子宫腺肌症206例临床分析

近年来，国内外文献报道子宫腺肌症的发病率有明显上升趋势［１，２］，但其临床漏诊率甚高。本研究回顾性分析２０６例子宫腺肌症的临床病理资料，以提高子宫腺肌症的临床诊断准确率。一、资料与方法收集我院１９９６年３月至１９９７年３月，因各种妇科疾病行子宫切除的...     

子宫腺肌症的发病原因和诊治研究进展

子宫腺肌症的发病原因和诊治研究进展周应芳，麦永嫣，郑淑蓉子宫腺肌症，以往又称内在性子宫内膜异位症。近年来，发现它与外在性子宫内膜异位症有许多不同之处。因此，已将其划分为一种独立的子宫疾病。子宫腺肌症和子宫内膜异位症一样，发病率有升高趋势，现已成为妇科...     

子宫内膜异位症合并子宫腺肌症不孕患者临床手术特点分析

目的:探讨子宫内膜异位症(EM)合并子宫腺肌症(AM)相关不孕患者的临床及手术特点。方法:回顾分析2017年1月至12月于北京协和医院妇产科行手术治疗的不孕患者的临床资料,其中39例同时合并EM和AM不孕患者(研究组),338例EM非AM不孕患者,39例AM非EM不孕患者,419例非AM非EM不孕患者(对照组)。比较研究组和对照组的临床特点及手术情况。结果:39例同时合并AM、EM的不孕患者,占同期内异症不孕手术者的10.34%,占同期腺肌症不孕手术者的50.0%。两组的年龄、孕产次、不孕类型、手术费用和住院费用方面无显著差异;研究组的中位住院时间、平均手术时间和术中出血量均显著高于对照组(P0.05)。研究组内异症IV期患者17例(43.59%),显著高于同期内异症不孕组(P0.01);深部浸润型内异症患者13例(33.3%),高于同期内异症不孕组,但差异尚无统计学意义。局灶型腺肌症与弥漫型腺肌症间内异症各分型无显著差异(P0.05)。结论:EM可协同AM共同影响女性的生育能力,与其他不孕手术相比,疾病程度重、手术难度大等,术前应充分评估。     

子宫内膜肌层功能失调综合征与子宫腺肌症的关系的研究进展

子宫腺肌症(ADM)和子宫内膜异位症(EMs)均以子宫内膜肌层交界区功能异常为特征.磁共振等影像检查为发现子宫内膜肌层交界区提供了有力证据,并对ADM的组织学诊断提供了有效的方法.“子宫内膜肌层功能失调综合征”的提出,对正确理解ADM及EMs的发病机制有很大帮助,并解释了子宫内膜肌层交界区与ADM的密切关系.     

妊娠合并子宫腺肌症2例

病例分析:患者,女,31岁,孕足月要求住院分娩,于2010年8月2日11点30分入院,末次月经2009年10月27日,预产期2010年8月4日,患者停经二月确诊早孕,孕期定期产检,孕7～8月各发作腹痛一次,均行保胎治疗成功,既往有痛经史,曾在北京地坛医院确诊为子宫腺肌症,曾于2003年孕5月自然流产,2004年孕8月死胎,入院时查体T36.7℃,BP100/70mmhg,R20bpm,P80bpm,心肺(-),肝脾(-),产检:腹围92cm,宫高32cm,LOA,胎心132次/分,头先露,高浮,内诊宫口未开,     

子宫腺肌症病灶切除术治疗子宫腺肌症66例临床观察

目的分析探讨子宫腺肌症病灶切除术后患者痛经改善情况以及妊娠情况。方法：选取2004年5月至2013年9月在我院接受子宫腺肌症病灶切除术治疗的患者66例,对其临床资料进行回顾性分析,66例患者有40例患者实行保留生育能力的开腹子宫腺肌症病灶切除术,另26例患者采用腹腔镜子宫腺肌症病灶切除术,分析其治疗效果。结果：66例患者手术均获得成功,实行不同手术方式的患者手术时间无明显差异,不具有统计学意义,但采用腹腔镜子宫腺肌症病灶切除术患者治疗过程中出血量少,有58例痛经患者经治疗后52例患者痛经症状明显改善,42例不孕患者经手术后17例患者妊娠成功。结论：子宫腺肌症病灶切除术对治疗子宫腺肌症效果明显,能够明显改善患者的痛经情况,提高其术后妊娠率,值得在临床推广应用。     

