盆腔子宫内膜异位症发病因素的调查

采用病例－对照研究，调查１９９１年３月至１９９３年２月我院子宫内膜异位症１９０（异位症组）和非子宫内膜异位症１９２例（对照组），进行单因素分析。结果：和子宫内膜异位症有关的因素有月经过多（ＯＲ＝３．０９）、月经周期＜２７天（ＯＲ＝１．８９）、合并子宫肌瘤或子宫腺肌症（ＯＲ＝１．８４）、干部职业（ＯＲ＝１．７１）。     

卵巢癌腹腔化疗应用导管的并发症分析

我院自１９７６年５月至１９９１年８月对１１５例卵巢癌患者放置直径０．２ｃｍ、长５０．０ｃｍ腹腔导管１９１根，化疗６０８次，其中用塑料导管２９例（塑料导管组），导管２９根，平均保留１８．４天；用硅胶导管８６例（硅胶导管组），导管１６２根，平均保留１０９．０天。两组共有并发症患者２９例（２４．５％），其中感染５例（４．３％），不全肠梗阻２例（１．７％），疼痛４例（３．５％），导管堵塞１２例（１０．４％），导管脱出６例（５．２％）。比较两组并发症的发生率，差异无显著性（Ｐ＞０．０５）；比较两组的导管保留时间，差异有极显著性（Ｐ＜０．００１）。提示：塑料导管及硅胶导管在卵巢癌腹腔化疗中有临床实用价值，而后者似更佳。     

澳门地区部分新生儿先天性畸形发病情况分析

对１９９３年１月至１９９６年１２月出生的７７４２例新生儿中先天性畸形发病情况及其影响因素进行回顾分析。结果显示：本组畸形发生率为１２．２７‰，先天性心脏病居首位，占４４．２％。男女发生率无明显差异（Ｐ＞０．２）；≥３５岁产妇新生儿畸形发生率明显高于＜３５岁者（Ｐ＜０．００１）；早产、过期产儿畸形发生率均显著高于足月产儿（Ｐ＜０．００１）；本组孕妇ＨＢｓＡｇ阳性率为９．３％，与畸形发生无明显关系（Ｐ＞０．２）。本组畸形儿死亡２０例，占同期围产儿死亡的３１．３％（２０／６４）。应加强优生宣教，减少高龄生产及多产；加强孕中期畸形筛查，以减少畸形儿的出生，降低围产儿死亡率     

吲哚美辛缓释片治疗痛经临床观察

随机选择成都市正常育龄期痛经患者６４例，１９－４８岁，平均２７．６±７．５岁，月经周期正常；痛经史１～１６年，平均６．±３．９年；无子宫内膜异位症，盆腔感染等妇科慢性病变。未婚３１例（４８．４％），已婚３３例（５１．６％）；未生育４５例（７０．３％），已生育１９例（２６．７％）。在无生理疾病及精神刺激条件下观察２个月经周期，第１次不予任何干预，作为空白对照，第２次在痛经前１天给予吲哚美辛缓释片－久保新（四川欧生制药有限公司产），测定２次月经期疼痛分数，疼痛持续时间，伴随症状。服药期间禁口服避孕药…     

促黄体激素释放激素激动剂的临床应用及对骨代谢的影响

应用促黄体激素释放激素激动剂（ＬＨＲＨ－Ａ）２００μｇ，每日肌内注射，连续３个月为１疗程，治疗轻、中型子宫内膜异位症、子宫肌瘤、子宫腺肌症共２０例。结果：用药结束时，促卵泡成熟激素（ＦＳＨ）、黄体生成素（ＬＨ）、雌二醇（Ｅ＿２）均受抑制，分别为４．８±２．９ＩＵ／Ｌ（Ｐ＞０．０５）、４．０±３．５ＩＵ／（Ｐ＜０．０５）、１６０．３±１１０．７ｐｍｏｌ／Ｌ（Ｐ＜０．００１）。临床上体征改善，痛经消失，副反应轻，易为病人接受。２０例用药前后骨钙素（ｏｓｔｅｏｃａｌｃｉｎ）与尿钙、磷测定比较，差异均无显著性（Ｐ＞０．０５）。双能Ｘ线吸收法（ＤＥＸＡ）测量腰椎２～４骨密度，用药３个月下降２％，停药３个月下降１％，尚属正常范围（Ｐ＞０．０５）；单光子吸收法（ＳＰＡ）测量桡、尺骨骨密度也未见影响（Ｐ＞０．０５）。     

