更新于：2024-11-01

Adenomyosis

子宫腺肌病

更新于：2024-11-01

基本信息

别名

ADENOMYOSIS、Adenomyoses、Adenomyosis

+ [44]

简介

The extension of endometrial tissue (ENDOMETRIUM) into the MYOMETRIUM. It usually occurs in women in their reproductive years and may result in a diffusely enlarged uterus with ectopic and benign endometrial glands and stroma.

关联

项与子宫腺肌病相关的药物

Ulipristal Acetate

醋酸乌利司他

靶点

作用机制

PR调节剂

在研机构

Laboratoire HRA Pharma SA [+2]

原研机构

HRA Pharma Development SARL

在研适应症

怀孕 [+1]

非在研适应症

异常子宫出血 [+8]

最高研发阶段批准上市

首次获批国家/地区

欧盟 [+3]

首次获批日期2009-05-15

Quinagolide Hydrochloride

盐酸喹高利特

靶点

D2 receptor

作用机制

D2 receptor激动剂

在研机构

原研机构

在研适应症

非在研适应症

最高研发阶段批准上市

首次获批国家/地区

南非

首次获批日期1997-09-24

Dienogest

地诺孕素

靶点

ER x PR

作用机制

ERs激动剂 [+1]

在研机构

Bayer HealthCare Pharmaceuticals, Inc. [+3]

原研机构

Bayer HealthCare Pharmaceuticals, Inc.

在研适应症

痛经 [+4]

非在研适应症-

最高研发阶段批准上市

首次获批国家/地区

德国

首次获批日期1991-12-11

278

项与子宫腺肌病相关的临床试验

IRCT20170612034489N2 / Suspended临床3期IIT

Effect of Melatonin on pelvic pain relief in women with endometriosis

开始日期2639-08-21

申办/合作机构

Islamic Azad University

NCT06652945 / Not yet recruitingN/AIIT

Efficacy of Uterine Artery Embolization (UAE) in Management of Symptomatic Uterine Adenomyosis

Aim of the work:
Evaluating the efficiency of uterine artery embolization as a minimally invasive method of treatment in management of symptomatic women with uterine adenomyosis

开始日期2025-03-01

申办/合作机构

Assiut University

NCT06663553 / Not yet recruitingN/AIIT

Protocol for a Comparative Study of the Efficacy of Transumbilical Laparoendoscopic Single-site Surgery (TU-LESS) and Transvaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES) in Hysterectomy Performed on Patients with Enlarged Uterus: a Prospective Single-blinded, Randomized Clinical Trial

Enlarged uterus is frequently encountered in clinical practice, and its incidence due to conditions such as adenomyosis, uterine fibroids, and other gynecological disorders has steadily increased over the years statistically. For example, greater healthcare awareness has led to more frequent early diagnoses of these conditions, contributing to the observed rise in incidence. Additionally, increasing life expectancy results in more women reaching the perimenopausal and postmenopausal stages, during which conditions like uterine fibroids and adenomyosis become more prevalent. For these women, hysterectomy (removal of the entire uterus) is often the recommended option of treatment.
With advances in surgical techniques over recent decades, there has been a notable shift from traditional open abdominal surgeries to minimally invasive approaches. Laparoscopic surgery has been widely adopted, significantly reducing the size and number of incisions required, thereby promoting faster recovery, minimizing postoperative pain, and reducing the risk of complications.
However, conventional multi-port laparoscopic hysterectomy still presents certain challenges, such as large uterus extraction following resection, and concerns about healing of incisions. In contrast, innovative techniques like Transumbilical Laparoendoscopic Single-Site Surgery(TU-LESS) and Transvaginal Natural Orifice Transluminal Endoscopic Surgery(vNOTES) both take advantage of natural anatomical openings to achieve minimal or no visible scarring. Studies demonstrate that these techniques provide superior outcomes in terms of reduced pain, faster recovery, and quicker return to daily activities compared to traditional multi-port laparoscopic approaches.
Yet a direct comparison of the efficacy of these two methods in real-world, particularly for enlarged uterus, remains inconclusive. Thus this study aims to evaluate and compare the outcomes of these two techniques in patients with enlarged uteri. Participants will be randomly assigned to receive one of the two surgical approaches, ensuring an unbiased comparison of the efficacy of the procedures in terms of healing status and recovery time.

