腹腔镜卵巢子宫内膜异位囊肿剥除术联合使用GnRH-a对卵巢储备功能的影响

目的:探讨腹腔镜下卵巢子宫内膜异位囊肿剥除术联合GnRH-a治疗对卵巢储备功能的影响。方法:选择有手术适应证的卵巢子宫内膜异位囊肿患者117例,将患者分成两组:A组56例预先GnRH-a治疗2个周期后行腹腔镜手术,其中单侧卵巢子宫内膜异位囊肿33例(A1),双侧23例(A2);B组61例直接行腹腔镜手术,其中单侧卵巢子宫内膜异位囊肿38例(B1),双侧23例(B2)。记录患者的术中情况,检测治疗前及术后6月其基础性激素水平(FSH、LH、E2),阴道超声探测窦卵泡数(AFC)、卵巢体积。结果:双侧卵巢子宫内膜异位囊肿患者中,术前先行GnRH-a(亮丙瑞林)治疗组与直接行腹腔镜手术组比较,手术时间短、术中出血量少(P0.05)。双侧卵巢内异囊肿剥除手术患者术后6月的FSH水平均较治疗前显著升高,E2显著下降(P0.05);直接行腹腔镜手术组的FSH的水平明显高于腹腔镜手术前先GnRH-a(亮丙瑞林)治疗组(P0.05),术后AFC、卵巢体积均明显小于腹腔镜手术前先GnRH-a(亮丙瑞林)治疗组(P0.05)。单侧卵巢内异囊肿剥除手术患者治疗前及术后6月FSH、E2比较,均无显著差异(P0.05),囊肿侧的AFC、卵巢体积较正常侧明显减少(P0.05)。结论:腹腔镜卵巢内异囊肿剥除术可影响卵巢储备功能,以双侧卵巢内异囊肿更明显,术前使用GnRH-a治疗,可减少对卵巢功能的影响。     

不同止血方法对双侧卵巢储备功能的影响

目的探讨不同止血方法对双侧卵巢储备功能的影响。方法选取我院2013年8月~2014年9月收治的卵巢子宫内膜异位囊肿患者78例,将其随机分为A组与B组,各39例。两组患者均行常规腹腔镜卵巢子宫内膜异位囊肿剥除术,A组采取超声刀止血,B组采取缝合止血。对两组患者术后窦卵泡计数(AFC)与促卵泡性腺激素(FSH)水平进行记录与分析,同时比较两组患者术后2年的自然妊娠情况。结果两组患者术后1个月、6个月及1年时的FSH水平较治疗前均有所升高,且B组与A组比较,差异有统计学意义(P0.05);B组术后6个月、1年时的AFC水平显著高于A组,差异有统计学意义(P0.05);B组患者的自然妊娠率显著高于对照组,差异有统计学意义(P0.05)。结论对于卵巢子宫内膜异位囊肿患者来说,在行腹腔镜剥除术时通过超声刀止血会影响到患者的卵巢储备功能,从而影响其自然妊娠能力,而缝合法对患者卵巢储备功能影响相对较小,安全性高,值得临床推广。     

