宫腔镜手术治疗子宫内膜息肉的临床应用

目的　探讨采用宫腔镜电切术治疗子宫内膜息肉的可行性。方法　 2 0 0 0年 1月至 2 0 0 2年 12月施行宫腔镜电切除术治疗子宫内膜息肉 6 7例 ,且行术后定期随访。结果　采用宫腔镜电切术治疗子宫内膜息肉 ,手术时间 ( 19 39± 0 4 8)min ,出血量 ( 33 5 7± 0 6 8)mL。术后月经量明显减少者 4 1例 ( 6 1 19% ) ,无术中、术后并发症 ,降低了手术的风险系数 ,随访无复发。结论　宫腔镜电切术是治疗子宫内膜息肉的一种较好的手术方式。     

子宫内膜息肉的治疗研究进展

子宫内膜息肉是最常见的宫腔病变之一,可引起不规则阴道出血、经量增多、不孕.目前子宫内膜息肉以手术治疗为主包括刮宫术,宫腔镜下息肉去除术和子宫切除术等.首选宫腔镜下息肉切除术加刮宫术.因息肉邻近内膜常有不同的病理改变,息肉有癌变可能,应同时行刮宫术.息肉的复发是治疗的难点,结合是否有复发的高危因素,选择适当的手术方法和预防措施.综述息肉的治疗研究,根据子宫内膜息肉的病理和临床特点选择合理的治疗方法,减少息肉复发.     

宫腔镜电切术治疗子宫内膜息肉47例临床分析

宫腔镜手术是治疗子宫内膜息肉的一个新方法，是一种疗效可靠、安全、简便的治疗手段。我院采用宫腔镜直视下切除息肉术(TCRP)治疗子宫内膜息肉47例，现将治疗结果报道如下。     

子宫内膜息肉的手术治疗及术后复发的预防

目的探讨子宫内膜息肉的宫腔镜手术治疗及术后应用孕激素预防复发的效果。方法选择北京大学深圳医院2001年8月至2007年8月行宫腔镜诊治的子宫内膜息肉86例患者,术后分为激素治疗组和观察组,激素治疗组术后给予安宫黄体酮周期性治疗3个月,观察子宫内膜息肉复发及妊娠情况。结果 86例患者中,宫腔镜检查多发性子宫内膜息肉56例,单发性子宫内膜息肉32例;激素治疗组术后2年,复发率为2.3%,观察组复发率为13.9%,两组比较,差异有统计学意义(P0.05)。32例有生育要求的患者中,术后2年23例自然妊娠,妊娠率为71.9%,但激素治疗组妊娠率(70.6%,12/17)和观察组(73.3%,11/15)比较,差异无统计学意义(P0.05)。结论子宫内膜息肉患者行宫腔镜诊断及治疗效果明确,术后应用孕激素治疗可能有助于预防子宫内膜息肉的复发。     

子宫内膜息肉的手术治疗

宫腔镜下子宫内膜息肉切除术是子宫内膜息肉诊治的“金标准”。近年来出现一系列宫腔镜下子宫内膜息肉切除术的新技术,能在提高手术效率的同时改善患者的就诊体验,实现“即诊即治”,使子宫内膜息肉的门诊诊疗成为趋势。在临床开展相应手术时,术者应根据实际情况选择合适的治疗方式以达到最优的治疗效果。文章介绍了子宫内膜息肉手术的适应证,简述常用手术系统及手术技巧,并分析了门诊宫腔镜进行子宫内膜息肉切除的注意事项。     

宫腔镜诊治子宫内膜息肉临床分析

目的：总结宫腔镜诊断子宫内膜息肉的准确性和治疗效果。方法：选取2007年1月－2012年9月宫腔镜检查诊断子宫内膜息肉120例患者临床资料。结果：120例患者在B超声监护下完成宫腔镜子宫内膜息肉切除术,手术恢复良好。没有出现一例手术并发症。手术后病理检查诊断子宫内膜息肉109例,宫腔镜诊断正确率91％应用宫腔镜治疗,月经增多有效率82％,阴道不规则流血有效率100％。结论：B超声监护下诊断治疗子宫内膜息肉是安全有效的。     

宫腔镜电切术52例

目的评价宫腔镜电切术的应用价值及效果。方法运用气化电切镜经宫颈行子宫粘膜下肌瘤切除术19例,子宫内膜切除术9例,宫颈管息肉切除术14例,其它宫内良性病变切除10例。结果宫腔镜下电切子宫粘膜下肌瘤、宫颈息肉、植入胎盘,术后完全满意率100％;子宫内膜异常增生、子宫内膜息肉行TCRE、TCRP术,术后完全满意率92.3％。结论宫腔镜电切术近期疗效好,可替代子宫切除治疗宫内良性病变,是一种较理想的手术。     

