广泛性子宫颈切除术后子宫载荷对子宫韧带和阴道影响的有限元仿真

目的 应用有限元法分析广泛性子宫颈切除术后不同子宫载荷(腹压和子宫重量)时子宫阔、圆韧带和阴道的应力分布和变形情况,获得子宫韧带和阴道对子宫载荷变化的敏感度。方法 建立后位子宫、韧带和阴道三维几何模型并导入ABAQUS软件,然后设置约束、施加载荷,计算各部位的应力和变形。结果 广泛性子宫颈切除术后阔、圆韧带的应力和位移均有不同程度增大;阔、圆韧带和阴道的应力和变形均随子宫载荷的增大而增大,阔韧带的变形和应力主要分布于中下部(腹压变化)或中上部(子宫重量变化),圆韧带的应力与变形主要分布于中下部,阴道的应力与变形主要分布于中上部;腹压与子宫重量单独变化或同时变化时,阴道所受应力及对载荷变化的敏感度最大,阔韧带变形及对载荷变化的敏感度最大,总的应力和变形排序因载荷情况不同而略有差异,并且子宫重量比腹压对韧带和阴道的影响程度显著。结论 研究结果与临床资料相符,可为临床手术方案优化和发病机制探索提供指导。     

子宫变异1例报道

子宫是孕育胎儿和产生月经的中空性肌性器官,呈上宽下窄、前后略扁的倒置梨形.子宫一般位于小骨盆中央,前面紧邻膀胱,后面紧贴直肠,呈前倾前屈位.子宫有四类韧带,分别是起于子宫两侧的子宫阔韧带,连于子宫角下部的子宫圆韧带,连于子宫颈的子宫主韧带和骶子宫韧带,以上韧带均对子宫的位置具有固定作用.先天性子宫畸形是由于在胚胎发育时...     

女性盆底子宫骶主韧带MRI的观察研究

目的通过MRI不同序列对健康女性盆底扫描,比较两种扫描序列对子宫骶主韧带的显示图像特点和清晰度,选择优化MRI扫描序列进一步三维建模研究女性盆底功能障碍。方法选择无盆底功能障碍性疾病的健康女性10例,分别采用质子密度加权自旋回波序列和TSE T2WI序列行盆底薄层MR成像,获得连续薄层断面的图像集,在横断面分别观察骶主韧带起源及终止点,观察每层的显示情况,辨认盆底器官与子宫骶主韧带解剖位置及与周围器官的关系,通过同一检查者相同的每一层辨认评分,比较两种扫描序列对子宫骶主韧带的显示图像辨认率和清晰度。结果质子密度加权自旋回波序列对子宫骶主韧带的显示优于TSE T2WI,有显著性差异（P〈0.05）,能更清楚地显示骶主韧带边界。10例检查者中骶韧带起自骶骨2例（20%）、尾骨肌/骶棘韧带复合体6例（60%）、坐骨棘2例（20%）;插入宫颈3例（30%）、阴道1例（10%）、宫颈和阴道6例（60%）;主韧带起自同侧骨盆侧壁坐骨大孔,解剖末端7例（70%）至宫颈,1例（10%）至阴道,2例（20%）至宫颈和阴道。结论采用MRI质子密度加权自旋回波脉冲序列对女性盆底成像,可清楚显示盆底器官与子宫骶主韧带解剖位置及与周围器官关系,活体骶主韧带解剖起止点、走行方向,与临床解剖对子宫骶主韧带观察一致,为探讨子宫脱垂患者的骶主韧带解剖改变与功能障碍关系奠定了研究基础。     

子宫骶韧带的应用解剖

目的:为临床开展子宫骶韧带悬吊术治疗子宫脱垂及阴道膨出提供解剖学基础资料。方法:取正常成年女性防腐标本15具,其中10具半侧盆腔标本,观测子宫骶韧带及相邻结构解剖形态。结果:子宫骶韧带大部分与第1~3骶椎相连,与第4骶椎多不相连;子宫骶韧带分颈部、中间部、骶骨部,其分别距离输尿管的长度为(0.8±0.5)cm、(2.4±0.8)cm、(4.0±0.7)cm;输尿管盆部分3段,其长度分别为:壁内段(4.6±0.9)cm,子宫主韧带内段(1.7±0.5)cm,膀胱后间隙内段(2.4±0.6)cm。输尿管膀胱后间隙内段距离坐骨棘的长度为(4.8±2.0)cm。结论:子宫骶韧带及相邻结构的解剖形态对临床开展子宫骶韧带悬吊术治疗子宫脱垂及阴道膨出有重要的指导意义。     

