上皮性钙黏蛋白在人输卵管妊娠种植与非种植部位组织中表达的比较

目的:比较上皮性钙黏蛋白(E-cadherin,E-cad)在人输卵管妊娠种植与非种植部位组织中的表达水平。方法:14例未破裂型输卵管壶腹部妊娠组织标本,均包括种植和非种植部位的组织,分为种植部位组(n=14)和非种植部位组(n=14);并以12例因其它疾患行全子宫加附件切除术的人分泌期正常输卵管壶腹部组织新鲜标本为对照组。采用免疫组织化学法观察E-cad蛋白在输卵管妊娠组织和输卵管黏膜上皮的表达情况,应用荧光定量聚合酶链反应(qRT-PCR)和免疫印迹法(Western blotting)检测其E-cadmRNA和蛋白表达水平。结果:E-cad蛋白表达于人输卵管黏膜上皮纤毛细胞和分泌细胞的胞膜,在细胞之间的连接面表达较强,管腔面表达较弱,纤毛未见表达。在输卵管妊娠组织,E-cad表达于蜕膜细胞、绒毛细胞滋养层细胞和绒毛外滋养细胞的胞膜,绒毛外滋养细胞的阳性显色弱于绒毛细胞滋养层细胞。E-cadmRNA和蛋白在种植部位组的表达显著低于非种植部位组和对照组(P<0.05),非种植部位组与对照组之间表达无显著性差异(P>0.05)。结论:E-cad在输卵管妊娠种植部位表达水平降低,可能与输卵管妊娠发生有密切的联系。     

整合素β_1在人输卵管及输卵管妊娠黏膜上皮中的表达

目的:检测整合素β1在人输卵管和输卵管妊娠黏膜上皮中的表达。方法:29例人输卵管组织标本取自因子宫肌瘤、子宫腺肌症等行全子宫加附件切除术的患者。输卵管标本包括峡部、壶腹部和伞部,按子宫内膜组织学分期将标本分为增生早期组(n=8)、增生中-晚期组(n=6)、分泌早期组(n=7)和分泌中-晚期组(n=8)。17例输卵管妊娠组织标本取自输卵管壶腹部妊娠的患者,标本分为种植部位组(n=17)和非种植部位组(n=17)。应用免疫组织化学法检测整合素β1在上述各组黏膜上皮中的表达。结果:整合素β1表达于人输卵管黏膜上皮纤毛细胞和分泌细胞的胞质,其中纤毛细胞的纤毛亦有表达。输卵管峡部及壶腹部黏膜的整合素β1表达水平,不同时期组间的比较无显著性差异(P>0.05);在输卵管伞部,分泌早期组的表达水平显著高于增生早期、增生中-晚期及分泌中-晚期组(P<0.05);在月经周期同一时期,输卵管峡部、壶腹部及伞部间的比较无显著性差异(P>0.05)。在输卵管妊娠黏膜,种植部位的滋养层细胞和蜕膜细胞的胞质可见阳性表达,种植部位的整合素β1表达水平显著高于非种植部位(P<0.05);种植部位和非种植部位的表达水平均显著高于分泌期壶腹部(P<0.05)。结论:整合素β1在分泌早期输卵管伞部黏膜的表达水平升高,在输卵管妊娠种植部位黏膜中表达水平亦升高。     

放置聚乙烯可复性输卵管避孕栓对新西兰兔输卵管黏膜的影响

目的:探讨聚乙烯输卵管节育栓的安全性。方法:14只新西兰实验兔随机分为3组:手术组(n=6)双侧输卵管放置聚乙烯输卵管节育栓;自身对照组(n=6)仅右侧输卵管放置聚乙烯输卵管节育栓,左侧为自身对照侧;空白对照组(n=2)不作任何处理。分别于节育栓植入3个月和12个月后取双侧输卵管制作标本,以显微镜及扫描电镜观察输卵管黏膜的组织变化。结果:实验组及自身对照组实验侧,显微镜下见输卵管黏膜皱襞参差不齐,黏膜及黏膜下层充血、水肿。黏膜皱壁间质有急性炎症细胞浸润,并有上皮细胞脱落现象,但未见黏膜坏死。扫描电镜:与对照组相比,实验组纤毛细胞表面纤毛凌乱,排列不整齐。分泌细胞及纤毛多数正常,少量分泌细胞变形,仍可见大量微绒毛。结论:聚乙烯输卵管节育栓放入兔输卵管3个月后,对输卵管影响轻微,12个月后,输卵管基本恢复正常。     

