子宫肌瘤430例临床分析

目的:探讨子宫肌瘤治疗的方式选择.方法:对430例子宫肌瘤患者的症状进行分析,并对手术的412例手术方式进行讨论.结果:430例患者中,有临床症状者315例,占73.25%,无临床症状者115例,占26.75%.手术方式以全子宫切除为主,占84.30%.结论:子宫肌瘤患者中有一部分无临床症状,定期体检是早期发现和早期诊断的主要方法.手术方式需根据患者年龄,有无生育要求决定,尽量保留卵巢功能.     

Antimicrobial mesh versus vaginal wall sling: a comparative outcomes analysis

PURPOSE: We prospectively compared transvaginal antimicrobial mesh (MycroMesh*) and anterior vaginal wall slings using an outcomes analysis. MATERIALS AND METHODS: Between August 1997 and November 1998 we implanted transvaginal slings in 40 consecutive women randomized to a synthetic mesh (20) or vaginal wall (20) group. All patients had documented stress urinary incontinence on preoperative urodynamics. We prospectively compared postoperative outcomes data obtained from pelvic examinations, cough stress test, cotton swab test and validated patient questionnaires using a visual analog scale. RESULTS: Complete followup was available in all patients. Mean followup was 22 months (range 12 to 27). Stress incontinence was cured in 95% of the mesh and 70% of the vaginal wall group, and pelvic prolapse was cured in 100% and 95%, respectively. Transient de novo urge incontinence was noted in 12.5% of the mesh and 14.3% of the vaginal wall group. Mean postoperative cotton swab angle during Valsalva's maneuver was 20 and 45 degrees for the mesh and vaginal wall groups, respectively. The incidence of urinary retention and tissue erosion was 0% for both groups. The satisfaction rate was 100% and 80% for the mesh and vaginal wall groups, respectively. CONCLUSIONS: The antimicrobial MycroMesh sling was superior to the vaginal wall sling for correction of stress incontinence and pelvic prolapse with comparatively low morbidity.     

经导管子宫动脉注药治疗子宫疤痕异位妊娠的临床分析

目的 探讨子宫疤痕异位妊娠的最佳治疗方法。方法 12例子宫疤痕异位妊娠首先行导管双侧子宫动脉注入二氢叶酸还原酶抑制剂（MTX）和明胶海绵条栓塞术后，在超声监视下再行清除胚胎（清官）术。结果 12例子宫疤痕异位妊娠均一次性彻底清除妊娠胚胎组织，出血极少，无1例发生子宫穿孔或术中、术后大出血，术后月经恢复正常。结论 子宫疤痕异位妊娠首先行经导管双侧子宫动脉注药加柽塞术后再行清官术，是避免清官术中发生大出血而切除子宫的有效方法，更是一种安全可靠方法。     

用计算机对子宫收缩传感器性能指标测量的研究

研究怎样用计算机自动测量子宫收缩传感器的性能指标。由信号放大器、数字电压表、数据采集器、计算机等组成测量系统。计算机对传感器数据进行自动处理后,给出了相应的性能指标、数据曲线和拟合曲线。     

Global endometrial ablation: a modern day solution to an age-old problem.

Menorrhagia remains a significant health issue for women worldwide. Traditionally hysterectomy has been the treatment of choice when excessive menstrual bleeding remains unresolved by hormonal manipulation. In an attempt to provide a less invasive alternative to hysterectomy, traditional techniques such as rollerball endometrial ablation were developed 20 years ago. Although extremely effective, they possessed the potential of significant intra-operative risks and their success depended on high technical proficiency of the surgeon. As surgery and technology evolved, second generation endometrial ablation devices were developed which demonstrated improved safety and efficacy rates that paralleled traditional treatments. Since 1997, the Food and Drug Administration (FDA) has approved five such devices for use in the United States. Each possesses a unique technology profile with supporting level I evidence that allows for the treatment of a wide variety of uterine anatomy.     

