米非司酮对子宫肌瘤组织中雌孕激素受体和表皮生长因子受体的影响

目的　探讨米非司酮对子宫肌瘤组织内雌、孕激素受体和表皮生长因子受体的影响。方法　 44例子宫肌瘤患者作全子宫切除或子宫肌瘤挖出术 ,其中米非司酮组 16例 ,术前予米非司酮 2 5mg ,每日 2次 ,连用 3个月 ;对照组 2 8例。采用免疫组化法测定子宫肌瘤及子宫平滑肌内雌、孕激素受体含量 ,用流式细胞仪测定EGF -R水平。结果　米非司酮组子宫肌瘤及子宫平滑肌内PR较对照组显著下降 (P <0 0 1) ,ER无显著差异 ;米非司酮组子宫肌瘤及子宫平滑肌EGF -R水平显著低于对照组 (P <0 0 1)。结论　子宫肌瘤内EGF -R减少是米非司酮治疗后子宫肌瘤缩小的重要机制 ,这一作用可能与米非司酮阻断孕酮与PR的结合有关。     

射频消融技术对子宫肌瘤组织中ER、PR表达影响的临床试验研究

目的 :开腹直视下射频消融子宫肌瘤后 ,观察射频消融对子宫肌瘤组织中ER、PR表达的影响 ,初探射频治疗子宫肌瘤的机制。方法 :30例需开腹行子宫切除术的多发性子宫肌瘤患者 ,分别用 0 .5cm、1.2cm长的射频自凝刀行肌瘤部位射频消融 ,治疗后立即切除子宫 ,作为试验组 ,并于消融灶中心 (A组 )、边缘 (B组 )、边缘外 1cm(C组 )、边缘外 2cm(D组 )处取材 ,HE染色观察病理变化 ,免疫组化检测ER、PR水平 ;选同一子宫上未做射频治疗的肌瘤组织作为对照组。结果 :射频治疗后 ,消融灶中心肌瘤组织呈凝固性坏死 ,ER、PR无表达 ;消融灶边缘肌瘤细胞变性 ,ER、PR表达减少 (P <0 .0 5 ) ;消融灶边缘外1cm ,肌瘤细胞无变性、坏死 ,但ER、PR表达低于对照组 (P <0 .0 5 ) ;消融灶边缘外 2cm ,ER、PR与对照组差异无显著性 (P >0 .0 5 )。结论 :射频消融技术使肌瘤组织凝固性坏死 ,ER、PR的表达丧失及低表达是射频消融技术能够治疗子宫肌瘤的循证依据     

射频消融术靶位治疗子宫肌瘤临床疗效研究

目的 探讨射频消融术靶位治疗子宫肌瘤的临床疗效.方法 选择暨南大学附属第一医院、武汉大学人民医院和陨阳医学院十堰市太和医院妇产科2001年8月至2006年12月经临床和超声检查确诊为子宫肌瘤的260例患者,在超声监视和引导下经阴道进行射频消融治疗,于术后第1、3、6和12个月随访.其中56例于治疗前和治疗后6个月同时行盆腔彩超检查子宫和卵巢血流的改变,放射免疫法检测卵巢和垂体激素水平变化.结果 治疗后6个月72.67%月经恢复正常,64.71%痛经消失,64.81%下腹不适和膀胱、直肠压迫症状均消失.治疗后12个月82.56%患者月经恢复正常,74.51%痛经消失,72.22%下腹不适和膀胱、直肠压迫症状均消失.射频消融治疗术后子宫及其肌瘤体积呈进行性缩小,治疗术后6个月和12个月肌瘤体积缩小率为69.56%和76.38%,子宫体积缩小率为42.29%和46.27%.术后6个月和12个月总有效率分别为95.38%和97.69%.子宫肌瘤患者子宫动脉血液供应比健康妇女丰富（P＜0.05）,治疗后明显降低,与健康妇女无明显差别.卵巢动脉血液供应、卵巢性激素、垂体促性腺激素水平治疗后与治疗前无明显变化,与健康妇女比较差异无显著性意义（P＞0.05）.全部治疗病例无严重并发症.结论 射频消融术靶位治疗子宫肌瘤临床疗效好,创伤小,安全性高.     