腹腔镜卵巢子宫内膜异位囊肿剥除术对卵巢储备功能的影响

目的:探讨腹腔镜卵巢子宫内膜异位囊肿(巧囊)剥除术对卵巢储备功能可能造成的影响。方法:前瞻性对照研究,对照组:单侧卵巢成熟性囊性畸胎瘤行腹腔镜囊肿剥除术20例;实验组:卵巢子宫内膜异位囊肿行腹腔镜囊肿剥除术80例。实验组分为4组:A组:单侧巧囊35岁(27例),B组:单侧巧囊≥35岁(13例),C组:双侧巧囊35岁(28例)和D组:双侧巧囊≥35岁(12例)。比较各组手术前、手术后24h内血清FSH,LH,E2的变化并根据单侧巧囊的大小和类型分层分析。随访患者术后6月基础FSH的恢复情况,术后6月超声测量患者双侧卵巢的体积。结果:双侧各组(C,D两组)卵巢子宫内膜异位囊肿剥除术后24h内FSH较术前明显增高(P0.05),E2明显减低(P0.05),LH变化不明显。畸胎瘤组及单侧各组(A,B组)手术前后各激素水平均无统计学差异,分层分析单侧巧囊大小和类型,各组内组间激素水平变化亦无明显差异。C组患者术后6月基础FSH恢复至正常范围内占72.22%,而D组患者基础FSH恢复至正常范围内仅占55.56%,差异有统计学意义(P0.05)。单侧卵巢囊肿剥除术后6月患侧与对侧卵巢缩小率均有显著差异(P0.05),单侧卵巢囊肿剥除术后与双侧卵巢囊肿剥除术后患侧卵巢缩小率无统计学差异。结论:腹腔镜双侧卵巢子宫内膜异位囊肿剥除术对卵巢储备功能有一定的影响,但大部分患者可在术后6个月内恢复。     

两种止血方法对卵巢子宫内膜异位囊肿术后卵巢储备功能的影响

目的探讨腹腔镜卵巢子宫内膜异位囊肿剥除术中创面采用二氧化碳激光消融止血、双极电凝止血两种不同的止血方法对卵巢储备功能的影响。方法选择2014年9月至2016年11月在上海市嘉定区妇幼保健院住院治疗的双侧卵巢子宫内膜异位囊肿患者128例,并随机分为两组,囊肿剥除术中采用二氧化碳激光消融术(研究组A组64例)、双极电凝止血(对照组B组64例);并于手术前、术后第1、3、6个月及12个月月经周期第3天查血FSH、LH及E2、超声测量双侧卵巢基础窦卵泡计数和卵巢体积等卵巢储备功能的指标。结果术后第1个月月经第3天两组LH、FSH水平、双侧卵巢基础窦卵泡计数、卵巢体积两组差异均无显著性(P0.05);术后第3个月、6个月及12个月A组LH、FSH水平均低于B组(P0.05),双侧卵巢基础窦卵泡计数、卵巢体积均大于B组(P0.05);术后第1、3、6个月及12个月,A组的E2水平均高于B组(P0.05)。结论腹腔镜卵巢子宫内膜异位囊肿剥除术中采用二氧化碳激光消融术对于卵巢储备功能的影响低于双极电凝组。     

手术剥除子宫内膜异位囊肿对IVF-ET结局的影响

目的:探讨子宫内膜异位囊肿手术剥除与否对IVF-ET结局的影响。方法:回顾性分析接受IVF-ET第1周期治疗的305例患者,分成子宫内膜异位囊肿手术组(A组)、子宫内膜异位囊肿未手术组(B组)和管性不孕对照组(C组),采用长、短方案进行超促排卵,比较3组的IVF结局。结果:无论刺激方案如何,A组平均获卵数低于B组与C组(P≤0.001),而FSH用量高于C组(P<0.001),A组妊娠率低于B组,B组妊娠率低于C组(P<0.05)。B组与C组相比,除FSH用量较高(P<0.001)外,获卵数、总胚胎数、优质胚胎率、可利用胚胎数3组间比较无统计学差异。此外,在A组中,手术侧卵巢平均获卵数低于健侧卵巢(P<0.01),且术侧卵巢未获卵的比例达24%。结论:子宫内膜异位囊肿患者IVF结局不良;手术剥除子宫内膜异位囊肿并不能改善IVF结局,反而降低了卵巢反应性。     

