绝经后阴道出血的临床分析

目的了解自然绝经后妇女阴道出血的原因。方法选择2010年1月~2014年1月在我院妇科住院和门诊就诊以绝经后阴道出血为主诉的患者98例,随机分为A组和B组,A组50例,绝经5年内,B组4 8例,绝经5年以上,观察两组患者引起阴道出血原因。结果 A组患者引起阴道出血原因:良性疾病16例(32%);功能性病变28例(56%);恶性肿瘤6例(10.2%);B组患者引起起阴道出血原因:良性疾病22例(45.8%);功能性病变18(37.5%);恶性肿瘤8例(16.6%)。结论因此对绝经后反复阴道出血、排液,及时行TVS及ECT检查,对于经过超声测量子宫内膜厚度1 cm的患者,即使通过细胞学检查患者子宫内膜呈阴性,也需要及时接受宫腔镜检查确诊,以排除恶变。     

宫腔镜诊治绝经妇女宫内病变的优点

为探讨宫腔镜手术治疗绝经妇女宫内病变的安全性和有效性进行研究。6年间50例绝经妇女宫腔镜检查有宫内病变,其中46例有异常阴道出血,4例无症状,因盆腔超声发现异常作宫腔镜检查。14例接受激素替代疗法(HRT),5例因乳腺癌服三苯氧胺(TAM),6例因严重内科病(阻塞性肺疾患1例,肺栓塞史2例和缺血性心脏病各2例、近期脑血管意外1例)不宜做大手术。术前宫颈细胞学检查仅1例异常,可疑腺棘皮癌。术前子宫内膜活检47例正常,2例子宫内膜息肉,1例术前未做内膜活检。术中发现32例内膜息肉,9例子宫肌瘤。8例内膜息肉并肌瘤,1例宫腔粘连合并宫腔积血。宫腔镜内膜息肉和肌瘤电切除术用26F连续灌流电     

绝经后妇女阴式手术前应用雌三醇的临床观察

目的 :观察绝经后妇女阴式手术前应用雌三醇 (E3 )的临床效果和安全性。方法 :12 6例Ⅱ度或Ⅲ度子宫脱垂伴不同程度阴道前后壁膨出患者按 1∶1随机入组 ,A组 (研究组 ) 6 3例 ,每晚用含 0 5mgE3 的膏剂 0 5g ,B组 (对照组 )6 3例 ,每晚用凡士林膏剂 0 5g ,连续 7天。于用药后 7天作阴道健康评分 (VHS) ,阴道细胞成熟指数 (MI) ,致密核指数(KI) ,血清E2 、FSH水平测定 ,观察术中出血量、手术时间 ,子宫内膜厚度及病理检查 ,不良反应情况 ,综合评价疗效及安全性。结果 :A组的VHS、KI、MI与B组相比明显升高 (P <0 0 5 ) ;术中出血量、手术时间与B组相比明显降低 ,差异有显著性 (P <0 0 5 ) ;血清E2 ,FSH水平 ,子宫内膜的厚度及病理检查无明显变化 (P >0 0 5 ) ,用药后无明显不良反应。结论 :雌三醇术前应用对绝经后妇女阴式手术是有效、安全的。     

子宫内膜息肉213例分析

目的　通过对 2 1 3例子宫内膜息肉的回顾性分析 ,探讨子宫内膜息肉的病因、诊断及处理。方法　回顾性分析 1 993年 1月～ 2 0 0 1年 1 2月我院通过手术病理诊断的 2 1 3例子宫内膜息肉病历。结果　患者平均年龄 4 9 1岁 (2 6～ 82岁 )。 3例 (1 4 % )有激素替代的历史 ;1 0例 (4 7% )为乳腺癌术后服用三苯氧胺。 5 6例绝经后患者中 ,2 4例 (4 2 9% )绝经后出血 ;32例 (5 7 1 % )无症状 ,仅通过超声或手术后发现。 1 5 7例未绝经患者中 ,5 7例 (36 3% )有不规则出血症状 ;5 3例 (33 8% )周期正常 ,但经量增多 ;4 7例 (2 9 9% )月经正常。经超声诊断率为 6 5 3% (1 30 1 99) ,刮宫诊断率为 30 0 % (1 8 6 0 )。病理报告 1 6 5例 (77 5 % )合并正常内膜 ;2 4例 (1 1 3% )合并存在子宫内膜单纯增生 ;6例 (2 8% )合并存在子宫内膜复合增生 ;3例 (1 4 % )并子宫内膜非典型增生 ;2例 (0 9% )合并子宫内膜癌 ;1例 (0 5 % )合并低度恶性子宫内膜间质肉瘤。结论　子宫内膜息肉是一种常见的宫腔内良性病变 ,常表现为异常出血 ,也可无症状 ,常与子宫内膜的增生或子宫内膜癌前病变合并存在。妇科阴道超声作为无创性检查 ,可提示内膜息肉的存在 ,宫腔镜是诊断内膜息肉的金标准。处理首选宫腔镜下内膜息肉     