人乳头状瘤病毒感染与子宫颈癌发病关系的探讨

应用多重引物人乳头状瘤病毒（ＨＰＶ）６Ｂ／１１、１６、１８　型聚合酶链反应（ＰＣＲ）技术检测９９例不同宫颈病变宫颈组织中人乳头状瘤病毒ＤＮＡ（ＨＰＶＤＮＡ）。其中宫颈湿疣２０例，宫颈上皮内瘤变（ＣＩＮ）１～２级（ＣＩＮ＿（１～２））１８例，ＣＩＮ３级（ＣＩＮ＿３）２０例，宫颈癌２３例和正常对照１８例。结果：上述宫颈组织中ＨＰＶＤＮＡ总检出率分别为８５．０％，８３．３％，８０．０％，８７．０％和２７．８％。宫颈各病变组中ＨＰＶＤＮＡ的检出率均显著高于对照组（Ｐ＜０．０１）。宫颈湿疣及ＣＩＮ＿（１～２）中ＨＰＶ６Ｂ／１１型检出率分别为８５．０％和７２．３％，ＣＩＮ＿３和宫颈癌中ＨＰＶ６和（或）１８型阳性率分别为５０．０％和７３．９％，两者ＨＰＶ型别分布差异有显著意义（Ｐ＜０．０１）。３例腺癌中ＨＰＶ１８型阳性２例，１６型阳性１例。低分化宫颈癌中均为ＨＰＶ１６和（或）１８型感染。提示：宫颈癌及其癌前病变的发生与ＨＰＶ感染高度相关。宫颈湿疣和ＣＩＮ＿（１～２）常与ＨＰＶ６Ｂ／１１型感染有关；ＣＩＮ＿３和宫颈癌的发生则与ＨＰＶ１６、１８型关系密切。     

盆腔子宫内膜异位症术后应用不同剂量米非司酮治疗的疗效观察

目的 探讨服用不同利量米非司酮治疗盆腔子宫内膜异位症术后患者的临床疗效，并观察其对内分泌功能的影响、方法 2003-01—2005-09上海市长宁区妇幼保健院选择进行保守性手术后盆腔子宫内膜异位症患者100例，随机分为3组：观察1组40例，服用米非司酮6．25mg／d；观察2组40例，服用米非司酮12．5mg/d，两组均于手术后第一次月经来潮5d内开始用药，疗程6个月：对照组20例患者，不用药物巩固治疗，定期随访。比较应用不同剂量米非司酮治疗子宫内膜异位症的疗效、副反应情况及对内分泌功能的影响。结果 3组病人痛经症状均得到不同程度缓解，观察1组和观察2组完全缓解率分别为85．0％和87．5％，明显高于对照组的55．0％，差异有统计学意义（P〈0．05）；观察1组和观察2组累积复发率分别为7．5％和5．0％，显著低于对照组的20．0％（P〈0．05）。观察1组和观察2组骨质密度均无明显变化．观察1组恶心症状发生率（32．5％）明显低于观察2组（62．5％）。观察1组血清性激素水平均无明显变化，但观察2组服用米非司酮后血清孕酮水平明显降低（P〈0．05）.结论 米非司酮用于盆腔子宫内膜异位症手术后巩固治疗．安全、有效，而且副反应小，对内分泌功能影响小.     

