宫颈评分监测氯菧酚胺诱发排卵的评价

本文分析33例无排卵患者应用氯菧酚胺治疗76周期中宫项评分(CS)与BBT、卵泡发育及激素参数的关系。19个周期无排卵反应,CS波动,但宫项粘液透明性状不变。57个周期有排卵反应,其中32周期停药后CS渐进增高,最高宫颈评分MCS≥8,卵泡发育好,LH峰后24h内排卵;22周期MCS<8,LH峰后卵泡不消失,形成LUF,激素测定提示停药后睾酮水平明显升高;另三个周期资料不全。结果提示停药后未见药物在宫颈水平的抗雌素效应;睾酮升高可能干扰CS并导致LUF。     

454例足月妊娠胎膜早破妊娠结局的临床分析

目的:探讨胎膜早破与分娩方式及围产儿不良结局的关系,为临床围产期保健和并发症防治提供参考。方法:对2005年1月至2008年12月在我院住院分娩的454例足月妊娠无骨盆异常胎膜早破的病例进行回顾性分析。结果:胎膜早破占同期分娩总数的11.76%,无骨盆异常,其难产率为46.47%,剖宫产率为33.7%,新生儿窒息率10.79%,新生儿肺炎发生率1.54%,明显高于对照组。结论:胎膜早破与难产互为因果关系,及时终止妊娠,以改善新生儿预后,减少母婴并发症。     

卵巢子宫内膜异位症恶性变25例临床分析

目的 探讨卵巢子宫内膜异位症恶性变的临床表现、病理特征、治疗方法和预后。方法 回顾性分析２５例卵巢子宫内膜异位症恶性变患者和病量资料。结果 卵巢子宫内膜异位症恶性变患者的主要症状为盆腔包块、腹胀、腹痛、异常阴道流血和流液。病理类型为子宫内膜样癌１４例,透明细胞癌２例,腺棘癌２例,浆液性腺癌１例,混合性卵巢上皮性癌６例,镜下均可见良性的异位子宫内膜向恶性移行的证据。临床分期为Ⅰ１４例,Ⅱ期７例,Ⅲ期３例,Ⅳ期１例。治疗方法均采用肿瘤细胞减灭术＋化学治疗。患者５年生存率达７７．７％。结论 卵巢子宫内膜异位症恶性变的确切发生率难以估计,该病的治疗以肿瘤细胞减灭术＋化学治疗为主。     

妊娠肝内胆汁淤积症1241例发病特点分析

目的探讨妊娠肝内胆汁淤积症(ICP)的发病特点。方法采用回顾性分析的方法,对我院1991年1月至2000年12月收治的1241例ICP患者的临床资料进行回顾性系统分析。结果1241例ICP患者中,多胎妊娠44例(3．5％),合并妊娠高血压综合征(妊高征)。101例(8．1％);。126例经产妇中,38例(30．2％)为ICP复发;有发病时间记录的1230例患者的平均发病孕周为32．6周,孕晚期发病有1100例(88．6％);1201例(96．8％)以皮肤瘙痒为首发症状,也有以黄疸(8例,占0．6％)、肝功能异常(28例,占2．3％)等为起始表现者;生化指标中主要以血清总胆汁酸(TBA)、丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)升高为主,但大多为轻、中度升高;也有患者TBA、ALT或AST正常(分别占17．7％、15．6％、17．1％),少数患者(35例,3．2％)白蛋白／球蛋白比值倒置。结论 (1)ICP具有复发性,多胎妊娠孕妇更易发病,瘙痒常是ICP显著而且首发的症状,TBA和肝脏转氨酶升高有助于该病的诊断。(2)少数患者发病时临床表现及实验室检查结果均不典型,对此要引起警惕。     

