子宫内膜异位症患者囊肿病灶特征与术后累计妊娠率的相关性分析

目的观察子宫内膜异位症患者囊肿病灶典型特征与术后近期和远期累计妊娠率的相关性,为解释"异位囊肿特征与术后妊娠率相关性的文献研究争议"提供参考。方法选取2015年1月至10月华中科技大学同济医学院附属武汉儿童医院诊治的143例子宫内膜异位症(有明显囊肿病灶,且接受手术+术后诺雷得治疗)患者为回顾性研究对象,观察患者囊肿病灶典型特征(病症分期、病灶部位、病灶浸润深度、粘连部位)与术后近期(12个月)和术后远期(24个月)累计妊娠率的相关性。结果不同囊肿病灶分期、部位、浸润深度、粘连部位患者的术后近期累计妊娠率比较,其差异均无统计学意义(均P0.05);术后远期累计妊娠率比较,其差异均具有统计学意义(均P0.05)。囊肿病灶Ⅲ期、Ⅳ期患者术后远期累计妊娠率低于囊肿病灶Ⅰ期、Ⅱ期患者,浸润深度5cm病灶患者术后远期累计妊娠率低于浸润深度≤5cm病灶患者,深部浸润型囊肿病灶患者的远期累计妊娠率低于腹膜型、卵巢型、混合型囊肿病灶患者,与卵巢粘连患者和与输卵管粘连患者的术后远期累计妊娠率明显低于与直肠陷凹连粘、与子宫底后壁粘连、与骶韧带壁粘连、与膀胱子宫腹膜返折粘连患者,其差异均具有统计学意义(均P0.05)。结论子宫内膜异位症患者囊肿病灶典型特征虽然与术后近期(12个月)的累计妊娠率无相关性,但与术后远期(24个月)的累计妊娠率存在相关性。病理分期越高患者,病灶为深部浸润型患者、病灶浸润深度5cm患者、病灶与卵巢粘连和与输卵管粘连患者的远期妊娠率较低,临床治疗应当予以重视。     

腹腔镜治疗子宫直肠陷凹子宫内膜异位症的临床价值

目的：探讨腹腔镜治疗子宫直肠陷凹子宫内膜异住症的临床价值。方法：选取2009年1月～2011年12月我院妇科共收治子宫直肠陷凹子宫内膜异位症29例,采用视觉模拟评分,分析术后疼痛缓解情况。结果：29例患者术前疼痛评分为（7．4±2．5）分,术后疼痛评分为（3．1±1．7）分,术后评分较术前明显降低,有显著性差异（t=7．6594,P〈0．01）。术前与术后疼痛各等级例数相比较有显著性差异（χ2=34．3723,P〈0．01）。结论：腹腔镜手术是治疗子宫直肠陷凹子宫内膜异位症的一种安全有效的方法。     

深部浸润型子宫内膜异位症的临床症状和妇科检查价值评估研究

目的:探讨临床症状和妇科检查对深部浸润型子宫内膜异位症(deep invasive endometriosis,DIE)的评估价值。方法:选取2015年1月至2016年12月我院收治的子宫内膜异位症患者120例为研究对象,所有患者均在我院行腹腔镜手术治疗并进行病理检查,以手术病理结果为金标准分为DIE组57例和非DIE组63例,然后与术前患者临床症状和妇科检查结果进行对比分析,评估临床症状和妇科检查对DIE的诊断价值。结果:根据美国生殖医学协会(r-AFC)制定的子宫内膜异位症分期评分标准,DIE组患者病程和r-AFC评分明显高于非DIE组,比较差异有统计学意义(P0.05);重度痛经、盆腔痛、性交痛、肛门坠胀等临床症状的诊断灵敏度分别为92.98%、40.35%、66.67%和31.59%;特异度分别为66.67%、71.43%、88.89%和71.43%。子宫大小、子宫活动度、附件囊肿活动度、宫骶韧带结节、宫骶韧带触痛阳性、阴道直肠隔结节、阴道直肠隔触痛阳性、后穹窿蓝色结节等妇科检查项目的诊断灵敏度分别为40.35%、63.16%、73.68%、68.42%、85.96%、14.04%、12.28%和40.35%;特异度分别为63.49%、55.56%、57.14%、80.95%、71.43%、100%、100%和100%。结论:重度痛经、阴道直肠隔结节和后穹窿蓝色结节对诊断DIE具有较高的价值,临床表现和妇科检查发现以上症状,应高度警惕DIE的可能。     

