不孕女性中衣原体感染与抗精子抗体关系研究

目的：研究不孕女性中衣原体（chlamydia trachomatis，CT）感染与抗精子抗体（antisperm anribody．AsAb）之间的关系。方法：选择2004年2月～2006年2月在计划生育指导所生殖医学门诊就诊的不孕女性370例．其中原发不孕120例（原发不孕组），继发不孕250例（继发不孕组）．同时选择健康已孕女性100例作为对照（对照组）。应用衣原体一步免疫层析法检测CT感染．酶联免疫吸附法检测血清中AsAb。结果：不孕组CT感染率、AsAb阳性率与对照组比较差异均有统计学意义（P〈0．05）；继发不孕组CT感染率、AsAb阳性率与原发不孕组比较差异无统计学意义（P〉0．05）；不孕组中AsAb阳性患者CT感染率与阴性患者比较差异有统计学意义（P〈0．05）。结论：CT感染及AsAb均可造成女性不孕．AsAb的产生与CT感染有关。     

不孕不育患者沙眼衣原体感染状况分析

目的:研究广东地区不孕不育患者沙眼衣原体(CT)的感染状况。方法:收集937例不孕不育患者(包括原发不孕不育、继发不孕不育和自然流产病例)的生殖道分泌物标本以及879例正常生育者生殖道分泌物标本,并用胶体金免疫沉析法检测CT抗原。结果:不孕不育组CT感染率为14.94%,显著高于对照组(2.62%);不孕不育女性CT感染率为17.62%,显著高于不育男性的CT感染率(10.93%)。女性原发性不孕、继发性不孕及反复自然流产的CT阳性率分别为16.24%、19.12%、16.67%,三组CT阳性率无统计学意义;男性原发性不育组、继发性不育组的CT性率分别为10.06%、11.65%,差异也无统计学意义。结论:CT感染是引起广东地区男性不育,女性不孕及自然流产的重要病因之一。     

635对不育夫妇不育因素临床分析

目的 探讨本地区不育夫妇的不育因素;方法 对１９９０年以来６３５对资料完整的不育夫妇进行临床分析;结果发现,原发不育４３７对,占６８．８２％,继发不发１９８对,占３１．１８％,二者有显著差异（Ｐ〈０．０１）。男性原发不育因素从高到低依次是精浆异常、无精子症、精索静脉曲张;而继发不育主要是副性腺感染。精浆异常和无精子症原发不育高于继发不育（Ｐ〈０．０５）,精索静脉曲张和免疫,因素继发高于原发（Ｐ〈０     

Infertility

Infertiliy factors encountered in everyday practice in East Africa are reviewed and treatment methods are reported. In a personal series of 220 patients with bilateral tubal occulusion, tubal surgery was undertaken in 52 cases, only 3 of which are known to have produced live births. Reinfection occurred in a large number of cases, indicating the need to maintain prophylactic antibiotics for at least 3 months postoperatively. 6 additional patients with secondary infertility were found to have sustained significant cervical laceration in a previous delivery. After cervical repair, 4 of the 6 had successful pregnancies. A pregnancy rate of 30-50% can be expected after fibroids are removed. East Africa lacks facilities for gonodotropic hormone level estimation. However, clomiphene citrate is widely used by gynecologists. It is administered in doses of 100-200 mgm/day on the 5th-9th days of the menstrual cycle. 10 pregnancies resulted among the last 50 patients treated with clomiphene for anovulatory infertility. Male factors are estimated to account for 20-30% of infertility. At least 3 semen analyses must concur for acceptance of a diagnosis of infertility or subfertility. Spermatogenesis may be enhanced by the testosterone rebound method or human pituitary gonadotropin therapy. It is estimated that about 50% of infertile couples can be helped within the 1st year based on information gained from a careful history and examination and routine blood and urine investigations.     

原发不孕与继发不孕妇女生殖道感染的临床分析

目的了解原发不孕与继发不孕妇女生殖道感染的情况及其病原体分布。方法对1462例不孕患者的临床资料进行回顾性分析,分为原发不孕组和继发不孕组,分别对其阴道分泌物、宫颈分泌物及血清进行生殖道感染相关病原体的检测。结果1462例不孕妇女中,原发不孕477例,继发不孕985例。共检出生殖道感染者655例,总体感染率为44．80％。原发不孕组中共检出生殖道感染者186例,感染率为3899％;继发不孕组中共检出生殖道感染者469例,感染率为47．61％。总体病原体检出率：依次为解脲支原体（25．72％）、阴道加德纳氏菌（15．87％）、假丝酵母菌（11．08％）、沙眼衣原体（506％）、人型支原体（2．33％）、阴道毛滴虫（075％）、梅毒螺旋体（055％）、淋球菌（0．34％）、人类免疫缺陷病毒（0．07％）。两组中衣原体感染率继发不孕组明显高于原发不孕组。其余病原体感染率差异无统计学意义。结论在不孕妇女中常规进行阴道分泌物病原体检测及血清梅毒螺旋体、HIV的检测非常重要。继发不孕妇女尤其要重视衣原体的检测。     

