小剂量肝素治疗妊娠期子宫肌瘤红色变性9例分析

我院自 1996年至 1999年 ,收治妊娠合并子宫肌瘤红色变性患者 9例 ,采用小剂量肝素治疗 ,取得较好效果 ,现报道如下。9例均为初产妇 ,年龄 2 3～ 31岁 ,于妊娠中、晚期入院 ,平均孕周 30 4 周。主要临床表现为腹痛、低热 ,体温波动在 37 0～ 38 0℃之间 ,4例红细胞压积大于 0 35。妇科检查 :子宫右侧壁肌瘤 4例 ,左侧壁肌瘤 2例 ,宫底部肌瘤2例 ,前壁肌瘤 1例。肌瘤部位均有压痛 ,有不规律宫缩者7例 ,阴道流血者 1例。患者均以妊娠合并子宫肌瘤 ,先兆早产收入院。入院后常规保胎治疗 ,硫酸镁抑制宫缩 ,不见好转。经Ｂ超提示为子宫肌瘤红色…     

重视抗凝治疗在妇产科中的应用

随着抗凝治疗在临床的广泛应用，抗凝治疗在妇产科领域中的应用逐渐受到重视，我国“十五”攻关课题之一即为抗凝治疗在妊娠期高血压疾病的前瞻性、对照性研究，2004年美国妇产科学会也将抗凝治疗重点提出。国内有关抗凝疗法在产科的应用已多有报道，足以说明抗凝治疗在医学领域的应用包括在妇产科领域日益深入人心，拓宽了治疗领域，产生了良好的治疗效果，越来越受到重视。     

单角子宫足月妊娠伴巨大子宫肌瘤红色变性1例

患者,35岁,因停经39 2周,发现子宫肌瘤逐渐增大6年,于2005年4月12日收住院。患者末次月经2004年7月10日,预产期2005年4月17日,停经早期无明显恶心呕吐等反应,孕4 月自觉胎动,孕期无阴道出血史,无发热、腹痛、尿频史,孕期一般情况好,血压110/85mmHg,T 37℃,P 84次/m in,R 21次/m     

应用小剂量肝素治疗妊娠合并子宫肌瘤退行性变14例分析

妊娠合并子宫肌瘤容易发生退行性变，甚至红色变，诱发腹痛、宫缩，临床上常常误诊为先兆早产而贻误治疗，造成早产。我们应用小剂量肝素治疗妊娠合并子宫肌瘤退行性变14例，效果确切，现总结分析如下。     

心理疗法联合运动疗法在妊娠期糖尿病治疗中的应用

妊娠期糖尿病(GDM)是临床最常见的疾病之一,主要是指女性在孕期出现血糖异常升高的症状,即血液中的葡萄糖含量一定程度的异常,也是孕期常见的疾病。在妊娠期常见的新陈代谢紊乱,如果未能采取有效措施控制血糖水平,会对孕妇和婴儿的健康产生不利影响。研究表明,患者更有可能行剖宫产分娩。巨婴出生后患2型糖尿病的风险较高,因此实施有效的干预措施非常重要,对改善预后具有积极作用。为探讨心理治疗与运动治疗相结合治疗妊娠期糖尿病的效果,本研究对近期国内外治疗妊娠期糖尿病的文献资料进行分析,为临床提供更多客观的、有效的临床参考数据。     

抗凝治疗在妇产科的应用：抗凝剂的种类及其在妊娠中的应用

妊娠期血液高凝状态、妊娠病理及病理妊娠在一定情况下需要给予恰当的防栓和溶栓治疗。既往有血栓栓塞病史者妊娠期复发率高达5％-10％；心脏病患者妊娠期容易促进血栓形成；心脏瓣膜置换术后妊娠也需进行抗凝治疗。某些产科因素如重度子痢前期、胎儿生长受限、死胎、妊娠肝内胆汁淤积症、胎盘早剥、羊水栓塞等，都可能需要恰当的抗凝治疗。     

GnRH-a治疗子宫内膜异位症及子宫肌瘤与反加疗法的合理应用

GnRH-a已成功地用于治疗许多妇科内分泌疾病,但是长期应用会导致低雌激素综合征及骨质疏松等副反应,反加疗法的目的是减轻副反应以增加治疗的安全性.对GnRH-a治疗中的副反应及反加方案作综述,探讨各种方案的有效性.     

