子宫动脉栓塞治疗子宫腺肌病对卵巢功能的影响

目的:探讨子宫动脉栓塞治疗子宫腺肌病对卵巢功能的影响。方法:对27例子宫腺肌病患者采用聚乙烯醇微粒(PVA)进行子宫动脉栓塞治疗,在栓塞前、栓塞后3个月及6个月,评估所有病人的症状改善情况,并且采用经阴道彩色能量多普勒超声对子宫及病灶进行动态监测,监测子宫大小,子宫动脉和卵巢动脉血流动态改变,及基础性激素水平和基础体温情况。结果:子宫动脉栓塞术后3个月,子宫体积显著减小,平均缩小136.48(37.6%),子宫动脉的最大血流速度Vmax(cm/s)显著降低,由(27.27±6.03)cm/s降至(14.19±5.98)cm/s,P<0.05。子宫动脉阻力指数(RI)由0.54±0.03降至0.86±0.04,P<0.05;栓塞术前、后卵巢血流、卵泡刺激素(FSH)、雌二醇(E2)和月经周期无显著性差别。1例患者出现短暂卵巢功能急剧减退。结论:子宫动脉栓塞治疗子宫腺肌病是一种新颖、微创、安全、有效、并发症少且恢复快的治疗方法,可保留子宫的生育功能,对卵巢功能无明显损害,但应注意可能导致卵巢衰竭。     

海藻酸钠微球经子宫动脉栓塞治疗子宫肌瘤的疗效观察

目的探讨栓塞剂海藻酸钠微球（KMG）用于子宫动脉栓塞治疗子宫肌瘤的疗效。方法选择30例子宫肌瘤患者，以Seldinger技术完成单侧股动脉插管，根据数字减影血管造影（DSA）检查结果，插管至双侧子宫动脉并经DSA检查证实后，以直径为500—700／am的KMG栓塞子宫动脉。结果KMG栓塞治疗后，子宫肌瘤患者的临床症状明显缓解，月经量为原月经量的57．35％；第6、12个月肌瘤体积分别缩小59．17％、72．54％，子宫体积分别缩小45．75％、57．83％。结论KMG应用于子宫动脉栓塞治疗子宫肌瘤可有效地缩小肌瘤及子宫的体积，并明显改善子宫肌瘤患者的临床症状。     

青春期子宫出血54例临床分析

目的 探讨青春期子宫出血的病因、诊断和治疗方法。方法 对1990-01-2004-05中山大学附属第二医院54例青春期子宫出血病例进行回顾性分析。结果 54例青春期子宫出血患者，功能失调性子宫出血（功血）共34例占63．0％，血液系统疾病14例占25．9％，生殖道器质性病变3例占5．6％，其他疾病3例占5．6％。54例均经超声检查，9例有异常发现者再接受宫腔镜检查，3例发现器质性病变。功血患者经性激素治疗均达止血效果。结论 青春期子宫出血的病因以功血为多，但需排除其他疾病。超声结合诊断性刮宫和宫腔镜检查，是有力的诊断手段。     

激素治疗对绝经妇女子宫肌瘤的影响

目的:观察个体化周期序贯激素治疗对绝经妇女子宫肌瘤发生及生长的影响。方法:选择因绝经相关症状且合并单发性子宫肌瘤(肌瘤最大径线<5 cm)的绝经妇女60例,给予雌孕激素周期序贯方案,起始剂量为口服戊酸雌二醇1.0 mg,每日1次,连用21~25天,后10~14天加用甲羟孕酮每日4 mg。随后,根据每人对药物的不同反应,调整口服戊酸雌二醇的每日用量为0.5~2.0 mg,甲羟孕酮的每日用量相应为4~6 mg。不能连续应用激素治疗或失访者被排除。分别于治疗前及治疗3、6、122、43、6个月时采用阴道超声测定肌瘤大小及子宫内膜厚度。结果:53例患者完成了3年的观察,平均年龄51.4(44~57)岁,绝经年限平均2.3(1~7)年。激素周期序贯治疗3、6、12、24、36个月,肌瘤大小均无明显改变(P>0.05),没发现新生肌瘤(P>0.05),子宫内膜厚度均无明显增厚(P>0.05)。结论:根据个体对药物反应不同制定不同剂量的激素周期序贯方案,不促进绝经妇女子宫肌瘤的发生和生长。     

The Manchester operation for uterine prolapse.

OBJECTIVE: To evaluate the clinical characteristics, complications, and satisfaction scores of patients who underwent the Manchester operation. METHODS: This retrospective observational study evaluated data from 204 women who underwent the Manchester operation at the Department of Obstetrics and Gynecology of Hacettepe University School of Medicine, Ankara, Turkey, from January 1985 to April 2004. RESULTS: Mean age was 34.68+/-4.24 years and parity 2.47+/-0.96; 85.8% of the patients were premenopausal; 176 patients (86.28%) had grade 3 and 28 (13.72%) had grade 2 uterine prolapse; 95.1% of the patients had associated cystoceles and 51.3% had associated rectoceles; and 81.4% had urinary incontinence. Regarding early postoperative complications, 27 patients (13.23%) had febrile morbidity; retroperitoneal hematoma occurred in 1 patient (0.49%); urinary retention occurred in 45 patients (22.05%), and cervical stenosis occurred in 23 patients (11.27%). At 1 year, 1 patient had undergone abdominal hysterectomy because of unsuccessful cervical dilatation; and a mean of 3.6 years following the operation, 8 patients (3.9%) had undergone the tension-free vaginal tape procedure plus a vaginal hysterectomy for recurrent stress urinary incontinence and uterine prolapse. The mean satisfaction/acceptance score for the operation was 8.52+/-2.13 (range, 2-10). CONCLUSION: A high degree of acceptance/satisfaction and a low morbidity rate show the Manchester operation to be a good option for the treatment of uterine prolapse in women who wish to keep their uterus.     

