卵巢上皮性癌合并卵巢子宫内膜异位症67例临床病理分析

目的 探讨合并卵巢子宫内膜异位症(内异症)的卵巢上皮性癌(卵巢癌)的临床病理特点.方法 选取1996年1月至2006年12月在复旦大学附属妇产科医院就诊并经手术确诊的卵巢癌共727例,对其中合并卵巢内异症的67例患者(其中由卵巢内异症恶变的卵巢癌患者34例,为A组;其他仅合并卵巢内异症的卵巢癌患者33例,为B组)的临床病理资料进行回顾性分析,并与660例未合并卵巢内异症的卵巢癌患者(C组)进行对照分析.同期本院经手术病理确诊的卵巢内异症患者共3890例.结果 卵巢内异症恶变为卵巢癌的发生率为0.87%(34/3890).卵巢癌合并卵巢内异症的发生率为9.2%(67/727).A、B、C组患者的平均年龄分别为(47.2±1.3)、(47.8±1.2)、(51.2±0.4)岁,3组问比较,差异有统计学意义(P=0.013).A、B组病理类型多为透明细胞癌(分别为67.6%、69.7%),其所占比例均明显高于C组的18.8%(P=0.000);而C组以浆液性腺癌(50.3%)为主,其所占比例明显高于A组的8.8%和B组的12.1%(P=0.000).A、B组手术病理分期多为Ⅰ期(分别为73.5%、63.6%),其所占比例均明显高于C组的31.4%(P=0.000);而C组多为Ⅲ期(47.7%),其所占比例明显高于A组的23.5%和B组的15.2%(P=0.001).A、B、C组高分化(分别为11.8%、6.1%、10.5%)、中～低分化(分别为88.2%、93.9%、89.5%)所占比例分别比较,差异均无统计学意义(P=0.602).A、B、C组雌激素受体(ER)阳性率分别为22.2%(6/27)、31.6%(6/19)、43.9%(136/310),3组间比较,差异有统计学意义(P=0.018);A、B、C组孕激素受体(PR)阳性率分别为22.2%(6/27)、15.8%(3/19)、35.5%(110/310),3组间比较,差异无统计学意义(P=0.082).患者总的5年累积生存率为55.6%,A、B、C组患者的5年累积生存率分别为78.9%、92.8%、51.9%,3组间比较,差异有统计学意义(P=0.000).结论 合并卵巢内异症的卵巢癌患者,具有年轻(尤其是内异症恶变患者)、多为卵巢透明细胞癌、期别早、ER表达水平低、预后好的特点.     

Clinical Application of Percutaneous Testicular Sperm Aspiration plus ICSI in Treating Azoospermia Induced Male Infertility：Report of 135 Cases

Objective To study the effectiveness of percutaneous testicular sperm aspiration(PTSA) plus intracytoplasmic sperm injection (ISCI) in treating male infertilitycaused by azoospermia.ized in our hospital from September 1998 to December 2000 were enrolled into thisstudy. Among the 135 patients, 71 were with obstructive azoospermia, 23 were withcongenital azoospermia, and the other 41 with idiopathic azoospermia. All thesepatients underwent ICSI with testicular sperm by PTSA. The fertilization rate wasdetermined.Results The mean concentration of testicular sperm was 73. 5± 42. 59/μL and theaverage motility was 1. 5± 1. 17% (ranging from 1 % to 5% ). The motion grade ofthe sperm was 1. A total of 1 263 eggs were obtained and ICSI was performed. AfterICSI, 849 eggs were fertilized with a total fertilization rate of 67.2%. In 71 patientswith obstructive azoospermia, 79 cycles of ICSI were performed and the spouses of 32patients achieved pregnancy, with a pregnancy rate of 40. 5%. In 23 patients withcongenital azoospermia, 28 cycles of ICSI were performed and the spouses of 9 pa-tients got pregnancy, having a pregnancy rate of 32. 1%. In the group of 41 patientswith idiopathic azoospermia, 41 cases were given ICSI and the spouses of 8 patientsgot pregnancy, with a pregnancy rate of 19. 5%.Conclusion ICSI in combination with PTSA is an effective method of treatingazoospermia induced male infertility, especially obstructive azoospermia.     

心肌梗塞后大鼠心肌组织中神经肽Y Y1受体mRNA水平的改变

目的观察心肌梗塞后心肌组织中神经肽Y(NPY)Y1受体水平的改变。方法实验在雄性Sprague-Dawley大鼠中进行,用结扎大鼠冠状动脉左前降支的方法,造成心肌梗塞动物模型,用RT-PCR方法观察心肌组织中是否存在有NPYY1受体mRNA,用定量PCR方法观察心肌梗塞后大鼠心肌组织中NPYY1受体mRNA水平的改变。结果用RT-PCR方法观察到,大鼠心肌组织中有NPYY1受体mRNA分布。在大鼠结扎冠状动脉一天及三天后,梗塞区及非梗塞区心肌组织中NPYY1受体mRNA水平较假手术组大鼠均有显著升高。此外,假手术组大鼠心肌组织中NPYY1受体mRNA水平较正常大鼠也有显著升高。结论心肌梗塞可导致梗塞区及非梗塞区心肌组织中NPYY1受体水平升高,手术创伤应激也可影响心肌组织中NPYY1受体水平。     

IVF-ET周期中高龄卵巢低反应患者不同受精方式的妊娠结局分析

目的：比较常规体外受精（ＩＶＦ）和胞浆内单精子注射（ＩＣＳＩ）２种受精方式对无明确男性因素的高龄卵巢低反应患者治疗结局的影响,探讨这类患者合适的受精方式。方法：回顾性分析IVF－胚胎移植（ＥＴ）周期中高龄（年龄≥４０岁）卵巢低反应周期共３８１个,按受精方式分为常规ＩＶＦ组（２００个周期）与ＩＣＳＩ组（１８１个周期）,分析比较２组间的受精率和临床结局。结果：ＩＶＦ组的受精率和移植周期临床妊娠率略高于ＩＣＳＩ组,ＩＣＳＩ组的有效周期率和有效胚胎率略高于ＩＶＦ组,但差异均无统计学意义（Ｐ＞０．０５）。结论：无明确男性因素的高龄卵巢低反应患者,ＩＣＳＩ受精并不能提高其受精率和临床妊娠率。