目的 探讨包块型剖宫产瘢痕妊娠(cesarean scar pregnancy,CSP)的临床特点及治疗方法.方法 回顾性分析2010年1月～2020年12月我院28例包块型CSP的临床特征及诊治情况.均有人流、药流或清宫史,术后异常阴道出血21例(其中失血性休克3例),血hCG下降不理想7例.入院距上次手术时间1～120 d,中位数21 d,其中<2周6例.包块直径14～66(35.3±14.7)mm;包块与膀胱间子宫肌层厚度1～5(1.7±1.0)mm.血β-hCG>1000 mIU/ml 18例(64.3％).行宫腔镜手术10例,宫、腹腔镜联合手术9例,腹腔镜手术5例,开腹手术4例.结果 行CSP残留组织清除27例,其中13例同时行剖宫产瘢痕修补,联合双侧子宫动脉栓塞或双侧子宫动脉上行支阻断6例,联合甲氨蝶呤治疗4例;腹腔镜全子宫双侧输卵管切除1例.手术均顺利完成,无并发症发生.其中5例术中或术后输悬浮红细胞400 ml.术后18～52 d(中位数26 d)血β-hCG降至正常范围.除全子宫切除术患者,余27例术后21～54 d月经复潮.结论 剖宫产瘢痕处剩余肌层薄和包块大是包块型CSP的两个重要特点,可采用联合治疗以减少并发症,提高疗效.

目的:探讨应用分碎器的腹腔镜子宫肌瘤手术后继发医源性寄生性平滑肌瘤的临床特点.方法 :回顾性分析2006 ～2019年北京大学第三医院收治的7例寄生性平滑肌瘤患者的临床资料.结果 :7例患者均有应用分碎器的腹腔镜子宫肌瘤手术史.发病年龄29 ～47岁,中位年龄38岁.2例表现为月经增多;1例自行触及下腹部包块;另4例无任何症状.本次发病距前次手术间隔4～8年,中位时间7年.寄生性平滑肌瘤均为多发,位于盆腹腔腹膜、肠系膜、大网膜、卵巢、阑尾、腹壁瘢痕,直径0.5 ～ 12 cm.切除后病理检查均为良性平滑肌瘤,伴有玻璃样变(2例)、梗死(2例)或黏液变性(2例).术后随访9 ～161个月,中位时间15个月,1例复发.结论 :寄生性平滑肌瘤可继发于应用分碎器的腹腔镜子宫肌瘤术后,经个体化的手术治疗预后良好.

什么是子宫内膜异位症 首先要了解什么是子宫内膜.子宫内膜是覆盖于宫腔里面的一层具有强大再生和转化能力的细胞,在雌激素、孕激素的调控下发生周期性的改变.它要么定期脱落,混在经血中排出体外,要么成为受精卵发育的温床.

Objective: To access the influence factors of diagnostic delay of endometriosis. Methods: We designed a questionnaire of diagnostic delay of endometriosis. From February 2014 to February 2016, 400 patients who had dysmenorrhea and diagnosed with endometriosis by surgery in Peking University Third Hospital were surveyed retrospectively. Time and risk factors of diagnostic delay were analyzed. Results: The diagnostic delay of 400 patients was 13.0 years (0.2-43.0 years), 78.5%(314/400) patients thought pain was a normal phenomenon and didn't see the doctor. Patients who suffered dysmenorrhea at menarche experienced longer diagnostic delay than those who had dysmenorrhea after menarche (18.0 vs 4.5 years; Z=191.800, P<0.01) . Patients who suffered aggravating dysmenorrhea experienced shorter delay time than those who suffered stable or relieving dysmenorrhea (11.0 vs 12.5 vs 18.0 years; Z=8.270, P<0.05) , with the difference statistically significant, single factor analysis shows. Severe dysmenorrhea, deep infiltration endometriosis (DIE) , family history of dysmenorrhea or endometriosis, previous surgical history of endometriosis, high stage, with infertility, adenomyoma or other symptoms, could help to shorten diagnostic delay with no significant difference (P>0.05) . By multiple logistic regression analysis, the results shown that whether have dysmenorrhea at menarche and clinical diagnosis time were the independent factors affecting delayed diagnosis (P<0.01) . Conclusions: Diagnostic delay of endometriosis is common and the mean delay time is 13.0 years mainly due to the unawareness of dysmenorrhea. Dysmenorrhea at menarche, clinical diagnosis time and dysmenorrhea intensity are the factors affecting time of diagnostic delay.