妊娠肝内胆汁淤积症患者的胎儿淋巴细胞研究

目的探讨胎儿淋巴细胞在妊娠肝内胆汁淤积症(ICP)发病中的作用。方法采用单向混合淋巴细胞反应法,检测20例ICP患者(ICP组)及20例正常孕妇(对照组)的脐血胎儿淋巴细胞与母体外周血已灭活的淋巴细胞、皮肤组织可溶性抗原、蜕膜组织可溶性抗原的增殖反应情况。结果(1)ICP组脐血胎儿淋巴细胞与母体已灭活的淋巴细胞混合反应中,胎儿淋巴细胞的增殖反应程度为2．75±0．36,显著高于对照组的1．45±0．19,两组比较,差异有统计学意义(P＜0．05);(2) ICP组脐血胎儿淋巴细胞与母体蜕膜组织可溶性抗原混合反应中,胎儿淋巴细胞的增殖反应程度为1．45±0．19,显著高于对照组的0．67±0．24,两组比较,差异有统计学意义(P＜0．05);(3)ICP组脐血胎儿淋巴细胞与母体皮肤组织可溶性抗原反应中,胎儿淋巴细胞的增殖反应程度为1．22±0．44,显著高于对照组的0．66±0．27,两组比较,差异有统计学意义(P＜0．05)。结论胎儿淋巴细胞可能是ICP发病过程中的主要效应细胞之一;母-胎间免疫失衡是ICP发病的重要机制之一。     

卵巢癌脑转移2例临床分析

统计443例卵巢癌患者中2例卵巢癌脑转移患者的临床资料,包括患者的一般资料、卵巢癌脑转移前后的治疗方式、卵巢癌脑转移后生存时间等。文献报道卵巢癌脑转移发病率为0.29%～12%,笔者统计为0.5%,年龄及治疗措施是影响预后的最重要因素。本文中2例患者,1例患者卵巢癌脑转移后采取多模式综合治疗,脑转移后生存期已30个月余;另1例卵巢癌患者确诊年龄＜50岁,脑转移确诊时60岁,两者确诊时间间隔13年,佐证了近年来文献中对影响卵巢癌脑转移发病率及预后因素的报道,手术结合放化疗的多模式综合治疗可有效缓解卵巢癌脑转移症状,延长生存期。雄激素受体表达情况、乳腺癌易感基因（BRCA）突变有望成为卵巢癌脑转移标志性事件。     

Comparison of the Effect on the Ovarian Reserve of Modern Methods of Treatment of Endometrioid Cysts

ObjectiveTo compare the efficacy and safety of autologous platelet-rich plasma (PRP) therapy in laparoscopy and transvaginal sclerotherapy for the treatment of endometrioid cysts for maintaining ovarian reserve.MethodsThe study included 71 women under age 35 years with primary and secondary infertility. Twenty women underwent sclerotherapy of endometrioid cysts followed by autologous PRP injection into ovarian tissue, and 21 underwent laparoscopic cyst removal by stripping followed by autologous PRP injection. The control group consisted of 30 women who underwent laparoscopic cystectomy by stripping without autologous PRP injection. We assessed ovarian reserve for all patients before surgery as well 3 and 6 months after surgery by measuring serum anti-Müllerian hormone (AMH) levels and calculating antral follicle count using ultrasound.ResultsIn the control group, AMH levels had decreased significantly at 3 and 6 months post-surgery, whereas levels in laparoscopy and PRP group remained almost unchanged from initial levels. In the sclerotherapy group, we observed a tendency towards increased AMH levels, but it was not statistically significant when compared with initial results. Follicle count changes were similar to AMH patterns.ConclusionIn this study, sclerotherapy in combination with PRP therapy for ovarian endometriomas was associated with improved measures of ovarian reserve, and the combination of laparoscopic excision of the endometrioma with PRP therapy facilitated ovarian reserve preservation.     

阴道平滑肌瘤25例临床分析

目的 探讨阴道平滑肌瘤的组织来源、临床特点和治疗方法。方法 回顾性分析1988年1月-1999年1月在我院住院手术并经病理检查证实的阴道平滑肌瘤25例。结果 阴道平滑肌瘤多高产田单雪,生长缓慢,症状与肿瘤的大小及部位有关,可复发及恶性变。治疗方式为阴道平滑肌瘤剔除术,结论 阴道平滑肌瘤临床少见,一旦发现,均应及时手术治疗,以免肌瘤增大产生症状甚至恶性变。     

早产儿视网膜病107例临床特点及预后分析

摘要：目的　评价早产儿视网膜病（ROP）临床特点及远期治疗效果。方法　回顾性分析2004-01-01—2009-07-31复旦大学附属儿科医院新生儿科收治的107例ROP患儿临床资料、ROP分期、治疗情况及远期预后。结果　1期和2期ROP共64例,6例2期病变达Ⅰ型阈值前病变而采用激光治疗,其他均未进行特殊治疗;除失访和死亡病例外,所有随访病例ROP病变均消退,远期视力不受影响。3期病变15例,其中14例达阈值病变者给予激光或冷凝治疗,1例未达阈值病变者不需要治疗。有完整随访资料的11例患儿中3例术后视力严重受损,仅存在光感,其余8例视力正常。4期和5期ROP共28例,随访的18例患儿中,仅1例手术后保存了正常视力（占5.6％）,失明者达12例（占66.7％）,其余5例虽保存视力,但视力极差,仅存光感（占27.7％）。结论　ROP防治关键在于预防ROP发生,当出现ROP早期病变时应严格筛查和及时干预,一旦疾病进入晚期,出现视网膜脱离时再治疗,则治疗效果不佳。     

