血管内皮生长因子与子宫内膜异位症发病关系的研究进展

子宫内膜异位症（EM）是妇科的一种常见病和多发病,虽为良性病变,但具有远处转移和种植能力。EM的内膜血管生成受多种因素的影响,而血管内皮生长因子（VEGF）是目前公认的关键性的促血管形成因子,VEGF对正常血管生成及病理性血管形成均起重要的生物调节作用,在EM的发生、发展及预后中起着重要的作用。本文对VEGF与EM发病关系的研究进展进行阐述。     

Influence of early-life factors on the development of endometriosis

Objective: Our aim was to study the association between early-life factors and the development of endometriosis.

Methods: This case–control study included 440 women with surgically confirmed endometriosis (cases) and 880 women without endometriosis (controls). Information on early-life factors was ascertained retrospectively by in-person interviews with participants and their mothers. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for the associations between endometriosis and maternal and paternal characteristics and foetal and infant exposures were estimated using unconditional logistic regression, adjusting for frequency matching and confounding variables.

Results: We observed that women who were not breastfed as infants had twice the risk of endometriosis compared with women who were breastfed (adjusted OR 2.0; 95% CI 1.6, 4.5). Our data suggested an increased endometriosis risk with neonatal vaginal bleeding (adjusted OR 1.9; 95% CI 1.2, 4.3) and paternal smoking (adjusted OR 1.8; 95% CI 1.1, 4.9). Although the CIs included the null hypothesis value, caesarean section (adjusted OR 1.7; 95% CI 1.0, 3.5) and prematurity (adjusted OR 1.4; 95% CI 0.8, 3.7) were probably associated with the incidence of endometriosis.

Conclusions: Some early-life factors including breastfeeding, neonatal vaginal bleeding and paternal smoking were associated with subsequent, surgically confirmed endometriosis in this cohort of Chinese women.     

Imaging benign gynaecological conditions

Radiology continues to play an essential role in the management of benign gynaecological conditions. Multiple imaging modalities are utilised to investigate benign conditions: ultrasound; computed tomography and magnetic resonance imaging. Each modality has a different role in diagnosis, treatment selection and follow-up. This review discusses the different imaging modalities and their recommended roles in the imaging benign gynaecological conditions. The imaging findings of common benign female pelvic pathology are discussed and illustrated.     

Other imaging techniques: Double-contrast barium enema,endoscopic ultrasonography,multidetector CT enema,and computed tomography colonoscopy

Double-contrast barium enema (DCBE), transrectal endoscopic ultrasonography (REU), multidetector computerized tomography enema (MDCT-e), and computed tomography colonoscopy (CTC) have been successfully used for the diagnosis of bowel endometriosis. DCBE provides a complete overview of the entire colon and allows detecting cecal nodules. The accuracy of DCBE is operator dependent and, thus, it may have low specificity. It does not allow identifying the cause of the mass effect. DCBE requires the administration of barium and exposure to radiation. REU precisely estimates the distance between the rectosigmoid nodule and the anal verge. However, it allows investigating only the distal part of rectosigmoid, it misses anterior pelvic lesions, and it has poor sensitivity for the diagnosis of endometriomas. MDCT-e is accurate and reproducible in diagnosing intestinal endometriosis and in assessing its characteristics: the largest diameter of the nodule, the distance between the distal part of the nodule and the anal verge, and depth of infiltration of endometriosis in the intestinal wall. MDCT-e requires the administration of iodinated contrast medium (CM) and the exposure to radiations. CTC has good performance in the diagnosis of rectosigmoid endometriosis. It allows estimating the degree of intestinal stenosis CTC, and the distance between the intestinal endometriotic nodule and the anal verge. It requires exposure to radiations, and it may require the administration of an iodinated CM.     

反向添加疗法联合醋酸亮丙瑞林在子宫内膜异位症病灶切除术后的应用效果及对机体Th1/Th2漂移现象的影响

目的探讨反向添加疗法联合醋酸亮丙瑞林在子宫内膜异位症(EM)病灶切除术后的应用效果及对机体Th1/Th2漂移现象的影响。方法选取2016年6月至2018年1月本院收治的96例EM患者作为研究对象,采用随机抽签法将其分为对照组(46例)与观察组(50例)。两组均接受腹腔镜下EM病灶切除手术,术后,对照组给予皮下注射醋酸亮丙瑞林治疗,观察组给予反向添加疗法联合醋酸亮丙瑞林治疗。比较两组的治疗效果。结果治疗后,两组的血清LH、AMH和腰椎BMD水平均明显下降,但观察组高于对照组(P<0.05)。治疗后,两组的血清IFN-γ水平及IFN-γ/IL-4均升高,IL-4水平均降低,观察组优于对照组(P<0.05)。随访18个月,观察组复发率明显低于对照组(P<0.05)。结论反向添加疗法联合醋酸亮丙瑞林应用于EM病灶切除术后,可有效纠正机体生殖激素表达,减少骨量丢失,促进患者卵巢功能恢复,纠正Th1/Th2漂移现象,预防疾病复发。     