GnRH—a治疗子宫内膜异闰症及子宫肌瘤与反加疗法的合理应用

GnRH-a已成功地用于治疗许多妇科内分泌疾病,但是长期应用会导致低雌激素综合征及骨质疏松等副反应,反加疗法的目的是减轻副反应以增加治疗的安全性。对GnRH-a治疗中的副反应及反加方案作综述,探讨各种方案的有效性。     

硬膜外自控镇痛在子宫动脉栓塞术治疗子宫腺肌病中的应用

目的：探讨病人硬膜外自控镇痛（patient controlled epidural analgesia,PCEA)在子宫动脉栓塞术（uterine arterial embolization,UAE)治疗子宫腺肌病中的应用。方法：选择75例行UAE治疗子宫腺肌病的患者，随机分成3组，Ⅰ、Ⅱ组术前开始予自自控镇痛24小时，予相同的镇痛模型，两种不同的药物配伍：罗哌卡配伍吗啡为Ⅰ组（n＝30），罗哌卡因，吗啡配伍氟哌啶为Ⅱ组（n=30)，Ⅲ组术后自觉疼痛时予传统的肌注四氢巴马汀（颅痛定）或盐酸哌盐啶（n=15)，比较三组术中和术后24小时内的镇痛效果。不良反应安全性。结果：PCEAⅠ组、Ⅱ组的镇痛效果优于Ⅲ组，结合不良反应其临床疗效为：Ⅱ组＞Ⅰ组＞Ⅲ组。结论：UAE治疗子宫腺肌病术中应用PCEA镇痛效果好，不良反应小，舒适。安全。     

GnRHa与小剂量利维爱反加疗法在治疗子宫内膜异位症中的应用

目的:探讨促性腺激素释放激素类似物(GnRHa)对子宫内膜异位症(内异症)的治疗作用,比较国产药物阿拉瑞林与进口药物高舍瑞林的疗效;探讨小剂量利维爱反加疗法的应用价值。方法:随机将内异症40例分为两组。研究组20例予以阿拉瑞林治疗,150μg/d,连用6个月,再随机分为HRTO组(10例,单用GnRHa)和HRT1组(10例,同时加用利维爱1.25mg/d)。对照组20例,予以高舍瑞林治疗,3.6mg/4周,也随机分为HRT’0组(10例,单用GnRHa)和HRT’1组(10例,同时加用利维爱1.25mg/d)。结果:治疗1月各组患者血清FSH、LH水平均降低,E2降至绝经期水平;患者的自觉症状明显改善,异位症的体征减少或消失,有效率为90.0％;卵巢巧克力囊肿缩小或消失,有效率为80.0％～90.0％;血清学指标CA125、AEMAb阳性率明显下降。各组疗效无显著性差异(P>0.05)。单用GnRHa组几乎均出现低雌激素症状。反加疗法组未出现低雌激素症状或症状很轻。结论:GnRHa能有效治疗内异症,阿拉瑞林与高舍瑞林具有相同的疗效。反加疗法能减轻GnRHa的副作用而不影响其疗效。GnRHa与利维爱反加疗法联合应用是治疗内异症较为理想的方案。     

Medical treatment of uterine leiomyoma

Uterine leiomyomas (also called myomata or fibroids) are the most common gynecologic tumors in the United States. The prevalence of leiomyomas is at least 3 to 4 times higher among African American women than in white women. Pathologically, uterine leiomyomas are benign tumors that arise in any part of the uterus under the influence of local growth factors and sex hormones, such as estrogen and progesterone. These common tumors cause significant morbidity for women and they are considered to be the most common indication for hysterectomy in the world; they are also associated with a substantial economic impact on health care systems that amounts to approximately $2.2 billion/year in the United States alone. Uterine myomas cause several reproductive problems such as heavy or abnormal uterine bleeding, pelvic pressure, infertility, and several obstetrical complications including miscarriage and preterm labor. Surgery has traditionally been the gold standard for the treatment of uterine leiomyomas and has typically consisted of either hysterectomy or myomectomy. In recent years, a few clinical trials have evaluated the efficacy of orally administered medications for the management of leiomyoma-related symptoms. In the present review, we will discuss these promising medical treatments in further detail.     

子宫肌瘤非手术治疗的理论基础及适应证

子宫肌瘤是女性生殖器中最常见的良性肿瘤,也是人体中最常见的良性肿瘤之一。在30～50岁妇女中,其患病率可达70％～80％[1]。若子宫肌瘤不大且无任何临床症状,可不用治疗,定期监测,一般在绝经后肌瘤可萎缩。对有症状的子宫肌瘤,如出血或出现盆腔邻近器官的压迫症状时,传统的治疗方法以手术为主。但考虑到手术所致的创伤和相关的并发症,近年来,对子宫肌瘤的非手术治疗越发受到关注。现今,子宫肌瘤的非手术治疗主要包括两大类：药物治疗及介入治疗。     