Neoadjuvant chemotherapy in Albinos with locally advanced skin cancer at a Blantyre Hospital: - Case Series

Albinism in Africa remains a public health concern with increasing numbers of advanced skin cancer in this population at presentation. There are challenges with availability of Radiotherapy (RT) units in Africa which is an important modality for controlling loco-regional disease alone or in combination with surgery. Proposed chemotherapy regimens have not been well validated through Randomized Controlled Trials thus posing difficulties for standard of care for units that do not have access to functional RT facilities. Malawi is one such country without radiotherapy.

Case summary

Seven patients with locally advanced skin cancer were seen in the adult oncology unit at Queen Elizabeth Central Hospital in Blantyre (QECH), Malawi between 2010 and 2013. QECH is one of the teaching hospitals in the country. All were subjected to neo-adjuvant chemotherapy. The primary treatment aim was cyto-reduction followed by surgery whilst the secondary outcome was general symptom control. Three patients achieved complete responses of which two underwent resection and a pectoralis major myocutaneous flap. One had a near complete response and three showed partial responses.

Conclusion

Neo-adjuvant chemotherapy may be a possible.     

不孕症618对病因分析

目的 为探讨不孕症的发病原因,借以指导临床治疗。方法对618对不孕夫妇进行病因调查,针对发病原因进行治疗。结果单纯女方异常267对占43．20％;单纯男方异常者126对,占20．39％;双方都异常者225对,占36．40％。女方继发不孕明显高于原发不孕,两组比较有显著性差异（P〈0．01）;男方原发不育发病率高于继发不育,两组有显著性差异（P〈0．01）。女方不孕267例中,排卵障碍原发不孕组高于继发组,差异有显著性（P〈0．01）。输卵管阻塞者285例,占58．28％。继发不孕组明显高于原发不孕组,差异有显著性（P〈0．01）。男方不育26例中,发病率高低依次为弱精子症、少精子症、男方副性腺感染史、免疫因素等。结论男方不育的因素不应忽视,特别是应该提高各时期的生活质量,任何不孕症均应考虑男女双方的因素。     

腹腔镜探查联合输卵管通液术诊治女性不孕症的临床研究

目的对应用腹腔镜及输卵管通液术诊治女性不孕症进行临床研究。方法女性不孕症患者行腹腔镜检查及手术的患者150例,进行病因及治疗效果的统计及分析。结果女性不孕症患者中,发现盆腔异常者占96.13%,继发不孕和原发不孕患者的病因构成比较差异有统计学意义（P〈0.05）;在患者的术后妊娠率分析中,共随访72例,随访率60.5%;术后妊娠47例,妊娠率66.67%。结论对于药物治疗效果不佳的不孕症患者,腹腔镜检查及治疗是一种有效的治疗方法,尤其适应用于输卵管异常及卵巢多囊性改变者。     

腹腔镜在不孕症诊断和治疗中的应用

目的评价腹腔镜在不孕症诊断和治疗中的临床应用价值。方法应用腹腔镜,对98例继发性不孕症和32例原发性不孕症妇女进行腹腔镜诊断和治疗,并对其资料进行分析。结果经腹腔镜检查,原发性不孕症32例,其中多囊卵巢28例,不明原因4例;继发性不孕98例,其中发现盆腔器质性病变93例,检查阳性率为94.9％。慢性盆腔炎、盆腔粘连和子宫内膜异位症是引起继发性不孕的主要盆腔疾病,占继发性不孕的93.2％。其中慢性盆腔炎、盆腔粘连占52.1％(51/98);子宫内膜异位症占42.8％(42/98)。慢性盆腔炎、盆腔粘连患者中94.1％(48/51)有一侧或双侧慢性输卵管梗阻;子宫内膜异位症患者中仅9.5％(4/42)有输卵管梗阻。盆腔炎、盆腔粘连者多无急性盆腔炎病史,66.6％(34/51)没有自觉症状。腹腔镜下给予相应的治疗,术后30％(39/130)受孕。结论生殖道炎症及盆腔感染是继发性不孕的重要病因,其症状隐匿,易被忽视,应引起临床医生的高度重视。腹腔镜技术对不孕症的诊断和治疗有重要价值,起到了诊断治疗一体化的作用。     