开始日期2024-12-01

申办/合作机构

四川大学华西第二医院

100 项与子宫腺肌病相关的临床结果

登录后查看更多信息

100 项与子宫腺肌病相关的转化医学

登录后查看更多信息

0 项与子宫腺肌病相关的专利（医药）

登录后查看更多信息

4,077

项与子宫腺肌病相关的文献（医药）

2025-01-01·Radiology Case Reports

Delayed diagnosis of Herlyn-Werner-Wunderlich syndrome with diffuse adenomyosis in bilateral horns

Article

作者: Silwal, Prabhat ; Paudel, Mukesh ; Sharma, Saroj ; Adhikari, Roshna ; Thapa, Sachchu

The Herlyn-Werner-Wunderlich syndrome is a rare congenital disorder with uterus didelphys, unilateral obstructed hemivagina and ipsilateral renal agenesis, more common on right side. HWW syndrome usually presents at puberty with symptoms like pelvic pain, dysmenorrhea and palpable mass due to the associated hematocolpos or hematometra. Delayed presentation in adulthood as infertility can occur in case of incomplete vaginal septum. Short term complications like pyohematocolpos, pyosalpinx, or pelviperitonitis, and long-term complications, such as endometriosis, increased risk of abortion and infertility can occur. Ultrasound is the initial investigation which demonstrates uterine anomaly, renal agenesis and hematocolpos.Magnetic resonance imaging (MRI) is the imaging modality of choice which helps in confirmation of diagnosis, delineation of vaginal septum, communication between 2 cavities and associated pathologies like adenomyosis better.Vaginal septum resection is the treatment of choice for obstructed hemivagina with hematocolpos. We present you a case of 43 years female with cyclical dysmenorrhea starting few years after menarche with uterine didelphys, left sided vaginal septum with hematocolpos and left renal agenesis. Along with this, diffuse bilateral adenomyosis was present which is uncommonly associated with this anomaly as obstruction is at the level of vagina. Patient was diagnosed late due to misdiagnosis and later treated with septal resection for hematocolpos and with hormonal medications for adenomyosis.

2025-01-01·Biochimica et Biophysica Acta (BBA) - Molecular Basis of Disease

Aberrant TCF21 upregulation in adenomyosis impairs endometrial decidualization by increasing PDE4C expression

Article

作者: Ouyang, Jing ; Li, Guojing ; Liu, Na ; Xu, Hong ; Wei, Chenxuan ; Yu, Ruoer ; Lin, Yu ; Gu, Nihao

BACKGROUNDImpaired decidualization is a major cause of infertility in patients with adenomyosis (AM). However, the effect of transcription factor 21 (TCF21) on AM and the underlying mechanism of associated-impaired decidualization remain unclear. The aim of this study was to investigate the expression of TCF21 in endometrial tissues of AM patients and the specific mechanisms by which it impairs the decidualization of human endometrial stromal cells (HESCs), with a view to improving the reproductive outcome of AM infertile patients.METHODSWe compared gene expressions via transcriptomics between the control and AM-associated recurrent implantation failure (RIF) groups. qRT-PCR, western blot, and IHC were performed to confirm the expression and location of TCF21 in the endometrium. Furthermore, we confirmed that high expression of TCF21 impairs decidualization by qRT-PCR, immunofluorescence, and western blot. RNA-seq following overexpression of TCF21 in HESCs was conducted to identify TCF21-related molecular changes during in vitro decidualization. Then we performed ChIP-seq/qPCR and dual-luciferase reporter assay to explore the exact interaction between TCF21 and PDE4C. The related downstream mechanisms were further proved using IHC, qRT-PCR, western blot, and ELISA.RESULTSAccording to the RNA-seq analysis, TCF21 expression was remarkably higher in the endometrium of the AM-related RIF group compared to the control group. We confirmed the same results using samples from patients with AM and controls. TCF21 overexpression in HESCs impaired decidualization through suppression of decidual markers and cytoskeleton alterations. The mechanistic analysis revealed that TCF21 inhibited intracellular cAMP levels by directly increasing PDE4C expression and suppressing FOXO1 expression.CONCLUSIONSTCF21 compromises decidualization in patients with AM via the PDE4C/cAMP-FOXO1 axis, which offers valuable insights on the pathology of decidualization-related infertility and indicates a potential treatment to improve endometrial receptivity in AM.

