目的 观察超声指征性宫颈环扎术对体外受精-胚胎移植(IVF-ET)术后双胎妊娠患者妊娠结局的影响.方法 回顾性分析85例经阴道超声提示宫颈长度＜25 mm的IVF-ET术后双胎妊娠患者的临床资料;其中,42例行期待治疗(对照组),43例行经阴道宫颈环扎术(手术组).比较两组患者一般资料、宫颈机能不全危险因素、妊娠结局和新生儿情况之间的差异.结果 两组患者年龄、晚期流产史或早产史、绒毛膜性、诊断孕周、多囊卵巢综合征病史、宫腔操作次数、子宫畸形、晚期流产率及新生儿窒息率比较差异均无统计学意义(P＞0.05).与对照组相比,手术组患者延长孕周、分娩孕周、≥35周分娩率、新生儿出生体重增加(P＜0.05),＜35周早产率和围产儿死亡率降低(P＜0.05).结论 对于阴道超声提示宫颈长度＜25 mm的IVF-ET术后双胎妊娠患者,经阴道宫颈环扎术可有效延长孕周,改善妊娠结局.

BACKGROUND:There are few studies on the relative factors related to postoperative recurrence. OBJECTIVES:To compare the outcomes of pelvic floor reconstruction involving Herniamesh mesh and biological grafts and to investigate the correlative factors of postoperative recurrence. METHOD:Two hundred and thirty-two patients were randomly divided into 2 groups: Herniamesh mesh group (117) and biological graft group (115). Follow-ups for 6 months and 1 year after the surgery. The primary outcomes were recurrence, perioperative complications. Secondary outcome was a questionnaire about the life habits associated with relapse. RESULTS:The recurrence rate at 6 months or 1 year did not differ substantially between the 2 groups (p = 0.787 and 0.968, respectively). Adverse events occurred with significantly different frequencies over 1 year (p = 0.005). Twelve factors were investigated and analyzed by logistic regression analysis. It showed that recurrence had a strong association with a long-term vegetarian diet (OR 0.283, 95% CI 0.117-0.683), long-term soybean product diet (OR 8.010, 95% CI 2.514-25.523), and vaginal intercourse (OR 5.154, 95% CI 1.461-18.184). CONCLUSIONS:The surgical recurrence rate for the mesh was similar to biological grafts at short-term follow-up. Eating soy products often and vaginal intercourse after surgery can reduce recurrence.

目的:探讨预处理对代谢综合征(MS)不孕患者体外受精-胚胎移植过程及结局的影响.方法:回顾性分析2015年1月-2017年10月112例不孕患者共167个短效长方案体外受精(IVF)或卵胞浆内单精子注射-胚胎移植(ICSI-ET)周期,根据WHO制定的亚洲成人体重指数(BMI)标准及2005年国际糖尿病联盟制定的MS标准按照是否预处理分为A正常组:无MS且体重正常;B1:超重MS未处理组,B2:超重MS处理组;C1:肥胖MS未处理组,C2:肥胖MS处理组.比较超促排卵结局、胚胎情况及妊娠结局.结果:①治疗情况:B、C两组的受精数、可移植胚胎数及优质胚胎数均显著低于A组(P＜0.05),而B1、C1组则明显低于B2、C2组(P＜0.05);②妊娠结局:B1、C1组的胚胎种植率及临床妊娠率明显低于其他3组(P＜0.05);B1、C1组的不良妊娠率较A、B2、C2组高(P＜0.05).结论:代谢综合征影响卵泡细胞的成熟及排卵,患者易产生不孕及不良妊娠结局.预处理影响IVF的治疗并改善其助孕结局.

目的 探讨刮宫术和经阴道子宫瘢痕妊娠病灶切除术及子宫修补术两种手术方式治疗剖宫产瘢痕妊娠的效果.方法 回顾性分析2016年1月至2017年4月南京医科大学附属妇产医院收治的104例剖宫产瘢痕妊娠患者的临床资料,所有患者均先行双侧子宫动脉灌注栓塞治疗,再按照不同手术方式分为A组:刮宫术,B组:经阴道子宫瘢痕妊娠病灶切除术及子宫修补术.分析两组术中出血量、手术时间、住院时间、住院费用、术后血β-hCG下降幅度及疗效.结果 B组术中出血量少、术后血β-hCG下降幅度大,较A组有显著差异(P＜0.05),B组较A组手术时间稍长;差异有统计学意义(P＜0.05),住院时间和住院费用无明显差别(P＞0.05).B组治疗均成功,A组有两例失败,治疗有效率差异无统计学意义(P＞0.05).结论 子宫动脉灌注栓塞治疗后行经阴道子宫瘢痕妊娠病灶切除术及子宫修补术安全有效,具有出血少、术后恢复快优点,值得临床推广.

女性压力性尿失禁(stress urinary incontinence,SUI)是一种常见的盆底功能障碍性疾病,其发生率约为10％～30％[1-2],年龄大于60岁的老年妇女SUI发病率为12％～34％[3-4].SUI是指女性在咳嗽、喷嚏、大笑、提重物或屏气等腹腔内压力突然增加时,不能自主控尿,尿液不自主流出.治疗SUI的微创术式曾有数十种之多,目前无张力性尿道中段悬吊术极有可能成为治疗SUI的金标准[5].

