超声介入配合中西药物杀胚保胎治愈宫内并宫角妊娠1例

1临床资料 女,33岁,因双侧输卵管不通6年未孕,于2003年4月17日在本院行X线下输卵管导管扩通术,扩通术后造影示子宫呈双角型,双侧输卵管显影,盆腔弥散良好(图1).2003年7月20日由外院诊断为宫内并宫角妊娠转入我中心.阴道彩色超声检查显示:宫腔内妊娠囊2.2 cm×1.4 cm,头臀长0.8 cm,胎心率126次/min,律规整.右侧子宫角部探及1.0 cm×1.1cm妊娠囊样反射,隐约见胎心搏动,周边探及少量彩色血流信号.7月22日B超见宫角妊娠囊增大,向宫角部突起明显.患者因多年未孕,求子心切,保胎愿望强烈,遂行经阴道超声下宫角妊娠介入杀胚术.术后给予阿奇霉素0.25 g静脉点滴3 d以预防感染,并给予中药参芪寿胎丸,水煎服,日1剂,药用:桑寄生15 g,续断15 g,杜仲15 g,菟丝子15 g,白芍15 g,制香附12 g,黄芩12 g,白术12 g,党参15 g,黄芪15 g,炙甘草6 g.     

祛瘀解毒颗粒治疗子宫内膜异位症患者卵泡液对小鼠胚胎发育的影响

目的 观察经祛瘀解毒颗粒治疗后子宫内膜异位症（endometriosis,EM）患者卵泡液对小鼠胚胎发育的影响。 方法 在常规培养液中分别加入治疗组EM患者卵泡液（祛瘀解毒颗粒）、对照组EM患者卵泡液及空白组（因输卵管因素行体外受精－胚胎移植）患者卵泡液,20只小鼠超排卵共收集189枚2 细胞鼠胚分别放入各组培养液进行培养,其中治疗组培养液70枚,对照组培养液60枚,空白组培养液59枚,观察和检测2 细胞鼠胚在体外发育至8细胞期、桑葚胚期和囊胚期的比率,及早期鼠胚优质胚胎数目和优质胚胎率。 结果 治疗组培养液有53枚鼠胚（75.71%,53/70）发育到8细胞期,48枚（68.57%,48/70）发育到桑葚胚期,45枚（64.28%,45/70）发育到囊胚期,与对照组培养液(56.67%,34/60、48.33%,29/60、35.00%,21/60)比较差异有统计学意义(P＜0.05)。治疗组有61枚优质胚胎（87.14%）,对照组为44枚（73.33%）,两组比较差异有统计学意义（P＜0.05）。 结论 EM患者卵泡液对早期鼠胚存在毒性作用,经祛瘀解毒颗粒治疗后EM患者卵泡液可提高早期鼠胚培养质量。     

二至天癸颗粒联合体外受精-胚胎移植治疗不孕症61例临床研究

目的：观察二至天癸颗粒对不孕症患者肾气阴两虚证候的疗效,评定其对卵细胞质量,优质卵、受精卵、优质胚数目及妊娠率的影响.方法：治疗组为超促排卵方案加服二至天癸颗粒,对照组单用超排.观察两组治疗前后肾气阴两虚证候改变、取卵数、优质卵率、受精率、优质胚胎率、妊娠率,统计促性腺激素（Gn）用药情况,并做相关性分析.结果：肾气阴两虚证候改善、优质卵率、受精率、优质胚胎率等方面两组比较差异有显著性;治疗组Gn剂量明显少于对照组;肾气阴两虚证候改善程度与优质卵率呈正相关.结论：二至天癸颗粒可明显改善肾气阴两虚证候,在不减少卵细胞数目的情况下,增加优质卵、优质胚数目,提高临床妊娠率.     

二至天癸颗粒对体外受精-胚胎移植周期人卵泡液白血病抑制因子和卵细胞质量的影响

目的探讨二至天癸颗粒对体外受精一胚胎移植（IVF-ET）周期人卵泡液中白血病抑制因子（LIF）和卵细胞质量的影响。方法入选患者随机分为两组,分别用二至天癸颗粒合西药（治疗组,42例）和单用西药（对照组,38例）治疗,观察患者取卵日肾虚证候较垂体降调节后的改善情况,比较两组获卵数、优质卵率、受精率、卵裂率、优质胚胎率、妊娠率和卵泡液LIF水平的差异;对卵泡液LIF水平与优质卵率、优质胚胎率的关系分别进行相关性检验。结果与对照组比较,治疗组肾虚证候改善程度、优质卵率、受精率、卵裂率、优质胚胎率及临床妊娠率均显著提高;卵泡液LIF水平明显高于对照组;卵泡液中LIF水平与优质卵率、优质胚胎率及妊娠结局均呈正相关。结论二至天癸颗粒能显著提高卵细胞数、胚胎质量和IVF-ET成功率,其机理与增加卵泡液LIF水平、激活卵泡微环境LIF活性充分表达有关。     