利多卡因在特殊人群放置宫内节育器中的应用

目的:探讨利多卡因在特殊人群放置宫内节育器的临床应用。方法:200例自愿要求放置IUD的特殊人群(因剖宫产、宫颈疾病接受过宫颈物理治疗),随机分为观察组和对照组,每组100例,观察组在放置宫内节育器手术中采用20mg/ml利多卡因进行宫颈注射,对照组则按常规放置,比较组间放置成功率、并发症等。结果:观察组放置IUD成功率100%,对照组失败23例,成功率77%,观察组无1例发生并发症,对照组发生探针穿孔2例,宫颈损伤4例,心脑综合反应12例。术中出血量组间无差异(P<0.05),但观察组手术时间(2.0±0.6min)明显短于对照组(3.5±0.8min)组间差异显著(P<0.05)。结论:对特殊人群放置IUD手术,采用20mg/ml利多卡因注射软化宫颈和镇痛的方法,可减轻疼痛、减少子宫损伤等并发症,同时提高了手术的成功率和放置IUD手术的质量及安全性。     

悬吊式无气腹腹腔镜手术治疗输卵管妊娠39例临床分析

目的探讨无气腹腹腔镜手术治疗输卵管妊娠的疗效及并发症。方法选择2010年3月至2011年8月收治的行双孔悬吊式无气腹腹腔镜下手术治疗的输卵管妊娠患者39例为研究组,同期住院因输卵管妊娠行有气腹腹腔镜下手术治疗的60例患者为对照组,分析两组患者的手术时间、出血量、术后肛门排气时间和术后住院天数等。结果研究组平均手术时间[(52.6±6.8)min]与对照组[(59.3±8.9)min]比较,差异有统计学意义(P<0.05)。研究组平均出血量、术后肛门排气时间和术后住院天数分别为(245.8±36.8)ml、(32.5±7.8)h和(4.1±1.8)d,对照组分别为(239.9±42.2)ml、(34.4±6.9)h和(4.3±1.6)d,两组比较,差异均无统计学意义(P>0.05)。研究组术后疼痛率(2.6%,1/39)与对照组(13.3%,8/60)比较,差异有统计学意义(P<0.05)。研究组未发生皮下气肿,对照组发生2例(3.3%)。研究组术后1个月保留输卵管的通畅率(55.6%,10/18)与对照组(26.7%,8/30)比较,差异有统计学意义(P<0.05)。结论无气腹腹腔镜治疗输卵管妊娠安全、有效,术后患者疼痛少,保留输卵管通畅率高,值得临床推广应用。     

血β-hCG 2000～8000 IU/L的输卵管妊娠保守治疗方案研究

目的:探讨较高水平血β-hCG(2 000~8 000 IU/L)输卵管妊娠的保守治疗方案。方法:将106例输卵管妊娠要求保守治疗的患者随机分为复方组和对照组,每组53例。复方组口服复方米非司酮片+肌内注射氨甲蝶呤(MTX)+口服本院协定处方宫外孕方+口服大黄蛰虫胶囊;对照组除不服用复方米非司酮片外,其余治疗同复方组。结果:临床总有效率复方组为96.2%,对照组为75.5%,组间比较差异有统计学意义(P<0.05);复方组45例1个疗程内治愈,对照组23例1个疗程内治愈,组间差异有显著统计学意义(P<0.01),阴道流血时间、平均住院时间、血β-hCG转阴时间和盆腔包块消失时间组间比较均有统计学差异(P<0.05)。结论:复方米非司酮协同MTX及中药治疗输卵管妊娠,能明显提高有较高水平血β-hCG(2 000~8 000 IU/L)输卵管妊娠的治愈率。     

