盆腔静脉瘀血综合征的解剖学因素

目的:为探讨输卵管结扎术后发生盆腔静脉瘀血综合征的解剖因素,并提出预防措施。方法:解剖观测40侧子宫阔韧带内静脉。结果:子宫上静脉于输卵管峡部中点处外径是3.8±0.4mm,汇人卵巢丛后外径为5.2±0.5mm;输卵管峡部中点距子宫上静脉6.5±0.6mm。结论:输卵管结扎手术阻断或扭曲子宫上静脉和输卵管静脉与盆腔静脉瘀血综合征的发生有关。     

输卵管的形态观测及临床意义

目的通过对育龄期妇女输卵管内部形态的观察和测量,提供输卵管各部位的活体和离体数据,为输卵管生育和节育研究提供科学依据。方法输卵管造影100例、宫腔镜检查30例和离体标本20例进行输卵管各部位长度,径线及内口的形态的观察和测量,采用两样本t检验进行分析。结果⑴造影观测双侧输卵管内口直径为(1.07±0.48)mm;间质部中段(0.50±0.22)mm;间质部远端(0.32±0.12)mm;峡部内径(0.46±0.28)mm;壶腹部内径(2.43±1.45)mm;间质部长度(5.27±4.28)mm;峡部长度(24.35±12.27)mm;壶腹部长度(39.94±22.05)mm;总长(70.78±32.07)mm。⑵宫腔镜观测内口为圆形占76.7%和椭圆形占23.3%;⑶离体标本观测内口周径(5.87±1.46)mm;峡部周径(2.83±1.87)mm;间质部长度(6.73±2.49)mm;峡部长度(20.56±7.61)mm;全长(85.42±22.93)mm。结论⑴输卵管是内外口扩大而内径不均匀走行曲折迂回的管道,间质部呈漏斗状,最狭窄的部位在间质部远端。⑵了解输卵管的内部形态对生育和节育的研究都具有重要意义。     

子宫动脉上行支的解剖学研究及临床意义

目的:为设计保留子宫动脉上行支及卵巢支的子宫剥除术式提供解剖学依据。方法:随机收集108例新鲜离体子宫连带一侧或双侧附件标本,解剖观测子宫动脉上行支及其各分支的起点外径、位置和分布走行;观察上行支主干与宫壁肌层间紧密度。结果:子宫动脉上行支主干左为(2.81±0.57)mm,右为(2 86±0.56)mm;卵巢支左为(2.00±0.50)mm,右为(1.74±0.51)mm;输卵管支左为(1.33±0.40)mm,右为(1.23±0.43)mm;宫底支左为(1.66±0.39)mm,有为(1.63±0.41)mm。在宫角部上行支的分支分布类型有3型Ⅰ型占58％,Ⅱ型占34％,Ⅲ型占8％;卵巢支分支部位在圆韧带附着子宫角下缘后方至下方3cm之间;上行支主干与宫颈峡部接触较为紧密且呈较大幅度迂曲状,向上行走后逐渐平直且与子宫壁间渐为疏松,至卵巢支分支处大约有0.5 cm。结论:子宫动脉上行支及卵巢支管经较粗,且与子宫外壁保持一定间距,经临床实践,在保留卵巢的子宫切除手术中可完整保留,且不必连带子宫肌层。     

以胎儿为供体卵巢移植的应用解剖

本文观察了60例女性7个月～足月胎儿尸体的卵巢血供和卵巢的大小,输卵管的长度和峡部外径及子宫动脉升支在子宫角处外径。讨论了供体的戴取方法、受区及其血管的选择和手术切口的设计等。为胎儿为供体的吻合血管卵巢移植提供解剖学资料。     