Objective To analyze the effect of oral contraceptives on dysmenorrhea in patients with endometriosis.Methods We designed dysmenorrhea and chronic pelvic pain questionnaire.From February 2014 to February 2016 in the Gynecological Department of Peking University Third Hospital,patients suffered dysmenorrhea with or without endometriosis or adenomyosis were included.According to their own willingness,patients were divided into the research group and the control group.The research group periodically took oral contraceptives (Diane-35 or Yasmin),while the control group received no treatment.They were followed-up about dysmenorrhea every six months,and the total follow-up time was one and a half year.Results The dysmenorrhea VAS scores of patients in research group after taking oral contraceptives for six or twelve months were significantly lower than that in baseline (VAS 4 vs 5 vs 7).The dysmenorrhea VAS scores increased after quitting medication,but remained still lower than baseline (VAS 6.5 vs 7).However,the dysmenorrhea VAS scores of patients in control group remained unchanged (VAS 6 vs 6).Patients who took pills for more than one year experienced the same severity of dysmenorrhea after six months' or one year's medication (VAS 2 vs 2),and they suffered slowly aggravating recurrent dysmenorrhea,while those who quitted after six months' medication suffered quickly recurrent dysmenorrhea.The relieving rate of dysmenorrhea in research group was significantly higher than that in control group (79.7％ vs 8.2％),and the relieving rate in patients with severe pain was significantly higher than that with mild or moderate pain (87.0％ vs 66.6 ％ vs 77.1％).The relieving rate in patients without lesions was significantly higher than patients with adenomyosis (92.6％ vs 59.1％).Conclusions Endometriosis is a progressing disease.Longterm medication of oral contraceptives can relieve the dysmenorrhea pain.The extent of pain relief was not connected with the length of medication.Dysmenorrhea recurred after quitting medication,and the longer of medication,the slower pain recurred.Patients without lesions experienced higher pain relieving rate than those with adenomyosis.

We reported two cases of pelvic retroperitoneal schwannomawe occurred in the young unmarried female successfully resected by laparoscopic surgery.One was a 16-year-old girl presented with secondary amenorrhea.Ultrasound and MRI found the existence of an ovarian cystic and solid mass,5.3 cm × 4.5 cm in size.Laparoscopic exploration found pelvic mass completely located in the left retroperitoneal obturator fossa and complicated with rudimentary horn of the uterus.The other was a 25-year-old female and asymptomatic.Ultrasound showed a mass in the right ovary.During operation a pelvic mass was discovered in the anterior of right sacral retroperitoneum,8 cm× 6 cm in size.Two cases of retroperitoneal lesions were preoperatively misdiagnosed as ovarian mass and had densely adhered to the surrounding tissues.Histopathologic examinations confirmed to be benign schwannoma and resected radically by laparoscopy without any complications.The operation time was 120 min and 166 min,respectively.The intraoperative bleeding was 150 ml and 600 ml,respectively.The S-100 protein on pathological immunohistochemistry showed strong positivity.We deem that laparoscopic resection is necessary for diagnosis and treatment of pelvic retroperitoneal schwannomawe,being safe and effective.Complete excision is benefical to prevent recurrence.

Objective To explore the clinical characteristics , diagnosis and therapy for primary cervical small cell carcinoma . Methods A total of 5 patients diagnosed as primary cervical small cell carcinoma between January 2006 and October 2016 in our hospital were enrolled .Clinical features , therapies and prognosis were retrospectively evaluated . Results The onset ages of these patients were 28-53 years old (median, 42 years old).All the patients suffered abnormal vaginal bleeding .Among the 5 patients, 3 patients received radical hysterectomy , excision of bilateral accessory and pelvic lymphadenectomy , 1 patient received radical hysterectomy and pelvic lymphadenectomy , and 1 patient received endometrial cancer cytoreductive surgery .All the patients received chemotherapy after surgery , and 3 patients received radiotherapy after surgery .Up to December 2016, there was no loss of follow-up cases.Three patients survived without tumor recurrence after 34, 34, and 68 months, respectively.Two patients with lymphatic metastasis died, with the survival time of 22 and 31 months, respectively. Conclusions Primary cervical small cell carcinoma has no specific clinical features , and its diagnosis is mainly based on histopathological examinations .Lymphatic metastasis can happen inⅠb2 phase patients, which is a signal for poor prognosis .It' s vital to provide early diagnosis and treatment for clinical benefit . Surgery combined with chemotherapy and radiotherapy is effective for Ⅰb1 phase patients and lymphatic-metastasis-negative Ⅰb2 phase patients .

