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991.
目的 探讨脆性组氨酸三联体（FHIT）基因蛋白与子宫颈癌生物学行为的相关性。方法 采用免疫组织化学SP法对20例慢性子宫颈炎和95例ⅠA～ⅢB期子宫颈癌放疗前、后患者进行FHIT蛋白表达水平的检测,分析FHIT蛋白表达水平与子宫颈癌临床病理特征之间的关系。结果 子宫颈癌组织中FHIT蛋白表达降低与子宫颈癌组织学分级、组织类型、淋巴结转移、浸润深度有关（χ2值分别为10.761、10.853、5.602,P＜0.05）;而与年龄、临床分期无关（P＞0.05）。子宫颈癌患者放疗前FHIT蛋白表达阳性率为36.0 %（18／50）,明显低于放疗后的84.0 %（42／50）（χ2＝2.271,P＜0.05）,且表达阳性率与放疗剂量呈正相关（χ2＝6.791,P＜0.01）。放疗前后FHIT蛋白阳性表达者3年生存率均高于阴性表达者（93.75 %比41.27 %,70.83 %比25.00 %）,差异有统计学意义[放疗前χ2＝28.729,P＜0.05;放疗后P＜0.05（精确概率法）]。结论 放疗前后FHIT蛋白表达水平对评估子宫颈癌的生物学行为和预后有重要的临床参考价值。 相似文献
992.
目的 探讨腹腔镜下电凝阻断子宫动脉在子宫肌瘤剔除术中的应用及预后。方法 对2009年2月~2011年2月来我院因子宫肌瘤行肌瘤剥除手术治疗的住院患者共83例,按照随机数字表法将患者分为实验组和对照组,实验组41例先行腹腔镜下子宫动脉电凝阻断再行肌瘤剥除术,对照组42例直接行腹腔镜下子宫肌瘤剥除术,比较两组的手术时间、术中出血量、肛门排气时间、住院时间、并发症发生率。2年内对所有患者定期随访,观察月经量,B超复查监测肌瘤复发情况。结果 与对照组比较,实验组手术时间缩短（109.92±17.52）min vs（84.83±8.63）min,术中出血量减少（163.13±36.42）ml vs（94.42±13.73）ml,差异有统计学意义（P＜0.05）;两组患者的肛门排气时间（29.64±2.44）h vs（28.84±2.94）h、住院时间（6.53±0.63）d vs（6.23±0.92）d、并发症发生率7.10% vs 7.30%比较,差异无统计学意义（P＞0.05）。随访2年,实验组月经量少于对照组（60.53±17.62）ml vs（133.82±32.53）ml,差异有统计学意义（P＜0.05）。实验组肌瘤无1例复发,对照组子宫肌瘤有6例复发,实验组复发率（0%）优于对照组（14.30%）,差异有统计学意义（P＜0.05）。结论 腹腔镜下电凝阻断子宫动脉后再行肌瘤剥除术可有效的减少术中出血量,缩短手术时间,减少术后月经量,降低肌瘤复发率。 相似文献
993.
近年来研究发现辅助性T细胞1型（Th1）/Th2的平衡调控与妇产科疾病的发生、发展、治疗和转归有密切的关系。Th1细胞调节细胞免疫,主要促进炎症反应和细胞毒性活动;Th2细胞调节体液免疫,主要刺激细胞的分化与增殖。Th1细胞通过合成γ干扰素（IFN-γ）抑制Th2细胞功能,Th2细胞通过合成白细胞介素4（IL-4）抑制Th1细胞的功能,二者相互作用、相互调节。正常妊娠情况下Th1/Th2细胞应答存在生理性失衡,母体Th2型细胞因子抑制Th1型细胞因子的产生,这种生理性失衡被破坏可导致复发性流产、早产、子痫前期及不孕症等妊娠相关疾病。而宫颈癌、卵巢癌、子宫内膜异位症等妇科疾病与Th1/Th2平衡调控有关,但其确切免疫学机制尚不明确,尚需进一步深入研究,以期为多种妇产科疾病的免疫学治疗开辟新的前景。 相似文献
994.
