≥50岁女性子宫颈锥切术后ECC在预测HSIL及以上#br# 病变残留或复发中的作用#br#

Objective?To investigate the role of post conization ECC in predicting residue/recurrence of hsil+in patients aged ≥50 years old. Methods?The clinical data of 151 patients aged≥50 years old who underwent cervical conization in Peking University First Hospital from January 2013 to December 2019 were analyzed retrospectively, and the results of at least 6 months follow-up were analyzed, and the role of post conization ECC in predicting HSIL+residue/recurrence was analyzed. Results?The residue/recurrence rate was 13.91% (21/151) after cervical conization. The residue/recurrence rate of HSIL+was 7.27%(8/110) in patients with negative margin and 31.71%(13/41) in patients with positive margin, which was statistically significant (P=0.00). After conization, the residue/recurrence rate of HSIL+was 6.35%(8/126) in ECC negative patients and 52.00%(13/25) in ECC positive patients, which was statistically significant (P=0.00). The residue/recurrence rates of HSIL+were 4.00%(4/100), 22.22%(8/36) and 60.00%(9/15) in both ECC and margin negative, any positive and both positive patients respectively, with statistical difference (P=0.00). In those with negative and positive margins, the residue/recurrence rate of HSIL+in ECC negative and positive patients was significantly different (P=0.00 and P= 0.01).Among those with negative and positive post conization ECC, there was no significant difference in HSIL+residue/recurrence rate between margin negative and positive patients (P=0.06 and P=0.43). Conclusion?The risk of HSIL+residue/recurrence in post conization ECC positive women over 50 years old is extremely high, management should be strengthened.     

诺舒子宫内膜去除术治疗异常子宫出血的预后影响因素分析#br#

Objective?To investigate the prognostic factors of NovaSure endometrial ablation in the treatment of abnormal uterine bleeding (AUB). Methods?A retrospective analysis was performed on 201 patients with AUB who underwent NovaSure endometrial ablation in our hospital from January 1, 2011 to December 31, 2018. We analyze the amenorrhea rate and the rate of reintervention at different time points after operation. Cox regression model was used to investigate the factors that influenced the outcome (amenorrhea rate) and treatment failure (reintervention rate). Results?The amenorrhea rate was 67.66%, 70.27%, 76.32%, 75.83%, 78.82% at 1, 2, 3, 4 and 5~8 years after NovaSure operation respectively. The re-intervention rate was 6.47%, 10.27%, 14.47%, 15.00%, 18.82%, respectively.  Multivariate analysis by Cox regression model was used to study the prognostic factors .AUB patients with the history of cesarean section (P=0.026, HR=0.588, 95%CI: 0.368~0.938) or the cases combined with adenomyosis (P=0.007, HR=0.424, 95% CI: 0.227~0.792) can reduce the rate of amenorrhea, which affected the curative effect of NovaSure operation. AUB patients with dysmenorrhea history (P=0.008, HR=3.239, 95% CI: 1.356~7.736) or combined with adenomyosis (P<0.0001, HR=4.952, 95% CI: 2.297~10.678) or with thicker endometrial (thickness>10 mm, P=0.021, HR=2.413, 95% CI: 1.139~5.111) can increase the postoperative re-intervention rate, which are the risk factors for failure of NovaSure operation. Conclusion?The history of cesarean section and adenomyosis can reduce the rate of amenorrhea, which affected the curative effect of NovaSure operation; Dysmenorrhea, adenomyosis and endometrial thickness 10 mm can increase the postoperative re-intervention rate and were the risk factors of NovaSure operation failure.     

