腹壁子宫内膜异位症病灶切除并行腹壁整形术的围手术期护理

当具有生长功能的子宫内膜组织出现在子宫腔被覆黏膜以外的身体其他部位时，称为子宫内膜异位症。近年来随着剖宫产率的上升。腹壁伤口子宫内膜异位症的发生逐渐增多。腹壁切口处子宫内膜异位症的发生率为3．5％，多继发于剖宫产手术。出现于术后1个月至数年。国外报道此症于剖宫产术后的发生率为0．03～0．45％，我院报告仅为4．6/万。腹壁子宫内膜异位症病灶的药物治疗效果差，临床上主要依赖于手术治疗。     

自体移植深部浸润型子宫内膜异位症大鼠模型的建立

目的探讨深部浸润型子宫内膜异位症（DIE）动物模型建立的方法,旨在为DIE的研究提供理想的实验平台。方法采用自体移植方法将成熟雌性SD大鼠（20只）的子宫内膜直接移植到腹腔内阴道顶端子宫联接处下方的腹膜处（相当于女性的子宫直肠窝位置,即Douglas窝）以建立DIE大鼠动物模型。应用大体观描述移植处病灶生长（包括囊泡大小、颜色、囊液性状）以及与周围的粘连情况,并测量囊泡体积;应用苏木素-伊红染色法（HE染色法）以明确子宫内膜组织,同时应用免疫组织化学检测病灶角蛋白和波形蛋白的表达以证实子宫内膜细胞。结果大体观在移植处可见囊泡状病灶及细小的散在病灶,同时可见有明显的异位子宫内膜囊肿,所有病灶均与周围组织有不同程度的粘连,分离粘连后可见病灶有不同程度向腹膜下浸润;显微镜下观察异位病灶的子宫内膜形态和结构与在位子宫内膜基本相同;角蛋白和波形蛋白分别在病灶子宫内膜腺上皮细胞和间质细胞中表达。共有18只大鼠建模成功,建模的成功率为90％。结论自体子宫内膜移植方法可成功建立DIE大鼠动物实验模型。     

腹壁子宫内膜异位症4例报告

腹壁子宫内膜异位症４例报告吴黛琳２２１３００江苏省邳州市第一人民医院子宫内膜异位症绝大多数局限在卵巢、子宫骶骨韧带等盆腔组织。近年来，随着中期引产术、剖宫产率不断增长，出现了发生在腹壁切口疤痕处，经腹羊腹腔内穿刺之腹壁穿刺点的子宫内膜异位症，现将我院...     

剖宫产术后腹壁切口子宫内膜异位症的超声诊断

子宫内膜异位症是指具有活性的子宫内膜组织出现在子宫内膜以外部位,是育龄妇女的常见病和多发病,该病可发生于身体任何部位,大多发生在盆腔脏器如子宫和卵巢,子宫骶韧带,子宫直肠陷凹、盆腔腹膜和阴道直肠隔等部位,发生在腹壁切口下的子宫内膜异位症临床少见[1],剖宫产术后腹壁切口下子宫内膜异位症是由于手术时将具有种植能力的子宫内膜带至切口处,在该处种植形成子宫内膜异位病灶[2];近年来,随着剖宫产率逐渐升高,术后腹壁切口下子宫内膜异位症的发生率也逐渐上升.本文回顾性分析了经术后病理证实的28例剖宫产术后腹壁子宫内膜异位症的超声图像特征,旨在探讨超声对腹壁子宫内膜异位症的诊断价值.     