子宫腺肌病的若干问题

<正>子宫内膜异位症(简称内异症)是指子宫内膜腺体和间质出现在子宫腔被覆内膜以外的部位(不包括子宫肌层),生长、浸润、反复出血,继而引发疼痛、不孕及结节或包块等症状的疾病。子宫腺肌病(简称腺肌病)是指子宫肌层内出现子宫内膜腺体和间质,在激素的影响下发生出血、肌纤维结缔组织增生,形成的弥漫性病变或局限性病变,也可局灶形成子宫腺肌瘤病灶。关于腺肌病,存在很多迷惑和问题,有很多模糊和争论。早在4000多年前的希波克拉底时代,     

子宫腺肌病的特殊类型及恶变的诊治

子宫腺肌病(adenomyosis,AM)以痛经、月经量增多、慢性盆腔痛及不孕等为主要临床表现。有囊性子宫腺肌病及子宫腺肌病恶变等少见特殊情况,易导致临床误诊。治疗方法由患者年龄、症状、有无生育要求、病变部位及范围决定,常需要以手术为主的多种治疗方式结合运用,才能达到缓解症状和延缓复发的效果。     

保留子宫手术治疗子宫腺肌病的现状与进展

子宫腺肌病是育龄妇女常见良性疾病,目前子宫腺肌病的根治手段仍然是经腹或经腹腔镜切除子宫。近年来随着磁共振成像(MRI)及经阴道超声(TVU)等医学影像技术的发展和普及应用,大量年轻女性子宫腺肌病被检出,越来越多的年轻育龄患者因为生活质量等多种因素,迫切希望保留子宫的完整性和生育力。因此,各种保留子宫的手术方式如腺肌病病灶切除后再成型子宫、部分腺肌病病灶切除联合子宫动脉阻断等越来越多地应用于临床,综述保留子宫的手术方式的临床应用现状及进展。     

Juvenile cystic adenomyosis mimicking uterine malformation: a case report

Cystic adenomyosis is a rare form of adenomyosis mostly seen in middle aged women. We report a case of cystic adenomyosis in a juvenile patient presenting with severe dysmenorrhea refractory to any given medication. The patient initially was diagnosed as uterus bicornis with an obstructed rudimentary horn. Surgical exploration and excision of the cystic mass relieved the symptoms of the patient.     

Relationship between adenomyosis and uterine polyps

Objective

To evaluate whether adenomyosis is associated with uterine polyps.

Study design

To perform an ethical human study, we planned a large retrospective observational study covering the entire patient population of the ULSS 17-Veneto district who underwent resectoscopy in 2007 and 2008 (959 patients). We enrolled all the patients underwent resectoscopy with resection of uterine polyps, with resection of myomas, with endometrial ablations by slicing, and with endometrial biopsies in both the presence and absence of hysteroscopically visible lesions. The diagnosis of adenomyosis was made by pathological examination of tissue specimens obtained using a resectoscope loop. Multivariate logistic regression was performed to determine if adenomyosis was one of the various risk factors for the presence and number of uterine polyps. Statistical Package for the Social Sciences (SPSS 16.0) was employed, and p ≤ 0.05 was the minimum for significance.

Results

Age (p = 0.005), adenomyosis (p = 0.013), high fasting glucose levels (p = 0.004), and hypertension (p = 0.045) were significantly associated with endometrial polyps. The presence of multiple endometrial polyps seemed to be associated with the presence of adenomyosis (p = 0.016). The presence of cervical polyps was significantly associated only with presence of adenomyosis (p = 0.002). The presence of multiple cervical polyps did not seem to be influenced by any of the variables considered.

Conclusions

The results clearly demonstrate an association between adenomyosis and uterine polyps. The pathogenetic role of adenomyosis in the development of polyps should therefore be investigated further.     

