残留卵巢综合征102例分析

目的 探讨全子宫切除术中保留一侧或双侧卵巢，术后残留卵巢综合征(ROS)的发生率、发病机制及治疗方法。方法 1996年1月～2000年12月，我院因良性疾病行全子宫切除术共1798例，其中发生ROS102例，均有明显的临床症状，且经超声检查证实，排除囊、实性肿块，一旦诊断明确应首选避孕药治疗，由门诊专人随访。测定39例ROS患者(研究组)及32名月经规则的健康妇女(对照组)的女性激素(于月经第12天抽取静脉血测定)。结果 102例ROS中，54例服药后症状消失，肿块缩小；22例症状明显好转，肿块缩小；13例药物治疗失败改用手术治疗；13例失访。研究组与对照组女性激素的差异无显著性。结论 全子宫或次全子宫切除术中保留一侧或双侧卵巢时可发生ROS，ROS妇女的卵巢功能基本在正常水平，一旦确诊可首先使用抑制卵巢药物治疗。     

Histopathological analysis of hysterectomy specimens

The objective of this study was to explore the histopathological findings and the rate of removal of ovaries in hysterectomy specimens. This study took into account 328 hysterectomy specimens examined in the Department of Pathology, Mymensingh Medical College and in one private Pathology Laboratory in Mymensingh town from March to August, 2005. Formalin fixed paraffin embedded tissue sections stained with haematoxylin and eosin were examined under light microscope. Patients' age, parts of uterus examined and their histopathological findings were retrieved from laboratory records. The common histopathological findings were: chronic cervicitis (87.80%), leiomyoma (17.07%), uterine prolapse (16.72%), adenomyosis (3.96), non-specific endometritis (3.35%), squamous cell carcinoma of cervix (2.44%), endometrial polyp (2.44%), serous cystadenoma of ovary (2.44%) and endometrial hyperplasia (1.83%). Some of the specimens show more than one lesions in the body of uterus, of which coexistence of adenomyosis and leiomyoma was the most common. Neoplastic lesions in cervix were 4.27%, in body 16.92% and in ovaries 5.06%. Malignant neoplasms were found in cervix 71.43%, in uterine corpus 3.03% and in ovaries 25%. Ovaries of both sides were removed in 48.17% of total cases. Their median age was 45 years, lowest age 23 years and maximum age was 82. The rate of removal of both ovaries was found to be increasing with the increase of age. Only one case was found to be subtotal hysterectomy and others were total hysterectomy. The present study revealed that the most common histopathological cause of hysterectomy is chronic cervicitis. Most common neoplastic cause of hysterectomy is leiomyoma. The rationalities and the possible after effect of hysterectomy in sexual functions and other physiological impairment should be followed up.     

良性病因子宫全切术后盆腔断端的B超与临床监测

为了观察良性病因子宫全切术后盆腔断端愈合情况，以盆腔检查与Ｂ超检查联合应用的方法对６３例患者进行连续１年的观察。结果：①术后阴道残端大小无显著性变化；②对４７例行阴道残端包块观察，其中２３．４％无包块；４６．８％出现包块但在１年内消失；２９．８％包块存留１年以上；③术后保留卵巢的５５例中１１例有卵巢囊性增大，６个月内消失。提示：盆腔检查与Ｂ超检查联合应用能较准确的监测术后盆腔断端的愈合情况     

良性病因子宫全切术后盆腔断端的B超与临床监测

为了观察良性病因子宫全切术后盆腔断端愈合情况,以盆腔检查与B超检查联合应用的方法对63例患者进行连续1年的观察.结果:①术后阴道残端大小无显着性变化;②对47例行阴道残端包块观察,其中23.4%无包块;46.8%出现包块但在1年内消失;29.8%包块存留1年以上;③术后保留卵巢的55例中11例有卵巢囊性增大,6个月内消失.提示:盆腔检查与B超检查联合应用能较准确的监测术后盆腔断端的愈合情况.     

自体带血管蒂的卵巢腹腔内移植的临床应用

观察放疗对腹腔内移植的卵巢功能的影响。对５例年轻的宫颈癌患者，在行广泛性子宫切除及盆腔淋巴结清除术毕，游离卵巢动、静脉并将卵巢移植于侧腹壁。于放疗前后分别测血ＦＳＨ、ＬＨ、Ｅ２、Ｐ及检查阴道细胞成熟指数。结果显示：５例患者放疗后卵巢功能均正常，性生活满意。提示自体带血管蒂的卵巢腹腔内移植，放疗后可保留卵巢功能，性功能不受影响，可提高患者的生活质量。     

