In-vitro fertilization and the ovarian hyperstimulation syndrome.

Eight patients who developed severe ovarian hyperstimulation syndrome (OHSS) were identified among 1302 patients undergoing in-vitro fertilization (IVF) over a 1 year period (prevalence of 0.6%); 63% had ultrasonically diagnosed polycystic ovaries (PCO) and 75% were undergoing their first attempt at IVF. Pretreatment with a superactive luteinizing hormone-releasing hormone (LHRH) analogue significantly increased the prevalence of severe OHSS (1.1% versus 0.2%, P less than 0.05) compared with ovarian stimulation with clomiphene citrate and human menopausal gonadotrophin (HMG). The mean serum oestradiol concentration on the day of human chorionic gonadotrophin (HCG) administration was 8200 +/- 2300 pmol/l. A mean of 19.6 +/- 6.8 follicles had been aspirated and 13.1 +/- 7.7 oocytes recovered at transvaginal ultrasound-directed oocyte recovery. All patients had an embryo transfer and luteal support in the form of HCG. The clinical pregnancy rate was 88%, multiple pregnancy rate 71% and implantation rate 63.5 +/- 41.3%. In a group of seven patients who were hospitalized for moderate OHSS during the same period, peak oestradiol levels were significantly lower than in those with severe OHSS (P less than 0.05). Of the group with moderate OHSS, 57% had PCO, the clinical pregnancy rate was 100% and multiple pregnancy rate 43%. Patients with ultrasound-diagnosed PCO have an increased risk of developing OHSS and the dose of HMG administered to them should be minimized. In patients at risk of developing OHSS, progesterone instead of HCG should be used for luteal support. Transfer of a maximum of two embryos or freezing all embryos for transfer in a subsequent cycle may reduce the likelihood of multiple pregnancy.     

Analysis on Mental Features and Nursing Countermeasures for Malignant Ovarian Tumor Patients

Objective To inquire into the mental features of malignant ovarian tumor patients and advance the way to appease the mental state. Methods The mental health status of 168 malignant ovarian tumor patients was evaluated using Symptom Checklist 90 （SCL-90）, and compared with that of normal crowd and other gynecologic malignant tumor patients. Results The scores of suppression, anxiety, fear, somatization, constrain, hostility, interpersonal relationship of the ovary malignant tumor patients were higher than those of the normal model, and the scores of suppression, anxiety, interpersonal relationship higher than those of other gynecologic malignant tumor patients. Conclusions To strengthen the nursing teaching, understand the mental state on time, use moral support therapy, and help the patients to change their inadequate attitude and behavior, can strengthen the therapy confidence and promote the health rehabilitation.     

经阴道卵巢良性肿瘤切除术的临床研究

目的研究经阴道行卵巢良性肿瘤切除术的临床效果和安全性。方法经过筛选68例要求保留子宫的卵巢良性肿瘤患者为研究对象,对患者实施经阴道穹隆切开,继而行卵巢肿瘤切除术,对所有患者手术时间、出血量、手术并发症、住院时间、手术效果等进行记录并行回顾性分析。结果所有患者均成功实施手术,平均手术时间(39±11)min,平均出血量(60±10)ml,切除肿瘤大小4～12cm,无一例膀胱及直肠损伤发生。结论经阴道行卵巢良性肿瘤切除术创伤小、恢复快、住院时间短、无腹部刀口疤痕、医疗费用低,相比较传统开腹手术和腹腔镜手术有独特的优势,是一种切实可行和值得推广的新术式。     

非典型输卵管妊娠的临床与超声

输卵管妊娠是一种常见的妇科急腹症 ,对妇女造成极大的危害 ,诊断不及时甚至可危及生命。近 2 0年来全世界异位妊娠的发病率均有显著增加 ,发生率增长了 2～ 3倍。我国部分地区统计异位妊娠与正常妊娠之比为 1∶ 4 3～ 1∶ 5 0 [1～ 5] ,其原因如下 :(1)诊断方法先进 ,手段增多 ,检出率提高 ;(2 )盆腔炎症未彻底治疗 ;(3)性病的蔓延流行等高危因素。为了提高对异位妊娠的诊断水平 ,特别是非典型输卵管妊娠 ,有必要再复习一下异位妊娠的成因、病理、临床及超声声像图的各种表现。1　病　因病因是多方面的 ,如生殖细胞精子畸形、核型分类异常、染色体异常、卵发育停滞、受精卵发育不良、着床部位异常。盆腔炎造成输卵管周围粘连影响输卵管蠕动 ,伞端粘连影响捕捉孕卵功能 ,使输卵管半阻塞、狭窄乃至阻塞 ,纤毛粘连成瘢痕。性传播性疾病 ,特别是沙眼衣原体与异位妊娠的关系 ,Martin,Chow等人研究结果表明异位妊娠患者与沙眼衣原体感染有关 [6 ,7] 。输卵管本身的因素 ,如手术、炎症 ,造成肌层增生、狭窄等。宫内避孕器可降低输卵管妊娠 95 % ,研究表明带避孕器者好发于输卵管伞端。人工流产可增加宫...     

