子宫肌瘤动脉介入治疗

目的评价子宫动脉栓塞治疗子宫肌瘤的疗效和并发症. 方法对27例子宫肌瘤患者进行子宫动脉栓塞治疗,随访复查子宫、瘤体大小变化和临床症状、并发症的情况. 结果子宫动脉栓塞后随访3～18个月,有效率为92.6%(25/27).月经过多的改善率89.5%(17/19),痛经改善率88.9%(8/9),子宫体积减少48.9±15.6% (t=13.3921,p<0.001),肌瘤体积减少56.8±17.9%(t=14.6403,p<0.001);并发症发生情况:轻中度发热20/27(74.1%)、中重度腹痛5/27(18.5%)、月经周期缩短10/27(37.0%)、短暂性停经4/27(14.8%)、闭经2/27(7.4%).结论子宫动脉栓塞术治疗子宫肌瘤安全、有效、损伤小.但栓塞前需行活检术排除恶性病变.     

探讨2种栓塞剂联合对34例子宫肌瘤介入治疗的疗效观察

目的 评价两种栓塞剂联合应用栓塞子宫动脉治疗子宫肌瘤的临床价值.方法 对34例有症状的子宫肌瘤患者进行选择性的子宫动脉造影及栓塞治疗,并进行术后临床观察.结果 症状改善率为92.7%(29/34),其中月经完全恢复正常者占88.7%(28/34),其他症状消失者占85.6%(27/34)栓塞后6个月全部得到随访,子宫肌瘤平均缩小53.4%.结论 两种栓塞联合剂联合应用栓塞子宫动脉治疗子宫肌瘤是一种安全有效的新技术,值得在临床推广.     

子宫动脉栓塞治疗子宫肌瘤伴月经过多的临床研究

目的:回顾分析24例子宫肌瘤伴月经过多患者入介治疗疗效和子宫动脉栓塞安全性.方法:选择24例子宫肌瘤伴月经过多患者进行子宫肌瘤供血动脉的栓塞.结果:插管栓塞动脉率100%,随访2年.治疗后1月,24例患者月经均明显减少,B超随访,3个月子宫肌瘤体积平均缩小30%.随访2年,其中2例行腹腔镜下子宫肌瘤经阴道摘除术,6例子宫肌瘤消失,16例子宫肌瘤体积平均缩小80%.结论:子宫肌瘤行介入治疗疗效肯定,对粘膜下子宫肌瘤及子宫肌瘤伴月经过多患者尤为适宜.     

复方磷酸萘酚喹及其组分单药治疗恶性疟的临床研究

为了对比观察复方萘酚喹(Co NQ)与组分单药磷酸萘酚喹(NQ)和青蒿素(QHS)对恶性疟的疗效和安全性,本研究用Co -NQ (总量含NQ 4 0 0mg及QHS10 0mg)、NQ (总量10 0 0mg)和QHS (总量2 5 0 0mg)分别治疗恶性疟患者30例。所有患者住院7天,随访2 8天,观察疗效和安全性。结果显示Co NQ、NQ和QHS 3组的平均退热时间分别为2 0 1±11 .8h、2 4 . 4±16. 1h和18 .0±9. 3h ;平均原虫转阴时间分别为30 . 1±5 . 7h、4 4 7±9 .2h和2 8 .9±5 . 6h ;2 8天治愈率分别为10 0 %、10 0 %和6 3 .3%。提示复方萘酚喹治疗恶性疟具有良好的临床效果。     