沙眼衣原体感染与输卵管性不孕的相关性研究

目的:探讨血清沙眼衣原体(CT)及其热休克蛋白60(C-HSP60)抗体反应与输卵管性不孕(TFI)的关系。方法:检测了60例TFI患者(TFI组)和30例正常生育妇女(对照组)血清CT抗体。用基因工程的方法重组C-HSP60,以纯化后的C-HSP60蛋白为抗原,采用酶联免疫吸附法(ELISA),检测二组对象血清C-HSP60抗体水平。结果:TFI组和对照组血清沙眼衣原体IgG抗体阳性率分别为73.22%和43.33%,组间有显著性差异(P<0.05);TFI组C-HSP60IgG抗体阳性率为46.67%,高于对照组阳性率6.67%,差异有统计学意义(P<0.05)。TFI组中28例C-HSP60IgG抗体阳性者与32例阴性者相比,阳性者的输卵管损害程度高于阴性者(P<0.01),而阴性者的盆腔粘连程度则较阳性组严重(P<0.01)。结论:女性生殖道沙眼衣原体感染是导致TFI的重要原因,C-HSP60与其发病机理有非常密切的关系。     

输卵管积液对小鼠胚胎体外发育的影响

目的 :了解输卵管积液是否具有胚治毒性。方法 :收集兔输卵管液和机械诱导的输卵管积液 ;小鼠超数排卵 ,收集 2 -细胞胚胎 ,随机分配到含有不同浓度输卵管积液、输卵管液 (正常对照 )和培养液 (空白对照 )中培养 ,观察并记录胚胎形态 ,同时测定新形成囊胚的细胞数和有丝分裂指数。结果 :1 0 0 %输卵管积液组囊胚形成率和胚胎孵化率均明显低于两对照组 (P<0 .0 0 1 ) ;而低浓度 (2 0 %和 1 0 % )积液组囊胚形成率和胚胎孵化率与两对照组相比 ,均无明显差异。各实验组囊胚的细胞数和有丝分裂指数均明显低于两对照组(P<0 .0 5)。结论 :机械诱导的输卵管积液 ,会影响早期种植前胚胎质量     

MCuⅡ与TCu 380A宫内节育器的临床比较性研究

目的:观察第二代爱母含铜宫内节育器(AiMu MCuⅡIUD)的临床效果。方法:对要求使用IUD避孕的825例育龄妇女,随机放置MCuⅡIUD(408例)与TCu380A IUD(417例),放置后3个月、6个月、12个月、24个月、36个月定期随访,记录IUD使用情况。结果:随访36个月时MCuⅡ与TCu380A组随访率分别为98.78%、98.57%。MCuⅡ组3个月、36个月的副反应主诉率分别为20.34%和8.28%,除了36个月外,4次随访副反应主诉率均低于TCu380A IUD组,差异有统计学意义(P<0.05)。随访12个月、36个月MCuⅡ组带器妊娠率分别为0.98/100妇女、1.96/100妇女,5次随访MCuⅡ组带器妊娠率均高于TCu380A IUD组,但无统计学差异(P>0.05)。MCuⅡ组6个月的因症取出率和36个月的终止率分别为7.60%和22.06%,MCuⅡ组因症取出率及终止率均低于TCu380A IUD组,除了3个月外,其余4次随访比较均有显著性差异(P<0.05)。结论:MCuⅡIUD副反应少、续用率高,避孕效果与TCu380A相当,是当前可供选择的有效IUD。     

