卵巢子宫内膜异位囊肿粘连程度及相关因素分析

Objective To investigate the relationship between degree of endometrioma adhesions and clinical feature, surgical treatment and postoperative recurrence. Methods From Jan 2003 to Mar 2008, 662 patients with endometrioma undergoing laparoscopic ovarian endometrioma excision in Peking Union Medical College Hospital were studied retrospectively. All patients were classified into four groups according to the extent of adhesions: 31 cases in none adhesions group, 123 cases in mild adhesions group (filmy thickness, avascular, easily separated adhesions), 310 cases in moderate adhesions group (less than a half of ovary was adjacent to dense thickness adhesions which was difficult to separate, or above a half of ovary were adjacent to filmy thickness adhesions) and 198 cases in severe adhesions group (above a half of ovary was adjacent to dense thickness, well vascularized adhesions which was difficult to separate, and always involved the other pelvic organs, observed angiogenesis). The comparison of degree, characteristics, period of pain, lab test, surgical management and postoperative recurrence was performed among those above groups. In the mean time, risk factors and multinomial logistic regression were analyzed. Results (1)Clinical characteristics: The incidence of patients with dysmenorrhea, dyspareunia, straining feeling in anus, chronic pelvic pain and the level of CA125 (>35 kU/L) was remarkably higher in moderate-to-severe adhesion groups than in none-to-mild adhesions groups (P=0.000, 0.000, 0.001, 0.006 and 0.000, respectively). Infertility rate were significantly higher in severe adhesions group(15.7%,31/198) than none adhesions group(3.2%,1/31), mild adhesions group(11.4%,14/123) and moderate adhesions group(9.7%,30/310, OR=1.728, P<0.05).(2)Operating time and blood loss: Operating time of each groups was as followed: (37±15) min in none adhesions group, (42±19) min in mild adhesions group, (50±20) min in moderate adhesions group and (63±22) min in severe adhesion group. Blood loss was (23±12) ml in none adhesion group, (31±27) ml in mild adhesion group, (40±32) ml in moderate adhesion group and (70±67) ml in severe adhesions group. Thicker adhesions result in longer operation time and more blood loss. (3)Combined with other disease: The ratio of patients who combined with adenomyosis or deeply infiltrating endometriosis in moderate-to-severer adhesion groups was higher than patients in none-to-mild adhesions groups (OR=3.466, P=0.000). (4) Postoperative recurrence: It was categorized into recurrence of pain and cyst. Moderate-to-severe adhesions was related to higher recurrence rate of pain (OR=1.685,P=0.046), but was irrelevant to recurrence of cyst. Conclusion The more extent of endometrioma adhesions was related to severer pelvic pain symptoms, longer operating time and more blood loss. Postoperative pain recurrence rate was observed in moderate-to-severe adhesion group. Extent of adhesions was irrelevant to cyst recurrence.     

西米替丁预防急性脑血管病并发应激性溃疡出血疗效观察

急性脑血管病 (ＡＣＶＤ)并发应激性溃疡出血临床上相当常见 ,病死率甚高 ,我院 1990年 2月～1999年 9月 ,应用西米替丁预防 10 6例病情较重的ＡＣＶＤ并发应激性溃疡患者 ,取得良好疗效 ,现报告如下 :1　临床资料1 1　病例选择　选择经头部ＣＴ检查确诊 ,病变面积大和 /或靠近中线 ,全脑症状重 ,有较大可能发生应激性溃疡者 (就诊时已有消化道出血者未列入 ) ,按入院先后随机分为观察组和对照组 ,每组 10 6例。两组病人年龄、性别、发病时间及病情相似。1 2　方法　观察组除按原发病作相应处理外 ,入院后即给予西米替丁 0 4ｇ加生理盐水稀…     

子宫腺肌病病灶切除术后子宫瘢痕妊娠一例

本文报道1例子宫腺肌病病灶切除术后子宫瘢痕妊娠患者的诊治经过,并复习相关文献,探讨子宫腺肌病病灶切除术后的妊娠并发症及术后子宫瘢痕妊娠的诊治方法。患者35岁,孕2产0,子宫腺肌病病灶切除术后3年,停经66 d,间断阴道流血20余天,血β-hCG水平升高,影像学检查提示子宫底壁肌层瘢痕周围囊性灶,考虑异位妊娠,予甲氨蝶呤...     

