产科手术学（原书第4版）
产科手术学（原书第4版）
刘俊涛，男，临床医学博士，北京协和医院妇产科学系副主任、产科中心主任，主任医师，博士研究生导师，全国产前诊断技术专家组成员。主要研究方向为产前诊断与母胎医学，对产科手术具有丰富的临床经验。兼任中华医学会围产医学分会常委，中国优生科学协会副会长，北京医学会围产医学分会副主委，中国医师协会遗传医师分会产前诊断专委会主任委员等职务。1999—2000年，作为高级访问学者去往澳大利亚 Royal Women's Hospital工作。承担及参与、省部级课题共10余项，科研成果获国家医学科技奖二等奖。
周希亚，女，中国协和医科大学临床医学系医学博士，北京协和医院产科中心副主任医师，主要研究方向为母胎医学。兼任中华医学会儿科分会出生缺陷防治委员会委员，中国医师协会遗传分会产前诊断委员会委员，北京医学会围产医学分会委员，北京医学会早产与早产儿分会委员等。2011年于英国King's College Hospital胎儿医学研究中心学习。参与国家“十五”“十一五”科技攻关及科技支撑课题研究，主持国家自然科学基金项目1项。
第 1 章 前腹壁、子宫及盆腔器官的解剖
一、前腹壁 1
二、子宫 7
三、输卵管 14
四、卵巢 14
五、子宫的韧带 15
六、子宫的血管、淋巴和神经 15
七、输尿管的盆腔部分 17
八、膀胱和尿道 18
九、乙状结肠、直肠和肛管 19
十、妊娠期肥胖 19
第 2 章 _x005f 会阴、外阴、阴道的局部解剖
一、外阴 22
Clinical pelvimetry
Elaine K. Diegmann Rhonda Nichols
产力、胎儿和产道，是控制分娩过程的三大要素。骨盆的尺寸保持不变。了解骨盆的作用，记住基本骨盆类型、径线大小和分娩预后具有极为重要的意义，因为医务人员要决定分娩方式，这对母亲和婴儿的结局至关重要。因此，本章将重点关注骨性盆腔结构，这是对出生结局佳的预测因素。了解骨盆是否足够大是决定试产和计划阴道分娩的基本要素。
一、骨盆解剖
骨盆由两块髋骨（每块髋骨又进一步分为髂骨、坐骨和耻骨）、骶骨和尾骨组成（图 3-1）。
每块髋骨都有几个点具有产科意义。髂骨有骶骨坐骨大切迹，位于髂前下棘和坐骨棘之间。坐骨有坐骨棘，是骨盆小直径的标志 ；坐骨结节，位于坐骨的下缘 ；坐骨棘与坐骨结节之间是骶骨坐骨小切迹。正常骨盆的坐骨侧壁轻微内聚。
耻骨连接着两块髋骨，形成前面的耻骨联合，其下缘是耻骨弓的。耻骨降支形成了耻骨弓的侧壁，耻骨弓具有重要的解剖意义，它的角度是能否成功阴道分娩的一个重要预测因素。
骶骨组成了骨盆后方的界限。它有 5 块融合的椎骨，其角度和倾斜度有助于预测出生结局。骶岬是第 1 骶椎的前表面。它是具有重要产科意义的骨盆标志点。
尾骨由 4 块退化的椎骨组成，形成“尾巴骨”，与骶骨连接。
有 4 个关节连接着盆骨。在两侧，骶髂关节将骶骨和两侧髋骨的髂骨部分相连接。在前面，耻骨联合连接着髋骨的耻骨部分。在后面，骶尾关节连接着骶骨和尾骨。骶棘韧带跨过骶骨尾骨大切迹，它起自第5 骶椎和第 1 尾椎的连接处，止于坐骨棘。骶骨坐骨大切迹是决定后骨盆腔容量的标志。骶结节韧带向后附着于第 3、4、5 骶椎，向前附着于坐骨结节。这两条韧带形成了阴部管（Alcock’s canal）的侧壁，阴部神经从此经过。
二、产科骨盆
骨盆分为假骨盆和真骨盆。骨盆界限，也称为髂耻线，是划分两者的结构边界。假骨盆
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Estimates: Standard shipping within the US typically takes 3-7 business days. These are estimates and not guarantees.
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You will receive a shipping confirmation email with a tracking number as soon as your order is dispatched. If you do not receive this email immediately, please be assured that your items will arrive within the estimated delivery window provided at checkout.
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If you need to cancel or modify your order, please contact our customer support immediately.
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If your order shows as delivered but you have not received it, please contact the shipping carrier directly to resolve the issue. For persistent problems, contact our customer service at cs@everymarket.com.
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Initiating a Return: Contact us at cs@everymarket.com to start your return. We will provide a return shipping label and instructions upon approval. Returns without prior approval will not be accepted.
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Defective Products: Return labels are provided for defective items.
