声脉冲辐射力成像技术对子宫腺肌病的诊断价值

目的观察子宫腺肌病（AM）患者月经周期中病变肌层声触诊组织量化VTQ值变化规律与特点,探讨应用声脉冲辐射力成像（ARFI）技术提高该病早期诊断率的可行性。方法应用超声声脉冲辐射力成像（ARFI）模式声触诊组织量化（VTQ）功能分别于月经周期的卵泡早期和黄体中期观测子宫腺肌病患者病变肌层声触诊组织量化VTQ值,分析对比观察组2个时期间及两组相应时期间VTQ值。结果黄体中期病变肌层VTQ值高于卵泡早期VTQ值,且差异有统计学意义（P〈0．05）。结论超声声脉冲辐射力成像（ARFI）技术能实时、敏感检测子宫腺肌病VTQ值,而且可重复性好．同时能体现子宫腺肌病肌层病变随月经周期性改变,有望成为子宫腺肌病诊断手段之一,从而为提高该病的早期诊断率提供有效依据。     

孕三烯酮保守治疗卵巢子宫内膜异位症并发不孕15例分析

目的　探讨孕三烯酮对卵巢子宫内膜异位症并发不孕的治疗疗效。方法　 1 5例患者给予孕三烯酮 2 .5mg ,每周 2次 ,共 6个月。对其中少数患者加用利维爱 (HRT)治疗以减少用药并发症。停用孕三烯酮后 ,部分患者应用促排卵药物 ,1例采用宫腔内受精(IUI)。治疗前、后分别行B超、MRI、血清CA1 2 5、生殖激素 (FSH ,LH ,E2 )及骨密度 (BMD)的测定。结果　治疗后痛经等症状缓解。B超、MRI显示 :卵巢病灶明显减小占 2 /3。血清CA1 2 5、生殖激素 (FSH ,LH ,E2 )水平明显降低 (P <0 .0 1 )。腰椎骨密度 (L -BMD)无明显变化 (P >0 .0 5) ,妊娠率达 73 .3 %。结论　孕三烯酮保守治疗卵巢子宫内膜异位症并发不孕是一种有效的方法 ,辅助诱导排卵和IUI可以使妊娠率进一步提高     

子宫内膜异位症及子宫腺肌症患者雌、孕激素受体研究

用葡聚糖—活性炭分离法(DCC)在18例卵巢宫内膜异位症患者的异位内膜组织及13例子宫腺肌症患者的局部腺肌组织中测得雌激素受体(ER)和孕激素受体(PR),但其阳性结果平均值低于正常宫内膜。18例卵巢宫内膜异位症中,PR阴性6例(33.4％),这可能与部分患者孕激素治疗效果不满意有关;13例子宫腺肌症中PR阳性10例(76.9％),提示对40岁以下患者保留子宫,采用激素治疗的可能性。雌、孕激素受体水平与这两种疾病患者的治疗及预后的关系,值得进一步探讨。     

宫腔声学造影对子宫腺肌病的鉴别诊断价值

目的探讨宫腔声学造影对子宫腺肌病的鉴别诊断价值。方法对120例子宫腺肌病及子宫肌瘤患者于术前一周内行宫腔声学造影。实验结果与病理结果对照,统计方法有t检验、x2检验等,结果用均数±标准差(x2±S)表示。结果宫腔声学造影可使诊断敏感性提高至80%,准确性提高至95%,鉴别诊断特异性100%。结论宫腔声学造影对子宫腺肌病有很好的鉴别诊断价值。     

Comparison of complications of vaginal hysterectomy in patients with leiomyomas and in patients with adenomyosis

We reviewed 1246 vaginal hysterectomies performed at Handa City Hospital between January 1984 and December 1996. We divided the patients into 2 groups: those with leiomyomas (n=893) and those with adenomyosis (n=353). There was no difference in operative time and estimated blood loss between the 2 groups when analyzed by uterine weight. However, adenomyosis was associated with an increased risk of bladder injury. Accepted: 7 April 1998     

The utility of diffusion-weighted MR imaging in differentiation of uterine adenomyosis and leiomyoma

Purpose

To investigate the value of diffusion-weighted MR imaging (DWI), especially apparent diffusion coefficient (ADC) in the differentiation of uterine adenomyosis and leiomyoma.

Materials and methods

17 patients with uterine leiomyoma and 22 patients with uterine adenomyosis underwent diffusion-weighted imaging (DWI) in addition to routine MR imaging. The ADC values, as well as ADC D-value (defined as the ADC value of high signal intensive foci minus the ADC value of lesion tissues the difference in value), were measured and compared to investigate whether they could help in the differentiation of uterine adenomyosis and leiomyoma. Histopathologic examination was conducted as the golden standard.

