左炔诺孕酮宫内缓释系统治疗子宫腺肌病的临床观察

目的:观察左炔诺孕酮宫内缓释系统(LNG-IUS)治疗子宫腺肌病的临床疗效。方法:52例子宫腺肌病患者于月经期的第5~7天放置LNG-IUS,观察术前、术后1个月、3个月、6个月及1年后痛经程度、月经量及子宫大小的变化。结果:放置LNG-IUS后3个月,月经量显著减少,降低为治疗前的(28±5)%,治疗前后比较差异有统计学意义(P<0.01);28例贫血患者血红蛋白含量显著增加,由治疗前的(85±24)g/L恢复至(118±7)g/L;子宫大小均较前缩小,由治疗前的(17.8±1.8)cm减小为(17.5±1.6)cm,但差异无统计学意义(P>0.01);放置LNG-IUS后12个月,52例患者中49例患者痛经完全消失,3例患者痛经评级降低≥2个级别,但疼痛未完全消失。结论:LNG-IUS治疗子宫腺肌病近期疗效显著。     

宫腔镜在子宫腺肌病诊断中的价值

子宫腺肌病是严重危害女性健康的多发疾病,早期诊断困难。宫腔镜下可以识别子宫腺肌病患者宫腔内特异或非特异的、有时表现为细微而特征性的病变形态,包括子宫内膜内陷、血管增生、子宫内膜炎性改变、宫腔受压和囊性子宫腺肌病等,对子宫腺肌病诊断具有重要辅助作用。宫腔镜联合超声检查可以提高宫腔镜对子宫腺肌病的诊断率,同时可以进一步判定病灶大小、位置和深度。超声引导下宫腔镜定位活检取得子宫内膜肌层交界区组织病理是目前最有价值的实现子宫腺肌病的微创诊断方法,为有生育要求的患者或有保留子宫愿望的患者选择个体化的治疗方式提供了可能。     

PVA与LPE子宫动脉栓塞治疗子宫肌瘤合并子宫腺肌病的疗效观察

目的 对比评价聚乙烯醇颗粒(PVA)与平阳霉素碘油乳剂(PLE)两种材料在行子宫动脉栓塞治疗子宫肌瘤合并子宫腺肌病的临床疗效.方法 对28例根据临床表现、超声及DSA造影诊断为子宫肌瘤合并子宫腺肌病的患者随机分为A、B两组,A组14人应用PVA行子宫动脉栓塞术(UAE);B组14人应用PLE行栓塞术.28例患者均应用微导管行超选择性子宫动脉插管并注射栓塞材料.术后随访6～30个月观察病人的痛经程度,月经量及子宫病灶的体积变化.结果 栓塞技术成功率100%.A组8例、B组10例术后3月痛经消失;A组6例、B组4例治疗后症状明显缓解.术后5个月痛经消失.A、B组患者术后6个月子宫体积平均缩小41.83%,43.59%.术后6个月A组、B组肌瘤体积平均缩小分别为51.63%,52.9%.结论 PVA与PLE两种材料在子宫动脉栓塞治疗子宫肌瘤合并子宫腺肌病的临床疗效对比观察中无明显差别,无统计学意义(P＞0.05).     

痛愈方治疗子宫腺肌病临床观察

目的：观察痛愈方治疗子宫腺肌病的临床疗效。方法：将100例子宫腺肌病患者随机分为2组。治疗组50例予痛愈方治疗，每日1剂，水煎内服配合中药保留灌肠及中药外敷。对照组50例予桂枝茯苓胶囊治疗，每次3粒，每日3次口服。2组均1个月经周期为1个疗程，3个疗程后统计疗效及测定血清雌激素（E2）。结果：治疗组总有效率100％，对照组总有效率80％，2组比较有统计学意义（P〈0．05）。结论：痛愈方治疗子宫腺肌病疗效确切。     

许润三教授妇科常见疑难疾病临证思辨特点

许润三教授从医62年,参合各家经验,精于脉理,详于辨证,以善用经方治疗疑难重证著称。临证主张西为中用,中主西随,衷中参西,尤其对妇科疑难疾病,如功能性子宫出血、盆腔炎性疾病、子宫内膜异位症等疾病的治疗有独到之处,充分体现了许老辨病与辨证相结合,方证相应的中医诊疗特色。     

