膀胱子宫内膜异位症四例临床分析

子宫内膜异位症(内异症)是具有生长功能的子宫内膜组织，异位到子宫腔以外的病变。常见的病变部位包括卵巢、宫骶韧带、子宫直肠窝、盆腔腹膜、输卵管和宫颈，但病变部位为膀胱者却很少见。本文总结了我院1999～2002年收治的4例膀胱内异症患者的临床资料，现报道如下。     

重度陈旧会阴裂伤修补手术27例分析

目的 :阐述重度陈旧会阴裂伤的临床特点 ,评价修补手术的方法及疗效。方法 :对 2 7例会阴陈旧性撕裂患者手术前后的症状、体征、手术方式、手术前准备和手术后处理的临床资料进行回顾性分析。结果 :大便失禁为主要症状 ,规范的会阴修补术可达到 96 %的治愈率。手术并发症主要为肛门阴道瘘 ,发生率为 7.4 %。结论 :重视修补术前后的处理及明确肛门括约肌的解剖位置是修补成功的关键。用吻合法进行修补 ,手术简便、并发症少 ,近期疗效好     

子宫腺肌病的手术治疗

子宫腺肌病是指子宫肌层内存在子宫内膜腺体和间质,在激素的影响下发生出血、肌纤维结缔组织增生,形成弥漫病变或者局限性病变(子宫腺肌瘤)。子宫腺肌病好发于30~50岁的妇女,发病率从8.8%~31%不等[1]。痛经和月经量过多为主要表现。对药物无效的患者,可选择手术治疗。手术治疗包括根治手术和保守手术。根治性手术即为子宫切除术,保守手术包括腺肌病病灶(腺肌瘤)切除术、子宫内膜及肌层切除术、腹腔镜下子宫肌层电凝术等。由于子宫腺肌病病变广泛且与正常肌层无明显界限,保守性手术一般难以切净或者消除病灶,失败率或者复发率高。手术方式的…     

子宫内膜异位症患者血清骨桥蛋白抗体及转铁蛋白抗体水平分析

目的:探讨血清中骨桥蛋白抗体和转铁蛋白抗体与子宫内膜异位症的关系。方法:用酶联免疫吸附试验方法检测108例子宫内膜异位症患者及88例健康妇女血清中骨桥蛋白抗体及转铁蛋白抗体水平。结果:子宫内膜异位症患者血清中骨桥蛋白抗体OD值为0.84±0.25,对照组为0.63±0.20;转铁蛋白抗体OD值为1.06±0.31,对照组为0.75±0.27,子宫内膜异位症组均明显高于对照组(均P<0.05)。子宫内膜异位症Ⅰ、Ⅱ期患者血清骨桥蛋白抗体OD值(1.04±0.30)明显高于Ⅲ、Ⅳ期患者(0.68±0.20)及对照组妇女(0.63±0.20)(均P<0.05)。子宫内膜异位症组转铁蛋白抗体阳性率为25.0%(27/108),骨桥蛋白抗体阳性率为20.3%(22/108),两者均阳性占13.9%(15/108),与对照组相比差异有统计学意义(P<0.05)。相关分析发现子宫内膜异位症患者血清中转铁蛋白抗体水平与骨桥蛋白抗体水平呈正相关(r=0.875,P<0.05)。结论:抗骨桥蛋白抗体可能与子宫内膜异位症的发展有关。     

子宫腺肌病病灶切除术后子宫瘢痕妊娠一例

本文报道1例子宫腺肌病病灶切除术后子宫瘢痕妊娠患者的诊治经过,并复习相关文献,探讨子宫腺肌病病灶切除术后的妊娠并发症及术后子宫瘢痕妊娠的诊治方法。患者35岁,孕2产0,子宫腺肌病病灶切除术后3年,停经66 d,间断阴道流血20余天,血β-hCG水平升高,影像学检查提示子宫底壁肌层瘢痕周围囊性灶,考虑异位妊娠,予甲氨蝶呤...     

