宫腔镜下3型子宫肌瘤切除术可行性及生殖预后分析

目的:分析3型子宫肌瘤(分型依据FIGO 2011)宫腔镜切除术的可行性以及患者生殖预后情况。方法:收集2013年1月—2017年10月诊断为3型子宫肌瘤(单发,直径大于2.5 cm)且行宫腔镜下子宫肌瘤切除术的患者共计59例。记录患者的症状、3型子宫肌瘤的大小、术前促性腺激素释放激素激动剂(GnRHa)类药物的使用情况、术前肌瘤距子宫浆膜层的距离、手术时间、术中出血情况、术后肌层恢复厚度,术中及术后并发症情况。有生育要求患者术后1个月及3个月宫腔镜检查复查情况,无生育要求者术后1个月及3个月门诊就诊复查症状改善情况。电话随访达术后12个月以上患者的术后妊娠情况。结果:患者年龄26~46岁,平均(37.1±4.8)岁,肌瘤的最大径线2.5~7.0 cm,平均(4.2±1.0)cm。一期手术完成率89.8%,手术时间(49.4±16.4)min(20~105 min),术中出血量10(10,20)mL(5~200 mL),术前肌瘤距子宫肌层厚度1~5.7 mm,平均(3.3±1.1)mm,术后瘤窝距子宫肌层厚度4.9~11.3mm,平均(8.9±1.3)mm。所有患者术中及术后均未发生子宫穿孔、大出血、TURP综合征和感染等并发症。术后症状均得到改善。有生育要求的患者术后3个月复查宫腔镜检查均无宫腔粘连发生,术后1年内妊娠率达73.3%(11/15),术后妊娠平均时间(6.0±3.3)个月。结论:对于3型子宫肌瘤,B型超声引导下宫腔镜手术安全、可行;术后恢复快,短期内可妊娠,但需由有经验的医生来完成。     

胎儿远程监护在高危妊娠监测中的临床应用

目的:探讨胎儿远程监护在高危妊娠监测中的临床意义。方法:选择孕周在28~37周并进行胎儿远程监护的高危妊娠孕妇50例作为观察组,随机抽取同期年龄、孕周、胎位相对应的同病种而未进行远程监护的50例孕妇作为对照组。结果:试验组无负荷实验(NST)异常检出率显著高于对照组;试验组新生儿Apgar评分较对照组显著升高;新生儿窒息发生率,尤其重度窒息发生率明显低于对照组。结论:电话远程胎儿监护系统是一种可靠、敏感、有效和实用的孕妇家庭自我监护的方法,可使孕妇在家中得到良好的胎心监护,既方便了病人,又能及时发现问题,及时处理,保障母婴安全,提高自然分娩率,值得推广普及。     

Expression of integrin β3 and osteopontin in endometrium of patients with adenomyosis

Objective To investigate the expression of integrin β3 and osteopontin(OPN) in eutopic and ectopic endometrium of adenomyosis. Methods From January 2007 to July 2008, the endometrium specimens were collected from 43 patients with adenomyosis undergoing hysterectomy in Peking University First Hospital. Eutopic endometrium were 11 in proliferative phase and 32 in secretory phase (18 cases in mid-secretory phase) were collected. Ectopic endometriums were also collected. In the mean time, it was chosen 41 cases with pure subserous uterine myoma or cervical intraepithelial neoplasia (CIN) Ⅱ-Ⅲ treated by hysterectomy as controls including 12 endometrium in proliferative phase and 29 endometrium in secretory phase (19 cases in mid-secretory phase). The expression of Integrin β3 subunit and OPN in the endometrium were assessed by immunohistochemical staining and quantitative real-time polymerase chain reaction. Results (1)Immunohistochemical staining showed that positive staining of integrin β3 and OPN were present predominantly in eutopic and ectopic endometrial glandular epithelium. There was significant different protein expression of integrin β3 and OPN, which were 1.6±0.8 and 1.7±0.7 in eutopic endometrium,1.7±0.7 and 1.8±0.9 in ectopic endometrium,2.1±0.9 and 2.0±0.9 in control endometrium (P<0.05). The protein expression of integrin β3 and OPN in eutopic endometrium of adenomyosis in the proliferative phase(0.8±0.4 and 0.7±0.3) were remarkably lower than those of the secretory phase(1.8±0.8 and 1.9±0.8,P<0.01). The protein expression of integrin β3 and OPN in the endometrium of controls in the proliferative phase(1.0±0.4 and 1.0±0.4) were significantly lower than those of the secretory phase(2.5±0.7 and 2.5±0.7)(P=0.000). In the mid-secretory phase, the protein expression of integrin β3(2.0±0.9) and OPN (2.1±0.8)in eutopic endometrium of adenomyosis were significantly lower than that of control endometrium(2.7±0.5 and 2.7±0.7)(P<0.01). (2)The mRNA expression level of integrin β and OPN in eutopic and ectopic endometrium were assessed by quantitative real-time PCR(result was shown by median index). It was observed that integrin β3 mRNA and OPN mRNA were significantly lower in the eutopic endometrium of adenomyosis (4.69 and 4.23), when compared with ectopic endometrium(7.96 and 14.84)and controls (13.47 and 17.40) (P<0.05). Eutopic endometrium had higher mRNA expression of integrin β and OPN mRNA in the secretory phase (5.54 and 11.40) than that in the proliferative phase(2.69 and 3.30) (P<0.01).The mRNA expression level of integrin β and OPN of control endometrium in the proliferative phase (3.12 and 4.75)were significantly lower than that in the secretory phase(19.94 and 21.00, P=0.000). The mRNA expression of integrin β and OPN were 10.10 and 14.34 in the mid-secretory phase, which were significantly lower than 21.50 and 24.18 in control endometrium(P<0.05). Conclusions High expression of integrin β3 and OPN in ectopic endometrium of adenomyosis may cause endometriotic lesions; abnormal expression of integrin β3 and OPN in the endometrium of adenomyosis during the implantation window may contribute to infertility in some patients.     

