宫内节育器出血副反应机理的研究进展

宫内节育器 (IUC)是我国育龄妇女最常使用的避孕工具之一 ,但作为置器主要副作用的子宫异常出血 ,至今未得到很好解决。为此 ,国内外对置器出血副反应的机理作了大量研究 ,现综述如下。1　带器子宫内膜血管形态学变化正常子宫内膜月经期微血管无扩张 ,行经早期螺旋动脉尤其海绵层螺旋动脉强烈收缩、阻断血流 ,使子宫内膜缺血、坏死、剥脱 ;月经晚期螺旋动脉残端大多数呈强烈收缩状态 ,管腔因而闭塞。而放置 IU D后 ,子宫内膜表浅微血管明显扩张、充血、通透性增强 ,微血管开放面积及密度增加 ,螺旋动脉明显扩张。置器出血者子宫内膜血管…     

三维能量多普勒对鉴别绝经期子宫内膜良恶性病变的探讨

目的探讨三维能量多普勒超声及子宫内膜血流参数在绝经期出血患者子宫内膜良恶性病变鉴别中的应用价值。方法回顾性分析79例绝经期阴道出血患者病变子宫内膜三维能量多普勒超声图像、血流分布及子宫内膜血流参数,以病理结果分为良性组和恶性组。结果79例研究对象中,59例子宫内膜病变良性组三维能量多普勒表现：血管分布多呈“短棒状”、“分枝状”或无血流;子宫内膜形态均规则,与肌层界限清晰或欠清晰。20例恶性组三维能量多普勒成像表现：病变内膜中血管除高分化腺癌以不丰富为主外,余均较丰富,呈“网格状”,子宫内膜血流与子宫肌层血流相延续;子宫内膜不规则,边界呈虫蚀样浸润肌层,与肌层界限不清。定量分析血流参数：内膜容积V（m1）、VI％、FI、VFI,良、恶性组差异有统计学意义（t值分别为2．096、3．436、2．594、2．668,P均〈0．05）;ROC曲线VI、FI、VFI的曲线下面积（AUC）分别为0．966、0．913、0．973,其中VFI的曲线下面积最大,当VFI截值0．814时,敏感性：95％,特异性：91．5％。结论三维能量多普勒成像能量化病变子宫内膜血管分布及密度情况,对鉴别绝经期子宫内膜良恶性病变具有较高使用价值。     

三丙烯微球栓塞子宫动脉对子宫内膜血管的影响

背景：子宫动脉栓塞已广泛应用于临床治疗多种妇产科疾病,但对于子宫动脉栓塞后子宫内膜微血管密度的有何变化及新生血管的形成至今少有文献报道。 目的：观察子宫动脉栓塞对子宫内膜微血管密度及新生血管形成的影响。 方法：60只雌性豚鼠随机分为对照组(n=15)及子宫动脉栓塞组(n=45),子宫动脉栓塞组动物应用三丙烯微球行双侧子宫动脉栓塞。子宫动脉栓塞组再随机分为E1,E2及E3三个亚组(n=15),分别于子宫动脉栓塞后7-15 d,16-30 d及31-45 d内获取子宫标本。 结果与结论：常规病理染色显示豚鼠子宫动脉一级分支、浆膜下动脉支及子宫肌层微小动脉血管内均可见大小不等栓塞微球分布。子宫动脉栓塞豚鼠子宫内膜基底层微血管密度CD34在子宫动脉栓塞后降低,而后随时间的延长而增加(P < 0.05);而子宫动脉栓塞豚鼠子宫内膜基底层微血管密度CD105在子宫动脉栓塞后增加,而后随时间的延长而降低(P < 0.05)。提示随着栓塞后时间推延,新生微血管数量显著增加,基底层微血管密度有逐渐恢复趋势。     

动脉化静脉皮瓣血管干管壁形态变化的实验观察

目的：实验观察动脉化静脉皮瓣血管干管壁的形态变化趋势。方法：取成年日本大耳白兔３６只，于每侧耳背面制作３．０ｃｍ×３．５ｃｍ原位再植皮瓣，以传统皮瓣作对照，单干型动脉化静脉皮瓣为实验组，分期用光镜和电镜观察血管干内膜和中膜。结果：实验组内皮细胞的长／短径比值逐渐接近对照组动脉干；术后第７０ｄ时，在内膜下出现呈波纹状、内含均匀基质的弹性膜样结构，平均厚度为１．６６μｍ，中膜平滑肌呈多层排列。结论：动脉化静脉皮瓣血管干管壁于术后第７０ｄ已初具动脉结构     

