非脱垂子宫经腹、阴式全切除术临床比较

目的 探讨非脱垂子宫经阴道与经腹全切术的临床比较。方法 2000年5月～2001年1月对阴式子宫全切术 (TVH)28例及腹式子宫全切术 (TAH)35例分为两组进行手术 ,对临床指标进行观察比较。结果 28例TVH手术均成功。平均重量255g(120～510g)。与TAH手术比较 ,其术后病率、肛门排气时间及术后住院天数有显著性差异 ( p<0.001及 p<0.05) ,但其手术时间及术中出血量无显著性差异 ( p>0.05)。结论 随着微创手术的开展 ,利用阴道天然孔道 ,经阴道切除较大的子宫是有效和安全的 ,手术的成功与术者经验、技术及子宫活动度有关 ,有合适器械也是手术成功的因素。     

特殊部位异位妊娠的临床分析

目的探讨特殊部位异位妊娠的临床特点，误诊原因及治疗原则。方法对1996年1月至2003年12月诊治的256例特殊部位异位妊娠进行回顾性分析。结果特殊部位异位妊娠发生率占同期异位妊娠的3．36％，术前诊断率48．4％，所有的患者均行手术。视术中情况进行不同的处理，所得标本均经病理切片证实，全部患者愈后良好。结论特殊部位异位妊娠的临床表现不典型，容易漏诊误诊，一旦怀疑本病应尽早住院，及时明确诊断并手术，患者愈后良好。     

分娩期子宫破裂64例分析

目的 分析分娩期子宫破裂的发病原因及预防措施。方法 回顾分析1985年8月至2001年12月，16a间64例分娩期子宫破裂的临床资料。结果 子宫收缩剂使用不当3l例，占48．4％；胎先露下降受阻13例，占20．3％；子宫疤痕16例，占25％；阴道助产4例，占6．3％。初产妇10例(10．9％)；经产妇54例(89．1％)。结论 降低分娩期子宫破裂发生率关键在于加强计划生育工作及围生期保健，严格掌握子宫收缩剂的适应证及剂量；严格首次剖宫产指征；严密观察产程，及时处理异常分娩。     

Ovarian and uterine findings in pelvic sonography: comparison between prepubertal girls, girls with isolated thelarche, and girls with central precocious puberty.

OBJECTIVE: To describe pelvic sonographic findings in girls as old as 7 years, to compare prepubertal girls with girls who had isolated thelarche or central precocious puberty, and to verify the accuracy of sonographic variables for distinguishing prepubertal girls from girls with central precocious puberty. METHODS: Ninety-six prepubertal girls and 2 reference groups (8 girls with isolated thelarche and 8 with idiopathic central precocious puberty) were included. Ovaries were classified morphologically as homogeneous, paucicystic, macrocystic, multicystic, and having isolated cysts. Receiver operating characteristic curves were used to choose the best cutoff points. RESULTS: Chronologic and bone age were correlated with uterine length, area, and volume and ovarian volume in prepubertal girls (P < .0001). Ovarian morphologic characteristics in prepubertal girls differed significantly from those of the reference groups (P < .0001). The best cutoff points were uterine length of 4.0 cm, uterine area of 4.5 cm2, uterine volume of 3.0 cm3, and ovarian volume of 1.0 cm3. CONCLUSIONS: Uterine and ovarian growth are proportional to age in prepubertal girls. Mean ovarian volume greater than 1 cm3 showed 100% sensitivity and specificity for discriminating between prepubertal girls and girls with central precocious puberty. Microcysts are common in prepubertal girls, but the presence of 6 or more follicles up to 10 mm in diameter may suggest central precocious puberty in girls younger than 8 years.     

子宫阔韧带肌瘤的CT诊断

目的　探讨子宫阔韧带肌瘤的CT诊断价值。方法　收集 2 1例子宫阔韧带肌瘤CT资料 ,进行回顾性分析 ,所有病例均经手术病理证实。结果　 2 1例均在盆腔内、子宫外显示肿块 ,CT表现 :实质性肿块 19例 ,边界清楚光整 16例 ,不甚清楚 3例 ,密度均匀 6例 ,平扫时与子宫肌密度相当 ,增强扫描呈明显强化 ,与子宫肌强化基本同步 ,不均匀 13例 ,其强化程度低于子宫肌 (约相差 10～ 2 0HU) ,瘤内变性、坏死或液化区不明显强化或不强化 ;囊实性 2例 ;肿块位置较固定 ,大多在宫旁匍匐生长 ,与子宫位置密切相关 ,其最大径层面与子宫体中心层面基本保持一致 ;形态各异 ,呈条块状、哑铃分叶状及扁圆烧饼状共 15例 ,呈圆形、椭圆形6例。结论　子宫旁呈条块、哑铃分叶状及扁圆烧饼状的实质性或实质性为主的肿块是本病较为可靠的CT征象 ,CT对诊断阔韧带肌瘤有实用价值     

