不锈钢O型宫内节育器的脱落与宫腔形态及收缩压力关系的研究

本文用国产GCH—Ⅰ型宫腔测量器对143例育龄妇女进行宫腔测量,模拟出宫腔形态,探讨不锈钢O 型宫内节育器(IUD)脱落原因。通过测量,80%左右的宫腔近似等腰或等边三角形;14～20%的妇女宫腔下段过窄或过宽。从13例数次脱环者中看出,这些不规则的宫腔形态是IUD 脱落的主要原因之一。对23例妇女置器前后子宫收缩压力测定表明,宫腔内有器时,其子宫收缩压力比无器时大,t 检验结果(P<0.05)有显著性差异。但置器后一周宫缩的振幅又恢复正常,说明单纯置器后在正常范围内的宫缩并不致引起脱落。不锈钢O 型宫内节育器的脱落与不规则的宫腔形态有一定关系。     

关于降低宫内节育器脱落率的研究

经研究发现,宫内节育器的型号必须与宫腔的几何尺寸及形态相适应。宫腔形态、大小的个体差异性很大,放器时,应对子宫内膜腔的长度与宽度进行逐个测量,不能用宫腔纵轴的全长作为选器的唯一依据。我们曾用GCH—Ⅰ型卸荷式宫腔测量器对1561例要求置器妇女进行逐个测量后选器,并与1355例仅用探针测量宫腔纵轴全长的选器组做了置器三年后的随访对比,前者脱落率为3.9%,后者为6.0%。因症取出率,前者更低,两组有显著性差异。     

成人子宫内腔形态观测研究

在临床上测量子宫内腔的各个径线,放置适合的宫内节育器,总是将子宫体腔作为一个理想的等腰三角形应用,但缺乏理论依据。本文则通过30例成年经产妇正常全子宫完整标本的测量证明子宫体腔是一个倒立的等腰三角形,以及用直探针测量宫腔深时,探针垂直于子宫内腔的底部。这给临床上研制和使用宫腔测量器,测量子宫内腔,选择适合的节育器,研制新型节育器提供了理论依据。     

50例结核性宫腔粘连手术效果及妊娠结局分析

目的:回顾性分析50例结核性宫腔粘连患者经宫腔镜下粘连分离术后宫腔形态、月经恢复情况及生育结局。方法:选取2007年1月至2016年6月就诊于中南大学湘雅三医院妇科的50例结核性宫腔粘连患者,患者均予规范抗结核治疗6~9月后行宫腔粘连分离术,观察患者术后经量、宫腔形态及生育结局。采用Logistic回归对术后经量及宫腔形态恢复情况进行相关影响因素分析。采用四格表Fisher确切概率法分析术后经量及宫腔形态与妊娠的相关性。结果:50例患者中20例恢复正常月经,26例宫腔形态恢复至正常或接近正常。IVF-ET术后6例妊娠,其中2例早期流产,4例成功分娩获得活产儿。Logistic回归分析显示,抗结核治疗后的经量影响患者最终经量的恢复(P0.05);宫腔粘连程度及抗结核治疗后经量共同影响宫腔形态恢复(P0.05)。经量恢复正常的患者妊娠率(6/19,31.6%)明显高于经量未恢复正常的患者(0%)(P0.05);宫腔形态恢复正常的患者妊娠率(6/25,24%)明显高于宫腔形态未恢复正常的患者(0%)(P0.05)。结论:结核性宫腔粘连患者粘连分离术后经量及宫腔形态恢复欠佳,生育结局差。宫腔粘连分离术能给部分患者带来生育希望,但结核的预防及早期治疗才能减少甚至避免不孕及后续手术治疗。     

宫腔镜宫腔粘连分离术后雌激素用量及其效果的Meta分析

目的:评价宫腔镜宫腔粘连分离(TCRA)术后雌激素使用与改善宫腔形态和月经情况的关系,探讨增加雌激素用量在改善宫腔形态中的作用。方法:计算机检索Cochrane Library、Medline、EMbase、Web of Scince、Ebsco数据库,纳入关于宫腔镜TCRA术后使用雌/孕激素辅助治疗的相关研究。用Stata 12. 0软件进行单个率的Meta分析。结果:共纳入11个观察性研究,Meta分析结果显示:宫腔镜TCRA术给予雌激素为主的综合性措施辅助治疗,轻、中、重度宫腔粘连宫腔形态的改善率分别为94. 0%(95%CI 0. 67～1. 21,P0. 05)、96. 0%(95%CI 0. 89～1. 02,P0. 05)、95. 0%(95%CI 0. 92～0. 98,P0. 05)。纳入研究中仅1篇文献报道轻度宫腔粘连TCRA术后的月经情况,术后月经较治疗前改善;纳入研究的Meta分析结果显示:TCRA术后中、重度宫腔粘连的月经改善有效率分别为79. 0%(95%CI 0. 65～0. 93,P0. 05)和91. 0%(95%CI 0. 85～0. 97,P0. 05)。泡状图显示轻、中度宫腔粘连TCRA术后在一定范围内增加雌激素用量与宫腔形态改善有效率之间有线性递增关系;重度宫腔粘连TCRA术后雌激素用量与宫腔形态改善有效率之间无线性关系。结论:宫腔镜TCRA术及雌激素等措施对治疗宫腔粘连有效,TCRA术后加大雌激素剂量有利于提高轻中度宫腔粘连的治疗效果,但不能提高重度宫腔粘连的疗效。     

