子宫内膜异位症的腹腔镜诊治现状及展望

子宫内膜异位症为全球流行性疾病 ,因其发病率高 ,且有年轻化趋势 ,常合并不孕 ,加上治疗后容易复发 ,已经成为近年研究的热点 ,微创外科技术在子宫内膜异位症诊断及治疗中的地位也显得越来越重要。国外 1997年已经开始使用机器人做腹腔镜手术[1] 。北京大学附属医院 2 0 0 1年提出“应重视子宫内膜异位症诊断与治疗的规范化” ,其中不但强调了腹腔镜在子宫内膜异位症诊断中的重要价值 ,还强调了腹腔镜手术是治疗子宫内膜异位症的首选手术治疗[2 ] ,本文主要就子宫内膜异位症腹腔镜诊治现状及展望综述如下。1　腹腔镜诊断1.1　异位病灶的大…     

安经妥片治疗经前期综合征：一项在中国妇女中的前瞻性、多中心、随机、双盲、安慰剂平行对照研究

目的研究安经妥片治疗经前期综合征（premenstrualsyndrome,PMS）的疗效和安全性。方法采用多中心、随机、双盲、安慰剂平行对照研究,入组217例,完成202例。根据DsM-IV改编的PMS初筛问卷（SQ）初筛合格后,前瞻性记录基础体温和PMS日记（PMSD）2个月经周期,并采用经前期综合征自评量表（PMTS）2次评价后,诊断为中、重度PMS者随机分配到试验组（安经妥片1片,qd）和对照组（安慰剂1片,qd）,连续用药3个月经周期。采用PMSD和PMTS进行资料收集评价疗效。结果基线期PMSD黄体期（即月经出血前的最后7d）平均分安经妥组与安慰剂组之间无显著性差异（分别为29．13和28．14,P〉0．05）。治疗3个月经周期后,PMSD黄体期平均分安经妥组由29．13降至6．41,安慰剂组由28．14降至12．64;两组之间下降幅度的差异有统计学意义（P〈0．01）。PMTS评分安经妥组由26．17降至9．92,安慰剂组由27．10降至14．59,与基线值比较有统计学差异（P〈0．01）。在治疗的第1、2、3个周期PMSD临床有效率安经妥组分别为52．9％、67．3％和79．8％;安慰剂组分别为38．5％、47．1％和50．0％。两组在治疗的3个月经周期间PMSD临床有效率的差异均有统计学意义。研究期间共有19例发生了23件不良事件,但无严重不良事件发生。不良事件发生率安经妥组为8．5％,安慰剂组为9．4％,两组之间差异无统计学意义。结论安经妥片能有效、安全地治疗妇女PMS。     

腹腔镜切除骶前腹膜后肿块2例报道

1 临床资料 患者,女,50岁.主因体检发现盆腔包块1个月余以"盆腔包块"于2004年7月入院.患者绝经1年,孕5产2.其父患神经水泡瘤已逝.妇科检查:外阴已婚已产型,阴道畅,宫颈光、肥大,子宫前位如孕8周大小、质中稍硬、活动好、无压痛,宫体右后方可扪及一直径约5 cm大小实性包块、活动差.     

Expression of integrin β3 and osteopontin in endometrium of patients with adenomyosis