与子宫颈癌手术有关部位的盆丛神经分布定性定量研究

取２４例（４８侧）子宫切除手术病人的近子宫端骶子宫韧带和子宫主韧带及子宫颈癌根治术１６例（３２侧）远子宫侧的骶子宫韧带和子宫主韧带材料。应用组织化学方法、图像分析法测得在骶子宫韧带后部深层和子宫主韧带外侧部（远子宫侧）含副交感神经丰富，密度比值（面积％）最高，分别为７４％和６７．７％。提示：在子宫颈癌根治术时为预防尿潴留的发生需对上述二部位的盆丛神经分支进行保留和分离。     

子宫圆韧带的形态学基础与临床应用进展

<正>子宫圆韧带是由子宫和输卵管相连的部位即子宫角发出的窄而略扁的束状带,它从子宫旁横过阔韧带由内向前外跨过髂外血管,沿盆腔侧壁经内环出腹部,与圆韧带动脉、腹股沟神经伴行穿腹股沟管终止于大阴唇,维持子宫前倾姿势。经典教材对子宫圆韧带的描述和记载并不详尽,国内外学术界对该结构及其应用进行了探索。随着腹腔镜、磁共振成像等技术的出现和发展,对子宫圆韧带系统全面的描述显得尤为重要,现就国内外相关研究文献进行综述。     

腹腔镜下子宫动脉阻断术联合病灶切除术以及宫骶韧带切断治疗子宫腺肌病35例临床研究

目的：探讨腹腔镜下子宫动脉阻断术联合病灶切除术以及宫骶韧带切断术治疗子宫腺肌病的临床疗效。方法对35例患者行腹腔镜下子宫动脉阻断术联合病灶切除术以及宫骶韧带切断术治疗。结果术后疼痛评分、分级均明显降低(P<0.05)，痛经、经量，血红蛋白水平，子宫体积缩小情况均得以改善；而手术前后月经周期及经期无统计学差异。结论腹腔镜下子宫动脉阻断术联合病灶切除术以及宫骶韧带切断术是一种易被患者接受的、有效、安全的治疗子宫腺肌病的新方法。     

筋膜内子宫全切除术的护理

子宫及子宫颈良性疾病是筋膜内子宫全切除术的手术指征。它兼有子宫次全切除术及子宫全切除术的两种优点:即不切断主韧带和骶韧带,防止术后阴道壁脱垂;另外,手术范围小,术后并发症少;同时切除宫颈,有效防止宫颈癌的发生;且阴道不缩短,对性生活无影响,副损伤小。我院从1998年3月至10月共收治子宫肌瘤及卵巢良性肿瘤病人行筋膜内子宫全切除术32例,未发生一例护理并发症,现将护理体会介绍如下。     

子宫骶韧带-阴道悬吊预防子宫切除术后盆底功能障碍性疾病的价值探讨

目的比较仅行腹腔镜子宫切除术患者与同时行腹腔镜子宫切除术及骶韧带-阴道悬吊术患者的术后发生盆底功能障碍(PFD)的状况,以探讨骶韧带-阴道悬吊术预防子宫切除术后PFD的价值。方法选择2017年7月至2018年2月在我院因子宫良性疾病行腹腔镜全子宫切除术的83例患者,根据有无同时行子宫骶韧带-阴道悬吊手术分为对照组41例及悬吊组42例,术后随访9~14个月,应用专科检查、妇科超声、问卷调查方法评估比较两组患者术后发生PFD的情况。结果与对照组相比,悬吊组术后发生下尿路症状(尿频、尿急、压力性尿失禁)的几率均明显下降,差异均有统计学意义(P<0.01),两组患者在术后便秘、阴道脱垂以及首次性生活时间方面的比较差异均无统计学意义(P>0.05)。结论腹腔镜全子宫切除术同时施行子宫骶韧带-阴道悬吊术可以有效减少子宫切除术后PFD尤其下尿路症状的发生。     

经阴道广泛性子宫切除术中自宫颈支持韧带的应用解剖

目的为经阴道广泛性子宫切除术提供应用解剖学基础。方法经阴道逆行解剖观测8例(16侧)常规防腐女性盆腔尸体标本。结果 (1)膀胱宫颈韧带位于膀胱、子宫颈和阴道之间,可分为宫颈部(2.10±0.85)cm、阴道部(1.70±0.61)cm;膀胱宫颈韧带长度为(4.10±1.05)cm,输尿管膝部距离子宫动脉跨越处(2.14±0.40)cm。(2)输尿管穿过子宫主韧带,距子宫颈(1.71±0.22)cm,其上方有子宫动脉和静脉。(3)子宫骶韧带的颈部、中间部、骶骨部距离输尿管的长度为(0.82±0.50)cm、(2.42±0.81)cm和(4.00±0.71)cm。结论经阴道广泛性子宫切除术中对起自宫颈的三对韧带的应用解剖了解非常重要,可避免损伤输尿管和子宫动脉等重要结构。     