卵巢癌的死亡率居妇科恶性肿瘤首位，5年生存率为30％左右［1］。目前，铂类药物联合紫杉醇已成为卵巢癌术后的一线标准化疗方案。已知临床上卵巢癌患者对铂类药物疗效存在明显个体差异，铂类耐药是化疗失败的主要原因［2］。研究表明，单核苷酸多态性是基因多态性的主要形式，是决定药物敏感性差异的主要因素，可作为临床预测指标［3－5］。

目的 肺栓塞具有发病急、病情重、病死率高、预后差等临床特点.通过分析妇科围手术期患者肺栓塞的发生情况,提高围手术期防治肺栓塞的意识,减少肺栓塞发病率,提高其诊断率.方法 回顾性分析2005-01-01-2015-06-30北京大学第三医院妇产科妇科病房21例围手术期肺栓塞患者的临床资料.21例肺栓塞患者中位年龄63岁.发生于手术后15例,其中恶性肿瘤11例(73.3％);发生于术前6例.结果 21例患者中,出现胸闷气短9例,咳嗽6例,呼吸困难3例,胸痛1例,晕厥4例,咯血1例,无症状5例.20例经肺CT肺动脉造影(computed tomographic pulmonary angiography,CTPA)检查的患者中有19例获得明确诊断,1例CTPA未见栓子,行肺灌注扫描,表现为肺多发血流灌注减低,呈外周分布,以亚段性为主;另外1例有癫痫病史直接经肺灌注确诊.21例患者给予溶栓、抗凝和(或)介入等治疗,20例好转,因病情严重放弃治疗1例.结论 肺栓塞临床表现差异大,出现典型呼吸困难、胸痛、咳血典型三联症状较为少见.手术是引起肺栓塞的重要危险因素,也可发生于术前,尤其是合并恶性肿瘤的老年患者,应引起警惕.肺栓塞风险评估后积极预防可明显降低围手术期肺栓塞发生率.对于易患因素者,CTPA和肺灌注扫描有助于早期发现肺栓塞.

避孕药的避孕机制 谈到避孕药的益处,我们需要先了解避孕药的成分及其避孕的机制,因为这些机制也是为女性带来额外益处的基础. 避孕药的主要成分为雌激素和孕激素,它们按照一定的比例复合而成,通过干扰人体内“下丘脑-垂体-卵巢轴”的正常功能抑制卵巢排卵.避孕药可改变输卵管正常的分泌和蠕动,从而阻碍卵子与精子结合,干扰受精卵着床.其所含的孕激素可使宫颈黏液量减少且变黏稠,阻止精子穿透;同时抑制子宫内膜增殖,导致子宫内膜腺体停留在发育不全阶段,不利于受精卵着床.

目的 妇科原发性小细胞癌病例罕见,预后差.结合北京大学第三医院病例探讨妇科原发性小细胞癌的发病特点以及诊断治疗方案.方法 回顾性分析2006 01-01-2015-08-31北京大学第三医院收治的经病理确诊的8例妇科原发性小细胞癌患者的临床特征、治疗方案以及预后.结果 患者年龄16～71岁,中位年龄43岁.常见症状包括阴道异常出血、腹痛、腹部包块等.诊断主要依靠手术病理确诊,其中宫颈小细胞癌ⅠB1期2例,ⅠB2期2例,ⅢB期1例;卵巢小细胞癌ⅢC期1例;子宫内膜小细胞癌Ⅳ期2例.治疗方案包括手术、化疗和放疗.手术方式参照相应部位肿瘤的治疗原则,有5例行广泛子宫切除术,2例行肿瘤细胞减灭术,1例因高龄伴高血压未行手术.7例手术患者中有3例接受术前化疗,7例术后均辅助化疗,有5例辅助术后放疗.随访至2015-12-20,无患者失访.有3例生存,分别随访22、22和56个月;5例死亡,生存期分别为2、8、10、22和31个月.患者疾病无进展生存时间(progression free survival,PFS)为0.3～56个月,中位PFS为1 5个月,总生存时间(overall survival,OS)为2～56个月,中位OS为22个月.结论 妇科小细胞癌术前影像学检查常有淋巴结转移,其确诊依靠组织病理学检查.该肿瘤预后差,手术是早期病变的主要治疗手段,晚期病例宜采用手术、化疗和放疗相结合的综合治疗.

Applying an atomic force microscope, we performed a nanomechanical analysis of morphologically normal cervical squamous cells (MNSCs) which are commonly used in cervical screening. Results showed that nanomechanical parameters of MNSCs correlate well with cervical malignancy, and may have potential in cancer screening to provide early diagnosis.

