子宫内膜异位症不孕患者子宫内膜整合素av、β3表达的初步探讨

目的:探讨子宫内膜异位症是否影响子宫内膜容受性而造成不孕。方法:前瞻性研究我院2004年1月到2005年6月经手术病理确诊的子宫内膜异位症不孕患者胚胎种植窗期血清孕激素、雌激素浓度,组织学分期和子宫内膜整合素av、β3的表达,并与同期已育妇女的指标作比较。结果:15例子宫内膜异位症不孕患者中Ⅰ期和Ⅱ期共8例(研究1组),Ⅲ期和Ⅳ期共7例(研究2组),与16例对照组比较,血清孕激素和雌激素浓度差异无统计学意义。病理组织学确诊的黄体功能不足差异无统计学意义。子宫内膜整合素β3的表达差异无统计学意义,子宫内膜整合素av的表达差异有统计学意义(P<0.05),且仅Ⅲ期和Ⅳ期子宫内膜异位症子宫内膜整合素av的表达差异有统计学意义(P<0.01)。结论:初步证实Ⅲ~Ⅳ期子宫内膜异位症不孕患者子宫内膜容受性标记物-子宫内膜整合素av的表达下降,与其导致不孕和流产相关,值得进一步进行大样本的研究。     

宫腹腔镜联合诊治不孕症的临床分析

目的运用宫腹腔镜联合检查治疗不孕症的疗效。方法选取我院2012年~2014年收治的不孕症患者70例为研究对象,其中原发不孕24例,继发不孕46例。这些患者不孕原因均排除男方因素引起的不孕症。结果 70例患者中盆腔炎性疾病后遗症28例(40%),盆腔子宫内膜异位症14例(20%),卵巢囊肿5例(7.1%),多囊卵巢6例(8.5%),子宫畸形7例(10%),子宫内膜息肉4例(5.7%),正常盆腔2例(2.8%),盆腔结核2例(2.8%),宫腔粘连2例(2.8%),复通成功率为70%,妊娠率为67%。结论宫腹腔镜联合检查能准确诊断不孕原因,并处理子宫及盆腔疾病,增加不孕症妇女的妊娠率,是一种安全有效的治疗方法。     

不孕症患者临床情况与子宫内膜息肉的关系研究

目的:探讨不孕症患者临床情况和子宫内膜息肉的关系,为临床诊治提供参考。方法:收集2008年11月至2009年10月间于本院行宫腹腔镜联合检查的244例不孕患者的临床资料,分别进行年龄、不孕年限、腹腔镜检查盆腔疾病和孕产史等与子宫内膜息肉发生的关系分析。同时分析B超检查与宫腔镜检查子宫内膜息肉的一致性。结果:不孕患者年龄、盆腔炎症情况在不同组别间子宫内膜息肉发生率差异无统计学意义(P均>0.05)。而不孕年限、孕产史以及子宫内膜异位症和子宫内膜息肉发生有关。随不孕年限增加,子宫内膜息肉发生率呈增高趋势(P=0.034),原发不孕组比继发不孕组子宫内膜息肉发生率高(15.71%vs5.8%,P=0.016),子宫内膜异位症组比无子宫内膜异位症组的子宫内膜息肉发生率高(19.0%vs7.5%,P=0.007)。宫腔镜检查子宫内膜息肉阳性率高于B超检查(11.5%与6.6%,P=0.000)。结论:子宫内膜息肉发生与不孕症患者不孕年限、病因、孕产史等因素相关,B超结合宫腔镜检查是排除内膜息肉有效手段。     

早期黄素化:可能为早期的卵巢低储备?

对31例原因不明的不孕妇女进行研究。31例均有正常排卵且黄体中期孕激素水平>10ng/ml,HSG和/或宫腔镜检查子宫腔正常。阴道超声检查为多囊卵巢、HSG及腹腔镜检查为输卵管阻塞、盆腔粘连、子宫内膜异位症病例除外。按照WHO标准的男性不育病例除外。卵巢基础储备研究包括:在卵巢刺激前2个月于自然月经周期第3天查血FSH、E_2、LH水平,所有夫妇在应用hMG超排卵治疗同时行IUI。     

白血病抑制因子在子宫内膜异位症并发不孕患者黄体中期子宫内膜中的表达

目的:探讨白血病抑制因子(LIF)在子宫内膜异位症(EM)导致不孕机制中的作用。方法:采用原位杂交及免疫组织化学方法对15例异位症并发不孕患者黄体中期子宫内膜中的LIF mRNA及其蛋白的表达进行定位及半定量分析,并以15例有生育妇女作为对照组。结果:子宫内膜异位症组LIF mRNA平均光密度为3.12±0.32,LIF蛋白平均光密度为9.31± 2.10,显著低于对照组的6.25±2.14与15.70±1.52(P<0.05)。结论:子宫内膜异位症组黄体中期子宫内膜LIF表达下降可能是其不孕的原因之一。     