盆底型子宫内膜异位症患者行IVF-ET助孕后妊娠结局及妊娠期并发症的分析

目的:探讨盆底型子宫内膜异位症(EMs)患者行IVF-ET助孕后妊娠结局及妊娠期并发症。方法:回顾性分析行IVF-ET治疗获临床妊娠的盆底型EMs 96个周期(A组),卵巢子宫内膜异位囊肿者107个周期(B组),并选择同期180个周期输卵管因素行IVF-ET助孕获临床妊娠者为对照组(C组)。分析比较各组患者行IVF-ET助孕的妊娠结局及妊娠期并发症。结果:A组早产率显著低于B组(9.38%vs 21.50%,P0.05);流产率(25.00%vs 12.78%)及单胎流产率(35.00%vs 17.31%)明显高于C组,差异有统计学意义(P0.05);异位妊娠发生率略高于B组(2.08%vs 1.87%),低于C组(6.67%),但3组间无统计学差异(P=0.072)。A组和B组妊娠期并发症发生率明显高于C组(30.21%vs 31.78%vs 16.11%,P0.05),但A、B组间无统计学差异(P0.05)。其中A组和B组子痫前期(8.33%vs 9.35%)、前置胎盘(9.38%vs 10.28%)发生率显著高于C组(2.78%;3.33%);A组先兆流产率高于B组和C组(18.75%vs 14.02%vs 8.33%),且与C组差异有统计学意义(P0.05)。结论:盆底型EMs患者行IVF-ET助孕其自然流产率显著高于输卵管不孕患者,早产率较卵巢型EMs降低;妊娠期并发症较输卵管不孕患者明显增多,主要表现在子痫前期、前置胎盘及先兆流产3个方面,而与卵巢型EMs无统计学差异。     

中药红藤方对大鼠的异位子宫内膜芳香化酶表达的影响

目的:探讨中药红藤方对异位子宫内膜的抑制作用。方法:用手术自体移植法成功建立的子宫内膜异位症大鼠模型,随机分成5组:红藤方高剂量组(80g生药/kg,A组)、低剂量组(20g生药/kg,B组)、达那唑组(60mg/kg,C组)、去势组(D组)和模型组(E组),连续给药21d后,检测各组的血清E2水平及异位内膜和卵巢的芳香化酶的变化;另测定异位内膜的体积。结果:A组、C组和D组的异位内膜生长均明显受到抑制,且3组间无统计学差异(P>0.05),与E组比有统计学差异(P<0.05);组织学观察可见,异位内膜呈退化趋势,A、C和D组间大鼠血清中的E2水平无统计学差异(P>0.05),与E组相比有统计学差异(P<0.05);A组、C组及D组异位内膜、卵巢组织的芳香化酶P450低表达,A组与E组间有统计学差异(P<0.05)。结论:红藤方可通过抑制异位内膜、卵巢的芳香化酶活性表达,降低局部雌激素含量,抑制异位内膜的生长,使异位内膜萎缩。     