Uterine position at real embryo transfer compared with mock embryo transfer

BACKGROUND: The purpose of this study was to determine the consistency in the uterine position between mock and real embryo transfer. METHODS: We reviewed 996 consecutive embryo transfer cycles (585 patients); 74% of patients had an anteverted (AV) uterus and 26% had a retroverted (RV) uterus at mock embryo transfer. All mock and real embryo transfers were performed under abdominal ultrasound guidance. RESULTS: Of 623 fresh embryo transfers in patients with an AV uterus at mock embryo transfer, only 2% became RV, while 55% of 213 embryo transfers in patients with an RV uterus on mock embryo transfer converted to AV at real embryo transfer (P < 0.0001). For frozen-thawed embryo transfer, 12% of AV uteri at mock embryo transfer became RV, while 33% of RV uteri became AV (P = 0.01). CONCLUSIONS: Our data suggest that an RV uterus at mock embryo transfer will often change position at real embryo transfer. Misdirecting the embryo transfer catheter can be avoided by accurate knowledge of the uterine position at the time of embryo transfer, which can be more accurately assessed by routine ultrasound guidance. Additionally, patients with an RV uterus at mock embryo transfer should still present with a full bladder for embryo transfer, since a significant number will convert to an AV position.     

Sacrospinous and sacrotuberous ligaments influence in pelvis kinematics

The alteration in mechanical properties of posterior pelvis ligaments may cause a biased pelvis deformation which, in turn, may contribute to hip and spine instability and malfunction. Here, the effect of different mechanical properties of ligaments on lumbopelvic deformation is analyzed via the finite element method. First, the improved finite element model was validated using experimental data from previous studies and then used to calculate the sensitivity of lumbopelvic deformation to changes in ligament mechanical properties, load magnitude, and unilateral ligament resection. The deformation of the lumbopelvic complex relative to a given load was predominant in the medial plane. The effect of unilateral resection on deformation appeared to be counterintuitive, suggesting that ligaments have the ability to redistribute load and that they play an important role in the mechanics of the lumbopelvic complex.     

Uterine contractility in response to different prostaglandins: results from extracorporeally perfused non-pregnant swine uteri

BACKGROUND: Prostaglandins (PGs) are important stimulators of uterine contractility. Limited data are available at present on the effects of different PGs on uterine contractility, measured using intraluminal pressure changes in the complete uterus. The goal of this study was to assess dynamic changes in uterine contractility and peristalsis in response to PGs in comparison with the effects of oxytocin administration. METHODS: An extracorporeal perfusion model of swine uteri was used, which keeps the uterus in a functional condition, and is appropriate for the study of physiological questions. Oxytocin- and PG-induced uterine contractility and peristalsis were assessed using an intrauterine double-chip microcatheter. RESULTS: A dose-dependent increase in intrauterine pressure (IUP) in the isthmus uteri (P < 0.001) and the corpus uteri (P < 0.001) was observed after the administration of PGF(2alpha) and oxytocin, which reached a plateau after further stimulation. A dose-dependent increase in IUP in the isthmus uteri (P < 0.001) and the corpus uteri (P < 0.001) was also observed after the administration of PGE(1) and PGE(2), with a plateau in IUP in the middle-concentration range and a decrease in the course of further stimulation. PGE(2) caused significantly more contractions starting in the corpus uteri and moving to the isthmus uteri (P = 0.008). The direction of most contractions caused by PGE(1), PGE(2) and oxytocin differed from that of PGF(2alpha). CONCLUSIONS: This study demonstrates that the PGs tested modulate contractility in non-pregnant swine uteri in a characteristic way, resulting in different contractility patterns.     