神经生长因子及其受体的表达在子宫内膜异位症患者中的临床意义

目的探讨神经生长因子(NGF)及其受体TrkA、p75在子宫内膜异位症患者中的临床意义。方法随机选取2014年1月至2016年12月收治的子宫内膜异位症患者100例,其中腹壁子宫内膜异位结节(AEM)22例,卵巢子宫内膜异位囊肿(OEM)45例,宫骶韧带深部浸润型子宫内膜异位结节(DIE)33例,所有患者术前采用视觉模拟(VAS)评分法对术前疼痛进行评分,入组病例为评分在0分或10分的病例,并根据评分分为无疼痛组和疼痛组。应用免疫组织化学法对组织标本患者病灶中TrkA、p75及NGF的蛋白表达进行检测。另外选择20例同期子宫肌瘤且无疼痛患者的宫骶韧带组织作为对照组。结果与对照组比较,NGF及其受体TrkA、p75在AEM、OEM及DIE病灶中的表达均明显升高,差异均具有统计学意义(P0.05);与AEM及OEM病灶比较,p75和NGF在DIE病灶中的表达明显升高,差异有统计学意义(P0.05)。与无疼痛组的DIE、OEM患者比较,疼痛组OEM、DIE患者p75表达明显升高,差异具有统计学意义(P0.05),而TrkA及NGF表达水平差异无统计学意义(P0.05)。结论子宫内膜异位症的发生和发展与NGF及受体p75、TrkA的参与有关,子宫内膜异位症患者疼痛的发生与受体p75有关。     

米非司酮联合手术治疗腹壁切口子宫内膜异位症4例临床分析

子宫内膜异位症为生育年龄妇女常见病．病灶多见于盆腔腹膜和脏器，腹壁切口疤痕子宫内摸异位症临床虽少见。但随着剖宫产率的增加．术后腹壁子宫内膜异位症也有发生，应引起重视。我院近2年共收治腹壁切口子宫内膜异位症4例．经术前术后口服米非司酮5-6个月．随访1—2年．疗效满意。现分析如下。     

保留子宫手术治疗子宫腺肌病合并深部浸润型子宫内膜异位症31例临床分析

目的探讨子宫腺肌病合并深部浸润型子宫内膜异位症患者行U形病灶挖除术切除子宫腺肌病病灶和子宫周围深部内膜异位病灶保留子宫的可行性。方法 31例子宫腺肌病合并深部浸润型子宫内膜异位症患者,行开腹手术U形挖除子宫腺肌病病灶,缝合子宫创面后,钝性加锐性分离切除骶韧带,阴道直肠隔,输尿管周围异位病灶。比较手术前,术后1、3、6、12个月子宫体积变化和视觉模拟评分(visual analogue scale,VAS),随访观察手术效果和并发症发生情况。结果 31例均保留子宫,顺利切除子宫以外的深部内膜异位病灶;术后12个月子宫体积明显小于术前;术后12个月痛经、性交痛、肛门坠胀VAS评分(2.08±1.58、1.35±0.68、1.34±0.92)均低于术前(9.06±1.08、3.96±1.84、5.11±1.96)(P0.05);术后12个月血清糖链抗原125水平[(16.28±6.62)u/L]低于术前[(98.26±18.65)u/L](P0.05);术后12个月,临床症状均明显缓解,月经正常来潮,月经量较术前减少;术后发生尿潴留2例,经持续留置导尿管7~10d,排尿功能恢复;乙状结肠腹壁瘘1例,换药2个月,瘘口自行闭合;腹壁切口子宫内膜异位1例,再次手术切除异位病灶后痊愈。结论子宫腺肌病合并深部浸润型子宫内膜异位症患者行U形病灶挖除术效果确切,可保留子宫。     

高频超声对腹壁子宫内膜异位症的诊断价值

目的探讨高频超声对剖宫产或妇科手术后腹壁子宫内膜异位症的诊断价值。方法回顾性分析26例经手术和病理证实的腹壁子宫内膜异位症的高频超声声像图表现。结果26例腹壁子宫内膜异位症中,19例位于脂肪层内,7例位于肌层内,瘤体均位于腹壁切口下方和（或）邻近软组织,直径1.2～5．1cm,无包膜,形态不规则,边缘不光滑,内部为低回声,部分内见不规则的无回声区,彩色多普勒超声显示病灶内部可见点状或条索状彩色血流信号,其动脉均为低速高阻型血流速度曲线。结论高频超声可直接显示腹壁子宫内膜异位症病灶的内部结构、大小、形态、回声及血供情况,为临床诊断及鉴别诊断提供了重要依据,高频超声可作为诊断腹壁子宫内膜异位症的首选影像学检查方法。     