护理配合干预在异位妊娠行腹腔镜下输卵管切除术的应用效果

目的 探讨护理配合干预在异位妊娠行腹腔镜下输卵管切除术的应用效果。方法 选取本院60例异位妊娠并接受腹腔镜下输卵管切除术的患者为研究对象,随机分为两组,各30例。对照组采用常规护理干预,观察组采用护理配合干预,比较两组负性情绪、术后相关指标及并发症发生情况。结果 干预后,观察组的焦虑、抑郁评分均低于对照组（P<0.05）;观察组术后首次排气时间、术后首次下床时间、住院时间均短于对照组（P<0.05）;观察组并发症发生率为6.67%,显著低于对照组的26.67%(P<0.05)。结论 护理配合干预应用于异位妊娠行腹腔镜下输卵管切除术中,能显著缓解患者的负性情绪,改善术后相关指标,且并发症发生率低,值得推广。     

The intrauterine device (IUD): are there still contraindications? A study of 300 Gyne-T 380 users (1987-1992)

During April 1987-July 1992, a gynecologist inserted 300 Gyne-T 380 IUDs in 274 women attending the obstetrical-gynecologic service at the University Hospital St. Antoine in Paris, France. Exclusion criteria for IUD use were nulliparity, prior confirmed genital infection, and indication of intolerance to an IUD in situ. The physician did not consider uterine scars (especially cesarean section scars), uterine malposition, and painless uterine retroversion as absolute contraindications. Instead, he considered them relative contraindications. He inserted the IUD in the beginning of the cycle without analgesia. He followed-up with IUD users every six months. 94% were followed-up at least once; most were followed-up regularly. After 1989, IUD insertions fell significantly. Most women (126) were 40-44 years old. Mean parity was 2.38. 96 IUDs were removed. The leading reason for IUD removal was menstrual cycle troubles (51.2%). 0.8% became pregnant. Pelvic inflammatory disease occurred in 3 women. 17% of the women had a retroverted uterus. Careful insertion led to hardly any difficulties in these cases. Secondary effects were more common in women with a retroverted uterus, however. IUD use was shorter in this group than in the entire group (16 vs. 25 months). None of the 18 cases with a uterine scar suffered adverse effects of the IUD. These findings show that IUD use can be safely extended and the IUD can be a valuable alternative to other contraceptive methods.     

绝经后宫内节育器去留的安全性研究

自１９６０年全国推广宫内节育器（ＩＵＤ）至今己有千万妇女进入绝经期，绝经后ＩＵＤ应予取出，但因种种因素尚有相当比例绝经后妇女并未取出ＩＵＤ。作为异物的ＩＵＤ长期不取是否安全？尚未报道。本研究调查了普查对象中绝经后妇女２６５８例，其中未取ＩＵＤ者３０２例（ＩＵＤ组）和无ＩＵＤ妇女２５４例进行比较。通过病史询问和妇科检查结果提示：１．绝经后未取ＩＵＤ者平均绝经年龄为４９．７３岁，明显高于对照组（４８．９９）；子宫明显萎缩者与对照组相似；对健康情况无明显影响；患病史中ＩＵＤ组明显低于对照组。２．通过２７６例宫腔分泌物直接涂片检查，白细胞和细菌计数与对照组相似。３．１２８例同时取出ＩＵＤ，取器困难率于绝经＜２年者为５％，≥２年者１８％～３５％。根据本研究结果，绝经后未取ＩＵＤ者未见明显的危害性，但建议有条件取器者应在１年内取器，如绝经２年以上遇有取器困难而临床又无症状，不宜强行取器，以免造成严重创伤，可严密随访。     

