盆腔外子宫内膜异位症18例临床分析

目的：探讨盆腔外子宫内膜异位症发病潜伏时间、临床表现、治疗原则及预后。方法：分析1996年8月～2006年11月我院收治的18例盆腔外子宫内膜异位症患者的临床资料，其中，15例为腹壁子宫内膜异位症，3例为会阴子宫内膜异位症。结果：根据典型病史，术前多可做出诊断，本组均为手术彻底切除病灶，随访16例，失访2例，随访时间6个月～5年，均无复发。结论：盆腔外子宫内膜异位症单纯彻底手术治疗可以治愈。     

盆腔外子宫内膜异位症25例临床分析

目的探讨盆腔外子宫内膜异位症发病、临床特征、治疗。方法分析我院1993年7月-2003年7月收治的25例盆腔外子宫内膜异位症的临床资料，其中20例为腹壁子宫内膜异位症，5例为会阴子宫内膜异位症。结果其发病的潜伏期多在1～3年。据临床表现，术前多可确诊。本组病例均行手术切除病灶。随访20例，随访时间6个月～5年，均无复发。结论盆腔外子宫内膜异位症行病灶切除为其主要治疗方法。     

孕三烯酮用于子宫内膜异位症术后的辅助治疗

目的：观察孕三烯酮用于子宫内膜异位症术后辅助治疗的临床效果。方法：将87例子宫内膜异位症术后的患者随机分为两组：孕三烯酮组和未用药组。术后1周开始用孕三烯酮，每周2次，2．5mg／次，连续3-6个月。术后半年复查1次，了解其症状、体征、妊娠情况、B超情况及监测CA125。每月复诊，了解药物的副反应，复查肝功能。结果：孕三烯酮组随访39例，均于服药后开始闭经，有21例痛经和性交痛基本消失，15例症状较前减轻，3例复发。未用药组随诊的40例中，有12例痛经和性交痛基本消失，15例症状较前减轻，13例复发。孕三烯酮组复发率与未用药组比较有显著性差异（P〈0．05）。结论：孕三烯酮用于子宫内膜异位症术后的辅助治疗能有效地控制子宫内膜异位症并减少其复发。     

中西医结合治疗子宫内膜异位症39例临床观察

目的观察中西医结合治疗子宫内膜异位症的临床疗效。方法对39例应用中西医结合方法治疗的子宫内膜异位症患者进行回顾性分析。结果治疗3个疗程后评定疗效。治愈23例（占58.9%）,症状全部消失,盆腔结节包块等局部体征基本消失,不孕患者受孕。显效9例（占23.1%）,症状基本消失,治疗前后月经周期的同期B超检查对比盆腔包块缩小〉1/2,虽局部体征存在但月经不调改善。有效5例（占12.8%）,症状减轻,包块缩小1/3～1/2,停药3个月内症状不加重。无效2例（占5.12%）,症状和体征无改变。结论子宫内膜异位症采用中西医结合治疗效果确切,值得推广。     

中药保留灌肠与口服序贯治疗子宫内膜异位症36例

目的：观察中药保留灌肠与口服序贯对子宫内膜异位症盆腔疼痛缓解的情况。方法：36例病例采用以活血化瘀、解毒止痛为主中药保留灌肠与口服序贯治疗,治疗前后进行疼痛症状评分。结果：治疗3个月后盆腔疼痛缓解情况与治疗前比较明显减轻（P〈0．05）。结论：中药保留灌肠与口服序贯治疗子宫内膜异位症盆腔疼痛有确切镇痛疗效。     

子宫内膜异位症保守性手术后延续治疗的效果

目的探讨子宫内膜异位症患者保守性手术后延续治疗的效果。方法对89例盆腔子宫内膜异位症患者应用腹腔镜技术明确诊断,并进行相应分解粘连手术、子宫内膜异位囊肿剥除术或附件切除术。患者术后随机分为两组:治疗组(n=44)于术后给予促性腺激素释放激素类似物(GnRHa)治疗3个月;对照组(n=45)不予任何药物。两组均密切随访临床症状和复发情况、CA-125、妇科检查盆腔情况以及盆腔B超,对有生育要求的患者(n=28)增加受孕情况的随访。结果所有患者术后临床症状基本缓解或减轻,复发率:术后6个月治疗组为0%,对照组为4%;术后12个月治疗组为2%,对照组为4%(P<0.05)。CA-125随病灶的复发而升高。在有生育要求的患者中,治疗组受孕率为58%,对照组为0%(P<0.001)。结论腹腔镜是诊断、治疗子宫内膜异位症的金标准,保守性手术后延续治疗能有效控制其复发率,提高术后受孕率。GnRHa是子宫内膜异位症治疗和助孕准备的重要选择。     

盆腔外子宫内膜异位症18例临床分析

目的:探讨盆腔外子宫内膜异位症发病潜伏时间、临床表现、治疗原则及预后。方法:分析1996年8月-2006年11月我院收治的18例盆腔外子宫内膜异位症患者的临床资料,其中,15例为腹壁子宫内膜异位症,3例为会阴子宫内膜异位症。结果:根据典型病史,术前多可做出诊断,本组均为手术彻底切除病灶,随访16例,失访2例,随访时间6个月-5年,均无复发。结论:盆腔外子宫内膜异位症单纯彻底手术治疗可以治愈。     