2024-12-31·Gynecological Endocrinology

Efficacy and uterine bleeding patterns in initiating goserelin therapy during different menstrual phases in patients with adenomyosis: a prospective cohort study

Article

作者: Sun, Hao ; Yan, Shumin ; Li, Dong ; Ming, Yuan ; Ren, Qianhui ; Wang, Xinyu ; Lin, Ying ; Jiao, Xue ; Wang, Guoyun ; Pan, Zangyu

OBJECTIVEWe carried out this study to explore the possibility of initiating goserelin therapy during the non-menstrual period in patients diagnosed with adenomyosis.METHODS115 premenopausal adenomyosis patients were enrolled and divided into three groups based on their menstrual cycle phase during the initial outpatient visit: menstrual, follicular, and luteal. Each received a 3.6 mg subcutaneous dose of goserelin monthly for three months. The endpoints encompassed alterations in uterine volume, dysmenorrhea Numerical Rating Scale (NRS) score, CA125 level, hemoglobin (HGB) after a 12-week treatment course, and the occurrence and duration of uterine hemorrhage during the first treatment cycle.RESULTSAnalysis revealed that the timing of goserelin therapy initiation in the menstrual cycle did not significantly impact its effectiveness in reducing uterine size, alleviating pain, lowering CA125 levels, or improving hemoglobin concentrations. However, patients starting treatment during the luteal phase experienced increased uterine bleeding (reference: menstrual period, OR = 4.33, 95% CI 1.23-15.25, p = .023).CONCLUSIONSThe results suggested non-inferiority of goserelin therapy initiated during the non-menstrual period, but the uterine bleeding rate was higher in the luteal phase group. Therefore, goserelin treatment for outpatient adenomyosis patients should not be limited to starting during the menstrual period; it can also be initiated outside the menstrual period, providing more convenience for patients as most consultations occur outside the menstrual period. However, the use of goserelin during the luteal phase should be avoided to reduce the risk of exacerbated bleeding, especially in anemic patients with heavy menstrual bleeding. This study highlights the importance of individualizing treatment initiation based on the patient's health profile to optimize therapeutic outcomes and minimize adverse effects.TRIAL REGISTRATIONChiCTR2200059548.