子宫腺肌病/卵巢异位囊肿炎性压力及其与临床特征相关性研究

目的:系统探讨子宫腺肌病/卵巢异位囊肿患者外周血炎性指标变化及其与临床特征的相关性,为子宫腺肌病/卵巢异位囊肿抗炎治疗提供依据。方法:选取来自同济大学附属杨浦医院收治的子宫腺肌病手术患者58例(子宫腺肌病组)、卵巢异位囊肿手术患者37例(卵巢异位囊肿组),健康女性47例(对照组),于增生期抽取外周血,检测血清炎性细胞因子和肿瘤相关抗原浓度,分析炎性压力与临床特征的相关性。结果:子宫腺肌病组外周血中性粒细胞(Neu)、Neu%、中性粒细胞与淋巴细胞比值(NLR)、白细胞介素6(IL-6)、IL-8、CA199、CA125高于对照组,差异有统计学意义(均P0.05);子宫腺肌病组外周血血红蛋白(HGB)低于对照组,差异有统计学意义(Z=688.50,P=0.00)。卵巢异位囊肿组外周血Neu、Neu%、NLR、IL-6、IL-8、肿瘤坏死因子-α(TNF-α)、CA199和CA125高于对照组,差异有统计学意义(均P0.05)。子宫腺肌病中度痛经组外周血白细胞(WBC)、CA125高于轻度痛经组,差异有统计学意义(均P0.05)。子宫腺肌病重度痛经组外周血WBC、Neu、Neu%、NLR、IL-8和IL-6高于中度痛经组,差异有统计学意义(均P0.05)。子宫腺肌病重度痛经组外周血WBC、Neu、Neu%、NLR、IL-6、IL-8和CA125高于轻度痛经组,差异有统计学意义(均P0.05)。子宫腺肌病中、重度痛经组外周血HGB低于轻度痛经组,差异有统计学意义(均P0.05)。子宫腺肌病经量过多组外周血WBC、Neu、Neu%、NLR、IL-6、IL-8和CA125高于正常月经组,差异有统计学意义(均P0.05)。卵巢异位囊肿重度痛经组外周血IL-6、IL-8高于轻度、中度痛经组,差异有统计学意义(均P0.05)。子宫内膜异位症患者肿瘤指标与外周血炎性指标在统计学上无明显相关性。结论:子宫腺肌病/卵巢异位囊肿处于全身炎症压力状态,并与临床特征相关,为子宫内膜异位症抗炎治疗提供了依据。     

大七气汤对大鼠异位子宫内膜VEGF、MMP-9表达的影响

目的:探讨中药大七气汤治疗子宫内膜异位症的机理。方法:建立SD大鼠子宫内膜异位模型,成功建模3周后将大鼠随机分模型组(B组,n=8)、大七气汤大剂量组(40 g/kg,C组,n=10)、小剂量组(20 g/kg,D组,n=8)、孕三烯酮组(0.5 mg/kg,E组,n=8),并以假手术为正常对照组(A组,n=8),每组给药3周,然后用免疫组织化学方法检测在位、异位子宫内膜组织血管内皮生长因子(VEGF)、金属蛋白酶(MMP)-9的表达情况。结果:C、D、E组均降低异位内膜组织VEGF/MMP-9的表达,与B组比较差异均有统计学意义(P<0.05);C、D、E组间无明显差异(P>0.05)。结论:大七气汤能明显抑制子宫内膜异位症模型大鼠异位内膜VEGF、MMP-9的表达,从而明显抑制异位内膜周围血管的形成,使异位内膜萎缩。     

腹腔镜下卵巢子宫内膜异位囊肿剥除术前使用GnRH-a预处理对卵巢储备功能的影响

目的:探讨腹腔镜下卵巢子宫内膜异位囊肿剥除术前预处理对卵巢储备功能的影响。方法:选择有手术指征的卵巢子宫内膜异位囊肿患者125例,将患者随机分成两组:术前GnRH-a治疗3个周期再行腹腔镜手术60例(研究组),其中单侧囊肿35例(研究组单侧组),双侧25例(研究组双侧组);直接行腹腔镜手术65例(对照组),包括单侧囊肿35例(对照组单侧组),双侧30例(对照组双侧组)。检测用药前、用药后和术后6个月基础性激素水平(FSH、E_2)及抗苗勒氏管激素(AMH)水平,术后6个月经阴道彩色多普勒超声检测双侧卵巢基础窦卵泡计数(AFC)和卵巢基质动脉血流的收缩期峰值(PSV)。结果:与用药前比较,两组双侧卵巢子宫内膜异位囊肿患者的术后AMH水平明显下降,FSH水平明显升高,E_2水平明显下降,差异均有统计学意义(P0.05);卵巢AFC、卵巢PSV均明显下降(P0.05)。术后研究组双侧组与对照组双侧组比较,AMH水平明显升高(P0.05),FSH水平明显下降(P0.05),E_2水平无明显变化(P0.05);术后卵巢AFC、卵巢PSV均明显升高(P0.05)。结论:腹腔镜双侧卵巢子宫内膜异位囊肿剥除术明显影响卵巢储备功能,术前行3个周期的预处理,可显著降低对卵巢储备功能的影响。     