产前应用地塞米松和沐舒坦对胎鼠及仔鼠肺组织Toll样受体4表达影响的比较

目的 比较产前单次应用小剂量地塞米松与联合应用地塞米松加盐酸氨溴索(沐舒坦)对胎鼠及仔鼠肺Toll样受体4(Toll-like receptor 4,TLR4)基因及蛋白表达的影响. 方法 54只SD孕鼠随机分为3组:地塞米松组(干预组1)、地塞米松加沐舒坦组(干预组2)和生理盐水对照组.妊娠17 d,腹腔注射给药,干预组1予地塞米松0.2 mg/kg,干预组2予地塞米松0.2 mg/kg加沐舒坦100 mg/kg,对照组予等体积生理盐水.分别在妊娠19d及生后3、7d取胎(仔)鼠肺组织,通过逆转录聚合酶链反应、免疫组织化学和蛋白质免疫印迹技术检测各组胎(仔)肺组织中TLR4基因转录水平及蛋白表达差异.统计学方法 采用方差分析和独立样本t检验. 结果 (1)孕19 d,2个干预组分别与对照组相比,TLR4 mRNA在胎鼠肺组织中的表达均明显增加(对照组:0.26±0.18,干预组1:0.39±0.21,t=5.866,P＜0.05;对照组:0.27±0.22,干预组2:0.46±0.13,t=9.572,P＜0.01).生后3d和7d干预组2与对照组相比,TLR4 mRNA在仔鼠肺组织中的表达均明显增加(生后3 d:0.59±0.23与0.47±0.24,t=2.295,P＜0.05;生后7 d:0.52±0.12与0.35±0.17,t=4.219,P＜0.05),但干预组1与对照组比较,差异无统计学意义(生后3 d:0.45±0.22与0.44±0.14,t=0.128,P＞0.05;生后7 d:0.40±0.16与0.36±0.12,t=1.365,P＞0.05).(2)免疫组织化学:孕19 d,2个干预组分别与对照组相比,TLR4蛋白表达量在胎鼠肺组织中的表达均明显增加(对照组:0.20±0.29,干预组1:0.35±0.32,t=7.179,P＜0.05;对照组:0.20±0.29,干预组2:0.39±0.25,t=10.764,P＜0.01).生后3d和7d干预组2与对照组相比,TLR4蛋白表达量在仔鼠肺组织中的表达均明显增加(生后3 d:0.55±0.32与0.37±0.18,t=7.121,P＜0.05;生后7d:0.41±0.29与0.25±0.24,t=6.355,P＜0.05),但干预组1与对照组比较,差异无统计学意义(生后3 d:0.40±0.21与0.37±0.18,t=0.683,P＞0.05;生后7 d:0.28±0.31与0.25±0.24,t=0.462,P＞0.05).免疫印迹法:孕19 d,2个干预组分别与对照组相比,TLR4蛋白表达量在胎鼠肺组织中的表达均明显增加(对照组:0.15±0.12,干预组1:0.27±0.20,t=7.835,P＜0.05;对照组:0.16±0.18,干预组2:0.34±0.16,t=10.470,P＜0.01).生后3d和7d干预组2与对照组相比,TLR4蛋白表达量在仔鼠肺组织中的表达均明显增加(生后3 d:0.37±0.20与0.25±0.22,t=6.379,P＜0.05;生后7 d:0.35±0.15与0.24±0.13,t=5.152,P＜0.05),但干预组1与对照组比较,差异无统计学意义(生后3 d:0.32±0.26与0.25±0.16,t=1.167,P＞0.05;生后7 d:0.29±0.19与0.24±0.10,t=1.248,P＞0.05). 结论 小剂量地塞米松可能参与调控大鼠胎肺中TLR4表达的上调,这可能是糖皮质激素促胎肺成熟的重要机制之一;小剂量地塞米松联合沐舒坦产前应用可能不仅参与调控大鼠胎肺组织中TLR4表达的上调,也上调生后大鼠肺中TLR4的表达.     

