子宫内膜息肉患者宫腔镜术后自然妊娠的影响因素探讨

目的 通过对子宫内膜息肉患者行宫腔镜微创电切术,观察其影响术后临床结局的独立危险因素。方法 选择98例子宫内膜息肉患者作为研究对象,患者均实施宫腔镜电切手术。根据1年内子宫内膜息肉患者妊娠情况,将其分为未妊娠组、妊娠组,采用单因素分析一般临床资料,利用Logistic回归模型评估子宫内膜息肉宫腔镜术后临床结局的多因素分析,利用ROC曲线评估相关指标对子宫内膜息肉宫腔镜术后预后情况的效能分析。结果 术后1年妊娠患者为67例,未妊娠患者为31例。单因素结果显示：年龄、息肉直径、息肉数量、雌激素受体、孕激素受体表达水平是影响子宫内膜息肉宫腔镜术后临床结局的相关因素（P<0.05）;多因素分析结果显示：年龄≥35岁、息肉直径≥10 mm、息肉个数多、雌激素受体及孕激素受体不均衡表达是子宫内膜息肉宫腔镜术后临床结局的独立危险因素（P<0.05）;以临床病理结果为标准,年龄≥35岁、息肉直径≥10 mm、息肉个数多及其联合预测对患者预后情况均具有一定效能,其中联合预测的效能最高（AUC=0.858）。结论 年龄≥35岁、息肉直径≥10 mm、息肉个数多、雌激素受体及孕激素受体不均衡表达...     

宫腔镜诊治子宫内膜息肉122例临床分析

目的探讨宫腔镜及阴道彩超在子宫内膜息肉中的诊断价值。方法回顾性分析2010年1～12月122例经宫腔镜及病理检查诊断为子宫内膜息肉患者的临床资料。41.8%的患者表现为异常阴道出血或绝经后出血。结果阴道超声诊断子宫内膜息肉的敏感性为98.4%（120/122）,特异性为3.8%（20/525）。宫腔镜诊断子宫内膜息肉118例,敏感性为96.7%（118/122）,特异性为98.9%（519/525）,其中合并子宫内膜非典型增生3例。结论阴道B超诊断子宫内膜息肉的敏感性高,但特异性低,宫腔镜检查在不降低敏感性的同时可以明显提高特异性,病理检查是诊断子宫内膜息肉的金标准。     

宫腔镜诊治宫内病变545例临床分析

近年来随着宫腔镜诊断技术的普及、提高,已逐步取代某些开腹手术。我们回顾分析了2006年在我院门诊完成宫腔镜检查的545例患者资料,现总结分析如下。一、资料与方法 1．临床资料：2006年1～12月在我院门诊行宫腔镜检查的患者545例,平均年龄为29．5岁（24～48岁）,其中不育症463例（85％）,子宫输卵管造影（HSG）提示宫腔形态异常71例（13％）,节育器取出困难、断裂、嵌顿11例（2％）。     

宫腔镜子宫内膜电切术后晚期并发症的分析

目的：总结宫腔镜子宫内膜电切术后晚期并发症的临床特点和治疗经验。方法2006年1月～2014年6月13例因功能失调性子宫出血行宫腔镜子宫内膜电切术后（＞9年）出现晚期并发症,再次宫腔镜探查并处理。结果13例宫腔镜二次探查结果：6例宫腔积血,其中4例位于宫角,2例位于宫腔;7例局灶或四壁内膜增生,其中1例出现子宫内膜去除-输卵管绝育术后综合征,1例子宫内膜病理为非典型增生Ⅰ级。7例术后症状好转（53．8％）;3例合并子宫腺肌病继发进行性痛经（23．1％）,2例子宫内膜增殖有乳腺癌手术史（15．4％）,1例子宫内膜非典型增生Ⅰ级（7．7％）均行腹腔镜下全子宫切除术。结论宫腔镜子宫内膜电切术后残存有功能的子宫内膜或日后再生的内膜可引起晚期并发症,需要临床进一步诊治。     