左炔诺孕酮宫内缓释系统用于子宫内膜异位症保守性手术后复发的治疗

目的 探讨左炔诺孕酮宫内缓释系统(LNG-IUS)用于子宫内膜异位症(内异症)患者保守性手术或保守性手术联合药物巩固治疗后复发者治疗的效果.方法 选择因内异症复发而就诊的患者23例,于月经周期第5～7天宫内放置LNG-IUS.所有患者均无生育要求且不愿再次手术.于放置LNG-IUS后3、6、12、24、36个月随访,观察放置LNG-IUS前后患者疼痛视觉模拟(VAS)评分、血清CA125水平、卵巢内异症囊肿体积的变化以及月经情况、体质量等指标.结果 (1)VAS评分:放置LNG-IUS后12个月,痛经、慢性盆腔痛或性交痛缓解最为明显,VAS评分由放置LNG-IUS前的(5.9±2.3)、(4.3±2.0)分下降为(1.0±0.7)、(1.4±1.1)分,分别比较,差异均有统计学意义(P＜0.01).(2)囊肿体积:11例患者复发表现为卵巢内异症囊肿,放置LNG-IUS后6个月,卵巢内异症囊肿体积由放置前的(11.4±6.1)cm3下降至(5.5±3.4)cm3,两者比较,差异也有统计学意义(P＜0.01);放置12个月时,2例卵巢内异症囊肿消失,放置24个月时,共9例卵巢内异症囊肿消失.(3)血清CA125:从放置LNG-IUS后6个月时开始,CA125水平显著下降,由放置前的(65.5±19.6)kU/L降至放置6个月时的(42.1±13.6)kU/L,差异有统计学意义(P＜0.01),放置后12个月时,CA125水平仍继续下降,此后趋于平稳.(4)其他:放置LNG-IUS后6个月内,阴道不规则出血或点滴出血是常见现象,随着放置时间延长,情况明显缓解.少数患者出现体质量增加的情况.结论 内异症保守性手术或手术联合药物巩固治疗后复发的患者,应用LNG-IUS可有效地缓解疼痛症状,降低血清CA125水平,缩小卵巢内异症囊肿体积,是一种有效、安全、持续时间长、全身副作用少、依从性高的治疗方法.

Abstract：

Objective To evaluate the efficiency of levonorgestrel-releasing intrauterine system (LNG-IUS) in the treatment of recurrent endometriosis after conservative surgery or conservative surgery combined with medical treatment. Methods Twenty-three patients with recurrent endometriosis after conservative surgery or conservative surgery combined with medical treatment were treated by LNG-IUS. All patients rejected further operation and had no desire of fertility. The visual analogue scale (VAS) scores of pain, menstrual model, weight and serum CA125 level and the volume of ovarian endometriotic cysts before and after 3, 6, 12, 24 and 36 months of treatment were recorded and compared. Results ( 1 ) VAS score:after 12 months of using LNG-IUS, dysmenorrheal, chronic pelvic pain or dyspareunia were relieved significantly. VAS score were dropped from 5.9 ± 2. 3,4. 3 ± 2.0 to 1.0 ± 0. 7,1.4 ± 1. 1 ( P ＜ 0. 01 ). ( 2 )Volum of cysts :after 6 months of using LNG-IUS, the volume of recurrent ovarian endometriotic cysts in 11 patients were reduced from ( 11.4 ± 6. 1 ) em3 to ( 5. 5 ± 3.4 ) em3 significantly ( P ＜ 0. 01 ). At 12 months of follow-up, it suggested that 2 patients' ovarian endometriotic cysts disappeared. At 24 months follow-up,9 patients ovarian endometriotic cysts disappeared ( 3 ) CA125: serum CA125 decreased from ( 65.5 ± 19. 6 )kU/L to (42. 1 ± 13.6) kU/L at 6 months after treatment remarkably (P ＜ 0. 01 ). Continued to decrease after 12 months and then become steady. Irregular bleeding and spotting was the main side effects, weight gain was also observed in few patients. Conclusions LNG-IUS could be used in treatment of recurrent endometriosis after conservative surgery or conservative surgery combined with medical treatment effectively. It could relieve pain, reduce the level of CA125 and decrease the size of ovarian endometriotic cysts. LNG-IUS seems to be an effective, safe, and long term treatment for endometriosis with fewer side effects and better compliance.     