The accuracy of transvaginal ultrasound and uterine artery Doppler in the prediction of adenomyosis

ObjectiveTo measure the accuracy of the ultrasonographic features in predicting adenomyosis and to determine if there is a role for uterine artery Doppler in adenomyosis prediction.Study designA prospective comparative study.SettingCairo University hospital.Materials and methodsThree hundred and fifty-two women who were scheduled for hysterectomy for various indications underwent preoperative transvaginal ultrasound scan (TVS) and uterine artery Doppler velocimetry in an attempt to diagnose adenomyosis. All the results were then correlated with histopathological results after hysterectomy.ResultsForty-eight participants were ultrasonographically diagnosed as having adenomyosis from which 37 patients were histologically confirmed. Both groups were comparable in age, but adenomyosis tend to occur in multiparas. We found that subendometrial linear striations, myometrial cysts’ number and poor endometrial delineation were significantly associated with adenomyosis. Sensitivity, specificity, positive predictive value, negative predictive value and overall accuracy of TVS for diagnosing adenomyosis were: 75.68%, 90.79%, 49.12%, 96.95% and 89.20%, respectively. Heterogenous myometrial echotexture was the most common ultrasonographic feature in adenomyotic cases. Neither uterine artery resistance index nor pulsatility index showed significant association with adenomyosis.ConclusionTVS is a potentially valuable tool in predicting adenomyosis especially when subendometrial linear echogenic striations, myometrial cysts, and poor endometrial delineations were found. However, uterine artery Doppler has no diagnostic values.     

子宫动脉栓塞术治疗子宫腺肌病的中远期临床疗效观察

目的探讨子宫动脉栓塞术(UAE)治疗子宫腺肌病(AM)的中远期疗效。方法对189例AM患者行UAE治疗,术前1个月及术后1、2、3、6、12、18个月及以后每年1次随访观察痛经、月经量的变化。结果(1)随访情况:UAE术后具有完整随访资料者168例,随访率88·9%,平均随访时间(50±15)个月。9例患者因痛经治疗无效或复发等原因而切除子宫。(2)痛经症状的变化:168例患者中,159例术前有痛经症状,UAE治疗后131例(82·4%,131/159)为临床有效,28例(17·6%,28/159)为临床无效,8例(5·0%,8/159)复发。AM合并和未合并子宫肌瘤患者的痛经临床有效率分别为92·9%(39/42)、78·6%(92/117),两者比较,差异无统计学意义(P>0·05);局灶型和弥漫型AM患者的痛经临床有效率分别为82·4%(75/91)、82·4%(56/68),两者比较,差异无统计学意义(P>0·05)。(3)月经量的变化:在168例患者中,93例为月经量过多,UAE术后78例月经量恢复正常,10例出现月经量过少,1例出现暂时性闭经,2例月经量无变化,2例出现月经稀少;74例为月经量正常,术后57例月经量无变化,15例出现月经量过少,2例出现子宫性闭经;1例为月经量过少的患者,术后月经量恢复正常。结论UAE治疗AM具有较好的中远期疗效。     

Ultrasound diagnosis of endometriosis and adenomyosis: State of the art

Transvaginal ultrasonography has become the primary test in the diagnosis of pelvic endometriosis and adenomyosis. A review of the literature on the diagnostic accuracy of ultrasonography in pelvic endometriosis and adenomyosis, as well as a comparison with magnetic resonance imaging, will be presented. Criteria for diagnosis of an endometrioma according to robust prospective data together with guidelines as to adequate reporting of the location of deep infiltrating endometriosis will be given. The sonographic features of adenomyosis including the differential diagnosis between focal adenomyosis and a uterine fibroid are reviewed. The available data in the literature on ultrasound diagnosis of pelvic endometriosis and adenomyosis, their clinical relevance, and their limitations are discussed.     

