中医诊治妇科病的经验

重点论述妇女月经周期的生理变化及施治用药规律,介绍崩漏、痛经、闭经的临床诊治用药经验,有一定的参考价值。     

宫腔镜诊治异常子宫出血432例中长期随访结果

目的 评价宫腔镜手术治疗异常子宫出血的中长期随访结果。方法 回顾分析我院2002年1月～2005年11月经宫腔镜诊治异常子宫出血且随访〉12个月的432例临床资料,诊断良性疾患391例[子宫内膜息肉96例（22.2%）,子宫黏膜下肌瘤38例（8.8%）,子宫内膜增生过长257例（59.5%）],行息肉或肌瘤切除、子宫内膜电切术;诊断子宫内膜腺癌41例（9.5%）,均为Ⅰ期,行经腹全子宫双附件切除、选择性盆腔淋巴结清扫术。结果 手术均获成功,未发生子宫穿孔等并发症。391例良性病变中,术后随访12～57个月,平均39个月,闭经占16.1%（63/391）,月经量少（每周期〈10片卫生巾）18.9%（74/391）,月经量正常（每周期10～20片卫生巾）58.3%（228/391）,术后改善不明显占6.6%（26/391）。26例月经量仍多者术后用孕酮治疗,7例有多发子宫肌瘤,术后32～44个月行全子宫切除术,8例复查阴道彩超子宫内膜厚度〉1.5 cm,术后5～19个月第2次行宫腔镜子宫内膜切除术,继续随访18～36个月,月经量少3例,闭经5例。41例子宫内膜癌Ⅰ期术后随访26～41个月,平均38个月,均无瘤存活。结论 异常子宫出血的治疗在结合病理学检查除外恶性病变后首选宫腔镜手术,严格B超监测是提高手术疗效和手术安全的保障。     

薄层斜轴位T2WI扫描在判断子宫恶性肿瘤宫颈浸润范围中的价值

目的 探讨薄层斜轴位扫描在判断子宫恶性肿瘤宫颈浸润范围中的价值. 资料与方法 回顾性分析53例经手术病理证实的子宫恶性肿瘤患者的MRI资料,比较普通轴位、旁矢状位及薄层斜轴位T2WI 3种扫描方法对判断子宫恶性肿瘤宫颈浸润范围的准确性. 结果 普通轴位、旁矢状位和薄层斜轴位T2WI判断宫颈病变浸润范围的准确性分别为77.36%、60.38%和92.45%.普通轴位与旁矢状位相比（χ2=3.56,P＞0.05）,两者之间差异无统计学意义;薄层斜轴位与旁矢状位比较（χ2=15.13,P＜0.05）,两者之间差异有统计学意义.薄层斜轴位与普通轴位比较（χ2=4.71,P＜0.05）,两者之间差异有统计学意义. 结论 对于宫颈病变浸润程度和范围的准确评价,薄层斜轴位扫描是一种非常必要而且有用的方法,应在常规轴位扫描的基础上加扫薄层斜轴位,提高宫颈病变浸润程度和范围判断的准确性.     

4-Methylumbelliferone inhibits hyaluronate synthesis in human uterine cervical fibroblasts

AIM: Hyaluronate plays an important role in the regulation of cervical function during parturition. In our previous study we showed that 4-methylumbelliferone (MU) suppresses hyaluronate synthesis by cultured human skin fibroblasts. The present study investigated the effects of MU on fibroblasts obtained from the human uterine cervix and assessed the possibility of controlling cervical ripening with MU. METHODS: Human uterine cervical fibroblasts were collected from uterine cervices obtained from the uteri of three patients who had a total hysterectomy for uterine myoma at Hirosaki University Hospital. The fibroblasts were cultured in Dulbecco's modified Eagle's medium until confluence. They were then cultured in medium containing [3H]glucosamine (0.074 MBq/mL) with various MU doses. Hyaluronate synthesis was evaluated by assessing the incorporation of [3H]glucosamine into the soluble fraction of hyaluronate. Three independent studies were carried out on each specimen to clarify whether MU causes compositional changes or promotes hyaluronate degradation, whether the inhibitory effects of MU on hyaluronate synthesis are dose-dependent, and whether the effects of MU are reversible. RESULTS: MU added to the medium of the cultured cells reduced the synthesis of hyaluronate in a dose-dependent manner. After MU was removed from the medium, hyaluronate synthesis recommenced, and the amount of [3H]hyaluronate synthesized was similar to the control level. CONCLUSIONS: MU inhibits the synthesis of hyaluronate in human uterine cervical fibroblasts.     

