子宫内膜异位症和子宫腺肌病患者降调节促排卵方案的选择

子宫内膜异位症和子宫腺肌病常合并不孕,其中部分患者需要IVF/ICSI辅助生育。目前,国内外的指南均推荐在进行辅助生育助孕治疗前先行3~6个月GnRH-a的预处理,以改善治疗结局。但长时间的垂体抑制会增加Gn用量,有卵巢反应不良的风险。在进行促排卵时究竟用什么方案合适,目前在临床上尚无定论。本文对子宫内膜异位症、子宫腺肌病的降调节促排卵方案的选择进行探讨,并对比不同类型子宫内膜异位症的降调节方案的结局,望能为临床工作提供参考。     

促性腺激素释放激素激动剂预防子宫纵隔切除术后宫腔粘连的初步研究

目的探讨促性腺激素释放激素激动剂(GnRH-a)在子宫纵隔宫腔镜切除术后预防宫腔粘连的作用。方法 12例患者均经宫腹腔镜检查诊断为子宫纵隔,同时合并子宫内膜异位症、子宫肌瘤、子宫腺肌症。所有患者行宫腔镜下子宫纵隔切除术,同时行腹腔镜下子宫内膜异位病灶烧灼术、卵巢子宫内膜异位囊肿剥除术、子宫肌瘤剔除术。术后注射GnRH-a 2～3个月之后复查宫腔镜。结果所有患者术后复查宫腔镜,仅1例患者宫腔见轻微粘连,其余均未见粘连。结论 GnRH-a可有效预防宫腔镜子宫纵隔切除术术后宫腔粘连,尤其适用于雌激素应用禁忌的患者。     

促性腺激素释放激素激动剂超长降调节改善子宫腺肌病冻融胚胎移植妊娠结局的作用

目的 评价促性腺激素释放激素激动剂(GnRH-a)超长垂体降调节对改善子宫腺肌病(AM)冻融胚胎移植(FET)周期妊娠结局的价值. 方法 将AM患者分为GnRH-a+人工周期组和单纯人工周期组,非AM患者行人工周期作为对照组.比较三组患者各项指标包括胚胎种植率、临床妊娠率、流产率、异位妊娠率差异. 结果 GnRH-a+人工周期子宫内膜准备方案明显提高AM患者FET周期胚胎种植率和临床妊娠率,而未增加流产率和异位妊娠率. 结论 GnRH-a超长降调节明显改善AM患者FET妊娠结局.     

超长方案体外受精胚胎移植失败后重复促排卵妊娠结果分析

目的:了解中、重度盆腔子宫内膜异位症或子宫腺肌症患者,经超长方案体外受精胚胎移植(IVFET)失败后,重复采用超促排卵治疗的IVF-ET结果。方法:回顾2009~2013年我中心因子宫腺肌症或中、重度盆腔子宫内膜异位症,采用3.75 mg促性腺激素释放激素拮抗剂(GnRH-a)2~6针超长治疗方案进行IVF-ET的患者,选择移植后14 d血绒毛膜促性腺激素(h CG)阴性,月经来潮的3~7 d,血促卵泡生成素(FSH)、促黄体生成素(LH)、雌二醇(E2)水平,窦卵泡直径、子宫内膜厚度,仍在降调满意水平(抽血检查FSH、LH10 m IU/ml,E230 pg/ml;B超监测窦卵泡直径10 mm)的37例患者,随即给予促性腺激素(Gn)促排卵,再次进行IVF-ET。自身比较重复促排卵前、后不同周期及妊娠结果。结果:重复周期较前一周期相比,启动日窦卵泡(AFC)的数目[(7.55±1.86)个vs(6.45±2.5)个]、注射h CG日直径≥14 mm以上卵泡数[(7.81±3.6)个vs(5.56±3.68)个]、E2水平[(2362.15±1210.49)pg/ml vs(1749.22±1139.44)pg/ml]、获卵数[(7.51±3.23)个vs(4.78±3.41)个]以及移植胚胎数[(2.00±0.33)个vs(1.50±0.67)个]明显增加,有统计学差异(P0.05)。重复周期Gn用量明显减少[(1 791.65±1 889.41)IU vs(3 439.56±1 836.53)IU],有统计学差异(P0.05)。临床妊娠率达到62.16%。结论:子宫腺肌症或中、重度盆腔子宫内膜异位症患者,经超长方案IVF-ET失败后,若FSH、LH、E2水平以及B超检测窦卵泡在降调满意范围,重复进行促排卵IVF-ET,可以改善卵巢反应性,提高妊娠结果。     