数字化原位子宫动脉血管3D可视化模型的构建及意义

目的探讨构建女性原位子宫动脉血管3D可视化模型和研究子宫动脉血管的结构特征。方法采用聚乙烯醇-氧化铈血管造影术进行2例女尸盆腔动脉血管灌注,X线平位摄影、64排螺旋CT扫描后采集数据,导入计算机Mimics10.01重建软件进行子宫动脉血管3D可视化模型构建,观察子宫动脉血管的形态及血供分布情况。结果①构建的子宫动脉血管三维模型图像清晰,管道饱满,立体空间感强,均能清晰地显示子宫动脉的4级以上血管,各级分支血管的形态、走行、分布及各血管间的吻合显影清晰,效果满意。2例子宫及附件无实质性病变,为正常子宫。②清晰显示子宫动脉血管网的构建特点:子宫动脉自主干依次发出膀胱支、输尿管支、上行支、下行支等分支动脉;上行支较粗呈弓状沿子宫体侧缘迂曲上行,至宫角处分为宫底支、输卵管支和卵巢支,主要向子宫体和子宫附件供血;下行支较细分布于宫颈及阴道上段,但分布于阴道的血管较少;子宫动脉通过其卵巢支与卵巢动脉相交通;同时子宫动脉的供血还存有着明显的同侧倾向,双侧子宫动脉在子宫的中轴线处有少量细小的交通支。结论采用聚乙烯醇-氧化铈血管造影术盆腔动脉血管灌注可构建理想的子宫动脉血管网3D可视化模型,为系统研究人子宫动脉血管网的形态结构和血供分布提供了血管解剖学基础。     

血管生成素与功能失调性子宫出血

近年研究血管生成素（Angiopoietin,Ang）及其受体系统是调控血管完善性的重要因子,参与子宫内膜生理性及病理性血管生成。正常月经周期中Ang-1对排卵后期子宫内膜血管发育,尤其对哺乳动物子宫内膜螺旋动脉的生长具有重要作用。在功能失调性子宫出血Ang-2可能促进异常子宫内膜血管生成,从而促进其病理发生过程。     

甘草酸二铵对家兔动脉血管成形术后胶原合成的影响

目的:研究甘草酸二铵(DG)对家兔颈总动脉血管成形术后胶原合成的影响。方法:用家兔复制成颈总动脉内皮损伤模型,4周后检测血清中Ⅰ型前胶原(PCI)、Ⅲ型前胶原(PCⅢ)及动脉组织胶原含量,并行动脉组织病理形态学检查。结果:大、小剂量DG治疗组的损伤动脉组织胶原含量,血清PCI、PCⅢ含量,动脉组织新生内膜厚度和狭窄率均明显低于损伤组。结论:DG可明显抑制家兔颈总动脉血管成形术后胶原的合成和内膜增生,降低狭窄百分率。     

异位散对子宫内膜异位症家兔血液流变性及血管活性物质的影响

目的 探讨中药异位散治疗子宫内膜异位症的作用机理。方法通过复制动物模型进行研究。结果发现子宫内膜异位症家免的血液流变性异常。经异位散治疗，其血液流变性得到明显改善．由于异位内膜所致而上升的6-酮前列环素。(6-keto-PCF1α)、血栓烷素B2(TXB2)水平明显降低。结论异位散治疗家兔子宫内膜异位症的机理与改善血液流变性和降低血管活性物质水平有关。     

一级子宫内膜样腺癌累及腺肌病临床病理分析

目的探讨子宫内膜一级子宫内膜样腺癌(endometri-oid adenocarcinoma,EA)累及腺肌病(adenomyosis,AM)的临床病理特点及鉴别诊断。方法观察2例子宫内膜一级EA累及AM的临床病理和免疫组织化学特点,并复习相关文献。结果 2例患者均为中年妇女,年龄分别为47、52岁,表现为进行性痛经伴月经量增多和经期延长,彩色超声示子宫内膜增厚、子宫增大伴肌壁间不均匀回声。病理检查:大体观察子宫增大,子宫壁增厚,子宫体底部子宫内膜局限型结节状和息肉状肿块。镜下为子宫内膜无肌层侵犯的一级EA,肌层内受癌累及AM腺体与子宫内膜EA形态一致,呈膨胀式扩张推挤周围平滑肌,肿瘤周边可见子宫内膜间质细胞;同时肌层内见未被癌累及的腺体和间质细胞。免疫组化:受癌累及的AM腺体周围及肿瘤周边子宫内膜间质细胞CD10(+),desmin(-)。结论一级EA累及AM确诊主要依靠组织学和免疫组化,病理诊断容易误诊为EA肌层侵犯或AM恶变,应引起注意。     