羊膜移植预防宫腔粘连分离术后再粘连的临床研究

目的:探讨羊膜移植预防宫腔镜下宫腔粘连(IUA)分离术后再粘连的临床效果。方法:选择2016年1月至2019年7月在中国医科大学附属盛京医院行宫腔镜检查并诊断为中、重度IUA的131例患者。依据术后预防宫腔再粘连方法分为羊膜球囊组(30例)、球囊组(46例)和宫内置环组(55例),比较宫腔镜下IUA分离术术后3种不同方法预防宫腔再粘连的临床效果。结果:羊膜球囊组在术后月经改善情况及宫腔恢复情况方面疗效明显优于球囊组和宫内置环组(P0.05),后两组比较差异无统计学意义(P0.05)。结论:羊膜移植结合传统球囊扩张方法预防宫腔镜下IUA分离术术后宫腔再粘连效果更佳,能明显减少再粘连的发生,更好地维持术后宫腔形态,改善月经情况,提高患者的生活质量,值得临床应用与推广。     

阴道超声及子宫腔细胞学联合检查绝经后妇女子宫内膜病变

目的 评估阴道超声及宫腔细胞学联合检查绝经后妇女子宫内膜病变的价值。方法 应用阴道超声测量143例绝经后子宫出血患者的子宫内膜厚度,并于当日或次日行宫腔细胞学检查及分段诊断性刮宫（诊刮）术,将内膜测量及宫腔细胞学检查结果与诊刮组织病理结果进行比较。结果 阴道超声检查施行率为100．0％,以5mm为临界值诊断绝经后内膜癌及癌前病变的敏感性为100．0％,假阳性率为56．9％;宫腔细胞学检查的施行率为97．9％,取材满意率为73．6％,特异性为96．3％,假阴性率为2．5％。两者联合应用后的假阳性率为43．2％（P＜0．01）,无一例内膜部中前病变漏诊。结论 阴道超声及宫腔细胞学联合检查,是一种较好的筛查内膜癌及癌前病变的方法,可减少诊刮。     

宫腔镜

宫腔镜是另一种内窥镜用以观察宫腔内部结构和病变.1869年Panteleoni首次应用于临床,但光源在外,显象不理想.后经几十年的努力,直至七十年代随着光学工业的发展,新型光导纤维冷光源、浸没放大光镜、注水膨宫系统,光导介质等不断发明,宫腔镜技术才逐步完善,提高了对妇科的诊断价值.一、宫腔镜装置有三种类型.一种带有充盈宫腔装置系统,宫腔膨胀后观察腔内全景,称全景式宫腔镜,也称普通宫腔镜(Panoramic Hysteroscope).另一种为观察直接接触部分的宫腔内膜,称接触式宫腔镜(Contact     

天津正常妇女子宫颈、子宫腔和子宫横径的测量

<正> 带器妊娠、脱落和出血是宫内节育器停用的主要原因。一般认为,IUD偏小容易移位,也易发生带器妊娠;IUD偏大容易刺激宫壁引起收缩,易发生脱落和引起疼痛,同时由于子宫内膜受压受损,可能是造成出血的原因。为了提高IUD的持续存放率,降低失败率以及为新型IUD试制提供宫腔大小、形态的数据,我们开展了本项研究。材料与方法对经后放置IUD或因各种原因取出IUD的妇女进行子宫颈、子宫腔和宫底横径测量。采用Hasson氏翼状探针测量子宫底至子宫外口的全长和子宫颈峡部至子宫外口的子宫颈管长度;子宫全长减去子宫颈长为子宫内膜腔长度。用子宫横径测量器测量宫底横径。     