子宫内膜息肉的治疗研究进展

子宫内膜息肉是最常见的官腔病变之一，可引起不规则阴道出血、经量增多、不孕。目前子宫内膜息肉以手术治疗为主包括刮宫术，宫腔镜下息肉去除术和子宫切除术等。首选官腔镜下息肉切除术加刮宫术。因息肉邻近内膜常有不同的病理改变，息肉有癌变可能，应同时行刮宫术。息肉的复发是治疗的难点，结合是否有复发的高危因素，选择适当的手术方法和预防措施。综述息肉的治疗研究，根据子宫内膜息肉的病理和临床特点选择合理的治疗方法，减少息肉复发。     

宫腔镜诊治子宫内膜息肉782例临床分析

目的:探讨宫腔镜诊治子宫内膜息肉的有效性。方法:回顾分析我院2004年1月至2010年12月共782例宫腔镜术前被诊断为子宫内膜息肉的患者行宫腔镜电切的临床及病例资料。结果:782例中,术后病例证实为子宫内膜息肉596例,粘膜下肌瘤82例,子宫内膜增殖症40例。分泌期子宫内膜20例;增生期子宫内膜18例,恶性肿瘤10例,不全纵隔10例,息肉样腺肌病6例;绝经前更容易发生子宫内膜息肉;有症状的子宫内膜息肉更容易发生病理结果异常。结论:宫腔镜下组织活检术及内膜息肉电切术是诊治子宫内膜息肉的金标准。     

宫腔镜下不同手术方式治疗子宫内膜息肉的临床疗效观察

目的探讨宫腔镜下不同手术方式治疗子宫内膜息肉的疗效。方法对不同年龄和不同生育要求的子宫内膜息肉患者327例,分别行子宫内膜息肉切除+子宫内膜汽化电切术(A组,53例);子宫内膜息肉切除+子宫内膜电切术(B组,175例);子宫内膜息肉切除+息肉旁浅层内膜切除术(C组,54例,要求保留生育功能者);子宫内膜息肉切除+子宫内膜电凝术(D组,45例,绝经后患者)。结果手术时间:A组(15·1±0·8)s,B组(19·7±0·7)s,C组(20·9±0·7)s,D组(22·1±0·8)s,A组平均手术时间与其他3组比较,差异有统计学意义(P<0·01);术后子宫内膜息肉复发率:A、D组为0,B组为1·7%(3/175),C组为7·4%(4/54),C组术后复发率与其他3组分别比较,差异均有统计学意义(P<0·05);C组术后无闭经者,但术后息肉复发率高于其他3组,C组中有14例术后5~23个月妊娠。结论宫腔镜下不同手术方式治疗子宫内膜息肉的临床疗效无明显差异,但子宫内膜息肉切除+息肉旁浅层内膜切除术后复发率高;应根据患者年龄、生育要求等选择适宜的宫腔镜下手术方式。     

Conservative treatment may be beneficial for young women with atypical endometrial hyperplasia or endometrial adenocarcinoma

OBJECTIVE: To evaluate whether an alternative treatment to radical hysterectomy exists for young women with endometrial adenocarcinoma. DESIGN: A review of the literature (70 articles) plus personal results. SETTING: University hospital. PATIENT(S): Women with atypical endometrial hyperplasia or adenocarcinoma. MAIN OUTCOME MEASURE(S): The recurrence rate and the pregnancy rate after conservative therapy. CONCLUSION(S): Conservative treatment of well-differentiated stage I endometrial adenocarcinoma can be considered in young patients, with close surveillance to diagnose any possible recurrence.     

