黄体期促排卵方案在卵巢低反应患者中的初步研究

目的:探索黄体期促排卵方案在卵巢低反应患者中应用的可行性及其初步效果。方法:分析77例接受黄体期促排卵的不孕症患者的卵泡期和黄体期促排卵时血清激素水平及获卵数、胚胎情况和助孕结局。结果:经过卵泡期和黄体期2次取卵,77例均有取卵机会,且获得卵子的患者数和有胚胎冻存的患者数均比仅接受卵泡期取卵的患者数显著增加(P0.001和P0.05);卵泡期与黄体期扳机日内分泌水平亦有统计学差异(P0.001),黄体期促排卵周期的回收卵子数、冷冻胚胎数均显著多于卵泡期(P0.001);已接受了冻融胚胎移植(FET)的34例患者中20例获得了临床妊娠。结论:在卵巢低反应患者中实施黄体期促排卵取卵是可行的,可以增加获卵数及获得胚胎的机会,从而为提高妊娠率提供可能。     

年轻宫颈癌患者卵巢移植和卵巢移位术研究

目的 探讨年轻早期子宫颈癌患者卵巢移植和移位手术效果。方法 ２６例中２例行卵巢移植术,２４例行卵巢移位术。结果 卵巢移植者,术后９￣１５个月功能恢复正常。卵巢移位者组,术后未接受放疗的９例患者卵巢功能正常,卵巢功能平均持续６．２４年;１５例术后辅以放疗,１４例保持卵巢功能,卵巢功能平均持续４．５年。     

Characterizing the Adolescent Premature Ovarian Insufficiency Phenotype: A Case Control Study

Study ObjectivesTo characterize the skeletal, cardiometabolic, cognitive, and mental health phenotype of adolescents with idiopathic premature ovarian insufficiency (POI)DesignCase controlSettingPediatric tertiary referral center in Cincinnati, OhioParticipantsNine adolescents (ages 11-18.99 years) with newly diagnosed POI and 9 normally menstruating controls, matched by age and body mass indexMain Outcome MeasuresBetween-group comparisons of bone characteristics assessed by dual energy x-ray absorptiometry (DXA) and peripheral quantitative computed tomography (pQCT), psychosocial health (anxiety, depression, and quality of life), and cognition and memory by questionnaireResultsAdolescents with POI had lower bone density Z-scores by DXA (lumbar spine −1.93 vs 0.80; whole body less head −2.05 vs 0.00; total hip −1.03 vs 0.83; and femoral neck −1.23 vs 0.91; all P < .001), as well as lower trabecular volumetric bone mineral density (tibia 3% site 226 vs 288 mg/mm³, P < .001; radius 3% site 200 vs 251, P = .001), smaller cortical area (tibia 66% site 251 vs 292 mm², P = .028), and thickness (tibia 66% site 3.56 vs 4.30 mm, P = .001) than controls. No abnormalities in cardiometabolic biomarkers were detected in POI cases. Adolescents with POI were also more likely to report low energy (78% vs 22%, P = .02).ConclusionEstrogen deficiency adversely affects bone health in adolescents with POI. However, we did not find associations with cardiometabolic, mental health, or cognitive outcomes in this small sample.     

Inflammatory Breast Metastases of Ovarian Cancer: A Case Report

BACKGROUND: Metastasis to the breast from extramammary malignancies is rare. CASE: A 35-year-old woman presented with bilaterally inflammatory breast involvement, 2 years after the diagnosis of stage IIIC epithelial ovarian cancer. Neoplastic tissue was immunohistochemically positive using antibodies against OC125 and negative for gross cystic disease fluid protein-15 (BRST-2) and estrogen receptor in biopsy material in the breast. Combination chemotherapy consisting of paclitaxel, cisplatin, and anthracycline was started. She died 18 months after the breast metastasis. CONCLUSION: Ovarian carcinoma usually presents with signs and symptoms related to the tumor burden within the abdominal cavity. The finding of isolated, distant metastases such as breast involvement without intraabdominal disease is extremely rare. Determining the origin of the primary tumor is important in directing the actual therapy.     

A Case of Ovarian Cancer with Metastasis to the Sternum and Costae

This report describes a case of ovarian cancer with metastases to the sternum and costae. Sternal and costal metastases from ovarian cancer are extremely rare. We introduce a case of sternal metastasis from ovarian cancer that occurred over 7 years after initial diagnosis which was successfully treated with local resection and systemic chemotherapy. Possible metastatic routes are discussed.     

