经阴道补充雌激素对促排卵期薄型子宫内膜的影响

目的:探讨经阴道补充雌激素对促排卵期薄型子宫内膜的影响。方法:将经B超监测有排卵发生但子宫内膜厚度7 mm的不孕患者随机分为对照组(CC组)和治疗组,治疗组又分成补佳乐组(CC+口服补佳乐)、芬吗通组(CC+芬吗通雌二醇片阴道用药)、联合用药组(CC+口服补佳乐及芬吗通雌二醇片阴道用药),观察内膜厚度增幅、类型、用药48 h后血雌激素浓度及妊娠率。结果:共纳入患者110例,对照组20例,治疗组90例,其中补佳乐组28例,芬吗通组28例,联合用药组34例。治疗组患者用药前、后子宫内膜增幅分别为2.3±0.3 mm、2.1±0.2 mm、2.9±0.2 mm;A型内膜比例分别为53.57%、46.43%、67.64%;用药48 h后血雌激素浓度分别为1 141.5±246.4 pmol/L、1 220.3±247.7 pmol/L、1 746.8±247.3 pmol/L;妊娠率分别为14.29%、17.86%、26.47%,均大于对照组,差异有统计学意义(P0.05)。用药48 h后直径15 mm的卵泡个数分别为1.1±0.5、1.2±0.5、1.2±0.5、1.1±0.5,对照组与治疗组间无统计学差异(P0.05)。联合用药组子宫内膜厚度、A型内膜比例、用药48 h后血雌激素浓度、妊娠率均大于补佳乐组和芬吗通组,差异有统计学意义(P0.05)。结论:经阴道补充雌激素可一定程度上提高血雌激素浓度,改变子宫内膜容受性,有助于胚胎着床,提高妊娠率,从而改善妊娠结局。     

薄型子宫内膜冻融胚胎移植周期中应用雌二醇/雌二醇地屈孕酮的疗效观察

目的:探讨雌二醇/雌二醇地屈孕酮(芬吗通)对薄型子宫内膜患者冻融胚胎移植(FET)周期中的子宫内膜厚度及妊娠结局的影响。方法:回顾性分析2013年1月至2014年6月56例患者62个FET周期的临床资料,根据内膜准备方案分为戊酸雌二醇(补佳乐)组29例(34个周期)和芬吗通组27例(28个周期),比较两组患者的一般情况、基础激素水平、超排卵情况、用药量及用药前后子宫内膜增幅和妊娠情况的差异。结果:两组一般情况、基础激素水平、超排卵情况及用药后妊娠情况比较,差异均无统计学意义(P0.05)。两组用药前、用药后子宫内膜厚度比较,差异无统计学意义(P0.05);但用药后子宫内膜厚度均增加(均8 mm),分别与用药前比较,差异均有统计学意义(P0.05);芬吗通组用药后子宫内膜厚度增幅(2.58±1.69 mm)大于补佳乐组(2.00±0.99 mm),差异有统计学意义(P0.05)。芬吗通组用药剂量(65.36±40.22 mg)少于补佳乐组(80.50±63.14mg),差异有统计学意义(P0.05)。结论:补佳乐及芬吗通均可改善薄型子宫内膜患者的内膜厚度,但芬吗通用药量较少且效果更明显,并可获得与补佳乐患者相似的妊娠结局。     

应用粒细胞集落刺激因子(G-CSF)宫腔灌注治疗复发性流产的临床研究

目的:探讨应用人重组粒细胞集落刺激因子(rh G-CSF)宫腔灌注治疗复发性流产(RSA)患者妊娠结局的影响。方法:早期RSA患者100例,随机分为rh G-CSF研究组(n=56)和生理盐水对照组(n=44),于围排卵期行宫腔灌注治疗3 d,连续2个周期,前瞻性比较研究组和对照组患者继续妊娠率和流产率,子宫内膜厚度、基底回声等血流动力学指标。结果:与对照组相比,研究组继续妊娠率高于对照组(88.87%vs 60.60%,P0.05),流产率低于对照组(11.11%vs 39.39%,P0.05);围排卵期内膜厚度组间无统计学差异(P0.05),研究组宫腔灌注治疗后内膜基底区回声优于对照组,差异有统计学意义(P0.05);内膜下血流分支呈增加趋势(P0.05)。结论:rh G-CSF宫腔灌注改善RSA患者的子宫内膜容受性,降低流产率。     