Ovarian cyst aspiration and the outcome of in vitro fertilization

This study was designed to ascertain whether any benefit would be derived from aspirating ovarian cysts identified before ovarian stimulation in patients undergoing in vitro fertilization. Thirty-seven patients who had ovarian cysts were categorized into two groups: group A (n = 14) with baseline ovarian cysts and group B (n = 23) with ovarian cysts that developed during pituitary suppression with the gonadotropin-releasing hormone analog. Each group was prospectively randomized into two subgroups depending on whether the ovarian cysts were aspirated or not. In group A, there was a significantly greater number of follicles and oocytes in the ovaries in which cysts were aspirated. However, there was no significant difference in the total number of follicles, oocytes retrieved and fertilized, or in the final outcome. In group B, there was no significant difference in folliculogenesis between the aspirated and nonaspirated subgroups. These observations suggest that the presence of a baseline ovarian cyst may reduce folliculogenesis but do not support routine cyst aspiration if the patient has two functional ovaries.     

左炔诺孕酮宫内缓释系统(LNG-IUS)治疗子宫腺肌病2年临床观察

目的:探讨左炔诺孕酮宫内缓释系统(LNG-IUS,商品名:曼月乐)治疗子宫腺肌病(adenomyosis,AM)的临床疗效及不良反应。方法:观察58例子宫腺肌病患者LNG-IUS放置前、放置后1个月、3个月、6个月、12个月、18个月、2年的痛经视觉模拟评分法(VAS)评分、月经量、血清CA125、子宫体积和内膜厚度及相关不良反应。结果:LNG-IUS放置后患者痛经明显缓解,VAS评分明显下降,月经量明显减少,子宫内膜变薄,并持续保持疗效,与放置前相比较,差异均有统计学意义(P<0.01);在一定程度上,子宫体积缩小,CA125降低,但差异均无统计学意义(P>0.05)。不良反应主要为阴道少许点滴出血,充分解释后患者多能接受;另有少量脱环、功能性卵巢囊肿、闭经、痤疮等。结论:LNG-IUS是治疗子宫腺肌病的一种有效的保守治疗方法,适合用于痛经和/或月经过多的子宫腺肌病患者。     

Intrauterine hormonelle Kontrazeption

Levonogestrel-IUS (LNG-IUS) are an innovative hormonal method of contraception. LNG-IUS have the advantages of oral contraceptives and IUD without specific disadvantages of these methods. The contraceptive safety is very high (Pearl-index =?0.16). LNG-IUS can be used in all woman, if the local uterine conditions are given. It is also possible in nulliparous woman, especially in cases of contraindications of other methods. The exclusion of genital infections is very important. A regular PAP-smear not older than 6 months is necessary. A postpartal use of LNG-IUS is possible 6 weeks after birth. LNG-IUS has no influence to lactation, so it is possible to use LNG-IUS also in the period of lactation. The risk of ectopie pregnancy is in LNG-IUS users lower in comparison to women using CU-IUD or no contraception. Bleeding disorders in the first months of LNG-IUS use occurred often, but a treatment is not necessary. In the first months of use LNG-IUS ovarian cysts occurred more often, but in the most of cases no treatment is necessary because they disappear spontaneously. After use of LNG-IUS no disadvantages for fertility are expected, LNG-IUS has also a place in specific situations because LNG-IUS has a lot of therapeutical side effects. LNG-IUS has labelling and is successfully woman suffering from heavy menstrual bleedings. Also in patients with endometriosis or adenomyosis the use of LNG-IUS has clinical advantages. Adenomyosis associated symptoms will be treated by LNG-IUS with a success rate of 70?%. In the perimenopause LNG-IUS is also a good contraceptive option because the endometrial protection effect is useful also for the prevention and treatment of endometrial hyperplasia. The introduction of low dose IUS (Jaydess^®) will extent the spectrum of intrauterine contraception. Advantages of Jaydess^® are especially the easier insertion in nulliparous women. In comparison to other contraceptive methods IUS have a lot of advantages.     