子宫内膜异位症保守性手术后延续治疗的效果

目的 探讨子宫内膜异位症患者保守性手术后延续治疗的效果.方法 对89例盆腔子宫内膜异位症患者应用腹腔镜技术明确诊断,并进行相应分解粘连手术、子宫内膜异位囊肿剥除术或附件切除术.患者术后随机分为两组:治疗组(n=44)于术后给予促性腺激素释放激素类似物(GnRHa)治疗3个月;对照组(n=45)不予任何药物.两组均密切随访临床症状和复发情况、CA-125、妇科检查盆腔情况以及盆腔B超,对有生育要求的患者(n=28)增加受孕情况的随访.结果 所有患者术后临床症状基本缓解或减轻,复发率:术后6个月治疗组为0%,对照组为4%;术后12个月治疗组为2%,对照组为4%(P＜0.05).CA-125随病灶的复发而升高.在有生育要求的患者中,治疗组受孕率为58%,对照组为0%(P＜0.001).结论 腹腔镜是诊断、治疗子宫内膜异位症的金标准,保守性手术后延续治疗能有效控制其复发率,提高术后受孕率.GnRHa是子宫内膜异位症治疗和助孕准备的重要选择.     

青春期子宫内膜异位症误诊分析

目的探讨青春期子宫内膜异位症的特点及误诊原因,提高诊断正确性。方法对20例青春期子宫内膜异位症的症状、体征及实验室检查进行分析。结果本组误诊12例（60％）,误诊为卵巢肿瘤7例,卵巢囊肿2例,盆腔炎2例,阑尾炎1例：结论青春期子宫内膜异位症临床表现复杂多样且不典型：有慢性盆腔疼痛、进行性痛经及CA125升高者应警惕本病,及早诊治。     

腹腔镜骶前神经切除术治疗中线性盆腔疼痛的疗效探讨

目的：评估腹腔镜骶前神经切除术（1aparoscopicpresacralneurectomy，LPSN）治疗中线性盆腔疼痛的疗效及安全性。方法：18例均为经保守治疗效果欠佳的中线性盆腔疼痛患者，其中12例为子宫内膜异位症，3例为原发性痛经，3例为慢性盆腔炎。所有患者均行LPSN，11例同时行异位病灶切除术和盆腔粘连分离术，均保留子宫，12例子宫内膜异位症患者术后接受GnRH—a治疗控制异位灶复发。术后随访时间（28±6．6）个月。结果：18例患者手术过程均顺利，未发生严重并发症，LPSN手术时间（39．0±8．3）min，术中出血（44．7±13．2）mL，肛门排气时间（17．1±5．4）h，术后24h拔除尿管，住院时间（4．6±1．1）d，随访6，12，24个月，疼痛缓解率为100％，94．4％，78．8％，完全缓解率94．4％，88．8％，61．1％。结论：LPSN治疗经保守治疗无效的中线性盆腔疼痛是安全、微创、疗效确切的手术方式。     

Leukaemia cutis in a patient with acute myelogenous leukaemia: case report

Leukaemia cutis is a specific lesion of leukaemia in which there is leukaemic cell deposit in the skin. There are few reports of this condition in our environment. Several mechanisms have been postulated for the pathogenesis of the disease. One of which is the tissue selective homing of a unique sub-population of malignant clone of cells. The presence of leukaemia cutis does not seem to worsen the prognosis as the acute myeloid leukaemia is an equally lethal disease. The fatality of the disease is compounded by the unavailability of the right regimen in our patient. This paper documents a case of leukaemia cutis in a patient initially diagnosed to have AML who developed skin lesion in remission. A skin biopsy was found helpful in diagnosing the first sign of relapse in a patient in haematological remission.     

A cutaneous manifestation of acute lymphoblastic leukaemia mimicking urticaria pigmentosa

A 37-year-old female developed what appeared to be the typical cutaneous manifestations of urticaria pigmentosa. These preceded the peripheral blood changes of acute null cell lymphoblastic leukaemia and skin biopsy revealed that the cutaneous changes were due to leukaemic infiltration. Chemotherapy resulted in clearance of the rash. The importance of skin biopsy in patients presenting with suspected urticaria pigmentosa is emphasized.     

Cardiac tamponade complicating leukaemia: immediate chemotherapy or pericardiocentesis?

Although leukaemic infiltration of the pericardium is frequently observed at post-mortem, clinically evident cardiac tamponade is rare. Two cases of cardiac tamponade complicating leukaemia are presented. One patient had cardiac tamponade as the initial presentation of acute lymphoblastic leukaemia and experienced complete resolution of the pericardial effusion within 6 days after chemotherapy without therapeutic pericardiocentesis. The other patient with chronic myeloid leukaemia developed cardiac tamponade requiring pericardiocentesis as the first sign of acute blastic transformation. The roles of early chemotherapy and pericardiocentesis in managing this complication are discussed.     