二至天癸颗粒提高卵细胞质量与小鼠卵巢内IGF-1R mRNA表达量关系的研究

目的探讨二至天癸颗粒提高卵细胞质量的机理.方法90只小鼠分为6组,实验1组与对照1组观察排卵后优质卵数目.实验2组与对照2组观察鼠胚卵裂率.用原位杂交的方法对实验3组与对照3组鼠卵颗粒细胞IGF-1R mRNA表达量进行检验.结果实验组与对照组优质卵率分别为[（78±8）%、（71±5）%],卵裂率分别为[（88±3）%、（83±5）%]及颗粒细胞IGF-1R mRNA表达量分别为[（0.4890±0.0454）、（0.4439±0.0283）],两组比较差异有显著性（P＜0.05）.优质卵率与颗粒细胞IGF-1R mRNA表达量呈正相关.结论二至天癸颗粒提高卵细胞质量的机理可能与提高颗粒细胞IGF-1R mRNA的表达量有关.     

Effect of Quyu Jiedu Granule (祛瘀解毒颗粒) on microenvironment of ova in patients with endometriosis

Objective:To observe the effect of Quyu Jiedu Granules(祛瘀解毒颗料,QJG) on the micro-environment of ova in patients with endometriosis(EM).Methods:Twenty EM patients who received in vitro fertilization and embryo transfer(IVF-ET) were randomized equally into a treated group and a control group. Further,20 patients who received IVF-ET due to oviduct factors were enrolled into a non-endometriosis group. The dosage of gonadotrophic hormone used,the number of ova attained,fertilization rate and clinical pregnancy...     

五子衍宗丸化裁联合卵细胞胞质内单精子注射治疗男性不育临床初探

体外受精-胚胎移植技术（IVF—ET）是近30年来在全世界范围内广泛开展的一项治疗不孕症的新技术,尤其是卵细胞胞质内单精子注射（ICSI）技术的应用,对严重少弱畸精子症男性患者而言,无疑又重新开启了一扇大门。中医对不孕不育的认识有2000多年的历史,其中蕴藏着十分丰富的生殖医学内容,对不孕不育的生理、病理及临床等有独特的见解与良好的疗效。     

Clinical observation on treatment of 50 patients with candidal vaginitis by Chinese herbal medicine combined with Canesten

From January 2001 to January 2002, 50 patients of candidal vaginitis were treated by Kushen powder (KSP, 苦参散) combined with Canesten as the treatment group, and controlled by a control group including another 50 patients treated with Canesten alone. The therapeutic results were satisfactory and reported as follows.     

Expressions of VEGF and Ki-67 in eutopic endometrium of patients with endometriosis and effect of Quyu Jiedu Recipe (祛瘀解毒方) on VEGF expression

Objective:To observe the clinical eff icacy of Quyu Jiedu Recipe(祛瘀解毒方,QJR) in treating endometriosis(EM),and to explore the levels of vascular endothelial growth factor(VEGF) and cell proliferative nucleoprotein antigen(Ki-67),their changes before and after treatment and the clinica signifi cance in the trial.Methods:Fifty patients of EM were randomly assigned to two groups.The 26 patients in the QJR group were treated with QJR,and the 24 patients in the gestrinone(GT) group with gestrinone.Besides,a normal control group with 20 healthy women was set up.The therapeutic effects in the two treated groups were compared.Expressions of VEGF and Ki-67 in eutopic endometrium of all subjects(with both patients and healthy women at the median secretive phase) were determined with immunohistochemical stain before treatment,and the determination in the two treated groups was repeated after 3-month treatment in the same phase.Results:Before treatment,the VEGF and Ki-67 expression positive rates and their mean optic density(MOD) were higher in patients than in healthy women(P<0.05).After treatment,the positive rate and MOD of VEGF expression lowered signif icantly than before treatment(P<0.05),but those of Ki-67 changed insignifi cantly,and comparison between the two treated groups showed no significant difference(P>0.05).Conclusion:QJR could markedly improve the symptoms of menorrhagia and menstrual disorder,and its mechanism might be related with the lowering of eutopic endometrial VEGF expression.VEGF and Ki-67 show a high expression in eutopic endometrium of patients with EM.