產科手術學(原書第4版)（簡體書）

母胎醫學是一門致力於母嬰健康、減少出生缺陷、提高出生人口素質的新學科，其從醫學角度將母體與胎兒置於同等地位。近10年來，歐美的母胎醫學已獲得了長足的發展，而在亞洲的發展還處在起步階段。本書是引自美國CRC出版社的高質量母胎醫學著作，由來自全球40餘家醫(學)院的80餘位母胎醫學專家聯袂編寫。歷經20餘年的不懈修訂，全新第4版對母胎醫學的發展現狀及治療趨勢進行了全面描述，並細緻闡述了盆腹腔解剖、正常分娩、助產技術、剖宮產、多胎分娩、產科麻醉等專業內容，深入講解了子宮瘢痕妊娠、妊娠期婦科腫瘤、外科併發症的處理技巧，詳細展示了介入性產前診斷操作技術、宮內微創胎兒治療、開放性胎兒手術等母胎醫學領域的新進展。

目 錄第 1 章 前腹壁、子宮及盆腔器官的解剖一、前腹壁······························· 1二、子宮································· 7三、輸卵管······························ 14四、卵巢································ 14五、子宮的韌帶·························· 15六、子宮的血管、淋巴和神經·············· 15七、輸尿管的盆腔部分···················· 17八、膀胱和尿道·························· 18九、乙狀結腸、直腸和肛管················ 19十、妊娠期肥胖·························· 19第 2 章 _x005f會陰、外陰、陰道的局部解剖一、外陰································ 22二、會陰································ 24三、陰道································ 26第 3 章 臨床骨盆測量一、骨盆解剖···························· 28二、產科骨盆···························· 29三、骨盆形狀···························· 30四、臨床骨盆測量························ 31第 4 章 孕早期胚胎胎兒鏡一、概述································ 34二、歷史································ 34三、技術································ 35四、應用································ 36五、倫理問題···························· 40六、總結································ 40第 5 章 絨毛膜取樣一、概述································ 43二、取樣過程···························· 44三、CVS 的實驗室部分 ··················· 47四、CVS 的安全性 ······················· 47五、CVS 的準確性 ······················· 51六、開展 CVS 項目······················· 52七、CVS 的接受度 ······················· 53第 6 章 羊膜腔穿刺一、概述································ 57二、羊膜腔穿刺在遺傳學檢查中的應用······ 57三、胎肺成熟度檢測······················ 59四、同種免疫···························· 59五、羊膜腔穿刺技術······················ 59六、多胎妊娠的羊膜腔穿刺················ 61七、羊膜腔穿刺的併發症·················· 62八、總結································ 62第 7 章 胎兒宮內輸血一、胎兒貧血的病因······················ 65二、總結································ 83第 8 章 減胎及選擇性減胎一、概述································ 87二、總結································ 98第 9 章 自然流產和人工流產一、流產的定義及臨床表現··············· 101二、發生率····························· 103三、病因······························· 103四、病理······························· 105五、診斷······························· 106六、治療······························· 107七、孕早期的手術治療··················· 108八、擴宮和刮宮法進行清宮··············· 110九、負壓吸宮術（擴宮和清宮）············ 111十、藥物流產··························· 112十一、稽留流產的處理··················· 113十二、自然流產的預防··················· 116十三、中期引產························· 117十四、關於妊娠結局的臨床決策··········· 120十五、多胎妊娠的選擇性減胎············· 121十六、胚胎病理和胎兒病理··············· 122十七、流產後諮詢······················· 123第 10 章 經皮宮內胎兒分流一、胎兒下尿路梗阻····················· 127二、胎兒膀胱出口梗阻的病理生理········· 128三、胎兒膀胱出口梗阻的篩查和診斷評估··· 130四、下尿路梗阻的干預技術··············· 130五、下尿路梗阻分流治療的小結··········· 133六、胸腔疾病進行宮內分流的簡介········· 133七、先天性肺氣道畸形··················· 136八、對先天性肺氣道畸形胎兒進行分流治療的選擇標準····················· 137九、胸腔穿刺和胸腔羊膜腔分流技術······· 137十、總結······························· 139十一、結論····························· 139第 11 章 臍血管穿刺術一、概述······························· 141二、方法······························· 141三、臍血管穿刺術的主要併發症和風險因素······························· 143四、臍血管穿刺術的適應證和應用········· 145第 12 章 微創胎兒手術――Colorado 途徑一、概述······························· 154二、結構畸形的胎兒鏡治療··············· 154三、單絨毛膜雙胎併發症的胎兒鏡治療····· 