Environmental and host-associated risk factors in endometriosis and deep endometriotic nodules: a matched case-control study

Peritoneal endometriosis (PE) and deep endometriotic nodules (DEN) are gynecological diseases recently shown to be associated with elevated serum concentrations of organochlorines. The objective of the present study was to compare risk factors associated with both forms of the disease, with a particular attention to potential sources of organochlorine exposure. This matched case-control study with prospective recruitment included 88 triads (PE-DEN-control). All women were face-to-face interviewed with a standardized questionnaire, and serum dioxin and polychlorinated biphenyl measurements were available for 58 of them. Alcohol consumption (odds ratio (OR): 5.82 [confidence interval at 95% (95%CI) 1.20-28.3]) in DEN and low physical activity at work for DEN (OR: 4.58 [95%CI 1.80-11.62]) and PE (OR: 5.61 [95%CI 1.90-16.60]) were traced as significant risk factors. Organochlorine-related factors (use of tampons, occupational or environmental exposure) were not related to the disease. The current consumption of foodstuffs that were more likely to contribute to organochlorine body burden did not differ among the groups. Only some of these fatty foodstuffs (marine fish, pig meat) were traced by multiple regression analysis as significant determinants of organochlorine body burden, explaining only a small fraction (20%) of the interindividual variation of organochlorine body burden. We conclude that PE and DEN share similar patterns of risk or protective factors.     

子宫腺肌病的MR征象分析

子宫腺肌病是妇科常见病,近年发病率有增高趋势.国内运用MR诊断子宫腺肌病报道不多.笔者就本院1995年2月至2002年6月46例子宫腺肌病MR表现报道如下.     

左炔诺孕酮宫内节育系统治疗子宫腺肌病患者的疗效和不良反应观察

目的探讨左炔诺孕酮宫内节育系统（曼月乐）治疗子宫腺肌病的疗效和不良反应。方法回顾性分析2013年9至12月于浙江大学医学院附属妇产科医院因子宫腺肌病就诊并放置曼月乐的患者75例，共随访39个月，观察曼月乐的疗效和不良反应。结果月经量增多和月经量正常的患者放置曼月乐后月经量评分均降低（118±13和29±33，82±15和14±13，均 P < 0.01），月经量增多者比月经量正常者的月经量评分降低更明显（90±35和69±19， P < 0.01）。放置曼月乐后患者痛经评分降低[7（6，7）和1（0，2）， P < 0.01]。患者发生曼月乐脱落18例（24.0%），放置曼月乐无效9例（12.0%），发生月经模式改变28例（37.3%）。多因素Cox回归分析未发现治疗后痛经评分、治疗前后月经量评分和月经稳定时间与曼月乐环脱落相关（均 P>0.05）。 结论曼月乐在子宫腺肌病的长期保守治疗中总体安全有效，约1/3的患者可能因曼月乐脱落或治疗无效接受进一步治疗。     

子宫腺肌病保守性手术治疗现状

子宫腺肌病是指子宫内膜腺体和间质侵入子宫肌层所致的一种良性病变,以月经量过多、痛经和不孕为主要表现.对想保留子宫的腺肌病患者,单纯药物治疗效果不满意时,可选择保守性手术治疗,包括腺肌病病灶切除、子宫内膜及肌层切除、子宫肌层病灶电凝、手术联合药物治疗、盆腔去神经支配治疗、子宫动脉阻断、介入性治疗等.手术方式的选择要考虑患者的年龄、意愿、生育要求、病灶部位和范围及医生的手术技巧.该文对保守性手术治疗子宫腺肌病的现状作简要的综述.     

Pregnancy and delivery outcomes in the women who have received adenomyomectomy: Performed by a single surgeon by a uniform surgical technique

ObjectiveAlthough adenomyomectomy for fertility-sparing is an expanding procedure worldwide, there is no guideline or consensus about how to manage the pregnant women who have previously received conservative surgery for adenomyosis. The aim of this study is to evaluate antenatal care and delivery outcomes in pregnant women after adenomyomectomy.Materials and methodsBetween May 2011 and May 2019, the medical record was reviewed in all delivery of pregnant women received adenomyomectomy performed by a single surgeon by a uniform surgical technique. The evaluating parameters consisted of antenatal care outcomes, delivery outcomes, intrapartum outcome, and neonatal outcomes.ResultsTwenty-two patients were evaluated to monitor pregnancy and delivery outcomes after the adenomyomectomy. Mean age of delivery was 37.0 years old (SD = 3.1, range 32–45, median 37). All were delivered by cesarean section. Mean gestational age was 36.2 weeks (SD = 3.6, range 27.4–39.4, median 37.3). The mean birth weight was 2560.9 g (SD = 771.8, range 1100–3920, median 2550) and the number of preterm births admitted for prematurity care was seven (31.8%, 7/22). Placental abnormality was found in the four cases, which included two placenta accreta and two previa. However, there were no cases of hysterectomy or intervention. We identified one case of uterine rupture during pregnancy (4.5%, 1/22) at 27 weeks of gestation. Except for preterm birth, adverse neonatal outcomes were not found in this study.ConclusionDelivery of pregnant women who received adenomyomectomy can obtain safe perinatal outcomes under close monitoring of preterm labor and surveillance of catastrophic pregnancy related complications.     