项与子宫腺肌病相关的新闻（医药）

2024-03-31

·生物谷

Protein & Cell｜车璇/高绍荣团队合作通过单细胞 RNA 测序结合空间转录组学技术破译人类子宫腺肌病的转录图谱

子宫腺肌症是一种慢性激素依赖性疾病，表现为子宫内膜异位生长于子宫肌层中，伴随着周围子宫平滑肌细胞的增生和肥大，导致子宫体积增大。这种状况影响大约20-35%的育龄期女性，主要临床症状包括继发性痛经、月经不规则、子宫增大和生育能力下降。子宫腺肌症的发病机制尚未明确，“内陷”与“化生”两种理论的争议持续存在。目前，由于缺乏有效的药物治疗，许多患者最终选择通过手术切除子宫来治疗，这严重影响了女性的身心健康。因此，深入探究子宫腺肌症的发病机制显得尤为重要。2024年3月15日，嘉兴大学附属妇儿医院的车璇教授团队与同济大学高绍荣教授团队在Protein & Cell在线发表研究论文“Comprehensive transcriptional atlas of human adenomyosis deciphered by the integration of single-cell RNA-sequencing and spatial transcriptomics”。该研究通过结合单细胞RNA测序和空间转录组学技术，全面揭示了子宫腺肌病的分子和空间特征，尤其是首次聚焦于子宫内膜肌层交界区。研究详细描述了异位内膜与在位子宫内膜之间的转录异质性，发现了病灶特异的上皮干细胞（LGR5+）亚群和侵袭性基质细胞亚群，以及子宫腺肌症的微环境特征。这项研究首次提出，子宫腺肌症的起源可能是“内陷”和“化生”理论的共同作用结果，这对于推进诊断和制定有针对性的治疗策略具有重要意义。研究团队收集了4名子宫切除患者（包括3名子宫腺肌病患者和1名子宫肌瘤患者）的15个子宫不同区域的组织样本。通过单细胞RNA测序和空间转录组分析，鉴定了15种细胞类型，揭示了子宫腺肌病子宫不同区域的细胞异质性，特别是子宫内膜肌层交界区的细胞亚群。研究发现，LGR5+细胞在子宫腺肌病病灶中的上皮细胞中显著富集，LGR5是已知的成体干细胞标记物，其在LGR5/WNT信号通路中的作用对于维持组织的正常生理功能至关重要。这一发现提示，LGR5+干/祖细胞上皮细胞可能是子宫腺肌症异位病变的关键参与者，而LGR5/WNT信号通路的激活可能是疾病进展的一个重要驱动因素。此外，研究还揭示了子宫腺肌症病灶中特定的PKIB+间质细胞亚群。这些细胞中PKIB基因的特异性高表达与细胞增殖和侵袭性行为有关，暗示这一亚群在疾病的侵袭性特征中可能起到促进作用。通过单细胞轨迹分析，研究人员进一步发现，WFDC1+间质前体细胞可能是PKIB+间质亚群的前体，在子宫腺肌症的发生和进展中起重要作用。研究还鉴定出7个内皮细胞亚群，观察到内皮细胞的异质性和涉及VEGF和ANGPT通路的异常血管生成信号，表明存在复杂的血管生成环境。最后，作者使用CellPhoneDB和CellChat分析发现病灶中的异位内膜和在位内膜之间的细胞间通信存在明显差异，在病变中涉及PTN、TWEAK和WNT级联的异常信号传导。总体而言，该研究通过单细胞RNA测序和空间转录组技术，绘制了子宫腺肌病子宫不同区域包括子宫内膜肌层交接区的转录图谱，揭示了病灶中独特的细胞亚群、功能异常的信号传导以及复杂的细胞相互作用，为制定精确的诊断和治疗策略提供了重要依据。陈涛、徐怡亮、徐小翠和王建章为论文共同第一作者。嘉兴大学附属妇儿医院车璇教授、同济大学高绍荣教授和吴丽副研究员为本文的共同通讯作者。原文链接：https://life.tongji.edu.cn/14/4f/c12615a332879/page.htm本文仅用于学术分享，转载请注明出处。若有侵权，请联系微信：bioonSir 删除或修改！

核酸药物

2023-03-06

·PRNewswire

SIR Foundation Receives Major Gift to Support Research Grants and Panel on Uterine Health

PHOENIX, March 6, 2023 /PRNewswire/ -- The Society of Interventional Radiology (SIR) Foundation announced a major gift from John Lipman, MD, FSIR, of Atlanta, that will propel uterine fibroid research forward. This gift will support four years of funding for SIR Foundation's newly announced Dr. Scott C. Goodwin Uterine Artery Embolization Grant and five years of funding for the Dr. James B. Spies Global Summit on Uterine Fibroid and Adenomyosis Research. The announcement was made at the SIR Foundation Gala on March 5 during the SIR 2023 Annual Scientific Meeting. The Dr. Scott C. Goodwin Uterine Artery Embolization Grant is focused on advancing uterine fibroid and uterine artery embolization research and will launch in October 2023. The first Dr. James B. Spies Global Summit on Uterine Fibroid and Adenomyosis Research will be hosted in June 2023. "Research into uterine fibroids and adenomyosis and the minimally invasive treatments that can address these conditions, such as uterine artery embolization, are invaluable in providing care to women," said SIR Foundation Board Chair Theresa M. Caridi, MD, FSIR. "We are incredibly grateful to Dr. Lipman for his personal commitment to advancing the