联用CA125和D-二聚体检测在卵巢癌鉴别诊断中的作用研究

目的研究卵巢癌与卵巢巧克力囊肿患者的血CA125和D-二聚体水平,旨在为两者的鉴别诊断提供更好的检测指标.方法测定50例卵巢癌与50例卵巢巧克力囊肿患者的血小板计数、血清CA125及血浆D-二聚体水平.结果50例卵巢癌患者血小板计数、CA125及D-二聚体水平均较卵巢巧克力囊肿患者明显升高(P均＜0.01),卵巢癌患者血浆D-二聚体水平与肿瘤期别有关,Ⅲ～Ⅳ期的D-二聚体水平显著升高(P＜0.05),联用CA125和D-二聚体时阳性似然比明显高于单用CA125检测阳性似然比,而两者的阴性似然比接近.结论卵巢癌患者体内存在着异常的血液高凝与继发纤溶状态,D-二聚体升高可能与卵巢包块的良恶性及肿瘤期别和预后有关,联用CA125和D-二聚体检测能提高卵巢癌的诊断率,降低误诊率.     

Preoperative Evaluation of Patients with Suspected Ovarian Cancer

A diagnosis of ovarian cancer should be suspected when a postmenopausal woman presents with a pelvic mass. The presence of ascites, which can be detected clinically or by ultrasound, increases the accuracy of the diagnosis. CA 125, although nonspecific in the premenopausal patient population, is very sensitive in postmenopausal patients when used in combination with clinical impression and an abnormal ultrasound. CAT scan is more sensitive than ultrasound, but may not alter surgical management. Preoperative preparation of the bowels should consist of a polyethylene glycol lavage in combination with oral and systemic antibiotics and is indicated for any woman with a mass adherent to the cul de sac. Preoperative total parenteral nutrition should be reserved for severely malnourished patients as determined by objective criteria. Early surgical intervention is a key component for the treatment of these patients, and extensive diagnostic testing should be used temperately in order to ensure expeditious treatment of these patients. In the future, the most significant impact on the survival of patients with ovarian cancer will be in the development of improved methods of screening and early detection. It is hopeful that clinical trials currently being conducted will bring us closer to that goal.     

卵巢癌患者生活质量的研究

尽管卵巢癌的诊断和治疗技术不断发展,其病死率仍居妇科恶性肿瘤首位。在疾病每一阶段（手术、化疗、随访、复发及其后的治疗、肠梗阻以及临终阶段）生活质量始终是应考虑的最重要因素之一。近年来,大量研究对卵巢癌患者的生活质量进行评估。不同的化疗药物、化疗途径以及化疗时机对卵巢癌患者的生活质量有不同的影响。选择不同的治疗方案以及治疗效果的不同对患者生活质量的影响也有差别。治疗后出现的并发症及晚期卵巢癌患者的症状都会影响患者的生活质量。其他如情感问题,包括心理情绪问题、婚姻、家庭社会支持等也会导致生活质量的改变。     

Variation of Laparoscopic Ovarian Drilling for Clomiphene Citrate-resistant Patients with Polycystic Ovary Syndrome and Infertility: A Meta-analysis

ObjectiveTo evaluate novel surgical variations of laparoscopic ovarian drilling (LOD) and compare with standard bilateral LOD.Data SourcesElectronic databases were searched, including Cochrane database, CENTRAL, Ovid MEDLINE, Embase, PsycINFO, PubMed, Virtual Health Library, OpenSIGLE, ClinicalTrials.gov, ISRCTN, and The Chinese Clinical Trial Register in February 2019.Methods of Study SelectionRandomized controlled trials (RCTs) evaluating LOD for patients with clomiphene citrate-resistant polycystic ovary syndrome and infertility and reporting reproductive outcomes, surgical complications, serum indexes, menses resumption, and ultrasound results were included. Quality and risk of bias were evaluated by 2 authors, respectively.Tabulation, Integration, and ResultsA total of 20 RCTs with 1615 patients were included. Evaluation of the quality of evidence for each study was based on each study's limitations of 5 outcome domains described by the Grading of Recommendations, Assessment, Development, and Evaluation and found to be moderate to very low. Live births were only reported by 4 studies. Unilateral LOD did not differ with bilateral LOD in reproductive outcomes, such as pregnancy (p = .11, I² = 75%), ovulation (p = .08, I² = 0%), miscarriage (p = .61), and menstruation resumption (p = .06). There was insufficient evidence regarding efficacy and safety of novel methods of LOD, such as transvaginal hydrolaparoscopy (1 RCT) and micro-LOD (3 RCTs). Evidence regarding the suitable number of ovarian punctures, duration of drilling, and antimüllerian hormone or antral follicle numbers following LOD were inconclusive.ConclusionUnilateral LOD seems to be suitable replacement for conventional bilateral LOD for clomiphene citrate-resistant polycystic ovary syndrome, although more studies involving long-term reproductive efficacy, adverse events, and varying forms of LOD are warranted.     

