目的 分析子宫动脉栓塞术(UAE)治疗子宫肌瘤的远期疗效.方法 选择因子宫肌瘤采用UAE治疗妇女181例,超声监测子宫和肌瘤的体积,比较子宫和肌瘤的平均体积缩小率;监测月经、血红蛋白及UAE后妊娠.结果 (1)肌瘤平均体积缩小率:UAE后1年达60.4％,UAE后5年达到最高(70.5％),UAE后10年有所降低(61.1％),UAE后15年又呈上升趋势(67.1％).(2)UAE后1年,黏膜下肌瘤组比非黏膜下肌瘤组的肌瘤缩小显著(P<0.05),两组月经过多症状消除、有效率达100％,月经过多导致贫血病例均在UAE后半年内恢复正常.结论 UAE对缩小肌瘤远期疗效较明显,对肌瘤引起的月经过多及贫血改善疗效显著,治疗后月经过多症状复发率低.

目的了解巨噬细胞抑制因子-1（MIC-1）和基质金属蛋白酶-7（MMP-7）在子宫内膜单纯性增生及子宫内膜癌组织中的表达情况,并探讨其临床意义。方法运用免疫组织化学S-P法检测61例子宫内膜癌组织、20例子宫内膜单纯性增生组织中MIC-1、MMP-7蛋白的表达,并对MIC-1、MMP-7与子宫内膜癌的临床病理因素进行分析。结果 MIC-1、MMP-7在子宫内膜癌组织、子宫内膜单纯性增生组织中均有表达,子宫内膜癌组织中MIC-1、MMP-7阳性表达率为90.16%、93.44%,子宫内膜单纯性增生组织中MIC-1、MMP-7阳性表达率均为80.00%,MIC-1、MMP-7在子宫内膜癌组织与子宫内膜单纯性增生组织的阳性表达率比较差异有统计学意义（P＜0.05）。MIC-1在子宫内膜样癌与非子宫内膜样癌的阳性表达率比较差异有统计学意义（P＜0.05）。MIC-1、MMP-7与子宫内膜样腺癌组织学病理分级呈负相关,与淋巴结转移呈正相关（P＜0.05）。MIC-1与MMP-7在子宫内膜癌中的表达呈正相关（r=0.722,P=0＜0.01）。结论 MIC-1、MMP-7联合检测可提高子宫内膜癌细胞分化程度、淋巴结转移、病理学分型判断的准确率并指导手术方案;MIC-1、MMP-7的同时表达可能为早期子宫内膜癌表现之一,因此同时检测MIC-1、MMP-7有望成为提高子宫内膜癌早期诊断率。

目的:探讨卡铂介入灌注化疗治疗子宫颈妊娠的可行性。方法:回顾性分析2005年4月至2010年12月间我院施行子宫动脉卡铂灌注及动脉栓塞术的8例宫颈妊娠患者的临床资料。结果:8例子宫动脉卡铂灌注及动脉栓塞术后清宫术出血<50mL,β-HCG术后前3d明显下降趋势,术后第5天下降至接近正常水平,5例患者核磁共振成像术后第7天宫颈形态基本恢复正常。结论:使用卡铂灌注和栓塞治疗宫颈妊娠取得良好肯定的治疗效果,可以作为子宫动脉栓塞术中可供选择的新方法。

OBJECTIVE:To explore changes of serum adiponectin and insulin resistance in patients with endometrial cancer and to evaluate the clinical significance and correlation. METHODS:The serum levels of adiponectin and fasting insulin were determined by ELISA, electro-chemilluminometry and radioimmunoassay in 35 patients with endometrial cancer [all patients divided into two groups, A1 group belonged to without postmenopausal when first visiting (n = 20), A2 group belonged to postmenopausal when first visiting (n = 15)] and 30 cases of health control. The result of homeostasis model assessment-insulin resistance (HOMA-IR) index was calculated. RESULTS:The levels of adiponectin in A1 group was lower than that of health control group [(6.7 ± 1.1) versus (10.0 ± 1.4) ng/L, P < 0.05], and HOMA-IR was higher than that of health control group (3.5 ± 1.8 versus 1.1 ± 0.7, P < 0.05). While there were not significant difference between A2 group and health control group (P > 0.05). Adiponectin and insulin resistance was negatively correlated (r = -0.389, P < 0.05). CONCLUSION:Adiponectin reducing and insulin resistance in reproductive age patients may be the independent factors to promote endometrial cancers.

