56例不孕症腹腔镜诊疗临床分析

目的探讨腹腔镜在诊疗因输卵管、卵巢及盆腔原因造成不孕方面的可行性及安全性。方法对我院2005年3月～2006年12月间应用腹腔镜诊治的56例不孕症病例进行回顾性分析,其中输卵管因素40例,卵巢因素10例,盆腔因素6例。结果56例不孕病例经腹腔镜手术的诊治,术后宫内妊娠29例,占51.79%,宫外孕4例,占7.14%,未孕23例,占48.21%。结论不孕症与多种原因有关,对于不明原因的病例用腹腔镜探查可明确病因对症处理,对于因输卵管因素、盆腔粘连、多囊卵巢引起的不孕,应用腹腔镜手术是安全的、可行的,值的广泛推广。     

腹腔镜诊治不孕症患者盆腔病变临床分析

目的探讨应用腹腔镜手术诊治不孕症的临床价值。方法对126例女性不孕症患者行腹腔镜诊断和治疗,观察术后妊娠率。结果 126例中发现盆腔病变117例,占92.86%;慢性盆腔炎是不孕症的第1位病因;其次为子宫内膜异位症、多囊卵巢综合征。腹腔镜手术术后妊娠率为47.50%,1例发生异位妊娠。结论腹腔镜手术对女性不孕症盆腔病变的诊治具有重要的价值。     

腹腔镜用于诊治女性不孕症的临床应用

目的：探讨腹腔镜在诊治不孕症中的应用。方法对78例不孕症患者行腹腔镜检查术,对不孕病因进行诊断,同时根据所查病因在腹腔镜下作出相应的手术治疗。结果盆腔粘连,输卵管阻塞,子宫内膜异位症和多囊卵巢综合征是引起女性不孕症的主要盆腔疾患。78例均行腹腔镜下输卵管通液和各种疾病的治疗。结论腹腔镜技术能早期、迅速明确不孕症输卵管及盆、腹腔病因,融诊断、治疗于一体,具有创伤小、出血少、康复快等优点,增加术后妊娠率,避免了治疗中的盲目性。     

应用宫、腹腔镜诊治不孕症128例分析

我院自1997年开始将宫、腹腔镜联合技术运用于不孕症的诊治，取得一定效果，现报道分析如下。 资料与方法 1．一般资料：2002年3月-2005年12月因不孕症在我院就诊行宫、腹腔镜联合手术的患者128例，其中原发不孕42例，继发不孕86例。年龄23—39岁，不孕年限1-11年，孕次0—5次。术前患者均常规进行B超检查，子宫输卵管造影，配偶精液检查等，以确定具有宫、腹腔镜联合手术指征。     

显微外科手术治疗输卵管因素的不孕症

本院1998年1月～2001年6月,应用显微外科技术行输卵管吻合手术27例,效果满意,现报道如下。 一、资料与方法 1.临床资料 受术者27例,因绝育术后子女夭折、再婚继发不孕症,和原发不孕症而要求行输卵管吻合术。凡无开腹禁忌症,女方月经周期规律,在月经干净后3～7天,行妇科检查,子宫大小、活动、双侧附件正常。配偶精液检查均正常者,按妇科手术常规准备。     

宫腹腔镜联合诊治不孕症23例临床分析

<正>近年来,不孕症患者数量逐渐增加,妇科内镜技术不断发展,宫腹腔镜手术以其微创、出血少、恢复快、并发症少等优点成为越来越多不孕症患者愿意选择的手术治疗方法。我院对子宫、输卵管病变致不孕,采用宫腔镜联合腹腔镜治疗,取得了良好的临床效果,现总结如下。     

腹腔镜对102例女性不孕症诊治的评价分析

目的探讨腹腔镜检查术对女性不孕症的诊治价值。方法回顾性分析腹腔镜检查的102例女性不孕症患者（术后随访2年）,对腹腔镜诊治的结果进行评价。结果镜下诊断盆腔各种病变101例（99.02%）,未发现异常1例（0.08%）。其中输卵管因素54例,子宫内膜异位症34例,卵巢异常8例,子宫异常5例,其他1例。术后随访2年,其妊娠率分别为：输卵管异常31.50%（17/54）,子宫内膜异位症38.24%（13/34）,卵巢异常12.5%（1/8）。结论输卵管因素和子宫内膜异位症是导致女性不孕的主要因素。腹腔镜对诊治输卵管性不孕和子宫内膜异位症,具有快速,准确,可靠,损伤小的特点。     

腹腔镜在治疗输卵管、卵巢性不孕症诊治中的应用

目的:探讨腹腔镜在输卵管、卵巢性不孕症治疗中的疗效及影响因素.方法:对35例不孕症患者行腹腔镜诊疗,其中原发性不孕症11例、继发性不孕症24例.结果:35例手术均顺利,无并发症.术后29例获随访,随访3～18个月,术后宫内妊娠率达37.93%(11/29).结论:腹腔镜手术对输卵管远端阻塞、盆腔粘连及肿块导致输卵管扭曲的不孕症有良好的治疗效果,对不明原因的不孕症能尽早明确诊断.     