161四、雙胎輸血綜合征····················· 162五、胎兒內鏡手術的併發症··············· 164六、總結······························· 165第 13 章 胎兒手術――Texas 兒童胎兒中心方法一、胎兒手術簡史······················· 168二、開放性胎兒手術及其併發症··········· 169三、開放性胎兒手術治療的疾病··········· 171四、胎兒鏡手術 ：Texas 方法及併發症····· 174五、胎兒鏡治療的疾病··················· 175六、超聲引導下的胎兒干預措施 ：技術和併發症····························· 178七、超聲引導下的胎兒干預措施治療的疾病······························· 179八、子宮外產時治療····················· 182九、胎兒手術的未來····················· 182第 14 章 宮頸功能不全一、宮頸功能不全定義··················· 186二、發病率····························· 186三、人類宮頸的解剖和生理··············· 187四、可能病因與相關因素················· 187五、診斷方法··························· 187六、處理······························· 190七、結論······························· 200第 15 章 晚期異位妊娠一、腹腔妊娠··························· 205二、輸卵管妊娠························· 205三、宮頸妊娠··························· 205四、卵巢妊娠··························· 206五、韌帶內妊娠························· 206六、殘角子宮妊娠······················· 207七、診斷性評估························· 207八、治療······························· 210九、結論······························· 212第 16 章 胎兒畸形情況下剖宮產的使用一、概述······························· 215二、致死性畸形························· 215三、非致死性畸形······················· 217四、其他考慮··························· 221五、總結······························· 221第 17 章 死胎的評估和管理一、死胎的診斷························· 223二、死胎的評估························· 224三、死胎的處理························· 227四、胎死宮內的情感問題················· 229五、總結······························· 230第 18 章 產前出血一、胎盤早剝··························· 232二、前置胎盤··························· 236三、胎盤粘連、植入和穿透··············· 237四、前置血管與臍帶帆狀附著············· 239五、絨毛膜外胎盤······················· 239第 19 章 產時胎心監護一、概述······························· 243二、病理生理··························· 244三、間斷的胎心率監護··················· 244四、連續的電子胎心率監護··············· 244五、電子胎心率監護指南的解讀··········· 245六、胎心率模式的不同組成部分的重要性··· 245七、胎心率模式的分類和它們的解讀與管理······························· 249八、Ⅱ類胎心率模式的管理··············· 249九、胎心率模式在產程中的變化··············· 250十、胎兒感染和胎心率模式··············· 251十一、胎兒頭皮血取樣··················· 253十二、胎兒頭皮刺激····················· 253十三、特殊情況························· 253十四、新技術 ：胎兒心電圖 ST 段的分析 ····255十五、臍帶血酸堿狀態··················· 256十六、持續胎心率監護對分娩結局的影響··· 256第 20 章 正常陰道分娩一、胎頭分娩··························· 261二、胎體娩出··························· 262三、斷臍······························· 262四、胎盤娩出··························· 263五、縮宮素的應用······················· 264六、胎盤滯留的處理····················· 265七、第四產程的處理····················· 265八、會陰切開術的應用··················· 266九、會陰切開技術······················· 266十、會陰切開的併發症··················· 266十一、會陰切開的縫合··················· 266十二、胎頭先露異常的分娩··············· 268十三、胎頭旋轉不良····················· 268十四、早產兒的陰道分娩················· 269第 21 章 肩難產一、定義······························· 271二、發病率····························· 271三、發病因素··························· 272四、預測與預防························· 272五、處理······························· 273六、主要手法··························· 274七、怎樣實施主要手法··················· 276八、培訓 ：模擬和演練··················· 276九、併發症····························· 276十、記錄和報告························· 277十一、總結····························· 277第 22 章 產後出血一、定義與分類························· 280二、危險因素與預防····················· 281三、診斷······························· 