深部浸润型子宫内膜异位症的诊治研究进展

本文综述深部浸润型子宫内膜异位症(DIE)研究进展。DIE是子宫内膜异位症的一种特殊类型,可以侵及盆腔不同组织及器官,主要表现为疼痛。目前,其诊断主要依据临床表现、体征和影像学检查。治疗上腹腔镜手术是主要的方法,但手术难度大,副损伤风险高;药物治疗不仅可缩小病灶,缓解疼痛,并且可延迟复发时间,是重要的辅助治疗措施。输尿管、肠道DIE由于常合并有泌尿系和肠道功能受损的相关症状,给临床诊断治疗带来困难,部分患者确诊时常已发生不可逆转的功能障碍,应当引起足够重视。     

妇科腹腔镜手术并发泌尿系统损伤的相关分析

目的:观察研究妇科腹腔镜手术并发泌尿系统损伤的情况,并探讨其相关因素。方法:选取2008年3月至2014年4月我院于妇科进行腹腔镜手术治疗的1895例患者为研究对象,将其中的泌尿系损伤发生率进行统计,并比较其中不同年龄、盆腔手术史、盆腔粘连情况、手术类型、子宫体积、子宫内膜异位症及电凝电切功率患者的发生率,并将上述因素与泌尿系损伤的关系采用Logistic分析进行处理。结果:1895例患者中共发生11例泌尿系损伤,发生率为0.58%,其中输尿管损伤3例(0.16%)、膀胱损伤8(0.42%),不同年龄者的发生率无明显差异,P0.05,而其中有盆腔手术史、盆腔粘连、子宫全切术、子宫体积较大、存在子宫内膜异位症及电凝电切功率过大者的发生率明显高于其他患者,经Logistic分析其均与泌尿系损伤有密切的关系,P均0.05,均有显著性差异。结论:妇科腹腔镜手术并发泌尿系统损伤的发生率较低,但是危害较大,其中盆腔手术史、盆腔粘连、手术类型、子宫体积较大、子宫内膜异位症及电凝电切功率较大均是其高危因素。     

腹腔镜子宫骶神经切断术治疗子宫内膜异位症疼痛的安全性和有效性观察

目的:观察腹腔镜下子宫骶神经切断术(LUNA)治疗子宫内膜异位症疼痛的临床效果,并对其安全性和有效性进行评价。方法:以本院2010年1月至2014年5月期间收治的134例子宫内膜异位症伴疼痛患者为研究对象,将134例患者按随机数原则分为对照组和观察组各67例。两组患者均行病灶切除术,此外观察组在此基础加做LUNA。比较两组患者的手术情况及术后疼痛缓急情况。结果:观察组手术时间为(78.09±12.03)min,高于对照组(47.41±11.84)min,差异具统计学意义(P0.05);术中出血量、术后肛门排气时间、住院时间、住院费用等指标两组患者间未见显著性差异(P0.05)。术前两组患者疼痛评分无显著差异(P0.05),术后两组患者均有所降低,疼痛症状得到缓解,组间比较结果显示,观察组疼痛评分显著低于对照组(P0.05),同时缓解率高于对照组(P0.05)。术后对照组患者未出现手术相关并发症;观察组有1例患者出现大便干结,排便习惯改变,经对症治疗后痊愈。结论:采用腹腔镜子宫骶神经切断术治疗子宫内膜异位症疼痛是安全且有效的,值得在临床进行推广。     

腹腔镜骶前神经切断术对子宫内膜异位症患者性生活质量的影响

目的:探讨腹腔镜骶前神经切断术对子宫内膜异位症患者性生活质量的影响。方法:随机选择2015年2月至2016年3月我院收治子宫内膜异位症患者80例,按照随机数字法分为两组,各40例,对照组实施腹腔镜下子宫内膜症病灶清除术,观察组联合骶前神经切断术,比较两组患者术后24h、术后72h及术后1周疼痛变化情况,统计存在性功能相关障碍比例,及两组恢复性生活时间、性唤起时间、每月性生活频率。结果:观察组术后72h及术后1周其疼痛VAS评分显著低于对照组(P<0.05),观察组存在阴道干涩、性交痛、性欲低下及性高潮缺失比例显著低于对照组(P<0.05),观察组性生活恢复时间早于对照组(P<0.05),性唤起时间短于对照组(P<0.05),每月性生活频率高于对照组(P<0.05)。结论:腹腔镜下子宫内膜异位病灶清除联合骶前神经切断,能有效的缓解患者疼痛症状,减少发生性功能障碍比例,缩短性唤起时间,促进患者早日恢复规律性生活。     