腹腔镜输卵管修复整形术治疗输卵管积水性不孕效果分析

目的：探讨腹腔镜输卵管修复整形术治疗输卵管积水性不孕的临床疗效。方法回顾分析采用腹腔镜输卵管修复整形术治疗的118例输卵管积水性不孕症患者的临床资料,观察和比较不同积水程度患者的疗效。结果本组术后共27例(22.88%)成功妊娠,其中,输卵管积水高评分组14例(46.67%),中评分组10例(16.67%),低评分组3例(10.71%),高评分组的妊娠率显著高于中、低评分组(P<0.05);高评分组的复发率显著低于中、低评分组(P<0.05)。结论腹腔镜输卵管修复整形术治疗输卵管积水性不孕尤其是输卵管积水高评分者疗效显著,但仍存在一定的复发率,且妊娠率较低,建议对输卵管积水中低评分者实施患侧输卵管切除术,以降低复发率、提高妊娠率。     

输卵管阻塞性不孕症介入治疗26例分析

输卵管阻塞是不孕症最常见的病因，约占不孕病因的１／３。本文对２６例输卵管阻塞性不孕症采用介入放射学的选择性输卵管造影和再通术，对２６例５２条输卵管，缺如２条，Ⅰ类梗阻６条，Ⅱ要，Ⅲ类９条，Ⅳ类４条，Ⅴ类７条。ＳＳＧ４３条复通２２条，ＦＴＲ２１条复通１７条，失败４条。ＳＳＧ＋ＦＴＲ复通成功率为９０．７％。至今已有９例妊娠。采用此介入治疗，提高了诊断和再通的成功率，临床上有其独特的治疗价值。     

Anti-Endometrial Autoantibodies in Women with a Diagnosis of Infertility

PROBLEM: The purpose of this study was to investigate the frecuency of anti-endometrial antibodies (AEA) in infertile women. METHOD OF STUDY: Sera from fertile women (n = 6), and from patients with ovulatory dysfunction (n = 11), tubal obstruction (n = 9) and unexplained infertility (n = 5) were investigated for the presence of anti-endometrial membrane antibodies. We used two human endometrial cancer cell lines and human endometrial cells from gynecological biopsies as an antigenic source for analysis. The immunoenzymatic assay (ELISA) was performed with cultured endometrial cells in monolayers. Immunoblot analysis was performed with these two cell lines. RESULTS: A good correlation between the response with each cell line and with human endometrial cells was obtained, indicating that the antigens analyzed were probably similar. Endometrial antibodies were detectable in a high percentage of women with tubal obstruction (77.8 and 66.7%, respectively) and ovulatory dysfunction (54.5 and 45.5%, respectively). Unexplained infertility showed anti-endometrial immunological response (40 and 60%, respectively). Some endometrial antigens in infertile women are the target for autoimmune response. The serum from a patient with tubal obstruction and ovulatory dysfunction showed two antigens by immunoblot, with molecular weights of 97 and 50 kDa. CONCLUSION: The presence of anti-endometrial antibodies, detected by ELISA, is associated with infertility, mainly with ovulatory dysfunction and tubal obstruction. Some endometrial antigens may be involved in these two pathologies.     

经阴道注水腹腔镜在输卵管妊娠诊治中的应用

目的探讨经阴道注水腹腔镜（transvaginal hydrolaparoscopy,THL）在输卯管妊娠诊治中的临床效果和安全性。方法选择输卵管妊娠患者22例（研究组）进行THL检查和治疗,选择同期输卵管妊娠30例（对照组）行单纯药物保守治疗。记录研究组手术时间、后穹隆穿刺成功率、手术成功率、诊断符合情况、手术并发症、对侧输卵管的通畅程度等：记录两组治愈率、治愈时间、化疗药物毒副作用发生率、住院时间、住院费用等。结果THL平均手术时间（25．4±3．5）min;后穹隆穿刺成功率95．6％,20例与术前诊断符合,18例手术成功,无手术并发症发生：术中发现对侧输卵管阻塞3例;两组治愈率比较差异无统计学意义（P〉0．05）,但研究组治愈率有增加趋势。治愈时间、药物毒副作用发生率、住院时间对照组均大于研究组,差异有统计学意义（P〈0．05）,住院费用两组比较差异无统计学意义（P〉0．05）。结论THL在应用于输卵管妊娠的早期诊断和治疗中既具备了单纯药物保守治疗的优势．又达到了经腹腹腔镜保守手术的效果,术中可以同时检查对侧输卵管的通畅度,为输卵管妊娠早期诊断和输卯管保守治疗开辟了新途径,有较好的应用前景。     