Omar M. Abuzeid John Hebert Mohammad Ashraf Mohamed Mitwally Michael P. Diamond Mostafa I. Abuzeid 《Journal of minimally invasive gynecology》2018,25(1):133-138
Study Objective
To determine the incidence of postoperative ascending infection without antibiotics with the use of a pediatric Foley catheter (PFC) after operative hysteroscopy for intrauterine pathology.Design
Retrospective case series (Canadian Task Force classification III).Setting
University-affiliated outpatient medical center.Patients
Patients who underwent operative hysteroscopy for uterine septum, arcuate uterine anomaly, or multiple submucosal myomas between 1992 and 2015.Interventions
In all patients, a PFC was placed in the endometrial cavity at the conclusion of operative hysteroscopy and left in place for 7 days to reduce intrauterine adhesion formation.Measurements and Main Results
A total of 1010 patients who underwent operative hysteroscopy for uterine septum (n?=?479), arcuate uterine anomaly (n?=?483), or multiple submucosal myomas (n?=?48) were studied. All patients presented with infertility, recurrent pregnancy loss, or excessive uterine bleeding (in patients with submucous myomas). In all patients, a PFC was placed at the conclusion of the procedure and left in place for 7 days. An 8Fr PFC was used after hysteroscopic division of uterine septum or arcuate uterine anomaly, and a 10Fr PFC was used after hysteroscopic myomectomy. Patients with a history of pelvic inflammatory disease were excluded. Following PFC placement, patients were prescribed estrogen for 6 weeks and progestogen for the last 10 days of the estrogen course. No prophylactic antibiotic therapy was provided. All patients were discharged to home on the same day. Postoperative pain was well controlled with oral pain medication in 98.5% of the patients. There were no reported postoperative infections, and all patients had an uneventful recovery.Conclusion
In 1010 consecutive operative hysteroscopies followed by temporary (7-day) PFC placement, no clinically significant uterine infection was observed. 相似文献995.
Yukio Suzuki Shinichiro Wada Ayako Nakajima Yoshiyuki Fukushi Masaru Hayashi Takuma Matsuda Ryoko Asano Yasuo Sakurai Hiroko Noguchi Toshiya Shinohara Chikara Sato Takafumi Fujino 《Journal of minimally invasive gynecology》2018,25(3):507-513
Study Objective
To evaluate a new magnetic resonance imaging (MRI) grading system for preoperative differentiation between benign and variant-type uterine leiomyomas including smooth muscle tumors of uncertain malignant potential (STUMPs).Design
Retrospective analysis (Canadian Task Force classification III).Setting
Teaching hospital (Teine Keijinkai Hospital).Patients
Three-hundred thirteen patient medical records were retrospectively reviewed if treated for uterine myomas and diagnosed with variant type leiomyomas or STUMPs (n?=?27) or benign, typical leiomyomas (n?=?286) and treated between January 2012 and December 2014.Intervention
Uterine myoma classifications using MRI findings according to a 5-grade system (grades I–V) based on 3 elements.Measurements and Main Results
Uterine myoma MRI classifications were based on 3 elements: T2-weighted imaging (high or low), diffusion-weighted imaging (high or low), and apparent diffusion coefficient values (high or low; apparent diffusion coefficient?<?1.5?×?10?3 mm2/sec was considered low). Grades I to II were designated as typical or benign leiomyomas, grade III as degenerated leiomyomas, and grades IV to V as variant type leiomyomas or STUMPs. Accuracy levels were 98.9%, 100%, 94.3%, 58.8%, and 41.9% for grades I through V lesions, respectively. The grades were divided into 2 groups to discriminate benign leiomyomas and STUMPs (grades I–III were considered negative and grades IV–V positive). Grades IV to V scored 85.2% for sensitivity, 91.3% for specificity, 47.9% positive predictive value, 98.5% negative predictive value, a 9.745 positive likelihood ratio, and a .162 negative likelihood ratio.Conclusion
This novel MRI grading system for uterine myomas may be beneficial in differentiating benign leiomyomas from STUMPs or variant type leiomyomas and could be a future effective presurgical assessment tool. 相似文献996.