整合素β3及骨桥蛋白在子宫腺肌病患者子宫内膜中的表达及其意义

目的 探讨整合素β3及骨桥蛋白(OPN)在子宫腺肌病患者在位及异位子宫内膜中的表达及意义.方法 选择2007年1月-2008年7月于北京大学第一医院妇产科因子宫腺肌病行子宫全切除术的子宫腺肌病患者43例,收集其在位子宫内膜(在位内膜组),其中增殖期内膜11例,分泌期内膜32例(其中18例为分泌期中期);同时收集其异位子宫内膜(异位内膜组).选择同期因宫颈上皮内瘤变(CIN)Ⅱ～Ⅲ级或单纯浆膜下子宫肌瘤行子宫全切除术的患者41例为对照组,收集其子宫内膜,其中增殖期内膜12例,分泌期内膜29例(其中19例为分泌期中期).采用免疫组化法和实时荧光定量PCR技术检测各组患者子宫内膜中整合素β3和OPN的蛋白及mRNA表达.结果 (1)整合素β3和OPN蛋白主要表达于在位和异位子宫内膜的腺体.子宫内膜中整合素β3和OPN蛋白的表达水平,在位内膜组、异位内膜组、对照组分别为1.6±0.8和1.7±0.7、1.7±0.7和1.8±0.9、2.1±0.9和2.0±0.9,各组之间分别比较,差异均有统计学意义(P<0.05).在位内膜组增殖期子宫内膜中整合素β3和OPN蛋白的表达水平分别为0.8±0.4和0.7±0.3,均低于分泌期(分别为1.8±0.8和1.9±0.8),差异均有统计学意义(P<0.01);对照组增殖期子宫内膜中整合素β3和OPN蛋白的表达水平分别为1.0±0.4和1.0±0.4,也均低于分泌期(分别为2.5±0.7和2.5±0.7),差异也均有统计学意义(P=0.000).在位内膜组分泌期中期子宫内膜中整合素β3和OPN蛋白的表达水平分别为2.0±0.9和2.1±0.8,均低于对照组(分别为2.7±0.5和2.7±0.7),差异均有统计学意义(P<0.01).(2)子宫内膜中整合素β3和OPN mRNA的表达水平(以中位数表示),在位内膜组(分别为4.69和4.23)均低于异位内膜组(分别为7.96和14.84)和对照组(分别为13.47和17.40),差异均有统计学意义(P<0.05).在位内膜组增殖期子宫内膜中整合素β3和OPN mRNA的表达水平(分别为2.69和3.30)均低于分泌期(分别为5.54和11.40),差异均有统计学意义(P<0.01);对照组增殖期子宫内膜中整合素β3和OPN mRNA的表达水平(分别为3.12和4.75)也均低于分泌期(分别为19.94和21.00),差异也均有统计学意义(P=0.000);在位内膜组分泌期中期子宫内膜中整合素β3和OPN mRNA的表达水平(分别为10.10和14.34)均低于对照组(分别为21.50和24.18),差异均有统计学意义(P<0.05).结论 整合素β3和OPN在子宫腺肌病患者异位内膜的侵袭和生长过程中起着一定的作用,可能影响子宫腺肌病患者的胚胎着床.     