宫腔镜双、单极电切割粘膜下子宫肌瘤的对照研究

目的:探讨宫腔镜下双极汽化切割粘膜下子宫肌瘤的临床价值。方法:双极汽化切割粘膜下子宫肌瘤61例与单极电切割粘膜下子宫肌瘤65例,就两组患者临床特征、手术时间、术中出血量、膨宫液量和并发症进行对比分析。结果:两组患者年龄、术前血红蛋白(HGB)、肌瘤大小、宫腔深度差异无显著性(P>0.05),手术时间、术中出血量、膨宫液量和术中并发症差异有显著性(P<0.01)。结论:宫腔镜双极汽化切割术与单极电切割术相比,具有手术时间短、术中出血少、膨宫液量少、并发症少等优点,宫腔镜双极汽化切割术可替代单极电切割术。     

绝经后阴道出血妇女性激素水平与子宫内膜病变关系的研究

目的　探讨绝经后阴道出血的妇女性激素变化及与子宫内膜病变的关系。方法　采用酶免疫法对 4 6例绝经后阴道出血的患者性激素水平测定。结果　绝经后阴道出血妇女血清E2 水平远高于正常绝经后妇女血清E2 值 ,两者存在显著性差异 (P <0 0 1 )。FSH、LH与正常绝经后妇女比较明显降低 (P <0 0 5 )。子宫内膜增生过长和子宫内膜癌的患者雌激素水平增高者分别占 71 4 %和 5 7 1 %。结论　绝经后阴道出血与雌激素水平增高有关     

绝经后阴道出血127例临床分析

目的　了解自然绝经后妇女阴道出血病因、病理。方法　选择 1 998年 1月～ 2 0 0 2年 1 2月在我院妇科住院和门诊就诊 ,以绝经后阴道出血为主诉的患者 1 2 7例。分为两组 ,Ⅰ组 73例 ,绝经 1年以上 ,5年以下 ;Ⅱ组 5 4例 ,绝经 5年以上。观察两组患者引起阴道出血原因。结果　Ⅰ组 73例患者引起阴道出血原因 :良性疾患 2 6例 ,占 35 6 % ;功能性病变 39例 ,占 5 3 4 % ;恶性肿瘤 8例 ,占 1 1 0 %。Ⅱ组 5 4例患者 ,引起阴道出血原因 :良性疾患 2 1例 ,占 38 9% ;功能性病变 1 4例 ,占 2 5 9% ;恶性肿瘤 1 9例 ,占 35 2 %。两组结果经 χ2 检验 ,P <0 0 1 ,差异有极显著性。结论　绝经后阴道出血 ,良性疾患和功能性病变为主要原因 ,绝经时间越长 ,出现的阴道出血 ,恶性肿瘤发生机率越大     

他莫昔芬对乳腺癌患者子宫内膜影响的前瞻性临床病理研究

目的:前瞻性研究他莫昔芬对乳腺癌患者子宫内膜的影响。方法:对2005年1月~2008年10月于温州医学院附属第二医院乳腺外科手术的155例乳腺癌患者进行随访,以阴道B超、宫腔镜及子宫内膜活检评价服用他莫昔芬前后子宫内膜情况。结果:可评价患者共135例,其中绝经前46例,绝经后89例。服用他莫昔芬后,未绝经组36例(78.26%)出现异常阴道流血,9例(19.56%)出现子宫内膜病变,绝经组22例(24.72%)发生异常阴道流血,出现子宫内膜病变29例(32.60%),其中术前绝经组18例(18/59,30.51%),化疗后绝经组11例(11/30,36.67%)。阴道B超对绝经后子宫内膜病变诊断的灵敏度为52.3%,特异度为90.2%,宫腔镜诊断相应的灵敏度为81.8%,特异度为100%。结论:他莫昔芬导致绝经后妇女子宫内膜病变发生增加,对绝经前妇女的影响还不确定。阴道B超可作为初步检测手段,宫腔镜检查可提高诊断的准确率。     