A case of generalised cutaneous granulocytic sarcoma in an elderly patient with myelodysplastic syndrome

Granulocytic sarcoma is a rare extramedullary malignant mass composed of primitive cells of the granulocytic lineage. It can arise from any part of the body and is frequently associated with haematological diseases, commonly acute myeloid leukaemia. Rarely, it has been found in conjunction with myelodysplastic syndrome. We report a case of cutaneous granulocytic sarcoma in a 73-year-old lady. The patient presented with a two-month history of multiple skin nodules which were confirmed by skin biopsy to be granulocytic sarcoma. Bone marrow examination was consistent with myelodysplastic syndrome. Localised radiotherapy to the skin lesions were given. She died from septicaemia six months after presentation. The management of this condition presents a diagnostic and therapeutic dilemma for both the pathologist and physician. In cases which are poorly differentiated as in this case, histological diagnosis is particularly difficult. Its definitive diagnosis would then require the additional use of a broad panel of immunohistochemical and cytochemical stains.     

B淋系/髓系混合表型急性白血病伴TEL-ABL1融合基因表达1例

 混合表型急性白血病（mixed phenotype acute leukemia,MPAL）临床罕见,约占急性白血病的2%~5%。TEL-ABL1融合基因阳性主要见于急性髓细胞白血病（acute myeloid leukemia,AML）、急性淋巴细胞白血病（acute lymphocytic leukemia,ALL）、骨髓增殖性肿瘤（myeloproliferative neoplasm,MPN）等恶性血液系统肿瘤,目前以病例报道为主,均提示预后不良。本例患者B淋系/髓系MPAL伴TEL-ABL1融合基因阳性为首次报道,我们给予针对淋系、髓系白血病化学治疗及酪氨酸激酶抑制剂靶向治疗后,达到完全缓解,经巩固化疗后进行人类白细胞抗原（human leucocyte antigen,HLA）相合同胞间异基因外周血造血干细胞移植,患者后因肠道排异反应死亡。     

Blastomycosis-like pyoderma in a case of chronic myeloid leukaemia.

Blastomycosis-like pyoderma, a rare skin lesion which may clinically resemble true blastomycosis, is seen in immuno-compromised individuals. We report one such case in chronic myeloid leukaemia.     

Extramedullary myeloid cell tumour: presentation as anterior chest wall mass during AML relapse

Acute myeloid leukaemia is an uncommon but an important cause of soft tissue swellings. Such extrameningeal, extramedullary leukaemic infiltrates are called extramedullary myeloid cell tumours. Despite their large size they may respond well to chemotherapy and local radiotherapy, as is demonstrated in this case.     

Leukaemia cutis presenting as leonine facies

Acute leukaemia may rarely present as diffuse papules, nodules and plaques forming leonine facies. Leukaemia cutis generally carries a poor prognosis, and responds less well to chemotherapy. We described a case of acute myelomonocytic leukaemia presenting as leonine facies as a result of extensive cutaneous infiltration. The patient did not achieve haematological remission following standard induction chemotherapy and succumbed 6 weeks after the diagnosis was made.     

黄荆子乙酸乙酯提取物对HL-60细胞生长和凋亡的影响

目的:观察黄荆子乙酸乙酯提取物(EVn-50)抑制人急性髓性白血病HL-60细胞生长和诱导凋亡作用。方法:体外培养HL-60细胞和人外周血单核细胞(PBMC),MTT法测定细胞增殖;软琼脂培养集落形成法检测细胞生长;PI染色流式细胞术分析细胞凋亡。结果:EVn-50对HL-60细胞增殖具有显著抑制作用,呈浓度依赖性;而对PBMC的增殖活性影响小。EVn-50对HL-60细胞集落形成有抑制效应,呈浓度依赖性。EVn-50有效诱导HL-60细胞凋亡。结论:EVn-50具有抑制HL-60细胞生长和诱导凋亡作用。     

急性白血病患者外周血T淋巴细胞亚群和NK细胞水平检测及临床意义

目的:研究急性白血病患者外周血T淋巴细胞亚群、NK细胞水平变化及临床意义。方法:采用流式细胞仪对32例急性白血病患者(急性髓细胞性白血病23例、急性淋巴细胞性白血病9例)及18例正常人外周血T淋巴细胞亚群及NK细胞水平进行检测。结果:初治急性白血病组与正常对照组比较,CD3 细胞、CD4 细胞、CD4 /CD8 比值及NK细胞下降(P<0.05),CD8 细胞略升高(P>0.05)。化疗后12例取得完全缓解,再次检测上述指标接近正常对照组(P>0.05)。初诊急性淋巴细胞性白血病组CD4 细胞及CD4 /CD8 比值低于初诊急性髓细胞性白血病组(P<0.05)。结论:急性白血病患者细胞免疫功能明显异常。与急性髓细胞性白血病相比,急性淋巴细胞性白血病细胞免疫功能更为低下。T细胞亚群及NK细胞水平检测在评价急性白血病疗效及判断预后方面具有一定的临床价值。