Uterine tumor resembling ovarian sex cord tumors in a patient using tamoxifen: report of a case and review of literature

Increasing number of uterine malignancies have been reported in breast cancer patients using tamoxifen. Most of these are endometrial adenocarcinomas. However, only a few cases of endometrial stromal sarcomas have been reported to be linked with tamoxifen usage. A 58-year-old postmenopausal women who had been using tamoxifen for 4 years after a surgery for breast cancer is presented with chronic pelvic pain. Preoperative investigations were indicative of a uterine myoma so that a standard total abdominal hysterectomy and bilateral salpingo-oophorectomy were performed. Postoperative histologic diagnosis was a uterine tumor resembling ovarian sex cord tumors, which is an exceedingly rare entity itself. The present case is the first designated diagnosis of this rare tumor, with a possible association of tamoxifen usage.     

青春期子宫出血54例临床分析

目的 探讨青春期子宫出血的病因、诊断和治疗方法。方法 对1990-01-2004-05中山大学附属第二医院54例青春期子宫出血病例进行回顾性分析。结果 54例青春期子宫出血患者，功能失调性子宫出血（功血）共34例占63．0％，血液系统疾病14例占25．9％，生殖道器质性病变3例占5．6％，其他疾病3例占5．6％。54例均经超声检查，9例有异常发现者再接受宫腔镜检查，3例发现器质性病变。功血患者经性激素治疗均达止血效果。结论 青春期子宫出血的病因以功血为多，但需排除其他疾病。超声结合诊断性刮宫和宫腔镜检查，是有力的诊断手段。     

Uterine metastasis from hepatocellular carcinoma: a case report

The extrahepatic spread of hepatocellular carcinoma (HCC) is uncommon. Moreover, metastatic uterine tumor from extragenital primaries is rare. We report a 63-year-old woman with uterine metastasis from HCC. She had undergone transcatheter arterial embolization four times and surgery for HCC from 2-4 years before. This time, she underwent resection of a newborn, head-sized uterine tumor that was proven to be metastasis from HCC. This is the first described case of metastatic uterine tumor originated from HCC.     

Levonorgestrel-releasing intrauterine system vs. transcervical endometrial resection for dysfunctional uterine bleeding.

OBJECTIVE: To compare the acceptability, efficacy, adverse effects, and user satisfaction of a levonorgestrel intrauterine system (LNG-IUS) and transcervical resection of the endometrium (TCRE) for the treatment of dysfunctional uterine bleeding. METHOD: Of 50 women with a pictoral blood loss assessment chart (PBAC) score of 100 or greater, 25 had a LNG-IUS inserted (Mirena; Schering, Berlin, Germany) and 25 underwent TCRE. Procedure-related complications, PBAC score, hemoglobin levels, adverse effects, and rates of acceptability and satisfaction were recorded at 3-month intervals for a period of 12 months. RESULTS: At the end of 1 year there were a 97% and a 94% reduction in menstrual blood loss in the LNG-IUS and TCRE groups, respectively, and hemoglobin concentration had increased by 5.5% in the LNG-IUS group and 5.2% in the TCRE group. Adverse effects were similar in both groups except for systemic effects, which were seen only in the LNG-IUS group. Satisfaction rates were about 80% in the 2 groups. CONCLUSION: Both treatments were found to be equally effective but LNG-IUS placement requires less operator skill and entails no operative hazards, and the device provides effective contraception.     

Role of lymphadenectomy and pelvic radiotherapy in patients with clinical FIGO stage I endometrial adenocarcinoma: an analysis of 208 patients

Two hundred and eight patients with a clinical stage I endometrial carcinoma were studied (164 fulfilled the inclusion criteria). High risk was defined as nonendometrioid, or endometrioid tumors grade 3 (G3), or G2 with any or G1 with deep (>1/2) myometrial infiltration. The low-risk group consisted of the remaining patients. Surgical staging in the high-risk group included pelvic lymphadenectomy with para-aortic lymphadenectomy in selected cases. Twelve percent of the high-risk patients had nodal metastasis. Patients with low-risk (group A, n = 85) and high-risk disease confined to the uterus (group B, n = 57) did not receive adjuvant radiotherapy. Patients with nodal metastases (group C, n = 10) received postoperative irradiation. The total recurrence rate of the entire population was 12.5%, and the actuarial overall survival, disease-specific survival, and disease-free survival were 90%, 94%, and 88%, respectively. All patients with only vaginal relapse (n = 9) were cured locally with salvage radiotherapy until the date of analysis. The pelvic relapse rate was low as only one patient of group B recurred in the pelvis. In conclusion, lymphadenectomy remains indicated to better select patients at high risk of pelvic recurrence that may benefit from postoperative radiotherapy.