宫腔镜电切术治疗子宫肌瘤56例临床分析

本研究通过对５６例子官肌瘤行官腔镜电切术后的随访,进行回顾性分析,现报告如下。１　资料与方法１．１ 研究对象。我院于１９９８年２月～２００１年５月对因子宫肌瘤致子宫出血的５８例病人行官腔镜肌瘤切除术。其中２例失访,将随访资料完整的５６例作为研究对象。患者年龄为２６～５８岁,平均年龄４３岁。５６例中,子宫粘膜下肌瘤４０例,其中窄蒂２６例,宽蒂 ６例,脱出宫颈外口 ８例,直径为 １．０～６．０ ｃｍ。壁间内突肌瘤１６例,其中肌壁间波及部分＜５０％１０例,直径为２．０～５．０ ｃｍ,肌壁间波及部分＞５０％６…     

宫腔镜电切术的手术配合

官腔镜电切术是利用宫腔镜在电视下治疗子宫腔内疾病的手术方法，足治疗子宫内膜息肉、子宫纵隔的标准术式，为官腔粘连和宫内异物提供了有效的途径，其创伤比值最低，效价比值最高。我院2004年1月。2005年10月，开展了官腔镜手术65例，效果满意。现将手术配合报告如下：     

宫腔镜电切术治疗难治性宫颈炎的临床分析

慢性宫颈炎是妇女的常见病，也是诱发宫颈癌的高危因素之一，目前治疗宫颈炎的主要方法有：激光、微波、冷冻、药物等．对轻度单纯宫颈炎疗效尚可，但对有些宫颈炎疗效欠佳。我院应用宫腔镜电切治疗收到良好效果，现报道如下。     

宫腔镜电切术治疗异常子宫出血243例临床分析

目的:观察宫腔镜电切术治疗异常子宫出血的疗效。方法:2002年1月～2006年1月对243例异常子宫出血患者行宫腔镜电切术(TCRE),其中12例同时行粘膜下子宫肌瘤电切术,73例行单纯粘膜下子宫肌瘤及内突壁间肌瘤切除术(直径≤5.0cm),44例行子宫内膜息肉切除术。结果:术后随访1个月～2年,月经改善率达98.5%,TCRE后118例无月经,38例月经减少,83例月经正常。结论:宫腔镜电切术治疗功能性子宫出血、粘膜下子宫肌瘤、子宫内膜息肉引起的异常子宫出血疗效满意。     

宫腔镜电切术治疗慢性宫颈炎疗效分析

目的探讨宫腔镜电切术治疗慢性宫颈炎的疗效。方法对32例慢性宫颈炎患者用宫腔镜环状锥形切除宫颈炎性增生组织,切除组织全部送病检,观察评价其疗效。结果30例治愈(93.8%),2例有效(6.2%),一次性治疗有效率达100%。结论宫腔镜电切术治疗慢性宫颈炎疗效确切,操作安全、简便,术后并发症少,治愈率高。     

宫腔镜电切术治疗宫腔良性病变效果观察

目的:探讨宫腔镜电切术治疗宫腔内良性病变的效果。方法:应用连续灌流式宫腔镜对156例宫腔内良性病变进行宫腔镜电切手术治疗,术中全程B型超声监护。结果:平均手术时间29 m in,出血量45 m l,平均住院天数4.5 d,术中无严重并发症,术后随访1年,行子宫切除2例。结论:超声引导下宫腔镜电切术治疗宫腔内良性病变,具有创伤小、恢复快、并发症少等优点。     

宫腔镜电切术致TURP综合征2例分析

TURP综合征即过度水化综合征,亦称稀释性低钠血症,主要是由灌流液在短时间内快速大量被吸收所致。此症已被人们认识,且随着双极电刀的应用,此症发生率减少,但如对此并发症早期认识不足,常可贻误治疗而导致死亡。我科曾发生此症2例,现报道如下:1临床资料1.1资料来源2例患者均为子宫粘膜下肌瘤(IV型),分别于2006及2012年入住我科行宫腔镜下肌瘤电切术。     

宫腔镜电切术治疗子宫内膜息肉90例临床分析

目的:探究宫腔镜电切术治疗子宫内膜息肉患者的临床治疗效果.方法:选取我院2016年3月至2017年7月收治的90例子宫内膜息肉患者,按照其自愿分为两组,即观察组和对照组.对照组采取刮宫术;而观察组采取宫腔镜电切术.对两组患者的临床治疗效果、临床并发症发生等方面情况进行对比和分析.结果:观察组患者临床治疗的总有效率显著高于对照组,且并发症发生率明显低于对照组(P<0.05).结论:子宫内膜息肉采取宫腔镜电切术进行治疗,不仅效果显著,且并发症少,值得在临床上进行推广和应用.     