子宫内膜不典型增生和早期子宫内膜癌保守治疗方案分析

随着癌症发病的年轻化,患有子宫内膜癌的育龄期女性越来越多。为了保留生育能力,大部分患者倾向于保守治疗。故而众多研究者提出了子宫内膜不典型增生和早期子宫内膜癌的保守治疗方案,并在临床上进行了小样本研究。传统治疗以口服大剂量孕激素为主,然而多数口服孕激素治疗的患者复发率高、并发症多。左炔诺孕酮宫内缓释节育系统通过局部作用于子宫内膜,可减少大量孕激素对机体造成的不良反应。宫腔镜能够精准切除病灶,保护正常子宫内膜,相对降低了发生不孕、流产风险。二甲双胍的抗肿瘤作用能增加孕激素的有效率。通过综述子宫内膜不典型增生和早期子宫内膜癌各种保守治疗后的缓解率、复发率和妊娠结局,为临床上在治疗前对每位患者的自身因素及疾病特点进行评估,以采取对患者最有益的治疗方案及管理模式提供依据。     

芳香化酶抑制剂治疗晚期或复发性子宫内膜癌的研究进展

近年来,子宫内膜癌复发率和死亡率呈上升趋势,严重威胁女性的生命健康。无论是子宫内膜癌术后预防复发转移的辅助治疗,还是晚期或复发转移性子宫内膜癌的治疗,内分泌治疗都占有十分重要的地位。芳香化酶抑制剂是临床中常见的辅助内分泌治疗药物,其具有强选择性,可通过抑制雌激素合成,减少雌激素对子宫内膜癌细胞的刺激,从而抑制肿瘤细胞的增殖。回顾芳香化酶抑制剂在子宫内膜癌中的临床疗效,并探讨增强芳香化酶抑制剂治疗效果的潜在策略,如联合紫杉醇+卡铂、联合新型靶向治疗药物以及二甲双胍等。     

Endometrial carcinoma with laparotomy wound recurrence: complete remission following surgery and chemotherapy consisting of paclitaxel and carboplatin

We present a patient with surgical stage I endometrial cancer who experienced laparotomy wound recurrence 4 years after primary treatment. She was treated successfully by complete surgical resection of recurrent tumors and chemotherapy. A 62-year-old white female with laparotomy wound recurrence of endometrial carcinoma with small-bowel involvement and concomitant subcutaneous metastasis in the abdominal wall underwent complete surgical resection of metastatic tumors followed by six cycles of chemotherapy consisting of paclitaxel (175 mg/m2) and carboplatin (area under the curve 5). Since 24 months after resection of recurrence, she has no evidence of disease recurrence. Endometrial carcinoma with laparotomy wound recurrences, especially those with concomitant metastases, can be successfully treated by complete surgical resection followed by chemotherapy consisting of paclitaxel and carboplatin.     

A successful live birth with in vitro fertilization and thawed embryo transfer after conservative treatment of recurrent endometrial cancer

Estrogen-dependent early stage endometrial cancer is relatively common in young women of reproductive age. The standard treatment is hysterectomy and bilateral salpingo-oophorectomy (BSO), even in early stage well-differentiated endometrial cancer patients. This surgical option results in permanent loss of fertility. There have been some reports of live births using in vitro fertilization after conservative management of endometrial cancer with high-dose progestin for the purpose of fertility preservation. However, most were not recurrent cases and pregnancy was achieved through conventional in vitro fertilization, which usually raises serum estradiol levels and may lead to the recurrence of endometrial cancer. To date, it is hard to find a case that can be referred for any possible different approach needed for the patients who experience recurrence. Here we report a successful live birth with in vitro fertilization using letrozole to maintain physiological levels of estradiol, and subsequent thawed embryo transfer after elective cryopreservation of embryos in a patient with recurrent endometrial cancer. There has been no evidence of disease recurrence at one year after delivery.     

Vaginal cuff recurrence of endometrial cancer treated by laparoscopic-assisted vaginal hysterectomy

BACKGROUND: Laparoscopic-assisted vaginal hysterectomy (LAVH) has been suggested as an alternative to total abdominal hysterectomy (TAH) for the treatment of early endometrial cancer. Although studies have reported good results with equivalent rates of recurrence and survival, the need for use of intrauterine manipulators during the LAVH raises the concern for operative dissemination of tumor cells. CASES: We report three patients with stage I, noninvasive or superficially invasive endometrial cancer with vaginal cuff recurrence within 9 months of treatment by LAVH. CONCLUSION: While LAVH may be a technically acceptable alternative to TAH for the management of early-stage endometrial cancer, its routine use should be undertaken with caution, as the long-term risks for recurrence and survival have yet to be defined in a randomized, controlled fashion.     