输卵管显微整复术的解剖基础和临床应用

目的 :通过对输卵管的显微解剖和对输卵管妊娠患者行显微整复术 ,探讨该术式的可行性和疗效。方法 :① 4具育龄期新鲜标本 ,动脉灌注红色乳胶 ,在手术显微镜下测量输卵管各部位长度 ,并观测其动脉来源及静脉回流。②对 16例输卵管妊娠患者进行输卵管显微整复手术 ,保留输卵管功能。结果 :①输卵管全长 8cm～ 13cm ,其子宫部长约 1cm、峡部长约 2cm～ 3cm、壶腹部长约 5cm～ 8cm、漏斗部长约 1cm。其动脉来源于子宫动脉的输卵管支、峡支和卵巢动脉的输卵管支 ;静脉与动脉伴行 ,内侧份汇入子宫阴道丛 ,外侧份汇入卵巢静脉丛。②所有病例均按其病变部位原解剖形态和长度进行整形、修补。术后行输卵管通液试验 ,通液成功率 10 0 %。结论 :输卵管血供丰富 ,显微手术整复准确、成功率高 ,但必须具备一定的物质条件和技术水平。     

多模态子宫输卵管超声造影评估输卵管堵塞性病变的诊断价值

目的：分析多模态子宫输卵管超声造影（HyCoSy）对输卵管堵塞性病变的诊断价值。方法：选择在龙岩市第一医院超声科完成子宫输卵管造影的948例患者，其中符合纳排标准的不孕患者84例，行2D/3D/4D-HyCoSy及宫腔镜下输卵管通染液检查（LDT）。记录84例患者宫腔镜与LDT分析结果，以LDT诊断结果为金标准，分析3D/4D-HyCoSy的多模态HyCoSy检查的灵敏度、特异度、准确率。结果：84例患者中慢性盆腔炎最多，占比为33.33%，内膜炎伴赘生物占比为19.05%，多囊卵巢占比为14.29%，子宫内膜异位症占比为13.09%，输卵管炎占比为11.91%，其他占比为8.33%。84例患者共168条输卵管中通畅110条，堵塞58条，其中58条输卵管堵塞中以单侧堵塞（89.66%）与远端堵塞（67.25%）为主。以LDT诊断结果为金标准，多模态HyCoSy诊断输卵管堵塞性病变的临床灵敏度、特异度及准确率分别为98.27%、94.55%、95.24%，分别高于3D-HyCoSy(86.20%、80.00%、82.14%)与4D-HyCoSy(91.37%、85.45%、87.50%)...     

活体输卵管的形态观察及测量

为探究活体输卵管形态、长度、管径及其与身高的关系,笔者进行了一些观察与测量,旨在积累国人体质资料为临床应用提供依据。 1材料与方法 本文观测了安徽省宁国、旌德、绩溪3县农村510例接受输卵管结扎术的健康育龄妇女的输卵管,年龄22～42岁,平均27.68岁。术前测量身长,行全身体格检查与妇科检查,以排除禁忌症。局麻下常规进腹,提出输卵管,用艾利氏钳固定并观察形态,术者以食指触及子宫角部,用硬膜外导管,沿食指与输卵管间子宫角部,用游标卡尺测得子宫角部至伞端的距离(即峡部、壶腹部和漏斗部三部之长度)。采用抽芯包埋法将切下之卵管(约1～1.5cm)用1％福尔马林固定,供活检及输卵管峡部之直径测量。     

活体育龄妇女输卵管长度和内径的测量及其临床意义

目的 探讨数字减影血管造影(DSA)血管分析软件测量活体育龄妇女输卵管管腔长度和内径的临床意义.方法 收集子宫输卵管造影(HSG)显示为输卵管正常的不孕患者200例,应用Philips Allira 12 DSA机血管分析软件测量输卵管长度和内径.结果 正常育龄妇女HSG检查所见输卵管总长度为(12.52±2.17)cm(8.31～15.64 cm),左侧总长度为(12.33±2.31)cm(8.31～15.32 cm),右侧总长度为(12.71±2.08)cm(8.57～15.64 cm).输卵管峡部内径左侧为(0.09±0.03)cm(0.05～0.12cm),右侧为(0.09±0.02)cm(0.06～0.10 cm);输卵管壶腹部内径左侧为(0.62±0.49)cm(0.25～1.54cm),右侧为(0.65±0.51)cm(0.23～1.61 cm).双侧输卵管长度和各部位内径差异均无统计学意义(均P＞0.05).结论 DSA血管分析软件可测量活体输卵管的内径和长度,有一定的临床意义.     

