目的 研究宫腔镜下宫腔粘连切除术后应用重组牛碱性成纤维细胞生长因子凝胶治疗对微血管密度(MVD)和血管内皮生长因子(VEGF)的影响.方法 将 2016 年 1 月至 2019 年 1 月时期收治 120 例择期行超声监测下行宫腔镜下宫腔粘连切除术患者以随机数字表法分成对照组与试验组,每组60 例.试验组患者术后以重组牛碱性成纤维细胞生长因子凝胶治疗,对照组患者则以透明质酸钠治疗,并对 2 组患者进行 12 个月的有效随访.比较 2 组患者术后情况(术后不同时间内出血量、出血停止时间、腹痛消失时间),月经复潮情况(复潮时间、复潮月经量、腹痛率),术前、术后 7dMVD水平和VEGF表达,随访期间再次粘连的发生率.结果 试验组患者术后不同时间内出血量明显少于对照组,而试验组患者出血停止时间、腹痛消失时间均短于对照组,差异均有统计学意义(P<0.01).试验组患者月经复潮时间明显短于对照组,复潮月经量多于对照组,而月经复潮腹痛率低于对照组,差异均有统计学意义(P<0.05).2 组患者术前、术后 7dMVD水平和VEGF表达差异无统计学意义(P>0.05).术后MVD水平和VEGF表达较术前明显下降,其中试验组均低于对照组,差异有统计学意义(P<0.05).结论 在超声监测下行宫腔镜下实施的宫腔粘连切除术后,应用重组牛碱性成纤维细胞生长因子凝胶治疗,可明显减少患者术后不同时间段内的出血量,缩短患者出血停止时间与腹痛症状消失时间,缩短月经复潮时间降低VEGF表达率与MVD水平,减少随访期间的宫腔再次粘连的发生率,效果理想.

目的 探讨超短聚焦超声技术对宫颈感染HPV16、18转阴治疗的可行性.方法 选取我院门诊自,HPV-DNA检测示有16和(或)18(+),病理提示低级别鳞状上皮内病变(LSIL)及以下者共110例,随机分入HIFU(聚焦超声)组(n=41)、LEEP组(n=39)、药物组(n=30)进行治疗,观察治疗后并发症的情况及治疗后6、12个月HPV转阴情况.结果 HIFU组和LEEP组转阴率高于药物组,差异有统计学意义(P<0.05).HIFU组和LEEP组间差异无统计学意义(P=0.065>0.05).Normal组和宫颈炎组转阴率高于LSIL组,差异有统计学意义(P<0.001),Normal和宫颈炎组转阴率比较,差异无统计学意义(P>0.05).HPV-mRNA阳性组无论采取哪种治疗方式,转阴率均低于阴性组,差异有统计学意义(P<0.01).HIFU组治疗后并发症发生明显低于LEEP组,创面愈合时间短于LEEP组(P<0.05).结论 利于病毒清除HPV转阴,同时自内向外的治疗,保留了组织完整,并发症低,对于育龄女性尤其有生育要求的女性,作为高危HPV感染的治疗方式更值得推荐.

Objective To analyze the hemodynamics charateristics of patients with missed abortion and early pregnant women by color Doppler ultrasonography in order to provide the basis for early diagnosis of missed abortion.Methods The transvaginal color Doppler examination was performed in 200 cases of missed abortion and 200 cases of normal early pregnancy.The hemodynamic indexes of uterine artery and spiral artery including pulsatility index (PI),resistance index (RI),systolic/diastolic flow rate ratio (S/D) were detected and statistically analyzed.Results RI and PI in uterine arteries and spiral arteries in missed abortion group were significantly higher than those in normal early pregnancy group (P ＜ 0.05),and the S/D in uterine arteries and spiral arteries in missed abortion group was higher S/D than that in normal early pregnancy group,but there was no significant difference between two groups (P ＞ 0.05) Conclusion The monitoring of uterine artery hemodynamic parameters has important clinical significance in.diagnosis of missed abortion.

目的:探讨CXCR4在宫颈癌细胞株Hela细胞中的表达情况,及CXCL12-CXCR4生物轴对Hela的增殖、迁移和侵袭能力的影响,并研究CXCR4的特异性拮抗剂AMD3100对CXCR4的特异性阻断效果.方法:将宫颈癌Hela细胞株细胞进行体外培养.免疫组化检测Hela细胞中CXCR4的表达情况.采用MTT法研究不同浓度CXCL12对Hela细胞增殖的影响;Transwell法进行实验,判断在无血清培养液的生长条件下,不同浓度的CXCL12和CXCR4拮抗剂AMD3100对Hela细胞迁移、侵袭的影响.结果:CXCR4在Hela细胞的细胞膜、细胞质中有表达.1组Hela细胞的增殖数与2组及3组两两比较,差异有统计学意义(P＜0.05),4组Hela细胞的增殖数较2组、3组低,差异有统计学意义(P＜0.05).与A组Hela细胞的迁移数和侵袭数相比,B组明显更高(P＜0.05);而C组Hela细胞的迁移数和侵袭数明显高于A组和B组;D组Hela细胞的迁移数和侵袭数均低于A、B、C3组,差异有统计学意义(P＜0.05).结论:CXCR4在Hela细胞的细胞膜、细胞质中均表达.CXCL12-CXCR4生物轴可促进宫颈癌Hela细胞株的迁移及侵袭,而CXCR4拮抗剂AMD3100能抑制这一过程,CXCL12-CXCR4生物轴在宫颈癌Hela细胞生长和转移过程中可能起着重要作用.