子宫内膜中自然杀伤细胞内血管原性生长因子mRNA的表达

子宫内膜的生长和修复需要血管的生成 ,破坏这个过程可能导致妇女的一些疾病 ,如痛经和子宫内膜异位症。在妊娠期 ,重建的子宫内膜螺旋动脉的减少可引起先兆子痫。研究发现 ,除血管内皮生长因子 A (VEGF- A)以外 ,子宫内膜中还含有编码 VEGF- C、胎盘生长因子 (PIGF)、血管促血细胞生成素类、血管促血细胞生成素 1(Ang1) ,Ang2、血管内皮生长因子受体 3(VEGFR- 3)、 Tie1和 Tie2的 m R-NA的表达 ,且 VEGF- C、 PIGF和 Tie2的表达水平随月经周期而变化。在子宫内膜分泌期 ,子宫内膜中自然杀伤细胞(NK细胞 )内发现有 VEGF- …     

宫颈癌子宫动脉血管网模型的构建及其三维可视化研究

目的：探讨研究宫颈癌子宫动脉血管网的方法及其临床意义。方法 ：用15％的过氯乙烯填充剂对一例宫颈癌离体子宫标本行子宫动脉和卵巢动脉分色灌注并铸型。分别于灌注前后行64层螺旋CT薄层扫描,并以最大密度投影法(MIP)和容积再现(VR)行三维重建。结果：(1)铸型和CT三维重建的宫颈癌子宫动脉血管网模型均可清晰的显示病变部位的血管供应及分布情况、子宫动脉及其分支的走行以及与卵巢动脉的关系;(2)利用CT薄层扫描重建的可视化模型可以从多方面清楚的显示病灶的大小及浸润范围。结论：应用血管铸型和CT薄层扫描技术可成功构建宫颈癌子宫动脉血管网模型,并可了解宫颈癌病灶的浸润范围及其血供特点等,对宫颈癌的诊断和治疗有一定的临床价值。     

A dominant ovarian follicle induces unilateral changes in the origin of the blood supply to the tubal corner of the uterus

BACKGROUND: The blood supply to the tubal corner of the uterus may originate from the uterine and ovarian arteries. The border of supply from the arteries has been found to move in young women; the change seemed dependent on ovarian steroid production. The present work investigated whether the border of supply could differ between the two sides of the uterus in the same woman having one dominant follicle (>10 mm). METHODS: Vagina was flushed with saline of room temperature in 15 women with a dominant follicle >10 mm. The temperature was measured in the mid-uterine lumen and in the tubal corner of the uterus at 2, 5 and 7 min after starting cooling. The investigation was repeated 30 min later measuring the temperature in the other tubal corner. RESULTS: The temperature decrease was, as found in previous investigations, more pronounced in the uterine cavity than in the tubal corners. However, a difference was found between the two tubal corners. At all measurement times the decrease was significantly smaller in the tubal corner corresponding to the dominant follicle than in the contralateral side. CONCLUSIONS: In our model, 'cold' is transferred from the vaginal venous blood to the uterine artery and the cooling defines the supply area of the uterine artery. Therefore, the results indicate that the area of supply from the ovarian artery in the tubal corner ipsilateral to the dominant follicle is greater than that in the contralateral side. It is possible to speculate that this difference is related to the hormonal production of the dominant follicle.     

Uterine first pass effect in postmenopausal women

BACKGROUND: Vaginally administered drugs distribute preferentially to the uterus; counter-current transfer from the vaginal veins to the uterine artery probably plays a pivotal role. In each side, the ovarian and uterine arteries form arterial anastomoses and controversy exists regarding the origin of the arterial supply to the Fallopian tube and tubal part of the uterus, and consequently whether these tissues can be reached through vaginal administration. METHODS: A thermocatheter with four measurement points, each separated by 5 mm, was inserted under endoscopic control into the tubal corner of uterus in 10 conscious, menopausal women and the temperatures registered every 2 s. The vagina was then flushed for 15 min with 1.5 l of saline at room temperature, after which the probe position was re-assessed by the endoscope. RESULTS: The lowest measurement point (15 mm from the tip) cooled significantly more than the other points (P < 0.0001). At 15 min, mean temperature reduction at point 4 was significantly greater than at all other measurement points (P < 0.05) due to local transfer of cold from vaginal vein blood to the uterine arterial blood (but not the ovarian artery). CONCLUSIONS: The results support the theory that, at least in postmenopausal women, the uterine artery supplies most of the uterus while the corneal part of cavity (up to 5-10 mm from the ostium) receives the blood supply from the ovarian artery. This finding represents a rationale for vaginal administration of drugs when a local effect on the uterus (e.g. progestational or relaxation) in postmenopausal women is requested.     