子宫肌瘤红色变性67例临床分析

目的　研究子宫肌瘤红色变性的临床特征及妊娠期与非妊娠期子宫肌瘤红色变性的异同 ,探讨子宫肌瘤红色变性的发生机制。方法　对 1993～ 2 0 0 2年间手术治疗的 2 3 17例子宫肌瘤患者进行回顾性研究 ,并对行子宫肌瘤切除术的患者进行随访。结果　红色变性 67例 ,占同期 2 3 17例子宫肌瘤患者的 2 89% ,子宫肌瘤合并妊娠患者中 2 1 85%发生红色变性 ,而非妊娠期子宫肌瘤患者仅 1 87%发生红色变性 ,二者差异有统计学意义(P <0 0 0 1)。子宫肌瘤红色变性患者最常见症状为月经改变 ,出现在 2 9 85%的患者 ,2 0 90 %的患者有腹痛症状 ,17 91%的患者肌瘤增大较快 ,16 42 %有肌瘤压痛 ,14 93 %的患者白细胞计数升高。B超提示肌瘤个数妊娠组少于非妊娠组患者 ,最大肌瘤妊娠组 61 54%位于浆膜下 ,而非妊娠组 82 92 %位于肌壁间 ,妊娠组最大肌瘤直径明显小于非妊娠组 ,两组分别为 4 0 8cm和 7 2 8cm ,以上差异均有统计学意义 (P <0 0 0 1)。 97 0 1%的患者最大肌瘤发生变性。行肌瘤切除术的子宫肌瘤红色变性患者术后复发率与是否合并妊娠无明显相关 ,而与肌瘤个数有关 (P =0 0 2 4)。结论　妊娠期与非妊娠期子宫肌瘤患者红色变性发生率、肌瘤大小和部位等临床病理特征存在很大差异 ,考虑其红色变性发生机制     

子宫肌瘤药物治疗

目前尚无治疗子宫肌瘤的有效药物。促性腺激素释放激素激动剂(GnRHa)能改善术前贫血症状,但费用高并可导致低雌激素状态。芳香化酶抑制剂和选择性雌激素受体调节剂(SERM)在绝经后有症状的子宫肌瘤治疗中有效。使用米非司酮治疗,闭经率高,副反应小。左炔诺孕酮宫内节育系统(LNG IUS)可治疗子宫肌瘤合并月经过多。     

Embolisation of uterine arteries or laparascopic uterine artery ligation as possible treatment of uterine leiomyoma

Background Many women with symptomatic uterine leiomyomata wish to preserve their uterus. Novel organ- and fertility-preserving treatment options such as embolisation of uterine arteries or laparascopic uterine artery ligation have frequently been discussed as viable alternatives to myomectomy. This article strives to bring together the conclusions of major studies on novel organ-preserving treatment alternatives for uterine myoma.Methods Minimally invasive organ-preserving laparascopic myomectomy remains the best treatment option for patients with symptomatic fibroids who wish to retain their uterus. However, in certain cases other options such as embolisation or laparascopic ligation of uterine arteries can serve as viable alternativesResults A failure rate of up to 39% and complications such as reduced fertility because of ovarian failure after transcatheter embolisation of uterine arteries might restrict the use of this method.Conclusions For postmenopausal women, transcatheter embolisation of uterine arteries is a possible treatment alternative. Laparascopic ligation of uterine arteries and anastomotic sites of uterine arteries with ovarian arteries might also be viable for young women who desire to preserve future fertility. Further data and studies on the long-term follow-up after ligation are yet to come.     

Uterine arteries embolization as a treatment of uterine leiomyoma

Uterine artery embolization is a new method of treating uterine leiomyomata, first carried out in France in the early 90s. The procedures involve placing a small catheter into an artery in the groin and directing it to the blood supply of the fibroid. Little plugs of polyvinyl alcohol are injected through the catheter to block these arteries. This cause the fibroid to shrink. Indications for uterine fibroid embolization include menorrhagia, pelvic pain or pressure, other "bulk" syndrome (low-back pain, urinary frequency and constipation. The fluoroscopic-guided procedure is performed under local anesthesia. Most patients are discharged within 72 hours. Post-embolization syndrome including severe pain is managed with morphine via patient-controlled pump. Paper reviews long term outcomes. Uterine artery embolization has several advantages: high efficacy, less invasiveness, ability to treat multifocal changes, uterine preservation, shorter hospitalisation and recovery (low cost) and disadvantages: postembolic syndrome (pain and fever), unknown relations to pregnancy and lack of long term results.     

Conservative treatment of uterine leiomyoma with the antiestrogen antiprogesterone R-2323

The case reported here shows how adequate conservative therapy of the antiestrogen R-2323 saved a uterus in a woman of child-bearing age who suffered a uterine leiomyoma. The patient's fertility was restored, and a twin pregnancy is currently in progress.