一种降低节育环脱落率的有效方法——GCH-1型宫腔测量器的研制与应用

多少年来,妇产科医生只能借助子宫探针探测子宫的长度,无法测量子宫腔底部的宽度。为了科学地选用宫内节育器,降低宫内节育器的脱落率,临床上很需要有一种既能测知子宫长度,亦能测知其宽度的器械。在这方面,旅大市计划生育科学技术研究所的同志作出了贡献。他们在机械工程技术人员和工人同志的配合下,研制出GCH-1型宫腔测量器,并于1980年2月经旅大市科委鉴定通过,进行批量生产。GCH-1型宫腔测量器,构造简单,操作方便,测量数据准确,经1159例正常育龄妇女宫腔的测量,无一例穿孔,无大出血,无感染和其他损伤,因此是比较安全的。我们将它推荐给大家,愿它为解决节育环的脱落率作出贡献。     

子宫内膜非典型性息肉样腺肌瘤10例超声表现及临床分析

目的探讨子宫内膜非典型性息肉样腺肌瘤（APA）结合临床表现及阴道超声特点,以协助术前对宫腔内病变的鉴别诊断。方法回顾10例病理诊断为子宫内膜非典型性息肉样腺肌瘤患者的临床表现及阴道超声检查图像并进行分析,观察其超声特征。结果患者年龄24～64岁（平均45.9岁）,8例表现为不规则阴道出血,2例不孕。超声表现：4例病灶位于宫腔下段至宫颈内口,5例位于宫腔内,1例位于宫角处。彩色多普勒超声（CDFI）检查7例病灶测出血流信号,阻力指数（RI）：0.33～0.71。结论子宫内膜非典型性息肉样腺肌瘤（APA）是一种比较罕见的宫腔内病变,临床上需与子宫内膜癌、内膜息肉及黏膜下肌瘤相鉴别,通过超声检查病灶的回声、部位及血流信号并结合临床表现可协助术前诊断。     

超声宫腔造影检查宫腔内疾病430例分析

目的 :及时发现宫腔内病变。方法 :回顾性分析 430例超声宫腔造影检查的资料。结果 :430例超声宫腔造影检查中 ,发现宫腔内异常者共 76例 ,异常检出率 1 7.7%。结论 :在辅助生殖工作中 ,B超下宫腔造影检查是了解宫腔疾病的有效方法之一     

Simplified therapy for Asherman''s syndrome

Objective: To evaluate a technique that converts a blind hysteroscopic procedure to a “septum” division.

Design: Open noncomparative clinical study.

Setting: Tertiary care center.

Patient(s): Six women with Asherman's syndrome; five with complete and one with incomplete obliteration of the uterine cavity.

Intervention(s): The patients underwent recreation of the uterine cavity by the hysteroscopic-laparoscopic technique described to establish the correct dissection plane.

Main Outcome Measure(s): The ability to reestablish the uterine cavity; postoperative resumption of menses and fertility.

Result(s): In all patients, the cavity of the uterus was restored; menses resumed in all women who were previously amenorrheic; and 5 women conceived, of whom four had live births and one a missed abortion. At hysteroscopy, two women incurred perforations and in another hemorrhage occurred.

Conclusion(s): This technique appears to be effective and safe for the reconstruction of a functional endometrial cavity in women with Asherman's syndrome.     

Factors affecting reproductive outcome following abdominal myomectomy

Purpose Fibroids may cause infertility and recurrent pregnancy loss. Studies have analysed the reproductive results after myomectomy according to the size, location and number of fibroids removed, but data are insufficient about comparison of opening the uterine cavity or not during surgery. Materials and methods Two hundred twenty-nine abdominal myomectomies with the indication of infertility and/or recurrent pregnancy loss were analysed retrospectively. The main purpose was to compare postoperative pregnancy, delivery and miscarriage rates according to either the uterine cavity was opened or not during the surgery. As a secondary outcome postoperative pregnancy rates were assessed by location, size and number of fibroids. Results There was no significant difference in reproductive results according to either the uterine cavity was opened or remained closed. Preoperative location, size and number of fibroids did not influence significantly the postoperative pregnancy rates. Conclusion Opening the uterine cavity does not impair postoperative pregnancy rates. Preoperative location, size and number of fibroids do not influence postoperative reproductive results. Capsule Comparing postoperative pregnancy rates after abdominal myomectomy we found no significant difference according to either the uterine cavity was opened or remained closed during surgery.     