Expression of integrin β3 and osteopontin in endometrium of patients with adenomyosis

Objective To investigate the expression of integrin β3 and osteopontin(OPN) in eutopic and ectopic endometrium of adenomyosis. Methods From January 2007 to July 2008, the endometrium specimens were collected from 43 patients with adenomyosis undergoing hysterectomy in Peking University First Hospital. Eutopic endometrium were 11 in proliferative phase and 32 in secretory phase (18 cases in mid-secretory phase) were collected. Ectopic endometriums were also collected. In the mean time, it was chosen 41 cases with pure subserous uterine myoma or cervical intraepithelial neoplasia (CIN) Ⅱ-Ⅲ treated by hysterectomy as controls including 12 endometrium in proliferative phase and 29 endometrium in secretory phase (19 cases in mid-secretory phase). The expression of Integrin β3 subunit and OPN in the endometrium were assessed by immunohistochemical staining and quantitative real-time polymerase chain reaction. Results (1)Immunohistochemical staining showed that positive staining of integrin β3 and OPN were present predominantly in eutopic and ectopic endometrial glandular epithelium. There was significant different protein expression of integrin β3 and OPN, which were 1.6±0.8 and 1.7±0.7 in eutopic endometrium,1.7±0.7 and 1.8±0.9 in ectopic endometrium,2.1±0.9 and 2.0±0.9 in control endometrium (P<0.05). The protein expression of integrin β3 and OPN in eutopic endometrium of adenomyosis in the proliferative phase(0.8±0.4 and 0.7±0.3) were remarkably lower than those of the secretory phase(1.8±0.8 and 1.9±0.8,P<0.01). The protein expression of integrin β3 and OPN in the endometrium of controls in the proliferative phase(1.0±0.4 and 1.0±0.4) were significantly lower than those of the secretory phase(2.5±0.7 and 2.5±0.7)(P=0.000). In the mid-secretory phase, the protein expression of integrin β3(2.0±0.9) and OPN (2.1±0.8)in eutopic endometrium of adenomyosis were significantly lower than that of control endometrium(2.7±0.5 and 2.7±0.7)(P<0.01). (2)The mRNA expression level of integrin β and OPN in eutopic and ectopic endometrium were assessed by quantitative real-time PCR(result was shown by median index). It was observed that integrin β3 mRNA and OPN mRNA were significantly lower in the eutopic endometrium of adenomyosis (4.69 and 4.23), when compared with ectopic endometrium(7.96 and 14.84)and controls (13.47 and 17.40) (P<0.05). Eutopic endometrium had higher mRNA expression of integrin β and OPN mRNA in the secretory phase (5.54 and 11.40) than that in the proliferative phase(2.69 and 3.30) (P<0.01).The mRNA expression level of integrin β and OPN of control endometrium in the proliferative phase (3.12 and 4.75)were significantly lower than that in the secretory phase(19.94 and 21.00, P=0.000). The mRNA expression of integrin β and OPN were 10.10 and 14.34 in the mid-secretory phase, which were significantly lower than 21.50 and 24.18 in control endometrium(P<0.05). Conclusions High expression of integrin β3 and OPN in ectopic endometrium of adenomyosis may cause endometriotic lesions; abnormal expression of integrin β3 and OPN in the endometrium of adenomyosis during the implantation window may contribute to infertility in some patients.     

孕激素受体亚型在子宫腺肌病中的表达及意义

目的了解孕激素受体亚型(PR-A、PR-B)在子宫腺肌病异位病灶、在位内膜中的表达,探讨其在子宫腺肌病发生及治疗中的作用。方法采用免疫组化抗生物素蛋白-过氧化物酶染色法(SP法)检测子宫腺肌病患者(21例)病灶及其在位内膜及对照组(19例)子宫内膜标本中孕激素受体亚型的表达。结果PR-A、PR-B蛋白在异位病灶中广泛表达,表达强度显著低于其在位内膜和对照组内膜。研究组在位内膜间质内PR-A蛋白表达明显低于对照组在位内膜。结论异位病灶内PR蛋白的低表达及研究组在位内膜间质PR-A蛋白的低表达可能参与了该病的发病过程,可能与"孕激素抵抗"有关。     

宫腔镜手术治疗早期弥漫性子宫肌瘤病临床分析

目的研究宫腔镜手术治疗早期弥漫性子宫平滑肌瘤病(DUL)的临床效果及生殖预后。方法 31例因月经过多合并贫血和(或)不孕症的生育年龄患者,经阴道超声和宫腔镜检查证实为DUL,在超声监护下行宫腔镜手术,切除宫腔内及壁间内突肌瘤,保留壁间肌瘤。随访手术后宫腔内膜修复情况、宫腔粘连形成情况、复发率、术后妊娠率及活产率。结果 31例患者平均随访(31.7±11.0)个月,6例患者行2次经宫颈子宫肌瘤切除术(TCRM),3例患者行3次TCRM,除1例患者术后月经改善效果不佳行腹腔镜下次全子宫切除术,其余30例患者均保留子宫。术后2～3个月子宫内膜修复,月经改善率为93.5%(29/31),复发率为32.3%(10/31),一次手术后宫腔粘连率为45.1%(14/31),19例不孕症患者术后妊娠率52.6%(10/19)、活产率为47.4%(9/19)。结论宫腔镜手术可替代传统手术治疗早期DUL,可改善月经,保留子宫,保留患者生育力。     