PCOS患者经长效GnRH-a降调节后雌激素不达标直接促排卵3例报道

多囊卵巢综合征(PCOS)患者常出现内分泌激素异常,基础雌激素水平异常增高,大多数病例在IVF控制性促排卵时,应用长效GnRH-a降调节后,雌激素水平可达到降调节标准,获得较好的促排效果。本文报道了3例PCOS患者,经卵泡期长效长方案进行垂体降调节后,血清LH水平、卵泡大小、内膜厚度等均达降调节标准,但雌激素水平未达标,此时直接启动促性腺激素促排卵,也获得较好助孕治疗结局。     

HCG日血清高雌二醇患者体外受精-胚胎移植妊娠结局的影响因素分析

胚胎种植成功最关键的因素是子宫内膜的容受性.目前的研究认为,雌、孕激素水平及其在子宫内膜的受体共同协调节子宫内膜的同步发育和容受性[1].体外受精-胚胎移植(IVF-ET)中,因控制性超排卵引起多卵泡同步发育产生超生理血清雌二醇(E2)水平.高E2水平反应卵巢对超排卵的高反应性,但过高的E2水平可能促使子宫内膜上皮细胞和腺体的过度增生,使子宫内膜的容受性发生改变,从而不利于胚胎的种植.本研究通过回顾性分析注射人绒毛膜促性腺激素(HCG)日高E2水平患者的多项临床参数及妊娠结局的差异,并针对年龄、HCG日孕酮(P)值及妊娠结局等进行分组,探讨HCG日血清高E2水平患者IVF-ET妊娠结局的主要影响因素,讨论适当的应对措施以提高高反应患者的临床妊娠结局.     

俞氏内异方组治疗子宫内膜异位症临床研究

目的了解俞氏内异方组治疗子宫内膜异位症(内异症)的临床疗效和可能的作用机制。方法48例内异症患者以益气补肾化瘀为主的水煎内服方、灌肠方及外敷方治疗,观察治疗前后临床症状、体征、基础体温(BBT)、血激素水平的变化及不育者的效果。结果内异症48例治疗有效率为94%,其中20例不育患者妊娠15例,妊娠率为75%。治疗后痛经积分及非经期盆腔痛积分显著降低(P<0.01),卵巢内膜样囊肿明显缩小(P<0.01),BBT类型分布及HPS(highphasescore)评分都有明显好转(P<0.01),血清泌乳素(PRL)水平明显下降(P<0.05),黄体生成素(LH)、雌二醇(E2)水平显著上升(P<0.05)。结论俞氏内异方组可显著改善内异症患者的症状和体征,改善患者的卵巢功能,促进不育者妊娠。     

子宫腺肌症亚型与生育结局相关性的回顾性分析

目的探讨子宫腺肌症(AM)亚型与妊娠结局的相关性。方法回顾性分析2013年1月至2018年6月北京协和医院妇科内分泌病房收治的188例不孕症合并子宫腺肌症的患者病历资料,随访生育结局至2019年6月,剔除失访、拒绝电话随访及经手术记录和病理复核不符合“子宫腺肌症”诊断的病例,总计107例次的妊娠结局纳入分析。子宫腺肌症的亚型借鉴MRI影像分型的理念,结合超声影像及术中所见综合判定。结果以“不孕症”为指征,宫腹腔镜手术后100例患者尝试怀孕(7例有两次妊娠结局),62例次获得良好结局(足月分娩或目前持续妊娠中),其中自然妊娠32例,IVF妊娠30例;45例次结局不良,含自然试孕未孕和早孕胚胎停育18例,IVF-ET失败及胚胎停育27例。AM不同亚型的构成比为:I型41.1%、D型32.7%、E型17.7%、J型7.5%、K型0.9%;其中I型“结局良好”百分比(70.5%),D型“结局不良”百分比(62.8%)有显著性差异(P<0.05)。与结局不良组相比,结局良好组患者的不孕年限较短,子宫体积较小,合并痛经比例较低(P<0.05)。结论AM亚型与妊娠结局密切相关,值得开展前瞻性队列研究予以验证。     

GnRH-a治疗子宫内膜异位症对骨代谢的影响与对策

子宫内膜异位症(内异症)是妇科腹腔镜手术中的常见手术。腹腔镜可以手术诊治内异症,却不能有效降低术后复发率,内异症总体复发率高达50%以上[1],术后需用药物巩固治疗。促性腺激素释放激素类似物/激动剂(gonadotropin-releasing hormone analogue/agonists,GnRH-a)是国际公认疗效较好的药物,但存在对卵巢激素和骨代谢影响的副作用。本文目的在于指导临床医师充分正确认识GnRH-a对骨代谢的影响,了解如何预防、处理其对骨代谢产生的不良影响。1GnRH-a影响骨代谢的机制GnRH-a是一类人工合成的促性腺激素释放激素(GnRH)结构类似物。1982年Meldrum等[2]首次报道用长效GnRH-a治疗内异症获得令人满意的临床疗效。随后20多年来大量的研究也证实了这一结果。目前常用的GnRH-a类药物有亮丙瑞林(leuprorelin)、戈舍瑞林(goserelin)、那法瑞林(nafarelin)、曲普瑞林(triptorelin)、普舍瑞林(buserelin)等。使用GnRH-a开始短期内垂体的绝大部分GnRH受体被占领和内化,血促卵泡激素(FSH)、黄体生成素(LH...     