future of interventional radiology for patients and our colleagues in all practice settings." Scott C. Goodwin, MD, FSIR, and James B. Spies, MD, FSIR, are highly regarded pioneers of uterine fibroid research, having led the SIR Foundation's Fibroid Registry, the largest collection of data on uterine fibroids, and conducted foundational research into uterine artery embolization. Dr. Goodwin and Dr. Spies are long-term members of the SIR, having each served as SIR president, as well as members of SIR Foundation's leadership. Dr. Lipman is a widely recognized expert on uterine fibroids and uterine fibroid embolization (UFE), having performed more than 10,000 UFE treatments throughout his career. Since 2015, he has served as founder and medical director of the Atlanta Fibroid Center, a renowned outpatient medical center treating patients from around Atlanta, the United States and world. In addition to his medical practice, Dr. Lipman is an active public speaker and advocate, delivering regular lectures and making media appearances to ensure more widespread knowledge about uterine fibroids among both medical and general audiences. "Dr. Goodwin and Dr. Spies have had a lasting and transformative impact on research into uterine fibroids and the safe and effective procedure of uterine artery embolization," said Dr. Lipman. "I am inspired by their decades-long service as physicians, researchers, educators and advocates, and grateful to have this opportunity to support ongoing research into this historically underfunded area of care afflicting historically underserved women in particular." About the Society of Interventional Radiology Foundation SIR Foundation fosters research and education in interventional radiology for the purposes of advancing scientific knowledge, increasing the number of skilled investigators in interventional radiology and developing innovative therapies that lead to improved patient care and quality of life. For more than 30 years, SIR Foundation has made grants and conducted research panels, driving research and innovation to build the future of interventional radiology and support promising interventional research. Visit sirfoundation.org. About the Society of Interventional Radiology The Society of Interventional Radiology is a nonprofit, professional medical society representing more than 8,000 practicing interventional radiology physicians, trainees, scientists and clinical associates, dedicated to improving patient care through the limitless potential of image-guided therapies. SIR's members work in a variety of settings and at different professional levels—from medical students and residents to university faculty and private practice physicians. Visit sirweb.org. The Society of Interventional Radiology is holding its Annual Scientific Meeting March 4–9, 2023, at the Phoenix Convention Center. Visit sirmeeting.org. SOURCE Society of Interventional Radiology Foundation