子宫膀胱瘘的病因、诊断及治疗方法：6例病例报告及文献复习

目的 探讨子宫膀胱瘘(VUF)发生的病因、诊断和治疗方法。方法 回顾性分析北京协和医院2000年1月至2021年7月收治的6例VUF患者的临床资料,并通过检索近20年的中英文文献筛选出276例病例,对这282例患者的临床资料进行汇总分析,同时进行文献复习。结果 282例患者中,VUF发生最主要的病因是子宫下段剖宫产,占87.23%;其最常见、最具特征的临床症状是周期性血尿,占61.61%。VUF常用的影像学诊断方法包括超声、膀胱镜、磁共振成像(MRI)、宫腔造影、膀胱造影和CT尿路造影(CTU)等,其中MRI对发现VUF有独特的诊断价值。97.15%的VUF患者通过手术修补瘘口,术后愈合良好。结论 VUF常为医源性疾病,多继发于剖宫产术后,术中仔细解剖有助于预防VUF发生。MRI是识别异常窦道的有效手段,单纯膀胱镜检查存在误诊或漏诊的风险。手术修补是根本的治疗方式,整体预后较好。     

子宫内膜异位症患者生育力保护的中国专家共识(2022版)

子宫内膜异位症(内异症)是育龄期妇女的常见疾病之一, 常导致患者生殖功能及卵巢储备功能降低, 因此, 在内异症诊治中应注意保护患者的生育力, 改善生殖功能。依据患者年龄、内异症病变范围、内异症生育指数、卵巢储备功能及患者意愿等因素综合制定治疗策略;术前做好评估, 术后积极备孕或辅助生殖技术;对于无生育需求者, 通过药物治疗改善症状, 控制病情进展, 做好长期管理。对于一些病情严重或复发的内异症患者, 可在术前进行生育力保存。     

卵巢子宫内膜异位囊肿粘连程度及相关因素分析

Objective To investigate the relationship between degree of endometrioma adhesions and clinical feature, surgical treatment and postoperative recurrence. Methods From Jan 2003 to Mar 2008, 662 patients with endometrioma undergoing laparoscopic ovarian endometrioma excision in Peking Union Medical College Hospital were studied retrospectively. All patients were classified into four groups according to the extent of adhesions: 31 cases in none adhesions group, 123 cases in mild adhesions group (filmy thickness, avascular, easily separated adhesions), 310 cases in moderate adhesions group (less than a half of ovary was adjacent to dense thickness adhesions which was difficult to separate, or above a half of ovary were adjacent to filmy thickness adhesions) and 198 cases in severe adhesions group (above a half of ovary was adjacent to dense thickness, well vascularized adhesions which was difficult to separate, and always involved the other pelvic organs, observed angiogenesis). The comparison of degree, characteristics, period of pain, lab test, surgical management and postoperative recurrence was performed among those above groups. In the mean time, risk factors and multinomial logistic regression were analyzed. Results (1)Clinical characteristics: The incidence of patients with dysmenorrhea, dyspareunia, straining feeling in anus, chronic pelvic pain and the level of CA125 (>35 kU/L) was remarkably higher in moderate-to-severe adhesion groups than in none-to-mild adhesions groups (P=0.000, 0.000, 0.001, 0.006 and 0.000, respectively). Infertility rate were significantly higher in severe adhesions group(15.7%,31/198) than none adhesions group(3.2%,1/31), mild adhesions group(11.4%,14/123) and moderate adhesions group(9.7%,30/310, OR=1.728, P<0.05).(2)Operating time and blood loss: Operating time of each groups was as followed: (37±15) min in none adhesions group, (42±19) min in mild adhesions group, (50±20) min in moderate adhesions group and (63±22) min in severe adhesion group. Blood loss was (23±12) ml in none adhesion group, (31±27) ml in mild adhesion group, (40±32) ml in moderate adhesion group and (70±67) ml in severe adhesions group. Thicker adhesions result in longer operation time and more blood loss. (3)Combined with other disease: The ratio of patients who combined with adenomyosis or deeply infiltrating endometriosis in moderate-to-severer adhesion groups was higher than patients in none-to-mild adhesions groups (OR=3.466, P=0.000). (4) Postoperative recurrence: It was categorized into recurrence of pain and cyst. Moderate-to-severe adhesions was related to higher recurrence rate of pain (OR=1.685,P=0.046), but was irrelevant to recurrence of cyst. Conclusion The more extent of endometrioma adhesions was related to severer pelvic pain symptoms, longer operating time and more blood loss. Postoperative pain recurrence rate was observed in moderate-to-severe adhesion group. Extent of adhesions was irrelevant to cyst recurrence.