Results

For high signal intensive foci within the lesions, uterine adenomyosis demonstrated significantly lower mean ADC value than uterine leiomyoma (1.582 vs. 2.122 × 10⁻³ mm²/s, P = 0.001). For lesion tissues, uterine adenomyosis demonstrated significantly higher mean ADC value than uterine leiomyoma (1.214 vs. 0.967 × 10⁻³ mm²/s, P = 0.001). However, there was overlap between uterine adenomyosis and leiomyoma in both measurements. Mean ADC D-value was significantly lower in uterine adenomyosis than in uterine leiomyoma (0.369 vs. 1.096 × 10⁻³ mm²/s, P = 0.000). ADC D-value had no overlap between uterine adenomyosis and leiomyoma.

Conclusion

DWI can be applied for the further differentiation of uterine adenomyosis and leiomyoma, in addition to routine MR imaging. ADC D-value may be a more useful tool than ADC value in the differentiation.     

子宫动脉栓塞术治疗子宫腺肌病的近期疗效观察

目的 探讨子宫动脉栓塞术治疗子宫腺肌病的近期临床效果.方法 对我院18例经MRI诊断为子宫腺肌病的患者行子宫动脉栓塞术,采用Seldinger技术经股动脉穿刺,将导管选择性插入双侧子宫动脉,应用PVA(500～700μm)与碘佛醇混匀后在透视下经导管缓慢推注将子宫动脉栓塞.阻断异位内膜病灶血供,术后定期复查磁共振观察病灶体积及信号等变化.对所有患者随访至术后2月.结果 治疗后11例患者痛经完全缓解消失,6例明显缓解,1例变化不明显;子宫体积由治疗前的(208.5±70.9) cm3,缩小至治疗后的(176.7±57.2)cm3(P＜0.01).结论 子宫动脉栓塞术能有效缓解子宫腺肌病患者痛经程度、缩小子宫体积,是一种安全、有效的治疗方法.     

Increased interleukin-6 messenger RNA expression in macrophage-cocultured endometrial stromal cells in adenomyosis

PROBLEM: To determine the effects of macrophage on endometrial stromal cells (ESCs) in women with adenomyosis. METHOD OF STUDY: Eutopic endometrium was obtained and separated into single ESC in 10 women with adenomyosis (study group) and 11 without adenomyosis (control group). ESCs were then cultured alone or with macrophage for 24 hr. RESULTS: Immunohistochemistry identified the presence of interleukin-6 (IL-6), IL-8, and IL-10 in ESCs. Real-time quantitative PCR revealed that the IL-6 mRNA was significantly expressed in macrophage-cocultured ESCs in adenomyosis than that in the controls, but was not different in ESCs cultured alone between the two groups. The levels of IL-8 and IL-10 mRNA were similar in ESCs either cultured alone or with macrophage between women with and without adenomyosis. CONCLUSION: IL-6 mRNA was significantly expressed in ESCs after in vitro coculture with macrophage in adenomyosis. This aberrant behavior of ESCs might play a role in the formation of ectopic endometrial implants in adenomyosis.     

子宫腺肌病相关危险因素病例对照分析

目的分析探讨子宫腺肌病患病的相关因素。方法采用流行病学病例对照的研究思想,通过对来本院就诊的80例子宫腺肌病患者及80例对照组健康女性临床资料的统计分析,进而探讨影响子宫腺肌病发生的相关因素。结果本次调查经统计分析后,发现子宫腺肌病的发病与职业、月经量、痛经、人工流产史、人工流产次数及是否有宫内节育器有关,差异有统计学意义（P〈0.05）,尚未发现其与血型、文化程度、分娩方式、生活方式等因素有关,差异无统计学意义（P〉0.05）。结论年龄31～45岁,从事脑力工作,有痛经,多次人工流产史,月经量过多的妇女患子宫腺肌病的风险较高,应提高保健意识,定期检查。宫内节育器在一定程度上可降低该病发生的可能性,应注意危险因素的预防。     

中医治疗子宫内膜异位症、子宫腺肌症临床研究

目的：探讨中药“异位消”汤剂治疗子宫内膜异位症、子宫腺肌症的疗效。方法：选取100例子宫内膜异位症、子宫腺肌症患者,按照随机数字表法将患者分为两组,观察组患者50例接受中药“异位消”汤剂治疗,对照组患者50例接受常规西医治疗。比较两组患者疗效。结果：观察组患者总有效为92．0％（46／50）,明显优于对照组的62．0％（31／50）,差异有统计学意义（P〈0．05）。结论：中药“异位消”治疗子宫内膜异住症、子宫腺肌症疗效显著,安全性高。