子宫、卵巢不同术式对中青年妇女内分泌的影响

目的:研究子宫、卵巢不同术式对中青年妇女内分泌变化的影响,探讨子宫卵巢最合理的术式,为术后的激素补充治疗提供依据。方法:对131例49岁以下的非绝经妇女按子宫和卵巢最常见的术式分为3组,即单纯切除一侧附件组(I组)、切除子宫和一侧附件组(Ⅱ组)、切除子宫和一侧附件同时对侧行卵巢囊肿剥除术组(Ⅲ组)。分别在术前和术后的7天、3个月、6个月测定FSH、LH、E2、P、PRL、T水平,并在术后3～6个月时对更年期症状进行随访。结果:单纯切除一侧附件手术前后的激素水平无明显变化,更年期症状不明显。Ⅱ组与Ⅲ组,FNH、LH均升高,E2下降,更年期症状增多,两组相比,差异无显著性,且E2随术后时间延长有逐渐上升的趋势。Ⅲ组术后7天PRL明显升高,6个月恢复至术前水平。结论:卵巢功能与血液供应直接相关,与垂体-卵巢-子宫激素轴的协调有关。残留卵巢的功能可代偿但有一定的构建阶段。     

不同术式子宫切除术对患者内分泌及骨代谢的影响

过去对一些患有某些子宫良性疾患如子宫肌瘤、功能性子宫出血的妇女常行全子宫切除。近来研究表明 ,子宫不仅是一个受激素作用的靶器官 ,而且还能分泌多种生物活性物质 ,与卵巢、垂体进行精细的内分泌调节 ,因此在有效治疗疾患的同时尽可能保留部分子宫对年轻妇女的身体健康和生活质量有积极的意义。本文旨在研究子宫切除及不同的子宫切除术式对绝经前女性的内分泌及骨代谢的影响 ,为临床选择恰当的术式提供依据。1　资料与方法1.1　一般资料选自 1998年 12月至 2 0 0 2年 12月我院因子宫良性病变行子宫切除术的未绝经病人 5 0例 ,年龄在 38…     

子宫及卵巢切除术对女性性功能影响

子宫及卵巢切除术对女性性功能可能产生一定影响.综述不同术式及不同途径子宫切除术及卵巢切除术对女性性功能的影响.研究发现选择何种术式或何种途径的子宫切除不是影响性行为重要因素.但经阴道和经腹腔镜手术能更早恢复性生活,保留宫颈的腹腔镜子宫切除术对性功能的恢复相对好.综述发现卵巢切除术后在雌激素替代基础上给予一定量的睾酮对提高性功能有一定益处.     

绝经前全子宫切除保留卵巢对妇女骨代谢及骨密度的影响

目的 :追踪观察绝经前妇女全子宫切除保留卵巢对远期骨代谢及骨密度的影响。方法 :对比观察绝经前行全子宫切除保留单侧卵巢 4 8例、全子宫切除保留双侧卵巢 15例和正常妇女 30例的血清钙 (Ca)、血清磷 (P)、血清碱性磷酸酶 (AKP)、血清骨钙素(BGP)、空腹尿Ca Cr及尿HYP Cr值、骨密度值的变化和差异。结果 :全子宫切除保留单侧卵巢组血AKP值、BGP值、空腹尿Ca Cr和尿HYP Cr均显著高于对照组 (P <0 0 5 ) ,而骨密度值则显著低于对照组 (P <0 0 5 )。保留双侧卵巢组尿HYP Cr显著高于对照组 (P <0 0 5 )。结论 :子宫全切除保留单侧卵巢者远期骨转换加快 ,导致骨丢失及骨密度下降 ,双侧卵巢保留者骨吸收亦加快 ,但骨密度无下降     

大子宫切除三种不同术式的比较

2004年9月至2007年9月，我院收治了154例超过妊娠12孕周的大子宫患者用3种方式行全子宫切除术，现对3组患者的临床资料回顾分析如下。     

绝经前子宫切除卵巢缺失现象与冠心病的危险

本文通过对照研究,观察了８２例患者术后出现的更年期症状及血脂的改变。旨在探讨绝经前妇女子宫切除术后发生冠心病的危险及雌激素治疗的必要性。１资料与方法１．１研究对象选择１９９２年１月至１９９５年１２月因妇科良性疾病在我院施行子宫切除、保留一侧或两侧卵巢...     