体外受精-胚胎移植后妊娠妇女的产科结局

目的 探讨体外受精－胚胎移植（ｉｎ ｖｉｔｒｏ ｆｅｒｔｉｌｉｚａｔｉｏｎ ａｎｄ ｅｍｂｒｙｏ ｔｒａｎｓｆｅｒ，ＩＶＦ－ＥＴ）后妊娠妇女的产科结局。方法 采用回顾性分析方法，对ＩＶＦ－ＥＴ后妊娠妇女１２８例（观察组）与１１３７２例自然妊娠妇女（对照组）的产科结局进行比较。结果 观察组早产发生率为２０．３％（２６／１２８），多胎发生率为２０．３％（２６／１２８），剖宫产率为８８．３％（１１３／１     

晚期卵巢上皮性癌的预后变化及影响因素分析

目的：了解近２０余年晚期卵巢上皮性癌的预后有无改善，及影响预后的因素。方法：对１９７０年至１９９３年在我院住院治疗的１４０例晚期卵巢上皮性癌病例进行分析，按患者的初治时间分为两组，１９８０年１月以前的５６例为第１组，之后的８４例为第２组，计算两组的Ｋａｐｌａｎ－Ｍｅｉｅｒ生存率曲线，用ＳＰＳＳ及ＳＵＲＶＣＡＬＣ统计软件对资料进行单因素及ＣＯＸ逐步回归分析，确定影响患者预后的因素。结果：两组的病理资料无差异，但第２组得到了更积极的化疗。总的１年、２年及５年生存率分别为６１．２％、３２．１％和８．５％，第１组分别为４２．３％、２９．６％和４．５％，第２组分别为６９．３％、３６．２％和１１．２％，第２组预后好于第１组（Ｐ＜０．０５）。临床分期晚、分化差、残余瘤直径＞２ｃｍ者预后差。联合化疗≥４个疗程者预后改善，≥６个疗程者又较≥４个疗程者预后好。结论：晚期卵巢上皮性癌的预后近１０余年来有所改善，提高肿瘤细胞减灭术的彻底性及行至少６个疗程的联合化疗是改善预后的重要措施。     

子宫内膜异位症致不孕的机理探讨－血清中肿瘤坏死因子、白细胞介素Ⅱ、抗心磷脂抗体的检测

检测２４例子宫内膜异位症（ＥＭ）及１１例非子宫内膜异位症（ＮＥＭ）患者血清中的肿瘤坏死因子（ＴＮＦ）、白细胞介素Ⅱ（ＩＬ－２）及抗心磷脂抗体（ＡＣＡ）。结果：（１）３５例样本除ＥＭ组一例ＴＮＦ呈明显升高，其余均低于正常值（２μｇ／ｍｌ）；（２）ＥＭ组患者血清中ＩＬ－２的平均浓度为３１．１４６±２．２５１μｇ／ｍｌ，而ＮＥＭ组为８．２１７±３．８４４μｇ／ｍｌ，两者有显著性差异（Ｐ＜０．０１）；（３）ＥＭ组患者血清中ＡＣＡ阳性率为１６．６７％，ＮＥＭ组为２７．２７％。两者无显著性差异（Ｐ＞０．０５）。结论：ＥＭ患者血清胚胎毒性作用可能与ＩＬ－２有关，ＡＣＡ可能是非特异性的，而ＴＮＦ则无明显相关性。     

Relation between pain symptoms and the anatomic location of deep infiltrating endometriosis

OBJECTIVE: To investigate whether specific types of pelvic pain are correlated with the anatomic locations of deeply infiltrating endometriosis (DIE). DESIGN: Retrospective data analysis. SETTING: University tertiary referral center. PATIENT(S): Two hundred and twenty-five women with pelvic pain symptoms and DIE. INTERVENTION(S): During surgery, we recorded the anatomic locations of DIE implants and associated endometriosis. MAIN OUTCOME MEASURE(S): We studied the incidence of pelvic pain symptoms including severe dysmenorrhea, deep dyspareunia, noncyclic chronic pelvic pain, painful defecation during menstruation, urinary tract symptoms, and gastrointestinal symptoms as related to the location of DIE. RESULT(S): The frequency of severe dysmenorrhea increased with Douglas pouch adhesions and decreased with parity. The frequency of dyspareunia increased with a uterosacral ligament DIE location and decreased when it involved the bladder. The frequency of noncyclic chronic pelvic pain was higher when it involved the bowel and was lower for women who were treated for infertility. The frequency of painful defecation during menstruation was higher when DIE involved the vagina; lower urinary tract symptoms were more frequent when DIE involved the bladder and less frequent in women with a lower body mass index. Gastrointestinal symptoms were associated with bowel or vaginal DIE locations. CONCLUSION(S): The types of pelvic pain are related to the anatomic location of DIE. Knowledge of the characteristics of pelvic pain symptoms is important in the preoperative assessment of patients with suspected DIE.     