Heterotopic ovarian transplantation without vascular pedicle in syngeneic Lewis rats: long-term evaluation of effects on ovarian structure and function

OBJECTIVE: To assess the long-term efficacy of intraperitoneal (IP) and subcutaneous (SC) ovarian autotransplantation in rats. DESIGN: Experimental animal study. SETTING: Unit of Experimental Research, Barcelona University School of Medicine. ANIMAL(S): Female syngeneic Lewis rats aged 14 weeks. INTERVENTION(S): Group A, control group undergoing ovariectomy (n = 15); group B, undergoing ovariectomy and IP autologous heterotopic transplant (n = 15); and group C, ovariectomized with SC autologous heterotopic transplant (n = 15). In groups B and C, five animals were killed and their ovaries removed for morphometric analysis at 30 days after transplantation; five additional animals were killed at 180 days, and the remaining five animals were killed at 360 days. MAIN OUTCOME MEASURE(S): Ovarian morphometric analysis and serial measurement of E(2) and FSH serum levels. RESULT(S); The mean number of antral follicles in the control group A was significantly higher than that observed in the ovarian grafts collected and examined 30 days after grafting in rats from groups B and C, but the mean granulosa cell area was significantly higher in both transplantation groups than in controls because of ovarian follicular hyperplasia. Histological examination of ovaries removed at 6 and 12 months after grafting in groups B and C showed increasing degrees of fibrosis, loss of primordial follicles, and the presence of epithelial cysts. In groups B and C, from day 30 after surgery onward, serum E(2) was significantly higher and FSH significantly lower, respectively, than in group A. E(2) and FSH patterns in groups B and C were similar throughout the study period. CONCLUSION(S): Heterotopic ovarian transplantation without vascular pedicle in rats is characterized by follicular hyperplasia endocrinologically functional, followed by progressive loss of follicles in heterotopic ovarian autografts.     

治疗GnRH-a引发的卵巢囊肿对体外受精结局的影响

目的:了解体外受精-胚胎移植过程中,促性腺激素释放激素激动剂(GnRH-a)引发的卵巢囊肿黄体晚期穿刺治疗对体外受精结局的影响。方法:选择2002年2月至2004年7月在我院行体外受精,黄体中期应用GnRH-a长方案的患者,其中35周期应用GnRH-a后引发卵巢囊肿,全部行囊肿穿刺治疗,设为研究组(A);对照组设为B、C两组,B组(46周期):选择与A组同期应用GnRH-a,未发现卵巢囊肿者;C组(35周期)选择与A组同期取卵进行体外受精-胚胎移植(IVF)或卵细胞浆单精子注射(ICSI)者。3组分别比较临床过程(降调满意时间、Gn的用量、获卵数)、实验室结果(受精率、卵裂率、可移植胚胎率、种植率)及结局(妊娠率、流产率)。结果:3组间临床、实验室结果及妊娠结局,统计学均无显著差异(P>0.05)。结论:黄体晚期穿刺治疗GnRH-a引发的卵巢囊肿,不影响体外受精的结局。     