子宫肌瘤与孕激素及细胞凋亡的相关研究

目的　通过检测孕激素受体 (PR)、增殖细胞核抗原 (PCNA)、凋亡抑制基因Bcl- 2蛋白在子宫肌瘤组织中的表达 ,探讨子宫肌瘤的发生与孕激素及细胞凋亡的关系。方法　应用免疫组化SP法检测 30例子宫肌瘤及其邻近肌层组织中PR、PCNA、Bcl - 2的表达。结果　PR、PCNA、Bcl- 2在子宫肌瘤细胞中的表达明显高于其邻近肌层 (P <0 0 5 ,P <0 0 5 ,P <0 0 0 1)。PR的表达与PCNA、Bcl- 2的表达均呈正相关。结论　子宫肌瘤是卵巢性激素依赖性肿瘤。孕激素是促进子宫肌瘤生长的重要因素 ,子宫肌瘤与细胞凋亡有关     

子宫富细胞平滑肌瘤47例临床病理分析

研究了了宫富细胞平滑肌瘤的临床及病理特征。方法分析了４７例子宫富细胞平滑肌瘤的临床及病理特征,并对其中３５例进行追踪随访。结果本病症状主要包括月经改变、贫血、疼痛、不孕主前诊断均为子宫肌瘤。结论子宫富细胞平滑肌瘤是一种良性肿瘤,术后不必补充化疗或放疗,预后良好。     

Immunohistochemical expression of estrogen and progesterone receptors and outcomes in patients with newly diagnosed uterine leiomyosarcoma

Objective

We assessed the IHC expression of ER and PR and their prognostic significance in uterine leiomyosarcoma (LMS).

Methods

We identified 43 “high-grade” uterine LMS cases from 7/82-7/07 for whom ER/PR IHC analysis was performed at initial diagnosis at our institution.

Results

Disease was confined to the uterine body in 20/43 (47%). Eighteen (42%) of 43 were ER(+); 17/42 (41%) were PR(+). At last follow-up, 33 (77%) had recurred or progressed, and 23 (54%) had died. PR expression was associated with improved progression-free survival (PFS; P = 0.002) and overall survival (OS; P = 0.03) overall; ER expression was not. After adjusting for stage, ER expression was associated with PFS (P = 0.01), not OS (P = 0.3), and PR expression maintained a significant association with PFS (P = 0.002) and approached a significant association with OS (P = 0.05). Neither ER nor PR expression was associated with outcome in cases with disease outside the uterine body. In cases with confined disease, median PFS for ER(+) or PR(+) cases was not reached compared to 16.9 months for ER(−) cases (95% CI: 8.1-25.7; P = 0.03) and 13.5 months for PR(−) cases (95% CI: 5.9-21.1; P = 0.001). Only 1/10 PR(+) cases recurred and died; 9/10 PR(−) cases recurred, and 5 died. Two of 9 ER(+) cases recurred and died; 8/11 ER(−) cases recurred, and 4 died.

Conclusion

ER/PR expression is associated with survival outcomes in patients with high-grade uterine LMS confined to the uterine body. PR expression seems capable of identifying cases confined to the uterine body, which have better outcomes.     

A comparison of uterine peristalsis in women with normal uteri and uterine leiomyoma by cine magnetic resonance imaging

Objective

The non-pregnant uterus shows wave-like activity (uterine peristalsis). This pilot study was intended to determine: (1) whether uterine peristalsis during the menstrual cycle is detectable by cine magnetic resonance imaging (MRI); (2) the effects of leiomyoma on uterine peristalsis.

Study design

Mid-sagittal MRI was performed sequentially with T2-weighted single-shot fast spin-echo (SSFSE) in 3 normal ovulatory volunteers and 19 premenopausal women with uterine leiomyoma. Direction and frequency of movement of the junctional zone were evaluated using a cine mode display.

Results

Junctional zone movement was identified in all subjects. Direction of uterine peristalsis in normal volunteers was fundus-to-cervix during menstruation, cervix-to-fundus during the periovulatory phase, and isthmical during the mid- and late-luteal phases. Abnormal peristaltic patterns were detected in three of five patients with uterine leiomyoma during menstruation and in the mid-luteal phase of the cycle, respectively.

Conclusion

Cine MRI is a novel method for evaluation of uterine peristalsis. Results of this pilot study suggest that abnormal uterine peristalsis during menstruation and the mid-luteal phase might be one of the causes of hypermenorrhea and infertility associated with uterine leiomyoma.     