宫腔镜术后子宫内膜息肉复发危险因素分析

目的探讨宫腔镜术后子宫内膜息肉(endometrial polyp,EMP)复发的危险因素. 方法47例EMP患者,39例采用子宫内膜息肉切除术(TCRP),8例采用宫腔镜引导下息肉摘除术,术后定期阴道超声随访.将年龄、体重指数、息肉大小、数目、是否伴子宫内膜增殖症及子宫肌瘤、产次、流产次数、手术方式、术后孕激素使用与否作Cox回归分析. 结果平均随访时间18.1个月.复发率为14.9%.TCRP组复发率为10.3%(4/39),均在1年后;宫腔镜引导下息肉摘除术组的复发率为37.5%(3/8),2例在术后3个月内,1例在术后1年复发.两种手术方式比较差异无显著性(P>0.05).术后长效安宫黄体酮治疗组和非用药组的复发率分别为12.5%、15.4%,差异无显著性(P>0.05).手术方式是影响息肉复发的唯一的强危险因素(OR=4.68). 结论手术方式与息肉复发相关,TCRP术后EMP的复发率较宫腔镜引导下息肉摘除术的复发率低,复发时间迟,术后长效安宫黄体酮治疗不能预防息肉复发.     

宫腔镜子宫内膜电切术治疗多发性子宫内膜息肉58例效果分析

目的 探讨宫腔镜子宫内膜电切术治疗多发性子宫内膜息肉的效果.方法 回顾性分析登封市中医院妇产科2018-01—2020-12行宫腔镜子宫内膜电切术治疗的58例多发性子宫内膜息肉患者的临床及随访资料.观察术中情况、术后临床指标.记录术后随访6个月期间的复发率和并发症发生率.比较治疗前、治疗后6个月时患者的经血量、排卵期子...     

丙泊酚减少乳腺癌患者术后复发率的网络药理学和分子对接分析

目的 乳腺癌患者术后血液里的肿瘤细胞数是复发率升高和生存率降低的独立影响因素。丙泊酚虽然已经被证实能减少乳腺癌患者术后血液循环里的肿瘤数,但是丙泊酚是否能直接与乳腺癌细胞相互作用、通过什么受体与乳腺癌细胞相互作用仍然处于未知状态,因此本研究通过网络药理学技术、癌症基因组图谱（TCGA）数据挖掘、分子对接技术试图探索出丙泊酚与乳腺癌细胞直接作用的靶点及相关的通路。
方法 在PubChem数据库中检索出丙泊酚的3D结构和Canonical smiles序列并在Swiss Target prediction、Chembl、Drugbank三个数据库中整合出丙泊酚的作用位点,在Uniprot数据库中转换成基因名称。在DisGeNet、Gene cards数据库中检索出与乳腺癌相关的基因。将上述两组基因数据集取交集得到19个共有基因。将得到的基因进行京都基因与基因组百科全书（KEGG）、基因本体论（GO）富集分析。筛选出与乳腺癌相关的KEGG通路和基因,并在TCGA乳腺癌的基因表达数据集中对筛选出的基因进行验证。最后使用分子对接技术将丙泊酚分子和雌激素受体α（ESRα）进行对接验证。
结果 丙泊酚作用靶点数据集与乳腺癌相关基因数据集有19个共有基因,KEGG分析中雌激素信号通路是与乳腺癌最相关的通路,富集在这条通路上的基因有γ氨基丁酸B型受体基因（GABBR1,GABBR2）、雌激素受体基因（ESR1）。在TCGA乳腺癌基因表达数据集中分析上述3个基因在肿瘤组织和非肿瘤组织中的差异性表达情况,发现上述3个基因在肿瘤组织和非肿瘤组织中存在明显的差异性表达,分子对接结果显示丙泊酚与ESRα结合良好。
结论 丙泊酚可能通过与乳腺癌细胞膜上的GABAB受体和雌激素受体结合,影响乳腺癌细胞的“膜启动类固醇信号传导”,从而减少乳腺癌细胞术中的微转移,减少乳腺癌患者术后血液循环内的肿瘤细胞数量,最终减少乳腺癌患者术后复发率。     