Ⅰ期子宫内膜样腺癌前哨淋巴结活检术学习曲线分析#br# #br#

【Abstract】?Objective?To explore learning curve of sentinel lymph node biopsy (SLNB) for stage I endometrioid adenocarcinoma. Methods?Sixty patients with stageⅠendometrioid adenocarcinoma from October 2015 to June 2018 were selected and divided into three groups according to the order of operation time: Group A (October 2015 to December 2016), Group B (December 2016 to February 2018) and Group C (February 2018 to June 2018). There were 20 patients in each group. The SLNB operation time, detection rate, and sensitivity were compared. Results?The operation time of SLNB in group C was significantly shorter than groups A and B (P<0.05). Among the 60 patients, 51 (85%) were successful SLN mapping, 43(71.67%) bilaterally SLN mapping, 47 (78.33%) were external iliac lymph nodes, 31 (51.67%) were obturator lymph nodes. The rate of group A, B, and C was 70% (14/20), 90% (18/20), and 95% (19/20), respectively. The difference between the total detection rates of three groups was statistically significant (P=0.021). The sensitivity of SLNB in group A was 50%, and the negative predictive value was 92.30%, and both groups B and C were 100%. Conclusion?There is a learning curve for SLNB. After 40 cases of SLNB, more proficient and accurate level can be achieved.     

子宫动脉栓塞术对胎盘前置状态引产患者生育能力及再妊娠结局的影响研究#br#

Objective?To explore the effects of uterine artery embolization on fertility and re-pregnancy outcomes of induced labor patients with placenta previa. Methods?A retrospective analysis of 260 patients with placenta previa induced labor was used as the research object. The control group (n=130) was induced labor with ethacridine lactate+mifepristone, and the observation group (n=130) was treated with uterine artery embolization combined with Lactated ethacridine+mifepristone to induce labor. The differences in induction of labor and postoperative complications between the two groups were compared, and the differences in postoperative fertility [follicle-stimulating hormone (FSH), estradiol (E2), and luteinizing hormone (LH)] between the two groups were investigated. Differences in pregnancy outcomes were analyzed in the two groups. Results?Success rate of labor induction and delivery rate in observation group were higher than those in control group. The total stage of labor, blood loss, hospital stay and menstrual recovery time were less than those in control group (P<0.05). There were no significant differences in incidence rates of postoperative complications, pregnancy rate, induced abortion rate and spontaneous abortion rate between the two groups (P>0.05). 4 months after surgery, the levels of FSH and LH in the two groups were increased while level of E2 was decreased compared to those 2 months after surgery, and levels of FSH and LH were lower while E2 level was higher in observation group compared to control group (P<0.05). Conclusion?The use of uterine artery embolization combined with lactate ethacridine+mifepristone to induce labor in patients with placenta previa is safe, can effectively reduce the impact on fertility, and is conducive to improving the outcome of re-pregnancy.     

糖皮质激素联合 GnRH-α 在轻度子宫内膜异位症合并复发性早期流产患者中的疗效评价 #br#

近年来,子宫动脉栓塞术（uterine arterial embolization,UAE）用于治疗子宫腺肌病（adenomyosis,AD）已取得较好的临床效果[1-4]。子宫动脉的发育情况虽然在传统妇产科治疗中无特殊意义,但对UAE的成功及栓塞后临床疗效可能起着一定的作用[5]。本研究将6例一侧子宫动脉缺如或发育不良的子宫腺肌病患者子宫动脉栓塞术后的临床疗效分析报道如下。     