Infertility: Prospective study of tubal mucosal lesions and fertility in hydrosalpinges

The relationship of abnormalities of the Fallopian tubes inpatients with tubal infertility due to hydrosalpinges and fertilityoutcome after salpingoneostomy was studied in a prospectivemulticentric project. Hydrosalpinges of infertile patients wereevaluated macroscopically and microscopically at the time ofsalpingoneostomy and the results were analysed with regard tothe fertility outcome. Peritubal adhesions, the diameter andthe quality of the mucosa were scored at the time of surgeryand biopsies from representative areas were evaluated by scanningelectron and light microscopy in 50 patients with bilateralhydrosalpinges or a hydrosalpinx of a single tube. Analysisof the different factors for fertility outcome was performedusing the Cox proportional hazards model. No intrauterine pregnancyoccurred in the thick-walled hydrosalpinges group (n = 13).In the thin-walled hydrosalpinx group (n = 37), 15 intrauterineand two tubal pregnancies occurred. The aspect of the mucosaas evaluated by an operating microscope was the most importantfactor in determining the fertility outcome; >50% abnormalmucosa was associated with an intrauterine pregnancy rate of7% which increased significantly to 50 and 69% when the mucosawas >50 and 75% normal respectively. The pregnancy rate wasnot influenced by the presence or extent of peritubal adhesionsbut small sized (<1 cm) hydrosalpinx had a better prognosisthan medium (1–2 cm) and large sized (>2 cm) hydrosalpinx.When mucosal adhesions were present (n = 19), the intrauterinepregnancy rate was 22% which increased significantly to 58%when adhesions were absent (n = 18). Both tubal pregnanciesoccurred in tubes with mucosal adhesions. These data indicatethat the evaluation of the tubal mucosa, and for practical endoscopicpurposes the presence of mucosal adhesions, is the most importantfactor for the proper selection of patients in the choice betweenreconstructive surgery and in-vitro fertilization.     

Surgery: Diagnosis and treatment of proximal tubal obstruction by fluoroscopic transcervical Fallopian tube catheterization

The efficacy of fluoroscopic transcervical Fallopian tube catheterizationin treating patients with proximal tubal obstruction was investigated.In 11 (15.9%) of the 69 patients who entered the study, patencyof the proximal Fallopian tubes was shown by a pre-treatmenthysterosalpingogram or an ostial selective salpingogram. TranscervicalFallopian tube catheterization attested to the success of recanalizationin at least one of the obstructed tubes in 41 of our 58 patients(70.7%). Of 92 obstructed tubes, 56 (60.9%) were successfullyrecanalized. However, normal tubal visualization was possiblein only 13 tubes (23.2%). Most of the recanalized tubes wereconsidered to be peritubal adhesions (64.3%). Eight of 36 (22.2%)patients who had been successfully recanalized achieved pregnancies;12 patients demonstrated normally appearing salpingograms afterthe procedure, and five (41.7%) had an intra-uterine pregnancy.Suspected peritubal adhesions were exhibited on post-operativesalpingograms of 24 patients, one of whom had an intra-uterinepregnancy, while two had tubal pregnancies. Transcervical Fallopiantube catheterization is a simple and effective method for evaluatingand treating proximal tubal obstruction. Most of the patients(70.7%) in whom recanalization was successful showed significantsigns of distal tubal damage. This procedure can also be usedto arrive at a prognosis regarding conception.     