乐力钙治疗更年期、绝经后妇女腰腿、关节痛的体会

目的 :观察更年期、绝经后妇女口服乐力钙 ,治疗因骨质疏松引起的腰腿关节疼痛及肌肉抽搐的临床效果。方法 :对 12 0例 45～ 6 5岁 ,更年期、绝经或人工绝经后 ,临床出现腰背、关节疼痛及肌肉抽搐的门诊病人随机分为 2组 ,A组口服乐力钙 (6 0例 ) ,B组 (对照组 )口服维生素 E,维生素 B1 (6 0例 ) ,追踪观察期为 6个月 ,观察临床症状的变化状况。结果 :A组 (乐力钙组 )的临床症状 1周后得到缓解 ,2～ 4个月症状完全消失。而 B组 (对照组 )临床症状无明显改善 ,差异有显著性 (P<0 .0 1)。结论 :更年期、绝经后妇女每天口服乐力钙可治疗骨质疏松引起的腰背关节疼痛及肌肉抽搐等症状 ,改善中老年人生活质量     

宫腔镜双极汽化切割手术42例分析

目的 :探讨宫腔镜双极汽化切割手术的安全性和疗效。方法 :术前宫腔镜诊断均为粘膜下或肌壁间突向宫腔肌瘤 42例 ,在宫腔镜下施行双极汽化切割手术。结果 :手术成功率 10 0 %,手术时间 2 8 71± 13 83分钟 ,出血量 16 0 7± 12 17ml,标本组织重量 32 2 4± 7 4 6g,术中、术后无并发症 ,术后 3、6、12和 2 4个月随访有效率分别达 97 1%、97 1%、94 3%和 91 4 %。结论 :宫腔镜双极汽化切割手术具有手术时间短、出血少、无并发症等优点 ,疗效满意 ,可替代单极电切割术。     

PK刀在腹腔镜辅助阴式子宫切除术中的应用

目的 探讨五合一双极PK等离子刀（Plasmakinetic^TM Tissue Management System，PK刀）在腹腔镜辅助阴式子宫切除术（LAVH）中的应用价值。方法 回顾性分析北京大学人民医院妇科2003年1月-2004年11月问，住院行LAVH的135例患者的临床资料结果，比较PK刀与五合一双极电凝切刀钳（双极）在LAVH中的手术时间、术中腹腔出血量、术中术后并发症和术后患者恢复情况。结果 与双极相比，PK刀明显减少术中出血量、显著缩短手术时间。结论 PK刀在LAVH中具有一定的优势，改变了双极凭经验掌握电凝程度的不足，避免了组织凝固不均、组织凝固过度炭化和凝固不全出血等缺点，并具有止血效果佳、热辐射损伤范围小、操纵简单等优点，值得推广使用。     

Pregnancy outcomes after laparoscopic myomectomy with ultrasonic energy and laparoscopic suturing of the endometrial cavity

STUDY OBJECTIVE: To evaluate pregnancy outcomes in women with laparoscopic removal of myomas that resulted in entry into the endometrial cavity and required laparoscopic repair of the endometrial cavity. DESIGN: Retrospective chart review (Canadian Task Force classification II-2). SETTING; Private obstetrics-gynecology practice and departments of obstetrics and gynecology at two university-affiliated hospitals. PATIENTS: Seven women with symptomatic uterine leiomyomata treated by laparoscopic myomectomy, who achieved pregnancy. INTERVENTION: Laparoscopic dissection of myomas with the ultrasonic scalpel and laparoscopic suturing of the uterus with the Endo Stitch device in three layers. MEASUREMENTS AND MAIN RESULTS: Indications for laparoscopic myomectomies were excessive bleeding and significant growth of uterine myomas. The size of myomas in all patients ranged from 12 to 2 cm. Average operating time was 232.8 minutes and average blood loss was 117.8 ml. The largest number of myomas removed from a single patient was nine. All procedures were performed on an outpatient basis and no complications occurred. All women easily achieved pregnancy and four were delivered at or near term by cesarean section. One delivered vaginally at 28 weeks secondary to uncontrolled premature labor, without uterine dehiscence. Two had elective terminations at 8 weeks. CONCLUSION: Laparoscopic suturing of the endometrial cavity in three layers does not prevent future pregnancies, and pregnancies can progress to term and in some cases be delivered vaginally without dehiscence. (J Am Assoc Gynecol Laparosc 8(1):129-136, 2001)     