Objective To investigate the changes of subtypes of macrophage treated by culture supernatant of ovarian cancer cell line-SKOV3 in vitro,and to explore the differences of expressions of CD80,CD86,CD40 in different subtypes of macrophage.Methods The peripheral blood mononuclear cells were separated from healthy adults by Ficoll density gradient method,which were induced into macrophages by GM-CSF.Then the macrophages were cultured in supernatant of SKOV3 ovarian cancer cells at exponential growth phase for 14 days.The changes of subtypes of macrophage and the expression levels of CD80,CD86,CD40 in different subtypes of macrophages were detected by flow cytometry.Results The examination results by flow cytometry showed that after the macrophages were treated in supernatant of SKOV3 ovarian cancer cells for 14 days, the macrophages were mainly differentiated into CD163-M2 subtype macrophages [M1/M2=(12.37±1.76)%/(22.23±2.21)%].The expression levels of CD40 in CD163-M2 subtype macrophages were significantly decreased,as compared with those in CD64-M1 subtype macrophage ( P <0.05).However there were no significant differences in the expression levels of CD80 and CD86 between two groups ( P >0.05).Conclusion After the macrophages are treated in culture supernatant of SKOV3 ovarian cancer cells,which are differentiated into different subtypes.Moreover the expression levels of costimulatory molecules are down-regulated in M2 subtype macrophages,as compared with those in M1 subtype macrophages ,which suggests that these costimulatory molecules play an important role in activation of macrophages and immune response,which may be correlated to immune escape of tumor cells.

Objective To detecte M2/M1 ratio of ascites or peritoneal washings of different macrophages subtypes of ovarian cancer patients at different stages,to separate M1 subtype macrophages and M2 subtype macrophages by flow cytometry,to test the mRNA expression of M1-and M2-related cytokines IL-10 and 1L-12,and to explain the immune mechanism of ovarian cancer abdominal metastasis at the point of cytokines.Methods ①M1 macrophages and type M2 macrophages were labeled with CD64 and CD163 respectively,and the ratio of M2/M1 in ascites or peritoneal lavage fluid in 10 cases of ovarian cancer and 17 cases of benign ovarian tumor was observed.②Flow cytometry was used to separate M1 subtype macrophages and M2 subtype macrophages.③RT-PCR was used to test the mRNA expression of M1-and M2-related cytokines IL-10 and 1L-12.Results M2/M1 ratio in control group was lower than that in Ⅰ+Ⅱ stage and Ⅲ+Ⅳ stage;while Ⅰ+Ⅱ stage M2/M1 ratio was lower than Ⅲ+Ⅳ stage,and there was statistically significant differencein two groups(P<0.05).IL-10 expression in M2 subtype macrophages was higher than it in M1 subtype macrophages.IL-12 expression in M1 subtype macrophages was higher than that in M2 subtype macrophages.There was statistically significant difference respectively(P<0.05).Conclusion There were macrophages in epithelial ovarian cancer patients' ascites.M1 subtype macrophages accounted for high proportion at the early stage,while M2 subtype macrophages accounted for high proportion at the terminal stage.The high proportion of M2 subtype macrophages indicated that ovarian cancer patients were at the terminal stage.The difference expression of IL-10 and IL-12 indicated that M2 macrophages may create favorable conditions for ovarian cancer peritoneal dissemination and distant metastases.