子宫肌瘤红色变性67例临床分析

目的　研究子宫肌瘤红色变性的临床特征及妊娠期与非妊娠期子宫肌瘤红色变性的异同 ,探讨子宫肌瘤红色变性的发生机制。方法　对 1993～ 2 0 0 2年间手术治疗的 2 3 17例子宫肌瘤患者进行回顾性研究 ,并对行子宫肌瘤切除术的患者进行随访。结果　红色变性 67例 ,占同期 2 3 17例子宫肌瘤患者的 2 89% ,子宫肌瘤合并妊娠患者中 2 1 85%发生红色变性 ,而非妊娠期子宫肌瘤患者仅 1 87%发生红色变性 ,二者差异有统计学意义(P <0 0 0 1)。子宫肌瘤红色变性患者最常见症状为月经改变 ,出现在 2 9 85%的患者 ,2 0 90 %的患者有腹痛症状 ,17 91%的患者肌瘤增大较快 ,16 42 %有肌瘤压痛 ,14 93 %的患者白细胞计数升高。B超提示肌瘤个数妊娠组少于非妊娠组患者 ,最大肌瘤妊娠组 61 54%位于浆膜下 ,而非妊娠组 82 92 %位于肌壁间 ,妊娠组最大肌瘤直径明显小于非妊娠组 ,两组分别为 4 0 8cm和 7 2 8cm ,以上差异均有统计学意义 (P <0 0 0 1)。 97 0 1%的患者最大肌瘤发生变性。行肌瘤切除术的子宫肌瘤红色变性患者术后复发率与是否合并妊娠无明显相关 ,而与肌瘤个数有关 (P =0 0 2 4)。结论　妊娠期与非妊娠期子宫肌瘤患者红色变性发生率、肌瘤大小和部位等临床病理特征存在很大差异 ,考虑其红色变性发生机制     

米非司酮对子宫肌瘤超微结构的影响

目的：探讨米非司酮对子宫肌瘤超微结构的作用。方法：随机选择子宫肌瘤患者24例，连续服用米非司酮25mg或12．5mg，12周后行子宫切除术，取子宫标本，在电镜下观察肌瘤超微结构变化。并随机选择6例未用药的子宫肌瘤患者，同样方法取标本进行比较。结果：米非司酮可使肌瘤细胞及血管不同程度的退行性改变。结论：米非司酮可用于子宫肌瘤的治疗。     

米非司酮对子宫肌瘤组织病理学影响的研究

目的 观察米非司酮对子宫肌瘤组织病理学的影响,探讨其使肌瘤体积缩小的机制。方法60例子宫肌瘤患者随机分为治疗组和对照组,其中治疗组21例患者手术前每天服用米非司酮10mg,共3个月,分别于治疗前后B超测定最大肌瘤三维经线判定肌瘤体积变化;对照组39例患者术前未接受任何激素治疗。两组患者术后行组织切片HE染色,观察两组肌瘤组织病理学的改变。结果 治疗组肌瘤组织退行性变的程度与对照组相比差异有显著性(P<0.05);而治疗后有效组与无效组在病理改变上差异无显著性(P>0.05)。结论米非司酮治疗后肌瘤组织退行性变的程度增加,可能与血供减少有关,是肌瘤缩小的原因之一。     

Calcifying uterine leiomyoma invading the urinary bladder

Leiomyomas are common benign tumors of the female genital tract and can be the leading cause of dysfunctional uterine bleeding, recurrent miscarriage or abdominal discomfort. Degeneration of fibroids occurs in menopause and is associated with fatty, hyaline, cystic, or myxoid degeneration or dystrophic calcification. However, based on their benign nature, these tumors are not known to invade other tissues. We here describe a rare case of an extensively calcified myoma invading the urinary bladder in an elderly patient who presented with hematuria and moderate abdominal discomfort.     

子宫肌瘤动脉内数字减影血管造影影像学特点及临床意义

目的 观察子宫骨瘤动脉内数字减影血管造影（IADSA）影像学特点。方法 对156例子宫肌瘤患者行子宫动脉栓塞术（UAE），通过术时DSA造影及术后DSA片观察子宫肌瘤DSA影像学特点。结果 156子宫肌瘤的血供均来自子宫动脉，共分3种类型：（1）Ⅰ型：一侧子宫动脉供血为主型，占53.2%（83／156）；（2）Ⅱ型：双侧子宫动脉供血为主型，占34.6%（54／156）；（3）Ⅲ型：单纯一侧子宫动脉供血型，占12.25(19/156)。子宫肌瘤的血管肉分两层，一层存在于子宫肌瘤的表面形成粗大的血管肉，另一层在子宫肌瘤的内部形成致密的毛细血管网。结论 子宫肌瘤属富血管性肿瘤，其血供来源于子宫动脉，由内外两层血管网组成。     

抗环瓜氨酸肽抗体在幼年特发性关节炎诊断中的意义

目的探讨抗环瓜氨酸肽(CCP)抗体检测在幼年特发性关节炎(JIA)诊断中的意义。 方法对华中科技大学同济医学院同济医院2002-06—2004-08收治的JIA患儿66例、其他风湿病患儿11例及正常儿童29名，运用酶联免疫吸附试验(ELISA)方法检测血清中抗CCP抗体，比较各组抗CCP抗体阳性率，并探讨抗CCP抗体在诊断JIA中的意义。 结果66例JIA患儿中抗CCP抗体阳性率为167%(11/66)，其中类风湿因子(RF)阳性多关节型阳性率为571%(4/7)，RF阴性多关节型为190%(4/21)、少关节型为231%(3/13)，22例全身型和3例附着点炎相关关节炎(ERA)患儿，抗CCP抗体均为阴性。其他风湿病患儿组和对照组抗CCP抗体亦为阴性。JIA组与正常对照组抗CCP阳性率比较有统计学意义(P<005)，其中多关节型及少关节型与正常对照组比较亦有统计学意义，而其他亚型与正常对照组比较无统计学意义。 结论抗CCP抗体尚不能作为JIA早期诊断的新的可靠的血清学指标。抗CCP抗体主要见于JIA多关节型和少关节型，推测抗CCP抗体对JIA分型及预后评价可能有指导意义。     

