MRI在子宫肌瘤与子宫腺肌病鉴别诊断中的价值

目的 分析子宫肌瘤与子宫腺肌病的MRI表现特点，评价MRI在两病鉴别诊断中的价值。方法 回顾性分析66例经手术病理证实的子宫平滑肌瘤和子宫腺肌症患者MRI资料，仔细观察两病在T1W、T2W、STIR及增强后T1W像上的表现。结果 MRI对两病诊断的敏感性为100％，诊断符合率为91．7％。两种病变的T1WI信号、边界、T2WI上病灶周围的改变、病侧子宫内膜以及临近结合带的改变方面具有较大差异；而在子宫形态、T2WI信号特点及增强特点上并没有明显差别；T2WI及STIR图像对病灶的显示最清晰。结论 子宫肌瘤和子宫腺肌病由于病理基础不同，MRI表现也各有不同；选择合适的MRI检查序列与方法对两病鉴别诊断具有重要的价值。     

Effectiveness of combined GnRH analogue plus raloxifene administration in the treatment of uterine leiomyomas: a prospective,randomized, single-blind,placebo-controlled clinical trial

BACKGROUND: Raloxifene hydrochloride is a synthetic non-steroidal drug used for the prevention and treatment of post-menopausal osteoporosis. Pre-clinical and clinical data have shown that raloxifene may have a beneficial effect on leiomyomas. The aim of this prospective single-blind, randomized, placebo-controlled clinical trial was to evaluate the effectiveness of the addition of raloxifene to GnRH analogues on uterine, leiomyoma, and non-leiomyoma sizes, and on the occurrence of leiomyoma-related symptoms. METHODS: After randomization using a computer-generated list, 100 pre-menopausal women with symptomatic uterine leiomyomas received either leuprolide acetate depot plus raloxifene 60 mg daily (group A) or leuprolide plus placebo tablet (group B) for six cycles of 28 days. At baseline and after treatment, uterine, leiomyoma and non-leiomyoma sizes, and leiomyoma-related symptoms were evaluated for each woman. Analysis was by intention-to-treat method. RESULTS: After six cycles of treatment, a significant decrease in uterine, leiomyoma, and non-leiomyoma sizes was detected in both groups in comparison with baseline. At the same time, no significant difference in uterine and non-leiomyoma sizes was observed between the groups. Leiomyoma sizes were significantly (P < 0.05) lower in group A than in group B. No difference was observed in leiomyoma-related symptoms between groups throughout the study period. CONCLUSIONS: In women treated with GnRH analogue, the raloxifene administration induces a higher reduction of leiomyoma sizes.     

高强度超声聚焦治疗子宫肌瘤的临床观察

目的探讨高强度超声聚焦治疗子宫肌瘤的有效性及安全性。方法选择不愿意行手术切除子宫肌瘤的育龄期已生育患者335例，应用FEP—BYO1型高强度超声聚焦治疗机进行治疗，治疗后定期随访观察。结果335例患者经高强度超声聚焦治疗后近期总有效率为97％（疗效显著30例、有效195例、部分有效100例），无效10例（3％）。结论高强度超声聚焦是无创治疗子宫肌瘤的有效方法。     

Low frequency of somatic mutations in the FH/multiple cutaneous leiomyomatosis gene in sporadic leiomyosarcomas and uterine leiomyomas

Germline mutations in the fumarate hydratase gene at 1q43 predispose to dominantly inherited skin and uterine leiomyomata and leiomyosarcomas. The enzyme, which is a component of the tricarboxylic acid cycle, acts as a tumour suppressor. To evaluate fumarate hydratase in respective sporadic tumours, we analysed a series of 26 leiomyosarcomas and 129 uterine leiomyomas (from 21 patients) for somatic mutations in fumarate hydratase and allelic imbalance around 1q43. None of the 26 leiomyosarcomas harboured somatic mutations in fumarate hydratase. Fifty per cent of leiomysarcomas tested showed evidence of allelic imbalance at 1q, but this was not confined to the vicinity of fumarate hydratase. Only 5% (seven out of 129) of the leiomyomas showed allele imbalance at 1q42-q43 and no somatic mutations in fumarate hydratase were observed. Our findings indicate that mutations in fumarate hydratase do not play a major role in the development of sporadic leiomyosarcomas or uterine leiomyomas     

3种子宫切除术式的临床应用效果比较

目的:探讨开腹子宫切除术(TAH)、腹腔镜下筋膜内子宫切除术(CISH)、腹腔镜辅助阴式子宫切除术(LAVH)3种子宫切除方式的临床应用效果.方法:102例子宫良性病变患者,子宫肌瘤72例,子宫腺肌病30例,分为3组:CISH组32例,LAVH组30例,TAH组40例,对3组患者的手术时间、术中出血量及术后情况进行比较.结果:LAVH、CISH组手术时间较TAH组明显延长,术中出血较TAH组明显减少,术后抗生素使用时间、下床活动时间、肛门排气时间、平均住院日较TAH组明显缩短,差异均有统计学意义(P＜0.05).结论:CISH和LAVH较TAH具有损伤少、恢复快的特点,是有效的子宫切除方式.     