Berna Haliloglu Peker Erdin Ilter Hakan Peker Aygen Celik Ali Gursoy Onur Gunaldi 《Journal of minimally invasive gynecology》2018,25(7):1146-1147
Study Objective
To demonstrate laparoscopic sacrohysteropexy for a case of uterine prolapse in a 12 weeks, 3 days pregnant woman. To our knowledge this is the first case of laparoscopic sacrohysteropexy performed at 12 weeks of gestation to be reported in literature.Design
A step-by-step explanation of the surgical procedure (Canadian Task Force classification III).Setting
Maltepe University Hospital.Patient
A 37-year-old pregnant woman.Intervention
Laparoscopic sacrohysteropexy. Institutional Review Board ruled that approval was not required for this study.Measurements and Main Results
Uterine prolapse is very rare condition, manifesting in an estimated 10 000 to 15 000 pregnancies [1]. The management plan must be individualized, and the obstetrician should aware of possible complications, such as preterm labor, high incidence of abortion, cervical ulceration, and cervical dystocia. In general, bedrest, good genital hygiene, and pessary use is recommended. Alternatively, in cases where conservative solutions have failed, laparoscopic surgery in the pregnant patient may be considered. To date, only 1 case of laparoscopic promontohysteropexy at 10th weeks of gestation was reported by Pirtea et al [2]. A 37-year-old woman, at 12 weeks and 3 days of gestation, with stage III pelvic organ prolapse was referred to our clinic. Conservative management with pessary failed. The patient underwent laparoscopic sacrohysteropexy after written informed consent form was obtained. In exploration, uterine manipulation was difficult because of softness and large size of the uterus. First, the sigmoid colon was suspended at the abdominal wall to gain an adequate surgical field. The promontorium was dissected and the parietal peritoneum incised on the right pelvic side wall after ureter visualization. A polypropylene mesh was fixed to the cervix at the level of the uterosacral ligaments. The other edge of the mesh was fixed at the level of the promontory using the Uplift device (Neomedic International, Barcelona, Spain). Then, the peritoneum was sutured to cover the mesh. The patient was discharged 2 days after surgery. At the examination the pelvic floor was detected to be normal. The patient delivered a healthy baby weighing 3030?g by cesarean section at 38 weeks of gestation. The position of the mesh was controlled during surgery. There was no peritoneal fold detected on the cervical part of mesh; however, no adhesion was observed.Conclusion
Laparoscopic sacrohysteropexy may be an alternative and safe approach, if conservative treatment fails, for pelvic organ prolapse during pregnancy. 相似文献997.
Benjamin D. Beran Marie Shockley Katrin Arnolds Michael L. Sprague Stephen E. Zimberg Andreas Tzakis Tommaso Falcone 《Journal of minimally invasive gynecology》2018,25(2):329
Study Objective
Uterine transplantation has proven feasible since the first live birth reported in 2014. To enable attachment of the uterus in the recipient, long vascular pedicles of the uterine and internal iliac vessels were obtained during donor hysterectomy, which required a prolonged laparotomy to the living donors. To assist further attempts at uterine transplantation, our video serves to review literature reports of internal iliac vein anatomy and demonstrate a laparoscopic dissection of cadaver pelvic vascular anatomy.Design
Observational (Canadian Task Force Classification III).Setting
Academic anatomic laboratory. Institutional Review Board ruled that approval was not required for this study.Intervention
Literature review and laparoscopic dissection of cadaveric pelvic vasculature, focusing on the internal iliac vein.Measurements and Main Results
Although the internal iliac artery tends to have minimal anatomic variation, its counterpart, the internal iliac vein, shows much variation in published studies 1, 2. Relative to the internal iliac artery, the vein can lie medially or laterally. Normal anatomy is defined as some by meeting 2 criteria: bilateral common iliac vein formed by ipsilateral external and internal iliac vein at a low position and bilateral common iliac vein joining to form a right-sided inferior vena cava [2]. Reports show 79.1% of people have normal internal iliac vein anatomy by these criteria [2]. The cadaver dissection revealed internal iliac vein anatomy meeting criteria for normal anatomy.Conclusion
Understanding the complexity and variations of internal iliac vein anatomy can assist future trials of uterine transplantation. 相似文献998.