Expression of integrin β3 and osteopontin in endometrium of patients with adenomyosis

Objective To investigate the expression of integrin β3 and osteopontin(OPN) in eutopic and ectopic endometrium of adenomyosis. Methods From January 2007 to July 2008, the endometrium specimens were collected from 43 patients with adenomyosis undergoing hysterectomy in Peking University First Hospital. Eutopic endometrium were 11 in proliferative phase and 32 in secretory phase (18 cases in mid-secretory phase) were collected. Ectopic endometriums were also collected. In the mean time, it was chosen 41 cases with pure subserous uterine myoma or cervical intraepithelial neoplasia (CIN) Ⅱ-Ⅲ treated by hysterectomy as controls including 12 endometrium in proliferative phase and 29 endometrium in secretory phase (19 cases in mid-secretory phase). The expression of Integrin β3 subunit and OPN in the endometrium were assessed by immunohistochemical staining and quantitative real-time polymerase chain reaction. Results (1)Immunohistochemical staining showed that positive staining of integrin β3 and OPN were present predominantly in eutopic and ectopic endometrial glandular epithelium. There was significant different protein expression of integrin β3 and OPN, which were 1.6±0.8 and 1.7±0.7 in eutopic endometrium,1.7±0.7 and 1.8±0.9 in ectopic endometrium,2.1±0.9 and 2.0±0.9 in control endometrium (P<0.05). The protein expression of integrin β3 and OPN in eutopic endometrium of adenomyosis in the proliferative phase(0.8±0.4 and 0.7±0.3) were remarkably lower than those of the secretory phase(1.8±0.8 and 1.9±0.8,P<0.01). The protein expression of integrin β3 and OPN in the endometrium of controls in the proliferative phase(1.0±0.4 and 1.0±0.4) were significantly lower than those of the secretory phase(2.5±0.7 and 2.5±0.7)(P=0.000). In the mid-secretory phase, the protein expression of integrin β3(2.0±0.9) and OPN (2.1±0.8)in eutopic endometrium of adenomyosis were significantly lower than that of control endometrium(2.7±0.5 and 2.7±0.7)(P<0.01). (2)The mRNA expression level of integrin β and OPN in eutopic and ectopic endometrium were assessed by quantitative real-time PCR(result was shown by median index). It was observed that integrin β3 mRNA and OPN mRNA were significantly lower in the eutopic endometrium of adenomyosis (4.69 and 4.23), when compared with ectopic endometrium(7.96 and 14.84)and controls (13.47 and 17.40) (P<0.05). Eutopic endometrium had higher mRNA expression of integrin β and OPN mRNA in the secretory phase (5.54 and 11.40) than that in the proliferative phase(2.69 and 3.30) (P<0.01).The mRNA expression level of integrin β and OPN of control endometrium in the proliferative phase (3.12 and 4.75)were significantly lower than that in the secretory phase(19.94 and 21.00, P=0.000). The mRNA expression of integrin β and OPN were 10.10 and 14.34 in the mid-secretory phase, which were significantly lower than 21.50 and 24.18 in control endometrium(P<0.05). Conclusions High expression of integrin β3 and OPN in ectopic endometrium of adenomyosis may cause endometriotic lesions; abnormal expression of integrin β3 and OPN in the endometrium of adenomyosis during the implantation window may contribute to infertility in some patients.     

早产合并胎膜早破临床分析

目的 探讨早产合并胎膜早破对围生儿的影响,预防和恰当地处理早产和胎膜早破,降低围生几死亡率.方法 对2000-2005年5年间收治的100例早产合并胎膜早破的临床资料进行回顾性分析.结果 孕28～33 6周与孕34～36 6周两组剖宫产分别为16/56例(28.6%)、14/44例(31.8%),无显著差异;两组出现窒息分别为20例(35.7%)、4例(13.6%),围生儿发病分别为20例(35.7%)和5例(11.4%),两组死亡分别为5例(8.9%)和1例(2.2%),有显著差异.结论 应当去除并积极治疗早产合并胎膜早破的诱因,预防早产和恰当处理胎膜早破是减少围生儿死亡的关键所在.