腹腔镜手术联合GnRH-a对子宫内膜异位症患者性激素水平及预后的影响

目的探讨腹腔镜手术联合促性腺激素释放激素激动剂(GnRH-a)对子宫内膜异位症(EMT)患者性激素水平及预后的影响。方法选择2017-04—2018-04间获嘉县人民医院收治的84例EMT患者,随机分为2组,各42例。对照组行腹腔镜手术,观察组行腹腔镜手术联合GnRH-a治疗。结果观察组的血清促黄体生成素(LH)、卵泡刺激素(FSH)、雌二醇(E_2)水平以及盆腔肿块大小、子宫内膜厚度、复发率低于对照组,妊娠率高于对照组,差异均有统计学意义(P0.05)。结论腹腔镜手术联合GnRH-a治疗EMT,能有效降低患者的性激素水平,缩小盆腔肿块和子宫内膜厚度,减少术后复发率,提高患者术后妊娠率。     

Hazards and complications of endoscopic transurethral ureterolithotripsy and lithoextraction and means of prevention

Complications related to ureterolithotomy and ultrasonic ureterolithotripsy performed under the control of visual endoscope were analyzed in 86 ureterolithiasis patients, methods of their prevention discussed. All the aforementioned complications were distributed into three groups: inapplicability of surgery due to anatomic and functional defects of lower and upper urinary tracts, intraoperative, and postoperative complications. The commonest ones were ureteral abruption and perforation, acute pyelonephritis, temporary vesicoureteral reflux. Their control measures were considered as relative methods of treatment: immediate surgical intervention in case of ureteral abruption, renal catheterization in patients with insignificant ureteral perforation or acute pyelonephritis. Adequate ureteroscopy, careful consideration of pro- and contraindications, catheterization of renal pelvis and urinary bladder performed within 2-3 days after the surgery and adequate antibacterial therapy are the most decisive steps in the control of aforementioned complications.     

牙体牙弓颌骨阻力中心及其临床意义

牙体、牙弓及颌骨的阻力中心在正畸矫治力系统中具有重要的意义,也是正畸学领域争论较多的一个问题。Dermaut等研究表明,当力作用于物体阻力中心时,物体将发生平动,否则将发生平动和转动的复合运动。目前,国内外多数学者认为牙体、牙弓及颌骨存在阻力中心,但其位置存在争议。本文就牙体、牙弓及颌骨的阻力中心及其临床意义作一综述。     

Characterisation and differentiation of chondroblastomas and chondromyxoidfibromas - presence and expression of collagen types I and II

AIM: Chondroblastomas and chondromyxoidfiibromas are rare benign skeletal neoplasms with reported overlapping histology. Aim of this study was to analyse the biochemical composition of the matrix of these tumour entities in order to further characterise the cellular phenotypes of these neoplasms using typical cell biological marker genes. METHODS: The matrix compositions of chondroblastomas and chondromyxoidfibromas were analyzed by HE-histology, histochemistry, and immunolocalization techniques. Cellular gene expression patterns were detected by mRNA in situ hybridization. RESULTS: Chondroblastomas are rich in collagen type I and show foci of an osteoid-like matrix, whereas collagen type II as a typical marker of chondrocytic differentiation was not detected in any of the specimens. Chondromyxoidfiibromas had foci of chondroid appearance with chondroblastic cellular differentiation characterised by collagen type II expression. CONCLUSION: These results characterise chondroblastomas and chondromyxoidfiibromas as skeletal neoplasms that have a different biology and which can be distinguished by matrix protein expression products: collagen type II, the typical marker of chondroblast differentiation, could only be detected in chondromyxoidfibromas, but not in chondroblastomas. Thus, both neoplasms are clearly different on the cell biological level.     