子宫内膜异位症、慢性盆器炎和盆腔疼痛患者腹水中的前列腺素和其同属

目前,尽管输卵管阻塞,输卵管周围粘连和排卵机能障碍是不孕症的明显原因,但许多原因不明的不孕症妇女有子宫内膜异位症,仍为一未解决的问题。子宫内膜异位症妇女不孕的原因,可能是免疫机能的改变和盆腔内前列腺素水平的改变,导致输卵管节律运动障碍,而使胚泡的成熟和到达子宫腔受影响。     

子宫内膜异位症患者术后不孕原因分析

目的 :分析子宫内膜异位症伴不孕患者腹腔镜术与开腹手术后仍然不孕的原因。方法 :选择 10 3例有手术指征的子宫内膜异位症伴不孕患者 ,分为腹腔镜与开腹手术两组进行手术治疗 ,术后口服孕三烯酮 3～ 6个月 ,随访患者 2年内妊娠情况 ,分析术后不孕的原因。结果 :子宫内膜异位症伴不孕患者腹腔镜术后 2年内妊娠率为 5 5 .2 0 % ,开腹手术 5 0 .0 0 % ,总妊娠率为5 2 .74 % ,两组妊娠率差异无显著性 (P >0 .0 5 ) ;子宫内膜异位症分期程度与输卵管通畅程度差异无显著性 (P >0 .0 5 )。术后不孕原因中 ,输卵管不通占 37.2 1% (16 / 4 3) ,子宫腺肌病 13.95 % (6 /4 3) ,子宫内膜异位症复发 9.30 % (4/ 4 3) ,子宫内膜异位症合并子宫肌瘤 6 .98% (3/ 4 3) ,既往有两次开腹史者 4 .6 5 % (2 / 4 3)。另外还有 2 7.91% (12 / 4 3)输卵管通畅但不孕原因未明。结论 :治疗子宫内膜异位症伴不孕应选手术治疗 ,有条件首选腹腔镜手术 ;术后不孕与输卵管不通关系密切 ,子宫内膜异位症合并子宫肌瘤及腺肌病等也是不孕的原因。     

应用腹腔镜诊断慢性盆腔痛244例分析

目的 :探讨腹腔镜在慢性盆腔痛 (chronic pelvic pain,CPP)病因诊断中的应用。方法 :对 2 44例 CPP患者行闭合式腹腔镜检查 ,术前行盆腔 B超检查。结果 :腹腔镜证实有病理改变者占 83.6 0 % ,其中慢性盆腔炎症、粘连占5 1.2 3% ,子宫内膜异位症占 33.6 1% ,卵巢囊肿占 3.6 9% ,盆腔瘀血症占 2 .87%。术前 B超发现有病理改变并经腹腔镜证实者占 2 2 .95 % ,B超准确率为 2 7.45 %。结论 :腹腔镜能明确大部分的 CPP病因 ,可作为诊断 CPP病因的常规和首选的手段     

腹腔镜检查不育症盆腔疾病916例分析

目的应用腹腔镜诊断技术,评价腹腔镜诊断不育症的价值。方法采用德国Storz型腹腔镜,对916例不育症妇女的盆腔疾病和不育的影响进行分析。结果916例妇女中837例(91．37％)找到了盆腔疾病的病因。盆腔粘连、子宫内膜异位症和输卵管炎是引起不育症的主要盆腔疾病。除宫内膜异位症外,原发不孕症中,又以内生殖器官发育异常、盆腔结核、多囊卵巢多见。继发不孕症以盆腔粘连、输卵管炎多见。继发不孕组中,有宫腔操作史占98．40％。结论应用腹腔镜诊断技术对不育症的诊断价值在于能早期明确不育症盆腔病因,可在直视下通液,动态观察输卵管通畅度和形态,并对由于盆腔疾病所引起的不育症的预后影响作出一定判断。     

子宫内膜异位症累及卵巢对未破裂黄素化卵泡发生频度的影响

子宫内膜异位症在生殖年龄妇女中的发病率高达10%,在女性不孕中,子宫内膜异位约占20%。未破裂卵泡黄素化(LUF)综合征指排卵期虽无排卵,但卵泡通过自行黄素化而出现黄体期相应改变的现象。现已发现在子宫内膜异位症不育患者中,LUF综合征的发生率明显增高,且与子宫内膜异位症病变程度相关。本文采取前瞻性分析方法,对126例22～55岁的不孕妇女施行诊断性腹腔镜检查。根据修订的美国生殖协会阶段评分标准进行分期。LUF的诊断标准为:连续B超监测无排卵征象,尽管血清孕酮水平升高,但黄体期行腹腔镜检未见排卵裂孔。本研究的目的在于评估不孕的…     