Treatment of uterine fibroids for abnormal uterine bleeding: myomectomy and uterine artery embolization

Uterine myoma is a common benign tumour in women and most cases do not require treatment. Excessive uterine bleeding is usually due to a submucous myoma or an intramural myoma that is encroaching into the uterine cavity. After eliminating endometrial malignancy, perimenopausal women could be managed expectantly or with gonadotrophin-releasing hormone agonist until menopause. Hysteroscopic myomectomy is highly effective in controlling menorrhagia that is related to submucous myoma. Concomitant endometrial ablation improves menorrhagia; however, the subsequent hysterectomy rate remains the same. For those with an intramural myoma, abdominal myomectomy results in good bleeding control. It could also be done by laparoscopic approach; however, the surgeon should have expertise in laparoscopic suturing and the uterine incision should be properly sutured. In women who have completed their family, hysterectomy remains the most effective treatment for excessive uterine bleeding. Compared with uterine artery embolization (UAE), it is associated with better improvement in pelvic pain. Nevertheless, UAE is a good alternative to hysterectomy.     

Tumour cell u-PA as a cause of fibrinolytic bleeding in metastatic disease

Tumour cells may express urokinase type plasminogen activator (u-PA). This may influence the invasive properties of the cells but has seldom been implicated in production of a systemic bleeding state. Two patients are described in whom severe bleeding occurred in association with disseminated malignancies. Thrombin generation was little disturbed and platelet numbers were insufficient to account for the bleeding. Florid plasmin generation was evident in the circulation and the fibrinolytic inhibitor tranexamic acid controlled the bleeding well. Free active u-PA was demonstrated in the circulation and u-PA antigen on the malignant cells which invaded the marrow of one of the patients. Tumour cell u-PA may occasionally be responsible for a bleeding state.     

胎盘血流量下降对大鼠胎仔生长和胎盘结构的影响——宫内生长迟缓动物模型的研究

本实验采用 SD 大鼠,在孕后期行孕鼠一侧子宫动脉中段完全结扎,另一侧作对照.23只孕鼠(150只胎仔)分成未结扎上、下(CU 和 CL)与结扎上、下(LU、LL)四组.结果表明,LU 组宫内胎仔体重、胎盘重、脑肝重均较其它三组有显著下降(P<0.01);LU 组脑/肝重比值及脑/体重比值较其它三组有显著增加(P<0.01).其胎仔呈不均称性宫内生长迟缓(IUGR)。52只胎盘作了光镜观察,12只胎盘作了电镜观察。在已知子宫胎盘血流不足,且胎仔发生 IUGR 的情况下,其胎盘的改变与以往报道的人类 IUGR 胎盘病理改变相一致,从而证实了子宫胎盘血流量下降是 IUGR 发病的重要原因之一。     

子宫肌瘤与细胞凋亡的研究

目的:探讨子宫平滑肌瘤的发生与细胞凋亡的关系.方法:采用凝胶电泳技术对子宫平滑肌瘤患者的肌瘤核组织(实验组)及其周围的正常肌组织(对照组)进行DNA片段分析;采用碘化丙啶(PI)对DNA染色,流式细胞仪检测两组细胞的凋亡率,进行细胞凋亡的定量分析.结果:实验组有9例出现DNA断裂的梯形条带(9/30,30.0%),对照组有20例出现DNA梯形条带(20/30,66.7%),二者比较有明显差异;实验组凋亡率明显低于对照组.结论:子宫肌瘤的发生与细胞凋亡异常有关.     

膀胱冲洗液适宜温度的临床探讨

目的 :确定最适温度的膀胱冲洗液 ,最大限度的减少膀胱痉挛的次数和强度 ,减少出血 ,提高病人生活质量。方法 :采用六组不同温度冲洗液对术后病人行持续膀胱冲洗 ,记录膀胱痉挛次数 ,膀胱出血程度及体温变化的情况。结果 :随着冲洗液温度升高 ,膀胱痉挛平均次数减少 ,冲洗前后患者体温差逐渐变小 ,2 0℃～ 3 0℃温度组术后冲洗液红细胞计数平均数明显低于其它温度组。结论 :2 0℃～ 3 0℃是持续膀胱冲洗的最适温度