Utero-ovarian morphology and blood flow after tubal ligation by the Pomeroy technique

OBJECTIVES: The objectives of this study were to evaluate ovarian sonographic morphology and pelvic blood flow in patients who had undergone bilateral tubal ligation by the Pomeroy technique. DESIGN: Twenty women who had undergone bilateral tubal ligation during cesarean section by the Pomeroy techniques were compared to 20 matched controls who had undergone cesarean section alone. Ovarian morphology as well as ovarian and uterine pulsatility index (PI), resistance index and peak systolic velocity were evaluated using transvaginal sonography and Doppler velocimetry. RESULTS: Patients post tubal ligation by the Pomeroy technique were found to have a significantly higher rate of polycystic appearance of the ovaries (60% vs. 5%; p < 0.005). Six patients (30%) had post tubal ligation symptoms, as compared to none of the controls. Five of the six symptomatic tubal ligation patients (83%) had ovarian polycystic appearance, which was not significantly different than asymptomatic patients. Ovarian artery PI was significantly higher in symptomatic patients (2.7 +/- 1.9) compared to asymptomatic patients (1.5 +/- 0.9) (p < 0.05). CONCLUSIONS: We therefore conclude that patients post bilateral tubal ligation by the Pomeroy technique may acquire an ovarian polycystic appearance and increased ovarian PI, which may be associated with a tendency to develop post tubal ligation symptoms.     

Hormonal and ovarian stromal blood supply changes after laparoscopic tubal sterilization: a prospective controlled study

OBJECTIVES: The purpose of this study is to determine if the effects of tubal sterilization (TS) by laparoscopy have any risk of a subsequent significant decrease in ovarian reserve and vascular support within the ovary by means of stromal artery Doppler study, and to compare the results with matched paired controls. DESIGN: Between February 2002 and January 2005, 148 healthy volunteers were enrolled sequentially, 74 undergoing laparoscopic TS (study group) and 74 age-, parity-, body mass index-matched women were recruited as a control group. The main outcome measurements were blood levels of follicle-stimulating hormone (FSH), luteinizing hormone and E2, ovarian volume, number of antral follicles and Doppler study of ovarian stromal artery pulsatile index (PI) and maximum velocity (Vmax) on the third day of the cycle immediately before, and 1 and 12 months after the surgical intervention. RESULTS: There were significant elevations in both serum FSH levels and PI values observed 1 month after TS, compared to the preoperative levels (p < .05), and also when compared to controls. However, there were no significant elevations at 12 months postoperation in both study and control groups. The other outcome measurements did not show any significant differences between the two groups. CONCLUSIONS: Tubal sterilization by laparoscopic electrocoagulation does not cause any decrease in ovarian reserve or ovarian stromal blood supply, except an early postoperative increase in FSH and PI.     

The effect of tubal sterilization through electrocoagulation on the ovarian reserve

Background

The study was conducted to compare the effects of tubal sterilization through electrocoagulation and the application of mechanical clips on the ovarian reserve.

Study Design

Eighty-eight patients in the reproductive period with the desire of tubal sterilization were included in the prospective, randomized study. The patients were divided into two groups by simple randomization as tubal sterilization through electrocoagulation group and the application of mechanical clips group. Day-3 serum follicle stimulating hormone, luteinizing hormone, estradiol, inhibin-B and antimüllerian hormone and Day-3 total ovarian volume measurements and anthral follicle counts of all patients in the preoperative and 10th postoperative months were compared both within and between the two groups.

Results

A significant difference between the postoperative 10th-month Day-3 total ovarian volumes and anthral follicle counts was detected between the electrocoagulation and mechanical clips application groups.

Conclusion

Tubal sterilization by electrocoagulation is very likely to have an adverse effect on the ovarian reserve in the postoperative period.     

绝经过渡期妇女卵巢大小及血流动力学变化与生殖激素和血脂变化的关系

目的:超声观察绝经过渡期妇女卵巢血流参数、卵巢大小,测定外周血中生殖激素、血脂水平,探讨卵巢衰老过程中三者之间的相互关系。方法:选择36例绝经过渡期妇女及20例健康妇女,应用阴道超声测定卵巢大小、卵巢血流参数;应用磁性分离酶联免疫法测定空腹外周血FSH、LH和E2水平;用胆固醇氧化酶-过氧化物酶终点法测量外周血总胆固醇(TC)水平;用免疫透射比浊法测定外周血TG、HDL、LDL水平。结果:绝经过渡期妇女卵巢缩小、卵巢内卵泡数目减少,卵巢血管的血流动力学参数有改变,外周血中基础FSH、LH、E2均升高;血脂谱有改变。结论:绝经过渡期妇女卵巢血供障碍,卵巢开始缩小,卵泡样结构减少;内分泌功能异常,血脂谱改变,它们之间互为因果,使绝经过渡期妇女卵巢衰老加剧,引起一系列内分泌的变化及临床症状。     

