腹腔镜手术联合亮丙瑞林治疗子宫内膜异位症的效果观察

目的:观察腹腔镜手术联合亮丙瑞林治疗子宫内膜异位症的效果。方法:选取80例子宫内膜异位症患者作为研究对象,依据随机数字表法将其分为对照组和观察组各40例,对照组给予腹腔镜手术治疗,研究组在对照组基础上联合亮丙瑞林治疗,比较两组临床疗效和并发症发生情况及复发情况。结果:治疗后研究组的治疗有效率为95.0%(38/40),明显高于对照组的72.5%(29/40),差异有统计学意义(P<0.05);研究组并发症发生率为7.5%(3/40),明显低于对照组的25.0%(10/40),差异有统计学意义(P<0.05);治疗1年后研究组复发率为20.00%(8/40),明显低于对照组的42.50%(17/40),差异有统计学意义。结论:与单纯应用腹腔镜手术治疗相比,腹腔镜手术联合亮丙瑞林治疗子宫内膜异位症的效果更显著,可明显改善患者病情,且术后并发症少,复发率低。     

亮丙瑞林联合腹腔镜治疗子宫内膜异位症不孕患者的疗效评析

目的:研究治疗子宫内膜异位导致患者不孕症时注射亮丙瑞林及腹腔镜进行手术的临床效果.方法:选取该院2012年1月至2016年1月80例因子宫异位导致的不孕的患者,将80患者随机分成对照组与观察组,每组40例.对照组注射亮丙瑞林进行常规治疗,观察组注射亮丙瑞林治疗加用腹腔镜进行手术.对比两组患者的妊娠率及临床效果.结果:观察组妊娠率(52.5)明显高于对照组(P＜0.05);观察组的临床有效率(97.5)明显高于对照组(P＜0.05).结论:在治疗子宫内膜异位时,采用腹腔镜进行手术,可以减少患者治疗时间,帮助患者改善子宫情况,减少并发症,值得临床推广.     

亮丙瑞林联合腹腔镜手术治疗子宫内膜异位症的效果观察

目的观察亮丙瑞林联合腹腔镜手术治疗子宫内膜异位症的临床效果。方法选取2015年3月至2016年3月正阳县中医院收治的82例子宫内膜异位症患者,将其按手术方法分为对照组与观察组,每组41例。对照组接受腹腔镜手术治疗,观察组则在腹腔镜手术治疗的基础上接受亮丙瑞林治疗。对比两组的治疗效果、性激素水平变化以及不良反应发生情况。结果观察组治疗总有效率为97.56%(40/41),高于对照组的78.05%(32/41),差异有统计学意义(P<0.05);治疗前,两组雌二醇、卵泡刺激素水平比较,差异无统计学意义(P>0.05);治疗后,两组雌二醇、卵泡刺激素水平均较治疗前降低,且观察组低于对照组,差异有统计学意义(P均<0.05)。观察组不良反应发生率高于对照组(19.51%比0.00%),差异有统计学意义(P<0.05),观察组停止用药后不良反应症状均消失。结论亮丙瑞林联合腹腔镜手术治疗子宫内膜异位症效果显著,可降低性激素水平,不良反应可耐受。     

亮丙瑞林治疗子宫内膜异位症患者的疗效和不良反应研究

目的:研究亮丙瑞林治疗子宫内膜异位症术后患者的疗效和不良反应.方法:选择2018年1月—2019年9月我院收治的子宫内膜异位症术后患者78例,以随机数字表法分为观察组和对照组.两组均接受子宫内膜异位症腹腔镜手术治疗,其中对照组给予炔雌醇环丙孕酮片,观察组给予醋酸亮丙瑞林微球.观察两组患者治疗效果、性激素内分泌指标[卵泡...     