目的:探讨子宫动脉栓塞术(UAE)治疗子宫腺肌病的临床疗效。方法:回顾性分析23例接受UAE治疗子宫腺肌病的临床资料并跟踪观察18个月。结果:①在痛经程度、子宫体积大小、血红蛋白和月经量变化数据比较,差异有统计学意义(P<0.05);②血清CA125术后明显下降,差异有统计学意义(P<0.05);③血清FSH、LH、E2水平术前术后比较,差异无统计学意义(P>0.05)。结论:UAE治疗子宫腺肌病可改善临床症状,对卵巢功能无明显影响,同时可动态监测血清CA125水平来观察疗效;在UAE治疗中选择KMG颗粒和明胶海绵颗粒作为栓塞剂,取得了良好的治疗效果,可以更广泛的用于子宫腺肌病的治疗。

<正>子宫内膜癌为女性生殖道常见三大恶性肿瘤之一,发病危险因素与内外源性雌激素、月经史、生育史、生活方式等有关[1]。肥胖、2型糖尿病、高血压被视为子宫内膜癌三联征。脂联素是脂肪细胞分泌的一种细胞因子,与肥胖、2型糖尿病、高血压等密切相关[2]。脂联素可通过影响细胞信号转导通路从而抑制子宫内膜癌细胞增殖,促进凋亡。2型糖尿病本身可增加妇科恶性肿瘤的发病危险。恶性肿瘤治疗过程中由于化疗药物的使用可产生胰岛素抵抗,继发2型糖尿病。现对脂联素、2型糖尿病与子宫内膜癌相关性作一

目的:探讨植入型子宫瘢痕妊娠的子宫动脉栓塞术的介入治疗方法。方法:回顾性分析2009～2011年在我院施行子宫动脉栓塞术联合清宫术治疗的5例植入型子宫瘢痕妊娠患者的临床资料。结果:5例子宫动脉栓塞术后清宫术出血平均64mL,β-HcG术后明显下降,术后14d下降至较低水平,术后1～2个月阴道超声复查子宫下段瘢痕处结构基本恢复正常。结论:子宫动脉栓塞术联合清宫术治疗植入型子宫瘢痕妊娠微创、高效、可重复性,是一种行之有效的治疗方法。

目的 探讨5-氟脲嘧啶和缩宫素在腹腔镜下行输卵管妊娠保守手术治疗中的应用价值.方法 回顾分析行腹腔镜手术治疗输卵管妊娠病例620例,其中A组(腹腔镜下输卵管病灶清除术+局部注射缩宫素、5-氟脲嘧啶腹腔冲洗)418例,B组(单纯行腹腔镜下输卵管病灶清除术)202例,比较两组观察指标的情况.结果 A组较B组手术时间[(35.24±9.68)min vs(56.86±11.12)min]及住院时间[(5.32±1.26)d vs(6.73±2.44)d]缩短,术中出血量[(42.32±2.29)ml vs(86.56±4.27)ml]减少,术后持续异位妊娠(PEP)发生率降低,差异均有显著性(P＜0.05).结论 5-氟脲嘧啶和缩宫素应用于腹腔镜下行输卵管妊娠保守手术治疗,有较好的临床疗效,值得推广应用.

