Do you know what are the common surgical diseases of women and children? In order to facilitate everyone to know more about the common clinical diseases of women and children surgery. The following is my understanding of the common clinical diseases of women and children surgery. Welcome to reading.
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(1) Maternal mortality rate: The maternal mortality rate in China is 94.7/65438+ 10,000, and there are about 20,000 maternal deaths every year. According to WHO, there are about 500,000 maternal deaths worldwide every year, and the maternal mortality rate in developing countries is 200 times higher than that in developed countries. (Note: It refers to the number of deaths per 654.38 million pregnant women caused by any pregnancy-related diseases or diseases with aggravated pregnancy management within 42 days after delivery. )
(2) perinatal mortality rate: perinatal mortality rate includes perinatal stillbirth, stillbirth and neonatal death. At the end of 1980s, the perinatal mortality rate in China was 9.8 ~ 49? , in the middle level of the world.
(3) Incidence rate of disabled children: refers to those who are not handled properly before and after delivery or have sequelae due to illness.
Fetal malformation accounts for about 3% of live births. There are about 5 million babies born with birth defects every year in the world, one every 5-6 minutes on average, and more than 85% of them occur in developing countries. The total number of children with congenital disabilities in China is as high as 800 ~ 654.38+200,000, accounting for 4% ~ 6% of the total population born in China. Severe deformity can lead to fetal/neonatal death or severe disability. The most common fetal malformations include: 2 1- trisomy syndrome, congenital heart disease, neural tube defect, cleft lip and palate, polydactyly and hydrocephalus.
An obstetric survey of 29 hospitals in Shanghai Maternal and Child Health Hospital (200 1) showed that the detection rate of syphilis during pregnancy was 3. 16? And Hainan (200 1) is 6.2? . The incidence of gonorrhea during pregnancy is about 1%~8%. The threats to the fetus are premature delivery and intrauterine infection, and the incidence of premature delivery is about 17%.
Maternal and child medicine has entered the era of fetal medicine.
Classical maternity and child medicine/before the 20th century;
Sign for: delivery. Obstetrics is the oldest medical specialty, and people can deliver babies before there is real medicine. However, compared with other clinical disciplines, the development of obstetrics is very slow. The main reason is that in the modern medical era, doctors engaged in other specialties are all medical graduates, and most of them are midwives who have not been qualified as midwives for a long time, which greatly hinders the development of obstetrics.
Modern maternal and child medicine/early 20th century ~ 1970s;
Signs: the appearance of midwives and obstetricians, cesarean section.
Modern maternal and child medicine/1970s ~ present;
The 1970s and 1990s were the formative period of perinatal medicine.
It marks the emergence of perinatal medicine, fetal monitoring, including electronic monitoring of fetal heart, biophysical score of B-ultrasound, biochemical monitoring of placental function, etc. Although in the era of perinatal medicine, the focus of attention is still on the safety of mothers and the reduction of maternal mortality, attention has been paid to fetuses and newborns, and cooperation with neonatology departments has been made to reduce perinatal mortality.
The growing period of perinatal medicine from 1990s to 265438+2000s.
It is an important part of perinatal medicine to make prenatal diagnosis and understand the health status of fetus in uterus. It is an important part of eugenics to diagnose the fetus in the uterus with some special examination methods in order to take measures to avoid the birth of sick and disabled children as soon as possible and improve the quality of the birth population.
2 10 ~ now is the maturity of perinatal medicine.
It marks the intrauterine treatment and focus of fetal medicine, including fetal diseases, from birth defects to all diseases that affect fetal intrauterine safety, such as twins and multiple births, fetal intrauterine growth restriction, polyhydramnios and oligohydramnios.
In the past 30 years, the progress of world medicine is mainly reflected in the transformation of medical thinking, the integration of medical resources and the high application of new technologies and materials.
Eight medical advances:
1, fetal medicine.
2. Internet medical care and precision medical care.
3, minimally invasive technology, robotics, stem cell therapy technology, 3D printing technology, organ reconstruction technology.
Maternal and child surgery has promoted the development of maternal and child medicine.
From prenatal diagnosis to fetal medicine, signs are the focus of intrauterine treatment of fetal diseases. From birth defects to all diseases that affect fetal intrauterine safety, maternity and child surgery has promoted the development of maternity and child medicine.
Maternal and child surgery is a branch of surgery under the guidance of new medical thinking mode, based on traditional surgery, obstetrics and gynecology, pediatrics and other interdisciplinary subjects, in order to solve the surgical problems in maternal and child clinic and ensure the healthy development of maternal and child medicine. Specifically, it can be divided into three sub-majors:
(1) Fetal and Neonatal Surgery: Pay attention to related organ malformations that affect fetal growth and development.
(2) Pregnancy surgery: Pay attention to diseases related to maternal health and fetal development during pregnancy.
(3) Female surgery: Pay attention to diseases related to fertility and endocrine changes.
