宫腹腔镜联合诊治子宫肌壁间妊娠2例

子宫肌壁间妊娠临床较为少见，发生率约占异位妊娠的1％，占妊娠的1／30000。随着人工流产率、剖宫产率的增高及胚胎移植增多，其发病率有上升的趋势，我院近1年共收治2例子宫肌壁间妊娠患者，均行宫腹腔镜手术治愈。     

早期异位妊娠快速诊断新方法

<正>异位妊娠(EP)是指受精卵种植在子宫体腔以外的部位,包括输卵管妊娠、卵巢妊娠、子宫肌壁间妊娠、腹腔妊娠、阔韧带妊娠和宫颈妊娠[1]。异位妊娠是妇产科常见的急腹症,随着盆腔炎性疾病发病率的上升以及宫内侵入性手术和辅助生殖技术的增加,EP发病率从1970年的0.5%上升到目前的1%~2%。EP破裂或流产严重威胁患者的生     

残角子宫妊娠、宫角妊娠诊断特点及处理

残角子宫又称为遗迹性双角子宫,受精卵种植在残角子宫内,称为残角子宫妊娠(rudimentary horn preg-nancy),1994年法国Star报道,发病率是1/10000～1/40000,也有报道为0.001%～0.0082%.而残角子宫残角部并发症则更为罕见,且诊断极为困难,术前诊断者更少,低于5%.     

腹腔镜治疗复合妊娠4例临床分析

<正>异位妊娠是指受精卵在子宫体腔以外着床发育,是妇产科常见的急腹症之一。宫内宫外同时妊娠又称复合妊娠(heterotopic pregnancy,HP),是临床上罕见的病理妊娠,既往自然发生率约1/7000～1/30000[1],临床工作中极易漏诊、误诊。近年随着辅助生殖技术的开展,复合妊娠的发生率可高     

腹腔镜保守手术治疗子宫腺肌瘤疗效观察

目的探讨子宫腺肌瘤腹腔镜保守手术的临床特点和治疗效果。方法以2004年4月到2007年7月于北京协和医院行腹腔镜子宫腺肌瘤病灶挖除术的72例患者为研究对象,记录其临床特点、辅助治疗、随访结果和妊娠结局,回顾性分析复发和妊娠的相关因素。结果 (1)腹腔镜子宫腺肌瘤病灶挖除术后2年,患者痛经程度减轻,子宫体积缩小,血清CA125值下降,和术前相比差异有统计学意义(P<0.05)。(2)术后症状复发率34.7%,复发中位时间30个月。复发组患者的年龄和子宫体积更大,术后妊娠者的复发率低于未妊娠者(P<0.05)。(3)和单纯手术组相比,术后辅助促性腺激素释放激素激动剂(GnRHa)组患者的子宫体积更大、多发腺肌瘤及合并子宫内膜异位症的比例更高(P<0.05),但两组复发率差异无统计学意义。(4)术后妊娠率68.8%,分娩率46.9%。妊娠距离手术的中位时间为13个月。未发现影响妊娠的有统计学意义的临床因素。结论对于有生育要求的局限性腺肌瘤患者,腹腔镜子宫腺肌瘤病灶挖除术能有效缓解症状、促进妊娠。年轻、子宫体积大的患者更容易复发,术后妊娠对复发有保护作用。术后联合GnRHa治疗有助于减少复发,但对妊娠的益处尚不肯定。     

子宫肌瘤剔除术后子宫肌壁间妊娠1例及文献复习

<正>子宫肌壁间妊娠(intramural pregnancy)是指妊娠囊着床种植于子宫肌层的一种特殊异位妊娠,其发病率极低,且无特异性的临床表现~([1-2])。延迟诊断常导致子宫破裂、大出血,甚至子宫切除等严重并发症,因此早期确诊是治疗关键~([3-4])。理论上血HCG联合经阴道超声可对其做出初步诊断,但往     

腹腔镜在异位妊娠诊治中的应用

异位妊娠包括输卵管妊娠、腹腔妊娠、卵巢妊娠、宫颈妊娠以及残角子宫妊娠 ,其中输卵管妊娠占 95 %～ 98%。近年来其发生率逐年升高 ,是早孕期间孕妇死亡的首要原因。腹腔镜的问世 ,为异位妊娠的早期诊断和治疗谱写了新的篇章。1　腹腔镜在异位妊娠早期诊断中的意义　　异位妊娠如果破裂 ,症状典型 ,诊断并不困难。早期诊断不仅可以选择合适的治疗方法如保留输卵管等成为可能 ,而且可以大大降低疾病及治疗引起的病率和病死率。早期诊断异位妊娠的方法有 :阴道超声波检查、血 β -ｈＣＧ测定、血孕酮测定以及诊断性刮宫等方法。其中应用阴道…     