子宫动脉血流在预测孕早期不明原因复发性流产中的价值

目的探讨子宫动脉血流阻力在不明原因复发性流产(URSA)早孕患者中的价值。方法选取2015年-2018年在本院就诊,在门诊行人流术、既往无稽留流产史的早孕者460例为早孕组;此次为单活胎早孕、既往URSA史的患者142例为复发性流产早孕组。所有对象行D-二聚体、经阴道超声检查子宫动脉血流阻力检测,参数包括搏动指数(PI)、阻力指数(RI)、有收缩期峰值流速/舒张末期流速(S/D)。比较早孕组与复发性流产早孕组两组中各参数的差异;复发性流产早孕组中使用低分子肝素前后各指标的变化。结果复发性流产早孕组中的PI、RI、S/D、D-二聚体的界值分别为2.6、0.85、6.8、0.65 mg/ml,各参数与早孕组相比均有增高;复发性早孕组患者使用低分子肝素前后子宫动脉血流及D-二聚体明显下降(P<0.05)。结论复发性流产早孕组子宫动脉血流、D-二聚体明显高于早孕组,低分子肝素可使两者降低,有效预防复发性流产的发生。     

子宫动脉栓塞治疗子宫腺肌病对卵巢功能的影响

目的:探讨子宫动脉栓塞治疗子宫腺肌病对卵巢功能的影响。方法:对27例子宫腺肌病患者采用聚乙烯醇微粒(PVA)进行子宫动脉栓塞治疗,在栓塞前、栓塞后3个月及6个月,评估所有病人的症状改善情况,并且采用经阴道彩色能量多普勒超声对子宫及病灶进行动态监测,监测子宫大小,子宫动脉和卵巢动脉血流动态改变,及基础性激素水平和基础体温情况。结果:子宫动脉栓塞术后3个月,子宫体积显著减小,平均缩小136.48(37.6%),子宫动脉的最大血流速度Vmax(cm/s)显著降低,由(27.27±6.03)cm/s降至(14.19±5.98)cm/s,P<0.05。子宫动脉阻力指数(RI)由0.54±0.03降至0.86±0.04,P<0.05;栓塞术前、后卵巢血流、卵泡刺激素(FSH)、雌二醇(E2)和月经周期无显著性差别。1例患者出现短暂卵巢功能急剧减退。结论:子宫动脉栓塞治疗子宫腺肌病是一种新颖、微创、安全、有效、并发症少且恢复快的治疗方法,可保留子宫的生育功能,对卵巢功能无明显损害,但应注意可能导致卵巢衰竭。     

经直肠超声检测底蜕膜血流及子宫螺旋动脉血流参数预测药物流产结局的价值

目的:探讨经直肠超声检测底蜕膜血流及子宫螺旋动脉血流参数预测药物流产结局的价值。方法:回顾分析流产完全和流产不全者30例,流产前、流产当日、流产后15d经直肠超声检测子宫底蜕膜血流分型、血流阻力指数和子宫螺旋动脉血流参数。结果:流产完全组底蜕膜Ⅰ型血流信号、子宫螺旋动脉及底蜕膜血流阻力指数显著高于流产不全组;Ⅲ型血流信号显著低于流产不全组(P<0.05);Ⅱ型血流信号与流产不全组比较无显著性差异(P>0.05);流产当天与流产后15d所有指标与流产不全组比较均无显著性差异(P>0.05)。结论:药物流产当日经直肠超声检测子宫螺旋动脉及底蜕膜阻力指数和底脱膜血流分型能有效预测药物流产结局。     