慢性盆腔痛病因及发病率分析

目的探讨女性慢性盆腔痛的病因及其发病率。方法对2010年5月～2011年5月到我院妇科就诊的1 017例慢性盆腔痛患者进行回顾性分析。结果 5 219例普通妇科疾病患者中,慢性盆腔痛就诊者1 017例,占19.5%。5 219例中20～40岁就诊者2 012例,慢性盆腔痛发病率为27.1%;41～55岁就诊者3 207例,慢性盆腔痛发病率为14.7%,两组比较,差异有统计学意义（P〈0.05）。1 017例慢性盆腔痛就诊者较常见病因：慢性盆腔炎占35.0%,子宫内膜异位症占28.5%,盆腔肿物占13.2%,盆腔静脉淤血综合征占12.9%。已生育组中盆腔静脉淤血综合征、盆腔肿物所致的慢性盆腔痛的构成比明显大于未生育组,两组比较,差异有统计学意义（P〈0.05）;未生育组慢性盆腔炎所致的慢性盆腔痛的构成比较生育组高,两组比较,差异有统计学意义（P〈0.05）;未生育组中子宫内膜异位症和原因不明所致慢性盆腔痛的构成比与已生育组比较,差异无统计学意义（P〉0.05）。慢性盆腔痛就诊者中既往有剖宫产手术史者占慢性盆腔痛患者53.0%,顺产者占19.5%,两组比较,差异有统计学意义（P〈0.05）。结论慢性盆腔痛常发生在育龄期妇女,其妇科常见原因是慢性盆腔炎、子宫内膜异位症、盆腔肿物及盆腔静脉淤血综合征等。剖宫产术可引起慢性盆腔痛,临床上要严格掌握剖宫产适应证,降低剖宫产率。     

产科急症子宫切除32例临床分析

目的分析产科子宫切除术的原因,探讨抢救产科出血的方法及降低产科子宫切除术的可能性。方法对我院产科5年间32例急症子宫切除病例进行回顾分析。结果产科急症子宫切除的指征是子宫大出血,其中胎盘因素是子宫切除的首要因素,占46.88%。结论产科子宫切除术是挽救产妇生命的有效措施,但需严格掌握手术指征;有胎盘异常如前置胎盘、胎盘早剥的产妇应高度警惕产后出血发生;降低剖宫产率有利于减少产后出血的发生。     

Endometrioid adenocarcinoma 13 years after total abdominal hysterectomy and bilateral salpingo-oophorectomy

Malignant transformation is an infrequent complication of endometriosis. As endometriosis is an ectopic endometrium, hyperestrogenism may cause hyperplasia or transformation into cancer. We describe a case of a 68-year-old woman who underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy for endometriosis. She was subsequently placed on estrogen-only replacement therapy. She presented with left-sided pelvic mass and shortness of breath. Computed tomography of chest, pelvis, and abdomen, demonstrated right-sided pleural effusion and soft tissue mass in the pelvis. Pleural effusion was tapped and biopsy from the peritoneal mass showed metastatic adenocarcinoma; immunohistochemistry findings favored endometrioid adenocarcinoma. She was treated by 6 cycles of Carboplatin/Paclitaxel and responded well. Unopposed estrogen stimulation may lead to premalignant or malignant transformation in the residual foci of endometriosis. Therefore, the addition of progestins to estrogen replacement therapy should be considered in women who have undergone hysterectomy with oophorectomy due to endometriosis.     

先天性无子宫无阴道9例的核磁共振检查分析

目的探讨先天性无子宫无阴道的原发性闭经患者的核磁共振检查结果。方法9名年轻女性行磁共振检查,由妇科医生及放射线医生共同评价苗勒氏管、阴道、卵巢和其他发现。结果全部病例盆腔内都发现双侧始基子宫,其中1例有单侧的宫腔。始基子宫平均长径（2．73±0．68）cm。在全部病例中,两侧始基子宫之间由纤维带状结构连接。在7个病例中,带状结构交汇于位于膀胱上方靠近中央的三角软组织。8例有阴道下1／3存在。9例在始基子宫附近有双侧正常卵巢组织。1例单侧盆腔肾,2例第五腰椎骶骨化。结论在先天性无子宫无阴道综合征的病人中典型的苗勒氏管残存结构表现为由纤维带状组织连接的双侧始基子宫,两侧组织在膀胱上方的三角形软组织中线处汇合。     