深部浸润型子宫内膜异位症的药物治疗

摘要:深部浸润型子宫内膜异位症 (DIE)是指病灶浸润深度≥5mm,可导致痛经、慢性盆腔痛及性交痛等症状。手术是主要的治疗方法,但手术治疗并发症发生率高。药物治疗是重要的辅助治疗措施,可以缓解患者的疼痛症状。术后药物治疗可以延长复发时间。     

子宫内膜异位症非手术诊断方法探讨

目的:评价子宫内膜异位症常见临床指标用于非手术诊断的价值。方法:因痛经、不育或盆腔包块住院行腹腔镜手术的育龄患者331例,术前纪录患者年龄、病程、初潮年龄、月经周期、月经期天数、结婚年龄或第一次性交年龄、孕产次、剖宫产史、继发性痛经、慢性盆腔疼痛、性交痛以及不育,阳性体征(宫骶韧带触痛结节、子宫直肠窝触痛结节或附件包块,具有三者之一者即为阳性),超声波检查(包块内部为无回声区并有散在或密集的光点为阳性),血清CA125值。计算各项临床指标单独及联合应用包括平行试验?系列试验诊断内异症的敏感性?特异性?阳性预测率及阴性预测率,并用Logistic回归方法计算诊断卵巢型及腹膜型内异症的公式。结果:单独应用各项临床指标诊断内异症的敏感性较低。超声波?血清CA125以及性交痛对内异症的预测率达90%以上,其他临床指标预测内异症的准确性较差。临床各项指标联合平行试验可明显提高诊断的敏感性(89%),各项指标联合系列试验则可明显提高诊断的特异性。任何3项临床指标联合,诊断内异症的预测率基本达到100%。卵巢型内异症的诊断公式为:1/[1+e-(-2.270+1.304*盆腔痛性结节+1.158*继发痛经+2.168*B超囊内光点+2.580*CA125异常)],腹膜型内异症的诊断公式为:1/[1+e-(-1.631+1.788*盆腔痛性结节+0.789*继发痛经+2.384*CA125异常)]。以结果>0.5为异常,此公式诊断卵巢型及腹膜型内异症的准确性分别为85.9%和84.5%。结论:疼痛症状、不育、盆腔体征、超声波以及血清CA125联合应用是内异症较准确的非手术诊断方法。     

Evaluation of the correlation between endometriosis extent, age of the patients and associated symptomatology.

Two-hundred-and-six patients newly diagnosed to have endometriosis at laparoscopy were evaluated in order to see if endometriosis-associated symptoms are proportional to the extent of the disease, as assessed using the Revised American Fertility Society Classification, and if the extent worsens with age. At hospital admission 81% of the patients complained of dysmenorrhea, 54% of chronic pelvic pain and 27% of dyspareunia. At laparoscopy, 39% of the patients had stage I endometriosis, 13% stage II, 35% stage III and 13% stage IV. At statistical analysis, no significant differences were found in total endometriosis scores, in active scores or in adhesion scores in different age groups. Although a difference in prevalence rate for dysmenorrhea and dyspareunia stage I versus III was found, a trend of increasing severity of symptoms with more widespread disease was not evident. There was not a significant difference in prevalence rate of symptoms for different aspects of endometriosis (implants, cysts or adhesions). Our data show that the American Fertility Society classification does not reflect the intensity of endometriosis-associated symptoms, probably underestimating the most active forms of this disease, and does not allow to follow a possible natural progression of the disease.     

