Initial experience with carbon dioxide laser laparoscopy

Adhesions and endometriosis are commonly encountered among patients presenting with pelvic or lower abdominal pain and also in a significant proportion of infertile patients. Laparoscopic investigation is usual in patients with these problems, and it has been possible to perform endoscopic surgery with special scissors and electrodiathermy. These methods can cause troublesome bleeding, and the diathermy produces high temperatures which can be hazardous if used in the vicinity of the bowel. The carbon dioxide laser can be used endoscopically to vaporize deposits of endometriosis and adhesions with great precision and virtually no bleeding. One hundred consecutive patients with endometriosis or adhesions were treated with the CO₂ laser laparoscope and followed up for at least a year. Seventy-five per cent of patients with pain due to endometriosis were cured, and 68% of patients were better after laser laparoscopic adhesiolysis. Pregnancy rate in the previously infertile group with endometriosis was 64%. There were no complications due to the intra-abdominal use of CO₂ laser energy under endoscopic control, although there is a need for a controlled trial. It appears that in the hands of an experienced laparoscopist this technique is safe and effective.     

3-氯丙二醇及2,3-氧丙醇合并给药对大鼠附睾、肝、肾超微结构的影响

以每日5mg/kg的3-氯丙二醇及75mg/kg的2,3-氧丙醇同时给大鼠灌胃,连续给药2天后停药8天,共10天为一疗程。观察了3,6,9疗程结束时,附睾起始部主细胞的超微结构改变,及附睾管起始部的精子和肝脏、肾脏的超微结构。发现在3、6疗程末,附睾主细胞的高尔基复合体扁平囊变窄,大泡皱缩。在6疗程末,细胞表面的吞饮小泡和静纤毛减少。仅在3疗程见到粗面内质网扩张。9疗程的超微结构与对照比较无明显区别。结果提示,每一疗程药物引起的附睾主细胞超微结构的改变,在多数动物是可恢复的。但由于个体差异,部分动物于疗程之末,尚未完全恢复。在第6疗程末的肝脏,有部分肝细胞滑面内质网扩张,线粒体体积缩小,基质电子密度增高。这些变化可能是一种轻度的细胞损伤,这种损伤在3,9疗程均未发现,说明它与疗程长短不呈平行关系。肾尿细管上皮细胞及附睾起始部精子的超微结构,无可见改变。这一结果为阐明3-氯丙二醇及2,3-氧丙醇合并用药的抗生育作用,及对有关内脏的毒性作用,提供了形态学的依据。     

Effects on Fertility of Rabbits After Active Immunization With Rat Testicular Cytochrome ct

ABSTRACT: A Male rabbit was immunized with rat testicular cytochrome (Cyt) c_t and mated with normal, unimmunized females. The matings resulted in abnormal pregnancies: no offspring or stillborn or undersized liveborn offspring weighing 25–30 gm each. Another unusual observation was that fur-pulling behavior, normally exhibited by pregnant female rabbits at the end of the gestational period, was absent in all of these pregnancies. Therefore, immunization of a normal rabbit with testicular cyt c_t appeared to interfere with physiological and behavioral aspects of pregnancy in normal female rabbits. The immunological basis of these findings remains to be determined.     

不孕及反复流产患者血清抗心磷脂抗体的检测

目的检测不孕及反复流产患者血清中的抗心磷脂抗体(ACA),探讨ACA的临床意义.方法应用酶联免疫吸附(ELISA)法检测105例原发或继发不孕患者(不孕组)、171例反复流产或有胚胎停育史患者(流产组)及40例正常对照组血清中的IgG、IgM及IgA-ACA 3种抗体.结果不孕组ACA总阳性率为44.76%,流产组为35.09%,均显著高于对照组(P＜0,01).不孕组及流产组的单纯IgG阳性率亦明显高于对照组(P＜0.05);而两组的单纯IgM阳性率与对照组相比,差异均无显著性意义(P＞0.05).结论ACA是导致不孕及反复流产的免疫学因素之一,IgG型的ACA比IgM型的更具临床意义     

The impact of hormonal therapy for infertility on the age at menopause

Objectives: To look for possible association between past history of ovulation induction and age at menopause. Design: Women attending our postmenopausal outpatient clinic were asked to fill questionnaires with demographic data, obstetrical history (including treatment for infertility), and medical details related to menopause. Patients: The study group (n=31) consisted of women with a history of ovulation induction, and a control group (n=200) included women who did not experience such intervention. Results: The age at the final menstrual bleeding was 46.4±5 in the study group, and 50±4 for the control group (P<0.001). This difference was most prominent for women who had induction of ovulation prior to age 35 years: they entered menopause at age 43.8±5 years. Smoking had a weak effect on the age at menopause (48.5±4 for current, vs. 49.9±4 for non- or past-smokers; P<0.03). Conclusions: This retrospective and preliminary study raises the question whether hormonal manipulations and ovarian over-stimulation during fertility treatments could be a risk factor for premature menopause.     