活性γCu380 IUD与TCu380A IUD多中心比较性研究

本研究通过增加原γCu2 0 0 IUD的铜表面积至 380 mm2 ,以期在不增加副反应的基础上进一步降低带器妊娠率 (包括异位妊娠 ) ,而达到与 TCu380 A IUD相似的避孕效果 ,并保持原来的低副反应发生率。方法 :1 998年 1～ 5月由全国五个中心参加的随机比较性研究 ,共随访 1 2个月。每个中心分别放置γCu380与 TCu380 A IUD各 1 0 0例 ,共 1 0 0 0例。结果 :1 2个月末 γCu380与 TCu380 A IUD脱落率每百妇女分别为 0 .80和 1 .99(P>0 .0 5)。带器妊娠率每百妇女均为 0 .2 0。异位妊娠率每百妇女分别为 0 .2 0和 0 .0 0 (P>0 .0 5)。因症取出率每百妇女分别为 1 .0 0和 2 .6 0 (P>0 .0 5)。结论 :γCu380 IUD临床效果与 TCu380 A IUD相似 ,而 γCu380 IUD副反应发生率明显低于 TCu380 A IUD。本研究结果证实载高铜面积 γCu380 IUD是一种优质的 IUD。     

含消炎痛VCu200与VCu200临床比较性研究

对１０００例含消炎痛ＶＣｕ２００与１０００例对照组进行比较性研究。在２４个月末，每１００妇女净累积续用率分别为８３．２０与８３．３６，其中妊娠率分别为２．２０与１．４１（Ｐ＞０．０５）。脱落率在１２与１８个月时药环组较对照组高（Ｐ＜０．０５），２４个月时分别为８．８１／１００与６．６２／１００妇女，无显著性差别，但相对来讲药环组还是较对照组高。因症取出率对照组高于药环组（Ｐ＜０．０５）。主要原因是出血，具体表现在经量增多，经期延长与点滴出血。这三种现象两组之间Ｐ值均＜０．０１，药环与对照环避孕效果相似而药环基本解决了用ＩＵＤ的主要副反应出血问题。本文分析脱落率较高的可能原因，并对药环的装置进行了改进，用改进后的药环观察一年，脱落率有所下降。     

活性γCu380IUD与TCu380AIUD临床比较性研究

本研究通过增加原γCu 2 0 0 IUD的铜表面积至 3 80 mm2 ,其目的为了进一步降低带器妊娠率 (包括异位妊娠 ) ,以期达到 TCu3 80 A IUD相似的避孕效果 ,而其副反应发生率明显低于 TCu3 80 A IUD。方法 :1 995年 8月～ 1 996年 6月由三个中心参加的随机比较性研究 ,共随访 2 4个月。每个中心分别放置γCu 3 80与 TCu 3 80 A IUD各 1 0 0例 ,共 6 0 0例。结果 :2 4个月末 γCu3 80与 TCu3 80 A IUD脱落率每百妇女分别为 0 .997和 2 .4 70 (P>0 .0 5)。带器妊娠率每百妇女分别为 0 .3 3 2和 2 .4 59(P<0 .0 5)。异位妊娠率每百妇女分别为 0 .1 6 1和 0 .3 3 0 (P>0 .0 5)。因症取出率每百妇女分别为 1 .6 6 1和 5.4 95(P<0 .0 5)。结论 :γCu 3 80 IUD临床避孕效果明显优于 TCu 3 80 A IUD;两种 IUD的异位妊娠率相似 ;γCu3 80 IUD的副反应发生率明显低于 TCu3 80 A IUD。本研究结果证实高铜面积 γCu3 80 IUD是一种优质的 IUD。     

The long-term safety of use of the stainless steel IUD: over 20 years use. Clinical and pathological analysis]

635 women with stainless steel rings retained in utero for 20 years or more and 724 women of similar age without IUDs as controls were under investigation. Comparison of incidences of clinical symptoms of paired wearers and controls by age in premenopausal women and by postmenopausal duration in postmenopausal women showed that the tinged vaginal discharge in the study group was 4.87% higher than the controls (P0.05). There was no difference in menorrhagia, irregular bleeding, or other main effects. No cancerous changes were found in the uterine curettage specimens of 374 IUD users in the study group. Special attention was paid to the epithelium at the site in contact with the IUD and its adjacent areas showed no apparent dysplasia. There were 9 cases (2.41%) with mild hyperplasia of the endometrium. The incidence had no correlation with the prolongation of insertion duration. Among the 315 relatively intact endometrium specimens, there were 32 cases of inflammation (10.15%). The incidence had no correlation with duration. 3 endometritis cases were actinomyces infection. Among 374 removals, the removal difficulties did not apparently relate with their IUD insertion duration but did correlate to duration of menopause. Hysterograms of 23 cases showed that atrophy of uterine cavities progressed with the increase of menopausal years; the longer the duration, the deeper incarceration of the IUD. (author's)     