透视下行子宫输卵管造影中近端输卵管梗阻假阳性因素分析

目的提高子宫输卵管造影中诊断输卵管近端梗阻的准确性。方法选择600例生殖医学中心的不孕受检者,年龄21～45岁,平均年龄34岁。随机分成A、B、C、D 4组,A组222例444条输卵管,B组121例242条输卵管,C组135例270条输卵管,D组122例244条输卵管。在实时透视下行子宫输卵管优维显造影,分析输卵管造影中近端输卵管梗阻的假阳性因素。结果导管顶端位于输卵管开口处121例,其中98例（80.99%）导致同侧宫角及输卵管不显影;经适当外拉或旋转导管后112例（92.56%）同侧宫角显影,其中84例（69.42%）同侧输卵管近端显影,仅有37例为近端输卵管梗阻。因球囊过大或过小导致造影剂未能充盈宫角者135例,其中78例（57.78%）单侧近端输卵管不能显影,经调整后59例（43.70%）单侧输卵管近端显影,仅19例为单侧近端输卵管梗阻。122例受检者仅以盆腔正位观察,有48例（39.34%）单侧输卵管近端不能显影,改变体位后35例（28.69%）近端输卵管得以显影。4组子宫输卵管造影中,B、C、D 3组输卵管近端梗阻率均低于A组常规输卵管造影,D组输卵管梗阻率明显低于前3组。结论在透视下行子宫输卵管造影,能及时判断造成近端输卵管不显影的假阳性因素并及时纠正,可直接提高输卵管显影率及诊断准确性。     

电视宫腔镜下输卵管间质部阻塞介入治疗的临床体会

目的观察电视宫腔镜下输卵管插管诊治输卵管间质部梗阻疗效。方法选择HSG诊为输卵管间质部梗阻病例132人,共182条输卵管,经宫腔镜尼鳅导丝插入输卵管开口,疏通进入输卵管间质部5~8mm,疏通后再用硬膜外导管注入含美蓝指示液的药水。结果疏通输卵管治疗182条输卵管,治疗通畅者119条,治愈率65.38%,共81例,治愈率65.38%。81例中,妊娠24例,宫外孕1例,妊娠率29.63%。结论电视宫腔镜下输卵管间质部阻塞介入治疗简便、快捷、安全有效。     

Specific response of ovarian and uterine veins of mice to sex hormones

Pellets of glass (control), progesterone (P), testosterone (T), and estradiol-17β (E) were placed on the mesentery or subcutaneously in the flank in ovariectomized (O) and ovariectomized-hysterectomized (OH) mice, insuring that all or most of the hormone would pass through the superior mesenteric or circumflex iliac veins. After 21 days the diameters of these and of the ovarian, uterine, and femoral veins and inferior vena cava were measured at autopsy. T and E caused significant enlargement of the uteri; E was also responsible for bladder distention. The ovarian and uterine veins enlarged significantly in mice treated with T and E as compared to the controls. All other veins failed to respond to P, T, and E. The evidence demonstrates a specific response of ovarian and uterine veins in O and OH mice to T and E.     

Vein size in intact and hysterectomized mice during the estrous cycle and pregnancy

The diameters of the ovarian, uterine, and femoral veins and the inferior vena cava were measured during stages of the estrous cycle in intact and hysterectomized mice and at intervals during pregnancy in mice with embryos in both uterine horns or in only the left horn. At metestrus I vein sizes were the least and were not significantly different in intact and hysterectomized mice. Ovarian and uterine veins showed the same or increased diameters at other stages of the cycle; veins enlarged progressively during pregnancy in intact mice. Non-gravid uterine horns showed little size increase as compared to gravid horns. Increases in vein diameter appeared to be correlated with local production of reproductive hormones. Evidence for transuterine migration of embryos was observed in 21 of 53 mice in which one uterine tube had been ligated or one ovary had been removed.     

Vein size in intact and hysterectomized mice during the estrous cycle and pregnancy.

The diameters of the ovarian, uterine, and femoral veins and the inferior vena cava were measured during stages of the estrous cycle in intact and hysterectomized mice and at intervals during pregnancy in mice with embryos in both uterine horns or in only the left horn. At metestrus I vein sizes were the least and were not significantly different in intact and hysterectomized mice. Ovarian and uterine veins showed the same or increased diameters at other stages of the cycle; veins enlarged progressively during pregnancy in intact mice. Non-gravid uterine horns showed little size increase as compared to gravid horns. Increases in vein diameter appeared to be correlated with local production of reproductive hormones. Evidence for transuterine migration of embryos was observed in 21 of 53 mice in which one uterine tube had been ligated or one ovary had been removed.     