低分子肝素钙抗凝对多囊卵巢综合征所致不孕症患者来曲唑诱导排卵疗效的影响

目的分析低分子肝素钙抗凝对多囊卵巢综合征(PCOS)所致不孕症患者来曲唑诱导排卵疗效的影响。方法选取2014年1月—2019年1月九江市第三人民医院和彭泽县妇幼保健院收治的156例PCOS所致不孕症患者,采用随机数字表分成两组,每组78例。对照组口服来曲唑治疗,观察组采取口服来曲唑联合低分子肝素钙注射液治疗。比较两组的疗效、子宫内膜容受性、凝血功能指标、促排卵结局及不良反应。结果观察组总有效率[94.87%(74/78)]显著高于对照组[80.77%(63/78)],差异有统计学意义(χ²=7.252,P=0.007)。治疗后,观察组子宫内膜厚度、子宫动脉搏动指数(PI)及阻力指数(RI)分别为(9.75±1.03)mm、(1.30±0.26)及(0.58±0.12),对照组子宫内膜厚度、PI及RI分别为(7.48±0.95)mm、(1.71±0.33)及(0.66±0.11),两组比较差异均有统计学意义(t=14.308,8.619,4.340,均P<0.05)。治疗后,两组凝血功能指标比较差异均有统计学意义(均P<0.05)。观察组妊娠率[52.56%(41/78)]显著高于对照组[32.05%(25/78)],自然流产率[2.44%(1/41)]显著低于对照组[16.00%(4/25)],差异均有统计学意义(均P<0.05)。观察组不良反应发生率[16.67%(13/78)]与对照组[12.82%(10/78)]比较差异无统计学意义(χ²=0.459,P=0.498)。结论PCOS所致不孕症患者在应用来曲唑诱导排卵的同时联合低分子肝素钙抗凝治疗能有效改善患者的凝血-纤溶状态,明显提高患者的子宫内膜容受性,改善促排卵结局。     

北京市和长治市三级妇幼专科医院女性不孕症患者病因的对比分析

目的调查分析北京市和长治市三级妇幼专科医院女性不孕症患者的病因和特点,为不同级别城市的妇幼医疗保健机构开展更有针对性的不孕症诊治提供参考依据。方法选取2019年3~6月在首都医科大学附属北京妇产医院生殖医学科(A组,3652例)和长治医学院附属长治市妇幼保健院妇科(B组,196例)就诊的不孕不育夫妇为调查对象,比较两组女性患者的一般情况、不孕症的病因构成及男女方不孕不育病因特点等。结果A组女性患者的平均年龄和不孕年限显著高于B组(P<0.05)。不孕病因上,A组女性患者由盆腔因素和男方因素引起不孕的比例显著高于B组(分别为32.12%vs.13.27%和51.23%vs.21.94%,P<0.05);排卵障碍引起不孕的比例显著低于B组(42.61%vs.77.55%,P<0.05)。两组女性患者均以卵巢性闭经或月经失调引起的不孕症为首位,A组显著低于B组(70.24%vs.80.92%,P<0.05)。男方因素中两组患者均以弱精子症占首位,且A组显著高于B组(98.24%vs.90.70%,P<0.05)。A组患者由2个病因引起不孕的比例显著高于B组(P<0.05)。A组患者由男方因素及男女双方因素引起不孕的比例均显著高于B组(P<0.05)。结论北京市和长治市三级妇幼专科医院的不孕症病因构成有显著差异,应在现有优势医疗资源的情况下,分别开展有侧重、有针对性的诊治。     

子宫内膜异位症不孕患者血清泌乳素水平分析

目的:探讨子宫内膜异位症不孕患者与非子宫内膜异位症不孕患者血清卵泡刺激素、黄体生成素、雌二醇、睾酮、促甲状腺激素及泌乳素的差异。方法:选取2015~2016年907例子宫内膜异位症不孕患者(观察组),与1579例非子宫内膜异位症的不孕患者(对照组),对比分析两组患者激素水平。结果:两组卵泡刺激素、黄体生成素、雌二醇、睾酮、促甲状腺激素水平差异无统计学意义。观察组泌乳素水平[(17.8±8.8)ng/mL vs.(16.8±8.2)ng/mL]高于对照组,差异有统计学意义(P=0.005)。子宫内膜异位症卵巢型患者血清泌乳素水平为(17.1±7.1)ng/mL,腹膜型为(18.9±11.0)ng/mL,腹膜型高于卵巢型,差异有统计学意义(P=0.009)。结论:子宫内膜异位症不孕患者泌乳素水平升高,针对泌乳素的机制研究与干预可能有助于了解不孕症的发生机制、提高临床诊治效果。     

卵巢子宫内膜异位症相关不孕年轻女性患者术后应用GnRH-a对自然受孕率的影响

目的观察腹腔镜手术后应用促性腺激素释放激素激动剂(Gn RH-a)对卵巢子宫内膜异位症(OEM)相关不孕的治疗效果,为临床应用提供依据。方法回顾性分析2013年1月-2017年12月于盘锦市中心医院接受保守性腹腔镜手术治疗的83例OEM伴不孕患者的临床资料。其中,37例患者单纯接受手术治疗,记为对照组;46例患者术后接受Gn RH-a治疗,记为观察组。对比两组月经周期与月经量恢复正常的时间、盆腔痛与痛经的视觉模拟评分法(VAS)评分、性激素[黄体生成素(LH)、雌二醇(E2)、卵泡刺激素(FSH)]水平、自然受孕率,并分析观察组给药期间的不良反应发生率。结果观察组月经周期与月经量的恢复时间均短于对照组,差异有统计学意义(P<0.05);治疗后,观察组盆腔痛、痛经的VAS评分低于对照组,差异有统计学意义(P<0.05);治疗后,观察组LH、E2、FSH水平低于对照组,差异有统计学意义(P<0.05);给药期间,观察组不良反应发生率为8.70%;随访期间,观察组自然受孕率高于对照组,差异有统计学意义(P<0.05)。结论腹腔镜手术后应用Gn RH-a对OEM相关不孕的治疗效果确切,可促进患者月经恢复正常,改善盆腔痛、痛经症状与性激素水平,提高患者自然受孕率,且安全性较高。