宫腔粘连术后留置玻璃酸钠联合大剂量雌激素预防再发粘连

目的:观察宫腔粘连(IUA)分解术后宫腔内放入玻璃酸钠联合大剂量雌激素口服预防再粘连的效果。方法:宫腔镜确诊为IUA患者272例,分为A组和B组,A组(n=103)行宫腔镜下IUA分离术及宫腔内节育器(IUD)放置术,术后口服大剂量雌激素及孕激素人工周期3个月;B组(n=169)在A组相同治疗的基础上加宫腔内留置玻璃酸钠;比较A组和B组的疗效。结果:中度粘连患者术后粘连再发率B组显著低于A组(P0.05);A、B组的治疗有效率分别为:轻度粘连100%、100%;中度粘连83.3%、94.6%;重度粘连68.2%、83.9%(P均0.05);轻、中度IUA的治愈率B组显著高于A组(P0.05)。结论:IUA分解术后宫腔内留置玻璃酸钠联合大剂量雌激素口服可提高预防再粘连的效果,特别对轻、中度IUA效果显著。     

复发性流产患者绒毛膜和蜕膜组织SOCS-3和LIF的表达

目的 探讨细胞因子信号转导抑制因子3(suppressor of cytokine signaling3,SOCS-3)和白血病抑制因子(leukemia inhibitory factor,LIF)在复发性流产(recurrent spontaneous abortion,RSA)患者绒毛膜和蜕膜组织中的表达情况,为RSA的早期识别和临床诊治提供一定理论依据.方法 随机抽取RSA患者45例作为观察组,选取同期在门诊行人工流产术的45例正常妊娠妇女作为对照组,采用Western blot法对所有患者绒毛膜和蜕膜组织中SOCS-3和LIF的表达水平进行检测.结果 观察组患者绒毛膜和蜕膜组织中的LIF相对表达量低于对照组(P<0.05),SOCS-3的相对表达量低于对照组(P<0.05).结论 较之于正常妊娠患者,RSA患者绒毛膜和蜕膜组织中SOCS-3和LIF的表达水平显著降低,可能反映出其宫体内妊娠状态时Th1/Th2的免疫耐受失衡、LIF的免疫保护作用减弱,进而引发的免疫损伤可能是导致RSA发病的原因之一.SOCS-3和LIF水平有望作为RSA患者识别的标志物之一.     

铜/低密度聚乙烯复合材料宫内节育器引起子宫异常出血与铜离子浓度和血管生成的相关性

BACKGROUND: To achieve excellent contraceptive effects, the copper wire on the copper-containing intrauterine device surface persistently releases copper ions, but ectopic intrauterine device, abnormal uterine bleeding, menostaxis and waist and abdominal pain are usually inevitable. OBJECTIVE: To investigate the correlation of abnormal uterine bleeding caused by copper/low-density polyethylene nanocomposite intrauterine device with copper ion concentration and expression of vascular endothelial growth factor in endometrial tissues. METHODS: Totally 60 female patients, aged from 25 to 40 years old, hospitalized for taking intrauterine devices were enrolled, and those patients were divided into abnormal uterine bleeding group (n=32) and non- bleeding group (n=28). In the meanwhile, another 20 women without intrauterine devices and with the normal menstrual cycle were selected as control group. Patients in the abnormal uterine bleeding group and non- bleeding group underwent the removal of intrauterine device and scraping endometrial tissues within 4-7 days after menstruation; patients in the control group underwent scraping endometrial tissues within 4-7 days after menstruation. The copper ion content in endometrial tissues was measured by atomic absorption method; expression of endometrial vascular endothelial growth factor detected by immunohistochemical staining and the microvessel density counted. Additionally, the corrosion ratio of copper ion in the simulated uterine fluid was detected using flame atomic absorption spectroscopy method. RESULTS AND CONCLUSION: The content and corrosion ratio of copper ion in the uterine abnormal bleeding group was significantly higher than those in the non-bleeding group (P < 0.05), and the copper ion content of no bleeding group was significantly higher than that of control group (P < 0.05). The amount of copper in the intrauterine device of abnormal uterine bleeding group was higher than that in non-bleeding group (P < 0.05). Compared with the control and non-bleeding groups, the vascular endothelial growth factor expression and microvessel density were significantly increased in the uterine abnormal bleeding group (P < 0.05); and the control group and non-bleeding group had no significant differences in the vascular endothelial growth factor expression and microvessel density. Furthermore, there was a positive correlation of the vascular endothelial growth factor expression with microvessel density and copper ion content. In conclusion, after implantation of copper/low-density polyethylene   nanocomposites intrauterine device, the higher copper ion concentration in endometrial tissues may lead to the over-expression of vascular endothelial growth factor that increases the endometrial microvessel density through a variety of ways, and promote microvessel expansion and congestion, finally resulting in abnormal uterine bleeding.     

FFA联合ICGA与传统分开造影不良反应的对比研究

Objective To study clinical effects of fundus fluoreseein angiography (FFA) combined with indocyanine green angiography (ICGA) compared to traditional separated exam.Methods Thirty patients in experiment group were undergone FFA combined with ICGA exams.The other 30 patients in tradition group were undergone ICGA exams a day after FFA exams by random.Complications of both groups were obsereved and studied.Results (1) One patient with nausea and vomit in experiment group was compared to one patient with nausea when FFA exam and one patient with nausea when ICGA exam in tradition group.There was no significant difference (P ＞ 0.05) in digestive complications between two groups.(2) There was no significant difference (P ＞0.05) in blood pressure,heart rate,blood oxygen saturation coefficient when exam between two groups.Conclusios FFA combined with ICGA is a safe and effective exam method.     

