子宫动脉栓塞术用于妊娠滋养细胞肿瘤治疗疗效研究

目的：深入探究子宫动脉栓塞术在治疗妊娠滋养细胞肿瘤方面的临床疗效。方法随机选取2013年1月至2015年3月在我院妇产科接受治疗的180例妊娠滋养细胞肿瘤患者,按治疗手段的不同将其均分为对照组与观察组。对照组采用常规妊娠滋养细胞肿瘤剔除术进行治疗,观察组患者则采用子宫动脉栓塞术进行治疗。对比分析两组不同治疗手段对妊娠滋养细胞肿瘤患者的临床疗效。结果采用子宫动脉栓塞术治疗的观察组仅3例无效,总有效率达93.33%;而采取常规妊娠滋养细胞肿瘤剔除术的对照组无效人数达26例,其总有效率仅为71.11%,两种治疗手段差异有统计学意义（P＜0.05）。同时,对照组患者共计26例患者出现低热、肠胃不适以及子宫穿孔等不良反应,不良反应率达28.89%,观察组患者仅5例患者出现肠胃不适和低热的不良反应,不良反应率为5.56%,两组对比,P＜0.05。而在手术时间、术中出血量、下床时间、出院时间等指标方面,两组比较差异无统计学意义,P＞0.05。结论在妊娠滋养细胞肿瘤治疗上采用子宫动脉栓塞术进行治疗不仅疗效显著,而且不良反应少,值得重视。     

Robotic-assisted vs. laparoscopic and abdominal myomectomy for treatment of uterine fibroids: a meta-analysis

Uterine fibroids are extremely common uterine neoplasms. However, whether robotic-assisted laparoscopic myomectomy (RALM) is superior to laparoscopic myomectomy (LM) or abdominal myomectomy (AM) is still debatable. Consequently, we aimed to compare the three currently major surgical techniques used in patients with uterine fibroids. We searched the PubMed, the Cochrane Library, MEDLINE, Embase, and Web of Science databases up to April 22, 2017. The meta-analysis included 20 studies involving 2852 patients. The number of complications [odd ratio (OR) 0.52, p?=?0.009], estimated blood loss (EBL) [weighted mean difference (WMD) ?33.03, p?=?0.02], conversions (OR 0.34, p?=?0.03), and postoperative bleeding (OR 0.18, p?=?0.03) in RALM cases was significantly less than that for LM. The numbers of complications (OR 0.56, p?=?0.03), length of hospital stay (WMD ?1.74, p?p?p?p?相似文献   

阴道超声在腹腔镜子宫肌瘤剔除术中对减少肌瘤残留及降低肌瘤复发的价值*

目的探究分析阴道超声应用于腹腔镜子宫肌瘤剔除术中对于减少肌瘤残留及降低肌瘤复发的运用价值。方法选择该院收治的120名进行了腹腔镜子宫肌瘤剔除术的患者,根据患者的入院时间随机分为观察组和对照组,两组患者都在腹腔镜下进行手术,观察组在手术时配合使用阴道超声,继续剔除残存的子宫肌瘤,术后对两组患者进行12个月的随访。记录两组患者在手术中的各项指标、术后肌瘤残存的情况以及术后12个月肌瘤的复发情况等数据。结果观察组的治疗时间、术中出血量、术后排气时间和住院时间与对照组相比,差异无统计学意义(P0.05)。观察组共出现1例血肿、1例输尿管损伤、2例膀胱损伤和1例直肠损伤;对照组共出现1例血肿、1例膀胱损伤、2例切口感染和2例直肠损伤。比较两组的术中并发症发生率,差异无统计学意义(P0.05)。观察组的肌瘤平均直径明显小于对照组,差异有统计学意义(P0.05)。观察组仅4例患者出现肌瘤残存明显小于对照组患者出现的21例,差异有统计学意义(P0.05)。观察组患者在术后9和12个月的时候各出现了1例复发情况,而对照组在术后3、6、9和12个月分别出现了1、2、5和7例复发,观察组患者出现病情复发的情况明显少于对照组,差异有统计学意义(P0.05)。结论使用阴道超声对接受腹腔镜子宫肌瘤剔除术的患者中引导剔除残存的肌瘤,能明显减少肌瘤的残留,值得在临床上推广。     

Clinicopathologic Analysis of Pituitary Adenoma: A Single Institute Experience

Pituitary adenoma (PA) is a common benign neuroendocrine tumor; however, the incidence and proportion of hormone-producing PAs in Korean patients remain unknown. Authors analyzed 506 surgically resected and pathologically proven pituitary lesions of the Seoul National University Hospital from 2006 to 2011. The lesions were categorized as: PAs (n = 422, 83.4%), Rathke''s cleft cysts (RCCs) (n = 54, 10.6%), inflammatory lesions (n = 8, 1.6%), meningiomas (n = 4), craniopharyngiomas (n = 4), granular cell tumors (n = 1), metastatic renal cell carcinomas (n = 2), germinomas (n = 1), ependymomas (n = 1), and unsatisfactory specimens (n = 9, 1.8%). PAs were slightly more prevalent in women (M: F = 1:1.17) with a mean age of 48.8 yr (9-80 yr). Immunohistochemical analysis revealed that prolactin-producing PAs (16.6%) and growth hormone-producing adenomas (9.2%) were the most common functional PAs. Plurihormonal PAs and nonfunctioning (null cell) adenomas were found in 14.9% and 42.4% of patients with PAs, respectively. The recurrence rate of PAs was 11.1%, but nearly 0% for the remaining benign lesions such as RCCs. 25.4% of patients with PAs were treated by gamma-knife after surgery due to residual tumors or regrowth of residual tumor. In conclusion, the pituitary lesions and the proportions of hormone-producing PAs in Korean patients are similar to those of previous reports except nonfunctioning (null cell) PAs, which are unusually frequent.