Preferential vascular-based transfer from vagina to the corpus but not to the tubal part of the uterus in postmenopausal women.

BACKGROUND: Vaginal administration of progesterone during infertility treatment has therapeutic advantages over oral administration. However, the reasons for this are poorly defined. To demonstrate a preferential vagina-to-uterus distribution of substances, we investigated cold distribution from vagina to the uterus and rectum. METHOD: In 10 postmenopausal women, thermoprobes were inserted into the uterine cavity and in the rectum at <9 cm or at >9 cm from the anus; temperatures were subsequently measured during 10 min flushing of vagina with cold saline. RESULTS: After 10 min, temperature decreased as follows: uterus, tubal angle: -0.22 +/- 0.07 degrees C, 10 (mean +/- SEM, n); uterus, middle cavity: -1.26 +/- 0.34 degrees C, 9; rectum, <9 cm insertion: -3.69 +/- 0.68 degrees C, 3; rectum, >9 cm insertion: -0.51 +/- 0.19 degrees C, 6. CONCLUSIONS: Despite obviously different distances to the vagina of the uterine and the low rectal probes (<9 cm) the temperature decrease occurred at the same time. Cold transfer from vagina to the uterus and rectum is probably not the result of simple diffusion but of a vascular counter-current transfer. Differential cooling of corpus and tubal angles suggests a different arterial supply; while uterine corpus is supplied from the uterine artery, the tubal angles seem to be mainly supplied from the ovarian artery via the tubal arcade.     

Role of ovarian artery-to-uterine artery anastomoses in uterine artery embolization: initial anatomic and radiologic studies

Purpose

To explore the anatomic features of normal human ovarian artery-to-uterine artery anastomoses and their impact on uterine artery embolization (UAE).

Methods

Using slice computed tomography (CT) scanning and vascular casting; models of the uterine arterial vascular network were constructed using five sets of uterus, bilateral adnexa and vagina from normal adult females. The anatomy and characteristics of these models were then studied.

Results

Both the casting specimen and the CT-reconstructed model showed the ovarian artery-to-uterine artery anastomoses clearly. Each was composed of the ovarian branch of the uterine artery and the ovarian branch of the ovarian artery. All 10 ovarian artery-to-uterine artery anastomoses were formed by direct connection between the ovarian branch of the uterine artery and the ovarian branch of the ovarian artery.

Conclusions

Thin slice CT scanning combined with vascular casting is a useful method to study the small arterial network. The anastomoses between the ovarian branch of the uterine artery and the ovarian branch of the ovarian artery were formed mainly by direct connection. The implications of the ovarian artery-to-uterine artery anastomoses on UAE are unclear; further function assessments are needed.     

Ramification Pattern of the Arteries Supplying the Rabbit Female Genital Organs

Uterine adenocarcinoma occurs in more than 60% of female rabbits aged 4 years and over. To cure or prevent this uterine disorder, ovariohysterectomy should be performed. Although knowledge of the arterial supply to the ovary, uterus, and vagina is required, few studies have described the arterial anatomy. Therefore, we dissected ovarian, uterine, and vaginal arteries in 15 New Zealand White and 15 Japanese White rabbits to clarify the anatomy. The ovarian artery arose from the abdominal aorta, and in 50% of cases, the left artery emerged more cranially than the right artery. The ovarian artery provided the ovarian, uterine, and tubal branches with three branching types. The most frequent type (67% of the halves on the right and 63% of the halves on the left) exhibited three branches that independently arose from the ovarian artery. The uterine artery usually originated from the umbilical artery, with its ramification pattern divided into two types, having one or two uterine arteries, respectively. The most frequent type (all halves on the right and 83% of the halves on the left) had one uterine artery that originated from the umbilical artery. We observed three types of vaginal artery origins, with the branching type where the vaginal artery arose from the internal iliac artery being the most frequent (97% of the halves on the right and 90% of the halves on the left). The detailed arterial supply pattern of the rabbit female genital organs determined in the present study will be helpful when performing rabbit gynecological surgeries. Anat Rec, 303:1478–1488, 2020. © 2019 American Association for Anatomy     