多囊卵巢综合征患者血清游离脂肪酸浓度测定及相关因素分析

目的:观察多囊卵巢综合征(PCOS)患者血清游离脂肪酸(FFAs)水平变化及相关因素分析.方法:PCOS患者(39例)分为肥胖组(11例)和非肥胖组(28例),对照组为年龄匹配的健康妇女(21例).测定血清FFAs、游离睾酮、雄烯二酮、睾酮、性激素结合球蛋白、TC、TG、HDL-c、LDL-c、空腹血糖(FPG)、餐后2h血糖(PPG)、空腹胰岛素及胰岛素敏感性(M值,两步法高胰岛素-正葡萄糖钳夹技术评价).结果:血清FFAs水平在肥胖PCOS组和非肥胖PCOS组之间无明显差别,但均高于对照组(P＜0.05).对所有研究对象的血清FFAs进行相关分析表明FFAs分别与游离睾酮(r=0.464,P=0.001),睾酮(r=0.368,P=0.01),雄烯二酮(r=0.418,P=0.003)和PPG(r=0.334,P=0.014)呈正相关,与M值(r=-0.392,P=0.003)呈负相关.进一步做回归分析表明,FFAs与游离睾酮显著相关(β=0.219,P＜0.05).结论:与年龄相当的健康妇女比较,PCOS妇女血清FFAs水平显著增高,并且FFAs升高与游离睾酮水平升高有关.     

两种术式治疗多囊卵巢综合征的远期疗效追踪比较

[目的]评价开腹卵巢楔形切除(OWR)和腹腔镜下双侧卵巢电灼开窗术(LOD)两种术式对多囊卵巢综合征(PCOS)的远期疗效.[方法]1981至2001年在我院诊断为PCOS并接受手术治疗的妇女共151例,其中行OWR 61例、LOD 90例,追踪分析两组妇女术后妊娠率、术后妊娠时间的分布及术前后月经模式变化.[结果]两组的临床特征具有可比性,OWR组累积妊娠率84%,LOD组累积妊娠率72%,两组间没有明显差异,绝大部分妊娠发生在术后18个月内;OWR组术后3个月、半年、1年、3年、5年及10年月经规律的妇女所占的比例分别是81.3%、81.3%、77.3%、77.6%、78.9%、85.2%,明显高于术前的31.1%(P值＜0.05);LOD组术后3个月、半年、1年、3年、5年及10年月经规律的妇女所占的比例分别是80.6%、63.5%、56.7%、58.0%、57.6%、42.9%,明显高于术前的35.6%(P值＜0.05);术后OWR组月经规律妇女占的比例明显高于LOD组(P均＜0.05).[结论]两种术式的术后妊娠率相似.OWR比LOD更好、更长远地改善PCOS妇女的月经异常.     

晚期卵巢癌理想肿瘤细胞减灭术的可行性研究

目的探讨晚期卵巢癌理想肿瘤细胞减灭术的可行性. 方法对22例Ⅲ、Ⅳ期晚期卵巢癌患者行肿瘤细胞减灭术,手术中尽可能多地切除盆腹腔内原发或继发癌灶,清扫盆腔和腹主动脉旁淋巴结,其中16例行理想肿瘤细胞减灭术(残留灶<2 cm). 结果切除前≥2 cm转移癌主要位于大网膜、盆腔和大肠;术后≥2 cm的残留灶主要位于盆腔,其次在胃结肠韧带、肝门和脾门.术后平均随访10(2～14)个月,达到理想手术的16例均无复发,未达理想减灭术的6例患者中复发及存活各1例,死亡3例,失访1例. 结论理想的肿瘤细胞减灭术对晚期及复发卵巢癌是安全可行的.     

胰岛素样生长因子-1在妇科疾病中的作用

在许多组织增生过程中，通过内分泌、旁分泌和自分泌会产生胰岛素样生长因子-1(IGF-1)。最近的研究发现，IGF-1存在于各种增生组织，如子宫内膜和卵巢组织。患有严重子宫内膜异位症时，血清中IGF-1水平较高，而子宫内膜局部的：IGF-1水平减低，这可能是导致不孕的原因，多囊性卵巢综合征(PCOS)患者卵巢局部的IGF-1活性增强，与患者肥胖、高雄激素水平等一系列临床症状有关。IGF-1在良、恶性肿瘤中也起着重要的作用，IGF-1能刺激子宫肌瘤细胞的生长。围绝经期妇女若存在高IGF-1和低IGF-1结合蛋白-3(IGFBP-3)水平，则患乳腺癌的风险增大。绝经前后女性的高IGF-1水平与宫颈癌、卵巢癌和子宫内膜癌的发病率存在相关性。     

Evaluation ofin vitro drug screening leads using experimental models of human ovarian cancer

Summary Five compounds which were identified as potential new anticancer drugs inin vitro screening with the human tumor colony forming assay were selected for further evaluation usingin vitro andin vivo models of human ovarian cancer. Three of five compounds were found to inhibitin vitro colony formation of ovarian cancer cell lines derived from both untreated and combination chemotherapy refractory patients. One compound was also found to prolong survival in a human ovarian carcinoma xenograft model system. This compound, chloroquinoxaline sulfonamide, was selected for development and has shown preliminary indication of activity in phase I clinical testing.     

A short luteal phase in cycles stimulated with clomiphene and human menopausal gonadotropin for in vitro fertilization

Of 70 cycles stimulated with clomiphene and human menopausal gonadotropin (hMG) for an in vitro fertilization-embryo transfer (IVF-ET) program, a short luteal phase of 11 days or less was found in 18. In this group the mean estradiol and progesterone levels were elevated in the early luteal phase. Despite the elevated initial values, progesterone levels fell rapidly at the mid luteal phase as a sign of premature luteolysis. The mean total amount of gonadotropin administered and the mean number of follicles punctured and of oocytes recovered did not show any significant difference between the groups of normal and short luteal phases. The present findings support the theory that hyperestrogenism in the early luteal phase may initiate the premature luteolysis observed in clomiphene-menopausal gonadotropin-stimulated cycles.