双胎之一胎儿宫内死亡原因及处理19例临床分析

目的 :探讨双胎妊娠中一个胎儿宫内死亡的原因及处理。方法 :回顾性分析 1995～ 2 0 0 0年我院收治的 19例双胎之一胎儿宫内死亡的原因及妊娠结局。结果 :5例 <2 8周者 4例放弃胎儿作引产术 ,1例孕 2 6周及 7例 2 8～ 34周从确诊一个胎儿死亡后继续保胎到存活儿分娩 ,平均延长 6周 ,5例 >34周者确诊后随即行剖宫产 ,此 13例新生儿均存活。另 2例足月但未及时处理 ,活胎死亡。死亡主要原因 :脐带因素 2例、帆状胎盘 3例 ,胎儿畸形 2例 ,原因不明 12例。妊娠并发症比例较高占 6 3.16 %。结论 :孕周 <2 8周者一般作终止妊娠处理 ;妊娠 2 8～ 34周存活的胎儿继续妊娠到孕 34周预后良好 ;对孕 34周以后发现的应及时终止妊娠抢救存活儿     

Determinants of the outcome of intrauterine insemination: Analysis of outcomes of 9963 consecutive cycles

Objective: Our aim was to determine which factors influence the effectiveness of intrauterine insemination. Study Design: This article is a retrospective statistical analysis of outcomes of 9963 consecutive intrauterine insemination cycles. Results: Patient age was the main determinant of pregnancy outcome (analysis of variance F ratio = 29, P < .0001), followed by the number of follicles at the time of intrauterine insemination (analysis of variance F ratio = 9, P < .0001) and sperm motility in the inseminate (analysis of variance F ratio = 4, P = .002). A total of 18.9% of all patients <26 years old conceived, compared with 13.9% of those 26-30 years old, 12.4% of those 31-35 years old, 11.1% of those 36-40 years old, 4.7% of those 41-45 years old, and 0.5% of patients >45 years old (P < .001). When analyzed by single years, ongoing pregnancy rates after intrauterine insemination remained high through age 32 years. Across all ages and causes of infertility, 7.6% of patients with 1 follicle at the time of intrauterine insemination conceived, compared with 10.1% with 2, 14.0% with 4, and 16.9% with 6 follicles (P < .01). When ovulation occurred before intrauterine insemination (ie, no visible follicular structures), 4.6% of patients conceived. The likelihood of pregnancy was maximized when motile sperm numbers were ≥4 million and sperm motility was ≥60%. Differences in pregnancy outcomes between sperm processing options were related to differences in sperm motility after processing; use of methods incorporating motility enhancement with pentoxifylline and motile sperm concentration through silica gradients yielded the highest overall pregnancy rates. Conclusion: When the results of ongoing retrospective analysis of intrauterine insemination outcomes are applied, overall intrauterine insemination pregnancy rates have increased from 5.8% per cycle in 1991 to 13.4% per cycle in 1996, during which time the average age of patients undergoing intrauterine insemination has increased from 36.1 (±0.2) to 39.2 (±0.1) years. (Am J Obstet Gynecol 1999;180:1522-34.)     

A critical review of patient-rated quality of life studies of long-term survivors of cervical cancer

OBJECTIVES: Increasing survival rates of cervical cancer (CC) patients and the trend towards more toxic multimodal therapy have led to focus on the quality of life (QOL) of cervical cancer survivors (CCSs). The aim of this critical review was to summarize and discuss the research findings of QOL in CCSs based on self-report measures in terms of physical, psychosocial, and sexual well-being. METHODS: Electronic databases were used to identify studies published between 1966 and August 2005. A quality assessment using methodological and treatment-related criteria was performed to distinguish between studies with good and less good methodology. RESULTS: Twenty-three studies were included, whereof eight had a good methodology. Eight studies used at least one questionnaire that had not been validated previously, and only one of the validated questionnaires had been tested in former studies of CCSs. The studies with good methodology focused primarily on sexual and social function after treatment, and less on physical and psychological well-being. The trend is that radiotherapy is more associated with reduced QOL dimensions than surgery or chemotherapy. In earlier stages of CC and following surgery alone, there seem to be minor differences between CCSs and control groups concerning various QOL domains. CONCLUSIONS: Reviewed studies indicate that quality of life in cervical cancer survivors is reduced compared to the general female population following radiotherapy, but less so following surgery and earlier stages of cervical cancer. Shortcomings of both methodology and content of the studies reviewed preclude definite conclusions concerning QOL for the moment.     