子宫颈妊娠的诊断及处理

宫颈妊娠是指受精卵种植在宫颈管内,组织学内口水平以下,并在该处生长发育。宫颈妊娠是异位妊娠中发病率很低但很危险的妊娠类型。宫颈妊娠占妊娠数的1∶10 0 0～95 0 0 0 ,在异位妊娠中发生率<1% [1] 。宫颈妊娠的形态学特征为滋养层浸润性、破坏性生长至宫颈壁内,形成胎盘植入,因宫颈壁仅含15 %肌肉组织,余为无收缩功能的纤维结缔组织,当宫颈妊娠发生自然流产、误诊刮宫时,因子宫颈收缩力弱,不能迅速排出妊娠产物,开放的血管不闭锁,发生大出血。1　病因宫颈妊娠发病的原因尚不清楚,可能与以下因素有关:(1)受精卵运行过快或发育迟缓,子宫内…     

宫腹腔镜联合治疗子宫肌壁间妊娠一例报告及文献复习

目的：探讨子宫肌壁间妊娠的治疗,评价宫腹腔镜联合治疗在子宫肌壁间妊娠中的应用。方法：分析1例宫腹腔镜联合治疗子宫肌壁间妊娠患者临床资料,并回顾子宫肌壁间妊娠相关文献。结果：对于妊娠囊着床靠近黏膜层的早期子宫肌壁间妊娠患者,腹腔镜监视下行宫腹腔镜手术可达到诊治子宫肌壁间妊娠的目的。结论：腹腔镜监视下行宫腹腔镜手术创伤小、出血少、恢复快、保留生育功能、对子宫肌层损伤小,为早期子宫肌壁间妊娠的理想治疗方法。 【关键词】 妊娠,异位;宫腔镜;腹腔镜;治疗     

残角子宫妊娠1例报告

残角子宫属女性生殖器官发育异常,是由于一侧副中肾管发育正常,而另一侧发育不全形成残角子宫,其发生率约为1/万～2.5/万。残角子宫妊娠是指受精卵于残角子宫内着床并生长发育,其发病率为1/万～8/万。现将我院收治的1例残角子宫妊娠病例的诊治体会,同时结合文献做一归纳总结,供同道参考。     

Co-existent ovarian mucinous cystadenocarcinoma and ovarian choriocarcinoma

We present the case of a 63-year-old woman with an ovarian neoplasm in which mucinous cystadenocarcinoma and choriocarcinoma coexisted. Blood levels of β-hCG were elevated and bilateral ovarian stromal luteinization was seen. The rarity of this association and its clinical and pathologic implications are discussed. Received: 15 February 2001 / Accepted: 29 May 2001     

Influence of ovarian cysts during controlled ovarian hyperstimulation

BACKGROUND: The use of gonadotrophin-releasing hormone agonist and purified follicular stimulating hormone increases the incidence of ovarian cysts during in vitro fertilization-embryo transfer cycles. The aetiopathogenesis and the effects of ovarian cysts on controlled ovarian hyperstimulation is unclear; most authors observed no-detrimental influence of ovarian cysts in controlled ovarian hyperstimulation cycles for IVF. The aim of this study was the evaluation of the real incidence and effects of ovarian cysts during in vitro fertilization-embryo transfer cycles. METHODS: Design: retrospective study. Setting: reproductive medicine units. Patients: 130 women. Interventions: r-FSH--225 U.I. was administered to 130 women i.m. after a long protocol of down regulation with GnRH-a (Triptoreline 3.75). The drug administration was personalized on the basis of: pre-existent patients pathologies; E2 blood levels; ultrasound evaluation of the follicular development. Main outcome measures: E2 levels, number and quality of oocytes retrieved, fertilization rate, number of embryos developed, pregnancy rate. RESULTS: At the end of stimulation ovarian cyst was observed in eighteen cases. There was no difference, between the cycles with or without cysts, in the follicular development, number and quality of eggs retrieved, fertilization rate, number and quality of the transferred embryos, pregnancy and miscarriage rate. CONCLUSIONS: The conclusion is drawn that the incidence of ovarian cysts during COH can be reduced observing some simple rules like: to exclude from the stimulation protocols patients with follicles of more than 12 mm diameters as observed at the preliminary ultrasound control; to personalize the therapeutic regime with the pre-existent patients pathologies; ultrasound evaluation of the follicular development; determination of the E2 serum levels, every two days.     