Objective To investigate the expression of integrin β3 and osteopontin(OPN) in eutopic and ectopic endometrium of adenomyosis. Methods From January 2007 to July 2008, the endometrium specimens were collected from 43 patients with adenomyosis undergoing hysterectomy in Peking University First Hospital. Eutopic endometrium were 11 in proliferative phase and 32 in secretory phase (18 cases in mid-secretory phase) were collected. Ectopic endometriums were also collected. In the mean time, it was chosen 41 cases with pure subserous uterine myoma or cervical intraepithelial neoplasia (CIN) Ⅱ-Ⅲ treated by hysterectomy as controls including 12 endometrium in proliferative phase and 29 endometrium in secretory phase (19 cases in mid-secretory phase). The expression of Integrin β3 subunit and OPN in the endometrium were assessed by immunohistochemical staining and quantitative real-time polymerase chain reaction. Results (1)Immunohistochemical staining showed that positive staining of integrin β3 and OPN were present predominantly in eutopic and ectopic endometrial glandular epithelium. There was significant different protein expression of integrin β3 and OPN, which were 1.6±0.8 and 1.7±0.7 in eutopic endometrium,1.7±0.7 and 1.8±0.9 in ectopic endometrium,2.1±0.9 and 2.0±0.9 in control endometrium (P<0.05). The protein expression of integrin β3 and OPN in eutopic endometrium of adenomyosis in the proliferative phase(0.8±0.4 and 0.7±0.3) were remarkably lower than those of the secretory phase(1.8±0.8 and 1.9±0.8,P<0.01). The protein expression of integrin β3 and OPN in the endometrium of controls in the proliferative phase(1.0±0.4 and 1.0±0.4) were significantly lower than those of the secretory phase(2.5±0.7 and 2.5±0.7)(P=0.000). In the mid-secretory phase, the protein expression of integrin β3(2.0±0.9) and OPN (2.1±0.8)in eutopic endometrium of adenomyosis were significantly lower than that of control endometrium(2.7±0.5 and 2.7±0.7)(P<0.01). (2)The mRNA expression level of integrin β and OPN in eutopic and ectopic endometrium were assessed by quantitative real-time PCR(result was shown by median index). It was observed that integrin β3 mRNA and OPN mRNA were significantly lower in the eutopic endometrium of adenomyosis (4.69 and 4.23), when compared with ectopic endometrium(7.96 and 14.84)and controls (13.47 and 17.40) (P<0.05). Eutopic endometrium had higher mRNA expression of integrin β and OPN mRNA in the secretory phase (5.54 and 11.40) than that in the proliferative phase(2.69 and 3.30) (P<0.01).The mRNA expression level of integrin β and OPN of control endometrium in the proliferative phase (3.12 and 4.75)were significantly lower than that in the secretory phase(19.94 and 21.00, P=0.000). The mRNA expression of integrin β and OPN were 10.10 and 14.34 in the mid-secretory phase, which were significantly lower than 21.50 and 24.18 in control endometrium(P<0.05). Conclusions High expression of integrin β3 and OPN in ectopic endometrium of adenomyosis may cause endometriotic lesions; abnormal expression of integrin β3 and OPN in the endometrium of adenomyosis during the implantation window may contribute to infertility in some patients.     

腹腔镜辅助的阴式子宫切除的最佳适应症探讨

目的:探讨腹腔镜辅助的阴式子宫切除术(LAVH)的最佳适应症。方法:选择2000年5月~2003年5月间住院的LAVH 50例及阴式子宫切除术(TVH)50例,比较两组的麻醉方式、费用、手术时间、术中出血量、手术所用器械数量、手术所用人员数、术中并发症、术后并发症、术后排气时间、住院时间等。结果:手术均成功。LAVH组均选用全麻,麻醉费用高,手术时间长;手术所用器械数量多,手术所用人员数多;术中有些并发症及术后腹壁并发症为TVH不可能发生的。两组术中出血量、术后排气时间、住院时间无显著差异。结论:对于LAVH和TVH均熟练的手术医生,能经TVH手术的病例,不要选择LAVH。而对于同时需要切除附件的此类手术,则选择LAVH为宜。     

子宫内膜异位症发病的家族倾向

调查近１年住院确诊的子宫内膜异位症１２２例，其中９例（７．３８％），亲属中有同样的病人，而对照组１１５例（１．７４％）亲属中有异位症患者（Ｐ＜０．０５）。表明异位症发病有家族倾向，对有异位症家族史的妇女应作适应处理。     

子宫内膜异位症患者急腹痛史的调查

子宫内膜异位症患者急腹痛史的调查北京医科大学第一医院妇产科（１０００３４）周应芳，韩临晓在临床工作中，我们发现不少异位症患者有急蝮痛的病史。为此，对１９９１年４月～１９９２年９月我院收治的异位症１５７例进行了调查，并和对照组比较，探讨异位症患者急腹痛...