Multiple leiomyomas of the vagina in a premenopausal woman

Case report A 32-year-old multiparous woman was seen for a history of dyspareunia and vaginal pain. She presented with two firm masses on the lower-medium left lateral wall of the vagina. Transvaginal ultrasonography showed two spherical smooth-walled masses, respectively of 33 and 35 mm in diameter. A transvaginal approach was used to remove the two tumors en bloc.Conclusion Histologically, the tumors were leiomyomas.     

CDFI鉴别诊断子宫肌瘤与子宫腺肌病

目的探讨彩色多普勒超声(CDFI)鉴别诊断子宫肌瘤与子宫腺肌病的应用价值。方法回顾我院2008年9月至2010年9月经手术及病理证实的866例子宫肌瘤、子宫腺肌病的CDFI声像图及血流变化情况,并对其进行比较分析。结果二者的声像图主要区别是子宫肌瘤瘤体与肌壁分界明显,而子宫腺肌病不明显;二者血流的区别是子宫肌瘤瘤体周边有环状、半环状血流,而且瘤体内有少许血流信号,而子宫腺肌病有弥散分布的血流。结论 CDFI对子宫肌瘤及子宫腺肌病的鉴别诊断有重要应用价值。     

CLINICAL ASSISTED REPRODUCTION: Uterine Leiomyomas and Their Effect on In Vitro Fertilization Outcome: A Retrospective Study

Purpose: The effect of uterine leiomyomas on the outcome of in vitro fertilization (IVF) treatment has been controversial. This study was undertaken to clarify influence of fibroids on IVF success, in a large population with age and other potential confounding variables controlled for in the analysis.Methods: A population of 141 patients with and 406 without leiomyomata undergoing their first IVF cycle was studied.Results: The association between uterine leiomyomas and assisted reproduction treatment outcome was not statistically significant (OR = 0.73, 95% CI: 0.49–1.19, p = 0.21) after controlling for age and other risk factors. Also, fibroids neither affected the risk of spontaneous abortion (OR = 1.06, 95% CI: 0.44–2.60) nor the risk of ectopic pregnancy (OR = 0.78, 95% CI: 0.08–8.02). Location of fibroids (intramural vs. submucosal/subserosal) and their size had no significant effect on pregnancy outcome.Conclusions: Results from our analyses indicated that in vitro fertilization outcome was not affected by the presence of uterine leiomyomas. Therefore, in patients with normal uterine cavities and fibroids less than a certain size (i.e., <7 cm), undergoing myomectomies as a prerequisite for assisted reproduction treatment is seriously questionable.     

子宫动脉栓塞术治疗子宫肌瘤临床分析

目的 分析子宫动脉栓塞术(UAE)治疗子宫肌瘤的疗效及并发症。方法 选用4F或5FCobra导管插管至双侧子宫动脉，给予聚乙烯醇(PVA)或．PVA加用明胶海绵栓塞子宫动脉至血流停止。分析1999年10月至2002年11月在本院接受LIAE治疗的105例子宫肌瘤患者的情况。结果最大肌瘤体积术后6个月和12个月分别平均缩小52％和53％，月经过多、腹痛腹胀及尿频缓解明显，而月经周期缩短、经期延长改善不明显。UAE术后59％的患者出现栓塞后综合征(不同程度的下腹痛、发热、呕吐等)，对症处理后缓解或消失。结论 作为一种微创手术，UAE可有效缩小肌瘤的体积，并明显缓解临床症状。     

Clinical utility of a microbubble-enhancing contrast (“SonoVue”) in treatment of uterine fibroids with high intensity focused ultrasound: A retrospective study

Purpose

To evaluate the clinical value of the contrast agent SonoVue in the treatment of uterine fibroids with ultrasound-guided high intensity focused ultrasound (HIFU) therapeutic ablation.

Materials and Methods

A total of 291 patients with solitary uterine fibroid from three centers were treated with ultrasound-guided HIFU. Among them, 129 patients from Suining Central Hospital of Sichuan were treated without using SonoVue. 162 patients from the First Hospital of Chongqing Medical University and Chongqing Haifu Hospital were treated with using SonoVue before, during and after HIFU procedure to assess the extent of HIFU.

Results

The non-perfused volume (indicative of successful ablation) was observed in all treated uterine fibroids immediately after HIFU ablation; median fractional ablation, defined as non-perfused volume divided by the fibroid volume immediately after HIFU treatment, was 86.0% (range, 28.8–100.0%) in the group with using SonoVue, and 83.0% (8.7–100.0%) without SonoVue. The rate of massive gray scale changes was higher with SonoVue than without the agent. The sonication time to achieve massive gray scale changes was shorter with SonoVue than without. The sonication time for ablating 1 cm³ of fibroid volume was significantly shorter with using SonoVue than without. No major complications were observed in any patients.

Conclusions

Based on our results, SonoVue may enhance the outcome of HIFU ablation and can be used to assess the extent of treatment.