薄型子宫内膜合并甲状腺功能减退不孕患者的辅助生育治疗结局

目的探讨薄型子宫内膜合并甲状腺功能减退不孕患者行辅助生育治疗后的效果。方法 165例因新鲜周期内膜≤7 mm而取消胚胎移植的不孕患者,在拟行冻融胚胎移植前,对游离甲状腺素T4(FT4)正常、促甲状腺激素(TSH)2.5 mIU/L的患者进行左旋甲状腺素片干预治疗。经治疗4~8周后,患者依据TSH水平分为A组(n=70),TSH2.5 mIU/L;B组(n=95),TSH≤2.5 mIU/L。所有患者均采用相同剂量激素替代方案准备子宫内膜,分析子宫内膜情况及辅助生育结局。结果 A组与B组相比,虽然子宫内膜下血流数量和阻力指数(RI)组间无统计学差异(P0.05),但B组内膜下血流数量的均值高于A组,RI均值低于A组。且B组的子宫内膜厚度、临床妊娠率显著高于A组(P0.05),流产率显著低于A组(P0.05)。结论薄型子宫内膜合并TSH升高的不孕患者,给予干预至TSH2.5 mIU/L后,行辅助生育治疗可改善这些患者的妊娠结局。     

不良妊娠史患者流产术后下腹部经皮电刺激对子宫内膜血流影响的研究

目的探讨术后电刺激治疗育龄妇女不良妊娠患者改善子宫内膜血流的有效性。方法将44例因稽留流产、不全流产、剖宫产瘢痕妊娠术后患者随机分为两组,对照组23例行常规治疗及随访,研究组21例在常规治疗的同时行下腹部经皮电刺激的治疗,并同期随访至治疗后4个月,观察患者的症状、子宫内膜厚度和血流变化。结果治疗前研究组和对照组患者在月经量减少、腹痛发生、子宫内膜厚度和子宫内膜血流方面比较,差异无统计学意义(P0.05);治疗后两组以上指标相比较,差异有统计学意义(P0.05);且研究组治疗前后以上指标比较,差异也有统计学意义(P0.05),对照组治疗前后以上指标比较,差异无统计学意义(P0.05)。结论不良妊娠患者术后进行针对性的电刺激治疗,可有效改善其盆腔内环境及子宫内环境。     

保守性手术治疗对不同类型子宫内膜异位症合并不孕的疗效探讨

目的:探讨保守性手术以及手术联合药物治疗不同类型子宫内膜异位症合并不孕患者的疗效.方法:回顾性分析因子宫内膜异位症合并不孕而接受保守性手术治疗的患者共235例,随访12～36月(平均19.19±6.70月).结果:198例完成随访,随访率84.26%(198/235).术后妊娠率为35.86%(71/198),继发不孕者术后妊娠率明显高于原发不孕(54.55%VS 26.52%,P＜0.001).单纯腹膜型子宫内膜异位症、腹膜型联合卵巢内膜样囊肿合并不孕患者术后妊娠率明显高于腹膜型联合子宫腺肌病合并不孕患者(39.71%、37.96%VS 13.64%,P＜0.05).原发不孕和单纯腹膜型子宫内膜异位症合并不孕术后加用GnRH-a治疗组术后妊娠率高于未用药组(34.67%VS 17.39%,58.62%VS 25.71%,P＜0.05).结论:①保守性手术可提高术后妊娠率,尤其对继发不孕;②手术对于单纯腹膜型子宫内膜异位症以及腹膜型联合卵巢内膜样囊肿合并不孕患者有明显的疗效;③原发不孕以及单纯腹膜型子宫内膜异位症患者术后加用GnRH-a治疗可以增加术后妊娠率.     