Luteal phase in infertility: problems of evaluation

This study was undertaken to examine the endometrial data in 200 infertile women whose three progesterone estimations per cycle totaled over 15 ng/ml when taken from 11 to 4 days preceding menstruation. Forty-three patients (21.5%) showed defective endometria in two separate cycles. No difference was found when plasma progesterone concentrations in this group were compared with those of the remaining 157 infertile patients with normal endometria. Further, plasma progesterone in infertile women (both groups) was similar to a control group of 12 fertile women with normal secretory endometria. Endometrial biopsy is essential in the evaluation of luteal function in infertility and cannot be totally replaced by the use of plasma progesterone in three samples during the luteal phase since it failed to detect as much as 21.5% of abnormal secretory phases.     

不孕症患者合并卵巢肿瘤的临床特点分析

目的 探讨不孕症患者合并卵巢肿瘤的临床特点、诊断、手术处理及妊娠结局。方法 回顾性分析1999年1月1日—2004年12月31日在浙江大学医学院附属妇产科医院生殖内分泌科因不孕症住院手术后经病理检查证实的110例卵巢肿瘤患者的临床资料。按病理检查结果分为卵巢上皮性肿瘤组（上皮性肿瘤组）、畸胎瘤组和其他组,分别为49、42、19例。结果 上皮性肿瘤组、畸胎瘤组和其他组的术前确诊率分别为29％、81％和63％,前组明显低于后两组（P〈0．01）。110例患者中,97例为直径〈5cm的卵巢小肿瘤患者;97例完成腹腔镜下卵巢肿瘤剔除手术,11例行开腹手术,2例腹腔镜检查后转开腹手术;上皮性肿瘤组合并盆腔致密粘连的发生率为61％,明显高于畸胎瘤组的26％（P〈0．01）。有随访结果的102例患者中,共45例妊娠,妊娠率44％,其中18例自然受孕,21例体外受精妊娠,6例人工授精妊娠。结论 （1）不孕症合并卵巢肿瘤以直径〈5em的小肿瘤为主,术前诊断率低,腹腔镜检查可明确诊断。（2）卵巢上皮性肿瘤合并慢性盆腔炎发生率较高,术中应认清解剖关系,完整剔除肿瘤,同时尽量保护卵巢功能。（3）不孕症合并卵巢肿瘤患者在手术和辅助生育治疗后可获得良好的妊娠结局。     

Subtle variations in tubal anatomy in infertile women

The frequency of tubal variations was recorded in 100 infertile and 100 fertile women at cesarean section. The infertile women had significantly more tubal/pelvic anatomical variation than did their fertile counterparts. Fimbrial agglutinations (25%), accessory tubes (13%), accessory ostia (10%), phimoses (13%), and sacculations (7%) were found more commonly in the infertile women. Paratubal cysts were found with equal numbers in both groups. There was no statistical difference in history of sexually transmitted disease/pelvic inflammatory disease (PID) or endometriosis. No significant relationship between a positive PID history and fimbrial agglutination was found; the majority of agglutinations were present with no associated adhesions.     

Pelvic schistosomiasis and infertility

The use of laparoscopy allowed us to diagnose asymptomatic pelvic schistosomiasis in 13 infertile women. The lesion was associated with dense pelvic adhesions in all cases, a defective luteal phase in 23.1% of the women and anovulation in 15.4%. Atraumatic adnexolysis, antibilharzial treatment and correction of ovulatory defects were followed by intrauterine pregnancy in 46% of the patients.     