血管紧张素原基因多态孕妇子宫动脉血流异常的临床意义

目的:通过检测具有血管紧张素原(AGT)基因多态孕妇的子宫动脉血流,探讨AGT基因多态与子宫动脉血流异常在子痫前期发病中的作用。方法:对80例来广州军区武汉总医院分娩的具有AGT基因多态的孕妇,行彩色超声检查,发现子宫动脉血流参数异常或多普勒频谱异常按照所具基因型(MM、MT、TT)分为2组:子痫前期组(PIH组)和正常妊娠组(对照组),观察两组子宫动脉收缩末期最大血流速度和舒张末期最大血流速度之比(S/D),搏动指数(PI),阻力指数(RI),胎儿宫内发育迟缓(FGR),低体重儿的发生率及T等位基因频率。结果:PIH组子宫动脉的S/D、PI、RI值均高于对照组,差异有统计学意义(P0.05)。PIH组FGR,低体重儿的发生率及T等位基因频率均高于对照组,差异有统计学意义(P0.05)。结论:AGT基因多态TT型孕妇子宫动脉血流异常提示子痫前期发病危险升高,此类患者存在子宫-胎盘循环障碍,子宫动脉阻抗增高,血供不足,导致不良妊娠结局。早期普查AGT基因多态孕妇,结合彩色超声检查子宫动脉血流在预测子痫前期及围产儿结局方面有重要临床价值。     

Impact of tubal ligation on ovarian reserve as measured by anti-Müllerian hormone levels: a prospective cohort study

Background

Tubal ligation (TL) is considered a very efficient contraceptive method. However, some patients complain of a variety of postoperative symptoms. The objective of this study was to investigate whether ovarian reserve may change after tubal ligation.

Study Design

This was a prospective cohort study of 80 fertile women who underwent TL. Ovarian reserve was evaluated by measuring pre- and postoperative (1 year after surgery) serum anti-Müllerian hormone (AMH) levels and transvaginal antral follicular count (AFC). Potential confounding factors were age, body mass index (BMI), smoking, surgical technique and prior contraceptive methods. The Wilcoxon test was used to compare pre- and postoperative (12 months) AMH and AFC, and simple and multiple linear regression were used to evaluate confounding factors.

Results

Fifty-two patients completed the study protocol. The median AMH level was 1.43 ng/mL (interquartile range 0.63–2.62) preoperatively and 1.30 ng/mL (interquartile range 0.53–2.85) after 12 months (p=.23). The mean AFC was 8.0 (interquartile range 5.0–14.0) and 11.0 (interquartile range 7.0–15.0) before and after TL, respectively (p=.12). These differences were not statistically significant. Use of a hormonal contraceptive method prior to TL was significantly associated with a postoperative increase in AMH.

Conclusions

This study suggests that ovarian reserve is not altered by TL.     

中孕期孕妇子宫动脉血流参数与早发型子痫前期的相关研究

目的 探讨中孕期孕妇子宫动脉血流参数与早发型子痫前期发病的相关性.方法 纳入中山市小榄人民医院2013年1月至2016年5月确诊为早发型子痫前期的患者50例,其中轻度患者26例,重度患者24例,同时纳入同期分娩的健康孕妇50例作为对照组.采用多普勒彩色超声诊断仪检测患者搏动指数(PI)、双侧子宫动脉收缩期与舒张期流速比(S/D)、阻力指数(RI)子宫动脉血流参数,随访至产后了解各项子宫血流参数对早发型子痫前期预测的效果.结果 轻、重度早发型子痫前期组患者孕22～ 24周PI、S/D、RI、子宫动脉血流参数均高于正常对照组,组间相比具有统计学差异(t值为2.364 ～3.458,均P＜0.05);RI与出生孕周呈负相关(r=-4.772,P=0.0050),与新生儿体质量呈负相关,出生孕周越小,指数越大(r=-3.005,P=0.0018).结论 运用子宫动脉血流指标可预测早发型子痫前期的的病情,具有良好的临床应用价值.     

彩色多普勒超声检测脐动脉血流参数与孕周相关性研究

目的:探讨彩色多普勒检测中、晚孕胎儿脐动脉血流参数与孕周的相关性。方法:对4283例孕14～41周的正常胎儿脐动脉血流参数进行统计学分析。结果:胎儿孕14周时即可用多普勒检测脐动脉血流;随着胎龄增长,收缩期最高血流/舒张期最低血流(S/D)、阻力指数(RI)、搏动指数(PI)的测值逐渐下降,至孕40周最低。脐动脉血流多普勒测值参数S/D、RI、PI与孕周呈负相关,r值分别为-0.95、-0.99、-0.97,P<0.001。结论:脐动脉血流多普勒测值参数S/D、RI、PI与孕周呈高度负相关,孕14～41周的胎儿脐动脉S/D、RI、PI测值可供产前超声诊断参考。     