Ⅱ期子宫内膜癌临床处理进展

Ⅱ期子宫内膜癌的发生率约占子宫内膜癌的12%,诊断Ⅱ期子宫内膜癌可将分段诊刮、宫腔镜检查及影像学相结合以提高分期诊断的准确性。目前对于Ⅱ期子宫内膜癌术式的选择存在争议,不同研究得出的结论不同,扩大切除范围降低复发率的同时也增加了术中和术后并发症,对此,需要仔细权衡,并需要更多的前瞻性研究进一步加以评估。术后放疗能够减少局部复发率,但对总生存率没有影响,其中阴道近距离放疗可能优于全盆腔放疗。对于合并高危因素者选择辅助化疗的生存率高于放射治疗。Ⅱ期子宫内膜癌的3年生存率为79%~85%。对Ⅱ期子宫内膜癌[2009年国际妇产科联盟(FIGO)分期]的临床特征、诊断方法、治疗及预后进行综述。     

子宫内膜损伤的病因与发病机制

创伤和感染是子宫内膜损伤的重要病因,子宫内膜损伤严重、深达子宫内膜基底层可引起子宫内膜修复障碍,表现为宫腔部分或全部闭塞的宫腔粘连（intrauterine adhesions,IUA）,导致月经量减少、闭经、复发性流产和不孕等。IUA分离术后易复发、高复发已成为临床瓶颈,因此针对其病因机制的防治问题亟待解决。文章阐述了子宫内膜损伤尤其是IUA的病因及发病机制的研究进展。     

DNA aneuploidy is associated with increased mortality for stage I endometrial cancer

OBJECTIVE: The current study was undertaken to determine if DNA ploidy is a useful prognostic variable for predicting recurrence in stage I endometrial cancer. For cancer of the endometrium, survival following recurrence may depend on a number of factors, including the pattern of recurrence and the response to second line treatment. Previous studies have demonstrated a worse survival for patients with DNA aneuploid tumors. It remains unclear, however, whether this is necessarily due to a higher risk of recurrence. This study was undertaken to assess DNA ploidy and risk of recurrence in patients with stage I endometrial cancer. METHODS: This is a retrospective study of surgically treated patients with stages IB and IC endometrial cancer treated from 1992 to 2000. All patients underwent definitive surgery, including staging lymphadenectomy. None of the patients received postoperative treatment. DNA ploidy was determined using flow cytometry and image analysis. Grade, lymph-vascular space invasion, stage (stage IB versus IC), and DNA ploidy were analyzed with regard to recurrence and survival. RESULTS: There were 100 patients with stages IB and IC endometrial cancer in this analysis. There were 17 recurrences (17%) and 10 patients that died of cancer (10%). Grade 3 and the presence of lymph-vascular space invasion were associated with increased risk of recurrence; DNA aneuploidy and stage were not. Grade, lymph-vascular space invasion, and DNA ploidy were associated with survival. These findings indicate that DNA aneuploidy does not increase the risk of disease recurrence but is associated with overall survival. CONCLUSION: Although the recurrence risk is not higher for patients with surgical stage I endometrial cancer and aneuploid tumors, overall mortality remains higher.     

A randomized prospective study of the use of endometrial ablation for prevention of recurrent endometrial polyps in breast cancer patients receiving tamoxifen

Objective: To assess the roles of endometrial ablation in prevention of recurrence of tamoxifen-associated endometrial polyps in breast cancer patients.Design: A randomized prospective study of tamoxifen-treated patients who underwent hysteroscopic removal of endometrial polyps with or without simultaneous resection of the endometrium.Materials and Methods: Twenty consecutive women (aged 43–61 years) undergoing hysteroscopic removal of tamoxifen-associated endometrial polyps were randomized via a computer-generated random table to undergo or not to undergo concomitant endometrial ablation. All patients had undergone endometrial sampling prior to the procedure. The patients were followed for at least 18 months (range 18–24 months). The follow-up included transvaginal ultrasonography every 6 months and hysteroscopy when endometrial irregularity was noted. The main outcome variable was recurrence of endometrial polyps while the occurrence of uterine bleeding was noted.Results: In the 10 study group women, who underwent endometrial ablation, only 1 patient had a 1 × 1 cm endometrial polyp diagnosed and removed during the follow-up period. Seven of the study women remained amenorrheic, and 3 experienced spotting a few days every month. In the control group, a recurrent endometrial polyp, necessitating hysteroscopic removal, was diagnosed postoperatively in 6 women (two-tailed Fisher’s Exact test; P < .06).Conclusion: Recurrence of endometrial polyps, one of the most common problems in breast cancer patients receiving long-term treatment with tamoxifen, can be significantly reduced by performing endometrial ablation at the time of hysteroscopic removal of the polyp. The possible risk of occult endometrial cancer is yet to be determined.