左炔诺孕酮宫内系统临床使用五年的安全性研究

目的观察左炔诺孕酮宫内系统(LNG-IUS)临床使用5年的抗生育效果、副反应及探讨其使用的安全性.方法对100例经产妇,随机放置LNG-IUS(LNG组)和宫内节育器TCu380A(TCu组)各50例,定期随访.对14例闭经者测定血清生殖激素水平及对9例闭经者进行子宫内膜病理学检查.结果 TCu组2例妊娠;LNG组无妊娠发生,因闭经停用24例.5年末续用率LNG组为24.0%,TCu组为74.0%(P<0.001).14例闭经者生殖激素水平与对照组相比,差别无显著性(P>0.05).LNG组子宫内膜病理检查为内膜萎缩、少数腺体分泌现象.结论 LNG-IUS导致的闭经是药物对子宫内膜的局限性抑制作用,是可逆的,对卵巢功能影响不大,卵巢仍能正常分泌激素.LNG-IUS是一种可长期使用、低妊娠率、安全的避孕系统.     

Follicle loss after laparoscopic treatment of ovarian endometriotic cysts

Objective

To evaluate follicle loss and its associated factors during laparoscopic cystectomy for ovarian endometrioma.

Method

Between October 2008 and December 2009, 140 patients with ovarian cysts undergoing laparoscopic cystectomy at Peking Union Medical Hospital were enrolled: 74 had ovarian endometrioma with no preoperative hormonal therapy (group A), 40 had ovarian endometrioma pretreated with GnRHa (group B), and 26 had non-endometriotic cysts (group C). Pre-, peri- , and postoperative clinical data were collected, and cyst specimens were evaluated histologically.

Results

The number of capsules showing follicles and the mean number of follicles per capsule were lower in group C than in group A or B (P < 0.05). Fewer type IIC than type IIB endometriomas showed follicles (P < 0.05). The number of follicles per cyst was related negatively to disease duration but positively to pain severity. Women in group A with unilateral endometrioma had a lower mean dysmenorrhea score after the surgery (P < 0.05), but no change in basal follicle-stimulating hormone (FSH).

Conclusion

The type of cyst, disease duration, and severity of dysmenorrhea were associated with ovarian follicle loss during laparoscopic excision of endometrioma. Laparoscopic unilateral cystectomy for endometrioma was effective in relieving pain but had little effect on serum FSH, which might reflect the remaining ovarian reserve.     

Levonorgestrel-Releasing Intrauterine System: A Promising Choice after Uterovaginal Anastomosis in Patients with Cervical Dysgenesis

BackgroundCervical dysgenesis is categorized into cervical fragmentation, cervical fibrous cord, and cervical obstruction. The definitive management for cervical dysgenesis is either uterovaginal anastomosis (UVA) or hysterectomy.ObjectiveTo compare the prevalence of dysmenorrhea, hematometra, and need for dilatation after UVA with and without postprocedural placement of a levonorgestrel intrauterine system (LNG-IUS).MethodsThis was a retrospective cohort study in which 14 patients with cervical dysgenesis were included. Patients had undergone UVA between May 2015 and January 2022 at the Department of Obstetrics and Gynecology of the Cairo University Teaching Hospital. Six patients who had an LNG-IUS inserted after UVA were included in group A, and 8 patients who had undergone UVA without LNG-IUS insertion were included in group B. Transabdominal and/or transvaginal ultrasound was performed monthly for the first 3 months after LNG-IUS insertion in group A and after UVA in group B. Thereafter, the patients were followed up every 6 months. The primary outcomes were dysmenorrhea, hematometra, and need for dilatation of the anastomosis site.ResultsThe number of patients who developed hematometra was significantly lower in group A than in group B (0 [0%] vs 6 [75%], P = .01). The number of patients who required dilatation was significantly lower in group A than in group B (0 [0%] vs 6 [75%], P = .01). There was no significant difference in the incidence of dysmenorrhea between the 2 groups.ConclusionWe recommend offering LNG-IUS after UVA for adolescents who present with cervical dysgenesis. LNG-IUS decreases the recurrence of hematometra and subsequent surgical interventions.