目的 分析子宫动脉栓塞联合宫腔镜治疗子宫切口妊娠的临床疗效。方法 选取50例汉川市第二人民医院2015年9月~2017年5月收治的子宫切口妊娠患者,通过随机方式将其分为常规组和联合组,各25例,给予常规组患者肌注氨甲蝶呤及B超检测下清宫术治疗,给予联合组患者子宫动脉栓塞联合宫腔镜下清宫术治疗,观察两组患者术中各指标水平,不良反应发生情况。结果 联合组患者各手术指标术中出血、阴道流血时间、血β-HCG转阴时间水平均低于常规组患者,差异有统计学意义（P＜0.05）;联合组患者不良反应发生率低于常规组患者,差异有统计学意义（P＜0.05）。结论 子宫动脉栓塞联合宫腔镜治疗子宫切口妊娠的临床疗效显著,能有效降低术中出血量,加快患者术后恢复,且具有较高的安全性,临床价值较高。 相似文献
999.
Brain metastases are the most commonly seen intracranial lesions in adults. What is more, meningiomas are the most common primary intracranial tumours after gliomas and their imaging characteristics are well known in both CT and MRI scans. However, there are lesions that can mimic meningiomas in imaging studies, including metastases of extracranial tumours, confronting us with a diagnostic and therapeutic challenge. We present the case of a patient with meningeal metastasis of a uterine leiomyosarcoma that was not known at the time of the surgical intervention. 相似文献
1000.
目的：探讨子宫动脉栓塞术（UAE）在剖宫产疤痕妊娠（CSP）治疗中的应用效果及其影响因素分析。
方法：选取2012年12月至2017年6月在我院拟采用药物保守治疗的CSP患者76例。其中26例采用肌内注射甲氨蝶呤+清宫术治疗（A组）,50例采用甲氨蝶呤+UAE+清宫术治疗（B组）。比较两组的一般资料及治疗结果,采用多因素Logistic回归模型分析影响采用UAE介入治疗的因素,并进一步应用ROC曲线得出最佳临界值。
结果：单因素分析显示：两组的年龄、孕次、产次、剖宫产史时间、血清β-HCG值比较差异无统计学意义。B组的停经时间较A组长[（53.6±20.2）d vs.（48.7±17.2）d],孕囊比A组大[（3.87 ±1.58）mm vs.（3.19±2.06）mm],疤痕肌层厚度比A组薄[（1.65±1.12）mm vs.（2.97±1.24）mm]、疤痕妊娠分型中Ⅱ型比例较高（66% vs. 35%）,与A组差异均有统计学意义（P<0.05）;Logistic回归分析显示：停经时间长、疤痕肌层厚度薄是影响采用UAE治疗CSP的独立危险因素。ROC曲线分析显示,妊娠时间≥51 d,疤痕肌层厚度≤2.7 mm为选择UAE的最佳临界值（ROC曲线下面积分别为0.813和0.808）。
结论：UAE可有效防治剖宫产疤痕妊娠保守治疗中的大出血;尤其对停经时间≥51 d,疤痕厚度≤2.7 mm的患者更具有重要的临床价值。 相似文献