生育镜在不孕症诊治中的应用

目的探讨生育镜用于不孕症诊治的价值。方法用生育镜[包括经阴道注水腹腔镜（THL）与宫腔镜]对115例不孕症患者进行盆腔检查,观察内容包括输卵管通畅性、盆腔粘连情况等,以及盆腔完全评价率（即盆腔器官是否能被生育镜全部观察到）及术中、术后并发症。同时行THL下输卵管通液术和宫腔镜下输卵管口插管通液术。穿刺套管针成功从后穹窿穿刺入子宫直肠陷凹110例,其中原发性不孕（原发组）49例,继发性不孕（继发组）61例。既往输卵管检查为双侧阻塞者,原发组21例,继发组22例。结果术后输卵管双侧或一侧通畅者原发组34例（69．4％,34／49）,继发组42例（68．9％,42／61）,两组比较,差异也无统计学意义（P〉0．05）;既往输卵管检查为双侧阻塞者,术后双侧或一侧输卵管通畅者原发组10例（47．6％,10／21）,继发组11例（50．0％,11／22）,两组比较,差异无统计学意义（P〉0．05）。盆腔粘连者原发组21例（42．9％,21／49）,继发组37例（60．7％,37／61）,两组比较,差异无统计学意义（P〉0．05）。两组总的盆腔完全评价率为69．1％（76／110）,其中原发组为77．6％（38／49）,继发组为62．3％（38／61）．两组比较,差异无统计学意义（P〉0．05）。术后需行常规腹腔镜手术者20例（18．2％,20／110）,原发组与继发组分别为4例（8．2％,4／49）和16例（26．2％,16／61）,两组比较,差异有统计学意义（P〈0．05）;其中17例接受了微型腹腔镜手术。术中无盆腔脏器损伤、出血、直肠损伤或穿孔,术后无穿刺部位出血及盆腔感染等并发症发生。结论生育镜用于不孕症的诊治,操作简单、微创、安全、患者依从性好;对于临床或超声检查均无明显盆腔疾病证据的不孕症患者,生育镜可以取代经腹腹腔镜,成为一步到位的盆腔检查方法。     

An assessment of the value of the menstrual history in differentiating acute appendicitis from pelvic inflammatory disease

In acute appendicitis, the most difficult group of patients to evaluate is that of women of childbearing age. The results of a recent report showed that women of this age group with acute appendicitis tend to have the onset of symptoms in the luteal phase of the menstrual cycle. In view of this, and since some forms of pelvic inflammatory disease tend to have the onset of symptoms in the menstrual phase of the cycle, a study was undertaken to determine if menstrual history might be of value in differentiating acute appendicitis and PID. In comparing the onset of symptoms of five groups--1, perforated or gangrenous appendicitis; 2, acute suppurative appendicitis; 3, normal appendix; 4, normal appendix with PID (a subgroup of group 3), and 5, PID only--no difference was found in the percentage of patients presenting in each phase of the menstrual cycle among the groups. The incidence of disease (per day) appeared to remain the same between phases of the cycle in each group, suggesting that patients in all groups present in a random manner in relation to the menstrual cycle. We conclude that the menstrual history does not appear helpful in differentiating acute appendicitis and pelvic inflammatory disease in women of childbearing age.     

不明原因不孕患者着床窗期子宫内膜形态结构与性激素及其受体表达

目的:研究着床窗期子宫内膜形态结构与性激素及其受体表达判断不明原因不孕患者的子宫内膜条件及黄体功能。方法:活检不明原因不孕55例及正常生育16例着床窗期子宫内膜行组织学天数及组织学分型;内膜扫描电镜观察胞饮突。检测黄体功能缺陷8例及子宫内膜反应不良6例着床窗期内膜性激素及其受体。结果:不孕组内膜的发育同步率(63.6%)明显低于正常生育组(93.8%),差异有统计学意义(P<0.05)。不孕组子宫内膜胞饮突数量少,且发育明显滞后于正常生育组。黄体功能缺陷患者着床窗期子宫内膜孕激素受体表达与正常生育组无统计学差异(P>0.05);子宫内膜反应不良患者孕激素受体表达明显低于正常生育组,差异有统计学意义(P<0.05)。结论:着床窗期子宫内膜发育同步性差,内膜容受性欠佳可能是部分不明原因不孕的病因之一。鉴别由黄体功能缺陷抑或子宫内膜反应不良引起的分泌期子宫内膜发育不良,是临床选择治疗方案的关键。     

Peritoneal Fluid Biochemistry in Infertile Women with Mild Pelvic Endometriosis

Although the factors involved in the pathophysiology of endometriosis are probably multiple and interrelated, prostaglandins may play an important role in the infertility of women with mild disease. In the present study, prostaglandin F2 alpha (PGF2 alpha) and 17 beta-oestradiol were measured in the peritoneal fluid of a selected group of infertile women who had mild pelvic endometriosis (without anatomical distortion) and compared with those values in normal women who had no pelvic disease and in women with pelvic infection. Although there was a wide scatter of PGF2 alpha values, the mean (1,066 pg/ml) in the endometriosis group was significantly greater than that in the other 2 groups (542 pg/ml, normal and 688 pg/ml, pelvic infection); the increase was found in both phases of the menstrual cycle. The mean concentration of 17 beta oestradiol was markedly higher in the luteal than the follicular phase in all 3 groups; however, no significant differences were found between the groups. Interestingly, the mean value of PGF2 alpha and 17 beta-oestradiol was higher in women with endometriosis who failed to conceive than in those who became pregnant. An estimation of PGF2 alpha in the peritoneal fluid may have prognostic value in the evaluation of infertile patients, especially those with mild endometriosis or in whom the problem is unexplained.