宫腔镜电切术治疗重度宫颈糜烂89例分析

我院自 2 0 0 1年 6月开始对重度宫颈糜烂患者进行宫腔镜电切术治疗 ,取得了良好的效果 ,现总结报告如下。1　资料与方法1 1　 一般资料。 2 0 0 1年 6月～ 2 0 0 2年 4月在我院门诊检查诊断为重度宫颈糜烂者 89例 ,其中颗粒型糜烂 36例 ,乳头型糜烂 5 3例。年龄 2 8～ 49岁 ,平均 38岁。术前常规行宫颈刮片细胞学检查。经后 3～ 7ｄ内进行手术。1 2 　仪器。采用日本Ｏｌｙｍｐｕｓ公司生产的 8ｍｍ可旋转持续灌流式宫腔电切镜及配套的环形电极、滚球电极、高频电刀。切割功率 40～ 60Ｗ ,凝固功率 30～ 40Ｗ。1 3　手术方法。患者取膀胱截…     

宫腔镜电切术治疗子宫纵隔23例临床分析

目的:探讨子宫纵隔患者接受宫腔镜电切术治疗后的妊娠结局。方法:回顾性分析23例子宫纵隔患者接受宫腔镜下子宫纵隔电切术后的妊娠结局。结果:23例子宫纵隔患者中,子宫完全纵隔5例,不完全纵隔18例,23例均在超声监视下完成手术,平均手术时间25min,平均出血30ml。与术前相比,术后足月活产率从4.35%增至48.83%,流产率从85.55%降至30.43%,具有显著性差异(P<0.01)。结论:宫腔镜电切术治疗子宫纵隔是安全、有效地治疗方法,能显著提高足月活产率,明显降低流产率。     

羊水粪染与绒毛膜羊膜炎关系探讨

目的:探讨Ⅱ～Ⅲ度羊水粪染与绒毛膜羊膜炎的关系及对围生儿的影响。方法:对2010年2～8月因羊水Ⅱ～Ⅲ度粪染行胎盘病理检查的236例临床资料进行回顾性分析。结果:在236例Ⅱ～Ⅲ度羊水粪染病例中,胎盘病理检查有组织学绒毛膜羊膜炎病例多于无组织学绒毛膜羊膜炎病例,重度绒毛膜羊膜炎新生儿窒息发病率较无急性绒毛膜羊膜炎和轻、中度急性绒毛膜羊膜炎病例高(P<0.05),有组织学绒毛膜羊膜炎与无组织学绒毛膜羊膜炎的胎盘病理表现基本相同(P>0.05)。结论:Ⅱ～Ⅲ度羊水粪染与绒毛膜羊膜炎密切相关;绒毛膜羊膜炎引起绒毛及血管病变是导致羊水粪染、胎儿窘迫、新生儿窒息原因之一。在临床工作中对羊水Ⅱ～Ⅲ度粪染病例应常规行胎盘病理检查,有利于诊断及指导孕产妇和新生儿的治疗。     

羊水污染与新生儿结局的关系

目的：探讨羊水污染与新生儿结局的关系。方法：选择分娩的孕妇共1074例进行回顾性分析。结果：新生儿窒息率在羊水1度和2度污染之间差别无显著性差异,在羊水3度同1度污染比较时,差别有显著性。结论：羊水3度污染同新生儿窒息关系密切。     