孕激素受体和线粒体porin蛋白在子宫肌瘤组织中的表达

目的：检测新型孕激素受体M（PR-M）、PR-A、PR-B和线粒体porin蛋白在子宫肌瘤组织及肌瘤旁正常子宫平滑肌组织中的表达,并探讨3种孕激素受体与porin表达的相关性。方法：采用RT-PCR、Western blot法检测PR.M、PR_A、PR.B和porin在20例子宫肌瘤组织和肌瘤旁正常子宫平滑肌组织中的表达。结果：子宫肌瘤组织中PR-M、PR-A、PR-B和porin的表达水平均显著高于正常子宫平滑肌组织（P〈0.001）。子宫肌瘤组织中PR-M与porin表达呈正相关（mRNA：r=0.562,P=0.010;蛋白：r=0.467,P=0.038）,PR-A、PR-B与porin表达无关（P〉0.05）。正常子宫平滑肌组织中PR.M、PR.A、PR-B与porin均无相关性（P〉0.05）。结论：子宫肌瘤的发生和发展可能与核外PR.M的作用有关,孕激素可能通过基因组和非基因组两种途径参与子宫肌瘤的形成和生长。     

表皮生长因子对子宫肌瘤发生发展的影响

目的探讨表皮生长因子与子宫肌瘤的关系.方法用酶联免疫吸附法(ELISA)测定22例子宫肌瘤患者子宫肌瘤组织和正常子宫平滑肌组织内表皮生长因子(EGF)水平.结果正常子宫平滑肌组织EGF质量浓度为(16.64±7.69)mg/L,肌瘤组织EGF质量浓度为(21.38±7.75)mg/L,肌瘤组织EGF质量浓度显著高于正常平滑肌组织(P＜0.05).肌瘤组织EGF质量浓度分泌期为(23.94±5.83)mg/L,增生期为(17.23±7.13)mg/L,两者之间有显著差异(P＜0.05).结论EGF在子宫肌瘤的发生、发展中起重要作用,EGF的合成可能受孕激素的调节.     

米非司酮配伍与不配伍甲基睾丸素治疗子宫肌瘤的临床研究

目的：评价米非司酮配伍与不配伍甲基睾丸素治疗子宫肌瘤的临床效果。方法：有症状的子宫肌瘤患者６０例，随机分为两组，每组３０例。Ａ组：口服米非司酮及甲基睾丸素。米非司酮２５ｍｇ，甲基睾丸素５ｍｇ，每日１次，连服９０天；Ｂ组：口服米非司酮及安慰剂，服药方法同Ａ组。结果：两组治疗后均使患者发生闭经。Ａ组治疗后经量减少４９３２％，瘤体缩小５２２０％；Ｂ组治疗后经量减少３９８０％，瘤体缩小４４１０％。结论：抗雌孕激素的联合治疗是保守性治疗子宫肌瘤较为理想的方法。     

Hysteroscopic resection of a symptomatic uterine leiomyoma in an adolescent

Background

Uterine leiomyomas or fibroids are rare in the adolescent population. Hysteroscopic resection is an ideal approach for adolescents with symptomatic intracavitary myomas.

Case

A 17-year-old female had a history of menometrorrhagia and symptomatic anemia, and had been hospitalized twice for acute management of heavy bleeding. On pelvic ultrasound and subsequent MRI, a 2 × 3 cm mass was visualized and appeared to distort the uterine cavity. Due to recurrent heavy bleeding, operative hysteroscopy was performed, and a 3-cm intracavitary mass was identified and resected; pathology evaluation confirmed a leiomyoma.

Summary and Conclusion

Surgical intervention for abnormal bleeding due to a submucosal myoma was more successful than medical treatment. In adolescents, hysteroscopic resection of a symptomatic submucosal myoma is a reasonable minimally invasive management option.     

Perforación intestinal tras ablación por radiofrecuencia de mioma uterino. Reporte de caso y revisión bibliográfica

Uterine leiomyoma are the most common pelvic tumours diagnosed in women of reproductive age. In recent years, the search for minimally invasive treatment that allows women to preserve their uterus has resulted in transvaginal radiofrequency ablation. This procedure is safe and effective.We present a case report of intestinal perforation after transvaginal radiofrequency ablation of two uterine leiomyomas. Finally, we present a review of the literature in relation to this complication of the technique.