Objective:To explore the expression and clinical significance of placental growth factor(PLGF) protein in epithelial ovarian carcinoma and its relationship with occurrence and development of ovarian carcinoma.Methods:Immunohistochemical method was used to detect the expression levels of PLGF protein in 52 cases with ovarian carcinoma,15 cases with benign epithelial ovarian tumor and 10 cases with normal ovarian tissues;the clinical significance of PLGF protein in ovarian carcinoma was analyzed based on clinical data of pathology and prognosis.Results:The over expression rates of PLGF protein in ovarian carcinoma,benign epithelial ovarian tumor and normal ovarian tissues were 46.15%(24/52),20.00%(3/15) and 0%(0/10),respectively;the over expression rate of PLGF protein in ovarian carcinoma was significantly higher than that in benign epithelial ovarian tumor(P=0.027,OR=4.286,95%CI for OR:1.11～16.60).The over expression of PLGF protein was related to differentiation degree of ovarian carcinoma,the over expression of PLGF protein in ovarian carcinoma of grade3 was significantly higher than that in ovarian carcinoma of grade1+grade2(P=0.012,OR=5.077,95%CI for OR:1.35～19.17).The median survival time of ovarian carcinoma cases with over expression of PLGF protein was 34 months,which was significantly shorter than that with normal expression of PLGF protein(47 months)(Log Rank=4.887,P=0.008).Conclusion:In the course of carcinogenesis of ovarian carcinoma,the level of PLGF protein over expression increases with the aggravation of ovarian lesions,which indicates that over expression of PLGF protein is related to occurrence of ovarian carcinoma;over expression of PLGF protein and malignant clinical phenotype of ovarian carcinoma are related to adverse prognosis closely;PLGF may be a new molecular marker to predict the occurrence and prognosis of ovarian carcinoma.

目的 探讨腹腔镜手术对女性不孕症治疗的应用价值.方法 回顾分析行腹腔镜手术治疗的186例女性不孕症的临床资料及疗效.结果 186例女性不孕症病例中,盆腔炎性疾病后遗症91例、子宫内膜异位症53例、多囊卵巢综合征26例、卵巢囊肿7例、正常盆腔2例、子宫肌瘤3例、子宫畸形1例及生殖器结核3例.盆腔炎性疾病后遗症是导致不孕的主要原因(P<0.01).术后1年内妊娠率:盆腔炎性疾病后遗症35.16%(32/91),子宫内膜异位症37.73%(20/53),明显高于其他病因(P<0.05).结论 腹腔镜手术可以在明确导致不孕原因的同时加以治疗,且创伤小,对盆腔干扰少,在女性不孕症诊治中具有重要价值.

Objective To investigate the mechanism and efficacy of neoadjuvant intra-arterial chemotherapy. Methods Eighty-six patients with cervical epidermoid carcinoma staged Ⅰb2～Ⅱb were randomly divided into two groups: Group A(n=46,neoadjuvant intra-arterial infusion chemoembolization with subsequent selected radiotherapy or surgery) and Group B(n=40,surgical operation only).Patients in Group A before and after chemoembolization were referred as Group A1 and Group A2,respectively.Proliferation antigen(Ki-67) and apoptotic cells in cervical cancer specimens were recorded for assessment of Ki-67 index(LI) and apoptotic index(AI). Results Total effective rate of intra-arterial infusion chemoembolization was 86.96% in Group A,in which 42 cases received surgical treatment.The haemorrhage volume during operation and reduction in hemoglobin were(364.4±111.5)mL and(16.4±8.8)g/L in Group A,and(527.3±150.6)mL and(24.7±10.5)g/L in Group B with significant differences.No significant difference was observed in lymph node metastasis rate,parametrium infiltration rate or vaginal infiltration rate(P0.05).LI(%) were 87.22±7.55,66.67±7.79 and 81.13±8.07 in Group A1,A2 and B,respectively.Although no significant difference was revealed in LI between Group A1 and B,significantly lower LI was found in Group A2 than those in Group A1 and B(P0.05).AI(%) were 0.67±0.21,3.56±1.29 and 0.83±0.27 in Group A1,A2 and B,respectively.Although no significant difference was revealed in AI between Group A1 and B,significantly higher AI was found in Group A2 than those in Group A1 and B(P0.05). Conclusion Intra-arterial chemoembolization on uterine cervical cancer of Ⅰb2～Ⅱb stage significantly reduces the size of lesion,increases opportunity for complete surgical resection,and lowers the haemorrhage volume during operation.Our study suggests that intra-arterial infusion chemoembolization inhibits proliferation and promotes apoptosis of tumor cells.