腹腔镜手术联合亮丙瑞林治疗Ⅲ～Ⅳ期子宫内膜异位症伴不孕的效果

目的 探讨腹腔镜手术联合亮丙瑞林治疗Ⅲ～Ⅳ期子宫内膜异位症伴不孕的效果.方法 选取武汉市普仁医院2017年1月至2018年6月收治的86例美国生殖医学协会子宫内膜异位症分期(r-AFS)评分法Ⅲ～Ⅳ期子宫内膜异位症伴不孕患者,采用随机数字法分为对照组和观察组,每组43例.对照组采用腹腔镜手术联合孕三烯酮治疗,观察组采用...     

戈舍瑞林联合腹腔镜手术治疗子宫内膜异位症的效果

目的:观察戈舍瑞林联合腹腔镜手术治疗子宫内膜异位症(EMs)患者的效果。方法:选取86例EMs患者作为研究对象,按照抽签法将其分为对照组和观察组各43例,对照组采取腹腔镜手术治疗,观察组在对照组基础上联合戈舍瑞林治疗。比较两组临床疗效、治疗前后血清性激素指标[金属蛋白酶组织抑制因子1(TIMP-1)、基质金属蛋白酶-9(MMP-9)]水平以及术后两组妊娠、复发情况。结果:观察组治疗有效率为93.0%(40/43),明显高于对照组的74.4%(32/43),差异有统计学意义(P<0.05);治疗后观察组MMP-9水平、MMP-9/TIMP-1均明显低于对照组,TIMP-1水平明显高于对照组,差异均有统计学意义(P<0.05);术后6个月、1年,观察组妊娠率明显高于对照组,复发率明显低于对照组,差异均有统计学意义(P<0.05)。结论:戈舍瑞林联合腹腔镜手术治疗子宫内膜异位症患者能有效改善MMP-9/TIMP-1水平、提高妊娠率和降低复发率的效果优于单纯腹腔镜手术治疗效果。     

腹腔镜手术联合促性腺激素释放激素亮丙瑞林治疗子宫内膜异位症并不孕的远期结局随访

目的：分析腹腔镜手术联合促性腺激素释放激素(GnRH-a)亮丙瑞林治疗子宫内膜异位症并不孕的远期结局。方法：回顾性分析2019年1月—2020年4月临颍县人民医院收治的100例子宫内膜异位症并不孕患者,按不同治疗方法分为两组,48例单纯腹腔镜手术患者(对照组)及52例腹腔镜术后联合亮丙瑞林治疗患者(观察组),观察两组患者近期效果,并随访12个月,统计其远期结局。结果：观察组术后整体总有效占比率为98.08%,明显高于对照组的83.33%,差异有统计学意义(χ²=4.947,P=0.026)。术后3个月：观察组术后卵泡刺激素(FSH)、黄体生成素(LH)、雌二醇(E2)表达以及盆腔疼痛均低于对照组,差异有统计学意义(t=11.717、22.556、16.405、5.664,P=0.000)。观察组血清血管内皮生长因子(VEGF)、白细胞介素(IL)-6以及核因子κB抑制蛋白(IκB-α)低于对照组,差异有统计学意义(t=18.725、17.440、14.035,P=0.000)。两组患者获得为期12个月随访,观察组自然妊娠率为67.31%,高于对照组的45.83%,...     

超声引导下穿刺联合亮丙瑞林治疗中重度卵巢型子宫内膜异位症患者术后妊娠结局的影响因素分析

目的 研究超声引导下穿刺联合亮丙瑞林促性腺激素释放激素激动剂（gonadotrophin releasing hormone agonist,GnRHa）治疗中重度卵巢型子宫内膜异位症患者术后妊娠结局的影响因素。方法 选取我院收治的重度卵巢型子宫内膜异位患者120例为研究对象。所有患者均进行超声引导下穿刺术,亮丙瑞林组62例术后加用亮丙瑞林进行治疗。对患者进行随访,记录患者的妊娠率。对患者妊娠成功与妊娠失败患者的年龄、不孕年限、囊肿直径、囊肿单/多发性、生育指数（fertility index,EFI）和术前CA125、血清抗苗勒管激素（serum antimüllerian hormone,AMH）水平、双侧/单侧卵巢受累等指标进行记录。结果 随访结束,所有患者均到访,随访率100%。亮丙瑞林组妊娠率高于非亮丙瑞林组（P<0.05）。亮丙瑞林组的复发率低于非亮丙瑞林组（P<0.05）。二元Logistic回归分析显示,术后GnRHa的使用、术前AMH水平、双侧卵巢受累及存在多个囊腔是影响患者妊娠成功的独立影响因素（P<0.05）。结论 超声引导下穿刺联合亮丙瑞林治疗...     