无痛人工流产和药物流产临床疗效的对比研究

目的：对比研究无痛人工流产、药物流产治疗早期妊娠患者的临床疗效。方法：回顾性分析2012年1月至2013年12月收治的155例早期妊娠患者的临床资料,分为无痛人工流产组81例、药物流产组74例.比较两组的完全流产率、阴道出血时间,治疗后月经复潮时间、感染率、继发不孕率。结果：无痛人流组完全流产率为98.77％、阴道出血时间为（6.89±2.46） d、术后感染率l.23％、继发不孕率7.41％;药物流产组分别为89.19％、（12.74±3.92） d、6.76％、2.70％,两组比较,差异有统计学意义（P〈0.05）。无痛人流组和药物流产组月经复潮时间分别为（31.67±3.05） d,为（29.13±2.84） d,两组比较,差异无统计学意义（ P〉0.05）。结论：两种流产方式各有优缺点,临床上应根据患者实际情况和意愿合理选择。     

85例不孕症患者子宫内膜活检病理分析

目的:通过对85例不孕症患者子宫内膜组织行病理活检,探讨不孕症患者子宫内膜病理变化与不孕症的关系,为临床诊治提供依据。方法:85例不孕症患者诊断性刮宫病理切片行临床病理分析。结果:85例不孕症患者原发性不孕71例,继发性不孕14例4。5例(52.94%)患者子宫内膜腺体分泌性反应,其中,子宫内膜腺体分泌反应良好12例(14.12%1,2/85),分泌反应欠佳、不良及无分泌33例(38.82%,33/85);子宫内膜增生期反应30例(35.29%),增生不足7例(8.24%),单纯性子宫内膜增长过长2例(2.35%),子宫内膜炎1例(1.18%)。结论:不孕症子宫内膜表现为分泌反应欠佳、不良、无分泌及增生性反应多见,不孕症的主要病因为卵巢黄体功能不全、失调和卵巢无排卵。     

A case-control study on the relationship between induced abortion and secondary tubal infertility in Vietnam

The incidence of induced abortion (IA) is high in Vietnam. The purpose of this study is to find out whether IA increases the risk of secondary tubal infertility. A case-control study was conducted at Tu Du Hospital in Vietnam between June and September 2001. Interviews were completed with 67 tubal infertility cases matched by age and residence to 67 controls. The median age of subjects was 34 years old. Proportion of subjects with history of IA was 50.8% and 44.8% for cases and controls, respectively. IA did not significantly increase the risk of secondary infertility. Age of first sexual intercourse was under 20 years old for 29.9% of cases and 9.1% of controls, and it significantly increased the risk of secondary infertility [odds ratio (OR)=3.80]. This study was unable to identify IA as a risk factor of secondary tubal infertility. However, the increased OR for age at first sexual intercourse may imply that being sexually active at an earlier age increases the risk of getting both sexually transmitted diseases and unwanted pregnancies and in turn, increasing the risk of infertility. It is recommended to provide young women and men with the information about health risks related to sexual activity.     

沙眼衣原体和解脲支原体感染与输卵管性不孕症关系的研究

目的探讨女性生殖道沙眼衣原体(chlamydia trachomatis,CT)和解脲支原体(ureaplasma urealyticum,UU)感染与输卵管性不孕症的关系。方法检测152例不孕症患者(原发不孕症69例,继发不孕症83例)宫颈黏液的CT(免疫荧光法)和UU(液体培养法),于检查后1～6个月内月经后3～7d行子宫输卵管碘油造影或腹腔镜检查,了解输卵管通畅情况。结果输卵管堵塞患者中,UU阳性率为25.0%,CT阳性率为15.6%,合并感染者12.5%;而输卵管通畅患者中,UU阳性率为11.3%,CT阳性率5.7%,合并感染者3.4%。二者相差均显著(P<0.05)。结论支原体及衣原体感染在输卵管性不孕症的发病中起重要作用。     

宫、腹腔镜联合诊治不孕症119例临床分析

目的 探讨宫、腹腔镜联合检查及镜下手术诊治不孕症的临床价值.方法 2002年1月至2005年6月广东省江门市妇幼保健院对119例不孕症患者进行宫、腹腔镜联合检查及镜下手术治疗,其中原发不孕41例,继发不孕78例,观察两组病例子宫及盆腔病变的发生率,术前后输卵管的通畅情况及术后妊娠率.结果 119例不孕症中发现盆腔病变112例,占94.12%.慢性盆腔炎发生率最高,为51.26%,继发不孕明显高于原发不孕(p＜0.01),多囊卵巢综合征的发生率原发不孕高于继发不孕(p＜0.05),其余的病变有子宫内膜异位症,卵巢囊肿及生殖器结核等,两者发生率相近(P＞0.05).宫、腹腔镜检查发现子宫畸形11例,占9.24%,宫腔内病变45例,占37.82%,其中宫腔粘连发生率最高,为11.76%,其次为子宫内膜息肉及粘膜下肌瘤等,原发不孕发生率与继发不孕相近(p＞0.05).两组术后输卵管(双侧或一侧)通畅率均高于术前(p＜0.05及p＜0.01).术后一年妊娠率为52.10%.结论 宫、腹腔镜联合检查及镜下手术治疗可对盆腔、宫腔内病变及子宫畸形作出准确的诊断同时予以治疗,术后输卵管通畅率明显增加,妊娠率高,治疗效果好,在诊治不孕症中有明显的优越性及十分重要的临床价值.     