宫腔镜在子宫内膜增生和子宫内膜癌中的诊治作用

子宫内膜增生是临床常见的妇科病变,具有一定的癌变倾向,被列为癌前病变,正确、及时地诊断和治疗对防止病变进展意义重大。子宫内膜癌是最常见的妇科恶性肿瘤,严重影响患者的生存质量和生命健康,对子宫内膜癌的早期诊断和及时治疗是提高患者生存预后的重要前提。近年来,宫腔镜在子宫内膜增生和子宫内膜癌诊治中的应用越来越广泛。本文就宫腔镜在子宫内膜增生和子宫内膜癌中的诊治作用做一综述。     

宫腔镜诊治子宫内膜息肉的临床应用

目的探讨宫腔镜对子宫内膜息肉的诊断价值及治疗作用。方法回顾性分析102例子宫内膜息肉患者的临床资料,均在宫腔镜下被诊断为子宫内膜息肉,均接受宫腔镜下子宫内膜息肉切除术,其中息肉电切除术88例,子宫内膜息肉钳夹＋诊刮术10例,活检钳钳除＋诊刮术4例。结果本组平均手术时间25.5（10－40）min,平均出血量36.5（5－50）ml,平均住院天数3（2－5）d。切除标本均经病理检查确诊为子宫内膜息肉。无感染、大出血、子宫穿孔、宫腔粘连、周围脏器损伤、过度水化综合征等并发症。术后随访12个月,无复发病例。10例有生育要求者5例已妊娠。结论宫腔镜是诊断子宫内膜息肉的金标准;治疗首选宫腔镜下子宫内膜息肉电切术。     

宫腔镜诊治子宫粘连效果分析

目的　探讨宫腔镜在诊治子宫粘连中的作用。　方法　 1996年 6月～ 1999年 10月妇科疾病116 5例中应用宫腔镜检出并治疗子宫粘连 134例。　结果　子宫粘连 134例中有流产史者占 93.3%。临床症状主要为闭经 ,(43.3% ) ,月经过少 (2 6 .9% ) ,其他症状占 2 9.8%。宫腔镜下松解粘连成功率94 0 % (12 6 / 134) ;临床治愈率 77.5 % (86 / 111) ,轻、中、重度治愈率依次为 85 .1% (40 / 4 5 )、6 4 .7% (2 2 / 34)及 6 0 .0 % (6 / 10 ) ;症状发生至镜检的时间越短 ,治愈率越高。　结论　宫腔镜是目前诊治子宫粘连的首选方法     

Bariatric surgery in patients with breast and endometrial cancer in California: population-based prevalence and survival

BackgroundThe number of bariatric surgeries performed in the United States has increased substantially since the 1990’s. However, the prevalence and prognostic impact of bariatric surgery, or weight loss surgery (WLS), among patients with cancer are not known.ObjectivesWe investigated the population-based prevalence of WLS in women with breast or endometrial cancer and conducted exploratory analysis to examine whether postdiagnosis WLS is associated with survival.SettingAdministrative statewide database.MethodsWLS records for women with nonmetastasized breast (n = 395,146) or endometrial (n = 69,859) cancer were identified from the 1991–2014 California Cancer Registry data linked with the California Office of Statewide Health Planning and Development database. Characteristics of the patients were examined according to history of WLS. Using body mass index data available since 2011, a retrospective cohort of patients with breast or endometrial cancer and obesity (n = 12,540) was established and followed until 2017 (5% lost to follow-up). Multivariable cause-specific Cox proportional hazards models were used to examine the associations between postdiagnostic WLS and time to death.ResultsWLS records were identified for 2844 (.7%) patients with breast cancer and 1140 (1.6%) patients with endometrial cancer; about half of the surgeries were performed after cancer diagnosis. Postdiagnosis WLS was performed in ～1% of patients with obesity and was associated with a decreased hazard for death (cause-specific hazard ratio = .37; 95% confidence interval = .014–.99; P = .049), adjusting for age, stage, co-morbidity, race/ethnicity, and socioeconomic status.ConclusionAbout 2000 patients with breast or endometrial cancer in California underwent post-diagnosis WLS between 1991 and 2014. Our data support survival benefits of WLS after breast and endometrial cancer diagnosis.     