不同内膜准备方案在冻融胚胎移植中的应用

目的:探讨不同内膜准备方案在冷冻胚胎复融移植中的应用价值。方法:回顾性分析了2011年5月至2011年12月在河南省人民医院行冻融胚胎移植的532个周期,根据内膜准备方案分为:自然周期组(97例),补佳乐人工周期组(286例),芬吗通人工周期组(39例),补佳乐联合芬吗通人工周期组(110例)。比较各组患者年龄、不孕年限、转化日内膜厚度、平均移植胚胎个数、冷冻胚胎复苏率、复苏后全部存活胚胎比率,部分存活胚胎比率、种植率、临床妊娠率、早期流产率及异位妊娠率的差异。结果:自然周期组内膜转化日内膜最厚(10.62±1.99)mm,芬吗通组内膜最薄(7.95±0.97)mm,但无统计学差异;芬吗通组临床妊娠率最低(48.72%),自然周期组早期流产率最低(5.26%),但与其他各组相比亦无统计学差异;各组间其他各项指标比较均无统计学差异。结论:冻融胚胎移植中行人工周期内膜准备,尤其是内膜偏薄者,使用芬吗通可获得与自然周期内膜准备相似的结果。     

不同雌激素用药方案对于重度宫腔粘连术后子宫内膜修复的影响

目的:探讨芬吗通对于重度宫腔粘连术后子宫内膜修复的影响。方法:选取2012年4月至2016年3月于中国医科大学附属盛京医院行宫腔镜宫腔粘连松解术的66例重度宫腔粘连患者,术后分别予芬吗通(实验组)及补佳乐(对照组)促进子宫内膜修复。观察用药后的月经及宫腔形态恢复情况、超声相关监测指标、药物不良反应及术后妊娠率,评价临床疗效。结果:实验组的月经恢复总有效率(88.6%)高于对照组(74.2%),宫腔形态恢复总有效率(68.6%)低于对照组(71.0%),但差异均无统计学意义(P0.05)。实验组的月经治愈率(31.4%)高于对照组(9.7%),子宫内膜厚度[(9.4±1.3)mm]厚于对照组[(6.8±0.7)mm],A型子宫内膜率(34.3%)高于对照组(16.1%),排卵日血E_2值[(812.4±76.5)pg/ml]高于对照组[(223.5±34.6)pg/ml],差异均有统计学意义(P0.05)。实验组的药物不良反应发生率(11.4%)高于对照组(9.7%),但差异无统计学意义(P0.05)。结论:重度宫腔粘连术后使用芬吗通阴道上药促进子宫内膜修复,疗效确切、安全,是一种有效的治疗手段。     

氯米芬联合低分子肝素钙治疗多囊卵巢综合征不孕症的临床疗效观察

目的探讨氯米芬联合低分子肝素钙治疗多囊卵巢综合征(PCOS)不孕症患者的临床效果。方法收集2016年9月至2018年4月于青岛大学附属妇女儿童医院就诊105例PCOS不孕症患者作为研究对象,随机分为观察组57例、对照组48例,对照组采用氯米芬促排卵治疗,观察组采用氯米芬联合低分子肝素钙促排卵治疗,比较两组患者子宫内膜容受性改变、妊娠率及不良反应的发生率。结果观察组排卵日子宫内膜厚度、血流指数(FI)增加,子宫内膜螺旋动脉血流阻力指数(RI)及搏动指数(PI)降低,妊娠率优于对照组,差异均有统计学意义(P0.05)。两组不良反应发生率比较,差异无统计学意义(P0.05)。结论氯米芬联合低分子肝素钙治疗多囊卵巢综合征不孕症可提高治疗有效率,且安全、可靠,值得临床推广应用。     