281四、處理的一般原則····················· 282五、第三產程的處理····················· 283六、子宮收縮乏力······················· 284七、胎盤殘留··························· 285八、手取胎盤··························· 285九、胎盤粘連、胎盤植入與胎盤穿透性植入······························· 286十、其他病因··························· 287十一、血管造影栓塞術··················· 287十二、主動脈壓迫······················· 288十三、抗休克褲························· 288十四、手術治療························· 289十五、子宮動脈結紮····················· 289十六、髂內動脈結紮····················· 290十七、卵巢動脈結紮····················· 292十八、B-Lynch 縫合 ···················· 292十九、圍生期子宮切除術················· 293二十、子宮破裂························· 294二十一、凝血功能障礙性疾病············· 294二十二、藥物治療······················· 294二十三、失血及血液補充················· 295二十四、遲發性產後出血················· 296第 23 章 產鉗助產一、產鉗助產的簡要發展史··············· 304二、產鉗的分類························· 305三、產鉗助產的傳統分類················· 306四、產鉗助產的現代分類················· 307五、產鉗助產的適應證··················· 308六、產鉗助產需要的輔助條件············· 308七、產鉗助產的操作過程················· 308八、產鉗助產的現狀和觀點··············· 317第 24 章 胎頭吸引器陰道助產一、歷史······························· 321二、胎頭吸引器的組成部分··············· 322三、胎頭吸引器的使用··················· 324四、胎頭吸引器的使用指征，適應證和禁忌證····························· 324五、技術和手法························· 325六、後置杯頭的吸引器使用標準流程······· 329七、牽引力和牽引時長··················· 330八、特殊情況··························· 330九、超聲和器械助產····················· 331十、硬膜外鎮痛和器械助產··············· 331十一、產婦損傷和發病率················· 333十二、新生兒損傷和發病率··············· 334十三、培訓····························· 335十四、胎頭吸引助產須謹記的十條規則····· 336第 25 章 胎先露異常一、臀先露····························· 340二、處理原則··························· 341三、臀位分娩··························· 342四、胎頭嵌頓··························· 346五、完全臀牽引術······················· 346六、內倒轉術··························· 346七、外倒轉術··························· 347八、總體考慮··························· 348九、橫產式····························· 349第 26 章 雙胎和多胎分娩一、對所有雙胎實施剖宮產··············· 353二、雙胎經陰道分娩····················· 354三、與多胎分娩相關的特殊情況·············358四、結語······························· 362第 27 章 母體產傷一、操作······························· 366二、會陰和外陰損傷····················· 367三、陰道裂傷··························· 370四、宮頸裂傷··························· 371五、子宮破裂··························· 372六、早期其他損傷······················· 375第28 章 產後子宮內翻一、分類······························· 382二、發生率····························· 382三、流行病學··························· 383四、病因······························· 383五、病理生理··························· 383六、死亡率····························· 383七、預防······························· 383八、診斷······························· 385九、治療······························· 385十、復發······························· 389第 29 章 傷口縫合與引流一、正常傷口癒合······················· 392二、不癒合傷口························· 393三、傷口癒合的類型····················· 394四、縫合材料··························· 394五、打結······························· 397六、縫針······························· 397七、引流······························· 398八、產科手術器械······················· 398第 30 章 剖宮產一、剖宮產適應證······················· 403二、剖宮產後陰道試產的人選············· 406三、剖宮產切口的類型··················· 407四、與剖宮產技術相關的併發症··············· 413五、手術併發症························· 418六、術後過程和管理····················· 420七、術後併發症························· 420八、死後剖宮產························· 421第 31 章 手術部位感染的預防一、手術服····························· 