深部浸润型子宫内膜异位症对患者生存质量的影响

摘要：深部浸润型子宫内膜异位症（DIE）为一种特殊类型的子宫内膜异位症,可导致痛经、慢性盆腔痛、性交痛及排便痛等症状。由于疾病本身及其治疗过程,给患者的生理、心理和社会功能造成严重的影响。改善症状、提高患者生存质量是DIE现阶段的治疗目的。该文主要从DIE对患者的生存质量、性生活和排便功能的影响几个方面进行探讨。     

子宫内膜异位症患者疼痛与盆腔病灶解剖分布的关系

目的研究子宫内膜异位症（内异症）患者疼痛症状与盆腔病灶解剖分布特点的关系。方法详细记录130例内异症患者痛经、慢性盆腔痛（CPP）、性交痛及排便痛的发生情况。以腹腔镜检查为诊断标准。评价疼痛症状包括痛经、CPP、性交痛及排便痛与盆腔内不同部位内异症病灶的关系。结果130例内异症患者中,痛经100例（76．9％）,无痛经30例（23．1％）。轻、中度和重度痛经者分别为27例（20．8％）、41例（31．5％）、32例（24．6％）,性交痛46例（35．4％）,CPP45例（34．6％）,排便痛67例（51．5％）。痛经者深部宫骶韧带结节、阴道直肠隔结节发生率分别为45．0％、16．0％,无痛经者深部宫骶韧带结节、阴道直肠隔结节发生率为13．3％、0,两者分别比较,差异均有统计学意义（P=0．00、P=0．01）;痛经者与无痛经者比较,子宫直肠窝封闭的比例增加（分别为41．0％、10．0％,P=0．00）,深部浸润型内异症（DIE）比例增加（分别为51．0％、16．7％,P=0．00）。痛经程度与宫骶韧带结节的数目（P=0．005,r=0．302）、宫骶韧带结节浸润深度（P=0．017,r=0．227）呈线性相关。痛经伴卵巢内异症囊肿患者中,发生中、重度盆腔粘连的比例增加（分别为29．1％、8．3％,P=0．029）。与无CPP的患者比较,CPP患者深部宫骶韧带结节（分别为51．1％、30．6％,P=0．018）以及DIE（分别为57．8％、35．3％,P=0．011）比例明显升高。与无排便痛的患者比较,排便痛患者深部宫骶韧带结节（分别为46．3％、28．6％,P=0．028）、阴道直肠隔结节（分别为19．4％、4．8％,P=0．01）、子宫直肠窝封闭（分别为44．8％、22．2％,P=0．005）以及DIE（分别为53．7％、31．7％,P=0．01）的比例升高。阴道直肠隔结节是性交痛的独立危险因素（OR=3．61）。结论痛经、CPP、性交痛以及排便痛与盆腔内异症病灶的部位和浸润深度有关,位于盆腔后部的深部浸润病灶以及子宫直肠窝封闭与疼痛症状关系密切。     

Naproxen sodium in dysmenorrhea secondary to endometriosis

Twenty patients with moderate to very severe painful menstrual periods secondary to endometriosis were treated in a double-blind, four-period, crossover clinical trial with naproxen sodium and placebo. Complete or substantial pain relief was obtained in 83% of the cases of painful menstruation with naproxen sodium and in 41% with placebo (P = .008). Only 5% of the naproxen sodium-treated women needed supplemental analgesics compared with 36% of the placebo-treated women (P = .002). There was a trend towards diminished interference of dysmenorrhea with normal patient activities during naproxen sodium treatment compared with placebo (P = .069). No significant side effects occurred with either treatment. These results indicated that naproxen sodium is efficacious and safe for the treatment of menstrual distress in patients with endometriosis.     

Endometriosis in patients with chronic pelvic pain: is staging predictive of the efficacy of laparoscopic surgery in pain relief?