精神分裂症院内康复策略及其疗效初探

目的 :探讨适合社区的院内康复策略及其对精神分裂症患者的作用。方法 :将 64例精神分裂症患者随机分为干预组和对照组 ,每组 3 2例。在药物治疗的同时 ,对干预组施以小组工作制 ,进行《药物自我处置》和《症状自我监控》两种技能训练 ,共十周 ,出院后随访一年。用阳性与阴性症状量表 (PAN SS) ,住院病人护士观察量表 (NOSIE -3 0 ) ,自知力和治疗态度问卷 ,社会功能缺陷筛选量表 (SDSS) ,康复状态量表 (MRSS)和复发率、再住院率、再就业率进行评估。结果 :1 干预组患者PANSS总分及各分量表评分自 2周减分率明显优于对照组 ,最后时点两组PANSS总分 ( 3 1 2± 3 1 5 2 3± 13 0 ,t =6 8)、阳性症状( 7 3± 1 1 12 4± 4 3 ,t =5 9)、阴性症状 ( 7 8± 2 1 13 3± 4 5 ,t =5 9)、一般精神病理总分 ( 16 1± 1 8 3 1 2± 9 8,t =7 5 )相比 ,研究组均优于对照组 ,差异有非常显著性 (P <0 0 0 1) ;2 干预组NOSIE -3 0出院时点与最后时点积极因素和消极因素的差值分别为 ( -18 3± 3 2 ,9 6± 6 2 ) ,而对照组分别为 ( 14 4±6 7,-2 2 3± 7 4,t=2 0 3及 2 3 8,P均 <0 0 1) ,两组比较差异有非常显著性。 3 干预组自知力和治疗态度问卷出院时点和最后时点分别为 ( 16 2 1± 5 43 ,16 3 5± 6     

原发性小肝癌术后早期复发的临床病理学研究

目的　探讨影响原发性小肝癌 (smallhepatocellularcarcinoma ,SHCC)术后早期复发的临床病理学因素。 方法　 70例SHCC术后患者 ,分别选择 6项可能对术后早期复发产生影响的临床与病理学因素 ,对指标进行t检验或 χ2 检验分析。结果　 70例患者的 1、3、5年总体复发率分别为 2 1 4 %、6 2 9%与 72 8%;生存率分别为 97 1%、85 7%和 70 0 %;36例复发者中的 70 6 %(36 /5 1)发生在术后 2年内。 2年内与 2年后复发者的复发灶数目差异有显著性 (P <0 0 5 ) ,术后 1、3、5年的生存率分别为 91 6 %、75 0 %、5 2 7%和 10 0 %、93 3%、80 0 %。复发者单纯肝动脉栓塞化疗术 (transcatheterarterychemotherapyandembolization ,TACE)治疗 2 6例中 ,直径≤ 2cm者 (18例 )与 >2cm者 (12例 ) ,平均生存时间分别为 48 2± 10 7个月与2 7 2± 7 5个月 ,二者差异有显著性 (P <0 0 0 1)。结论　SHCC术后 2年是复发的高峰时间 ,可能与肿瘤对血管的侵犯及肿瘤血管的密度直接相关 ;2年内复发者预后差。对于直径≤ 2cm的复发肿瘤 ,TACE的疗效较好。     

双轴点掌背皮动脉轴行皮瓣的应用解剖

目的 :报道手背一种新型皮动脉岛状皮瓣设计的解剖学基础。方法 :对 2 0侧新鲜成人标本 ,在 5倍显微镜下观测掌背血管、肌腱、神经的解剖特点和皮肤的血供。结果 :手掌背皮下组织内存在掌背动脉相平行的皮动脉。第 1掌背动脉出现率为 95 % ,起点外径 ( 0 .8± 0 .1)mm ,长度 ( 7.8± 1.1)cm ,末端外径 ( 0 .4± 0 .2 )mm。第 2掌背动脉出现率为 10 0 % ,起点外径 ( 0 .6± 0 .1)mm ,长度 ( 6.5± 0 .8)cm ,末端外径 ( 0 .4± 0 .1)mm。第 3掌背动脉出现率为 10 0 % ,起点外径 ( 0 .5± 0 .1)mm ,长度 ( 6.5± 0 .7)cm ,末端外径 ( 0 .3± 0 .1)mm。第 4掌背动脉出现率为 90 % ,起点外径 ( 0 .4± 0 .1)mm ,长度 ( 5 .5± 0 .9)cm ,末端外径 ( 0 .3± 0 .1)mm。结论 :掌背皮动脉走行、分支较为恒定 ,可以其为蒂 ,设计双轴点的顺行或逆行岛状皮瓣 ,用于腕、手及手指的软组织缺损的修复。     