肺结核合并气管支气管结核危险因素及诊断

气管支气管结核是肺结核的一种特殊类型,其临床表现及影像学特征不典型,容易导致漏诊、误诊,晚期可能出现气道狭窄甚至闭塞、毁损肺等严重并发症。近年来多项研究指出女性、症状持续时间大于4周、合并糖尿病、职业为肺结核合并气管支气管结核常见危险因素,本文通过对相关危险因素进行综合分析,并对气管支气管结核诊断现状进行总结,以期控制结核病流行并为气管支气管结核防治措施提供新思路。     

超声对宫角妊娠与输卵管间质部妊娠的诊断分析

目的 探讨超声对早期宫角妊娠与输卵管间质部妊娠的诊断价值。方法 按病理结果,将60例患者分为宫角妊娠组（31例）及间质部妊娠组（29例）,根据超声声像图特征将其分为孕囊型及包块型,比较孕囊周边肌层厚度及孕囊与宫腔相通率,并分析超声诊断的准确性及误诊率。结果 宫角妊娠组孕囊周边肌层厚度及与宫腔相通率大于间质部妊娠组（P〈0.05）。孕囊型超声诊断的符合率为94.59%（35/37）,误诊率为5.41%（2/37）。包块型超声诊断的符合率为69.57%（16/23）,误诊率为30.43%（7/23）。结论 超声对早期宫角妊娠及间质部妊娠有一定的临床应用价值。     

The Presence of Antithyroid Antibodies in Euthyroid Patients With Unexplained Infertility and Tubal Obstruction

PROBLEM: The presence of antithyroid antibodies in euthyroid patients with unexplained infertility and tubal obstruction. METHOD: The presence of antithyroid autoantibodies (microsomal and thyroglobulin) was measured in 40 patients with unexplained infertility, and 40 patients with tubal obstruction infertility, and compared to 40 healthy nulligravidae. RESULTS: Eight patients (20%) in the unexplained infertility study group, seven (17.5%) in the tubal obstruction group and two (5%) in the healthy nulligravida group, were positive for antithyroid autoantibodies: five (12.5%) were positive for antimicrosomal antibodies, two (5%) were positive for antithyroglobulin antibodies, and one patient (2.5%) was positive for both. The tubal obstruction group comprised seven (17.5%) patients positive for antithyroid autoantibodies: four (10%) for antimicrosomal antibodies, two (5%) for antithyroglobulin antibodies, and one patient (2.5%) was positive for both. In the healthy nulligravidae group only two patients (5%) were positive for antithyroid antibodies: one for antimicrosomal and one for antithyroglobulin. No significant differences were found in the presence of antithyroid antibodies between patients with unexplained infertility and those with tubal obstruction infertility. Both groups differed significantly from the healthy controls with regard to the presence of antithyroid antibodies (P < 0.05). CONCLUSION: Subclinical presence of antithyroid autoantibodies is characteristic of both unexplained and mechanical infertility, as opposed to healthy controls. Further investigation of larger groups is needed to determine the prevalence of antithyroid antibodies in the unique population of infertile women.     

输卵管通液术加综合治疗输卵管性不孕的疗效分析

目的 探讨输卵管通液术加微波热疗及中西药治疗输卵管阻塞性不孕的效果.方法 将253例输卵管阻塞性不孕患者随机分为两组.观察组132例采用输卵管通液术加微波热疗及中西药治疗;对照组121例予输卵管通液后配合中西药治疗,观察两组患者治疗后输卵管通畅及受孕情况.结果 观察组治愈率为73.5%,总有效率为96.9%,,而对照组的治愈率为50.4%,总有效率为85.1%,两组比较有显著性差异(P<0.05);观察组的受孕率达72.7%,对照组的受孕率为53.7%,两组比较差异有非常显著性(P<0.01).结论 输卵管阻塞是引起女性不孕的重要因素,输卵管通液加微波热疗及中西药治疗输卵管性不孕优于输卵管通液术加中西药治疗.     

恒温扩增检测结核分枝杆菌特异性IS6110片段在肺结核检测中的应用

目的 比较恒温扩增技术检测、抗酸杆菌涂片、结核分枝杆菌培养在肺结核患者检测中的应用.方法 收集2016年1月1日至12月31日我院呼吸科肺结核患者清晨痰液,将标本分为3份,分别进行痰涂片抗酸染色,结核菌培养及恒温扩增检测结核分枝杆菌特异性IS6110片段,统计分析3种方法的检测结果.结果 56例痰标本,恒温扩增检测结核分枝杆菌特异性IS6110片段阳性33例,阳性率为58.93％,抗酸染色阳性15例,阳性率为26.79％,恒温扩增检测结核分枝杆菌特异性IS6110片段阳性率高于抗酸染色方法;结核分枝杆菌培养阳性为35例,阳性率62.50％;恒温扩增检测结核分枝杆菌特异性IS6110片段和结核分枝杆菌培养两种方法检测Kappa系数为0.776,检测一致性较好.结论 恒温扩增检测结核分枝杆菌特异性IS6110片段是一种简便、高灵敏度的检出结核分枝杆菌的方法.