Testosterone and 17β-oestradiol secretion of the human ovary. I. Normal young women,and premenopausal women with endometrial hyperplasia

Testosterone and 17β-oestradiol were determined in blood obtained from the ovarian veins of 26 women, 16 of whom were young and regularly ovulating and menstruating, and 10 of whom were premenopausal with uterine bleedings and endometrial hyperplasia. The concentrations of these two hormones in the cubital veins of the premenopausal women were also determined. It was found that the concentrations of the two hormones were not significantly greater in the premenopausal women than in the control group of young normally ovulating and menstruating women in the periovulatory phase of the menstrual cycle, but that the ovarian secretion rates of both hormones, particularly of testosterone, were considerably greater in the premenopausal women. In these women the concentrations of both hormones were significantly lower in the cubital veins than in the ovarian veins. The conclusion is that the augmented oestrogenic effect on the endometrium and on other target organs of premenopausal women with endometrial hyperplasia may be due not only to an increased ovarian secretion rate of estradiol, but also and more specifically to an increased ovarian secretion rate of testosterone, and to the rapid conversion of this hormone into oestradiol in the periphery.     

子宫动脉栓塞治疗产后大出血的临床应用

目的评价应用子宫动脉栓塞手术治疗产后大出血的临床应用价值。方法26例产后大出血患者行子宫动脉栓塞手术,超选择插管进入双侧子宫动脉及侧支供血血管,造影证实后,注入明胶海绵颗粒予以栓塞,重复造影,证实栓塞成功。结果26例患者共栓塞子宫动脉51支,侧支供血血管3支,全部栓塞成功,21例患者术后即时止血,5例患者出血逐渐停止,无一例出血复发,无一例严重并发症发证。结论子宫动脉栓塞手术治疗产后大出血,即时、准确,疗效高,创伤小,恢复快,并发症少,保留了子宫、卵巢正常的生理功能,有利于患者的身心健康,具有较高的临床应用价值。     

16alpha-hydroxy-progesterone as a sex hormone antagonist: effect on venous diameters in the female mouse.

Pellets of progesterone plus 1% 16alpha-hydroxy-progesterone (16alpha-OH), testosterone plus 1% 16alpha-OH, and estradiol-17beta plus 1% 16alpha-OH were implanted in the right uterine fat mass in ovariectomized (O) and ovariectomized-hysterectomized (OH) mice. Three weeks later they were killed and the diameters of the ovarian, uterine, and femoral veins and the inferior vena cava were measured and averaged. The averages were compared with averages for O and OH mice bearing pellets of glass and of progesterone, testosterone, and estradiol-17beta without 16alpha-OH. It is concluded that in castrate mice the size of ovarian and uterine veins is influenced not by the presence or absence of the uterus but by sex steroids, that progesterone usually causes decreases while testosterone and estradiol-17beta cause increases in vein diameter, and that both the presence of the uterus and the administration of 1% 16alpha-OH are associated with partial inhibition of increases in vein size induced by steroids. Uterine hypertrophy and urinary bladder distention resulting from the administration of testosterone and estradiol-17beta were not prevented by the addition of 1% 16alpha-OH.     

CT在外突性子宫肌瘤与卵巢性索间质肿瘤的鉴别诊断价值

目的:探讨CT对外突性子宫肌瘤与卵巢性索间质肿瘤的鉴别诊断价值。方法:回顾性分析2015年1月~2019年2 月重庆医科大学附属第一医院收治的外突性子宫肌瘤（n=43）和卵巢性索间质肿瘤（n=36）患者资料。分析CT平扫及增 强图像，将数据传输至ADW4.5工作站完成多平面重建、最大密度投影和容积再重建等CT后处理重建。观察并记录肿瘤 与输尿管位置、肿瘤供血动脉、卵巢静脉与肿瘤关系、肿瘤强化程度及方式、有无腹水。以病理结果为金标准，计算CT诊 断准确率。结果:外突性子宫肌瘤位于输尿管前或内前方，主要由子宫动脉供血，分支多且于瘤体内呈较均匀分布，肌瘤 实性部分呈漩涡样中度或明显强化改变，追踪卵巢静脉可见正常卵巢组织，不易合并腹水；卵巢性索间质肿瘤位于输尿管 前或内前方，主要由卵巢动脉供血，分支少且于肿瘤实质内呈较均匀分布，静脉期见卵巢血管蒂征，肿瘤实性部分呈无或 轻度强化改变，追踪卵巢静脉不能显示正常卵巢组织，常合并腹水，可见卵巢血管蒂征。以病理结果为金标准，术前CT诊 断外突性子宫肌瘤准确率为93.03%，术前CT诊断卵巢性索间质肿瘤准确率为80.56%。结论:根据CT特点并结合临床 表现可较好地对外突性子宫肌瘤与卵巢性索间质肿瘤做出鉴别诊断，值得临床推广应用。     