PCOS患者卵巢胰岛素抵抗的发生机理探讨

目的:探讨胰岛素抵抗/高胰岛素血症在PCOS生殖功能障碍中的作用。方法:收集行IVF-ET治疗的11例PCOS患者(PCOS组)和15例排卵正常的输卵管性不孕患者(对照组)促排卵后卵巢黄素化颗粒细胞,行体外培养,分别用不同浓度胰岛素处理细胞48h,采用RT-PCR和Westernblot检测黄素化颗粒细胞胰岛素受体底物(IRS)-1和IRS-2mRNA及蛋白的表达。采用放射免疫法检测血清性激素及空腹血清胰岛素(FIN)水平;采用葡萄糖氧化酶法测定空腹血糖(FPG)水平;计算胰岛素抵抗指数(HOMA-IR)。结果:①PCOS患者血清LH、LH/FSH、T、FIN及HOMA-IR均明显高于对照组(P<0.05);②0mU/ml胰岛素时,PCOS组黄素化颗粒细胞IRS-1mRNA及蛋白的表达水平明显高于对照组(P<0.05),而IRS-2mRNA及蛋白的表达水平较对照组明显降低(P<0.05);③10mU/ml胰岛素对二组患者黄素化颗粒细胞IRS-1和IRS-2mRNA及蛋白的表达均无影响(P>0.05);④100mU/ml或1000mU/ml胰岛素作用后,二组患者IRS-1mRNA及蛋白的表达水平均明显增高(P<0.05),而IRS-2mRNA及蛋白的表达水平均明显降低(P<0.05)。结论:PCOS患者胰岛素抵抗/高胰岛素血症通过提高卵巢颗粒细胞IRS-1的表达,降低IRS-2的表达参与患者卵巢生殖功能障碍的发生。     

Is the Decision for Colorectal Resection Justified by Histopathologic Findings: A Prospective Study of 100 Patients with Advanced Ovarian Cancer

Objective. We compare the indication for colorectal resection in patients with advanced ovarian cancer with histopathologic findings. We describe the effect on pelvic control and morbidity associated with surgery.Methods. Between February 1995 and March 2001, 100 patients with FIGO stage IIIc ovarian cancer underwent pelvic en bloc resection with excision of the rectosigmoid colon as part of primary or secondary cytoreductive surgery. Decision for resection was made by the surgeon when tumor involvement of the cul-de-sac was suspected. Rectosigmoid infiltration was histopathologically defined as infiltration of the serosa or deeper.Results. In 73 of 100 patients (73%) tumor involvement of the rectum was confirmed histopathologically: infiltration of the serosa in 28 (28%) patients, infiltration of the muscularis in 31 (31%) patients, and infiltration of the mucosa in 14 (14%) patients; in 27 (27%) patients no infiltration was found. Histopathologically confirmed pelvic R0 resection was achieved in 85 (85%) patients. In 11 (11%) patients the pelvic resection margins were tumor-involved and in four (4%) patients visible parametric tumor remained in situ. Pelvic recurrence occurred in 4 (4.7%) of 85 optimally debulked patients compared with 9 (60%) of 15 patients with suboptimal pelvic resection status (P < 0.05). End colostomy could be prevented in 94 (94%) of 100 patients.Conclusion. Pelvic en bloc surgery with rectosigmoid resection was justified by histopathologic outcome since deperitonealization with preservation of the rectosigmoid would have left tumor in situ in 73% of patients with suspected cul-de-sac involvement.     