结合雌激素联合方案连续应用防治绝经早期妇女骨量丢失的观察

目的　探讨两种剂量结合雌激素 (CEE)对绝经早期妇女骨丢失的影响及副作用。方法将 2 36例绝经妇女分为 3组 ,A组每日口服CEE 0 62 5mg+醋甲羟孕酮 (MPA) 2mg +钙剂 (Ca D) 1片(含元素钙 60 0mg) ;B组每日口服CEE 0 3mg +MPA 2mg +Ca D 1片 ;C组每日仅服Ca D 1片 ,连续用药 2年。于治疗前、治疗 1 2及 2 4个月测量第 2～ 4腰椎 (L2～ 4 )的骨密度 (BMD) ,记录每月阴道出血情况。结果　A组治疗前、治疗 1 2及 2 4个月 ,L2～ 4 BMD分别为 (1 0 62± 1 4 1 )、(1 0 86± 1 4 5)及 (1 1 0 1±1 34)mg/cm2 ,治疗前后比较 ,差异均有极显著性 (P <0 0 0 1 ) ;B组分别为 (1 0 81± 1 35)、(1 1 1 1± 1 68)及(1 0 90± 1 50 )mg/cm2 ,治疗 1 2个月时与治疗前比较 ,差异有显著性 (P <0 0 5) ,治疗 2 4个月时与治疗前比较 ,差异无显著性 (P >0 0 5) ;C组分别为 (1 0 70± 1 1 9)、(1 0 65± 1 34)及 (1 0 53± 1 30 )mg/cm2 ,治疗前后比较 ,差异均无显著性 (P >0 0 5)。治疗前后BMD的变化 ,A与C组、B与C组之间差异均有显著性 (P <0 0 0 1 ,<0 0 5) ;A与B组治疗 1 2个月时的BMD比较 ,差异无显著性 (P >0 0 5) ,2 4个月时比较 ,差异有极显著性 (P <0 0 1 )。各组子宫内膜均无不典型增生。A、B组出血率 ,治     

Long-Term Reproductive Outcomes after Hysteroscopic Treatment of Dysmorphic Uteri in Women with Reproductive Failure: An European Multicenter Study

ObjectiveTo evaluate the long-term reproductive outcomes in patients with dysmorphic uterus treated by hysteroscopic metroplasty with miniaturized instruments.DesignRetrospective multicenter cohort study.SettingTertiary care university hospitals.PatientsThe study was conducted on 214 women with a dysmorphic uterus (T-shaped, infantilis, or other type of dysmorphic uterus according to the European Society of Human Reproduction and Embryology and the European Society for Gynaecological Endoscopy classification system) with history of primary unexplained infertility (group 1) or repeated (>2) early miscarriages (group 2). Dysmorphic uteri were diagnosed by office hysteroscopy and 3-dimensional transvaginal ultrasound (3D-TVS).InterventionsAll patients underwent in office hysteroscopic metroplasty using a continuous-flow hysteroscope with a 5 Fr operating channel introduced into the uterine cavity using the vaginoscopic approach. Longitudinal incisions were performed on the fibromuscular constriction rings in the isthmic area and in some cases on the other uterine walls with a 5 Fr bipolar electrode or scissors. At the end of the procedure, an antiadhesive gel was applied into the uterine cavity to minimize adhesion formation. Postsurgical assessment of the uterine cavity was carried out through office hysteroscopy and 3D-TVS. All patients were followed for at least 24 months.Measurements and Main ResultsThe metroplasty was completed in all cases, resulting in a significant increase of uterine cavity volume (100%) and optimization of uterine morphology in 211 of 214 women (98.6%). After 60 months, the overall clinical pregnancy rate was 72.9% (n = 156/214), and the live birth rate was 80.1% (n = 125/156). Specifically, 74 of 156 women (47.4%) conceived spontaneously (with a median time to pregnancy of 5.5 months), of whom 32.4% had previously failed 1 or more attempts at in vitro fertilization/intracytoplasmic sperm injection.ConclusionOur long-term follow-up data demonstrate that the hysteroscopic correction of dysmorphic uteri may result in a high live birth rate in women suffering from unexplained infertility or repeated miscarriages.     

