中隔子宫不孕不育合并子宫内膜异位症的临床诊治

目的:探讨中隔子宫不孕不育患者合并子宫内膜异位症的临床特征、诊断及治疗方法。方法:对2001年2月～2005年8月北京大学深圳医院住院治疗的24例中隔子宫不孕不育合并子宫内膜异位症患者的临床资料进行回顾性分析。结果:24例中隔子宫不孕不育患者全部合并子宫内膜异位症,平均年龄28.5岁,临床表现均为不孕不育,其中不孕不育16例,月经紊乱4例,无症状体检发现4例,全部患者经手术治疗(宫腔镜、腹腔镜联合手术)。手术证实完全中隔7例,不全中隔17例。子宫内膜异位症按(ASF-r)分期,均为Ⅰ～Ⅱ期,多处盆腔异位病灶8例,直肠窝异位病灶6例,子宫骶骨韧带异位病灶10例,所有患者术后均放置宫内节育器,雌激素治疗3～6个月,追踪随访妊娠10例,分娩5例。结论:中隔子宫不孕不育患者易合并子宫内膜异位症,应早期诊断、早期手术治疗,宫腔镜、腹腔镜联合手术治疗是治疗的最佳方法。术后雌激素治疗有利于子宫内膜的修复。但对盆腔子宫内膜异位病灶则不利,必要时需二次腹腔镜手术去除异位病灶,疗效满意。     

非脱垂子宫阴式子宫全切的创新应用

目的:寻求并发症少、手术操作安全的非脱垂子宫阴式子宫切除术式。方法:对非脱垂子宫阴式子宫切除术进行创新,术前1天阴道准备,即10%的氯化钾、2%的双氧水加碘伏冲洗阴道2次,番泻叶30g代茶饮。手术当天清洁灌肠,术前30min给予5%葡萄糖注射液50ml加头孢噻肟钠2.0g静脉推注。3%的垂体后叶素盐水60ml注入阴道穹隆黏膜下,电刀沿穹隆部环形切开阴道黏膜,打开前后穹隆,进入腹腔,窄S拉钩分别自前后穹隆部伸入腹腔拉开,暴露术野。术中根据子宫大小采取对半、去核、碎解的单一或联合应用。结果:该术式并发症少、手术操作安全、手术时间短、创伤小、出血少,明显优于传统术式。结论:创新术式并发症少、手术操作安全增加了非脱垂子宫阴式子宫切除术的安全性及易行性并扩大了适应证。     

经导管动脉化疗栓塞治疗中晚期子宫颈癌疗效观察

目的探讨和评价经导管动脉化疗栓塞治疗中晚期宫颈癌的应用价值。方法对29例中晚期子宫颈癌患者进行双侧髂内动脉前干或子宫动脉化疗及栓塞治疗。按国际妇产科协会临床分期标准：Ⅱb期22例,Ⅲb期7例,均无盆腔外转移。其中鳞癌25例,腺癌3例,鳞腺癌1例。结果全部患者术后阴道出血停止,症状明显改善。25例行根治性手术切除,20例Ⅱb期患者宫旁组织内未见癌细胞。结论经导管动脉化疗栓塞治疗中晚期宫颈癌可减少淋巴结和脉管内的亚临床转移,提高手术切除率,是一种安全有效的新方法。     

Simultaneous pregnancy in each cavity of a double uterus. A case report

A case of twin pregnancy in an anovulatory woman with uterus didelphys who conceived after ovulation induction is described. The management and possible complications of such cases are discussed.     

外源性雌激素对雌性青春期前大鼠性腺影响的形态计量学研究

目的 探讨外源性雌激素对青春期前大鼠子宫和卵巢影响的形态计量学变化。方法 40只6周龄雌性青春期前SD大鼠随机分为实验组（n=20）和对照组（n=20），分别肌肉注射苯甲酸雌二醇（40μg／kg）和等容积生理盐水2周，末次注射24h后用10％水舍氯醛麻醉，解剖取两组大鼠子宫、卵巢，比较器官湿重及其器官系数；做组织切片，在光学显微镜下观察并行随机采取图像输入Mivnt显微图像分析系统进行形态计量学分析，比较两组大鼠子宫内膜高度、肌层厚度以及卵泡总数、闭锁卵泡比例、卵泡总面积、卵泡总周长、卵泡面密度、卵泡周长密度。在SPSS13．0上进行两个独立样本t检验。结果 实验组大鼠子宫湿重、子宫系数、内膜高度及肌层厚度均明显高于对照组（P〈0.05）；实验组大鼠卵巢湿重、卵巢系数、卵泡总面积、卵泡总周长、卵泡面密度、卵泡周长密度均明显低于对照组（P〈0.05），卵泡总数、卵泡数密度两组比较差异无显著性（P〉0.05），但实验组大鼠闭锁卵泡／卵泡总数明显高于对照组。结论 外源性雌激素可明显损害青春期前大鼠子宫、卵巢的正常发育。     