Graphical Abstract

相似文献   

Postoperative Outcomes After Robotic Versus Abdominal Myomectomy

Background and Objectives:

Differences in postoperative outcomes comparing robotic-assisted laparoscopic myomectomy (RALM) with abdominal myomectomy (AM) have rarely been reported. The objective of this study was to compare surgical, quality-of-life, and residual fibroid outcomes after RALM and AM.

Methods:

Consecutive patients who underwent RALM (n = 16) were compared with AM patients (n = 23) presenting with a uterine size of <20 weeks. Study patients participated in a telephone interview at 6 weeks and underwent a no-cost ultrasonographic examination at 12 weeks after surgery to obtain quality-of-life and residual fibroid outcomes. Medical records were reviewed to obtain surgical outcomes.

Results:

Longer operative times (261.1 minutes vs 124.8 minutes, P < .001) and a 3-fold unfavorable difference in operative efficiency (73.7 g vs 253.0 g of specimen removed per hour, P < .05) were observed with RALM compared with AM. Patients undergoing RALM had shorter lengths of hospital stay (1.5 days vs 2.7 days, P < .001). Reduction of patient symptoms and overall satisfaction were equal. RALM patients were more likely to be back to work within 1 month (85.7% vs 45.0%, P < .05). Residual fibroid volume in the RALM group was 5 times greater than that in the AM group (17.3 cm³ vs 3.4 cm³, P < .05).

Conclusion:

RALM and AM were equally efficacious in improving patient symptoms. Although operative times were significantly longer with RALM, patients had a quicker recovery, demonstrated by shortened lengths of stay and less time before returning to work. However, greater residual fibroid burden was observed with RALM when measured 12 weeks after surgery.     

NATURAL SKIN REDUCTION AND BREAST RECOVERY USING A TISSUE EXPANDER AFTER ENUCLEATION OF A GIANT BREAST TUMOUR

We report a new use of the tissue expander for reshaping a breast after resection of a giant tumour. After resection of giant fibroadenomas, two patients had expanders inserted into the tissue defect and gradually reduced in size over five months. This facilitated healing and natural skin shrinkage and resulted in a natural shape and size.     

Successes and failures of uterine leiomyoma drug discovery

Introduction: To-date, the only cure for symptomatic uterine fibroids (UFs) is surgical intervention. However, surgery may eliminate the hope of future pregnancies; moreover, the intrinsic risks of surgery make it a less favorable to women with UFs. Because of this, conservative medical therapies have become an attractive and prior option for those women. Leuprolide acetate (LA), a gonadotropin-releasing hormone (GnRH) agonist, is the only pharmacological agent currently approved for the short-term and pre-operative management of symptomatic UFs in the USA.

Areas covered: This systematic review covers the successes and failures of prominent drugs that have been researched for UFs in the past and agents that have shown promise in recent clinical trials. The most recent clinical trials and advances in drug therapy are presented in a comprehensive overview outlining the direction UF drug discovery is heading.

Expert opinion: Experts in the field are already on the forefront leading the responsibility to uncover potential drugs as long term fertility friendly viable options for non-invasive treatment/prevention of UFs. Indeed, a shift in the UF management is expected in the future.     

晚期妊娠合并子宫肌瘤80例临床分析

目的:探讨晚期妊娠合并子宫肌瘤的临床处理方法。方法:对1997年1月至2006年12月本院治疗的80例晚期妊娠合并子宫肌瘤的资料进行回顾性分析。结果:80例晚期妊娠合并子宫肌瘤患者中经阴道分娩12例,剖宫产68例。剖宫产同时行肌瘤剔除术54例,剖宫产并子宫次全切除术2例。剖宫产同时行肌瘤剔除术,手术失血量和手术时间没有显著增加。结论:晚期妊娠合并子宫肌瘤的患者在剖宫产时行肌瘤剔除术是安全可行的。     

经阴道与经腹腔镜行子宫肌瘤剔除术的临床分析

目的比较分析经阴道与经腹腔镜行子宫肌瘤剔除术的临床效果。方法选取扬州友好医院行手术治疗的子宫肌瘤患者96例,其中观察组46例行经阴道子宫肌瘤剔除术,对照组50例行经腹腔镜子宫肌瘤剔除术,观察两组患者术中情况、住院花费、术后情况、肌瘤复发率及肌瘤残留率。结果两组患者手术时间、术中出血量、住院时间、术后病率及镇痛剂使用率方面比较,差异无统计学意义(P0.05);观察组剔除的肌瘤数多于对照组(P0.05),观察组住院费用、肛门排气时间少于对照组(P0.05);两组子宫肌瘤复发率、残留率比较,差异无统计学意义(P0.05)。结论经阴道子宫肌瘤剔除术剔除的肌瘤数多,而经腹腔镜子宫肌瘤剔除术手术创伤小,粘连发生率低。两种手术方式的选择应根据患者的需求、子宫肌瘤的数目、大小及手术者的经验来选择合适的手术方式。