CA系列对恶性肿瘤诊断临床表达的价值

目的 :利用标记免疫分析CA5 0 ,CA12 5 ,CA199和CA15 3水平进行肝癌、结直肠癌、卵巢癌、胰腺癌、乳腺癌、肺癌和胃癌的诊断研究。方法 :标记免疫分析了 6 7例肝癌 ,88例结直肠癌 ,48例卵巢癌 ,36例胰腺癌、乳腺癌 ,12 8例肺癌 ,2 71例胃癌和 6 8例正常对照组。CA5 0 ,CA12 5 ,CA199和CA15 3的批内变异分别为3 7% ,4 8% ,7 6 %和 8 1% ,批间变异分别为 8 1% ,10 1% ,12 3%和 10 4% ,回收率平均介于 95 %～ 10 7%之间。结果 :6 7例肝癌CA5 0 ,CA12 5 ,CA199和CA15 3分别为 40 1± 30 0U/ml,2 8 1± 2 1 2U/ml,11 4± 9 6U/ml和16 2± 8 0U/ml;88例结直肠癌分别为 6 7 8± 45 0U/ml,44 4± 36 1U/ml,6 0 1± 35 8U/m和 2 0 8± 14 8U/ml;48例卵巢癌分别为 40 6± 2 5 1U/ml,180 1± 10 0 2U/ml,15 1± 11 2U/ml和 47 1± 16 4U/ml;36例胰腺癌分别为37 1± 2 2 1U/ml,2 1 8± 14 2U/ml,2 34 2± 6 6 5U/ml和 17 1± 9 1U/ml;34例乳腺癌分别为 10 4± 4 4U/ml,16 4± 9 8U/ml,11 8± 9 8U/ml和 80 1± 36 3U/ml;12 8例肺癌分别为 13 0± 4 6U/ml,10 0 1± 76 4U/ml,12 1±8 8U/ml和 40 3± 18 1U/ml;2 71例胃癌分别为 6 0 6± 40 1U/ml,2 5 7± 18 1U/ml,80 3± 43 2U/ml     

动脉栓塞术治疗子宫肌瘤的临床研究

目的评价子宫动脉栓塞术治疗子宫肌瘤的疗效。方法对32例子宫肌瘤患者采用改良的Seldinger's法经股动脉穿刺,导丝引入4F或5F Cobra引导下至子宫动脉开口,将PVA 250~355um微球、平阳霉素16mg、庆大霉素8万U依次注入。术后拔管并加压包扎,使用盐袋压迫伤口,常规应用3~5d抗生素,预防感染。结果32例患者术后每隔6个月复查1次,观察发现患者子宫及肌瘤体积与治疗前比较不断缩小(P<0.05),治疗后患者月经周期、月经血量及持续时间与治疗前有明显差异(P<0.05)。所有患者均未出现子宫坏死和盆腔感染等严重并发症。结论子宫动脉栓塞术作为一种新的技术用于治疗子宫肌瘤,既能保留子宫,又能缩小肌瘤、明显改善症状,且具有微创、并发症少、住院周期短等优点,值得临床进一步研究。     