BACKGROUND/AIMS: Endometriosis is considered an important cause of chronic pelvic pain. Despite its high prevalence, controversy still exists regarding the true association between the extent of endometriosis and the severity of symptoms. We conducted this prospective study to investigate the association between the stage of endometriosis and type and severity of pain, and to evaluate the efficacy of laparoscopic surgery in pain relief. METHODS: Ninety-five patients complaining of chronic pain were diagnosed with endometriosis and were treated with laparoscopic surgery. The severity of pain was assessed in patients with an endometriosis AFS (American Fertility Society) score less than 16 (group 1) and those with an AFS score greater than or equal to 16 (group 2), preoperatively and 6 months after surgery, using a visual pain scale. Any reduction in pain scores by 2 points or more was considered to be an improvement. RESULTS: Dysmenorrhea and deep dyspareunia, were significantly more frequent in patients of group 2. Preoperative pain scores were significantly higher for dysmenorrhea (p = 0.0022) and deep dyspareunia (p < 0.0001) but not for non-menstrual pain in group 2. Deep dyspareunia was correlated with the presence of dense pelvic adhesions. After surgery, dysmenorrhea improved in 43% of cases in group 1, vs. 66% of cases in group 2 (p = 0.0037). For deep dyspareunia, improvement was reported by 33% in group 1, vs. 67% in group 2 (p = 0.074). Improvement in non-menstrual pain was not significantly different between the two groups (67% vs. 56%). CONCLUSIONS: Advanced endometriosis is more frequently related to dysmenorrhea and deep dypareunia in comparison to early disease. Laparoscopic surgery may offer relief or improvement in the majority of patients with endometriosis and chronic pelvic pain. Cases with advanced disease seem to benefit the most.     

腹腔镜子宫骶神经切断术治疗子宫内膜异位症疼痛的多中心前瞻性对照研究

目的:研究、评价腹腔镜子宫骶神经切断术(LUNA)治疗子宫内膜异位症疼痛的安全性和有效性。方法:应用多中心随机对照的前瞻性研究方法,收集82例中、重度痛经患者的临床资料,分析比较同时行LUNA对子宫内膜异位症保守手术后各种疼痛缓解率的影响,并评价手术的安全性。结果:71例患者纳入分析,LUNA组51例,对照组20例。LUNA组术后痛经缓解率90.2%,高于对照组的60.0%(P=0.02);LUNA组性交痛术后缓解率85.7%,高于对照组的50.0%(P=0.048);LUNA组慢性盆腔痛(CPP)缓解率100%,高于对照组的71.4%(P=0.041),差异均有统计学意义。手术安全性:LUNA组患者手术时间延长,术后肛门排气时间延长,但两组术中出血量、术后体温、住院时间、总住院费用以及手术费用均无统计学差异。所有研究对象均无手术并发症发生。结论:内异症保守手术同时行LUNA手术,术后2年内能有效的缓解内异症的各种疼痛。     

Generalized hyperalgesia in women with endometriosis and its resolution following a successful surgery

Although pains of various kinds top the list of complaints from women with endometriosis and are the most debilitating of the disease, little is known about the mechanism/mechanisms of endometriosis-associated pains. To test the hypothesis that women with endometriosis have generalized hyperalgesia which may be alleviated by a successful surgery, we recruited 100 patients with surgically and histologically confirmed endometriosis and 70 women without, and tested their responses to pain stimulations. Before the surgery, all patients rated their dysmenorrhea severity by Visual Analog scale (VAS) and went through an ischemic pain test (IPT) and an electrical pain test (EPT). The controls were also administrated with IPT/EPT. Three and 6 months after surgery, all patients were administrated with IPT/EPT and rated their severity of dysmenorrhea. We found that patients with endometriosis had significantly higher IPT VAS scores and lower EPT pain threshold than controls, but after surgery their IPT scores and EPT pain threshold were significantly and progressively improved, along with their dysmenorrhea severity. Thus, we conclude that women with endometriosis have generalized hyperalgesia, which was alleviated by surgery. Consequently, central sensitization may be a possible mechanism underlying various forms of pain associated with endometriosis, and its recognition should have important implications for the development of novel therapeutics and better clinical management of endometriosis.