目的：观察宫腔粘连术前两种不同宫颈预处理方法的疗效。方法收集在石家庄市第一医院行宫腔镜治疗的宫腔粘连患者72例。根据术前宫颈预处理方法不同随机分为研究组及对照组。研究组术前3 d晨起空腹顿服米非司酮200 mg，术前2 h阴道后穹窿放置卡前列甲酯栓1 mg。对照组术前30 min给予间苯三酚80 mg静脉注射，术中观察宫颈软化的程度、手术时间、出血量情况，术后观察患者的月经改变。结果研究组宫颈软化的有效率83．33％高于对照组50．00％（ P ＜0．05）。研究组手术时间（26．30±6．25）min、出血量（15．02±5．26）ml低于对照组的（35．64±8．16）min、（23．30±8．09） ml（ P ＜0．05）。术后研究组月经较前好转的明显高于对照组（ P ＜0．05）。结论米非司酮联合卡前列甲酯栓应用于宫腔粘连术前宫颈预处理中，可充分软化宫颈，促进宫颈成熟，减少术中出血，缩短手术时间，且术后月经情况较前好转。

目的 探讨卵巢癌SKOV3细胞系培养上清液处理巨噬细胞不同时间后,巨噬细胞分化亚型的改变.方法 Ficoll密度梯度法分离健康成人外周血单个核细胞,GM-CSF诱导为巨噬细胞(M0)后,用对数生长期的SKOV3细胞培养上清液处理为实验组,用1640培养基处理为对照组,分别于培养第7天和第14天光学显微镜下观察巨噬细胞形态变化;流式细胞术检测实验组和对照组在不同时间后巨噬细胞表面细胞因子(CD64、CD163)表达情况.结果 培养第7天时,实验组巨噬细胞形态改变明显,细胞突起增加,细胞变细长,对照组细胞形态无明显变化,实验组CD64-M1型巨噬细胞所占比例高于对照组,CD163-M2型巨噬细胞所占比例低于对照组(P＜0.05);培养第14天时,实验组巨噬细胞形态逐渐恢复,对照组细胞形态仍无明显变化,实验组CD64-M1型巨噬细胞所占比例低于对照组,CD163-M2型巨噬细胞所占比例高于对照组(P＜0.05).实验组CD64-M1型巨噬细胞在第7天时M1/M0水平高于第14天,CD163-M2型巨噬细胞在第7天时M2/M0低于在第14天,差异均有统计学意义(P＜0.05).结论 SKOV3细胞培养上清液可改变巨噬细胞形态,激活巨噬细胞免疫反应,随着时间的推移,细胞形态恢复,发生免疫抑制;同时,也可促进巨噬细胞分化,随着时间的推移,亚型也有不同,主要由CD64-M1型巨噬细胞向CD163-M2型巨噬细胞转变.

<正>1病例报告患者,27岁,G1P0。因停经2月余,下腹坠痛伴阴道流血3天于2012年4月25日急诊入院。平素月经规律,末次月经:2012年2月15日。1月前因停经40天在当地医院行人工流产术,自诉手术顺利,术后1周阴道流血停止,绒毛情况不详。3天前无诱因突发下腹坠痛伴阴道流血就诊我院,门诊以"异位妊娠破裂,腹腔内出血,失血性休克"急诊收住院。患者既往体健。入院查体:贫血貌,血压80/50mmHg,脉搏不清;心肺听诊未见异常;下腹部稍隆起,全腹压痛、反跳痛及肌紧张明显,移动性浊

子宫内膜异位症多发生在盆腔脏器,也可发生在宫颈、阴道、会阴和腹部手术切口.随着剖宫产率的上升,剖宫产术后引起的腹部手术切口子宫内膜异位症发生率有上升的趋势.我院1991年1月至2006年10月收治剖宫产术后腹壁切口子宫内膜异位症患者21例,报告如下.

<正>妊娠高血压综合征(简称妊高征)是威胁母儿健康的一种严重产科并发征,是我国孕产妇三大死亡原因之一。如能根据血液动力学改变,在临床症状出现之前预测妊高征,并得到及时的生活指导和药物预防,将能避免或减少母婴损害。我院于2004年使用北京易思医疗器械有限责任公司研制的MP妊高征监测系统结合血钙预测妊高征,监测孕妇200例,取得了较好的预测效果,现报告如下。

近十年来,由于血绒毛膜促性腺激素(HCG)测定方法灵敏度的增强,经阴道超声诊断技术、腹腔镜技术的广泛应用,以及临床妇科医生对异位妊娠警惕性的提高,绝大多数异位妊娠在早期已能做出诊断,为临床上选择保守性治疗创造了有利条件.

卵巢巧克力囊肿又称为卵巢子宫内膜异位囊肿,因其内含有暗褐色黏糊状陈旧血,状似巧克力液体而得名.卵巢巧克力囊肿破裂发生率近年来呈上升趋势,误诊率可达42.9%～85.7%[1].卵巢巧克力囊肿破裂后,由于囊内液流入腹腔引起急腹症,容易误诊.今将我院20例卵巢巧克力囊肿破裂患者临床特点作一分析,以探讨其早期诊断,指导临床治疗.

宫内节育器(IUD)是育龄妇女常易接受的避孕措施,随着使用IUD人数的增加,IUD与异位妊娠的关系已逐渐引起我们的重视.我院自1985年1月～1995年12月11年手术并经病理证实异位妊娠194例,其中IUD合并异位妊娠52例,现报道如下.