产妇均以急性腹痛为首发症状；4例被误诊为胃肠道疾病，4例存在血栓形成危险因素。（3）辅助检查：7例MVT孕产妇均因急腹症行血常规检查，其中，6例发病后白细胞计数升高；7例孕产妇D-二聚体水平均有升高。7例MVT孕产妇腹部增强CT或CT血管造影（CTA）检查均提示肠系膜静脉血栓形成。（4）治疗及结局：7例MVT孕产妇均行抗凝治疗。5例发病时间为妊娠期的MVT孕妇中，1例因“急腹症”行剖宫产+腹腔探查术，术中腹腔探查未发现肠管异常；1例因“放弃胎儿、二次剖宫产术后”行剖宫取胎+腹腔探查术；2例选择人工流产终止妊娠；1例发生不全流产并清宫。7例孕产妇均好转出院，无手术相关并发症及死亡。 结论 孕产妇是发生MVT的高危人群，起病隐匿，容易误诊和漏诊，死亡率高，产科医师应加强对该疾病的认识，早期识别和早期诊断至关重要。
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