子宫内膜异位症动物模型的构建

目的 :建立人子宫内膜异位症的移植动物模型。方法 :将子宫内膜异位症患者的在位内膜及异位内膜种植于SCID小鼠腹部皮下 ,观察其生长情况 ,留取标本行病理检查。结果 :从SCID小鼠腹部皮下取出成活的内膜组织 ,其形态和结构与原内膜组织一致。结论 :成功地建立了SCID小鼠子宫内膜异位症模型 ,为研究子宫内膜异位症的发病机理和药物治疗提供了实验动物模型     

胎膜早破162例临床分析

目的探讨胎膜早破与难产及母儿并发症的关系.方法对829例无妊娠合并症及并发症的产妇资料进行回顾性分析,其中胎膜早破病例162例,胎膜未破病例682例作为对照组.结果胎膜早破组的剖宫产率、早产率、新生儿窒息及肺炎发病率均较对照组显著升高,母亲产褥病率两组间无差异.破膜距妊娠结束时间及早产与新生儿窒息及肺炎关系密切.结论胎膜早破与难产互为因果关系.对不同孕周胎膜早破患者应采取不同治疗方案,以尽可能减少母儿并发症.     

克罗米芬对增殖期子宫内膜组织形态影响的定量研究

应用图像分析仪，定量分析１４例因男方因素（６例）或不明原因（８例）不孕妇女克罗米芬（ＣＣ）用药前、后增殖期子宜内膜细胞结构及ＤＮＡ含量。结果：ＣＣ周期第１２天子宜内膜细胞核ＤＮＡ含量显著低于自然周期同期水平，表面上皮、腺上皮细胞核面积、核周长、核最大直径小于自然周期值，面积减小程度与ＤＮＡ量下降程度呈正相关。提示：ＣＣ抑制ＤＮＡ合成，影响上皮细胞核增殖、分裂及细胞结构，作用机理可能与ＣＣ在受体水平阻断雌二醇作用有关。     

Management of complications of mesh surgery

Polypropylene mesh (PPM) has been used in abdominal sacrocoplopexies since the 1990's however following a patient led campaign controversy surrounds its use incontinence procedures, midurethral slings (MUS) and vaginal mesh prolapse repairs. The complication rates following mesh surgery may be as high as 10%. NHS England paused the vaginal insertion of polypropylene mesh in July 2018 pending a review by Baroness Cumberledge. This review will outline the assessment and basic management of complications of polypropylene mesh. This is a relatively new area of urogynaecological practice which non-specialist obstetric and gynaecology clinicians and GPs need to be aware of. Symptoms which could be due to mesh complications are vaginal discharge or bleeding, recurrent urinary tract infection, haematuria, dyspareunia and pelvic pain. Women presenting with any of the above symptoms should be asked if they have had previous surgery for stress incontinence or prolapse. The women may not recall having mesh inserted and may use different terms “sling” “net” or “tape”. They should be examined to both look and feel for PPM. Mesh complications should be managed by the designated mesh centres which are listed on the BAUS and BSUG websites. All mesh complications should be reported to the Medicines & Healthcare products Regulatory Agency (MHRA) by the yellow card system. All mesh complications requiring further surgical intervention should be recorded on the British Society of Urogynaecology (BSUG) national database.     

Rapid evaluation of the absence of inflammation after rupture of membranes

Abstract

Objectives: The aim of this study was to validate the results of an immunochromatographic bedside test to detect IL6 and IL8 in vaginal secretions after rupture of membranes (ROM) with results obtained by ELISA tests.

Methods: A prospective cohort of 60 women with ROM or preterm ROM (PROM) was recruited. An immunochromatographic bedside test was performed with vaginal secretions samplings at admission, every 48?hrs until labor and during labor. Remaining samples were frozen for ELISA analysis. The results of bedside tests were compared to those from ELISA analysis for 114 samples.

Results: With all samples combined, the positive predictive values were 50% for IL6 and 86.8% for IL8 and the negative predictive values were 97.4% for IL6 and 53.3% for IL8. Kappa coefficients were 0.54 for IL6 and 0.41 for IL8.

Conclusion: Our findings show that a bedside test can detect the absence of IL6 in vaginal secretions. This result suggests that bedside test could be used for expectant management after premature PROM to inform the attending physician of the absence of inflammation in vaginal secretions.