Complex hyperplastic endometrium in a peritoneal leiomyoma following a CISH hysterectomy

We describe a case of a patient presenting with an abdominal tumor 4 years after a classical intrafascial serrated-edged macro-morcellated hysterectomy. The tumor was removed surgically and proved microscopically to be a peritoneal leiomyoma containing complex hyperplastic endometria. To our knowledge, this has never been described before. In addition, the pathogenesis of this rare disease is discussed.     

可行走分娩镇痛应用于潜伏期的临床研究

目的评价可行走分娩镇痛在潜伏期应用的临床效果。研究宫口开张不同大小应用分娩镇痛后的产程进展，对子宫收缩力的影响及新生儿Apgar评分情况。方法确认已临产无内科合并症的初产妇共75例，随机分为三组。Ⅰ组：宫口开张1cm左右；组：宫口开张2～3cm；Ⅲ组为正常对照组未采用分娩镇痛。观察镇痛起效时间、子宫收缩力的变化、总产程、产后出血量、分娩结局及新生儿Apgar评分。结果Ⅰ组与Ⅲ组比较总产程差异无统计学意义。Ⅰ组与Ⅱ组第一产程比较时间延长，差异有统计学意义（P〈0．05），Ⅱ组与Ⅲ组比较子宫收缩力无明显降低，第一产程中Ⅰ组与Ⅲ组比较子宫收缩力显著降低，P（0．05，Ⅰ组催产素使用率为100％。三组间产后出血、新生儿Apgar评分各组间差异无统计学意义。结论舒芬太尼合并低浓度的罗哌卡因引导下无痛分娩，从潜伏期应用，有明显的分娩镇痛作用，不增加产后出血量，对新生儿的Apgar评分无影响。     

子宫动脉灌注化疗栓塞治疗宫角妊娠的临床观察

目的 探讨子宫动脉灌注甲氨喋呤加明胶海绵颗粒栓塞术对宫角妊娠治疗的临床效果.方法 回顾性分析宫角妊娠36例患者的临床资料,所有患者均经子宫动脉灌注甲氨喋呤100 mg,再予以明胶海绵颗粒栓塞阻断双侧子宫动脉血流,以及其终末端分支血流.结果 35例患者经治疗后妊娠囊自然流产或吸收,患者均未出现明显骨髓抑制和肝肾功能损害等不良反应,仅部分出现轻微的栓塞综合征.行子宫动脉灌注化疗栓塞治疗后4～11周血β-HCG降至正常,6 ～13周经阴道超声检查孕囊消失.1例患者因孕囊过大,于治疗后2周子宫内见孕囊及胎心搏动,血β-HCG为12467.7 IU/L,超声引导下孕囊内注入甲氨喋呤80 mg后2d在宫腔镜下行清宫术.结论 子宫动脉灌注甲氨喋呤化疗加明胶海绵颗粒栓塞术治疗宫角妊娠的手术创伤小,术后恢复快,可降低切除子宫的风险,较大程度上保留了患者的生育功能,是一种治疗宫角妊娠有效的保守措施.     

Pathological Uterine Perfusion in the Second Trimester Is Not Associated with Neutrophil Activation

Objective: Preeclampsia and intrauterine growth retardation (IUGR) are associated with elevated concentrations of myeloperoxidase (MPO) and polymorphonuclear (PMN) elastase, which indicate maternal neutrophil activation. The aim of the study was to measure maternal MPO and PMN elastase plasma concentrations in second trimester pregnancies with pathological uterine perfusion that are a high risk group for preeclampsia and IUGR, and compare them to normal controls. Methods: The study includes 25 pregnancies with normal and 25 pregnancies with pathological uterine perfusion. In both groups, doppler‐sonographic measurement of uterine perfusion was performed in the twenty‐first week of gestation. Maternal plasma concentrations of MPO and PMN elastase were measured using a specific ELISA for both enzymes. Results: The plasma MPO concentration of pregnant women with normal perfusion did not differ significantly from that of the group with pathological perfusion (27.4 ± 3.3 vs. 23.7 ± 2.0 ng/mL). Likewise, the plasma PMN elastase‐concentration also did not show a significant difference between the groups (5.7 ± 0.5 ng/mL normal vs. 8.0 ± 1.0 ng/mL pathological). Patients with pathological perfusion that later developed preeclampsia or IUGR (9/25) showed unchanged MPO and PMN elastase values in the second trimenon compared to those with pathological perfusion and normal outcome. Conclusions: Pathological uterine perfusion in the second trimester was not associated with maternal neutrophil activation. The measurement of the MPO and PMN elastase concentration suggested that neutrophil activation in preeclampsia or IUGR is a secondary effect of the disease rather than a primary pathophysiological factor.