剖宫产术后腹壁子宫内膜异位症28例细胞学诊断

子宫内膜异位症多发生在卵巢、宫骶韧带和盆腔腹膜,也可发生在其他部位和腹部的手术切口,但并不常见,近年来,随着剖宫率的增加,术后腹壁子宫内膜异位症也随着增多,细胞学诊断子宫内膜异位症尤为重要.本文探讨剖宫产术后腹壁切口旁子宫内膜异位症的细胞学特点及与临床的关系.     

腹壁切口子宫内膜异位症16例分析

子宫内膜异位症（内异症）是常见的妇科疾病之一,它在生育年龄上发病率为10%～15%,且现在有明显的上升趋势.子宫内膜异位症以盆腔内病灶占绝大多数,但有一类发生在腹壁切口瘢痕处,称之为腹壁切口子宫内膜异位症[2].1990-01～2003-06我院共收治腹壁切口内异症16例,现分析如下.     

剖宫产术后腹壁切口子宫内膜异位症20例临床分析

目的：探讨剖宫产术后腹壁切口子宫内膜异位症临床表现、治疗方法及预防。方法：对2006年3月—2011年8月收治的20例剖宫产术后腹壁切口子宫内膜异位症的患者的临床资料进行回顾性分析。结果：20例子宫内膜异位症患者均经手术治疗,术后随访1年均未复发。结论：剖宫产术是子宫内膜异位症最主要的医源性因素,手术时应用纱布垫保护子宫周围术野,缝合子宫壁时避免缝针穿过子宫内膜层,关腹后冲洗腹壁切口,降低剖宫产术后腹壁切口子宫内膜异位症的发生率。     

剖宫产腹部切口子宫内膜异位症23例临床分析

目的：探讨剖宫产手术后腹部切口子宫内膜异位症诊断、治疗和预防。方法：对23例剖宫产术后腹部切口子宫内膜异位症的患者进行回顾性的分析和总结。结果：剖宫产术后腹部切口子宫内膜异位症是剖宫产术后远期并发症之一,多发生于剖宫产术后2年左右,表现为手术切口部位出现随月经周期而出现的痛性包块,随病程发展而增大,部分患者CA125可有升高,有较典型的病史和临床表现。结论：手术切除包块是治疗宫产术后腹部切口子宫内膜异位症的有效方法,剖宫产术中应严密预防子宫内膜种植。     

Pharmacological treatments for acute migraine: quantitative systematic review

Endometriosis and urinary calculosis can co-occur. Clinical studies have shown that both painful and non-painful endometriosis in women are associated with enhanced pain and referred muscle hyperalgesia from urinary calculosis, but the mechanisms underlying this phenomenon are still poorly understood. The aim of this study was to develop an animal model adequate to explore this viscero-visceral interaction in standardized conditions.Using a model of endometriosis previously developed to study reduced fertility and vaginal hyperalgesia, endometriosis (endo) or sham-endometriosis (sham-endo) was induced in rats by autotransplantation of small pieces of uterus (or, for sham-endo, fat) on cascade mesenteric arteries, ovary, and abdominal wall. After the endometrial, but not the fat autografts had produced fluid-filled cysts (3 weeks), urinary calculosis was induced by implanting an artificial stone into one ureter. Pain behaviors were monitored by continuous 24-h videotape recordings before and after stone implantation. Referred muscle hyperalgesia was assessed by measuring vocalization thresholds to electrical stimulation of the oblique musculature (L1 dermatome). The data were compared with previously reported data from rats that had received only the stone. Neither endo nor sham-endo alone induced pain behaviors. Following stone implantation, in endo rats compared to sham-endo and stone-only rats, pain behaviors specifically associated with urinary calculosis were significantly increased and new pain behaviors specifically associated with uterine pathology became evident. Muscle hyperalgesia was also significantly increased. To explore the relationship between the amount of endometriosis and that of ureteral pain behavior, two separate groups of endo rats were treated with either a standard non-steroidal anti-inflammatory drugs (ketoprofen) or placebo from the 12th to the 18th day after endometriosis induction. The stone was implanted on the 21st day. Ketoprofen treatment compared to placebo significantly reduced the size of the cysts and both ureteral and uterine pain behaviors post-stone implantation. The size of the cysts showed a significant linear correlation with the post-stone ureteral pain behaviors. In conclusion, endo increased pain crises and muscle hyperalgesia typically induced by a ureteral calculosis, and the ureteral calculosis revealed additional pain behaviors typically induced by uterine pathophysiology; and this enhancement was a function of the degree of endometriosis. This result closely reproduces the condition observed in humans and could be due to a phenomenon of 'viscero-visceral' hyperalgesia, in which increased input from the cyst implantation sites to common spinal cord segments (T10-L1) facilitates the central effect of input from the urinary tract.     