子宫动脉栓塞术治疗子宫肌瘤的近期疗效分析

目的:研究子宫动脉栓塞术治疗子宫肌瘤的近期疗效.方法:选择2018年1月至2020年1月我院收治的120例子宫肌瘤患者作为研究对象,随机分为观察组和对照组,每组各60例.观察组予以子宫动脉栓塞术治疗,对照组予以子宫全切除术治疗.比较观察组手术前后子宫体积与瘤体体积,比较两组手术前后血清指标及远期复发率.结果:观察组术后3、6m时子宫体积与瘤体体积均低于术前(P<0.05);术后两组基质金属蛋白酶2(Matrix metalloproteinase 2,MMP-2)、基质金属蛋白酶9(Matrix metalloproteinase 9,MMP-9)水平均低于术前,基质金属蛋白酶抑制剂-2(Matrix metallo-proteinase inhibitor,TIMPS-2)、基质金属蛋白酶抑制剂-9(Matrix metallo-proteinase inhibitor,TIMPS-9)水平均高于术前(P<0.05),两组组间比较无统计学差异;观察组治疗后0.5 y、1 y复发率、2 y复发率明显低于对照组(P<0.05).结论:子宫动脉栓塞术治疗子宫肌瘤具有可靠的近期效果,能有效缩小患者子宫肌瘤体积的同时抑制肌瘤生长发展,对患者卵巢功能影响更小,2 y复发率明显更低,值得推广.     

Uterine sarcomas

A wide variety of sarcomas occur in the uterus but two subtypes - leiomyosarcoma and endometrial stromal sarcoma - account for a majority of those more routinely encountered. Using the 2003 World Health Organization classification, this review focuses on six uterine sarcomas: endometrial stromal sarcoma, undifferentiated endometrial sarcoma, leiomyosarcoma, rhabomyosarcoma, angiosarcoma and liposarcoma. The epidemiological, clinical, pathological and molecular features are presented along with therapeutic approaches. Familiarity with molecular aspects of these tumors and application of novel technologies in their assessment should be encouraged as they may provide alternate therapies resulting in improved survival for the patient. Clinical information necessary for accurate diagnosis of these lesions is emphasised. A multidisciplinary approach to management of patients with uterine sarcomas is essential for optimal management.     

Uterine pseudotumors

Pseudotumoral uterine lesions include benign reactive and artefactual changes, epithelial and mesenchymal, which occasionally are incorrectly interpreted as malignant or even premalignant lesions. Although some of these changes may have architectural or cytological abnormality, they are different from those observed in premalignant and malignant uterine lesions. The most common pseudotumoral lesions of the endometrium include various types of epithelial and stromal metaplasia, pseudolymphomas, inflammatory pseudotumor, adenomyosis, post-therapy surgical changes, artefactual changes, etc. Most of these changes may coexist with endometrial hyperplasia or endometrial carcinoma, and also with some benign conditions such as polyps or in combination with hormonal therapy or even in normal cyclic endometrium. These associated endometrial changes may raise important issues regarding the diagnosis and subsequent therapy.     

Uterine bizarre lipoleiomyoma

A case of uterine bizarre lipoleiomyoma occurring in a 58-year-old woman is described. A subserosal 8.5 cm mass in the posterior wall of the body had a lipoma-llke appearance with strands of fibrous tissue. Histologlcally, the tumor predominantly consisted of adipocytes which varied in size and shape. Some cells had the appearance of signet ring cells, some had hyperchromatlc nuclei, and multivacuo-lated lipoblasts with hyperchromatlc nuclei were observed throughout the lesion. The fibrous areas showed a proliferation of smooth muscle cells with and without atypical nuclei. There was no mltotlc figure. Row cytometric analysis Indicated aneuploldy. The patient was well without disease 10 months after hysterectomy. Patients with this type of tumor need a close and long-term follow-up because of the paucity of clinical information.     