影响卵巢巧克力囊肿卵巢间质血流变化的临床病理因素

目的:探讨影响卵巢巧克力囊肿卵巢间质血流变化的临床病理因素。方法:应用彩色多普勒超声检测60例卵巢巧克力囊肿患者卵巢间质动脉血流,搜集相关临床病理资料进行分析研究。结果:①卵巢巧克力囊肿卵巢间质动脉频谱为高阻型,血流灌注差,显示率低;②病程1年、囊肿长径4cm是血流不易显示的危险因素;③卵巢巧克力囊肿卵巢间质血流的显示区域存在差异,病程、囊肿类型(单房或多房)、囊肿大小是其影响因素(P0.05)。结论:加强对病程、囊肿大小及多房囊肿的监测有助于揭示卵巢巧克力囊肿对卵巢间质组织的损伤,为临床诊治提供参考。     

子宫切除对卵巢血供和卵巢功能的影响

目的:使用彩色多普勒观察子宫切除前后卵巢血供的变化,在血液动力学水平上了解子宫切除对卵巢功能的影响。方法:对50例子宫切除术患者(子宫全切35例,子宫次全切15例)进行彩色多普勒检查,于术前及术后3、6个月、2年测定子宫动脉卵巢支及卵巢动脉的收缩期最大血流速度(Vmax)、舒张末期最小血流速度(Vmin)、阻力指数(RI)、搏动指数(PI)。同时应用放射免疫方法检测患者手术前后血清雌二醇(E2)、孕酮(P)、卵泡刺激素(FSH)、黄体生成素(LH),根据E2术后2年变化情况,将其作为卵巢功能是否减退的依据。将50例病人分为2组:卵巢功能无减退组(Ⅰ组)16人,卵巢功能减退组(Ⅱ组)34人。结果:对手术前两组子宫动脉卵巢支及卵巢动脉的各血流参数进行比较发现,仅子宫动脉卵巢支的Vmax[Ⅰ组(0·55±0·14)m/s,Ⅱ组(0·45±0·12)m/s]比较有显著性差异(P<0·05),其余各参数比较均无显著性差异(P>0·05);手术后两组的卵巢动脉Vmax、Vmin值下降,RI、PI值升高,两组间各参数比较无显著性差异(P>0·05);每组内手术前后卵巢动脉各参数比较有极其显著性差异(P<0·01)。术前两组间E2[Ⅰ组(75·43±37·11)pg/ml,Ⅱ组(197·85±112·46)pg/ml]比较有极其显著性差异(P<0·01)。对子宫全切及子宫次全切不同手术方式患者进行手术前后卵巢动脉的各血流参数比较无显著性差异(P>0·05)。结论:子宫切除可导致术后卵巢动脉Vmax、Vmin值下降,RI、PI值升高;术前子宫动脉卵巢支的Vmax低、E2水平高的患者(Ⅱ组)术后卵巢功能明显下降;术前子宫动脉卵巢支的Vmax高、E2水平低的患者(Ⅰ组)术后2年内卵巢功能不受影响。故术前彩色多普勒检查子宫动脉卵巢支收缩期最大血流速度,并参考血清雌二醇水平对预测子宫切除术后卵巢功能影响程度有重要参考价值。     

Uterine artery blood flow in the periimplantation period in embryo transfer cycles

ObjectiveTo assess the role of the uterine artery blood flow in the prediction of implantation in women undergoing embryo transfer during the periimplantation period.MethodsA total of 233 couples were included in this prospective study. All patients had embryo transfer, 125 were performed in in-vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) and 108 in cryo cycles. Ultrasound measurements were performed immediately before transfer. The pulsatility index (PI), Resistance index (RI) and the peak systolic velocity (PSV) were measured in both uterine arteries using endovaginal ultrasound.ResultsIn IVF/ICSI cycles the doppler parameters PI (2.48 vs. 2.15), RI (0.78 vs. 1.30) and PSV (60 vs. 63) did not differ significantly between the pregnant and non-pregnant group. The pregnancy rate per transfer was similar in women showing an unilateral (24%), bilateral (33%) or no (27%) notch in the uterine blood flow. In cryo cycles the uterine artery blood flow parameters PI (3.2 vs. 3.0), RI (0.9 vs. 0.9) and PSV (53.2 vs. 51.2) did not differ either between pregnant and not pregnant patients.ConclusionsPrevious studies were aiming at the measurement of arterial doppler parameters during the follicular phase which may not be adequate for the prediction of implantation. However, our results show that doppler studies during the early luteal phase of assisted reproductive technology cycles are not indicative for the likelihood of pregnancy, too.     