(1) Fetal and neonatal surgery
Fetal congenital malformation refers to the morphological defects of body organs or parts caused by abnormal internal development, also known as birth defects. The birth defect rate of human beings is very high, and the incidence rate abroad is about 15? The incidence of China is about l3.7? .
The Ministry of Health of China monitored 65,438+0,243,284 perinatal infants in China. The incidence of malformed infants was 65438 0.3%, of which neural tube malformation and cleft lip malformation were the highest.
(1) malformation of heart and brain organs
Congenital heart diseases, such as atrial/ventricular septal defect, tetralogy of Fallot, transposition of great vessels, double outlet of right ventricle, complete atrial/ventricular septal defect, pulmonary atresia, etc.
Abnormal lung development, such as cystadenoma and solitary lung.
Mediastinal diseases, such as mediastinal tumors and esophageal atresia.
Diaphragmatic dysplasia, such as esophageal hiatal hernia and congenital diaphragmatic hernia.
Congenital hydrocephalus, spinal cord and meningocele, tethered spine syndrome, cerebellar tonsil hernia malformation, premature closure of cranial suture and various congenital craniofacial malformations.
(2) Malformation of digestive tract
Intestinal malformations, such as duodenal atresia, annular pancreas, pyloric hypertrophy, congenital intestinal malrotation, intestinal atresia, biliary atresia, congenital megacolon, congenital anorectal malformation, etc.
Hepatobiliary malformations, such as choledochal cyst, biliary atresia, cholestasis, hepatic cyst, etc.
Abdominal wall defects, such as congenital gastroschisis, omphalocele, indirect inguinal hernia, umbilical hernia, abdominal wall hernia and other hernias;
Acute abdomen, such as acute intussusception, incarcerated hernia, acute appendicitis, acute intestinal obstruction, acute gastrointestinal bleeding, acute pancreatitis, abdominal trauma, etc.
(3) Malformation of urogenital system
Renal malformations, such as congenital hydronephrosis, duplication of kidney and ureter, nephroblastoma, polycystic kidney, etc.
Ureteral malformations, such as giant ureter malformation, ureteral stricture, ectopic ureter opening, etc.
Bladder malformations, such as neurogenic bladder, vesicoureteral reflux, bladder rhabdomyosarcoma, etc.
Urethral malformations, such as posterior urethral valve, urethral diverticulum, urinary incontinence, etc.
Genital malformations, such as hypospadias, cryptorchidism, concealed penis, hermaphroditism, etc.
(2) Pregnancy operation
(1) Common surgical diseases during pregnancy
Include acute appendicitis, cholecystitis, gallstones, pancreatitis, peritonitis, intestinal obstruction, gastroduodenal perforation, thrombotic external hemorrhoid, renal colic, ureteral obstruction, urinary tract infection, hematuria, pyelonephritis, ureteral calculi, urinary retention, deep vein thrombosis, thrombotic external hemorrhoid, etc.
(2) Acute abdomen during pregnancy
Pregnancy complicated with acute appendicitis: it is a common surgical disease during pregnancy. The incidence of acute appendicitis in pregnant women is 0. 1-2.9% abroad and 0. 1-2.95% at home. Acute appendicitis can occur in all stages of pregnancy, but most of them occur in the first 6 months of pregnancy. Pregnancy will not induce appendicitis, and the enlarged pregnant uterus will change the position of the appendix, which will increase the difficulty of diagnosis. In addition, appendicitis in pregnancy is prone to perforation and peritonitis, and its incidence rate is 1.5-3.5 times that of non-pregnancy
Pregnancy complicated with acute cholecystitis: it can occur in all stages of pregnancy, especially in the third trimester and puerperium, with an incidence rate of about 0.8? , second only to pregnancy complicated with appendicitis, higher than non-pregnancy, 50% ~ 70% of patients complicated with gallbladder stones.
Intestinal obstruction during pregnancy: rare, the incidence rate is 0.0 18%~0. 16%. Intestinal obstruction during pregnancy is a serious complication for both mother and fetus. Intestinal obstruction will not only cause changes in the anatomical structure and function of the intestine itself, but also lead to systemic physiological disorders. Due to the enlargement of uterus during pregnancy, intestinal obstruction is easy to delay diagnosis and operation, which leads to an increase in maternal and perinatal mortality. The maternal mortality rate is as high as 6%~ 16.6%, and the fetal mortality rate is 26%~44.40%.
(3) Pregnancy complicated with urinary tract obstruction
Urinary tract infection during pregnancy: The incidence of asymptomatic bacteriuria during pregnancy is 15%, which can sometimes develop into cystitis or pyelonephritis. Urinary tract infection, asymptomatic bacteriuria and pyelonephritis are related to premature delivery and premature rupture of membranes.