16α-hydroxy-progesterone as a sex hormone antagonist: Effect on venous diameters in the female mouse

Pellets of progesterone plus 1 % 16α-hydroxy-progesterone (16α-OH), testosterone plus 1 % 16α-OH, and estradiol-17β plus 1 % 16α-OH were implanted in the right uterine fat mass in ovariectomized (O) and ovariectomized-hysterectomized (OH) mice. Three weeks later they were killed and the diameters of the ovarian, uterine, and femoral veins and the inferior vena cava were measured and averaged. The averages were compared with averages for O and OH mice bearing pellets of glass and of progesterone, testosterone, and estradiol-17β without 16α-OH. It is concluded that in castrate mice the size of ovarian and uterine veins is influenced not by the presence or absence of the uterus but by sex steroids, that progesterone usually causes decreases while testosterone and estradiol-17β cause increases in vein diameter, and that both the presence of the uterus and the administration of 1 % 16α-OH are associated with partial inhibition of increases in vein size induced by steroids. Uterine hypertrophy and urinary bladder distention resulting from the administration of testosterone and estradiol-17β were not prevented by the addition of 1 % 16α-OH.     

Changes in fast uterine muscle potentials in rabbits exposed to chronic hypoxia

Changes in high-frequency myometrial electrical activity after separate and simultaneous division of the uterine and ovarian vessels were studied in 137 chronic experiments on 18 nonpregnant parous rabbits. The deepest and longest (up to 45 days) depression of the amplitude and frequency of fast myometrial potentials was shown to take place after simultaneous division of the uterine and ovarian arteries and veins. Both the amplitude and frequency of the potentials were gradually restored during compensation of the circulation along collateral vessels.Departments of Normal Anatomy and Operative Surgery, Ivano-Frankovsk Medical Institute. (Presented by Academician of the Academy of Medical Sciences of the USSR V. N. Chernigovskii.) Translated from Byulleten' Éksperimental'noi Biologii i Meditsiny, Vol. 85, No. 6, pp. 667–670, June, 1978.     

Uterine first pass effect in postmenopausal women

BACKGROUND: Vaginally administered drugs distribute preferentially to the uterus; counter-current transfer from the vaginal veins to the uterine artery probably plays a pivotal role. In each side, the ovarian and uterine arteries form arterial anastomoses and controversy exists regarding the origin of the arterial supply to the Fallopian tube and tubal part of the uterus, and consequently whether these tissues can be reached through vaginal administration. METHODS: A thermocatheter with four measurement points, each separated by 5 mm, was inserted under endoscopic control into the tubal corner of uterus in 10 conscious, menopausal women and the temperatures registered every 2 s. The vagina was then flushed for 15 min with 1.5 l of saline at room temperature, after which the probe position was re-assessed by the endoscope. RESULTS: The lowest measurement point (15 mm from the tip) cooled significantly more than the other points (P < 0.0001). At 15 min, mean temperature reduction at point 4 was significantly greater than at all other measurement points (P < 0.05) due to local transfer of cold from vaginal vein blood to the uterine arterial blood (but not the ovarian artery). CONCLUSIONS: The results support the theory that, at least in postmenopausal women, the uterine artery supplies most of the uterus while the corneal part of cavity (up to 5-10 mm from the ostium) receives the blood supply from the ovarian artery. This finding represents a rationale for vaginal administration of drugs when a local effect on the uterus (e.g. progestational or relaxation) in postmenopausal women is requested.