戈舍瑞林联合腹腔镜手术治疗子宫内膜异位症致不孕症的疗效

目的:观察戈舍瑞林联合腹腔镜手术治疗子宫内膜异位症(EMT)致不孕症的疗效。方法:选取EMT致不孕症患者86例,按照随机数字表法分为对照组和观察组各43例。对照组行腹腔镜手术治疗,观察组在对照组基础上联合戈舍瑞林治疗。比较两组临床疗效、症状积分变化、不良反应发生情况,以及随访1年后两组妊娠及复发情况。结果:观察组总有效率(93.02%)明显高于对照组(74.42%),差异有统计学意义(P<0.05),治疗后观察组痛经、月经不调、性交痛、周期性膀胱刺激症状、周期性直肠刺激症状积分均高于对照组,差异有统计学意义(P<0.05);两组不良反应发生率相比,差异无统计学意义;治疗后随访1年,观察组复发率(4.65%)低于对照组25.58%,妊娠率(41.86%)高于对照组(20.93%),差异有统计学意义(P<0.05)。结论:戈舍瑞林联合腹腔镜手术治疗子宫内膜异位症致不孕症的疗效优于单纯腹腔镜手术治疗。     

腹腔镜在子宫内膜异位症182例诊治中的应用

目的 探讨腹腔镜在子宫内膜异位症患者诊断与治疗中的价值。方法 对182例子宫内膜异位症患者施行了腹腔镜下异位病灶切除术，卵巢异位内膜囊肿剥除术及骶前神经切断术。结果 所有病例腹腔镜手术均获成功，随访2－12个月，52例不孕症患者受孕28例，妊娠率53.8%，95例痛经患者完全缓解56例，部分缓解32例，总有效率92.6%。结论 腹腔镜用于子宫内膜异位症的诊断和治疗是一种安全、有效、微创、适于临床广泛开展的手术方式。     

Hepatic endometriosis: a rare case and review of the literature

Hepatic endometriosis is one of the rarest disorders characterized by the presence of ectopic endometrium in the liver. To our knowledge, only 21 cases of hepatic endometrioma have been described in the medical literature. We report a case of a 36-year-old primiparous female with hepatic endometriosis forming a large cystic mass. The patient presented once with severe right quadrant pain as her only symptom and no history of endometriosis. Complete blood count and biochemical tests were normal. Abdominal ultrasonography and computed tomography scans suggested the presence of a 6.5 × 6.0 cm cystic mass in segment III of the liver. The mass was completely removed by local liver resection. The intraoperative frozen sections suggested a diagnosis of hepatic endometriosis. The diagnosis was confirmed through histological immunostaining without intrinsic abnormality. A preoperative diagnosis of hepatic endometriosis is made on the basis of considering the possibility in advance. Hepatic endometriosis should be considered in the differential diagnosis of a cystic liver mass despite conducting exhaustive investigations in the absence of characteristic clinical and radiological features. Histological examination is essential, and surgery remains the treatment of choice.     

复杂深部浸润型子宫内膜异位症的诊断与治疗:附1例病例报道及文献复习

目的:探讨深部浸润型子宫内膜异位症的诊断与治疗。方法:回顾分析1例深部浸润型子宫内膜异位症的临床诊治资料。结果:1例39岁女性,确诊复杂深部浸润型子宫内膜异位症,病变累及宫颈、两侧宫旁、子宫骶韧带、左输尿管、左卵巢、Douglas凹、直肠阴道膈及阴道,临床表现似晚期宫颈癌。患者以下腹痛、阴道不规则出血和发现宫颈肿物收入院,经宫颈锥切术和腹腔镜检查确诊,促性腺激素释放激素激动剂(GnRH-A)治疗3个月后行子宫内膜异位症根治手术和输尿管粘连松解术,有效切除病灶并缓解肾积水,术后2年随访检查未复发。结论:深部子宫内膜异位症同时累及宫颈且与宫颈恶性肿瘤难以鉴别时,应依靠组织病理学检查确诊。     