预防性输卵管切除术对卵巢功能的影响及其对盆腔疾病的预防作用

目的：探讨围绝经期女性因子宫良性疾病行开腹全子宫切除术同时预防性切除双侧输卵管对卵巢功能的影响以及对盆腔疾病（卵巢恶性肿瘤、卵巢良性肿瘤和盆腔炎性疾病等）的预防作用。方法：选择因子宫良性疾病行开腹全子宫切除术的患者100例,其中仅行全子宫切除术者50例作为对照组,行全子宫切除术同时行预防性双侧输卵管切除术者50例作为预防组。比较2组患者手术时间、术中出血量、排气时间和住院时间;比较术前及术后6个月、术后1年患者的卵巢基础窦卵泡数目和血清雌二醇（E2）、卵泡刺激素（FSH）及黄体生成素（LH）水平以及围绝经期综合征的发生率,随访患者术后盆腔疾病的发生率。结果：2组患者手术时间、术中出血量、排气时间及住院时间比较差异无统计学意义（P>0.05）;与术前比较,2组患者术后6个月和术后1年卵巢基础窦卵泡数目减少,E2水平降低,FSH和LH水平升高（P<0.01）;但组间卵巢基础窦卵泡数目和E2、FSH及LH水平比较差异无统计学意义（P>0.05）。2组患者术后围绝经期综合征发生率比较差异无统计学意义（P>0.05）。2组患者术后6个月、术后1年卵巢恶性肿瘤和卵巢良性肿瘤发病率比较差异无统计学意义（P>0.05）;对照组患者术后盆腔炎性疾病发病率明显高于预防组（P<0.05）。对照组有2例患者术后确诊为输卵管癌,预防组有2例患者输卵管病理回报见不典型细胞。结论：切除子宫同时行预防性输卵管切除术对患者卵巢功能未见明显影响,且能够有效降低盆腔良、恶性疾病及盆腔炎性疾病的发病率。     

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.     

腹式子宫全切除术并发症的预防和处理——附520例病案分析

本文对1976～1980年520例腹式子宫全切除术进行了临床分析,47例术后发生感染(9.04%),膀胱损伤1例,阴道断端出血72例(13.85%),烫伤4例。预防感染,要掌握无菌技术,术前治疗生殖器炎,术后选用抗生素。阴道残端出血的预防,要严格控制感染和改进缝合方法,避免器官损伤、熟悉盆腔解剖,细心操作。     

附件肿瘤超声误诊临床分析

目的分析超声诊断附件肿瘤误诊为盆腔包裹性积液的原因。方法回顾性研究9例经超声诊断为盆腔包裹性积液的附件肿瘤病史、超声图像特征等,与盆腔包裹性积液的图像特征进行比较。结果9例经超声诊断为盆腔包裹性积液的病例经手术确诊为各种良恶性附件肿瘤。其中,卵巢浆液性囊腺癌l例;库肯勃氏瘤1例;卵巢黏液性囊腺瘤3例;卵巢恶性梭形细胞肿瘤1例;卵巢浆液性乳头状囊腺瘤1例;1例左卵巢成熟囊性畸胎瘤,右卵巢黏液性囊腺瘤;输卵管子宫内膜异位囊肿1例。结论对于不典型的附件良性肿瘤及恶性肿瘤进行超声诊断时要仔细观察,加用彩色多普勒,结合病史及各种检查结果如肿瘤指标如CA125等,一侧卵巢未显示时,应高度警惕是否该侧的囊性占位来源于卵巢,有助于与盆腔包裹性积液相鉴别。     

Laparoscopic findings of subfertile female patients in a tertiary hospital

Sub-fertility affects approximately 15% of couples. Approximately 40% of cases involve a male factor, 40% involve a female factor and the remainder involves both sexes. The polycystic ovary syndrome (PCOS) is one of the most common causes of sub-fertility due to anovulation in women. Treatment of sub-fertility in female partners mainly depends on the laparoscopic findings of patients with PCOS, pelvic inflammatory disease (PID), endometriosis and fibroid uterus. Between February 2007 and April 2009, 73 subfertile women with PCOS were evaluated on their laparoscopic findings in a tertiary hospital in Dhaka city. Mean±SD age was 28.55±3.98 years and primary sub-fertility was 68.5% vs. secondary 31.5% (p<0.01). In most cases, uterine size and position was normal (91.8%, p<0.001 and 89%, p<0.001) and 78.1% mobile. In most of the cases pouch of douglas was normal (78.1%, p<0.001) and adhesion absent (72.6%, p<0.001). In majority of the cases both right and left fallopian tubes were patent (80.8% vs. 75.3%) and ovary healthy (65.8% vs. 64.4%). Positive dye test of right and left fallopian tubes was significantly high (p<0.001). Careful evaluation of laparoscopic findings, are likely to help appropriate treatment modalities for desired outcome.     