子宫缺血再灌注损伤大鼠模型的建立

背景：子宫缺血再灌注损伤可导致能量代谢障碍、大量自由基产生及细胞凋亡等。 目的：建立一种简易、实用、可靠的子宫缺血再灌注损伤大鼠模型。 方法：将50只健康Wistar雌性大鼠随机等分为5组。子宫缺血组(共3组)开腹后采用线栓法分别阻断大鼠子宫动脉45 min、阻断大鼠腹腔动脉30 min或阻断大鼠腹腔动脉45 min进行子宫缺血处理;子宫缺血再灌注组开腹后采用线栓法阻断大鼠腹腔动脉30 min再灌注60 min;假手术组不阻断子宫供血动脉。 结果与结论：子宫动脉纤细,结扎过紧,子宫动脉常常断裂,结扎过松,不能够充分阻断血液,不适宜建立子宫缺血再灌注损伤模型。苏木精-伊红染色显示,阻断大鼠腹腔动脉30 min后子宫细胞及间质肿胀,肌纤维排列尚整齐;阻断大鼠腹腔动脉45 min及子宫缺血再灌注组的子宫细胞及间质明显水肿,渗出增加,肌纤维排列紊乱,有大量中性粒细胞浸润。分光光度计检测显示,阻断大鼠腹腔动脉45 min及子宫缺血再灌注组子宫丙二醛水平升高最明显 (P < 0.01)。提示采用线栓法结扎腹腔动脉30 min后进行再灌注可建立大鼠子宫缺血再灌注损伤模型。     

Vascular nature of pre-eclampsia

The etiology of preeclampsia is not known. There are some partial well established mechanisms like decreased refractoriness to vasoactive agents, reduced placental and artery wall production of prostacyclin, increased production of thromboxane, and luminal trophoblast invasion of spiral arteries. We propose that it would be of primary importance to elucidate the role of uterine artery as an early pathway of preeclamptic disease. Defective hypertrophy of the uterine artery during pregnancy may give way to stretching, distortion and narrowing of the arterial lumen. The rate of growth of the pregnant uterus may not be synchronous with the expected hypertrophy of the uterine artery, thus jeopardizing the blood flow in its branches, such as arcuate and spiral arteries. This disturbance may cause non invasion by the trophoblast of the spiral arteries and subsequent placental hypoxia. Exaggerated uterine volume, like multiple pregnancy, hydatiform mole and hydramnios, may facilitate preeclampsia by demanding more blood supply from an inadequate uterine artery. The prevalence of preeclampsia in primiparous women can be understood, since additional pregnancies will find the uterine arteries already elongated, at least to some extent.     

Endothelium-dependent relaxation in response to acetylcholine in pregnant guinea-pig uterine artery

Recently, strong evidence has suggested that nitric oxide (NO) synthesis is significantly increased in the uterine artery during pregnancy, which may mediate the increased blood flow to the uterus that is characteristic of pregnancy. We therefore investigated the nature of the mediators of acetylcholine (ACh)-induced relaxation in pregnant guinea-pig uterine arterial rings. ACh (0.1 nM to 60 microM) induced endothelium-dependent relaxation of phenylephrine-precontracted pregnant guinea-pig uterine artery. N(G)-monomethyl-L-arginine (3-30 microM) antagonized the effect of ACh, with suppression of maximal ACh- induced relaxation, in a concentration-dependent manner. The inhibition of relaxation by N(G)-monomethyl-L-arginine (10 microM) was significantly overcome by L-arginine (10 microM), but not by D-arginine (100 microM). On the contrary, the administration of indomethacin (10 microM) and diethylcarbamazine (100 microM) did not modify the relaxation of guinea-pig uterine artery induced by ACh. The ACh-evoked relaxation was unaltered when K+-rich Krebs-Ringer bicarbonate solution was used to induce tone instead of phenylephrine, or when a nonselective blocker of K+ channels, 4-aminopyridine (6 mM), was applied to phenylephrine-precontracted segments. It is concluded that the relaxation induced by ACh in pregnant guinea-pig uterine artery can be explained entirely by the release of NO from vascular endothelial cells, without involvement of other endothelium-derived relaxing factors, similar to that previously reported for non-pregnant guinea- pig uterine artery. Thus, it seems that increased activity of NO synthase during pregnancy is without significant influence on the ACh action on uterine artery.