Spontaneous cutaneous endometriosis in Mons Pubis: review of literature

Cutaneous endometriosis is not a very often seen condition and is broadly classified as primary (spontaneous) and secondary. While perineal endometriosis arising in a previous scar has been reported, spontaneous cutaneous endometriosis in perineum is extremely rare and only three cases occurring in mons pubis have been reported in literature. We report a case of 34-year-old lady presented with a swelling in pubic region and associated dull aching pain of 1-year duration with no history of cyclical variation of symptoms. Investigations finally concluded a diagnosis of endometriosis and a Complete excision with clear margins. Clinicians should be aware that a spontaneous endometriosis in the perineum can occur and can have atypical presentation with no increase in size or pain during menstruation.     

Postmenopausal intestinal obstructive endometriosis: case report and review of the literature

CONTEXT: Endometriosis is characterized by the presence of endometrial tissue outside the uterine cavity, which is commonly detected in gynecological practice but rarely reported as a coloproctological disorder. The objective of the present report was to discuss a rare case of postmenopausal intestinal endometriosis simulating a malignant lesion, following a review of the literature. CASE REPORT: A 74-year-old woman with complaints of hematochezia and tenesmus of two months' duration accompanied by liquid feces and pelvic pain, but with no other gastrointestinal or gynecological complaints, was referred to our service. She had been menopausal for 22 years, with no hormone replacement treatment, and had undergone panhysterectomy three years before the referral to us, due to endometrial thickening and a right adnexal cyst. Five months before this referral, she had undergone laparotomy due to acute obstructive abdomen, which revealed a tumor mass involving the small bowel. Anatomopathological examination of the enterectomy suggested a hypothesis of intestinal endometriosis. A proctological examination was normal. Computed tomography of the pelvis revealed thickening of the rectosigmoid transition and colonoscopy revealed friable tumor formation in the rectum. A biopsy of the lesion revealed mucosal fragments of endometrial type, which led to a review of the previous anatomopathological examination. The patient underwent rectosigmoidectomy with protective transversotomy, with a good postoperative course, and anatomical examination confirmed the intestinal endometriosis. The patient subsequently suffered a stenosing recurrence of the lesion and has undergone colostomy since then.     

肝下巨大卵巢成熟性囊性畸胎瘤并发对侧卵巢子宫内膜异位囊肿1例报告及文献复习

目的：探讨肝下巨大卵巢成熟性囊性畸胎瘤并发对侧卵巢子宫内膜异位囊肿患者的临床特点,分析诊断经验和治疗过程。方法：回顾性分析1例肝下巨大卵巢成熟性囊性畸胎瘤并发对侧卵巢子宫内膜异位囊肿患者的临床资料,并进行相关文献复习。结果：患者体检时发现腹腔巨大肿物。妇科超声提示腹部巨大囊肿,左卵巢内见61mm×48mm囊性光团回声,内液稠。腹部CT平扫提示右腹部巨大团块状混杂密度影,其内可见脂肪密度、钙化密度及软组织密度影,临近肝脏呈受压状态改变。术中探查,右侧卵巢肿瘤大小约40cm×35cm×30cm,上达膈下,下至盆腔,肿瘤后壁与肝左叶粘连,并将肝脏挤向右上方。左侧卵巢子宫内膜异位囊肿大小约7cm×6cm×6cm。手术剥除右侧卵巢肿瘤及左侧卵巢子宫内膜异位囊肿并重建双侧卵巢。病理诊断,右侧卵巢成熟性囊性畸胎瘤、左侧卵巢子宫内膜异位囊肿。术后随访已超过2年,未发现肿瘤复发,并经体外受精-冻融胚胎移植（IVF-ET）受孕。结论：巨大卵巢成熟性畸胎瘤粘连于肝脏下方同时并发对侧卵巢子宫内膜异位囊肿临床上罕见,手术治疗预后良好,如术后不孕,应及早行IVF-ET助孕。     