2022-07-01

·丁香园

主任提问：剖宫产抗菌药是在断脐后还是术前 30 分钟使用？

妇产科围手术期抗菌药物的预防使用，应根据手术切口类别、手术创伤程度、可能的污染细菌种类、手术持续时间、手术部位感染发生概率和后果严重程度、抗菌药物预防效果的循证医学证据以及对细菌耐药性的影响和经济学评估等因素，综合考虑是否需要预防使用抗菌药物。妇产科手术的可能污染菌及预防使用药物选择不同手术预防用药给药方案具体抗菌药物选择有循证医学证据的第一代头孢菌素为头孢唑林，故第一代头孢菌素首选头孢唑林；有循证医学证据的第二代头孢菌素为头孢呋辛，故第二代头孢菌素首选头孢呋辛。弥漫性子宫腺肌病剔除术/涉及肠道深部浸润性内异病灶切除术，手术部位深，涉及肠道，预防用药可选择第一、二代头孢菌素 ± 甲硝唑，或头霉素类，或头孢曲松 ± 甲硝唑。对于多西环素不可获得的地区，可考虑米诺环素替代；同理，甲硝唑不可获得时，可考虑替硝唑代替。由于磷霉素常作为多重耐药导致严重感染时联合用药的最后手段，以及氨曲南为特殊使用级管理，因此尽可能避免将该 2 种药物作为预防用药，而仅在必要时作为围术期预防用药的替代品种考虑。此外，考虑克林霉素与氨基糖苷类药物都具有神经肌肉阻滞和呼吸抑制作用，两者联用不推荐作为经阴道子宫切除术以及剖宫产术的替代方案。围术期预防性应用抗菌药物的给药时机静脉输注应在皮肤、黏膜切开前 0.5～1 h 内给药或麻醉开始时给药（注：万古霉素由于需输注较长时间，应在手术前 1～2 h 开始给药）。预防性使用抗菌药物推荐的成人用法用量一、二代头孢菌素（静脉滴注）：① 头孢唑啉 1～2 g，q 8 h，日剂量 ≤ 6 g；② 头孢呋辛 0.75～1.5 g，q 8 h，日剂量 ≤ 9 g第三代头孢菌素（静脉滴注）：头孢曲松 1～2 g，q 24 h，日剂量 ≤ 4 g。其他（静脉滴注）：① 万古霉素 1 g·次，q 12 h；② 克林霉素 0.6～0.9 g，q 8～12 h；③ 庆大霉素：5 mg/kg，qd；④ 磷霉素：4 g，q 12 h；⑤ 甲硝唑 0.5 g，q 8 h。口服：多西环素首剂 200 mg，人流术后 100 mg，或首剂 100 mg，人流术后 200 mg（一日方案）；如果子宫输卵管造影发现输卵管增粗，预防术后盆腔炎的发生，推荐多西环素 100 mg，bid，连用 5 d。头孢呋辛 0.25 g，bid；甲硝唑 1 g 顿服或 0.5 g，bid。剖宫产抗菌药使用是在断脐后还是术前 30 min 呢？传统的观点是断脐后使用抗菌药物，是为了避免抗菌药进入新生儿体内。我国《卫生部办公厅关于抗菌药物临床应用管理有关问题的通知》（2009 年 38 号文）曾规定「结扎脐带后给药」。而按照《抗菌药物临床应用指导原则（2015 版）》的规定，抗菌药物的预防性应用，静脉输注应在皮肤、黏膜切开前 0.5～1 小时内或麻醉开始时给药，在输注完毕后开始手术，保证手术部位暴露时局部组织中抗菌药物已达到足以杀灭手术过程中沾染细菌的药物浓度。《原则》并未对剖宫产的用药时机提出特别规定。2017 年的《国家抗微生物治疗指南（第 2 版）》指出，剖宫产预防性使用抗菌药，手术开始前还是结扎脐带后给药尚无定论，前者可能更有利于预防切口感染。那么国外指南是如何规定的呢？2015 年《WHO 孕产妇围产期感染的预防和治疗》推荐，剖宫产手术切皮前预防性、单剂量使用一代头孢或青霉素。2017 年加拿大妇产科医生协会（SOGC）《产科手术抗生素预防治疗》规定，预防性抗菌药应于切皮前 15～60 min 给药。2017 年美国疾病预防控制中心（CDC）《预防手术部位感染指南》规定，预防性抗菌药应于切皮前给药。2018 年美国妇产科协会（ACOG）《正常分娩中预防性抗生素的应用》规定，预防性抗菌药应于剖宫产术前 60 min 内给药。如果要对处方做事后点评，可以所在省份的规定为准（如《四川省围手术期预防性应用抗菌药物实施细则（2019 版）》规定切皮前 1 小时内或剪断脐带时均可），如所在省份或所在医院并未下发相关细则，那么综合国内现有的各项规定，无论是切皮前给药还是断脐后给药，均不应点评为给药时机不合理。作者：王帅策划：dongdong投稿：zhaochen@dxy.cn参考文献：[1]Infectious Diseases Cooperative Group，Gynecology and Obstet-rics Branch，Chinese Medical Association. Guidelines for antibi-otic use in obstetrics and gynecology［J］．Chin J Obstet Gynecol（中华妇产科杂志），2011，3（ 46）：230-233．[2]IOＲIO A，SPENCEＲ F A，FALAVIGNA M，et al． Use of GＲADE for assessment of evidence about prognosis：rating confidence in es-timates of event rates in broad categories of patients［J］． BMJ，2015，350：h870．[3]BALSHWM H，HELFANDA M，SCHUNEMANN H J，et al．GＲADE Guidelines：3. Ｒating the Quality of Evidence［J］． Chin J Evid Base Med（中国循证医学杂志），2011，6（ 4）：451-455．[4]Working Group on the revision of the Guidelines for Clinical Ap- plication of Antimicrobial Therapy. Guidelines for Clinical Appli- cation of Antimicrobial Therapy（抗菌药物临床应用指导原则）［M］． Beijing：People's Medical Publishing House，2015．[5]Ministry of Health of the People'ASIs Ｒepublic of China． No． 84，Ministry of Health on revising the home page of inpatient medical re- cords［EB/OL］． National Health Commission of the People's Ｒe- public of China，2011 ［2020-05-08］．[6]SiChuan Pharmacy Administration andQuality Control Center．Implementation Ｒules of Perioperative Prophylactic Application of Antibiotics in Sichuan Province（四川省围手术期预防性应用抗菌药物实施细则）[7]BEN SHOHAM A，BAＲ-MEIＲM，IOSCOVICH A，et al． Tim- ing of antibiotic prophylaxis in cesarean section：retrospective， difference-in-differences estimation of the effect on surgical-site- infection［J］． J Matern Fetal Neonatal Med，2019，32（5）：804- 808． [8] Berríos-Torres SI， Umscheid CA， Bratzler DW， et al. Centers for Disease Control and Prevention Guideline for the Prevention of Surgical Site Infection[J]. JAMA Surgery， 2017， 152（8）：784–791.[9] American College of Obstetricians and Gynecologists， ACOG Practice Bulletin No. 199：Use of Prophylactic Antibiotics in Labor and Delivery[J]. Obstetrics & Gynecology， 2018， 132（3）：e103-e119.