The therapeutic role of fulvestrant in the management of patients with hormone receptor-positive breast cancer

Although selective estrogen receptor modulators (SERMs), such as tamoxifen, or aromatase inhibitors (AIs), such as anastrozole, are the preferred endocrine treatment approach for most patients with hormone receptor-positive breast cancer, many patients progress despite this therapy or become resistant. Fulvestrant is a selective estrogen receptor down-regulator (SERD) that has demonstrated activity and efficacy in patients with hormone receptor-positive breast cancer previously untreated or treated with hormonal therapy. The efficacy of fulvestrant has been demonstrated in the neoadjuvant and metastatic settings, either alone or in combination with other therapies such as anastrozole or targeted drugs. Additionally, 500 mg of fulvestrant have been shown to be more effective than 250 mg, without significant differences in the toxicity profile. In this review, the unique mode of action of fulvestrant and the clinical data for different dosing regimens both alone or in combination with other drugs is critically assessed.     

The Gail model predicts breast cancer in women with suspicious radiographic lesions

BACKGROUND: We sought to evaluate whether a woman's 5-year Gail risk adds to the predictive value of the Breast Imaging Reporting and Data System (BI-RADS) classification for the detection of breast cancer. METHODS: We performed a retrospective review of the BI-RADS classifications and pathology results for all image-guided needle breast biopsy examinations over a 3-year period at our institution. The 5-year Gail risk was calculated for eligible patients. Chi-square analysis was used to compare rates of malignancy based on Gail and BI-RADS scores. RESULTS: A total of 632 image-guided needle biopsy examinations were performed in 609 women. A total of 414 women had suspicious (BI-RADS 4) lesions and underwent 424 biopsy examinations. For this subset, women with a Gail risk of less than 1.7% had 21% malignant results, whereas those with a Gail risk of 1.7% or greater had 42% malignant results (relative risk, 1.94; 95% confidence interval, 1.45-2.66). CONCLUSIONS: The Gail model can stratify further the risk for breast cancer in women with suspicious breast imaging reports.     

宫腔镜诊治在反复种植失败患者中的临床疗效

目的探讨宫腔镜诊治在反复种植失败(RIF)患者中的临床应用疗效。方法回顾性分析2014年1月至2015年6月在我院行宫腔镜检查及治疗的RIF患者105例,根据宫腔是否异常及是否行宫腔搔刮术将患者分为3组:A组,43例,患者宫腔正常,行诊刮术;B组,28例,患者宫腔正常,未行诊刮术;C组,34例,患者宫腔异常,行诊刮术。比较3组患者宫腔镜诊治后的生化妊娠率、临床妊娠率及着床率等。结果 RIF患者宫腔镜检查宫腔异常的检出率为32.38%。3组患者宫腔镜诊治后的临床结局均有所改善,105例RIF患者共94个移植周期,有56例患者获得生化妊娠,47例患者获得临床妊娠,6例流产。3组间的生化妊娠率(60.0%vs.52.0%vs.65.5%)、临床妊娠率(50.0%vs.48.0%vs.51.7%)及着床率(29.6%vs.22.6%vs.31.5%)比较均无显著性差异(P0.05)。结论宫腔镜诊治能够提高RIF患者的临床妊娠率。对于宫腔正常的患者,宫腔镜检查的同时行宫腔搔刮术与单纯宫腔镜检查相比并未提高妊娠率。     