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Product Conditions for Return
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Eligible Products: Returns are only accepted for items in new condition.
Nonreturnable Items
Certain items are not eligible for return:
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Electronic devices after 30 days (e.g., computers, laptops, Kindles)
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Gift cards, prepaid game cards
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Perishable goods, live insects, some jewelry, some health and personal care items
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Customized or personalized products
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Items with special shipping restrictions
Refund Policy
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Window: Eligible products may be returned within 30 days of delivery for a refund.
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Refund Method: Refunds are processed to the original payment method or as store credit for items purchased with gift cards.
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Processing Time: Refunds are processed within 3-5 business days after we receive the return; please allow additional time for shipping and bank processing.
Claims
Inspect your order upon arrival and report any defects, damages, or incorrect items immediately to allow us to address the issue. For claims, contact our support team with details of the issue.
Exchange Policy
For the quickest service, return your original item and place a new order for the desired product once your return is accepted.
Return Address
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Customer Support
Available 24/7 for any questions or assistance needed:
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Phone: +1 636-312-5925
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Email: cs@everymarket.com
刘俊涛，男，临床医学博士，北京协和医院妇产科学系副主任、产科中心主任，主任医师，博士研究生导师，全国产前诊断技术专家组成员。主要研究方向为产前诊断与母胎医学，对产科手术具有丰富的临床经验。兼任中华医学会围产医学分会常委，中国优生科学协会副会长，北京医学会围产医学分会副主委，中国医师协会遗传医师分会产前诊断专委会主任委员等职务。1999—2000年，作为高级访问学者去往澳大利亚 Royal Women's Hospital工作。承担及参与、省部级课题共10余项，科研成果获国家医学科技奖二等奖。
周希亚，女，中国协和医科大学临床医学系医学博士，北京协和医院产科中心副主任医师，主要研究方向为母胎医学。兼任中华医学会儿科分会出生缺陷防治委员会委员，中国医师协会遗传分会产前诊断委员会委员，北京医学会围产医学分会委员，北京医学会早产与早产儿分会委员等。2011年于英国King's College Hospital胎儿医学研究中心学习。参与国家“十五”“十一五”科技攻关及科技支撑课题研究，主持国家自然科学基金项目1项。
第 1 章 前腹壁、子宫及盆腔器官的解剖
一、前腹壁 1
二、子宫 7
三、输卵管 14
四、卵巢 14
五、子宫的韧带 15
六、子宫的血管、淋巴和神经 15
七、输尿管的盆腔部分 17
八、膀胱和尿道 18
九、乙状结肠、直肠和肛管 19
十、妊娠期肥胖 19
第 2 章 _x005f 会阴、外阴、阴道的局部解剖
一、外阴 22
Clinical pelvimetry
Elaine K. Diegmann Rhonda Nichols
产力、胎儿和产道，是控制分娩过程的三大要素。骨盆的尺寸保持不变。了解骨盆的作用，记住基本骨盆类型、径线大小和分娩预后具有极为重要的意义，因为医务人员要决定分娩方式，这对母亲和婴儿的结局至关重要。因此，本章将重点关注骨性盆腔结构，这是对出生结局佳的预测因素。了解骨盆是否足够大是决定试产和计划阴道分娩的基本要素。
一、骨盆解剖
骨盆由两块髋骨（每块髋骨又进一步分为髂骨、坐骨和耻骨）、骶骨和尾骨组成（图 3-1）。
每块髋骨都有几个点具有产科意义。髂骨有骶骨坐骨大切迹，位于髂前下棘和坐骨棘之间。坐骨有坐骨棘，是骨盆小直径的标志 ；坐骨结节，位于坐骨的下缘 ；坐骨棘与坐骨结节之间是骶骨坐骨小切迹。正常骨盆的坐骨侧壁轻微内聚。
耻骨连接着两块髋骨，形成前面的耻骨联合，其下缘是耻骨弓的。耻骨降支形成了耻骨弓的侧壁，耻骨弓具有重要的解剖意义，它的角度是能否成功阴道分娩的一个重要预测因素。
骶骨组成了骨盆后方的界限。它有 5 块融合的椎骨，其角度和倾斜度有助于预测出生结局。骶岬是第 1 骶椎的前表面。它是具有重要产科意义的骨盆标志点。
尾骨由 4 块退化的椎骨组成，形成“尾巴骨”，与骶骨连接。
有 4 个关节连接着盆骨。在两侧，骶髂关节将骶骨和两侧髋骨的髂骨部分相连接。在前面，耻骨联合连接着髋骨的耻骨部分。在后面，骶尾关节连接着骶骨和尾骨。骶棘韧带跨过骶骨尾骨大切迹，它起自第5 骶椎和第 1 尾椎的连接处，止于坐骨棘。骶骨坐骨大切迹是决定后骨盆腔容量的标志。骶结节韧带向后附着于第 3、4、5 骶椎，向前附着于坐骨结节。这两条韧带形成了阴部管（Alcock’s canal）的侧壁，阴部神经从此经过。
二、产科骨盆
骨盆分为假骨盆和真骨盆。骨盆界限，也称为髂耻线，是划分两者的结构边界。假骨盆
Shipping Overview:
• Shipping: Standard Domestic Shipping within the United States charges USD 4.99. Standard International Shipping from United Kingdom and Germany to the United States charges 14.99.