Combined Cystoscopic and Laparoscopic Approach in Deep Endometriosis of the Bladder

Study ObjectiveTo report the combined cystoscopic and laparoscopic approach in deep endometriosis with full-thickness infiltration of the bladder.DesignVideo (Canadian Task Force classification III).SettingUniversity hospital.PatientA 34-year-old nulliparous woman with a large (35-mm) endometriosis nodule infiltrating the bladder and deep endometriosis of the rectum and sigmoid colon.InterventionThe urologic surgeon performed cystoscopy, identified the limits of mucosal involvement, and incised the muscular layer up to fat tissues surrounding the bladder. The gynecologic surgeon identified and followed the circular incision, and completed full-thickness resection of the bladder wall. Surgical technique reports in anonymous patients are exempt from ethical approval by the institutional review board.Measurements and Main ResultsThe patient's functional outcome was uneventful. Laparoscopic resection of large endometriotic nodules of the bladder per se may lead to inadvertent removal of healthy bladder muscle. Thus it increases the risk of postoperative complications and symptoms due to small bladder volume. Conversely, if resection of the nodule is performed only cystoscopically, it probably would not be completely removed. We routinely combine the 2 approaches because this enables complete resection of the endometriotic nodule. It not only averts the risk of excessive removal of healthy bladder muscle but also leaves no disease behind.ConclusionsOn the basis of our experience, we propose the combined cystoscopic and laparoscopic approach in managing large endometriotic nodules with full-thickness infiltration of the bladder.     

Effects of tramadol on viscero‐visceral hyperalgesia in a rat model of endometriosis plus ureteral calculosis

The effects of tramadol versus placebo administration on behavioral indicators of ureteral pain, pelvic pain and referred lumbar muscle hyperalgesia were investigated in a rat model of viscero‐visceral hyperalgesia from endometriosis plus ureteral calculosis (endo + stone). Fifty female Sprague‐Dawley rats underwent surgical induction of endometriosis and, 2 weeks later, were randomly assigned to five groups (10 each), to be treated i.p., twice a day, with tramadol (0.625, 1.25, 2.5, or 5 mg/kg) or saline for 5 days (14–18th day postendometriosis; prestone treatment). On the 21st day, they underwent laparotomy for stone formation in the upper left ureter (dental cement injection). All were video‐taped 24 h nonstop for 7 days before and 4 days after stone formation (14–25th day postendometriosis) to record ureteral and pelvic pain behaviors. Lumbar sensitivity (L1) was tested bilaterally, daily over the same period, by verifying presence/absence of vocalization upon muscle pinching at a predefined pressure (calibrated forceps). Additional fifty endo + stone rats underwent the same protocol, except that treatment was performed on 21st–25th day (poststone treatment). Tramadol vs. saline significantly reduced number and duration of ureteral crises, duration of pelvic behavior, and incidence of muscle hyperalgesia (P < 0.0001), with a dose‐dependent effect. Prestone treatment was significantly more effective than poststone treatment for the 1.25 dose for all parameters and 2.5 dose for pelvic and muscle parameters (0.003 > P < 0.02). Tramadol, even at low doses, is thus highly protective against pain from ‘viscero‐visceral hyperalgesia’ in endometriosis plus ureteral calculosis; it can represent a valid therapeutic approach in women with these comorbidities.     

Eotaxin/CCR3在子宫内膜异位症不孕小鼠的表达及中药莪棱胶囊的干预作用

目的:通过建立子宫内膜异位症(EMS)导致不孕症小鼠模型,观察比较趋化因子EOTAXIN及其受体CCR3在子宫内膜异位症(内异症)怀孕鼠以及不孕鼠之间的差异,分析EOTAXIN/CCR3基因对内异症不孕的影响,并探讨中药莪棱胶囊的干预作用。方法:建立EMS小鼠模型,同时皮下注射乙烯雌酚。观察24周后,进行同笼交配以计算该模型不孕率,同时区分怀孕鼠以及不孕鼠。对不孕鼠口服给予莪棱胶囊进行治疗,4周后取材,采用荧光定量PCR法分别观察正常鼠、怀孕鼠、不孕给药鼠、不孕给水鼠子宫内膜中Eotaxin/CCR3的表达情况。结果:假手术组小鼠子宫内膜Eotaxin表达,以及CCR3基因表达均较低。EMS模型怀孕鼠子宫内膜Eotaxin/CCR3基因表达明显升高。但EMS模型不孕鼠子宫内膜Eotaxin,以及CCR3基因表达较怀孕鼠更加明显。在不孕鼠中,给予莪棱胶囊的小鼠,子宫内膜Eotaxin表达以及CCR3表达均较给水组降低。结论:EOTAXIN/CCR3可能直接参与了子宫内膜异位症导致的不孕症的病理过程。莪棱胶囊可直接下调不孕鼠子宫内膜EOTAX-IN/CCR3表达,而起到缓解炎症,改善内异症作用的。