Risk factors associated with loss to follow-up of breast cancer patients: A retrospective analysis

BackgroundLoss to follow-up (LTFU) during post-operative surveillance of breast cancer patients is detrimental. The pattern of LTFU and its risk factors in Chinese breast cancer patients remains unknown.MethodEligible non-metastatic breast cancer patients who underwent surgery at our institution between 2009 and 2012 were included. The clinicopathological features, as well as the LTFU status, were retrieved from the REDCap database. LTFU was defined as the absence of patients for at least 12 months since her last contact. 5-year LTFU was defined as the LTFU status of each patients at 5 years after surgery. The incidence and potential risk factors of LTFU were analyzed. A LTFU-risk score was developed to quantify the risk of LTFU.ResultsA total of 1536 patients with breast cancer were included, and 411(26.8%) patients were 5-year LTFU. 198 patients were LTFU in the first year. Univariate and multivariate analysis revealed that age (younger and older), a lack of medical insurance, longer distance from residence to the hospital, pathology (DCIS/Paget’s/Phyllodes), lymph node metastasis, the absence of endocrine therapy and fewer than five contact numbers were significantly and independently associated with the risk of LTFU. A LTFU-risk score was developed and was predictive of LTFU.ConclusionsA series of risk factors were significantly associated with post-operative LTFU of breast cancer patients. Patients with different risks of LTFU could possibly be identified, and surveillance plans could be individualized for different patients, so as to effectively reduce the overall LTFU rate, and optimize the allocation of medical resources.     

Follow-up of patients with localized breast cancer and first indicators of advanced breast cancer recurrence: A retrospective study

We conducted a retrospective study to assess the follow-up of patients with localized breast cancer and the first indicators of advanced breast cancer recurrence.All patients with advanced breast cancer recurrence treated between January 2010 and June 2016 in our institution were registered. Among these patients, 303 patients initially treated for early breast cancer with curative intent were identified.After initial curative treatment, follow-up involved the oncologist, the general practitioner and the gynecologist in 68.0%, 48.9% and 19.1% of cases, respectively. The median DFI was 4 years for luminal A, 3.8 years for luminal B, 3.7 years for HER2-positive and 1.5 years for TNBC (p = 0.07). Breast cancer tumor marker was prescribed for 164 patients (54.1%). No difference in terms of follow-up was observed according to the molecular subtype. Symptoms were the primary indicator of relapse for 143 patients (47.2%). Breast cancer recurrence was discovered by CA 15.3 elevation in 57 patients (18.8%) and by CAE elevation in 3 patients (1%). The rate of relapse diagnosed by elevation of CA 15.3 or CAE was not statistically associated with the molecular subtype (p = 0.65). Luminal A cases showed a significantly higher rate of bone metastases (p = 0.0003). TNBC cases showed a significantly higher rate of local recurrence (p = 0.002) and a borderline statistical significant higher rate of lung/pleural metastases (p = 0.07).Follow-up recommendations could be adapted in clinical practice according to the molecular subtype. General practitioners should be more involved by the specialists in breast cancer follow-up.     

乳腺癌激素受体状态与复发风险分布特征的相关研究

目的 研究不同激素受体(hormone receptor,HR)状态的乳腺癌患者术后复发风险时间分布特征.方法 回顾性研究北京肿瘤医院乳腺中心自1999年12月-2006年4月手术的1099例原发性乳腺癌患者激素受体状态的复发风险曲线模式.结果 所有患者均获得随访,中位随访时间60.6个月,1099例患者中171例复发.激素受体阴性(hormone receptor-negative,HR-)的乳腺癌患者,在术后第12个月出现第一个复发高峰,54个月左右出现第二个复发高峰.激素受体阳性(hormone receptor-positive,HR+)患者的第一峰在36个月出现,峰值较低且上升较缓和,约在54个月出现第二高峰,随后激素受体阳性肿瘤患者复发风险曲线高于激素受体阴性者.淋巴结阳性(lymphnode-positive,LN+)组与阴性(lymph node-negative,LN-)组在HR-组与HR+组有类似的复发风险曲线模式,淋巴结转移越多复发风险越高.HR+组中LN+亚组复发风险峰值高于LN-亚组2～3倍,HR-组中LN+亚组复发风险峰值高于LN-亚组3～4倍.HR(+)组无复发生存率高于HR(-)组(P＜0.01). 结论 HR+组乳腺癌术后54个月时复发风险高于HR-组,HR+组中LN+患者复发风险高于LN-者.     