Objective To explore common disease prevalence status of vulnerable groups of women in Guangzhou,master the incidence trends and control disease status,to investigate the health-related factors,and promote the health recommendations and measures according to these factors.Methods A cross-sectional study method was performed in a total of 16 180 cases and other related inspection questionnaire was used,and the corresponding results of the census of the health status and health related factors of the disease were analyzed.Results The guaranteeing women sufferred from them were mostly concentrated in the 41 to 50 years old,reproductive tract infections and gynecological cancer prevalence rate was still higher,which were 41.8%,32.9%,respectively.Conclusion ①Guangzhou guaranteeing women's reproductive health status was poor,which may be occupational,economic and other factors than the backward correlation,which seriously hampered the improvement of women's health.②guaranteeing the disadvantaged groups of women on a regular basis to carry out general survey and treatment of gynecological diseases,improve the rural women will continue to be one of the effective reproductive health.

目的 检测宫颈癌行新辅助动脉化疗后细胞凋亡及Bcl-2、Bax的变化,探讨其意义.方法 选取宫颈癌Ⅰb2~Ⅱb期患者46例,动脉化疗前后宫颈活检,采用DNA片段末端标记法检测凋亡细胞,免疫组化法检测Bcl-2及Bax蛋白.结果 动脉化疗后,细胞凋亡指数(%)由0.67±0.21升高至3.57±1.29,P<0.05;Bcl-2表达阳性率(%)化疗前为19.23±4.17,化疗后为8.15±5.03,化疗后较化疗前降低,P<0.05;Bax表达阳性率(%)化疗前7.46±5.43,化疗后22.34±6.58,化疗后较化疗前明显升高,P<0.05.结论 宫颈癌行新辅助动脉化疗后细胞凋亡增加,Bcl-2表达降低,Bax表达升高,Bcl-2/Bax比值降低,提示动脉化疗可通过提高Bax的表达,降低Bcl-2/Bax的比值,从而诱导肿瘤细胞凋亡.

目的:探讨CyP19基因多态性与子宫内膜癌及子宫肌瘤易感性之间的关系.方法:采用正反向DNA直接测序法对子宫内膜癌组、子宫肌瘤组及对照组CYP19基因中[TTTA]n和TCT插入/缺失两个多态位点进行多态性检测,并计算各基因型出现的频率,X2检验比较各组间有无差异.结果:TCT和△3在子宫内膜癌组出现频率为58.0%、42.0%,在子宫肌瘤组为61.5%、38.5%,在对照组为66.7%、33.3%.[TTTA]7和X在子宫内膜癌组出现频率为38.0%、62.0%,在子宫肌瘤组为65.4%、34.6%,在对照组为59.3%、40.7%.TCT插入/缺失多态性的总体分布在3组间无明显差异(P＞0.05);子宫内膜癌组携带[TTTA]n长基因型的频率显著高于子宫肌瘤组及对照组(P＜0.05),而在子宫肌瘤组和对照组间[TTTA]n的频率分布差异无统计学意义(P＞0.05).结论:CYP19基因第4内含子四核苷酸重复[TTTA]n的长基因型可能增加子宫内膜癌的易感性,而对子宫肌瘤的发病无显著相关性.

目的比较腹腔镜下子宫肌瘤切除术、阴式子宫肌瘤切除术及腹式子宫肌瘤切除术3种手术方式的临床疗效。方法回顾分析行子宫肌瘤切除术病例,经排除干扰因素后,筛选出:腹腔镜下子宫肌瘤切除术组84例、阴式子宫肌瘤切除术组68例及腹式子宫肌瘤切除术组126例,对比分析3组患者的术中、术后情况。结果 3组在手术时间、术中出血量、切除肌瘤个数及大小、术后体温、术后肛门排气时间及住院时间比较,差异均无统计学意义(P>0.05)。结论 3种手术方式各有利弊,临床医生应根据自己的经验及患者的具体情况选择恰当的术式。