细胞凋亡与妊娠期肝内胆汁淤积症妊娠结局的关系

目的:研究妊娠期肝内胆汁淤积症(ICP)患者胎盘细胞凋亡与羊水污染、新生儿窒息、早产、剖宫产的关系,探讨ICP患者妊娠结局不良的原因。方法:采用免疫组织化学方法检测ICP组和正常组凋亡相关基因Caspase-3的表达水平,再根据Caspase-3表达强弱将ICP组孕妇分为3组,了解羊水污染和新生儿窒息的发生率,探讨ICP患者胎儿预后不良是否与胎盘细胞凋亡有关。结果:ICP组胎盘细胞促细胞凋亡相关基因Caspase-3表达增加,且随着促凋亡基因表达的增加临床上表现为羊水污染及剖宫产几率升高。结论:ICP患者胎盘细胞促凋亡基因表达增加,胎盘细胞过度凋亡,与血清胆酸水平有相关性,使胎盘功能减退,导致羊水污染的几率增加。     

左右侧卵巢卵泡液中白血病抑制因子与卵子质量关系的研究

目的:对比性分析左右侧卵巢卵泡液中白血病抑制因子(LIF)含量及其与卵子和胚胎质量的关系。方法:选择首次实施体外受精/卵胞浆内单精子注射(IVF/ICSI)不孕症妇女37例,采卵日采集血清及左右侧卵巢卵泡液,按左右标记后编号。ELISA法测定LIF含量。结果:右侧卵巢卵泡液中LIF含量明显高于左侧(P0.05);右侧卵巢减数分裂中期(MII期)卵数、正常受精的双原核(2PN)数、可移植胚胎数明显多于左侧(P0.05);双侧卵泡液中LIF浓度与可移植胚胎数呈明显正相关(P0.05)。结论:右侧卵巢内卵子的数量和质量优于左侧,卵泡液中LIF含量有可能作为评估卵子正常受精及早期胚胎质量的参考指标之一。     

妊娠高血压综合征孕妇羊水儿茶酚胺水平与胎儿预后关系的研究

目的:探讨妊娠高血压综合征(妊高征,PIH)孕妇羊水中儿茶酚胺(CA)水平的变化。方法:采用高效液相(HPLC)方法对足月正常孕妇及妊高征孕妇羊水中去甲肾上腺素(NE)、肾上腺素(E)及多巴胺(DA)水平进行监测。选择对象均为择期剖宫产孕妇,正常对照组80例,妊高征组146例,其中轻度38例,中度44例,重度64例,并且对中重度妊高征孕妇存在胎儿合并症的羊水中CA进行分组测定,I组无合并症组,Ⅱ组合并胎儿宫内发育迟缓(IUGR),III组合并胎儿宫内窘迫,IV组IUGR合并胎儿宫内窘迫。结果:中重度妊高征孕妇羊水中NE、E及DA水平明显增加(P<0.05),以重度更为明显,合并IUCR或胎儿宫内窘迫者羊水中NE、E及DA水平明显高于对照组(P<0.05),无合并症组有增高趋势,但差异不显著。结论:妊高征孕妇羊水中CA水平与胎儿预后有关。     

The relationship between low back magnetic resonance imaging, surgery, and spending: impact of physician self-referral status

Objective. To examine the relationship between use of magnetic resonance imaging (MRI) and receipt of surgery for patients with low back pain. Data Sources. Medicare claims for a 20 percent sample of beneficiaries from 1998 to 2005. Study Design. We identify nonradiologist physicians who appear to begin self‐referral arrangements for MRI between 1999 and 2005, as well as their patients who have a new episode of low back pain care during this time. We focus on regression models that identify the relationship between receipt of MRI and subsequent use of back surgery and health care spending. Receipt of MRI may be endogenous, so we use physician acquisition of MRI as an instrument for receipt of MRI. The models adjust for demographic and socioeconomic covariates as well as month, year, and physician fixed effects. Data Collection/Extraction Methods. We include traditional, fee‐for‐service Medicare beneficiaries with a visit to an orthopedist or primary care physician for nonspecific low back pain, and no claims for low back pain in the year prior. Principal Findings. In the first stage, acquisition of MRI equipment is a strongly correlated with patients receiving MRI scans. Among patients of orthopedists, receipt of an MRI scan increases the probability of having surgery by 34 percentage points. Among patients of primary care physicians, receiving a low back MRI is not statistically significantly associated with subsequent surgery receipt. Conclusions. Orthopedists and primary care physicians who begin billing for the performance of MRI procedures, rather than referring patients outside of their practice for MRI, appear to change their practice patterns such that they use more MRI for their patients with low back pain. These increases in MRI use appear to lead to increases in low back surgery receipt and health care spending among patients of orthopedic surgeons, but not of primary care physicians.     