Pregnancy complicated with urinary calculi: the incidence rate is1/2500 ~11500. According to statistics, the premature delivery related to urinary calculi during pregnancy accounts for about 40% of the total premature delivery. Urethral orifice is the most common non-obstetric cause among pregnant women who need hospitalization for pain. Urinary septicemia caused by stone obstruction poses a serious threat to maternal and fetal development.
3) Female surgery
(1) general surgery
Common diseases: including thyroid tumor, nodular goiter, thyroid cancer, hyperthyroidism, breast fibroma, hyperplasia of mammary glands, breast cancer, cholecystitis, gallstones, constipation, anal fissure, hemorrhoids, deep venous thrombosis, varicose veins of lower limbs, etc.
Thyroid tumor: .65438+0% of all malignant tumors. The incidence of thyroid cancer in the United States is relatively high. According to statistics, from 1973 to 2002, the annual incidence of thyroid cancer in the United States increased from 3.6 per 100,000 to 8.7 per 100,000, an increase of about 2.4 times (P
Breast cancer: The incidence data of breast cancer in 2009 released by the National Cancer Center and the Bureau of Disease Control and Prevention of the Ministry of Health on 20 12 showed that the incidence rate of breast cancer in the national tumor registration area ranked 1, the total incidence rate of female breast cancer in China was 42.55/ 1, and that in cities was 5 1.
Constipation: it is a disease that constipation can't stop, defecation time is prolonged or defecation is difficult. Constipation can be temporary or long-term. Usually, chronic constipation is also called chronic constipation.
(2) Female Urology
Common diseases include urinary tract infection, pyelonephritis, ureteral calculi, bladder calculi, frequent micturition, urgency, dysuria, urinary incontinence, hematuria, leukoplakia of bladder, cystitis glandularis, interstitial cystitis, bladder cancer, urethral caruncle, paraurethral adenitis, urethral carcinoma, etc.
Interstitial cystitis is a disease that causes discomfort or pain around the bladder and pelvis. There are more female patients than male patients. It is estimated that there are more than 700,000 patients in the United States, 90% of whom are women.
Leukoplakia of bladder: it is a benign epithelial proliferative lesion, and its incidence is closely related to infection, obstruction and proliferative lesions of lower urinary tract. Some studies believe that leukoplakia of bladder is potentially malignant. Clinical statistics show that the malignant rate is 15% ~ 20%, and most of them are squamous cell carcinoma. Bladder leukoplakia can also coexist with bladder cancer, and the incidence rate is about 10% ~ 20%.
Urogenital fistula: The incidence of urinary organ injury in gynecological surgery is 0.32%. Bladder is the most common site of injury, and ureter is the most important site, which often leads to acute renal insufficiency (ARF), and can lead to multiple organ failure in severe cases. Severe cases can lead to rectal bladder (urethra) fistula.
Urinary incontinence: 23%-45% of the female population has different degrees of urinary incontinence, about 7% have obvious symptoms of urinary incontinence, and about 50% of them are stress urinary incontinence.
Bladder cancer: In 2002, the age-standardized incidence of bladder cancer in China was 3.8/65438+ 10,000 for males and 1.4/65438+ 10,000 for females. In recent years, cancer incidence reports in some cities in China show that the incidence of bladder cancer is on the rise. Urinary epithelial carcinoma accounts for more than 90% of bladder cancer, squamous cell carcinoma accounts for about 3% ~ 7% of bladder cancer, and the proportion of adenocarcinoma.
(3) Pelvic floor surgery
Common diseases: including low back pain, lower abdominal pain, perineal pain, pelvic pain, dysuria, urine leakage, defecation difficulty, urethral prolapse, bladder prolapse, uterine prolapse, vaginal prolapse, rectal prolapse, etc.
Chronic pelvic pain (CPP) refers to a multifactorial disease in which benign pelvic pain persists or recurs for more than 6 months, or recurs periodically for more than 3 months. Pain is related to negative cognition, behavior, sexual activity and emotion, accompanied by lower urinary tract symptoms and intestinal, pelvic floor, gynecological or sexual dysfunction. If there is no obvious infection of local pelvic organs and tissues or other pathological changes, CPP is called chronic pelvic pain syndrome (CPPS). 40% gynecological patients, 25% urological patients, 25% anorectal patients, 10% other patients; Among them, 20% patients have a history of surgery.
Urgency and frequent urination are two different concepts in diagnostics of traditional Chinese and western medicine. Urgency means that patients can't wait to urinate as soon as they have a sense of urination, which is difficult to control. Frequent urination is a symptom, not a disease. Due to various reasons, frequent urination can be increased, but there is no pain, also known as frequent urination.
Female pelvic floor dysfunction (FPFD) includes a group of diseases caused by defects or degeneration, injury and dysfunction of pelvic supporting structure. Pelvic organ prolapse, abnormal urination and defecation function, pelvic pain and genital tract injury are common problems for women. About 45% of married pregnant women in China have different degrees of pelvic floor dysfunction, which seriously affects the quality of life of women.
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