奇异性子宫平滑肌瘤15例临床病理分析

目的 探讨奇异性子宫平滑肌瘤的临床及病理特点。方法 对15例奇异性子宫平滑肌瘤的病因及临床表现进行分析，并作病理及免疫组化检查。结果 奇异性子宫平滑肌瘤以不规则阴道流血、盆腔包块、贫血为主要临床表现。其中3例合并妊娠，4例有孕激索治疗史。镜下见多核或单核瘤巨细胞，核分裂象0～3／10HPF。孕激素受体（PR）均呈阳性表达．其中8例Ki-67、p53呈微弱阳性表达，雌激素受体（ER）呈阴性表达。结论 奇异性子宫平滑肌瘤属良性肿瘤，临床表现及治疗与子宫平滑肌瘤相似。其发病与外源性孕酮及内源性孕激素有一定关系。与子宫平滑肌肉瘤的鉴别主要依靠苏木素伊红染色（HE）切片观察，免疫组化表达有一定的特征。     

A Quantitative Evaluation of Active Gelatinolytic Sites in Uterine Endometrioid Adenocarcinoma Using Film in situ Zymography: Association of Stronger Gelatinolysis with Myometrial Invasion

Collagen matrix degradation by malignant tumor cells plays an essential role in the process of tumor invasion and metastasis. The purpose of this study was to detect in situ gelatinase activity in endometrioid adenocarcinomas of the uterine corpus. In order to carry out quantitative evaluation, autoexposure tune (AET) on gelatin-coated film (film in situ zymography: FIZ) was measured. The gelatinase activity was located primarily within cancers and was prominently suppressed by the addition of a chelating agent to the film. This suggests that matrix metalloproteinases (MMPs) play an important role in the gelatinase activity. The gelatinase activity in the normal endometrium is almost negligible, despite positive immunoreactivity for MMP-2 and -9. Tumor tissues that had invaded more than half of the myometrium showed significantly higher activity than those that had invaded less than half. There was no significant difference in gelatinase activity among tumor stages, grades, vessel invasion or immunoreactivity for MMPs, with the exception that stage 2b cancers showed higher activity than stage la. The study suggested that the level of MMP-mediated gelatinolysis is an important factor for myometrial invasion in uterine endometrioid adenocarci- noma. Thus, a quantitative assessment of active gelatinolysis using FIZ and AET should be a useful tool in evaluating in situ matriolytic activity in local myometrial invasion by uterine endometrioid adenocarcinoma.     

益妇止血丸药理作用的研究

目的：探讨益妇止血丸的药理作用。方法：以家兔为观察对象，灌胃给药检测各组家兔血中部分凝血活酶时间（PPT）、复钙时间（RT）、凝血酶原时间（PT）、血小板计数和血小板粘附率。体外给药检测各组家兔血中部分凝血活酶时间（PPT）、复钙时间（RT）、凝血酶原时间（PT）。用离体子宫实验检测对已服用和未服用雌激素的家兔离体子宫的收缩节律与强度作用。结果：益妇止血丸能促进家兔内源性凝血功能，使PPT和RT时间显著缩短，其促凝作用的机理与安络血相似，但与血小 板的粘附聚集和外源性的促凝系统无关。对服用和未服用己烯雌酚的兔离子体宫平滑肌具有同样的兴奋作用，加强其收缩的幅度和频率。     

MR imaging findings of uterine endometrial stromal sarcoma: differentiation from endometrial carcinoma

Endometrial stromal sarcoma (ESS) is a rare malignant neoplasm of the uterus. We retrospectively analyzed pelvic MR imaging in 8 cases of ESS to determine the characteristic MR findings of ESS. Magnetic resonance images of 8 cases of ESS were evaluated for findings including the size, margin of the tumor, nodular lesions at the tumor margin, intramyometrial worm-like nodular extension, multiple nodular mass formation, hemorrhage, and necrosis in the tumor. The degree of contrast enhancement was also analyzed. The MR imaging findings of 21 consecutive cases of endometrial carcinoma (EC) were also evaluated and compared with those of ESS. The mean and the standard deviation of the maximum diameter of ESS and EC were 8.80 ± 4.99 and 3.93 ± 2.47 cm, respectively. Increased enhancement in at least a part of the tumor was observed in five of the six analyzed ESS cases and in 2 of 12 analyzed EC cases. The irregular margin, nodular lesions at the margin, intramyometrial nodular extension, and multiple nodular mass formation were more frequently seen in cases of ESS than in cases of EC. Magnetic resonance imaging can play a role in both diagnosing ESS as well as in differentiating ESS from EC. Received: 17 December 1999 Revised: 18 May 2000 Accepted: 22 May 2000     

子宫平滑肌和胎膜组织表皮生长因子受体mRNA表达水平与分娩？…

目的　探讨子宫平滑肌和胎膜组织表皮生长因子受体 (EGFR)mRNA表达水平与分娩发动的关系。方法　用半定量逆转录聚合酶链反应检测分娩发动前、后各 10例产妇子宫平滑肌和胎膜组织的EGFRmRNA表达水平。结果　子宫平滑肌EGFRmRNA表达水平由分娩发动前的 0 .91± 0 .3 2增高至分娩发动后的 1.3 3± 0 .2 3 ,两者比较 ,差异有显著性 (P <0 .0 5 ) ;胎膜组织EGFRmRNA表达水平由分娩发动前的 1.0 5± 0 .3 0增高至分娩发动后的 1.65± 0 .71,两者比较 ,差异有显著性 (P<0 .0 5 )。结论　分娩发动前、后子宫平滑肌及胎膜组织中EGFRmRNA表达水平升高 ;并与分娩发动有密切关系 ,是诱发子宫平滑肌收缩的重要因素。