424二、圍術期干預························· 426三、手術室環境························· 430四、標準預防措施······················· 431五、圍術期預防性抗生素················· 432六、抗生素預防性用於其他產科操作······· 434七、妊娠期肥胖························· 435第 32 章 剖宮產瘢痕妊娠一、概述······························· 439二、剖宮產瘢痕的背景和情況············· 439三、剖宮產瘢痕妊娠的超聲診斷和鑒別診斷··························· 442四、CSP 的結局和自然病程 ·············· 444五、治療方式的選擇····················· 448六、處理方案與患者決策················· 449七、進一步治療························· 452八、再次妊娠··························· 452九、雙胎 CSP 的難題···················· 453十、總結······························· 453第 33 章 產科麻醉一、宮頸環紮術························· 456二、普通外科手術······················· 458三、分娩鎮痛··························· 459四、剖宮產····························· 462五、剖宮產術後的疼痛管理··············· 463六、特別關注··························· 464七、總結······························· 465第 34 章 妊娠期心臟監測一、概述······························· 467二、孕期心血管系統的生理性改變····················467三、孕期心臟的無創監測················· 467四、孕期心臟的有創監測················· 469五、特殊病情及血流動力學評估··············· 472六、心臟有創監測的風險················· 476七、新的監測方法······················· 477八、多學科協作························· 477第 35 章 孕期創傷一、概述······························· 480二、流行病學··························· 480三、對急性創傷孕婦的評估與處理········· 481四、院前階段··························· 482五、初步監測··························· 482六、氣道和呼吸························· 482七、循環······························· 483八、殘疾······························· 483九、暴露······························· 483十、進一步監測························· 483十一、評估胎母出血····················· 485十二、凝血和創傷······················· 485十三、孕期影像學檢查方法及特殊考慮····· 486十四、孕期非產科手術··················· 487十五、心臟停搏························· 487第 36 章 孕期手術一、闌尾炎····························· 490二、膽道疾病··························· 491三、胰腺炎····························· 491四、腸梗阻····························· 492五、腹腔內出血························· 492六、炎性腸病··························· 492七、深靜脈血栓························· 493八、妊娠患者的影像學檢查··············· 493九、妊娠相關的腫瘤及相關內分泌問題····· 494十、產後乳房腫物的診斷和治療··············· 494十一、診斷····························· 495十二、治療前分期······················· 495十三、治療····························· 495十四、乳腺癌倖存者的後續妊娠··············· 496十五、黑色素瘤························· 496十六、淋巴瘤··························· 497十七、內分泌腫瘤······················· 499第 37 章 妊娠期泌尿系統併發症一、妊娠期生理變化····················· 504二、泌尿系統感染和腎盂腎炎············· 505三、妊娠期腎結石······················· 506四、腎盂輸尿管積水和自發性腎破裂······· 508五、既往膀胱擴大術或尿道改流術後······· 508六、泌尿系統惡性腫瘤··················· 508七、尿路損傷··························· 509第 38 章 妊娠期女性生殖系統惡性腫瘤和癌前 病變的管理一、宮頸浸潤前病變····················· 514二、宮頸浸潤癌························· 516三、附件腫瘤和卵巢癌··················· 521四、結論······························· 523第 39 章 妊娠滋養細胞疾病一、流行病學··························· 527二、葡萄胎的發病機制與分類············· 528三、臨床表現··························· 529四、診斷······························· 530五、妊娠滋養細胞疾病的併發症··········· 531六、葡萄胎的治療與隨訪················· 532七、妊娠滋養細胞腫瘤的治療············· 534八、化療······························· 535第 40 章 患者安全一、概述······························· 539二、醫療過失··························· 540三、關注患者安全的倡議················· 542四、安全文化··························· 544五、報告和衡量安全····················· 545六、其他······························· 546