子宫内膜异位症伴不孕125例临床分析

目的分析子宫内膜异位症(内异症)伴不孕患者的临床情况及影响妊娠的相关因素.方法回顾分析因不孕行开腹或腹腔镜检查确诊为子宫内膜异位症125例的临床及手术情况.结果治疗后125例患者中34例受孕,妊娠率27.2%.妊娠率Ⅰ～Ⅱ期高于Ⅲ、Ⅳ期患者(P均＜0.05),单纯卵巢子宫内膜异位囊肿高于仅有盆腔其他部位病灶患者和囊肿合并盆腔其他部位病灶患者(P＜0.05),右侧卵巢子宫内膜异位囊肿高于左侧和双侧(P＜0.05).结论子宫内膜异位症对生育的影响是肯定的,手术治疗及术后辅以药物治疗后有一定的妊娠率.临床期别、内异症病灶部位、巧克力囊肿侧别与治疗后妊娠率有关.     

模拟二氧化碳气腹对离体子宫内膜细胞增殖的影响

子宫内膜异位症(内异症)是妇科常见病,在育龄期妇女中的发病率高达10%～15%,病因至今未明.虽然内异症是一种良性病变,但异位子宫内膜却表现出异常的种植、侵袭甚至转移等类似恶性肿瘤的生物学特性.腹腔镜手术切除病灶是目前治疗内异症最常用的手术方法,且有较好的近期疗效,但术后复发率仍较高.     

保守性腹腔镜手术与经腹手术治疗Ⅲ～Ⅳ期卵巢型子宫内膜异位症临床疗效对比分析

<正>临床上Ⅲ～Ⅳ期子宫内膜异位症约占内异症的37.5%～48.4%[1],卵巢是内异症最常见的部位。传统观念认为,对于中重度卵巢子宫内膜异位症,经腹手术更易清除盆腔病灶或保留卵巢功能。我们选择手术治疗的Ⅲ～Ⅳ期卵巢子宫内膜异位症患者,其中腹腔镜手术61例,经腹手术36例,对比分析了两种术式的临床疗效,现报道如下。     

子宫内膜异位症对体外受精-胚胎移植结局的影响

在不孕症的病因中,子宫内膜异位症(内异症)越来越受到重视.随着腹腔镜技术在不孕症检查中的广泛应用,人们发现,不孕症患者伴有内异症的比例可能高达50%以上[1].对于大多数伴有内异症的不孕患者,体外受精.     

腹腔镜下骶前神经切断术治疗子宫内膜异位症痛经

子宫内膜异位症(内异症)是妇科的常见病，目前对其痛经的治疗方法仍不理想。我院于1999年1月～2001年12月在腹腔镜下行骶前神经切断术治疗内异症痛经患者28例，效果较满意，报告如下。     

米非司酮对子宫内膜异位症患者在位及异位子宫内膜中血管内皮生长因子表达及微血管密度的影响

子宫内膜异位症(内异症)近年来发病率呈明显上升趋势。内膜细胞的转移及种植、血管生成等类似肿瘤的生物学行为可能是发病的关键。该病具有转移、浸润和复发的特点，治疗困难。我们采用小剂量米非司酮治疗内异症，观察子宫内膜中血管内皮生长因子(VEGF)及微血管的变化，旨在评价米非司酮治疗内异症的临床效果。     

《现代妇产科进展》2005年第一期国家级继续医学教育试题

1、以下哪项是子宫内膜异位症发病学说 ?　　A .经血逆流学说　　　B .化生学说　　　C .免疫学说　　　D .在位内膜决定论　　　E .以上均正确2、诊断子宫内膜异位症的金标准是　　A .腹腔镜　　　B .痛经、肛门坠痛及慢性盆腔疼痛　　　C .妇科检查双侧宫骶韧带有触痛结节　　D .超声波检查附件区囊肿 ,内有散在光点　　　E .血CA12 5升高3、腹腔镜对诊断下列哪种类型的子宫内膜异位症有局限性 ?　　A .腹膜型内异症　　B .卵巢型内异症　　C .阴道直肠型内异症　　D .子宫及直肠壁内异症　　E .以上均正确4、以下哪项是子宫内膜异…     

175例子宫内膜异位症患者血清CA125水平的回顾性分析

目的:分析子宫内膜异位症患者合并子宫内膜息肉的情况,探讨血清CA125水平与痛经、内异症rAFS分期、病灶部位的相关性,为临床上更好地解读CA125水平提供依据。方法:回顾性分析2010年1月至12月我院术中或术后病理诊断为子宫内膜异位症的175例患者的临床资料。结果:(1)20.0%的子宫内膜异位症患者合并子宫内膜息肉;(2)36.6%的内异症患者有中、重度痛经,痛经程度与血清CA125水平无相关性;(3)Ⅰ期、Ⅱ期、Ⅲ期、Ⅳ期内异症患者的平均CA125水平分别为21.5U/ml、28.4U/ml、38.6U/ml、57.1U/ml,Ⅲ～Ⅳ期内异症患者血清CA125水平高于Ⅰ～Ⅱ期患者(P<0.05);(4)腹膜型、混合型、卵巢型内异症患者血清CA125的阳性率分别为21.4%、63.0%和67.4%,混合型、卵巢型内异症患者血清CA125阳性率显著高于腹膜型(P<0.001)。结论:血清CA125水平不能作为内异症合并子宫内膜息肉的预测指标;血清CA125水平可用于辅助鉴别内异症的分期和病灶部位,但是CA125对于内异症的早期诊断缺乏敏感性。     