剖宫产术的起源和发展 剖宫产术指剖开腹壁与子宫取出胎儿的手术,源于古罗马时期.公元前715～前672年,古罗马王朝率先制定了剖宫产律,允许对胎儿成熟存活但产妇已死亡或濒死者立即施行剖宫取胎以挽救胎儿生命.古罗马帝国的恺撒大帝即剖宫产而生,故在日本又将剖宫产称之为“帝王切开术”.16世纪后叶以前,剖宫产术仅仅是为了抢救胎儿,施行于死亡或濒死的产妇,几乎所有接受剖宫取胎的产妇均死于出血与感染.1876年,意大利产科医生波罗在施行剖宫产的同时,首次切除了产妇的子宫,以避免产妇感染.

“今天做人流,明天就上班”“三分钟,在睡梦中轻松解除意外”“安全、保宫、零伤害”……如今,无痛人流广告不仅随处可见,而且随处可听.许多无痛人流广告都在大肆宣传无痛人流手术的简单、安全、零负担,却避而不谈人流手术带来的痛苦及可能造成的后果.间接地给人们,尤其是年轻人种下了人流手术对身体健康没什么影响的印象.

A 何为肿瘤标记物 肿瘤标记物是指肿瘤细胞或正常细胞分泌并脱落到体液或组织中的物质,也可能是机体对微生物起反应后产生并进入到体液或组织中的物质,我们将其称为抗原.机体针对这些抗原产生抗体,抗原抗体结合产生免疫复合物.利用此原理,临床上将在体外标记的抗体与被检者的血清放在一起,采用化学方法捕捉被检者血清中对应的肿瘤标志物.

目的 观察卵巢Sertoli-Leydig细胞瘤的临床病理及免疫表型特点,探讨其诊断、鉴别诊断及预后.方法 对7例卵巢Sertoli-Leydig细胞瘤进行光镜及免疫组化检测,并结合临床及病理特点进行分析.结果 7例Sertoli-Leydig细胞瘤的平均年龄为31.00±13.52岁,均发生于一侧卵巢,平均直径9.93±6.58 cm.镜下Sertoli细胞排列呈管状或条索状,细胞核圆形或卵圆形,部分为短杆状,胞质淡染或透明;性腺间质细胞排列密集,核浆比例较大,核染色深,细胞界限不清;两种细胞逐渐过渡移行.Leydig细胞单个或成簇出现于间质内,核小,具有丰富的嗜酸性胞质.随访10～96个月,所有患者无瘤存活.结论 本病罕见,病理诊断尤其在术中冷冻诊断有一定的难度.卵巢支持间质细胞肿瘤较少有术前明确诊断,部分患者年龄轻,有保留生育功能要求,术中冷冻明确诊断具有较重要意义.

Objective To determine whether total laparoscopic radical hysterectomy ( TLRH ) is a feasible alternative to abdominal radical hysterectomy ( ARH ) in the treatment of early-stage cervical cancer ( stage ⅠB -ⅡA ) . Methods The outcomes of 42 patients with cervical cancer (stageⅠB-ⅡA) who underwent laparoscopic (LPS group, n=21) or laparotomic (LPT group, n=21) radical hysterectomy and pelvic lymphadenectomy in our hospital from January 2005 to March 2010 were retrospectively estimated.All of the patients from the LPT group were matched 1∶1 with the patients from the LPS group based on stage , age, histological subtype , and nodal status for case-controlled analysis .The parameters were compared between two groups including operating time, intra-operative blood loss, number of lymph nodes resected, gastrointestinal recovery time, intra-and post-operative complications , hospital stay , relapse and mortality rate . Results The operating time and complications were similar between the two groups.The LPS group had less intra-operative blood loss [(233.3 ±202.1) ml vs.(983.3 ±462.2) ml, t=-6.814, P=0.000] and shorter gastro-intestinal recovery time [(41.0 ±13.9) h vs.(55.4 ±15.0) h, t=-3.219, P=0.003] as compared with the LPT group.However, the LPS group showed less lymph nodes resected [(19.7 ±8.2) vs.(27.5 ±7.7), t=-3.170, P=0.003] and longer indwelling catheter time [(31.8 ±23.4) d vs.(14.5 ±4.7) d, t=3.177, P=0.005] as compared with the LPT group.Follow-up visits for 53-107 months (median, 53 months) in 17 patients (with 13 patients in LPS group and 12 patients in LPT group lost of follow-up) found the relapse rate was similar between the two groups [0 (0/8) vs.11.1% (1/9), P=1.000]. Conclusions It is feasible to do radical hysterectomy and pelvic lymphadenectomy by laparoscopy instead of laparotomy for early -stage cervical cancer .Laparoscopy shows more favorable operative outcomes after mid-term follow-up time.