输卵管的淋巴流向

用多色淋巴管间接注射方法，对３２例６４侧女性新生儿及婴儿输卵管的淋巴向及输卵管和卵巢淋巴管间的联系进行了观察。     

Skin Graft Survival in the Uterine Lumen of Ewes Treated With Progesterone

ABSTRACT: An experiment was conducted to determine the effect of progesterone on survival of skin transplants placed in the uterine lumen of ovariectomized ewes. Animals were treated for 30 days with either a corn oil vehicle (n = 4) or progesterone at 50 (n = 3) or 200 mg/day (n = 3). An autograft and allograft were then placed in each uterus, and treatments were continued for an additional 30 days before grafts were examined for survival. All autografts were present 30 days after grafting and most appeared healthy upon histological examination. Allografts placed into the uterine lumen of progesterone-treated ewes were present 30 days after grafting but were necrotic in histological appearance. Allografts placed within the uterus of corn oil-treated ewes were completely resorbed. Uterine secretions that accumulated in the uterine lumen were examined for inhibitory effects on [³H-methyl]thymidine incorporation by lymphocytes stimulated with phytohemagglutinin (PHA). The total amount of immunosuppressive activity in the uterine lumen was greater (P< 0.05) for progesterone-treated ewes than for corn oil-treated ewes. Concentrations of progesterone in uterine secretions of progesterone-treated ewes ranged from 0.3 to 3.4 ng/ml. Thymidine incorporation into PHA-stimulated lymphocytes was not affected by in vitro treatment with up to 500 ng/ml of progesterone. In conclusion, progesterone delayed resorption of skin allografts placed in the uterine lumen. Results are consistent with the hypothesis that progesterone mediated this effect by stimulating the secretion of immunosuppressive substances into the uterine lumen.     

Opsonization of Bacteria by Uterine Secretions of Cyclic Mares

ABSTRACT: Uterine flushings collected from mares before and after bacterial-induced inflammation were assayed for ability to opsonize Streptococcus zooepidemicus for phagocytosis by polymorphonuclear leukocytes. Opsonization was measured as the peak phagocytic rate of bacteria preincubated with uterine flushings relative to the peak phagocytic rate of unopsonized bacteria. Flushings from four mares with non-infected uteri were unable to opsonize bacteria regardless of whether uteri were flushed at estrus or on day 10 postovulation. In a second experiment, 7 × 10⁹live S. zooepidemicus were inoculated into the uterus of five mares during estrus. Uterine flushings collected at the estrus before inoculation or at the estrus after inoculation did not opsonize bacteria. Four of five flushings collected 6 hr post inoculation, however, were capable of opsonization. Based on heat inactivation at 56°C, the opsonizing activity of one of four flushes was due to a complement protein. It was concluded that one aspect of the acute inflammatory response of the mare's uterus is accumulation of opsonins in the uterine lumen.     

Uterine rupture following hysteroscopic lysis of synechiae due to tuberculosis and uterine perforation

A patient with genital tuberculosis who conceived with in-vitrofertilization and embryo transfer following hysteroscopic synechiolysiscomplicated by a fundal uterine perforation subsequently presentedwith uterine rupture at 36 weeks gestation. Immediate Caesareansection and repair of the ruptured uterus were performed. Womenwith a history of uterine perforation should be counselled regardingthe risk of uterine rupture during their subsequent pregnancies.     

Uterine dehiscence in a nullipara,diagnosed by MRI,following use of unipolar electrocautery during laparoscopic myomectomy: Case report

Uterine scar dehiscence following laparoscopic myomectomy (LM) is a rare event. We present a case of an magnetic resonance imaging-diagnosed uterine dehiscence in a primigravid patient at 29 weeks gestation, following a laparoscopic subserosal myomectomy, performed using unipolar electrocoagulation. Pregnant patients with a history of prior surgery where unipolar electrocoagulation is used on the uterus should be closely followed throughout pregnancy and uterine dehiscence or rupture should be part of the differential diagnosis when they present with abdominal pain.     

Isoflavone Genistein Induces Fluid Secretion and Morphological Changes in the Uteri of Post-Pubertal Rats

A reported increase in the incidence of infertility following high genistein intake could be related to alteration in the normal fluid volume and morphology of the uterus in adult female. In view of this, we investigated the effect of this compound on fluid secretion, fluid volume and morphology of the uterus in post-pubertal rats. Methods: Ovariectomised SD rats were treated with 17-β oestradiol (E) (0.8 X 10^-4 mg/kg/day) and genistein (0.5, 5, 10, 25, 50 and 100 mg/kg/day) for three days. Following drug treatment, in-vivo uterine perfusion was performed and the rate of fluid secretion and the volume of fluid in the uterus were determined via changes in weight (μl/min) and F-dextran concentration of the perfusate respectively. The animals were then sacrificed and the uteri were removed for weight determination, morphological analyses and proliferative cell nuclear antigen (PCNA) expression analyses by Western blotting. Results: Subcutaneous genistein treatment resulted in a dose-dependent increase in fluid secretion rate, fluid volume and uterine wet weight. Treatment with 100 mg/kg/day genistein resulted in a remarkable increase in the rate of uterine fluid secretion, the volume of the uterine luminal fluid as well as the circumference of the uterine and uterine glandular lumen suggesting an excessive fluid accumulation. Meanwhile, there were evidence of glandular hyperplasia and an increase in the expression of PCNA following treatment with 50 and 100 mg/kg/day genistein. Conclusion: High genistein intake could potentially cause adverse effects on the uterus by inducing excessive fluid secretion and accumulation as well as hyperplasia.