第七届国际子宫内膜异位症会议纪要

第七届国际子宫内膜异位症会议于2000年5月14～17日在英国伦敦举行。内容涉及子宫内膜异位症(内异症)发病机理、诊断、手术及药物治疗等方面。现简要介绍如下。 发病机理研究 一、血管形成 血管形成在子宫内膜异位症(内异症)的作用受到重视,目前的研究主要涉及几种血管形成分子。 1.血管内皮生长因子(VEGF)是一关键的血管形成刺     

子宫内膜异位症激素治疗

子宫内膜异位症 (以下简称内异症 )是一种激素依赖性疾病 ,它的发生发展与内分泌功能状态有关。激素治疗主要依靠抑制卵巢功能 ,以诱发异位子宫内膜萎缩。临床上药物治疗主要用于轻、中度内异症或术后复发者 ,以达到缓解内异症疼痛和增加妊娠率的目的。对于直径 5～ 6ｃｍ以上的卵巢内膜样囊肿以手术治疗为主 (经腹或腹腔镜手术 ) ,术前用药有利于手术切除 ,而术后用药可减少复发。常用激素治疗如下。1　雌 /孕激素假孕疗法及孕激素治疗根据妊娠可使内异症患者症状改善的原理 ,模仿妊娠采用雌 /孕激素造成假孕 ,使异位内膜转化为蜕膜 ,继而…     

Complete remission of cerebral endometriosis with dienogest: a case report

The most recent evidences suggest the use of progesterone mimicking drugs for the treatment of endometriosis. Particularly, dienogest has been largely tested. However, the standard treatment of extra-pelvic endometriosis is debated. Particularly, cerebral localization of endometriosis is a very rare clinical condition. The surgical approach for such a particular disorder would consist in difficult procedures, thus leading to prefer the medical treatment. We hereby report the clinical case of a cerebral localization of endometriosis treated with dienogest who experienced a complete remission of the disease.     

Bladder endometriosis and barrenness: diagnostic and treatment strategy

Deep infiltrating endometriosis is a well-known female disease responsible for chronic pelvic pain, urinary dysfunction, infertility, and altered quality of life. Endometriosis and infertility are complex entities and the optimal choice of management of both of them remains obscure. Mechanism of development of the disease has to be understood to optimize patients care. The link between barrenness and endometriosis is well known, but there is no direct link between bladder lesion and infertility. Bladder endometriosis is a deeply infiltrating endometriosis lesion. Its management is first diagnostic and then remedial. In case of ineffectiveness of medical strategy, surgical treatment is indicated. However, for patient suffering from symptomatic isolated bladder endometriosis, surgical management can be offered in first intention. Isolated bladder injuries due to endometriosis are mostly treated by conservative laparoscopic surgery, after a complete evaluation of endometriosis disease and barrenness by clinical exam and imaging techniques.     

Diagnosis and treatment of endometriosis. A review

The correct approach for endometriosis management is still unclear. This review explores recent data concerning diagnosis and treatment of endometriosis, trying to define guidelines for the most appropriate diagnostic approach and therapeutic regimen. At present, laparoscopy is still considered the gold standard in endometriosis diagnosis. The risks and the diagnostic limitations of laparoscopy and the inaccuracy of clinical examination justify the considerable efforts made to improve the diagnosis with imaging techniques. The therapeutic approach is still far from being defined as causal and focuses on management of clinical symptoms of the disease rather than on the disease itself. A first-line medical therapy should be tried in patients with pelvic pain not asking for a pregnancy. Surgical treatment is considered the best treatment for women with pain and or pelvic mass who wish to become pregnant in a short time. For infertile patients, medical therapy has a limited role. The 2 treatment options include surgery or in vitro fertilization (IVF). According to our results, it seems that correct management of infertile women with endometriosis is a combination of surgery and IVF in women who did not obtain post-surgery pregnancy spontaneously.     

药物治疗在子宫内膜异位症长期管理中的应用和选择

子宫内膜异位症（简称内异症）是一种慢性、复发性疾病,单纯保守性手术难于治愈,药物治疗占据重要地位。治疗内异症疼痛常用而有效的药物除非甾体类抗炎药（NSAIDs）外,还有口服避孕药、孕激素、雄激素衍生物、促性腺激素释放激素激动剂（GnRH-a）和拮抗剂及中医中药等。术后药物维持治疗以控制疼痛和预防复发的长期管理方案已达成中国专家共识,内异症长期管理中的药物治疗要以临床问题为导向,以患者为中心,分年龄阶段选择药物,综合治疗。近年来,倡导对内异症早期预防,推荐对青春期有痛经及月经相关疼痛症状,或临床诊断为内异症但无手术适应证者,推荐经验性药物治疗,以缓解疼痛症状,降低内异症发病率或延缓内异症进展。     