子宫腺肌症的MRI表现及其病理学对照研究

目的：研究MRI在子宫腺肌症诊断中的应用价值。方法：对30例子宫腺肌症患者行矢状面快速自旋回波（Turbo SE)T1WI,T2TI,T1和T2频谱预饱和翻转恢复序列（T1SPIR和T2SPIR）扫描，必要时辅以横断面或冠状面扫描。所有病例均经手术病理证实。结果：弥漫型子宫腺肌症12例，在T2WI上表现为子宫结合带弥漫性增厚，厚度10－35mm，平均18mm，6例病变呈均匀低信号；6例病变内有散在的点高信号区，其中5例在T1WI仍表现为高信号。局限型子宫腺肌症（腺肌瘤）18例共23个病灶，在T2WI上表现为肌层内卵圆形，不规则形或类圆形肿块，呈与结合带信号相近的低信号，直径2．0－7.5cm，平均3.9cm，除1个病灶与周围肌组织有较清楚的界限外，其余病灶均与周围肌组织分界不清，15个病灶内有散在点状高信号区，其中12个在T1WI上也呈高信号，MRI上弥漫增厚的结合带和局限性低信号肿块，病理学上为异位内膜岛周围增生肥大的平滑肌，其内散在的点状信号区异异位内膜岛。仅在T2WI表现高信号的为示出血的内膜岛，在T1WI和T2WI均为高信号的为出血的内膜岛。结论：MRI是诊断子宫腺肌症的优越的无创性检查方法，T2WI最佳扫描序列，T2WI与T1WI，T1SPIR，T2SPIR4种序列相结合可大大提高断诊准确率。     

血清CA125在子宫肌腺症诊断价值中的探讨

为探讨血清CA125水平在子宫肌腺症中的临床价值,本研究应用电化学发光免疫分析检测了120例子宫肌腺症组患者,疾病对照组的105例子宫肌瘤组患者、80例卵巢囊肿组患者及80名健康人血清CA125水平.结果显示,子宫肌腺症组血清CA125水平(129.0±98.2)IU/mL较子宫肌瘤组(39.4±28.3)IU/mL、卵巢囊肿组(30.2±21.7)IU/mL及正常对照组(26.2±8.3)IU/mL显著增高,与疾病对照组及正常对照者比较,其差异均具有统计学意义(P＜0.001),而子宫肌瘤患者和卵巢囊肿患者血清CA125水平与正常对照者比较其差异均无统计学意义(P＞0.05),并且,在子宫肌瘤组和卵巢囊肿组之间血清CA125水平亦无统计学意义(P＞0.05).因此,结合患者体征及影像学检查,血清CA125可作为子宫肌腺症诊断的重要指标.     

Effectiveness of the levonorgestrel-releasing intrauterine system in the treatment of adenomyosis diagnosed and monitored by magnetic resonance imaging

BACKGROUND: This study was conducted to evaluate the effect of the levonorgestrel-releasing intrauterine system (LNG-IUS) on adenomyotic lesions diagnosed and monitored by magnetic resonance imaging (MRI). STUDY DESIGN: LNG-IUS was inserted during menstrual bleeding in 29 women, 24 to 46 years of age, with MRI-diagnosed adenomyosis associated with menorrhagia and dysmenorrhea. Clinical evaluations were carried out at baseline and at 3 and 6 months postinsertion. MRI was performed at baseline and at 6 months postinsertion and was used to calculate junctional zone thickness (in mm), to define the junctional zone borders, to identify the presence of high-signal foci on T(2)-weighted images and to calculate uterine volume (in mL). RESULTS: A significant reduction of 24.2% in junctional zone thickness was observed (p<.0001); however, no significant decrease in uterine volume was observed (142.6 mL vs. 136.4 mL; p=.2077) between baseline and the 6-month evaluation. A significant decrease in pain score was observed at 3 and 6 months after insertion (p<.0001); however, six women continued to report pain scores >3 at 6 months of observation. At 3 months of use, the most common bleeding pattern was spotting, and at 6 months of observation, oligomenorrhea was the most common pattern observed, although spotting was present in one third of the women. CONCLUSIONS: The insertion of an LNG-IUS led to a reduction in pain and abnormal bleeding associated with adenomyosis. MRI was useful for monitoring response of adenomyotic lesions to the LNG-IUS.