北京协和医院临床住院医师对超声检查认识情况的调查分析

目的调查临床科室住院医师对超声检查的了解及认识情况,为今后的超声工作及教学培训提供依据。方法2014年12月对北京协和医院4个临床学系105名住院医师发放调查问卷,调查其对超声检查的理解程度、与超声医师沟通情况及超声检查在临床中作用的认识等。结果共获得100份有效问卷。81%的临床住院医师对于超声检查指征略微或中等了解,而对检查结果为中等或相等接受程度者占91%;70%对床旁超声的检查指征略微或中等了解;住院医师与超声医师的沟通较少,90%认为超声检查在临床工作中是相当及非常重要的,而对于完整地为患者解释超声报告自信心中等者占59%。结论了解临床需求并进行针对性培训有助于超声在临床工作中发挥作用。     

黄牛木中的异戊烯基酮类化合物

目的 研究黄牛木茎60%乙醇提取物的化学成分.方法 运用多种色谱学方法对黄牛木茎60%乙醇提取物的化学成分进行分离,并根据光谱数据鉴定化合物的结构.结果 从该植物中分离得到5个(口山)酮类化合物,分别鉴定为1,7-二羟基-2-(3-甲基丁-2-烯基)-5"-羟基-6"-甲基-6"-(4-甲基戊-3-烯基)-4",5"-二氢吡喃(2",3":3,4)双苯吡酮(Ⅰ)、5,9-二羟基-8-甲氧基-2,2-二甲基-7-(3-甲基丁-2-烯基)-2H,6H-吡喃一[3,2.b]一双苯吡-6-酮(Ⅱ)、黄牛木(口山)酮A(Ⅲ)、4-(3',7'-二甲基辛-2',6'-二烯基)-1,3,5-三羟基-9H-双苯吡-9-酮(Ⅳ)和黄牛木酮A(Ⅴ).结论 化合物Ⅰ为新化合物,命名为越南黄牛木(口山)酮E(cracochinchinone E).化合物Ⅱ和Ⅳ为首次从黄牛木属植物中分离得到.     

子宫内膜异位症患者生育力保护的中国专家共识(2022版)

子宫内膜异位症(内异症)是育龄期妇女的常见疾病之一, 常导致患者生殖功能及卵巢储备功能降低, 因此, 在内异症诊治中应注意保护患者的生育力, 改善生殖功能。依据患者年龄、内异症病变范围、内异症生育指数、卵巢储备功能及患者意愿等因素综合制定治疗策略;术前做好评估, 术后积极备孕或辅助生殖技术;对于无生育需求者, 通过药物治疗改善症状, 控制病情进展, 做好长期管理。对于一些病情严重或复发的内异症患者, 可在术前进行生育力保存。     

狭基线纹香茶菜的化学成分

目的对唇形科香茶菜属植物狭基线纹香茶菜(Isodon lophanthoides(Buch.Ham.ex D.Don)Haravar.gerandianus(Benth.)Hara)即中药溪黄草的化学成分进行研究。方法体积分数为95%乙醇提取物的水混悬液经环己烷、乙酸乙酯、正丁醇分步萃取,再对乙酸乙酯层运用硅胶、D101大孔树脂S、ephadex LH 20、ODS等柱层析手段并配合HPLC进行分离、纯化;通过化学方法及波谱分析鉴定其结构。结果分离得到并鉴定了6个化合物:既6去羟基迷迭香酸甲酯(methyl 6 dehy-droxyl rosmarinate,1)、迷迭香酸甲酯(methyl rosmarinate,2)、咖啡酸(caffeic acid,3)、6,7二羟基香豆素(6,7 dihydroxycoumarin,4)、槲皮素(quercetin,5)、蓟黄素(cirsimaritin,6)。结论化合物1为新天然产物,化合物4为首次从该属中分离得到,化合物3、6为首次从该植物中分离得到。     