Obstetrician-gynecologists and the intrauterine device: a survey of attitudes and practice

OBJECTIVE: To assess obstetrician-gynecologists' clinical use of the intrauterine device (IUD), their attitudes toward the IUD and how they select IUD candidates, and to test the hypotheses that limited residency training in IUDs, fear of litigation, and a belief that IUDs cause pelvic inflammatory disease decrease IUD use. METHODS: We performed a national mailed survey of 811 practicing obstetrician-gynecologists obtained from systematic sampling of ACOG membership listings to assess use of and attitudes toward the IUD. RESULTS: The survey response rate was 50%. Most respondents agreed that the copper IUD is safe (95%) and effective (98%). However, 20% of respondents had not inserted an IUD in the past year, and of those who had, most (79%) reported inserting 10 or fewer. Fear of litigation and a belief that IUDs cause pelvic inflammatory disease were associated with lower IUD use; the number of IUDs inserted during residency was not. In selecting IUD candidates, respondents were most restrictive about patient monogamy. Having less conservative criteria for selecting IUD candidates was associated with greater IUD use. Respondents with liberal criteria inserted a mean of nine IUDs in the past year, whereas those with conservative criteria inserted four. CONCLUSIONS: Because most obstetrician-gynecologists are inserting few IUDs, educational programs should target these physicians to expand their IUD use. Such programs should highlight modern IUD safety and the rarity of litigation. The number of IUDs inserted in residency may be less important than the development of less restrictive, more evidence-based criteria for selecting IUD candidates.     

Use of intrauterine contraceptive devices in nulliparous women: personal experience over a 12-year period.

OBJECTIVE: To evaluate the use of intrauterine contraceptive devices (IUDs) in nulliparous women compared to their use in parous women. METHODS: A comparative cross-sectional study was carried out to determine the reasons for removal of IUDs inserted between 1985 and 1996 in a sample of 227 nulliparous women and 2080 parous women. The statistical analysis was performed using the chi 2 test; the differences were considered to be significant when p < 0.05. RESULTS: The reasons for removal of IUDs in the two groups were: expiry, 49.1% in the nulliparous group vs. 48.2% in the parous group; planned pregnancy, 21.7% vs. 15.4%; accidental pregnancy, 4.8% vs. 6.3%; expulsion, 1.6% vs. 5.1%; pelvic inflammatory disease, 1.6% vs. 1.1%; pain and/or bleeding, 14.5% vs. 10.2%; other, 6.4% vs. 6.3%; vasectomy or tubal sterilization, 0% vs. 7%. CONCLUSION: Our data suggest that nulliparity is not a contraindication for the use of an IUD, and that the use of an IUD in nulliparous women is as safe and effective as in parous women.     

Preventing infection related to insertion of an intrauterine device

A study was undertaken to determine whether pelvic inflammatory disease (PID) resulting from the insertion of an intrauterine device (IUD) could be eliminated by inserting the IUD during ovulation and administering prophylactic antibiotics to cover insertion. IUDs, 95% of which were Progestaserts, were inserted within two days of probable ovulation in 288 patients. These study patients were compared with a matched control group of 288 patients not using IUDs. None of the 288 IUD patients (totaling 619 woman-years of IUD use) developed PID after insertion, and only 0.5% per 100 woman-years developed PID later. The incidence of PID seen in these patients was less than that observed in the control group. It was also less than that in the general population or that following legal induced abortion. The expulsion rate of 1% per 100 woman-years in our patients is the lowest ever reported. It probably is related to the low motility of the uterus and expansion of the cervix during ovulation; the latter facilitates insertion during ovulation.