染锰大鼠神经行为功能改变与单胺类递质的关系

目的探讨锰对大鼠神经行为功能的影响与单胺类递质的关系。方法ＳＤ雄性大鼠饮水染锰９０天,染毒前和染毒第３０、６０、９０天时测定其自发活动、转棒和方位水迷宫;染毒９０天后测定其血锰、纹状体单胺类递质及其代谢产物含量。结果染毒３０天时大鼠自发活动增多;９０天时转棒测试的停留时间随剂量增加而减少,方位水迷宫测试的学习次数随剂量增加而增加;染毒９０天后高剂量组纹状体内高香草酸和５羟吲哚乙酸含量明显下降。相关分析表明：运动协调能力与多巴胺系统相关;学习记忆能力与多巴胺、５羟色胺系统均相关。结论锰可能通过多巴胺和５羟色胺系统影响动物的神经行为功能     

中老年脊柱手术后患者血清维生素D和T细胞亚群水平变化与术后感染的关系

目的 探讨维生素D(VitD)和T细胞亚群水平变化与中老年脊柱手术后患者感染的关系。方法 以2013年1月至2017年12月某院脊柱手术后并发感染的中老年患者41例为观察组并分为感染评分高组和低组,选择同期治疗42例手术后未感染者为对照组;抽取静脉血检测患者血清VitD和T细胞亚群(CD3+数目以及CD4+/CD8+)水平情况。结果 感染评分高、低组VitD水平、CD3+数目及CD4+/CD8+比值均低于对照组(P＜0.05);感染评分高组VitD水平、CD3+数目及CD4+/CD8+比值低于低组(P＜0.05);Spearman相关分析显示老年脊柱手术后患者VitD水平、CD3+数目、CD4+/CD8+比值与感染评分呈负相关(P＜0.001);多重线性回归分析显示,VitD水平与CD3+数目及CD4+/CD8+比值呈正相关(t=6.842和6.9333,P<0.001)。结论 VitD和Ｔ淋巴细胞亚群水平降低的中老年脊柱手术后患者感染风险增加;VitD水平与中老年脊柱手术后患者免疫功能相关。     

The relationship between the changes in the level of progesterone and the outcome of in vitro fertilization-embryo transfer

Abstract

We observed the effects of changes in progesterone (P) during late follicular phases on the treatment outcome of in vitro fertilization-embryo transfer (IVF-ET) and intracytoplasmic sperm injection (ICSI) in patients with different ovarian responses. The data of 8,575 cycles of patients receiving gonadotropin-releasing hormone (GnRH) agonist using the long protocol were retrospectively analyzed. According to the number of oocytes retrieved, the cycles were divided into poor ovarian response group (oocyte retrieval <5), intermediate ovarian response group (5≤ oocyte retrieval ≤15), and high ovarian response group (oocyte retrieval ≥16). We found that in the poor ovarian response group, the clinical pregnancy rate was not significantly associated with both the level of P or the day of human chorionic gonadotrophin (hCG) and the duration of pre-hCG P elevation (p?=?0.66 and p?=?0.1874). In intermediate and high ovarian response groups, the clinical pregnancy rate was inversely related to both the level of P on the day of hCG administration and the duration of pre-hCG P elevation (all p?<?0.0001). The cut-off values of serum P level on the day of hCG administration were 1?ng/ml and 1.75?ng/ml in intermediate and high ovarian response groups, respectively. The cut-off values of pre-hCG P elevation duration were obtained on day 1 in the intermediate ovarian response group, and days 1 or 3 in the high ovarian response group. After correcting for other confounding factors, multivariate logistic regression analysis indicated that P level on the day of hCG administration was not associated with clinical pregnancy rates, but pre-hCG P elevation duration was negatively associated with clinical pregnancy rate in the intermediate and high ovarian response groups. P level is associated with clinical pregnancy rate only in the patients with intermediate or high ovarian response. The longer the duration of pre-hCG P 1?ng/ml, the lower the clinical pregnancy rate.