糖皮质激素联合醋酸亮丙瑞林微球对子宫内膜异位症腹腔镜手术患者的疗效及预后分析

目的 分析糖皮质激素联合醋酸亮丙瑞林微球对子宫内膜异位症（EMS）腹腔镜手术患者的疗效及预后的影响。方法 选取2020年2月—2022年3月青岛大学附属青岛市海慈医院收治的228例EMS患者,以随机数字表法分为对照组和研究组,每组114例。两组患者均接受腹腔镜手术治疗,对照组腹部皮下注射醋酸亮丙瑞林微球,研究组在对照组基础上口服糖皮质激素,持续治疗3个月评价疗效。对比两组临床疗效、子宫内膜动脉血流动力学、性激素、炎症因子及药物不良反应,比较两组随访期间复发及妊娠成功情况。结果 研究组总有效率高于对照组（P <0.05）。研究组治疗前后子宫动脉收缩期峰值流速、搏动指数、阻力指数、雌二醇、黄体生成素、促卵泡生成素、白细胞介素-4、肿瘤坏死因子-α、白细胞介素-17的差值均高于对照组（P <0.05）。两组总不良反应发生率比较,差异无统计学意义（P>0.05）。研究组复发率低于对照组（P <0.05）,妊娠成功率高于对照组（P <0.05）。结论 糖皮质激素联合醋酸亮丙瑞林微球用于EMS腹腔镜手术患者可增强疗效,改善子宫内膜动脉血流动力学及性激素水平,抑制炎症因...     

Tumor necrosis factor gene polymorphisms and endometriosis in Asians: a systematic review and meta-analysis

Background Numerous studies have described the association between polymorphisms in the tumor necrosis factor （TNF） gene and risk of endometriosis.However,the results remain controversial.Here we reviewed studies reporting the association between TNF gene polymorphisms and endometriosis risk in Asians.Methods PubMed and Embase were searched.Twelve case-control studies assessing the role of multiple TNF gene polymorphisms in endometriosis were included.If no less than two articles evaluated one variant,meta-analysis was conducted; otherwise,narrative analysis was chosen.A fixed-or random-effects model was employed according to the heterogeneity among studies.The strength of the association between TNF gene polymorphisms and endometriosis risk was assessed by odds ratios and 95％ confidence intervals.Results For TNF-α-238G＞A,-308G＞A,-857C＞T,and-863C＞A,no significant associations were identified from all genetic models.For TNF-α-850T＞C,results from one study showed that patients harboring the heterozygote TC were less susceptible to endometriosis than patients harboring the homozygote TT.For TNF-α-1031T＞C,a mild increase in endometriosis risk was found in the Asian population.Meta-analysis from two studies found that the TNF-β ＋252＞G polymorphism had a protective effect in Chinese individuals.Due to the limitations of the included studies,it is necessitated to perform more studies to elucidate the possible roles of TNF gene polymorphisms in the pathogenesis of endometriosis.Conclusions TNF-α-1031T＞C and TNF-β ＋252A＞G were significantly associated with the risk of endometriosis in Asian and Chinese populations,respectively.To further evaluate these associations,more large-scale,rigorously designed studies are needed.     

热消融联合不同方法治疗肝细胞癌的研究进展

肝细胞癌(HCC)是常见的恶性肿瘤之一.无论是切除还是移植,手术都是根治性的治疗方法,然而只有不到20％的患者最终成为候选者.热消融技术已被公认为手术不可切除的肝细胞癌患者的治疗方式,包括射频消融(RFA)和微波消融(MWA).近年来,出现了许多联合应用的方式来提高疗效.本文就热消融技术联合不同方法治疗肝细胞癌的现状进行综述.     

Clinical use of the laparoscope

A technique for laparoscopy is described and the indications for operation and the laparoscopic findings in 406 patients detailed.