宫、腹腔镜联合手术对子宫内膜异位症合并子宫内膜息肉不孕患者妊娠结局的影响

目的探讨宫、腹腔镜联合手术对子宫内膜异位症(EMS)合并子宫内膜息肉(EP)不孕症患者的生殖预后及其相关影响因素。方法回顾性分析2014年1月—2014年12月期间接受宫、腹腔镜联合治疗的301例EMS合并不孕患者作为研究对象,按是否合并EP分为EP组和非EP组,EP组术后随访治疗效果,并与同期妊娠的96例正常孕产妇(对照组)的妊娠经过和围产结局进行比较,分析其可能相关影响因素。结果 301例EMS合并不孕患者的EP发生率为42.86%(129/301)。Ⅲ～Ⅳ期EMS患者EP发生率高于Ⅰ～Ⅱ期EMS患者(P=0.018)。EP在深部侵润型EMS的发生率(53.13%)明显高于卵巢型(36.36%)(P=0.014)和腹膜型(42.54%)(P=0.003)。EP组的胚胎停育率(4.65%)高于非EP组(2.91%),差异有统计学意义(P=0.028);而自然妊娠率、临床妊娠率与非EP组相比差异无统计学意义。Ⅰ～Ⅱ期患者术后的自然妊娠率(48.15%)、临床妊娠率(43.21%)均高于Ⅲ～Ⅳ期患者(31.25%,27.08%),差异有统计学意义(P=0.002,P=0.017)。EMS合并EP组宫、腹腔镜术后,孕期并发症发生率及围产儿死亡率与对照组比较,差异无统计学意义(P0.05),但剖宫产率显著高于对照组,差异有统计学意义(P=0.012)。结论 EP在EMS合并不孕患者中的发生率明显升高。EMS合并EP不孕症患者应尽早接受宫、腹腔镜手术治疗,以提高术后自然妊娠率。宫、腹腔镜联合手术可明显改善EMS合并EP不孕患者的生殖预后,不增加孕期并发症,不影响围产儿结局。     

宫腔镜治疗子宫纵隔52例分析

目的探讨宫腔镜下子宫纵隔切开术治疗效果。方法对52例子宫纵隔患者行宫腔镜下子宫纵隔切开术。结果手术颇利，无并发症发生。自然流产率由术前的91．95％下降至术后的31．82％，分娩率由术前的3．45％上升至术后的54．55％。术后使用宫内节育器＋人工周期与术后无任何措施者，两者的自然流产率厦分娩率无差别。结论宫腔镜下子宫纵隔切开术治疗子宫纵隔安全，可靠，疗效佳。     

门诊药物流产健康宣教方法探讨

目的：探讨不同的宣教方法在门诊药流健康教育的效果。方法：将195例门诊药流患者随机分为三组,分别用三种不同的方法进行相关的健康知识宣教,对其接受效果及相关因素进行比较分析。结果：阅读材料组与口授组效果无明显差异,阅读口授结合组与前两组比较结果均有显著性差异。婚姻状况不影响宣教效果,文化程度高的阅读效果好。结论：根据健康教育的内容结合患者的文化程度,采取相应的宣教方式可以达到较好的效果。     

腹腔镜卵巢楔切治疗难治性多囊卵巢综合征不孕的临床观察

目的:探讨腹腔镜卵巢楔切治疗难治性多囊卵巢综合征引起不孕的疗效。方法:在腹腔镜下行卵巢楔切或加打孔术治疗51例难治性多囊卵巢综合征患者,术后观察月经恢复及妊娠情况。结果:术后排卵率67.4%,累积妊娠率63.9%,流产率2.8%,异位妊娠率2.8%,多胎妊娠率2.8%。结论:腹腔镜手术是治疗难治性多囊卵巢综合征不孕的简单、疗效肯定的好方法,应在最佳妊娠时间内积极治疗。     

米非司酮治疗子宫肌瘤的临床观察

子宫肌瘤是育龄妇女最常见的良性肿瘤。它的病因和发病机制尚不清楚。传统认为雌性激素是子宫肌瘤发病的重要因素。近年来研究发现 ,孕激素在子宫肌瘤的发病中起重要作用。我们应用孕激素拮抗剂米非司酮治疗子宫肌瘤 ,观察其疗效。1　资料与方法1 .1临床资料　自愿要求用米非司酮治疗子宫肌瘤患者 30例 ,年龄 2 8～ 54y,平均 41 .3y。其中月经量增多者 7例 ,下腹痛者 7例。无肝、肾疾患 ,无明显贫血。1 .2药品　米非司酮 (北京第三制药厂 ,批号970 71 0。规格 2 5mg/片 )。在月经周期 d 1～ 5开始连续服用米非司酮 2 5mg/d,共服 3mo。1 .3方…     

FFA联合ICGA与传统分开造影不良反应的对比研究

目的 探讨荧光素眼底造影(FFA)联合吲哚箐绿血管造影(ICGA)与传统分开造影不良反应的发生率.方法 随机选择60例有指征行眼底造影检查的患者,实验组30例行FFA+ICGA联合造影,对照组30例行FFA+ICGA传统分开造影,观察各组不良反应的发生情况.结果 (1)实验组(联合造影组)1例出现恶心、呕吐,对照组行FFA时1例出现一过性心慌、恶心,行ICGA时1例出现恶心.两组患者不良反应发生率无显著性差异(P＞0.05).(2)两组患者注射造影剂前、中、后的血压、心率、血氧饱和度无显著性差异(P＞0.05).结论 FFA联合ICGA检查能提高眼底病的诊断效率,降低医疗成本,减轻患者两次造影的风险及痛苦,是安全可行的.