• Order Processing: Please allow 1-2 business days for order processing and preparation before shipment.
• Domestic Shipping: Orders within the U.S. are shipped via USPS or FedEx, depending on the origin of the product. The average transit time is 3-7 business days.
• International Shipping: Currently, we only ship within the USA.
• Tracking Information: Every order is trackable. You will receive a tracking number once your order has been shipped. Products may be shipped from various global fulfillment centers.
Shipping Delays:
Please note that shipping times may vary due to factors beyond our control, such as weather conditions, natural disasters, or peak holiday periods. While we strive to ensure timely delivery, the exact arrival time cannot be guaranteed and is managed by the shipping carrier.
Shipping Options:
-
Standard Delivery: Most orders are shipped within 3-7 business days. Larger items may utilize LTL shipping for safe handling.
-
Handling Time: We handle shipments on business days (Monday - Friday), with a preparation time of 1-2 days.
-
Additional Charges: Some items require additional shipping charges due to their size, weight, or special handling. These charges are specified on the product pages and are not eligible for shipping discounts.
-
Exclusions: Gift cards, packaging, taxes, and prior purchases do not count toward the minimum purchase requirement for free shipping. This offer is valid only for shipments to U.S. addresses, including Puerto Rico.
Delivery Details:
-
Estimates: Standard shipping within the US typically takes 3-7 business days. These are estimates and not guarantees.
-
Shipping Restrictions: We ship to all 50 states, Washington, DC, U.S. territories, and APO/FPO/DPO addresses. Shipping options vary based on the delivery address.
-
Remote Areas: Shipments to remote areas may incur additional charges or require pickup from a nearby shipping partner’s location.
Shipping Confirmation:
You will receive a shipping confirmation email with a tracking number as soon as your order is dispatched. If you do not receive this email immediately, please be assured that your items will arrive within the estimated delivery window provided at checkout.
Order Modifications:
If you need to cancel or modify your order, please contact our customer support immediately.
Issues with Delivery:
If your order shows as delivered but you have not received it, please contact the shipping carrier directly to resolve the issue. For persistent problems, contact our customer service at cs@everymarket.com.
Customer Support:
Our team is available 24/7 to assist you with any questions or concerns regarding your order. We are committed to ensuring a smooth shopping experience.
Return & Refund Policy Overview
Please review our return and refund policies below to ensure a smooth transaction process.
Return Policy
-
Duration: You have 30 days from receiving your item to initiate a return.
-
Condition: Items must be unworn, unwashed, with original tags and packaging intact.
-
Shipping Costs: Customers are responsible for return shipping costs.
-
Packaging: Ensure returned items are well-packaged to avoid damage during transit.
-
Tracking: Use a trackable and insured shipping method as we are not liable for items lost or damaged on return.
-
Initiating a Return: Contact us at cs@everymarket.com to start your return. We will provide a return shipping label and instructions upon approval. Returns without prior approval will not be accepted.
How to Return
-
Method: Returns must be sent back by mail to the address provided in the return instructions.
Return Label
-
Defective Products: Return labels are provided for defective items.
-
Non-Defective Returns: Customers are responsible for obtaining their return shipping label.
Product Conditions for Return
-
Eligible Products: Returns are only accepted for items in new condition.
Nonreturnable Items
Certain items are not eligible for return:
-
Electronic devices after 30 days (e.g., computers, laptops, Kindles)
-
Gift cards, prepaid game cards
-
Perishable goods, live insects, some jewelry, some health and personal care items
-
Customized or personalized products
-
Items with special shipping restrictions
Refund Policy
-
Window: Eligible products may be returned within 30 days of delivery for a refund.
-
Refund Method: Refunds are processed to the original payment method or as store credit for items purchased with gift cards.
-
Processing Time: Refunds are processed within 3-5 business days after we receive the return; please allow additional time for shipping and bank processing.
Claims
Inspect your order upon arrival and report any defects, damages, or incorrect items immediately to allow us to address the issue. For claims, contact our support team with details of the issue.
Exchange Policy
For the quickest service, return your original item and place a new order for the desired product once your return is accepted.
Return Address
EveryMarket Customer Service 2101 E Terra Ln, O'Fallon, MO 63366
Customer Support
Available 24/7 for any questions or assistance needed:
-
Phone: +1 636-312-5925
-
Email: cs@everymarket.com
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