Rollerball Endometrial Ablation: A Histological Study in Danazol Pretreated Patients

Summary: Endomyometrial biopsies were taken from danazol pretreated patients about to undergo rollerball endometrial ablation for menorrhagia. The biopsies were taken with a loop electrode at hysteroscopy before and after 1, 2, 3 passes of a rollerball electrode over the endometrium using powers of electrocoagulation diathermy varying from 30 to 100 watts. The biopsies were then assessed histologically. Nineteen biopsies from the perceived endocervical canal, 25 posttreatment curettings and 3 hysterectomy specimens were also assessed. Biopsies taken after danazol pretreatment but before diathermy showed a thinned inactive endometrium. A histological classification of the effect of electrocoagulation diathermy on the endometrium was developed describing increasing endometrial damage. The degree of endometrial damage was directly related to the number of rolls of the ball over the endometrium and to the power of electrocoagulation diathermy. Endometrium was found in 84% of biopsies from the perceived endocervical canal and endometrium was found in curettings from 3 of 11 patients who were amenorrhoeic following ablation.     

林奇综合征患者子宫内膜癌及卵巢癌的筛查与预防

患有林奇综合征(Lynch syndrome,LS)的妇女终生患子宫内膜癌和卵巢癌风险大幅增加.而子宫内膜癌或卵巢癌可以是LS患者的首发恶性肿瘤,也可以是第二原发恶性肿瘤.LS相关子宫内膜癌主要类型是子宫内膜样腺癌.近年来,有关LS相关子宫内膜癌及卵巢癌的筛查研究较少,主要是通过门诊子宫内膜活检、微卫星高不稳定性(mi...     

A Phase I Study of Paclitaxel, Doxorubicin, and Cisplatin in Patients with Previously Untreated Epithelial Ovarian Cancer

Objective.Although doxorubicin is not currently popular as a primary agent in ovarian cancer, overviews of previous studies suggest that the inclusion of doxorubicin may have improved outcome. The purpose of this phase I study was to determine the maximal dose of doxorubicin that could be added to standard doses of paclitaxel and cisplatin with G-CSF support.Methods.Women with FIGO stage III or IV epithelial ovarian cancer were primarily treated with escalating doses of doxorubicin in combination with paclitaxel (135 mg/m²over 24 h) and cisplatin (75 mg/m²) every 3 weeks. Doxorubicin was started at 30 mg/m²and escalated by 10 mg/m²per treatment level. All patients received G-CSF support.Results.Eleven patients were treated at two dose levels. Dose limiting toxicity (DLT) was reached at the 40 mg/m²dose of doxorubicin. All patients experienced grade 4 neutropenia although none required hospitalization. DLT included renal toxicity and prolonged thrombocytopenia. Despite vigorous antiemetic regimens 60% of patients experienced severe nausea and vomiting. Nine patients were assessable for response. Eight patients have had a complete clinical response (89%). Of the five patients undergoing second-look laparotomy two were negative.Conclusions.The maximum tolerated dose of doxorubicin in this three-drug regimen is 30 mg/m²with standard doses of paclitaxel and cisplatin. Hematologic toxicity is manageable using G-CSF. Doxorubicin appears to increase the renal toxicity of cisplatin which may be exaggerated by marked nausea and vomiting. This is an active but toxic regimen and alternative sequences and strategies should be evaluated.     

卵巢癌患者生活质量研究进展

卵巢癌临床症状相对隐蔽,大多数患者在被确诊时已处于卵巢癌晚期。但随着治疗方案的进步,不少患者可以得到长期生存。因此,对于卵巢癌患者,尤其是晚期复发性卵巢癌患者,改善其生活质量与延长其生存期同等重要。大量研究证实卵巢癌患者在躯体、心理、社会和性等方面受到较为严重的损害,为改善患者生活质量,除需对患者进行贯穿始终的心理调节外,还需根据卵巢癌患者所处的不同时期针对性地进行生活质量的改善。对于初治卵巢癌患者,应审慎选择治疗方案,针对性处理治疗相关不良反应或并发症,督促患者加强体育锻炼;对于无瘤生存期患者,应注重帮助患者恢复工作、社会能力,增强生存信心;对于带瘤生存期患者,应进行症状管理、家庭支持等。