复方玄驹胶囊联合小剂量雌激素治疗肾阳虚型薄型子宫内膜不孕症患者的临床疗效观察

目的:探讨复方玄驹胶囊联合小剂量雌激素治疗肾阳虚型薄型子宫内膜不孕症患者的临床疗效。方法:选择h CG注射日或排卵日子宫内膜厚度7 mm的肾阳虚型薄型子宫内膜不孕症患者,按数字随机原则分组:A组(n=30),来曲唑(LE)/h MG/+戊酸雌二醇+复方玄驹胶囊治疗;B组(n=30),LE/h MG/+戊酸雌二醇治疗。观察患者的卵泡发育、h CG注射日或排卵日子宫内膜厚度及分型,统计临床妊娠率及生化妊娠率等指标。结果:卵泡平均直径、平均卵泡数目及直径≥18 mm的卵泡数组间比较差异均无统计学意义(P0.05);A组子宫内膜厚度明显高于B组(9.73±1.35 mm vs 8.04±1.23 mm),差异有统计学意义(P0.05);治疗后子宫内膜厚度≥7 mm患者比例及子宫内膜分型的构成比组间均无统计学差异(P0.05)。A、B组临床妊娠率(23.33%vs 6.67%)、生化妊娠率(3.33%vs 6.67%)亦无统计学差异(P0.05)。结论:复方玄驹胶囊联合小剂量雌激素治疗肾阳虚型薄型子宫内膜不孕症,可在一定程度提高子宫内膜厚度,间接地提高子宫内膜容受性。     

Incidence of endometrial carcinoma in patients with endometrial hyperplasia

OBJECTIVE: The purpose of this retrospective study was to establish the risk of developing endometrial adenocarcinoma in patients diagnosed with endometrial hyperplasia. MATERIAL AND METHODS: The incidence of endometrial hyperplasia and its relation with endometrial adenocarcinoma was evaluated in 1,139 patients who presented with abnormal bleeding between January 2000 and December 2004; D&C was performed in all cases. There were 591 (51.88%) cases of simple endometrial hyperplasia, out of which 110 (18.61% from 51.88%) cases had atypia, 60 (5.26%) cases of complex hyperplasia, out of which 19 (31.66% from 5.26%) had atypia, and the remaining 488 (42.84%) had different forms of mixed hyperplasia. RESULTS: The incidence of endometrial adenocarcinoma was 3.87% in atypical hyperplasia and 0.81% in other forms, and was related only to cases with atypia in which the incidence was 0.61%. CONCLUSIONS: The most indicated measure to prevent endometrial carcinoma in cases with complex endometria hyperplasia with atypia is hysterectomy, while for other forms of hyperplasia, hormonal treatment is used but only under strict control.     

血小板参数与子宫内膜增生及子宫内膜癌的关系

目的:评估血小板参数与子宫内膜病理情况之间的相关性,并探讨其在子宫内膜癌(EC)诊断预测中的价值及临床意义。方法:回顾分析2012年1月至2018年1月因异常阴道流血或流液于滨州医学院附属医院妇产科行子宫内膜病理学检查的386例患者的临床资料。根据子宫内膜病理结果将患者分为3组,其中子宫内膜癌组211例、子宫内膜增生组106例、正常子宫内膜组69例,比较刮宫术前获取的血小板计数(PLT)、血小板分布宽度(PDW)、平均血小板体积(MPV)及血小板比积(PCT)。结果:子宫内膜癌组的PLT、PDW、MPV水平高于正常子宫内膜组,差异有统计学意义(P0.05)。肌层浸润深度≥1/2患者的术前PDW及MPV值高于肌层浸润深度1/2患者,差异有统计学意义(P0.05)。腹腔冲洗液细胞学阳性患者的PLT及PCT值高于腹腔冲洗液细胞学阴性者,差异有统计学意义(P0.05)。结论:血小板参数可能对子宫内膜癌具有预测价值。术前PLT、PDW及MPV水平在正常子宫内膜、子宫内膜增生及子宫内膜癌中呈增高趋势,且术前PDW、MPV有助于预测子宫内膜癌的进展程度。     

Comparison of endometrial carcinoma coexisting with and without endometrial hyperplasia

OBJECTIVE: It has been reported that endometrial carcinoma has two pathogenic types; one with and the other without endometrial hyperplasia. The present study was done to clarify whether this was true in our series of a large number of Japanese patients. METHODS: Three hundred and twenty-eight patients with endometrial carcinoma were classified into two groups, one coexisting endometrial hyperplasia (group 1; 182 cases) and the other having normal endometrium without endometrial hyperplasia (group 2; 107 cases). The clinical and pathological observations of the two groups were compared. RESULTS: The ages of the patients were significantly lower in group 1 (30-83; mean 50.7) than in group 2 (34-81; mean, 57.2). The incidence of the carcinoma with invasion limited to less than 1/3 of the myometrium, with surgical stage I, lower grade endometrioid type and higher levels of progesterone receptor, and without lymph node metastasis were significantly higher in group 1 than in group 2. The cumulative survival rate for stage I was also significantly higher in group 1 patients. CONCLUSION: A significant difference was found between groups 1 and 2 in age distribution, degree of progress and pathological observations. Stage I patients in the former group had a better prognostic than the latter.     