Brief update on endometriosis treatment

Endometriosis is a chronic debilitating disease with features of chronic inflammation. Endometriosis is defined as the presence of endometrial like stroma and glands outside the uterine cavity (1). Medical professionals dealing with endometriosis face a lot of problems; in diagnosis, treatment and follow up of patients. Recent advances in molecular and clinical sciences offered a wide range of modalities for treatment. However, up to date there is no single very successful option for the ultimate treatment. In this review I have searched the literature using Medline, Pubmed, text books and other search engines to look for the most updated modalities for the treatment of endometriosis both surgical and medical ones. It seems to be that for fertility purposes surgical treatment followed by ART is the best available most beneficial way of dealing with endometriosis, while medical treatment is the best way to treat pain symptoms associated with endometriosis.     

Medikamentöse Therapie der Endometriose

Approximately 10% of reproductive age women suffer from endometriosis. The disease manifests itself by several severe symptoms such as chronic pelvic pain, dysmenorrhea, dyspareunia and infertility. Several effective medical treatment options are available. A curative therapy of endometriosis however does not exist until to date. As first-line therapy of symptomatic endometriosis, NSAID and oral contraceptives are applied. Subsequent to the use of progestagens and their derivatives, GnRH-agonists became the gold-standard of second-line therapy in the 1990s. The use of aromatase inhibitors is currently examined in clinical studies. In general, treatment of endometriosis is considered a long-term therapy due to the chronic character and frequent recurrence of the disease, and has to be tailored to the individual needs of the patient during different phases of life.     

细胞凋亡与子宫内膜异位症

子宫内膜异位症（EMs）发病原因尚未明了。EMs是妇科常见良性疾病,但却有增生、浸润、转移及复发等恶性行为,对其预防和治疗仍是目前难点。凋亡是基因控制的程序性细胞自我消亡过程,对机体维持自身稳态和组织器官正常生理功能至关重要。近年有资料表明,凋亡异常可促进EMs的发生发展。综述细胞凋亡途径,凋亡相关基因及凋亡在正常子宫内膜与EMs的在位、异位内膜中的不同表达,期望能操控细胞程序性死亡并应用于EMs的预防和治疗中。     

细胞凋亡与子宫内膜异位症

子宫内膜异位症（EMs）发病原因尚未明了。EMs是妇科常见良性疾病,但却有增生、浸润、转移及复发等恶性行为,对其预防和治疗仍是目前难点。凋亡是基因控制的程序性细胞自我消亡过程,对机体维持自身稳态和组织器官正常生理功能至关重要。近年有资料表明,凋亡异常可促进EMs的发生发展。综述细胞凋亡途径,凋亡相关基因及凋亡在正常子宫内膜与EMs的在位、异位内膜中的不同表达,期望能操控细胞程序性死亡并应用于EMs的预防和治疗中。     

Minimal endometriosis: A therapeutic dilemma?

Accidental finding of minimal endometriosis during surgery for complaints unassociated with endometriosis presents a therapeutical dilemma. Because the clinical significance of minimal endometriosis is not thoroughly defined, it is uncertain by which means, if at all, such types of peritoneal or ovarian lesions should be treated. We, therefore, compiled our clinical observations and evaluated them in relation to the results reported in the recent literature. A search on the clinical importance and the need for any treatment of minimal and mild endometriosis was conducted. Based on the available evidence, we are tempted to conclude that minimal endometriosis should be treated surgically when accidentally discovered. This approach should be exerted even in the absence of clinical symptoms. However, postoperative medical treatment is not warranted in those patients who are without clinical complaints. Because the clinical course of minimal endometriosis is not predictable, any benefit from specific medications remains uncertain. When associated with infertility, minimal endometriosis should be surgically erased, thus to allow spontaneous conceptions to occur. As there is no evidence of medical treatment modalities altering the clinical course of minimal and mild endometriosis, any specific medical treatment (i.e. GnRH analogues, danazol) is not indicated in asymptomatic patients and those desiring pregnancy.     

血小板及相关因子功能的异常与子宫内膜异位症发病机制的关系

子宫内膜异位症是妇科的常见病及多发病,其是一种良性的慢性疾病,影响着10%～15%的育龄女性,其症状主要表现为痛经、盆腔粘连及不孕,其发病机制已有许多的假说但尚未认识清楚。近年来国内外学者相继发现血小板在子宫内膜异位症发病中具有重要的作用,主要表现子宫内膜异位症患者的血小板黏附、聚集功能存在缺陷,子宫内膜异位症患者的血小板计数升高,其血液处于相对高凝状态,并能介导炎症反应,血小板相关因子如P-选择素、CD40L、血小板生长因子在子宫内膜异位症的发病中起到不同程度的促进作用,而且血小板能够影响子宫内膜异位症患者体内的雌激素及其受体的表达,因此综述血小板功能上的异常与子宫内膜异位症的发病机制之间可能存在的联系,为临床上应用血小板来诊治子宫内膜异位症提供理论依据。