腹壁切口疤痕子宫内膜异位症14例临床分析

目的 探讨腹壁切口疤痕子宫内膜异位症的临床特点,为临床诊断、治疗和预防提供依据.方法 对14例腹壁切口疤痕子宫内膜异位症的临床资料进行分析,所有病例均采取手术治疗彻底切除病灶,观察疗效.结果 内膜异位症病灶外观呈暗红色或紫蓝色、甚至黑色,直径l.0～6.0 cm,平均3.0 cm.术后观察1年,无一例复发.结论 手术彻底切除病灶是腹壁切口疤痕内膜异位症惟一有效的治疗方法,并且是预防其术后复发的关键措施.     

卵巢子宫内膜异位囊肿临床与MRI表现的相关性

目的 探讨卵巢子宫内膜异位囊肿MRI表现与临床、手术、病理结果的相关性。材料与方法 回顾性研究45例137个卵巢子宫内膜异位囊肿MRI表现，全部病例均经手术病理证实。结果 45例中15例单发、30例多发；62个囊肿T1WI、T2WI增色为高信号；37个T1WI高、等混杂信号，T2WI高信号；21个T1WI低信号，T2WI高信号；21例大囊肿周围伴有小囊肿；28例囊壁增厚，边界欠清。结论 MRI表现异位囊肿内的信号变化、大囊肿伴小囊肿、囊肿周围粘连征象与手术结果和临床表现具有明显的相关性，是本病极其有用的非创伤性检查手段。     

Nodular endometriosis: dynamic MR imaging

Purpose In this study we aimed to investigate the value of contrast enhanced dynamic MR imaging (DMI) in the diagnosis of nodular abdominal endometriosis. Subjects and methods Fourteen patients with surgically and pathologically proven endometriosis were examined with DMI. The patients were 22–54 years old (mean age 30.8 years). The dynamic MR studies of these patients were retrospectively reviewed by two radiologists who were aware of the clinical data. Nodular masses showing enhancement were evaluated for size, margins, and signal intensity on T1- and T2-weighted MR sequences. The protocol was tailored to selectively determine the diagnostic utility of signal intensity time course analysis for the behavior of nodular endometriosis and endometrial tissue, in DMI. Contrast-enhanced DMI was performed and the time–intensity curves of the lesions and the uterine endometrial tissue of each patient were compared. Mean enhancement values were calculated. Each DMI was evaluated for signal intensity value. Results In 8 (57%) of 14 patients, we found endometriosis in the abdominal wall. All patients with abdominal wall endometriosis had pelvic surgical operation history. Diameter of nodular endometriosis determined in the abdominus muscle ranged between 3 and 40 mm. Of eight cases, five had only one lesion and three had multiple lesions. Remaining 6 (43%) cases had deep pelvic endometriosis located in the uterosacral ligaments (n = 3), rectosigmoid (n = 2), and rectovaginal septum (n = 1). Diameter of pelvic endometriosis ranged between 9 and 53 mm. Noncontrast mean signal intensity of endometriosis and endometrial tissue were 280 ± 73 and 216 ± 20, respectively. The mean values of both endometriosis and normal endometrial tissue were calculated for each patient examined with five-slice DMI. All of the curves showed significant correlation. The lesion showed significant enhancement in the course of time similar to the endometrial tissue in all patients. Conclusion Our study was inspired from the fact that endometriosis is the ectopic endometrial tissue and we thought that endometrial tissue and endometriomas should have similar vascularity. In this way imaging with MR, getting the time–intensity curves and experiencing the correlation between the endometriosis and endometrial tissue may support the diagnosis in the cases with suspected endometriosis. This first study shows that the ectopic nodular endometriosis can easily be identified with dynamic MRI. It may be used to differentiate nodular endometriosis from the other pathologic conditions of abdominal wall and pelvis.     