染色体变异与男性不育

目的 探讨染色体异常与男性不育的关系。方法 对565例男性不育患者进行染色体分析。结果 发现染色体异常69例,异常率为12.21%。其中性染色体异常48例,占异常核型 69.75%;性反转综合征1例,占异常核型1.45%;常染色体异常20例,占异常核型28.98%。结论 染色体异常是造成男性不育的重要遗传因素。提示对精液检查异常者或男性性征发育不良者进行染色体检查,将有助于不育病因的诊断。     

人流术后社区随访减少炎症性不孕的研究

目的:探讨人流术后早期社区随访对盆腔炎症性不孕的预防效果。方法:在社区建立健康档案的7 566名育龄妇女中,对既往5年内有人流手术史的患者通过门诊诊疗结合电话随访的178名患者作为观察组,未按要求进行社区诊治但配合随访的256名患者作为对照组,对患者人流术后5年内的继发不孕发生率及病因进行分析。结果:观察组与对照组比较,其炎症性继发不孕的发病率明显下降(6.7%vs 17.5%),观察组CT和Uu感染率均逐月显著下降。结论:人流术后早期定期进行盆腔炎症性疾病的社区随访诊治可以显著减少患者的继发性盆腔炎症性不孕。     

Ovarian structure in cases of primary and secondary infertility

The present study was carried out to assess the ovarian structure in cases of primary infertility (PI), and secondary infertility (SI). 40 patients were selected from the infertility clinic of Al Azhar University hospital from those suspected to have ovarian abnormalities with history of amenorrhea or oligomenorrhea or those having enlarged ovaries on pelvic examination. Their ages ranged from 17 to 40 years; their husbands were generally in good health and fertile. 28 were suffering from PI and 12 from SI. Ovarian biopsy was taken in 20 patients by laparoscopic technique and 20 patients by wedge resection. At the same time endometrial biopsy was taken with a specimen of cervical mucus and vaginal cells to detect the presence or absence of ovulation. Evidence of recent ovulation was present in 57.1% of the cases of PI and 50% of the cases of SI. However, the ovarian structure was abnormal in 92.9% of the cases of PI and 83.3% of the cases of SI. Polycystic ovary was present in 71.4% of PI cases and in 58.3% of SI cases and was considered the most common ovarian abnormality in both groups, followed by sclerotic ovary, which was detected in 14.3% of PI cases and no SI cases. Other findings in both groups included tubo-ovarian abscess, ovarian fibroma and a serous cystadenoma.     

宫腔镜联合腹腔镜在女性不孕症诊断及治疗中的应用

目的探讨宫腔镜联合腹腔镜在女性不孕症诊断及治疗中的应用价值。方法选择2007年1月至2010年12月北京市丰台中西医结合医院收治的200例不孕症患者,所有患者给予宫、腹腔镜联合检查明确病因并采取有针对性的治疗措施,治疗后随访3 a,观察治疗效果。结果 200例患者中,不孕症的病因主要有慢性盆腔炎、子宫内膜异位症、宫腔粘连和多囊卵巢综合征等。原发性不孕症与继发性不孕症的病因构成存在差异,子宫内膜异位症在原发性不孕症患者中的发生率高于继发性不孕症患者(P=0.001);慢性盆腔炎和宫腔粘连在继发性不孕症患者中的发生率高于原发性不孕症患者(P=0.047,P=0.039)。获得随访的196例患者中,正常妊娠96例,其中自然受孕69例,辅助妊娠27例,总妊娠率48.98%。结论宫腔镜联合腹腔镜检查能快速、准确地诊断不孕症的病因,并可及时采取针对性治疗措施,具有诊断准确、手术创伤小、术后妊娠率高等优势。     

男子不育症105例临床分析

目的：探讨男子不育症的临床特点及治疗策略。方法：回顾性分析105例男子不育症的临床资料及随访结果。结果：105例男子不育症患者睾丸体积测量显示：其中72例睾丸体积≥18ml，15例睾丸体积≤12ml，18例睾丸体积在12ml-18ml之间。精液分析结果：89例显示各项指标异常－其中16例精液不液化，64例显示弱精症或少精症，9例显示无精症（做睾丸活检4例，结果显示大量间质细胞，生精细胞幼稚、量少），23例精液中出现白细胞。经过临床综合治疗，随访3－5年，恢复生育力5例，精液不液化改善8例，精液常规指标改善46例。结论：男子不育症病因复杂，治疗效果不理想。治疗上应采取个性化原则，分而治之。