地佐辛复合布托啡诺在剖宫产产妇术后镇痛、镇静效果及并发症的对比分析#br#

Objective?To analyze the application effects of dezocine combined with butorphanol on postoperative analgesia, sedation and complications of puerperae with cesarean section. Methods?98 patients after cesarean section treated in the First Affiliated Hospital of Henan University of CM between October 2019 and March 2021 were selected, and randomly divided into control group (n=48, treated with butorphanol) and observation group (n=50, treated with dezocine combined with butorphanol). Visual Analogue Scale (VAS), Bruggrmann Comfort Scale (BCS) and Ramsay Sedation Score (RSS) were used to compare the analgesic effects at 1 h, 6 h, 12 h and 24 h after surgery (T1-T4). Levels of C-reactive protein (CRP), interleukin-6 (IL-6) and interleukin-2 (IL-2) of the two groups were compared at T1 and T4. Incidence rate of postoperative complications was compared between the two groups. Results?VAS scores of patients in observation group at T1-T4 were lower while BCS scores were higher compared those in control group, and Ramsay sedation scores at T1-T3 were higher than those in control group, with time-point effect, between-group effect and interaction effect (P<0.05). Levels of CRP and IL-6 of observation group at T1 and T4 were lower while level of IL-2 was higher compared to control group (P<0.05). The incidence rates of complications of the two groups were 8.00% and 16.67% respectively (P>0.05). Conclusion?Dezocine combined with butorphanol has better sedative and analgesic effects on puerperae after cesarean section, and it helps to improve the comfort and relieve the body’s inflammatory response, with few complications.     

卵巢打孔术治疗枸橼酸氯米芬抵抗型多囊卵巢综合征不孕患者#br# 临床效果的荟萃分析

【摘要】 目的 评价腹腔镜下卵巢打孔术（laparoscopic ovarian drilling,LOD）治疗枸橼酸氯米芬（clomifene citrate,CC）抵抗型多囊卵巢综合征（polycystic ovary syndrome,PCOS）不孕患者的临床效果。方法 收集已经发表的有关LOD治疗CC抵抗型PCOS不孕患者疗效对比的随机对照临床试验,对筛选后纳入的的研究进行质量评价,对LOD及药物治疗后的排卵率、妊娠率进行荟萃分析。结果 纳入9个研究共1362名CC抵抗型PCOS不孕患者,经统计,LOD与药物相比,治疗后排卵率（P=0.35,OR=0.88,95%CI 0.67~1.16）、妊娠率(P=0.88,OR=0.98,95%CI 0.78~1.23）均无明显差异;药物组多胎妊娠率高于LOD组（P=0.04）。结论 LOD与药物治疗CC抵抗型PCOS不孕患者具有相似的临床效果。     

基于云技术和人工智能的自动化细胞学诊断平台在703 103名女性宫颈癌筛查中的应用研究#br# #br#

目的探讨低危子宫内膜癌的淋巴结转移情况、相关因素及预后。方法回顾性分析2013年1月至2018年9月在郑州大学第一附属医院行分期手术的452例低危子宫内膜癌患者的临床资料,采用单因素分析淋巴结转移的危险因素。结果 452例低危子宫内膜癌患者盆腔和(或)腹主动脉旁淋巴结转移率2.65%(12/452),复发率0.66%(3/452),死亡率0.44%(2/452)。单因素分析显示,浸润表浅肌层、组织学分级G2、低体质指数与淋巴结转移的关联有统计学意义(P 0.05)。年龄、CA125水平、淋巴脉管间隙浸润、肿瘤大小、腹水细胞学阳性等与淋巴结转移的关联无统计学意义(P0.05)。269例浅肌层浸润患者G1组与G2组淋巴结转移率[1.00%(1/100)、6.51%(11/169)]比较,差异有统计学意义(P 0.05)。结论病变局限于子宫内膜的低危子宫内膜癌患者,无论肿瘤大小及分级,淋巴结转移率低,复发率低,预后好,可不行腹膜后淋巴结切除术;低体质指数、浅肌层浸润且组织学G2的患者淋巴结转移率较高,建议评估淋巴结转移情况。     

浅谈阴道内镜技术的发展与临床应用#br#

正适龄妇女定期子宫颈癌筛查,并对筛查异常者进行进一步管理,最大限度地检出及治疗子宫颈癌前病变,是预防子宫颈浸润癌的首要目标。但在临床上管理筛查异常者时,需对筛查低级别异常及高级别异常实施分层管理,由此产生的复杂性可能会导致临床医生管理认识上的混乱[1],往往存在着对低级别异常者管理过度或对高级别异常者管理不足问题,均不利于子宫颈癌的防控。为此,近年来世界卫生组织及各国阴道镜和子宫颈病理学会(Society for Colposcopy and Cervical Pathology, SCCP),