盆腔单纯囊性肿物超声定性诊断与穿刺治疗病例选择

目的探讨女性盆腔囊性肿物的超声定性诊断及其对超声引导穿刺抽吸治疗病例选择的指导意义.方法分析526个有病理结果的女性盆腔囊性肿物的声像图表现及144个病变超声引导介入治疗效果.结果 526个肿物中超声定性诊断与病理诊断总符合率为95.6%(503/526).部分卵巢囊性畸胎瘤、黏液性囊腺瘤、输卵管积脓、卵巢出血性囊肿或交界性浆液性囊腺瘤可有与子宫内膜异位囊肿或卵巢冠囊肿相似的声像图表现.超声介入治疗后复发者多为子宫内膜异位囊肿中囊壁厚、囊内或囊壁有中等回声块状物或酒精凝固时间短者.包裹性积液和绝经后卵巢囊肿抗炎治疗或随访观察中可完全消失.结论超声对盆腔囊性肿物的定性诊断率较高,但部分不典型病例仍有误诊可能.超声引导穿刺抽吸治疗前应观察2～3个月经周期.     

子宫内膜异位的CT诊断(附26例分析)

目的：分析子宫内膜异位的CT表现和诊断价值。方法：回顾分析26手术、病理证实子宫内膜异位的CT表现。结果：卵巢子宫内膜异位16例,膀胱壁2例,子宫壁5例和阴道3例。CT表现为圆形或卵圆形或不规则形,囊性或实性或囊实性肿块,边缘不锐,与周围结构不同程度粘连,肿块内有多个小囊。增强后,囊壁和实性部分强化。结论：CT表现结合临床,能诊断子宫内膜异位。     

腹壁切口子宫内膜异位症临床分析

目的探讨腹壁切口子宫内膜异位症的临床特点、诊治方法及预防情况。方法回顾性分析2007年2月-2011年8月收治的295例经病理诊断确诊为腹壁切口子宫内膜异位症患者的临床资料。结果患者术前均有过腹部手术史，其中99％为剖宫产史。患者年龄为（31．6±4．5）岁。病灶大小为（2．66±1．12）cm，显著大于术前超声检查的平均大小（1．91±0．83）cm（P〈0．05）。术后随访5个月～3年，无复发。结论结合病史、典型的临床症状和体征、超声等辅助检查，腹壁切口子宫内膜异位症的诊断并不困难。预防此病的发生很重要。手术治疗仍为腹壁切口子宫内膜异位症的最佳治疗方法。     

Androgen-producing, atypically proliferating endometrioid tumor arising in endometriosis

A case of androgen-secreting borderline endometrioid tumor arising in endometriosis of the rectovaginal septum is presented. It occurred 10 years after total abdominal hysterectomy and bilateral salpingo-oophorectomy for extensive endometriosis of the fallopian tubes and ovaries, adenomyosis, and leiomyomas of the uterus. We believe 7 years of unopposed continuous oral estrogen replacement therapy contributed to the malignant transformation of the endometriosis.