The discrepancy between immunocytochemical and biochemical assay of estrogen receptor in breast cancer patients treated by endocrine therapy

Estrogen receptor (ER) expression was investigated by ER-immunocytochemical assay (ICA) and the dextran coated charcoal (DCC) method in 10 recurrent or primary-advanced breast cancer patients treated with endocrine or chmmo-endocrine therapy. In 6 of these 10 patients, ER was examined both before and after treatments by the 2 methods. ER contents measured by the DCC method were found to be decreased after treatments, however, no change in the immunoreactivities of ER-ICA was observed. In the remaining 4 patients, the ER of new lesions refractory to endocrine or chemo-endocrine therapy was examined. ER status was determined as negative in 3 of the 4 patients by the DCC method, whereas by ER-ICA, the proportion of ER stained cells was about 70 per cent, those cells being diffusely distributed in the section. A discrepancy between ER-ICA and the DCC method was thus demonstrated in breast cancer patients treated by endocrine therapy.     

黑升麻对乳腺癌化疗患者的临床研究

目的 探讨黑升麻是否可以通过非雌激素通路改善乳腺癌化疗患者的类更年期症状.方法 选取2012年1月-2013年6月在哈尔滨医科大学4个附属医院诊治的乳腺癌女性患者,年龄20～51岁,术前未停经,且月经规律,术后行规律按时化疗,化疗后Kupperman评分≥15分的120例患者.对所有患者进行随机双盲均分为两组,每组均60例,实验组口服黑升麻提取物药物莉芙敏40 mg每天一次,对照组口服安慰剂(德国SchaPer&Brümmer)40 mg每天一次,服药前和服药12周后对所有患者行雌激素、妇科超声、健侧乳腺超声检测、Kupperman评分,评判其疗效.结果 服药前后实验组与对照组雌激素、子宫内膜的厚度均在正常范围,且差异没有统计学意义(P＞0.05);服药后实验组与对照组健侧乳腺组织均没有发现新肿块.服药后,实验组Kupperman评分比服药前明显降低,差异有统计学意义(P＜0.05);对照组Kupperman评分与服药前相比差异没有统计学意义(P＞0.05).5例实验组的患者服药后Kupperman≥15分,但是均比服药前的评分低.结论 黑升麻可以通过非雌激素通路改善乳腺癌化疗患者的类更年期症状,无论雌激素受体阳性还是阴性,都有较好的疗效.     

输血对乳腺癌患者术后感染的影响观察

目的　观察输血对乳腺癌患者术后感染的影响。方法　选择 3 11例乳腺癌手术患者进行临床观察 ,其中 10 9例患者术中输注浓缩红细胞 ,112例输注去白细胞浓缩红细胞 ,90例未输血 ,对三组患者术后感染率进行比较。结果　浓缩红细胞输血组术后感染率为 5 .5 0 % ,去白细胞浓缩红细胞输血组术后感染率为 0 .89% ,与浓缩红细胞输血组比较差异有显著性 (P <0 .0 1) ,未输血组患者术后感染率为 1.11% ,与浓缩红细胞输血组比较差异有显著性 (P <0 .0 1) ,而与去白细胞浓缩红细胞输血组比较差异无显著性 (P >0 .0 5 )。结论　乳腺癌患者术中输注浓缩红细胞较输注去白细胞浓缩红细胞患者及未输血患者术后感染率高 ,且术后感染率与浓缩红细胞输注量密切相关。