Pipelle endometrial sampling in patients with known endometrial carcinoma

The purpose of this prospective clinical trial was to determine the reliability of the Pipelle endometrial biopsy instrument in recovering adequate tissue for confirmation of the diagnosis of endometrial cancer in patients with known endometrial carcinoma, and to compare endometrial histology of the sampling specimen with that of the subsequent hysterectomy specimen. Forty patients were enrolled in this study. All biopsies were performed in the office without anesthesia. The patients had a median age of 62 years (range 40-83). Discomfort was reported by the patient as mild, moderate, or severe; only two patients (5.0%) reported severe pain. There were no complications experienced with endometrial sampling. Thirty-nine of 40 specimens (97.5%) confirmed endometrial carcinoma; therefore, this study yielded a 97.5% sensitivity for the Pipelle endometrial sampling device. Comparing Pipelle and hysterectomy histology for individual patients, the histologic grade was the same in 29 (74.4%), while the Pipelle demonstrated a more advanced degree of differentiation in five (12.8%) and a lesser degree in five (12.8%). There was no residual tumor identified in one hysterectomy specimen (2.5%). Among the 12 patients who had a D&C for diagnostic purposes before referral, the Pipelle biopsy correlated with the D&C histology in ten of 12 (83.3%) and revealed a more advanced grade of tumor in one (8.3%) and a more differentiated grade in one (8.3%). In one patient, the D&C histology was adenocarcinoma grade 1, with the Pipelle demonstrating atypical hyperplasia and the hysterectomy specimen interpreted as endometrial adenocarcinoma in situ. This study demonstrates the Pipelle to be an accurate device for endometrial sampling in patients with endometrial carcinoma.     

Comparison of endometrial biopsy with the endometrial Pipelle and Vabra aspirator

Endometrial biopsy can be used to evaluate women at high risk for endometrial cancer and to follow women on hormone replacement therapy. Biopsy methods may produce enough pain, however, to lower patient acceptance. The Endometrial Pipelle is a new plastic endometrial suction curette that provides a histologic biopsy. This study compared the performance of the Pipelle to that of the Vabra aspirator, a widely accepted biopsy device. Endometrial sampling using both techniques was performed on 56 patients. Both instruments provided the correct diagnosis in 50 patients (89%). The Pipelle obtained more tissue than the Vabra in 28 patients (50%) and was noted by the clinician to cause less pain in 50 patients (89%). Forty-seven patients (84%) stated that biopsy with the Pipelle was less painful than with the Vabra. These results suggest that the Pipelle is as efficacious as the Vabra aspirator and has greater patient acceptability.     

Dopamine-producing endometrial carcinoma with argyrophilia

A case of moderately differentiated adenocarcinoma with argyrophilia arising in the endometrium of a 58-year-old Japanese woman is reported. Although she showed no endocrine symptoms, neuro-secretory granules were documented in the cytoplasm of some tumor cells by electron microscopy. Moreover, dopamine production by the tumor was demonstrated by biochemical determination. The possible mechanism accounting for such a lesion is discussed.     