子宫切除术后卵巢功能的变化

为了解子宫切除后保留卵巢的功能变化 ,对此类患者 1 60例进行 1～ 3年追踪观察。观察指标包括更年期症状、性欲、阴道涂片、性激素、骨密度以及心血管疾病发生情况等。发现 :切除子宫者的卵巢比有子宫者的卵巢功能低下且衰退得早 ;术后第 3年子宫切除者的卵巢功能明显下降 ,雌激素浓度甚至低于同龄人早卵泡期的浓度。结果提示 :对子宫切除并保留卵巢的患者术后要严密监测卵巢功能并要适时补充雌激素     

卵巢的器官内淋巴管及其淋巴流向

目的 为卵巢恶性肿瘤手术的淋巴结清扫提供形态学依据。方法 用墨汗硝酸银水溶液或伊文氏蓝水溶液对１５只家兔的卵巢进行了灌注或注射。结果 卵巢内含有丰富的毛细淋巴管和淋巴管,卵巢的集合淋巴管除注入腰淋巴结处,还注入盆淋巴结。结论 在行卵巢癌淋巴结清扫时,不但要清扫腰淋巴结,同时也要清扫盆淋巴结。     

宫颈癌根治术后泌尿系统并发症临床分析

目的探讨宫颈癌根治术后泌尿系统发生并发症的相关因素及防治方法。方法 2008-01～2011-12间,我院共收治宫颈癌患者144例,行手术治疗66例,其中:行根治性手术53例。本文回顾性分析该53例患者的临床资料。结果患者平均年龄46岁,临床分期:I a～II b期,均行子宫根治术+盆腔淋巴结清扫术,其中:行双附件切除35例,双卵巢活检+移位术18例。术后膀胱功能障碍发生率为49.1%,泌尿系感染发生率为26.4%,无1例尿漏发生。手术范围广是造成神经损伤导致尿潴留的主要原因,预防性使用促进平滑肌收缩药物可降低尿潴留发生率;尿路感染与年龄、留置导尿管时间长具有相关性。结论术后泌尿系统并发症是宫颈癌根治术后最常见并发症,可能对患者健康造成不良影响,应引起足够重视,并积极预防和处理。     

女性生殖道同期发生的黏液性上皮化生和肿瘤14例分析

 目的 探讨女性生殖道同期发生的黏液性上皮化生和肿瘤(synchronous mucinous metaplasia and neoplasia of the female genital tract,SMMN-FGT)的临床表现、病理特征、诊治方法及预后。方法 回顾性分析2014年10月至2020年4月复旦大学附属妇产科医院诊断的14例SMMN-FGT患者的临床资料和随访记录。结果 发病中位年龄为46岁(33~70岁),初发症状主要为阴道排液(8/14)及卵巢囊肿(4/14)。所有行HPV检查的患者(13/14)结果均为阴性。所有患者均接受手术治疗,其中7例行全子宫+双附件切除术,4例行广泛全子宫+双附件切除术+盆腔淋巴结清扫术,3例行全子宫+双侧输卵管切除术,保留卵巢。术后病理提示14例病变累及子宫内膜,13例累及宫颈,9例累及输卵管,9例累及卵巢,7例同时累及宫颈、子宫内膜,输卵管及卵巢。8例患者进展为恶性肿瘤,术后接受辅助治疗。随访14~80个月,1例因复发死亡,13例继续随访中。结论 SMMN-FGT是一组同时累及女性生殖道多个部位的黏液性病变,阴道排液多为其首发症状,其宫颈病变与HPV感染无关。治疗以手术为主,合并恶性病变患者须行辅助治疗,预后有待进一步随访。     

重度宫颈上皮内瘤变子宫切除术前行宫颈环切术临床价值

目的：探讨重度宫颈上皮内瘤变（ CINⅢ）患者子宫切除术前行宫颈环切术（ LEEP）的临床价值。方法：将70例阴道镜下活检确诊为CINⅢ患者先行LEEP后行全子宫切除术,对比阴道镜活检、LEEP后病理及切缘状态与全子宫手术标本病理情况的差异。结果：阴道镜活检、LEEP后宫颈组织病理学检查结果诊断不符合率28.57%,病理升级为浸润癌5例,升级率为7.14%;子宫切除术后病理提示慢性宫颈炎39例,无病变率55.71%;LEEP切缘阳性50例中,全子宫切除术后阳性23例,阳性率46.00%,LEEP切缘阴性20例中,全子宫切除术后阳性8例,阳性率40.00%;环切切缘阳性与阴性患者发生子宫残余病灶风险差异无统计学意义（P〉0.05）。结论：阴道镜下多点活检对宫颈病变存在漏诊;需要全子宫切除的CINⅢ患者,术前一定要先行诊断性环切,直接切除子宫是有风险的。     

FALLOPIAN TUBE PROLAPSE FOLLOWING HYSTERECTOMY

FALLOPIANtubeprolapse(FTP)isararecompli cationafterhysterectomy.Itisconsideredasaherniabetweentheperitonealcavityandvaginalcanal.ThefirstcasewasreportedbyPozzi1in1902,andsporadiccaseshavebeenaddedtotheliteraturesincethen,butonlylessthan200caseswerereporte…