因良性病变行子宫切除时保留卵巢

因子宫良性病变行子宫切除时常预防性切除卵巢，其目的主要是为降低卵巢癌的发病风险。在美国，切除子宫同时行双侧附件切除的比例由1965年的25％增至1999年的55％。1999年美国妇产科学会发布的临床治疗指南中建议：预防性卵巢切除术不仅要考虑患者的年龄．还要权衡发生卵巢癌的风险以及丧失卵巢功能的利弊。     

多囊卵巢综合征临床内分泌代谢对子宫内膜病变的影响

目的　探讨多囊卵巢综合征 (PCOS)患者临床内分泌代谢改变对子宫内膜病变的影响。方法　用组织学方法检测 94例PCOS患者子宫内膜病理改变 ,用放射免疫学方法测定血清泌乳素、黄体生成激素、卵泡刺激素、雌二醇、睾酮、雄烯二酮水平 ,82例同时行糖耐量及胰岛素释放实验。结果　① 70例PCOS患者子宫内膜为无排卵型 ,其中增殖期内膜 45例 ,增殖症 2 5例 (单纯增生 2 3例、不典型增生 2例 ) ;2 4例为排卵型子宫内膜 ,其中13例分泌反应不佳 ,11例分泌反应良好。②无排卵型子宫内膜组与排卵型子宫内膜组比较 ,前者血清空腹及糖负荷后 6 0min、12 0min的胰岛素水平和胰岛素曲线下面积明显增高 (P均 <0 0 5 )。③子宫内膜增殖症患者与增殖期内膜患者比较 ,前者胰岛素曲线下面积明显增高 (P <0 0 5 ) ,其中单纯增生患者糖负荷后 6 0min、12 0min的胰岛素水平和胰岛素曲线下面积比增殖期内膜患者明显增高 (P均 <0 0 5 )。结论　PCOS患者高胰岛素血症是导致无排卵型子宫内膜的重要因素之一 ,增高的胰岛素对子宫内膜的异常增生也可能起促进作用。     

良性子宫肌瘤切除术式与卵巢去留的问题

子宫肌瘤是妇科最常见的一种良性病变，多见于30—50岁，往往需要手术治疗。在切除子宫时，对卵巢的去留是需要慎重考虑的，根据患者当时的情况，关系到将来的影响，做全面的考虑，选择最合适的手术方法，才能保证患者的身体健康。     

Clinical Features and Plasma Hormone Levels After Surgical Menopause

This study reports the plasma levels of follicle stimulating hormone, luteinising hormone, oestradiol and testosterone in 43 women who had undergone bilateral o?phorectomy. Age was the only variable of those investigated which appeared to influence a hormone level; testosterone levels were found to decrease with increasing age. Two significant associations were found between clinical features of the menopause and the plasma hormone levels measured. Low levels of oestradiol were associated with pruritus vulvae and high levels of testerone were associated with headaches.     

A Comparative Study of CEE,Tibolone, and DHEA as Hormone Replacement Therapy for Surgical Menopause

Objective(s)

The objective of this study was to compare the efficacy and safety of CEE, tibolone, and DHEA for prevention of menopausal symptoms.

Method(s)

One hundred patients with surgical menopause were included in this study: 25 of whom were not treated with any HRT, 25 were treated with 0.625 mg of CEE, 25 were treated with 2.5 mg of tibolone, and 25 were treated with 25 mg of DHEA for 1 year, and the results were statistically analyzed regarding drug efficacy and side effects at follow-up periods of 1, 6 and 12 months.

Result(s)

Frequency of menopausal symptoms was significantly less in cases received with CEE, tibolone, DHEA with p values 0.001, 0.004 and 0.004, respectively. Percentage gain in BMD was 2.8 % with CEE at lumbar spine, which was greater than that caused by DHEA and tibolone, but this difference was not statistically significant. CEE caused side effects like headache (40 %) and nausea (28 %).

Conclusion(s)

CEE, Tibolone, and DHEA are very effective in alleviating climacteric symptoms. CEE has beneficial effects on lipid and bone and is a low-cost drug but frequently causes side effects. Tibolone offers beneficial androgenic effects on mood and libido with fewer side effects but is a costly drug. DHEA shows positive effects on psychological symptoms. However, its cost and androgenic side effects limit its use as long-term HRT.