Coexisting endometrial cancer in patients with a preoperative diagnosis of atypical endometrial hyperplasia

AIM: To investigate the possibility of coexisting endometrial cancer (EC) in patients with atypical endometrial hyperplasia (AEH). METHODS: Forty-six consecutive women who underwent hysterectomy for AEH were analyzed. RESULTS: Final histopathological evaluation of hysterectomy specimens revealed EC in 11 patients (23.9%). Preoperative diagnosis of AEH was established by pipelle biopsy in eight patients and curettage was performed in the remaining patients. Of the patients with pipelle biopsy, two had a diagnosis of EC (25%), whereas nine women who underwent curettage, were further diagnosed as having EC (23.7%) (P > 0.05). Four (13.3%) of 30 women who had frozen sections at hysterectomy, were diagnosed with EC. Diagnosis of EC was missed in two patients (50%) at frozen section. In contrast, seven of 16 women (43.7%) who did not have frozen section, had EC. CONCLUSION: A relatively high incidence of EC is seen in patients with a diagnosis of AEH. Diagnostic results of pipelle biopsy and curettage were comparable. Frozen sections of hysterectomy specimens does not guarantee to exclude the possibility of EC, especially in patients with no myometrial invasion.     

Identification of high risk patients with endometrial carcinoma. Prognostic assessment of endometrial cancer

OBJECTIVES: To verify the importance of DNA ploidy on clinical outcome in endometrial carcinoma and to investigate whether the prognostic information obtained by this variable is independent from other clinical-pathologic features. MATERIALS AND METHODS: Univariate and multivariate analysis of clinical and pathologic prognostic factors obtained from 203 consecutive cases of endometrial cancer, that had been surgically treated in our hospital, were performed. RESULTS: Significant prognostic factors according to the Kaplan-Meier method were age at the time of diagnosis, grade of differentiation, peritoneal cytology, node involvement, vascular invasion, myometrial infiltration and ploidy. At multivariate analysis only DNA ploidy resulted to be an independent variable. CONCLUSIONS: In our analysis DNA content is the only parameter which preserved prognostic significance in multivariate analysis.     

Magnetic resonance imaging for assessment of deep endometrial invasion for patients with endometrial carcinoma

Aims: To evaluate the value of magnetic resonance imaging (MRI) for the detection of deep myometrial invasion.
Methods: The patient group consisted of 53 women with endometrial cancer who underwent preoperative workup, including MRI, and surgical staging between August 1999 and August 2008 at Korea University Medical Center, Seoul, South Korea. The pathological data from surgical staging were compared with the preoperative MRI results.
Results: The mean age of the patients was 51 years and most patients had endometrioid cancer. On pathological evaluation of the myometrium, 20.8% had a deep myometrial invasion. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of MRI in detecting deep myometrial invasion were 50.0%, 89.7%, 79.2%, 63.6% and 83.3%, respectively. Evaluation of MRI findings and tumour grades by preoperative biopsy had a sensitivity and specificity of 88.9% and 87.5%, respectively, with a kappa of 0.764.
Conclusion: In patients with endometrial cancer, MRI is limited in its ability to detect deep myometrial invasion. The combination of MRI findings and tumour histology or grade can be helpful in determining if lymphadenectomy is necessary.     

Five-year follow-up of endometrial ablation: endometrial coagulation versus endometrial resection

OBJECTIVE: A randomized, controlled trial was performed to compare the patient complication rate, effectiveness, and satisfaction rate of transcervical hysteroscopic endometrial coagulation versus endometrial resection in the treatment for heavy dysfunctional bleeding. METHODS: One hundred and twenty women requiring endometrial ablation for the treatment of heavy bleeding disorders entered the study. All patients were offered a clinical examination 24 months postoperatively and had a questionnaire by mail 5 years after the initial treatment. The number of complications during and after the operation, re-ablations, and hysterectomies were registered. A bleeding index and the patient satisfaction rate were stated. RESULTS: Sixty-one patients were treated by endometrial coagulation, and 59 were treated by endometrial resection. No differences between the two groups were observed concerning fluid absorption, bleeding, perforation, and infection. At the 5-year follow-up, 64% of the patients had only one ablation, 15% were treated twice, 15% had a hysterectomy, and 6% were lost to follow-up. After 5 years, the bleeding index was halved in patients with menses. Seventy-nine percent of the women would recommend the treatment to their best female friend. CONCLUSION: We found no significant differences in the frequency of complications. Only 15% of the women had a hysterectomy after 5 years. No significant difference was observed with respect to bleeding reduction and patient satisfaction in the two groups.