Differential diagnosis of septate and bicornuate uterus by sonohysterography eliminates the need for laparoscopy

OBJECTIVE: To determine whether sonohysterography can differentiate septate from bicornuate uterus. DESIGN: Prospective study. SETTING: Outpatient infertility clinic of a university hospital. PATIENT(S): Twenty patients with history of recurrent pregnancy loss and hysterosalpingographic diagnosis of septate or bicornuate uterus. INTERVENTION(S): Sonohysterography was done in all patients. Laparoscopy was performed to confirm diagnosis in 10 patients and was not done in 10 patients. All patients with septate uterus underwent hysteroscopic metroplasty; simultaneous laparoscopy was done in women who had diagnostic laparoscopy. Abdominal metroplasty was performed in patients with bicornuate uterus. MAIN OUTCOME MEASURE(S): Shape of the uterine cavity after surgery and pregnancy outcome. RESULT(S): The shape of the uterine cavity was normal in seven cases in each group and almost normal in six other patients after surgery. There were two pregnancy losses after metroplasty, one in a woman who had laparoscopy and one in a woman who did not have laparoscopy. One case of bicornuate uterus occurred in each group. CONCLUSION(S): Sonohysterography can differentiate septate and bicornuate uterus and may eliminate the need for laparoscopy to diagnose these uterine anomalies.     

Uterine cavity shape and the best site for embryo transfer

Objective

To determine the best site for embryo placement in uterine cavities of varying shapes.

Method

In this prospective investigation, 638 embryo transfers were allocated to two groups: for group 1 (n = 558) embryos were transferred into uterine cavities of normal shape; for group 2 (n = 80) embryos were transferred into uterine cavities of abnormal shape. The uterine cavity was divided into 3 equal regions: upper, middle, and lower. Pregnancy outcomes for placements in each region were compared within and between the 2 groups.

Results

No significant differences were found in rates of pregnancy or implantation among the 3 regions in group 1. In contrast, the implantation rate in group 2 was highest when embryos were placed in the middle region of the uterine cavity: 28.8% compared with 6.8% and 8.3% for the upper and lower regions, respectively (P < 0.05).

Conclusion

For the normal uterine cavity, pregnancy outcomes do not depend on embryo placement. However, for uterine anomalies, embryo placement in the middle region of the uterine cavity gave the best outcome.     

子宫腔整复手术规范操作与子宫内膜保护

子宫腔整复手术是治疗先天性子宫异常和获得性子宫异常的重要方式。手术目的是保护器官,促进和改善生理和生育功能。规范手术操作,保护子宫内膜才能实现从解剖恢复到功能恢复。手术规范操作涉及严格掌握手术指征、完善术前评估、术者规范化培训、术中安全监护及保护子宫内膜的相关措施等内容。     

Sonographic appearance of the uterus in the early puerperium in vaginal versus cesarean deliveries: a prospective study

Purpose: The purpose of this study is to compare uterine sonographic characteristics in early puerperium, following vaginal versus cesarean deliveries; and in women with abnormal third stage of labor, compared to uncomplicated vaginal delivery.

Materials and methods: This is a prospective study of women after delivery of singleton, appropriate-for-gestational-age weight, term neonates; 66 women delivered vaginally and 33 delivered by cesarean section. Sonographic uterine dimensions (height, length, and width), intracavitary thickness and its echogenicity (at level of fundus, midcavity and cervix) were recorded at less than and after 24?h from delivery, and compared between women delivered vaginally and by cesarean section. Among women delivered vaginally, data were further analyzed according to whether women underwent manual revision of the uterine cavity.

Results: Sonographic evaluations were taken at 15.4 (4.3–24.0) and 39.5 (28.8–108.8) hours after delivery (median, range). We found no clinically significant differences in uterine characteristics according to mode of delivery or according to manual revision of the uterine cavity. The sonographic appearance of the uterus was similar when performed at less than or after 24?h from delivery.

Conclusions: Postpartum sonographic evaluation of the uterus appears similar after vaginal and cesarean deliveries.     

Comparative outcomes of hysteroscopic examinations performed after uterine artery embolization or laparoscopic uterine artery occlusion to treat leiomyomas

Hysteroscopic examination of the uterine cavity revealed that patients previously treated for intramural myoma(s) by uterine artery embolization had a significantly higher incidence of abnormal findings compared with patients treated by laparoscopic occlusion of uterine arteries (59.5% vs. 2.7%). In particular, there was a higher incidence of necrosis in the uterine cavity of patients subjected to uterine artery embolization (43.2%) compared with patients after surgical uterine artery occlusion (2.7%).     

宫腔粘连子宫腔整复手术质量控制

官腔粘连是子宫内膜损伤引起的严重危害女性生育功能与生理健康的疾病.随着子宫腔整复手术的普及开展,官腔粘连的确诊率与治疗效果均有了显著提高.宫腔镜能够在直视下明确粘连形成的程度、性质并进行量化分期;官腔镜粘连分离子宫腔整复手术被誉为治疗官腔粘连的金标准方法,明显提高了手术疗效和改善患者生育结局.然而,与现实不符的是,目前...