鸡矢藤提取物对小白鼠离体子宫的作用

鸡矢藤[Paederia Scandens]提取物0.32mg 加入营养槽内,对小白鼠各期离体子宫的收缩张力、收缩强度、收缩频率以及子宫活动力均有增强作用。与给药前比较,诱导期组分别增加85%、47%、21%和72%;动情期组分别增加70%、77%、41%和41%;非动情组分别增加47%、76%、62%和66%,而且三组间作用无显著性差异。本品还能增强 PGE_2对小白鼠离体子宫的收缩张力、收缩强度、收缩频率以及子宫活动力。与 PGE_2的作用比较,分别增加34%、39%、9%和45%,但收缩频率增加无统计学意义(P>0.05)。上述结果表明,鸡矢藤提取物对小鼠子宫有显著性兴奋作用,而且还能增强PGE_2对小鼠子宫兴奋作用,其机制尚待进一步研究。     

Acute abdomen in a case with noncommunicating rudimentary horn and unicornuate uterus.

Unicornuate uterus with a rudimentary horn is the rarest congenital anatomic anomaly of the female genital system, causing many obstetrical and gynecologic complications. The frequency of this pathology is approximately 1/100 000. A rudimentary horn usually develops following insufficient development of mullerian ducts. These patients present with dysmenorrhea, dyspareunia, and chronic pelvic pain because of endometriosis and rarely with acute abdominal symptoms following distention and torsion of the noncommunicating rudimentary horn. The case of a patient referred for acute abdomen after distention of a noncommunicating rudimentary horn is presented herein.     

宫腔镜双极电切除子宫黏膜下肌瘤300例临床分析

目的评价应用双极电能治疗子宫黏膜下肌瘤的优势和安全性。方法应用官腔镜双极电切除子宫黏膜下肌瘤300例，其中0型212例，Ⅰ型54例，Ⅱ型34例。结果术中膨宫液总用量500～2000ml，平均626ml，手术时间20～50min，平均25min，术中出血量10—20ml。1例术中心脑综合征，经及时处理缓解。无一例因疼痛而中止手术。切除肌瘤直径3—5cm，平均3．8cm。1例术后病理为平滑肌肉瘤，术后10天行广泛全子宫切除及盆腔淋巴结清扫术。277例术后随访1—24个月，40例（Ⅰ型12例，Ⅱ型28例）需再次宫腔镜手术。结论宫腔镜下双极电治疗子宫黏膜下肌瘤具有安全、损伤小、恢复快、高效率等特点，宜于推广。     

产后子宫内翻临床分析

目的 提高对产后子宫内翻诊治及预防的认识。方法 回顾性分析我院收治的3例子宫内翻患的临床资料。结果 3例年龄分别为26、28、29岁，均有多次生育史，临床表现为出血、休克、疼痛、阴道口见脱出的红色球状肿物，多伴有排尿困难。第三产程的非适当处理为其主要原因。结论 提倡新法接生，提高助产技术，正确处理第三产程是预防子宫内翻的关键。而提高对子宫内翻的认识，早期发现，及时正确的处理，又是治疗子宫内翻的关键。     

Perivascular epithelioid cell tumor of the uterus: immunohistochemical, ultrastructural and molecular study

A case of perivascular epithelioid cell tumor of the uterus is reported, occurring in a 32-year-old woman. The tumor (8.0 cm in dimension) showed exophytic growth from the outer half of the myometrium. Histopathologically, the tumor was composed of thick blood vessels and perivascular epithelioid cells. The neoplastic cells were strongly immunoreactive for HMB45 antigen, CD117 (c-kit), vimentin and the progesterone receptor, but completely negative for S-100 protein, smooth muscle actin, desmin, CD34, the estrogen receptor and p16. The Ki-67 labeling index was low (1.25%). Ultrastructurally, the neoplastic cells had numerous premelanosomes with some glycogen deposits. Single-stranded DNA conformational polymorphism of p53 and methylation-specific polymerase chain reaction of p16 revealed negative results. Definite melanosomes on electron microscopic analysis and coexpression of HMB45 antigen and stem cell factor receptor (CD117) may provide the clue to understanding perivascular epithelioid cell tumor because angiomyolipoma also coexpresses HMB45 antigen and CD117.