腹腔镜不同术式治疗卵巢子宫内膜异位囊肿的临床观察

目的:探讨腹腔镜不同术式治疗卵巢子宫内膜异位囊肿的手术疗效。方法:回顾性分析2013年1月至2015年8月杭州市第一人民医院、杭州市妇产科医院采用腹腔镜治疗卵巢子宫内膜异位囊肿患者95例的临床资料,根据术式分为凝固术组(45例)和囊肿剥除组(50例),术后对两组患者进行12个月的随访,比较两组患者术后卵巢子宫内膜异位囊肿及相关疼痛复发、术后血清促卵泡生成素(FSH)值和卵泡计数等差异。结果:术后两组均随访12个月,囊肿剥除组卵巢子宫内膜异位囊肿复发率、卵巢子宫内膜异位囊肿相关疼痛复发率均明显低于凝固术组(P0.05)。术后6个月及12个月,囊肿剥除组卵泡计数均明显多于凝固术组(P0.05),而两组FSH水平无显著差异。结论:与腹腔镜卵巢子宫内膜异位囊肿凝固术比较,腹腔镜囊肿剥除术能更有效降低痛经、性交痛、非经期盆腔痛等相关疼痛及子宫内膜异位症病灶的复发,并在术后卵巢储备功能方面更具优势。     

宫、腹腔镜联合手术对子宫内膜异位症合并内膜息肉患者妊娠结局的影响

目的:探讨宫、腹腔镜联合手术对子宫内膜异位症合并内膜息肉患者的治疗效果。方法:采用回顾性分析法,选取2014年4月至2015年5月期间于我院接受宫、腹腔镜联合手术的120例子宫内膜异位症患者的临床资料,根据是否合并子宫内膜息肉将患者分为两组,内膜息肉组和非内膜息肉组,每组各60例患者。观察两组患者子宫内膜息肉发病特点和术后对妊娠情况的影响。结果:经过分析发现,子宫内膜息肉在单纯腹膜型DIE型、卵巢型及累及Douglas窝的深部浸润型内异症中发病率分别为28.33%(17/60)、21.67%(13/60)、48.33%(29/60),三种类型子宫内膜息肉发生率之间比较有明显的差异(P0.05);息肉组术后自然妊娠率、临床妊娠率、分娩率分别为:31.67%、26.67%、25.00%,非息肉组自然妊娠率、临床妊娠率、分娩率分别为:35.00%、33.33%、26.67%,两组患者术后自然妊娠率、临床妊娠率、分娩率之间没有明显的差异(P0.05);但是息肉组患者胚胎停育率明显高于对照组(P0.05)。结果:经宫腹腔镜联合手术治疗后,子宫内膜异位症合并子宫内膜息肉与不合并息肉患者相比,在妊娠结局上易并发胚胎停育,可考虑术后辅助药物治疗,改善妊娠结局。     

芳香化酶抑制剂在子宫内膜异位症相关性疼痛及不孕中的作用研究进展

子宫内膜异位症是一种雌激素依赖性的妇科慢性炎症性疾病,在育龄妇女中的发病率为5%~10%,在子宫内膜异位症患者中有5%~50%表现为慢性盆腔疼痛,此外还有33%表现为不孕。第三代芳香化酶抑制剂(aromatase inhibitors,AIs)目前获批用于雌激素受体阳性的乳腺癌的治疗。分子生物学研究表明,芳香化酶P450是卵巢雌激素生物合成中的关键酶,在子宫内膜异位组织内,研究发现异位子宫内膜组织也可具有合成雌二醇的作用。以AIs为主的治疗方案目前已经广泛应用到子宫内膜异位症的治疗,对盆腔疼痛和不孕的患者具有一定临床疗效。本文旨在综述使用AIs治疗子宫内膜异位症相关疼痛和不孕的作用。     

Apoptosis, the dermatologist, the venereologist and the patient

Apoptosis is the genetically mediated process whereby individual cells determine their deletion from normal and diseased tissues. Deregulation of apoptosis occurs to a greater or lesser extent in malignant tumours and in certain skin diseases, and also largely accounts for the progressive depletion of CD4⁺ lymphocytes in HIV infection. Greater understanding of apoptosis modulation by oncogenes and tumour suppressor genes such as c-myc. Fas, p53, bcl-2, and abl will facilitate the development of new therapeutic strategies for cancer and other diseases.     

Objective,measurable assessment of the elasticity of the skin around the eyes following the carboxytherapy treatment

Background

Carboxytherapy is one of the most popular procedures used in dermatology. The treatments are known to be minimally invasive and highly effective for various skin disorders. Therefore, the research carried out in the paper is purposeful and addresses an important area of aesthetic therapies.

Aims

Objective, apparatus-based assessment of the effect of carboxytherapy on skin elasticity around the eyes.