腹腔镜子宫全切除术216例临床分析

目的探讨应用腹腔镜行子宫全切除术的安全性及效果。方法对自2002年3月至2004年3月,于腹腔镜下行全子宫切除的216例患者的资料进行回顾性分析。患者平均年龄45.5岁(38～60岁);其中功能失调性子宫出血24例,子宫内膜不典型增生5例,子宫肌瘤139例,子宫腺肌病46例,子宫颈原位癌2例。216例患者中,曾有下腹部手术史36例。腹腔镜下行子宫全切除均由超声刀完成,切除的子宫经阴道取出,并于腹腔镜下缝合阴道断端及膀胱腹膜反折。结果216例患者均于腹腔镜下完成手术,无一例转为开腹手术。216例中,103例行单纯子宫切除术;113例同时行下列手术,即行单侧或双侧附件切除术23例,卵巢囊肿剔除术36例,盆腔粘连松解术54例。手术时间平均为(103±35)min,出血量平均为(83±45)ml(60～300ml)。术后住院时间2～11d,平均为(5.3±1.9)d。术中发生膀胱穿孔1例,经腹腔镜下行缝合修补。术后发生膀胱阴道瘘2例、输尿管阴道瘘1例,均经保守治疗后治愈。结论腹腔镜子宫全切除术是一种安全、有效的术式。为子宫切除提供了一种可选择的方法。     

Reducing costs of laparoscopic hysterectomy.

STUDY OBJECTIVE: To establish the role of laparoscopic hysterectomy using reuseable surgical equipment. DESIGN: Prospective, observational study (Canadian Task Force classification II-2). SETTING: Tertiary major teaching hospital. PATIENTS: Fifty consecutive women carefully selected for laparoscopic hysterectomy. INTERVENTIONS: The ultrasonically activated (harmonic) scalpel was used for coagulative cutting of pedicles and ligaments attached to the uterus and adnexa, backed by bipolar diathermy. No nonabsorbable material was left in the pelvis at the conclusion of the procedures. MEASUREMENTS and MAIN RESULTS: Patient characteristics, uterine weight, histology, operating time, recovery, analgesic requirements, and hospital stay were recorded. Complications were noted and critically assessed for constructive quality assurance appraisal. Outcomes were satisfactory according to both patients and gynecologists. CONCLUSION. This pilot study suggests that the method is an efficacious, cost-effective, and well-controlled technique of laparoscopic hysterectomy.     

A clinical comparison of sonographic hydrotubation and hysterosalpingography.

OBJECTIVE--To assess the value of vaginal sonographic hydrotubation as a preliminary test of uterine configuration and tubal patency in infertility investigation, and to compare this new test with hysterosalpingography. DESIGN--A prospective blind comparison of the two tests in an unselected group of infertile women. SETTING--Hillbrow Hospital, Johannesburg, South Africa. SUBJECTS--Sixty women undergoing routine infertility investigations agreed to participate in the study. There were no refusals. INTERVENTIONS--Within 4 weeks before or after hysterosalpingography sonographic hydrotubation was performed as follows: The uterus and tubes were identified using a 5 MHz vaginal ultrasound probe and between 10 and 20 ml of normal saline were injected into the uterine cavity through an endocervical catheter. MAIN OUTCOME MEASURES--The shape of the uterus and its cavity, the flow of saline through the tubes, the presence of hydrosalpinges before and after injection of saline and the presence of free fluid in the pouch of Douglas. RESULTS--The sonographic and hysterosalpingographic findings were similar in 82% of the women with respect to uterine assessment and in 72% with respect of tubal findings. In seven women (12%) found to have bipolar tubal disease on sonography and cornual block on hysterosalpingography, the sonographic diagnosis was confirmed at laparoscopy. Septate uterus in three women was diagnosed with greater certainty with sonographic hydrotubation. CONCLUSIONS--Sonographic hydrotubation is a simple office procedure which should be used in the preliminary assessment of the uterine cavity and fallopian tubes. Its use will reduce the need for hysterosalpingography and in some cases laparoscopy.     