目的探讨阴道镜结合病理组织学检查在宫颈病变诊断中的价值。方法回顾728例阴道镜结合病理组织学检查的病例,分析阴道镜图像的变化,比较阴道镜诊断结果与病理诊断结果的符合程度,以及对155例行宫颈电环切除术(LEEP)病例术后的病理结果与术前的病理结果进行比较分析。结果阴道镜对宫颈病变的诊断与病理诊断的符合率为93.96%,155例行LEEP术病例术后的病理结果与术前的病理结果符合率为72.90%(113/155),术后诊断减轻者为16.77%(26/155),术后诊断加重者为10.32%(16/155)。结论阴道镜结合病理组织学检查对宫颈病变,尤其是癌前病变、早期癌变的诊断与治疗具有重要应用价值。

目的研究胰岛素α,β受体在子宫内膜腺癌中的表达,探讨其在早期诊断及治疗中的临床意义。方法设定子宫内膜癌66例为研究组(A组),另设66例对照组(B组)包括正常子宫内膜组织(B1组)38例、子宫内膜增生组织(B2组)28例,采用免疫组化EnVision通用型二步法检测各组中胰岛素α,β受体的表达并进行组间比较。结果胰岛素α,β受体在A组中阳性表达率均明显高于B组、B1组中的阳性表达率,在B2组中阳性表达率均明显高于在B1组中的阳性表达率,且差异有显著性(P<0.05)。胰岛素α、β受体在A组中阳性表达率高于B2组,但差异无显著性(P>0.05)。在A组中,胰岛素α,β受体在高分化(G1)中阳性表达率均明显低于在中+低分化(G2+G3)组织中阳性表达率、在内膜样腺癌中阳性表达率均高于在非内膜样腺癌组织中阳性表达率,且差异有显著性(P<0.05)。而两者在不同病理期别肌层浸润深浅、有无淋巴结转移、是否绝经中的阳性表达率比较中,差异均无显著性(P>0.05)。结论胰岛素α、β受体的异常表达与子宫内膜组织的病变性质有关,为防止内膜组织向癌变发展提供新思路。

目的探讨用放射性介入技术行子宫动脉灌注和栓塞治疗宫角妊娠的临床效果和价值。方法回顾分析用子宫动脉灌注杀胚药(甲氨喋呤或卡铂)及栓塞治疗5例早期宫角妊娠患者的临床资料。结果本组5例患者治疗后4~11周血β-HCG降至正常,治疗后6~13周B超病灶消失,5例均治疗成功,无副作用。结论子宫动脉灌注及栓塞治疗早期宫角妊娠效果好、安全、能保留子宫完整性,为宫角妊娠患者提供一种微创治疗手段。

Objective To determine the influence of different surgical procedures on the postoperative survival rate and recurrence of stage Ⅰ endometrial carcinoma. Methods 67 cases of stage Ⅰ endometrial carcinoma were retrospectively analyzed. The patients were divided into two groups, group with radical hysterectomy and pelvic lymphadenectomy (group A, n = 36) and group with total hysterectomy and bilateral salpingo-oophorectomy (group B, n = 31). Survival rate and incidence of recurrence were analyzed after the procedures. Results There were no significant differences between group A and group B in the incidence of recurrence and the five-year survival rate (18% vs 17% and 88% vs 90%, respectively; P > 0.05). 11 relapses were found during follow-up and 7 of them (64%) developed distant metastasis. The incidence of distant metastasis differed significantly between the patients receiving chemotherapy and those without chemotherapy (40% vs 83%, P < 0.05). Conclusions Total hysterectomy and bilateral salpingo-oophorectomy can be performed in patients with stage Ⅰ endometrial carcinoma and radical resection and pelvic lymphadenectomy can not increase the survival rate. Distant metastasis is frequent in postoperative recurrence. Postoperative adjuvant chemotherapy is helpful in suppressing recurrence outside the pelvic cavity.

目的探讨子宫动脉栓塞术治疗子宫肌瘤的机理。方法随机选择子宫增大在妊娠10周大小以上的子宫肌瘤患者30例行子宫动脉栓塞术,于术前及术后1,8,24,48h经腹行子宫穿刺术,取出肌瘤组织在电镜下观察子宫肌瘤细胞超微结构的变化。结果子宫肌瘤子宫动脉栓塞术后肌瘤细胞短时间内即出现超微结构的改变,且随着术后时间的延长,细胞内细胞器的坏死越明显。结论子宫动脉栓塞术可用于治疗子宫肌瘤。