Patients/Methods

The study included a group of 39 Caucasian individuals aged 35–55 years. Participants were subjected to a series of five carboxytherapy treatments of eye area at weekly intervals. The Cutometer measuring probe was used to assess skin elasticity. Additionally, photographic documentation was out using the Fotomedicus system.

Results

In this study, statistically significant increase in R2 parameter was found as the result of applied treatment. This parameter is considered to be the most important indicator of changes in skin elasticity. In 29 out of 39 subjects, the carboxytherapy treatment significantly improved skin tension and elasticity. Such therapy may also exert a beneficial effect on flexibility since in 28 participants the favorable change in the R7 parameter was visible.

Conclusions

The objective analysis of the impact of carboxytherapy treatment on parameters determining skin elasticity revealed that this therapy can be used as an anti-aging method in the eye area. Obtained results are in agreement with other biochemical, histological, and photographical documentation analyses of the effect of carboxytherapy on skin, performed by independent researchers.     

Cosmetics, the consumer, the factory worker and the occupational physician

Methods for investigating contact eczematous patients and for measuring the sensitizing potential of various substances are well known and in general, sufficiently effective. This is not true for irritant dermatitis, or for possible (skin) irritant substances; moreover, cosmetics commonly do not contain acutely harmful ingredients. The use of various instrumental measurements (insensible H2O loss, CO2 release, electrical impedance, sweat rate) as indicators of the irritant potentials of substances is advocated. At the same time it is suggested that the factory physician actively investigate the workers in his factory, since these workers are exposed to known substances in known concentrations and combinations, possibly for extensive periods. This may prove to be part of a new role for him. A cosmetic may be one of several factors increasing impairment and only beyond a certain limit may this result in overt disease. Below that limit the health reserve is only partially depleted. Whether this is harmful to a person depends on other stresses, such as medicaments, work materials, other cosmetics and environmental chemicals. The effect of these must also be quantified. A model of these cumulative stresses and reactions is presented and discussed.     

Interrogating the integument: the role of the epidermis in hair induction

Hair follicle development is driven by interactions between the epithelium and underlying mesenchyme. These reciprocal interactions are essential for development, as a lack of response from either the mesenchyme or epithelium results in arrested growth. A large body of research has focused on the role of mesenchymal cells during hair follicle development and their inductive properties for hair neogenesis. In this commentary, the role of the epidermis during hair follicle induction will be discussed.     

Measurement of the mechanical properties of the skin using the suction test

INTRODUCTION: The suction test is commonly used to study the mechanical properties of human skin in vivo. The unevenness of the stress fields complicates obtaining the intrinsic mechanical parameters of the skin in vivo because the values of the local stresses and deformations cannot be calculated directly from the displacements and forces applied by the test apparatus. In general, users only take into account the negative pressure applied and the elevation of the dome of skin drawn up in order to deduce the properties of the skin. This method has the major disadvantage of being dependent on the experimental conditions used: in particular, the size of the suction cup and the negative pressure applied. Here, we propose a full mechanical study of the test to provide rigorous results. We compare the frequently used geometric method (making the thin plate hypothesis), Timoshenko's method (which can take greater plate thicknesses into account) and finally various results obtained by the finite elements (FE) technique. METHODS: The suction test was modelled by FE with large displacements and large deformations both for orthotropic and isotropic plates. The results obtained in the elastic domain for various values of Young's modulus and of applied negative pressure were used as references and were compared with methods using analytical relationships. RESULTS: The geometric method generally used in the interpretation of suction tests gives results, which in certain configurations, are very different from those obtained by FE. The method of Timoshenko is suited to thick plates 'in contact' or embedded round the edge, the elevation of the dome and the tension and flexion stresss are analytically accessible through relationships involving four constants that are dependent on the limit conditions. Comparison with the FE results enabled the optimisation of the coefficients to adapt the relationships to the particular conditions of the suction trials. CONCLUSION: We showed the limits of the geometrical method and proposed a solution, which while remaining simple to use, gives results that are closer to reality both for the calculation of the modulus and for the determination of the state of the stresses obtained.     

阿维A治疗重症银屑病临床疗效与安全性评价

目的　评价阿维A治疗重症银屑病的临床疗效与安全性。方法　24例重症银屑病患者采用阿维A治疗,剂量为 20~50mg/d,平均疗程 4~8周。结果　治疗重症银屑病有效率为 79. 2%,其中斑块状寻常性银屑病、红皮病型银屑病、泛发性脓疱型银屑病、掌跖脓疱病有效率分别为 62. 5%, 75. 0%, 100%, 88. 9%;且阿维A治疗剂量与副作用间有相关性。结论　阿维A治疗重症银屑病临床疗效显著,长时间于临床监测下服用阿维A未出现严重的毒副作用。