目的:分析Prolift(Prolift Pelvic Floor)和AMS(AMS Peep Connection Tool)两种盆底修复系统治疗女性盆腔器官脱垂(pelvic organ prolapse,POP)的临床疗效以及并发症的差异.方法:选取南京医科大学附属南京妇幼保健院2010年11月—2013年6月收治的60例POP患者,随机分为Prolift组和AMS组,Prolift组29例,AMS组31例.比较2组患者的临床疗效和并发症.结果:2组患者的手术时间、术中出血量、术后最高体温、尿管留置时间、残余尿量及住院时间比较差异均无统计学意义(P＞0.05);排尿困难、会阴部下腹坠胀、网片暴露、阴道壁膨出等术后并发症在2组患者间差异也无统计学意义(P＞0.05),Prolift组患者的疼痛及性生活质量下降的发生率显著高于AMS组(P＜0.05).结论:应用Prolift和AMS两种盆底修复系统治疗POP,均能实现盆底解剖重建和功能恢复,但AMS比Prolift更具优势.

目的：探讨剖宫产术后腹壁子宫内膜异位症的临床特点、治疗和预防。方法收集62例腹壁子宫内膜异位症患者的临床诊疗资料，分析其临床特征、治疗效果和预防措施。结果患者术后病理结果均为腹壁子宫内膜异位症，经手术切除病灶治疗，4例复发。结论腹壁子宫内膜异位症诊断较容易，手术是首选治疗方法，彻底切除病灶是治疗该病的关键；应防止医源性腹壁子宫内膜异位症。

Histone deacetylase (HDAC) 4 is an emerging target in cancer therapeutics, but little is known about the function of HDAC4 in gynecologic malignancies. Therefore we investigated the mechanism of HDAC4 promoting the proliferation of epithelial ovarian cancer cells (OV). In this study, we observed that the proliferation of cells with HDAC4 inhibitor Trichostatin A (TSA) treatment was markedly decreased, Further, we showed that epithelial ovarian cancer tissues with stage III/IV had higher HDAC4 expression, compared to that with stage I/II. We examined first that the HDAC4 expression was increased in response to fibrillar collagen matrices. In addition, we found that HDAC4 was retained in the nucleus by regulation of PP1α, which regulated HDAC4 cellular fraction via phosphorylation of HDAC4. In addition, we found that HDAC4 bound to Sp1 in epithelial ovarian cancer cells. Finally, ovarian cancer cell line OVCAR3 was evaluated via gain/loss-of-function of HDAC4 by either overexpression of HDCA4 or knock-down of HDAC4 with shRNA. We examined both protein and mRNA of p21 by western blotting and qPCR. We performed analysis of colony formation in matrigel and migration by ECIS. Our results suggest that the accumulation of HDAC4 induced by fibrillar collagen matrices in the nucleus via co-localization of PP1α, leads to repression of the mRNA/protein of p21 and in turn promotes the proliferation and migration of epithelial ovarian cancer cells.

先天性无阴道综合征( mayer rokitansky kuster huser, MRKH)是胚胎发育过程中双侧副中肾管发育不全或双侧副中肾管会合后未向尾端延伸形成阴道所致,其发生率为1：4000~1：5000。 MRKH 患者几乎均合并无子宫或始基子宫,卵巢功能通常正常[1],阴道成形术可解决患者无法性生活的困扰。目前阴道成形术的方法有多种,寻找一种简单、方便、创伤小、效果满意的方法成为必然。我院自2010年3月利用美国COOK生物技术公司研制的Surgisis ES软组织修复补片(简称COOK生物补片)移植阴道成形术,取得了满意的效果,现报道如下。

目的:探讨腹腔镜手术治疗异位妊娠的临床价值。方法:60例异位妊娠患者随机分为腹腔镜组(n=30)和剖腹组(n=30),分别采用腹腔镜手术与剖腹手术,比较观察两组手术时间、术中出血量、下床活动时间、肛门排气时间、住院时间、术后病率、术中术后并发症发生率、术后镇痛剂使用率等。结果:与剖腹组比较,腹腔镜组术中出血量小,下床活动时间、术后肛门排气时间、住院时间缩短,术后病率、术后镇痛剂使用率低,差异有显著性(P<0.05,P<0.01)。而手术时间腹腔镜组长于剖腹组(P<0.01)。结论:腹腔镜手术治疗异位妊娠痛苦少,恢复快,效果优于传统的开腹手术。

近年来,子宫腺肌病发病率有明显上升趋势,严重影响了妇女的身心健康,但因其术前误诊、漏诊率较高,部分病人治疗较棘手,已受到妇科界广泛关注.我院自1998年1月到2002年12月经手术治疗并术后病理确诊子宫腺肌病102例,现临床回顾性分析,以提高对子宫腺肌病的认识及临床诊断准确率.