局麻单孔腹腔镜双极电凝与经腹近端抽芯包埋两种输卵管绝育术对生殖激素近期影响的对比观察

目的:比较观察局麻单孔腹腔镜双极电凝输卵管绝育术与经腹近端抽芯包埋输卵管绝育术对卵巢功能的影响。方法:在贵州省内14个县随机抽取2014年10月~2015年10月行上述两种输卵管绝育术妇女各100例,测定卵巢基础激素(FSH、LH和E2)。结果:共133例研究对象进入观察,其中腹腔镜输卵管绝育术组82名,年龄28.84±4.02岁;开腹输卵管绝育术组51名,年龄27.61±4.20岁。两组术后1个月的卵巢基础性激素平均水平无统计学改变;术后1个月基础FSH≥10U/L、基础FSH/LH升高2的比例开腹组明显高于腹腔镜组。结论:腹腔镜输卵管绝育术近期对卵巢功能的影响小于开腹输卵管绝育术。     

绝经过渡期妇女卵巢内分泌功能与卵巢内血流量的相关性研究

目的:研究卵巢内分泌功能与卵巢内血流量的关系。方法:应用经阴道彩色多普勒观察48例绝经过渡期妇女卵巢动脉血流情况,用放免法检测激素水平,并以40例正常生育期妇女作对照。结果:绝经过渡期妇女PSV水平明显低于对照组,而PI和RI明显高于对照组,血清FSH和LH明显高于对照组,P和E2水平明显低于对照组,其中PSV水平与FSH、LH呈负相关,与P、E2呈正相关。结论:绝经过渡期妇女卵巢血供障碍,内分泌功能异常,两者之间相互作用导致卵巢功能下降。     

监测脐动脉、腹主动脉血流预测胎儿宫内发育

提高出生人口的素质是计划生育内容之一。探讨在胎儿期预测胎儿宫内发育的方法对优生具有重要意义。运用彩色多普勒监测胎儿脐动脉、腹主动脉血流,若脐动脉血流S/D>3、PI值>1.7、RI值>0.7时,预示胎儿宫内状况差,围产儿结局不良者占48％;若胎儿腹主动脉S/D值>4、PI值>1.8、RI值>0.8时,预示胎儿宫内发育迟缓(IUGR),围产儿结局异常者占50％。     

彩色多普勒血流成像血流阻力指数联合形态影像在良恶性卵巢肿瘤鉴别中的应用研究

目的:探讨彩色多普勒血流成像(CDFI)血流阻力指数联合形态影像在良恶性卵巢肿瘤鉴别中的应用价值.方法:选取医院接诊的73例卵巢肿瘤患者,将其不同检查方法的影像资料分为观察组和对照组,观察组采用超声形态影像联合血流阻力(RI)指数进行检查;对照组采用二维超声形态影像检查.将RI值和形态诊断进行5分法量化处理,绘制受试者...     

子宫肌瘤患者保留附件的子宫切除对卵巢组织学及功能的影响

目的: 探讨子宫动脉对卵巢组织学及功能的影响。方法: ①对子宫肌瘤需手术患者 30例采用保留双侧子宫动脉的大部子宫切除成型手术方式 (研究组), 同期进行 30例常规全子宫切除 (对照组 1)、30例子宫次全切除作为对照 (对照组2), 3组手术前及手术后 3个月、6个月及 12个月性激素测定; ②进行兔实验, 手术后 3月取兔卵巢标本行病理学检查。结果:3手术组术前性激素比较无明显差异P>0 05, 2对照组手术后 6个月开始出现的内分泌改变, 12个月后出现明显改变P<0 05;子宫切除的兔卵巢组织 3月后有缺氧改变。结论: 子宫动脉是卵巢的主要血液来源, 直接影响卵巢组织功能。     

超声多普勒测定正常早产儿脑血流速度的研究

目的:探讨正常早产儿脑血流参数值以及胎龄(gestational age,GA)、出生体重(b irth we ight,BW)、日龄、血压对早产儿脑血流的影响。方法:应用超声多普勒测定正常早产儿的脑血流参数。结果:生后第2天各组正常早产儿的颈内动脉(ICA)、大脑前动脉(ACA)的收缩期峰值血流速度(Vs)、平均血流速度(mV)与第1天比较差异显著(P<0.01);正常早产儿脑血流速度与胎龄(GA)、体重(BW)呈正相关。结论:在评价早产儿脑血流灌注状态时,应注意GA、BW、日龄对其的影响。