功能失调性子宫出血宫腔镜检查结果分析

目的：应用宫腔镜检查功能失调性子宫出血，以探明该项技术临床应用的价值和成果。方法：将我科收治的子宫疾病998例进行宫腔镜检查，逐一登记、分类、整理、计算并进行统计学处理。结果：宫腔镜检查的子宫疾病，按其构成比，居首位的是功能失调性子宫出血，依次是黏膜下子宫肌瘤、子宫内膜息肉、带环出血及子宫颈息肉。以上5种共占受检人数的90．2％。且比临床诊断更直观、快捷、准确。结论：通过临床应用表明宫腔镜技术是现代诊断和治疗功能性子宫出血的金标准和首选的外科微创治疗方法。     

p53 immunoreactivity in endometrial metaplasia with dysfunctional uterine bleeding

AIM: Overexpression of p53 has been reported in endometrial carcinomas, especially in uterine papillary serous carcinoma (UPSC), to correlate with worse prognosis. Endometrial metaplasia is commonly encountered in patients with dysfunctional uterine bleeding (DUB) and may on occasion be difficult to distinguish from atypical endometrial hyperplasia or carcinoma on biopsies. The present study was initiated in the belief that metaplastic tissue might not show overexpression of p53 and would thus help to distinguish it from carcinomas of non-endometrioid histology. METHODS AND RESULTS: Paraffin-embedded tissue of endometrial biopsies with papillary metaplasia (22 cases), tubal metaplasia (five cases) and eosinophilic meta-plasia (seven cases) from patients with DUB were immunostained for p53 immunoreactivity. No evidence of hyperplasia was noted in any of the cases selected for the study. Twenty-eight cases of UPSC were included for comparison. Our study showed p53 overexpression in 25 of 28 (89%) UPSC. Weak and heterogeneous p53 immunoreactivity was present in 10 of 22 (45%) papillary metaplasias, four of five (80%) tubal metaplasias and four of seven (57%) eosinophilic metaplasias. Follow-up of 16-45 (median 32) months was unremarkable except for one patient with eosinophilic metaplasia who had simple endometrial hyperplasia in subsequent biopsy. CONCLUSIONS: The presence of weak and heterogeneous p53 immunoreactivity in metaplastic endometrium is unexpected and might be a consequence of DNA damage. Intense, diffuse and homogeneous p53 staining favours carcinoma.     

诺舒阻抗控制子宫内膜切除术治疗围绝经期功能失调性子宫出血的研究进展

围绝经期功能失调性子宫出血是女性的常见病,诺舒阻抗控制子宫内膜切除系统（NovaSure endometrial ablation system,NovaSure）属于第二代子宫内膜去除术.以阻抗控制为原理,一次性全面去除子宫内膜全层及其下方的浅肌层组织,防止子宫内膜再生,使月经量减少甚至闭经,从而控制过量的子宫出血.与其他子宫内膜切除术比较,具有术前无需预处理,自动化操作,手术时间短、恢复快、不受经期限制,安全性高、疗效显著等特点.     

Endometrial hormone receptors in women with dysfunctional uterine bleeding

Objective The objective was to study the estrogen receptor (ER) and progesterone receptor (PR) expression in endometrium of women with dysfunctional uterine bleeding (DUB) as compared to women with normal menstrual cycles.Methods In this study, 30 patients and 20 controls were selected. Transvaginal ultrasound and endometrial sampling for histology and ER and PR estimation immunohistochemically was carried out for all the subjects. Students t-test and linear correlation was used for statistical analysis. Their response to treatment was assessed by clinical follow-up.Results Endometrial thickness and ER and PR levels in DUB patients were significantly higher. In cases showing hyperplastic endometria, ER and PR levels were higher than patients with normal histology. In contrast to hyperplastic tissue, steroid receptor levels decrease in hyperplastic tissue containing atypia.Conclusion Altered endometrial morphology and increased receptor levels in DUB patients suggest that unopposed estrogen effect could have an important role in the pathogenesis of DUB. Cases of DUB, which showed atypical hyperplasia, may have a down-regulation of these receptors and could be a precursor lesion to carcinoma and thus do not respond to medical therapy by hormones.     

从奇经八脉理论辨治崩漏的古代文献考略

崩漏是妇科的常见病与疑难重症之一,古代中医文献中有关崩漏病因病机及治则治法的研究记载极为丰富,而从奇经八脉理论辨治崩漏是其中一个重要的组成部分。其发展源流,滥觞于内经时期,历经数千年众多医家的完善发展,流传至今;而究其辨证要点当先审具体经脉,辨明寒热虚实,再结合脏腑辨证。     

Perimenopausal Dysfunctional Uterine Bleeding: Physiology and Management

The perimenopause is the bridge between reproductive and post-reproductive life and within it is included the menopause itself. Perimenopause may be defined in temporal, physiological, biological or symptomatic terms. Currently in Canada, there are about four million peri- and post-menopausal women, and their numbers will increase significantly over the next decade as the “boomers” join their ranks. As a result of the waxing and waning ovarian function which occurs during the perimenopause, menstrual cycles vary in length, and bleeding is often erratic; sometimes long, other times short, sometimes light, sometimes heavy, frequently with intermenstrual or premenstrual spotting. This unpredictable ovarian function, however, not only is associated with abnormal and dysfunctional uterine bleeding, but also has important implications regarding fertility, both with respect to the achievement of pregnancy and to recommendations for conception prevention and fertility control. A decision about the management of abnormal bleeding, which commonly occurs in this age group, requires that a diagnosis be made. Following a logical diagnostic scheme facilitates this process. Measurement of endometrial thickness by ultrasound is playing an increasingly important role in the workup of perimenopausal women with abnormal bleeding. However, the necessity for endometrial sampling is evident as it provides histological confirmation of the diagnosis and, thus, directs the patient’s subsequent therapy. A variety of treatments, both medical and surgical, is available, the appropriate choice being dictated by an understanding of the physiology of the perimenopause coupled with the results of the investigations. Medical treatment may be hormonal or non-hormonal and includes NSAIDs, antifibrinolytics, progestins used cyclically or continuously, oral contraceptives, progestin-releasing intra-uterine contraceptive devices, danazol, and analogues of gonadotrophin-releasing hormone. The commonest surgical approaches are diagnostic and therapeutic hysteroscopy, endometrial ablation, and hysterectomy.     

曼月乐环联合补肾安冲汤用于围绝经期功血的临床观察

目的临床观察曼月乐环联合补肾安冲汤治疗围绝经期功血的效果。方法选取120例围绝经期功血患者,随机分为治疗组(曼月乐+补肾安冲汤)60例、对照组(曼月乐)60例,对比两组治疗前后阴道出血时间、血清NO含量、子宫内膜的厚度、月经血中血清PGE2和PGF2α的含量,比较两组中医的症候疗效、随访一年功血复发率。结果治疗组在放置曼月乐环并口服中药补肾安冲汤3个月后,阴道出血时间减少(P0.05),子宫内膜厚度变薄(P0.05),月经血中NO含量明显降低(P0.05),PGF2α含量明显升高,PGE2/PGF2α的比值显著降低(P0.05),治疗组中医的症候疗效中有效率明显升高(P0.05),治疗后随访一年,功血复发率明显降低(P0.05)。结论曼月乐环联合补肾安冲汤用于围绝经期功血的治疗,能够有效减少阴道出血的时间,临床疗效非常满意。