Benign or malignant ovarian neoplasms and ovarian endometriomas

STUDY OBJECTIVE: To investigate clinical features and biologic behavior of ovarian cancer that might be closely related to endometrioma and/or endometriosis. DESIGN: Retrospective study (Canadian Task Force classification II-2). SETTING: University hospital. PATIENTS: All 324 women who were operated for endometriomas and/or ovarian tumors 5 cm or greater in diameter between January 1988 and December 1997. INTERVENTION: One hundred twelve women underwent laparoscopic surgery and 212 had laparotomy. MEASUREMENTS AND MAIN RESULTS: All tissues were evaluated histologically. Clinical examinations including ultrasound and serum tumor makers were performed in all patients preoperatively. No malignancies were found at laparoscopic surgery (76 endometriomas, 36 ovarian tumors). The frequency of endometriosis in benign, borderline malignant, and malignant tumors was 9.7%, 12.5%, and 11.4%, respectively. Endometriosis was present most frequently (40%) in women with endometrioid adenocarcinoma. It was present in 81 patients with endometriomas and 25 with ovarian neoplasms. Of these, nine women (8.5%) had malignant tumors, including borderline malignancy. Among patients with malignant tumors, those without endometriosis were significantly older (mean +/- SD age 54.9 +/- 16.2 yrs) than those with endometriosis elsewhere in the pelvis (45.9 +/- 8.9 yrs). CONCLUSION: Endometriosis may be closely related to ovarian tumors such as endometrioid adenocarcinoma. Surgeons should be aware of this possibility, and candidates for laparoscopic surgery should be carefully selected based on preoperative evaluations.     

原发性卵巢功能不全与卵巢早衰的病因学研究进展

目前,卵巢早衰(premature ovarian failure,POF)是被广泛接受和应用的专业术语,通常是指女性40岁之前闭经,伴有高卵泡刺激素(FSH)和低雌激素水平.由于临床治疗很棘手,如何预防和预测POF的发生风险,成为临床医生关注的焦点.尽管在POF发病机制的探讨中,染色体结构或数目异常、自身免疫功能、医源性及环境等相关因素与POF发病的相关性研究已取得很大进展,但仍有部分POF患者的病因不清,称为"特发性POF".     

Genetic alterations in ovarian borderline tumours and ovarian carcinomas

OBJECTIVE: To evaluate the benefits associated with routine uterine curettage following complete second trimester termination of pregnancy by extraovular prostaglandin E2. STUDY DESIGN: Fifty-five patients between 15 and 24 weeks' gestation who had undergone complete termination of pregnancy by continuous extraovular instillation of prostaglandin E2 (PGE2), were randomly assigned into either no further intervention (n=25), or uterine curettage under general anesthesia (n=30). The need for late uterine curettage, clinical and ultrasonographic parameters at 1 and 42 days follow-up, as well as the incidence of the minor and major complications, were compared between groups. RESULTS: Baseline and post-abortion clinical and ultrasonographic characteristics were similar in both groups. Mean (+/- Standard error of the mean) number of post-abortion bleeding days in the curettage group was 8.9+/-1.8 versus 10.1+/-2.6 days in the non-curettage group (P=NS). No patient in the former group, compared to three patients in the latter group, needed late uterine curettage, (P=NS). Major and minor complications rates in the curettage and in the no-curettage groups were not significantly different. Considerably more patients in the curettage group needed analgesic agents following the abortion compared to the no-curettage group (60% vs. 3.3%, respectively; P<0.001). CONCLUSIONS: Routine uterine curettage in patients undergoing complete second trimester termination of pregnancy by extraovular instillation of PGE2, exerts no benefit.     

A case of primary ovarian adenomyoma mimicking ovarian malignancy

Adenomyoma is a benign tumor composed of smooth muscle and benign endometrium. These tumors typically originate within the uterus. An extrauterine adenomyoma is an extremely rare entity. After an extensive literature search, only four cases of primary ovarian adenomyoma appear to have thus far been reported. Here, we report a case of ovarian adenomyoma in a 39-year-old woman mimicking malignant neoplasma of the ovary, along with a brief literature review.     

卵巢储备功能与卵巢反应性评估

辅助生殖技术（ART）的成功率依赖于正确的卵巢刺激方案,而卵巢刺激方案的决定依靠准确的卵巢储备功能和卵巢反应性的评估,主要包括年龄、基础性激素水平、基础窦卵泡数（AFC）、抗苗勒管激素（AMH）等,但是目前尚无能够独立评价卵巢储备功能和卵巢反应性的特异性标志物,仍需联合应用评估。