卵巢子宫内膜异位囊肿粘连程度及相关因素分析

Objective To investigate the relationship between degree of endometrioma adhesions and clinical feature, surgical treatment and postoperative recurrence. Methods From Jan 2003 to Mar 2008, 662 patients with endometrioma undergoing laparoscopic ovarian endometrioma excision in Peking Union Medical College Hospital were studied retrospectively. All patients were classified into four groups according to the extent of adhesions: 31 cases in none adhesions group, 123 cases in mild adhesions group (filmy thickness, avascular, easily separated adhesions), 310 cases in moderate adhesions group (less than a half of ovary was adjacent to dense thickness adhesions which was difficult to separate, or above a half of ovary were adjacent to filmy thickness adhesions) and 198 cases in severe adhesions group (above a half of ovary was adjacent to dense thickness, well vascularized adhesions which was difficult to separate, and always involved the other pelvic organs, observed angiogenesis). The comparison of degree, characteristics, period of pain, lab test, surgical management and postoperative recurrence was performed among those above groups. In the mean time, risk factors and multinomial logistic regression were analyzed. Results (1)Clinical characteristics: The incidence of patients with dysmenorrhea, dyspareunia, straining feeling in anus, chronic pelvic pain and the level of CA125 (>35 kU/L) was remarkably higher in moderate-to-severe adhesion groups than in none-to-mild adhesions groups (P=0.000, 0.000, 0.001, 0.006 and 0.000, respectively). Infertility rate were significantly higher in severe adhesions group(15.7%,31/198) than none adhesions group(3.2%,1/31), mild adhesions group(11.4%,14/123) and moderate adhesions group(9.7%,30/310, OR=1.728, P<0.05).(2)Operating time and blood loss: Operating time of each groups was as followed: (37±15) min in none adhesions group, (42±19) min in mild adhesions group, (50±20) min in moderate adhesions group and (63±22) min in severe adhesion group. Blood loss was (23±12) ml in none adhesion group, (31±27) ml in mild adhesion group, (40±32) ml in moderate adhesion group and (70±67) ml in severe adhesions group. Thicker adhesions result in longer operation time and more blood loss. (3)Combined with other disease: The ratio of patients who combined with adenomyosis or deeply infiltrating endometriosis in moderate-to-severer adhesion groups was higher than patients in none-to-mild adhesions groups (OR=3.466, P=0.000). (4) Postoperative recurrence: It was categorized into recurrence of pain and cyst. Moderate-to-severe adhesions was related to higher recurrence rate of pain (OR=1.685,P=0.046), but was irrelevant to recurrence of cyst. Conclusion The more extent of endometrioma adhesions was related to severer pelvic pain symptoms, longer operating time and more blood loss. Postoperative pain recurrence rate was observed in moderate-to-severe adhesion group. Extent of adhesions was irrelevant to cyst recurrence.     

华容县部分健康人群乙型肝炎感染情况分析

目的了解华容县健康人群乙型肝炎(乙肝)感染率及免疫水平,探讨健康人群乙肝预防的对策与措施.方法对2 290名前来华容县疾病预防控制中心预防门诊要求接种乙肝疫苗的健康人群,采用酶联免疫吸附法(ELISA)测定HBsAg、抗-HBs、HBeAg、抗-HBe、抗-HBc,按年龄、性别分组进行5项标志物(HBVM)的分析比较.结果HB-sAg总阳性率为12.93%,男、女分别为16.53%、10.00%,差异有显著性(P＜0.01);抗-HBs总阳性率为49.61%,其中男性为46.93%,女性为51.72%,各年龄组间抗-HBsAg阳性率差异有显著性(P＜0.01);HBVM全阴率为31.44%,男性为31.49%,女性为31.41%,差异无显著性(P＞0.05).结论人群中乙肝感染率高,免疫水平低,易感者多,建议制定成人乙肝疫苗扩大免疫计划,及时对易感人群接种乙肝疫苗,减少乙肝发病率.     

85例下肢顺行静脉溶栓治疗分析

下肢静脉顺行性造影是诊断下肢静脉疾病的一种重要方法，由于造影剂顺血流方向充盈，故能观察到静脉的全貌，适用于不同类型的静脉疾病诊断，同时也是检验治疗效果的黄金标准。临床上，我们将此方法用于早期下肢深静脉血栓形成(deep vein thrombosis，DVT)的溶栓治疗，研究顺行静脉溶栓(ascending intravenous thrombolysis)临床疗效，现报道如下。