     

Hormone Therapy for the Management of Menopause Symptoms

Many women will undergo menopause without incident, but others will experience bothersome effects resulting from declining estrogen levels. Vasomotor symptoms, which manifest as intense feelings of warmth, flushing, and perspiration, are the most common symptoms for which women seek treatment. Hormone therapy is indicated for the relief of vasomotor symptoms related to menopause. We review current Food Drug Administration‐approved options for hormone therapy and discuss implications for practice and patient education.     

Hormone Replacement Therapy at the Menopause A Double Blind Controlled Study of Women's Preferences

Summary: Forty-nine women who had previously undergone hysterectomy and bilateral oöphorectomy took part in a double blind cross-over trial of hormone replacement therapies. This consisted of 3 months each of ethinyl oestradiol 50 μ g per day, d norgestrel 250 μg per day, a combination of these 2 substances ('Nordiol'), and a placebo. All drugs were administered in a randomized sequence as identical tablets. The 36 women who completed the study concorded in their preference of the drug received. The order of preference was ethinyl oestradiol, the combination of ethinyl oestradiol and d norgestrel, d norgestrel and placebo. From a symptomatic viewpoint, this suggests the use of oestrogen alone as the preferred hormone replacement therapy in menopausal women. The combination of oestrogen and progestogen may provide a satisfactory alternative where the use of unopposed oestrogens is undesirable.     

Measurement of Luteinizing Hormone Level After Gonadotropin-Releasing Hormone Agonist Trigger Is Not Useful for Predicting Oocyte Maturity

Objective

To study whether the measurement of LH after GnRH agonist trigger is correlated with the proportion of mature oocytes.

绝经早期低剂量激素治疗对乳腺的影响分析

目的:研究绝经早期低剂量激素治疗(HT)对乳腺的影响.方法:收集绝经早期妇女104例,随机分为激素组和中药组各52例,治疗1年,每3个月随访1次,由专人进行绝经期生存质量量表评分,受试者每日记录乳房胀痛情况.结果:绝经期生存质量量表中,激素组用药前评分为1.90±0.94分,用药后3月,6月,9月,12月评分较前均有显著性下降,分别为1.27±0.67分,1.08±0.62分,0.97±0.64分,0.69±0.50分;中药组用药后3月,6月,9月,12月评分也较用药前有显著性下降.激素组在用药3月,6月,9月,12月的乳房胀痛发生率分别为29.17%.14.63%,22.22%,9.09%,各时间点与中药组相比差异无统计学意义;在用药1～3月,激素组乳房胀痛程度为中度或重度的受试者占35.7%,显著多于中药组0%,其余各时间点两组在乳房胀痛程度上无统计学意义;激素组用药前乳腺小叶增生发生率为60%,用药后为91.4%,用药前后差异有统计学意义.结论:绝经早期低剂量HT和中药治疗1年均能有效提高生存质量,HT使乳腺小叶增生发生率增加,应用HT的过程中应加强乳房监测.     

Migraine and the Menopause

Migraine is a disorder characterized by recurrent or episodic headaches which is about three times more common in adult women than in men. Fluctuations in estrogen, particularly falling estrogen levels, can trigger a perimenopausal exacerbation of migraine. Keeping the estrogen level above the migraine threshold can be useful in migraine prophylaxis at this hormonally turbulent time. Migraine eventually improves in most women who undergo a natural menopause. Cyclic hormone replacement could trigger a recurrence of migraine in such women. Continuous hormone replacement therapy provides the most stable estrogen environment and is the preferred replacement for women with migraine.     

三种激素制剂用于绝经期激素补充治疗的对比研究

目的 :对比三种用于激素补充治疗的制剂 ,为用药选择提供参考。方法 :73例绝经妇女随机分为三组 ,分别用克龄蒙、尼尔雌醇和妇舒宁共 6个月。用药前后观测绝经期症状、血脂 4项、骨密度及子宫内膜厚度。结果 :用药后三组之绝经期症状均明显改善 ,Kupperman评分显著下降 ;各组总胆固醇、甘油三酯 (除尼尔雌醇组外 ) ,低密度脂蛋白均显著下降 ,高密度脂蛋白均显著上升 (均 P<0 .0 5或 0 .0 1) ;三组之骨密度均无明显变化 (P>0 .0 5 ) ;无一例宫内膜过度增生。对上述指标之影响 ,三种制剂相比无显著性差异 (P>0 .0 5 )。结论 :三种制剂均能显著改善绝经期症状 ,有利血脂代谢和抑制骨丢失。宜根据治疗目的 ,患者需求及经济能力选择用药