Histochemical and contractile properties of striated muscles of urethra and levator ani of dogs and sheep

AIMS: To understand their possible importance in long- and short-term control of continence, some properties of the striated muscles of the urethra and pelvic floor (levator ani) of dogs and sheep were investigated, especially fiber types and contractile characteristics. MATERIALS AND METHODS: Striated muscles of urethra and levator ani of 29 male and 6 female dogs and 11 male and 6 female sheep were removed and cut into strips. Some strips were frozen and stained for ATPase at pH 9.4 and 4.3 for fiber typing; others were set up in an organ bath to study contractile responses to nerve stimulation. RESULTS: All muscles contained both type I (slow) and type II fibers, ranging from 97% type II in female greyhound urethra to 60% in female sheep levator ani. For each muscle, there were fewer type II muscles in sheep than in dog. The diameters of the urethral fibers were about 60% of the levator ani in dogs and 34% in sheep. Contraction of the urethral muscle was faster than for levator ani and declined to about 80% of the peak, 500 msec after the beginning of stimulation at 20 Hz. The levator ani contraction rose to a steady level as long as stimulation continued. CONCLUSIONS: Both the levator ani and urethral striated muscles contain slow and fast fiber types. The levator ani muscles are capable of sustained contraction with rapid onset which will produce long-term closure of the urethra. The circular urethral muscle contraction was faster but less well maintained.     

Incorporation and release of85Sr and14C-proline-hydroxyproline in mineral and collagen of bone and incisor teeth of growing rats

The extent to which exchange and reutilization processes of mineral tracers affect skeletal mineral accretion and resorption measurements was evaluated by comparing the rates of appearance and disappearance of⁸⁵Sr and¹⁴C-proline-hydroxyproline in bones and teeth in growing rats for 12 days following simultaneous parenteral injection of these tracers. Expressions for the relative rates of collagen synthesis and breakdown, which unlike mineral metabolism are considered not to be complicated by exchange phenomena, were based on¹⁴C-proline conversion to¹⁴C-hydroxyproline; the specific activity of the latter was determined. Both the mineral and the collagen specific activities reflected the rates and patterns of growth of the samples assayed; rapid growth and a short interval of time between formation and resorption of tissue in themetaphyseal bone which contains the cartilagineous growth plate, slow growth and an interval of time between formation and resorption of tissue indiaphyseal bone and incisor teeth which is longer than the 12 days of the experiment. However, in metaphyseal bone the specific activity collagen/mineral ratio dropped by one half during the 4–12 day interval in contrast to diaphyseal bone and incisor teeth in which no change in this ratio was observed during this period of time. The data indicate that collagen in the metaphyseal growth zone is removed by resorption before it has become fully mineralized, and that exchange is a relatively unimportant factor in the long term kinetics of bone mineral.

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Zusammenfassung Das Ausmaß, bis zu welchem Austausch- und Wiederverwendungsprozesse der mineralen Tracer die Messungen des mineralen Skelett-Auf- und Abbaues beeinflussen können, wurde ausgewertet; zu diesem Zweck wurde die Geschwindigkeit des Auftretens und Verschwindens von⁸⁵Sr und von¹⁴C-Prolin-Hydroxyprolin in Knochen und Zähnen von wachsenden Ratten während der 12 auf die simultane parenterale Injektion dieser Tracer folgenden Tage verglichen.Der Ausdruck für die relative Geschwindigkeit des Kollagen-Auf- und Abbaues, bei welchem im Gegensatz zum Mineralmetabolismus kein Mitwirken des Austauschphänomens vermutet wird, basiert auf der Umwandlung von¹⁴C-Prolin zu¹⁴C-Hydroxyprolin; die spezifische Aktivität des letzteren wurde bestimmt.Aus der spezifischen Aktivität des Minerals sowie jener des Kollagens konnten die Geschwindigkeit und die Art des Wachstums der untersuchten Proben ersehen werden, d.h.schnelles Wachstum und ein kurzes Zeitintervall zwischen Bildung und Resorption des Gewebes imKnochen der Metaphyse, die auch die knorpelige Wachstumsplatte enthält, und andererseitslangsames Wachstum und längeres Zeitintervall (länger als die 12 Tage des Experimentes) zwischen Bildung und Resorption des Gewebes imKnochen der Diaphyse und in den Schneidezähnen. Immerhin fiel die spezifische Aktivität des Kollagen/Mineral-Anteils im Knochen der Metaphyse während dem 4–12tägigen Zeitintervall auf die Hälfte, im Gegensatz zum Knochen der Diaphyse und der Schneidezähne, bei welchen während dieser Zeitspanne kein Unterschied in diesem Verhältnis beobachtet wurde.Diese Ergebnisse zeigen, daß Kollagen in der Wachstumszone der Metaphyse durch Resorption verschwindet, bevor es ganz mineralisiert ist, und daß der Austausch ein relativ unwichtiger Faktor in der Kinetik auf lange Sicht des Knochenminerals ist.