Ras/Raf/P-C-Raf在子宫腺肌病中的表达及意义

目的:检测Ras/Raf/P-C-Raf在子宫腺肌病在位内膜、异位病灶组织中的表达水平,以及阻断Ras表达后病灶细胞抑制率的变化,探讨Ras/Raf/P-C-Raf在子宫腺肌病中的发病机制。方法:收集子宫腺肌病患者的病灶组织或石蜡切片,Western blot法、免疫组化法检测Ras、Raf及P-C-Raf在子宫腺肌病组织中的表达水平;体外培养子宫腺肌病病灶细胞,CCK-8法检测FTS组(Ras抑制剂)及FTS+E2组细胞生长抑制率。结果:Ras、Raf主要表达定位于胞浆与胞膜。与对照组子宫肌层及内膜相比,子宫腺肌病异位病灶、在位内膜中Ras、Raf表达水平均明显升高(P0.05);子宫腺肌病在位内膜P-C-Raf水平较异位病灶及正常子宫内膜组高(P0.05)。FTS组、FTS+E2组均能抑制子宫腺肌病病灶细胞增殖,其中FTS+E2组的细胞抑制率较FTS组高,差异有统计学意义(P0.05)。结论:通过抑制Ras表达证实子宫腺肌病异位病灶及在位内膜过高表达的Ras/Raf及在位内膜P-C-Raf过表达促进子宫腺肌病病灶细胞增殖,参与子宫腺肌病的发生发展。其中E2促进病灶细胞增殖效应的途径之一可能通过Ras发挥作用。     

促性腺激素释放激素激动剂治疗子宫腺肌病26例疗效观察

目的探讨促性腺激素释放激素激动剂(GnRHa)治疗子宫腺肌病的临床疗效。方法2003年1月至2004年1月广州市第一人民医院对26例子宫腺肌病患者予GnRHa3.6mg皮下注射,每4周1次,同时加用利维爱1.25mg/d口服,两者均连用6个月。治疗前后观察月经量、痛经程度及子宫体积等变化,并进行血癌抗原(CA125)、抗子宫内膜抗体(EMAb)及性激素水平测定。结果治疗后随访6个月,26例患者中20例月经量明显减少;痛经程度分级明显降低,痛经缓解率达100%;子宫体积平均缩小56%;血清CA125、EMAb及性激素水平均显著降低;10例不孕患者中治疗后,妊娠率达50%。结论GnRHa能有效控制子宫腺肌病症状,提高妊娠率,并可诱导围绝经期妇女闭经。     

Minimally invasive treatment of adenomyosis

The aim of the present review is to give a comprehensive overview of minimal invasive treatment options and suggest a minimally invasive approach in women with adenomyosis (AD).A review of relevant literature on medical and surgical treatment options is performed. Surgical options include endometrial ablation, hysteroscopic endometrial and adenomyoma resection, laparoscopic resection of AD, high-intensity focused ultrasonography (HIFU), and uterine artery embolization (UAE).This review summarizes treatment strategies for the management of AD and highlights the present lack of knowledge, which makes suggestions of evidence-based treatment difficult.     

子宫颈癌551例诊治分析

目的：对子宫颈癌５５１例进行诊治分析，以提高子宫颈癌患者的早诊率，使患者早期得到治疗，从而提高患者的生存率和生存质量。方法：由上海市子宫颈癌专题协作组设计表格，由经过培训的专职妇科医师调查填表。将１９９１年新发病例与年龄范围上下相差２岁的同期、同地区妇女按１∶２的比例设对照组进行流行病学调查。结果：子宫颈癌５５１例平均发病年龄６４．７岁，＞５０岁５２４例、占９５．１％。多因素分析表明，经济条件差、丈夫吸烟有显著意义（Ｐ＜０．０５）。子宫颈癌Ⅰ期６２例、仅占１１．３％，＞Ⅱ期４８９例、占８８．７％。宫颈鳞癌４４８例、占８１．３％，腺癌５５例、占１０％，其它癌４８例、占８．７％，根据分析结果实施综合性防治措施，上海市普查中子宫颈癌的诊断率从４．３％提高到１９％，早诊率从１０．６％上升到２８．６％。结论：采取综合措施可提高子宫颈癌早诊率，执行《中国常见恶性肿瘤治疗规范》可提高子宫颈癌患者的生存率和生存质量。