Utility of bipolar electrocautery scissors for cervical conization

OBJECTIVE: To evaluate the usefulness of bipolar electrocautery scissors for cervical conization. METHODS AND MATERIALS: Forty patients with severe dysplasia/in situ carcinoma of the uterine cervix underwent cervical conization: 20 randomly selected patients were operated on with the unipolar energy scalpel and the other 20 were operated on with bipolar electrocautery scissors. In both groups operating time, number of ligations, blood loss, duration of recovery, perioperative complications and adequacy of the margins of the lesion were assessed. Data were compared by analysis of variance. RESULTS: In the bipolar group the average operating time and duration of recovery were significantly reduced (halved), no ligations were needed and the amount of blood loss was significantly reduced. Regarding perioperative complications, in the bipolar group there were no hemorrhages nor need of a second operation or transfusion. Infections did not occur in either group. We found no difference between the two groups regarding adequacy of the margins of the lesion for a good pathologic examination. CONCLUSION: Bipolar electrocautery scissors were safe and useful in cervical conization by reducing the operating time and blood loss without increasing postoperative morbidity.     

Clinic-pathological study of 485 cases of postmenopausal bleeding]

Four hundred and eighty-five patients with postmenopausal bleeding (PMB) who underwent a curettage were studied retrospectively to evaluate the relationship of clinical cause and pathological findings. The results showed that nonorganic causes were the most common, benign causes were much commoner than malignant causes. Bleeding from the uterus was the most common in all PMB. Pathological examination revealed atrophic endometrium in 41.5%, proliferative and secretory endometrium only a few. Endometrial and cervical carcinoma were the most common among the malignant causes. PMB with an enlarged uterus, and women with advanced age have a statistically significant correlation with more serious pathology. It is suggested that the postmenopausal endometrium changes are regulated by ovarian and ectopic sex hormones, and endometritis or vascular diseases of the endometrium may be involved in the mechanism of bleeding.     

Serum vascular endothelial growth factor concentrations in postmenopausal women: the effect of hormone replacement therapy

OBJECTIVE: To assess serum vascular endothelial growth factor (VEGF) concentrations in healthy postmenopausal women in relation to hormone replacement therapy (HRT) and the presence or absence of a uterus. DESIGN: Cross-sectional study. SETTING: The Middlesex Hospital. PATIENT(S): A total of 199 postmenopausal women were enrolled: 132 had uterus in situ and 67 had had hysterectomies. Of the 67 women who had had hysterectomies, 6 received no HRT, 20 received tibolone, 25 received transdermal E2, and 16 received conjugated equine estrogens. Of the 132 women with uteri in situ, 34 received no HRT, 56 received tibolone, 24 received transdermal E2 with sequential norethisterone acetate, and 18 received conjugated equine estrogens with sequential levonorgestrel. INTERVENTION(S): Serum VEGF level measurement. MAIN OUTCOME MEASURE(S): Serum VEGF concentrations. RESULT(S): Women who received HRT had higher VEGF concentrations than those not receiving HRT. Among women who received no HRT, those with uterus in situ had higher VEGF levels than did those who had had hysterectomies. Among women who had had hysterectomies, VEGF concentrations were higher in those who received conjugated equine estrogens than in those who did not receive HRT and those who received tibolone or transdermal E2. Among women with uterus in situ, no difference was found between subgroups. CONCLUSION(S): Postmenopausal women with uterus in situ and those who received HRT had higher VEGF concentrations than did those who had had hysterectomies and who did not receive HRT. Among women receiving HRT, those who received conjugated equine estrogens alone had higher VEGF concentrations. This estrogen-mediated increase in serum VEGF concentrations may be a mechanism by which HRT benefits the cardiovascular system.