曼月乐治疗子宫腺肌病临床使用12个月效果分析

目的 观察子宫腺肌病患者放置左炔诺孕酮宫内缓释系统(LNG-IUS,商品名:曼月乐)后的临床效果.方法 观察31例子宫腺肌病患者放置曼月乐前后在痛经程度、经量、月经经期及血清CA-125等临床指标的变化.结果 放置曼月乐的患者痛经症状明显缓解,经量明显减少,经期缩短,血清CA-125降低,差异有统计学意义.(P＜0.01).结论 曼月乐治疗子宫腺肌病安全有效,值得临床推广.     

OTR、ER在子宫腺肌病中的表达及与痛经的关系

目的:探讨OTR、ER在子宫腺肌病患者在位及病灶组织中的表达及其与痛经的关系。方法:采用免疫组化法检测30例子宫腺肌病在位和异位内膜中OTR、ER的表达,以子宫正常肌层组织和在位内膜为对照。结果:在子宫腺肌病灶组织中OTR、ER的表达高于在位内膜组及对照组(P<0.05);在子宫腺肌病组的在位内膜和病灶组织中,痛经组OTR、ER的表达高于无痛经组及对照组(P<0.05);在不同痛经程度分组中OTR、ER的表达依次降低。在子宫腺肌病的在位内膜和病灶组织中,OTR、ER两者之间存在正相关关系。结论:子宫腺肌病组织中OTR、ER的表达随痛经程度增强而增加,在子宫腺肌病痛经的发生与发展间可能存在协同作用。     

不同大小聚乙烯醇颗粒在子宫腺肌症介入治疗中的临床疗效

目的评价不同大小聚乙烯醇(PVA)颗粒在子宫腺肌症介入治疗中的临床疗效。方法回顾性分析152例经子宫动脉栓塞术治疗的子宫腺肌症患者,根据PVA颗粒的大小随机分为A(350⁵00μm)、B(500500μm)、B(500⁷10μm)两组,每组病例76例,比较两组病例经子宫动脉栓塞术治疗后临床症状缓解程度及术后不良反应的差异。结果在痛经减轻、子宫体积变化方面两组比较,术后3个月差异有统计学意义(P<0.05),术后6个月两组比较无统计学差异(P>0.05),术后1年两组痛经减轻程度有统计学差异(P<0.05),而子宫体积方面两组比较无统计学差异(P>0.05),1年后两组病例完全缓解率均达到80%以上,无统计学差异,术后不良反应两组比较有统计学差异(P<0.05),A组不良反应更为显著,而两组在月经期及月经量改变、总有效率比较无统计学差异(P>0.05)。结论虽然两组临床效果半年后即达到相似,但A组术后不良反应疼痛更为严重,故从中长期效果及安全性来看,B组似乎更占优势。     

巨噬细胞CD68、IL-6在子宫腺肌病组织中表达的研究

目的探讨巨噬细胞CD68、IL-6子宫腺肌病发病机制的作用。方法采用免疫组化法检测巨噬细胞CD68、IL-6在58例子宫腺肌病病灶及结合带组织中的表达,以同期54例子宫肌瘤、30例子宫腺肌病合并肌瘤、30例CINⅢ为对照。结果 (1)CD68、IL-6在子宫腺肌病病灶组织及结合带组织中的表达均高于其在子宫肌瘤及CINⅢ组织中的表达,差异有统计学意义(P<0.001);(2)CD68、IL-6在子宫腺肌病病灶组织的表达高于其在腺肌病结合带组织的表达(P<0.001);(3)CD68、IL-6在子宫肌瘤病灶组织、结合带组织及CINⅢ结合带组织中的表达差异无统计学意义(P>0.05);(4)子宫腺肌病合并子宫肌瘤组CD68、IL-6在腺肌病病灶组织中的表达均高于其在肌瘤病灶组织中的表达,差异有统计学意义(P<0.001);(5)Pearson相关分析显示:在子宫腺肌病病灶组织中CD68与IL-6的表达呈正相关(r=0.303,P=0.021)。结论巨噬细胞CD68与IL-6可能共同参与了子宫腺肌病的发生发展,在子宫腺肌病的发病机制中发挥着重要作用。     

真正的纳豆不仅仅是溶栓

真正的纳豆除了纳豆激酶还应含有其它营养成分,如纳豆菌、大豆异黄酮、皂甙等多种有效成分。纳豆的神奇离不开它们,下面我们就针对纳豆中的一些其它主要成分及功能做一个简单介绍。首先,我们来了解一下纳豆菌。