Uterine leiomyoma cytogenetics

Uterine leiomyoma--a benign smooth muscle tumor--has recently been found to contain tumor-specific chromosome aberrations. Although only normal karyotypes were detected in 50 to 80% of cytogenetically investigated tumors, 104 leiomyomas with karyotypic aberrations have already been reported. At least four cytogenetically abnormal subgroups have been identified thus far, characterized by rearrangements of 6p, del(7)(q21.2q31.2), +12, and t(12;14)(q14-15;q23-24). The remaining abnormal tumors have had various nonrecurrent anomalies. Secondary karyotypic rearrangements, sometimes including ring chromosomes, have been found in one-third and reflect clonal evolution. Occasional leiomyomas have contained multiple numerical and structural rearrangements. Though benign, these cytogenetically grossly aberrant tumors often displayed more atypical histological features than are usually seen in leiomyoma. Multiple leiomyomas have been investigated from 69 patients, with detection of chromosome anomalies in at least two separate tumors from the same uterus in ten cases. In half of these patients unrelated aberrations were found in different leiomyomas from the same uterus. On other occasions the aberrations were identical, indicating that although some uterine leiomyomas originate independently, others may develop by intra-myometrial spreading from a common neoplastic clone. Some common features are discernible between the karyotypic pictures of uterine leiomyoma and angioleiomyoma; rearrangements of 6p, 13q, and 21q have been described in both tumor types. The cytogenetic similarities so far detected between leiomyoma and the malignant muscle tumors--leiomyosarcoma and rhabdomyosarcoma--are few and may be fortuitous. The cytogenetic profiles of leiomyoma and lipoma are strikingly similar; both tumor types have nonrandom rearrangements of 12q13-15, t(12;14) in leiomyoma and t(3;12) in lipoma, as well as variant rearrangements of the same 12q segment. Both also have cytogenetic subgroups characterized by changes in 6p and ring chromosomes. Finally, karyotypic similarities exists also between leiomyoma and pleomorphic adenoma of the salivary gland, which includes a subset of tumors with anomalies of 12q13-15, and with myxoid liposarcoma, which has t(12;16)(q13;p11) as a tumor-specific rearrangement.     

Management of Bleeding Uterine Arteriovenous Malformation with Bilateral Uterine Artery Embolization

Purpose

To evaluate the technical feasibility and clinical outcome of bilateral uterine artery embolization (UAE) as a first-line therapeutic option for bleeding uterine arteriovenous malformation (AVM).

Materials and Methods

Between 2002 and 2012, 19 patients were diagnosed with acquired uterine AVM clinically and through imaging studies. The clinical characteristics, angiographic features, technical success rate of embolization, procedure-related complications, imaging, and clinical follow-up data were assessed. Clinical success was defined as immediate symptomatic resolution with disappearance of vascular abnormality on subsequent imaging studies.

Results

A total of 20 bilateral UAE, with or without embolization of extra-uterine feeders, were performed as the first-line treatment. Technical and clinical success rate was 90.0% (18/20) and 89.5% (17/19), respectively. Embolization was incomplete in two patients who had residual extra-uterine fine feeders to the AVM or a procedure-related complication (ruptured uterine artery); the former showed slow regression of the vascular malformation during the observation period, while the latter underwent a successful second bilateral UAE. Immediate clinical success was achieved in the remaining 17 patients after a single session and no recurrence of bleeding was found. Recovery to normal menstrual cycle was seen in all 17 patients with clinical success within one or two months, two of whom subsequently had uneventful intrauterine pregnancies carried to term.

Conclusion

Bilateral UAE is a safe and effective first-line therapeutic option for the management of bleeding uterine AVMs. However, incomplete embolization due to unembolizable feeders or difficult access into the uterine artery may lead to suboptimal treatment.     

Uterine leukocytes and decidualization

The transformation of endometrium into decidua is an essential feature of normal implantation and pregnancy. There is a close association with an unusual leukocyte population, uterine natural killer (NK) cells, and onset of decidualization. These uterine NK cells are seen in close contact with stromal cells ultrastructurally and are also seen encircling vessels and glands. The possibility that uterine NK cells in the late secretory phase and in early decidua may be important in initiating and maintaining decidualization is raised. In contrast, the death of uterine NK cells could be an early event in the onset of endometrial breakdown at menstruation. The period between implantation and menstruation (7-14 days after luteinizing hormone surge) is the time when implantation is known to be particularly vulnerable. In this review, the possibility that uterine leukocytes might influence the critical decision that the mid- to late secretory endometrium must make either to decidualize or to undergo menstruation is explored.