化疗耐药作为影响卵巢上皮性癌(卵巢癌)预后的重要因素一直是卵巢癌研究领域的热点.化疗耐药机制复杂,其中之一是由三磷酸腺苷结合盒转运蛋白(adenosine triphosphate-binding cassette transporter protein,ABC)介导.ABC蛋白是1个跨膜蛋白超家族,可以完成多种分子的跨膜转运,包括细胞膜及细胞内膜结构;也可将药物从细胞内排出.ABCG2是最晚被发现的ABC蛋白.多种肿瘤中ABCG2的表达与肿瘤类型、分化、肿瘤大小、淋巴结转移以及复发、侵袭相关[1-5].ABCF2可能通过诱导与化疗耐药相关的因子造成肿瘤化疗耐药[6].也有研究发现,ABCF2在卵巢透明细胞癌中的表达增高,ABCF2可能使卵巢透明细胞癌更易耐药[7].卵巢癌中以浆液性腺癌最为常见,而透明细胞癌等其他类型则更易发生耐药,本研究通过检测卵巢透明细胞癌及卵巢浆液性腺癌组织中ABCG2及ABCF2的表达,探讨ABCG2及ABCF2的表达与卵巢癌耐药的关系。

目的 探讨卵巢成熟性畸胎瘤鳞癌变与慢性炎症的关系,以及早期诊断和治疗的方法.方法 报道两例卵巢成熟性畸胎瘤发生鳞癌变的病例,结合近10年的文献进行讨论.结果 两例患者均为绝经后妇女,均有长期慢性盆腔感染的病史,开腹探查术中发现卵巢畸胎瘤恶变合并盆腔脓肿,肿瘤广泛转移,侵犯肠管等多个脏器,均诊断为IIIc期.因腹茧症手术极困难,术后患者化疗与不化疗均在6～9个月内死于肠梗阻.结论 卵巢成熟性畸胎瘤鳞癌变罕见,恶变的机制不清,但长期慢性盆腔感染可能是重要的诱因.由于鳞癌变早期缺乏临床症状,术前诊断困难,故预后差,血清SCC结合巨噬细胞集落剌激因子有利于MCT鳞癌变术前的诊断.卵巢畸胎瘤长期存在有恶变可能,鉴于此,一旦发现MCT应手术治疗,特别是伴有盆腹腔炎时更应积极治疗.

目的 探讨腹腔镜下子宫肌瘤剔除术中子宫创面连续垂直褥式填塞缝合法的安全性、有效性和可靠性.方法 2003年1月～ 2013年1月80例肌壁间肌瘤行腹腔镜下子宫肌瘤剔除术采用连续垂直褥式填塞缝合法(研究组),132例肌壁间肌瘤行腹腔镜下子宫肌瘤剔除术采用传统缝合方法(对照组).比较2组手术时间、出血量、手术前后血红蛋白差、术后病率、术后并发症、拔除盆腔引流管时间、术后住院时间、术后妊娠情况等.结果 研究组手术时间(115.7 ±43.7) min,与对照组(121.2±42.0)min无统计学差异,(t=-0.910,P=0.364);研究组出血量中位数112.1 ml(5～550 ml),与对照组中位数124.4 ml(5 ～500 ml)无统计学差异(Z=-1.414,P=0.149);研究组术后血红蛋白下降(11.9±9.5)g/L,与对照组(14.0±8.7)g/L无统计学差异(t=-1.645,P=0.101);研究组术后病率5.0％ (4/80),与对照组12.1％(16/132)无统计学差异(x2=2.956,P=0.086);研究组拔引流管时间(1.8±1.0)d,与对照组(1.9±1.1)d无统计学差异(t=-0.664,P=0.508);研究组分娩率73.7％(14/19)与对照组58.8％(20/34)无统计学差异(x2 =1.170,P=0.279);研究组术后住院时间(4.1±0.9)d,显著短于对照组(4.6±1.7)d,(t=-2.431,P=0.016).2组无一例妊娠期发生子宫破裂.结论 腹腔镜下子宫肌瘤剔除术中子宫创面采用连续垂直褥式填塞缝合法安全、有效、可靠,值得临床推广应用.