Objective:To evaluate the clinical efficacy of autologous bone marrow nucleated cell transplantation on ovarian dysfunction-related diseases.Methods:From September 2020 to August 2021, we conducted a before-after study in Shanghai Institute of Planned Parenthood Research Hospital and Shanghai New Hongqiao International Medical Center. A total of 28 patients with premature ovarian insufficiency, perimenopausal syndrome or repeated assisted reproduction failure were treated with ultrasound-guided autologous bone marrow nucleated cell transplantation into the ovaries. Clinical efficacy was evaluated by comparing the patients' self-reported symptoms, endometrial thickness, bilateral ovarian volume, the number of bilateral ovarian follicles, the maximum diameter of bilateral ovarian follicles, and the level of plasma estradiol, follicle-stimulating hormone (FSH), luteinizing hormone (LH), progesterone, prolactin, and testosterone.Results:After autologous bone marrow nucleated cell transplantation, the number of bilateral ovarian follicles and the maximum diameter of bilateral ovarian follicles statistically significantly increased by an average of 1.26±2.12 ( P=0.005) and (5.40±8.92) mm ( P=0.006), respectively. Endometrial thickness and bilateral ovarian volume increased after treatment although without statistically significance (all P>0.05). However, the ovarian volume, the number of follicles, and the maximum diameter of follicles with greater changes between the left and right sides of the treatment, were found to statistically significantly increase after treatment ( P=0.007, P<0.001, P=0.002). Besides, the levels of FSH, LH, progesterone, and prolactin decreased with no statistical significance (all P>0.05). The stratified analysis of disease types found that endometrial thickness, the number of bilateral ovarian follicles, and the maximum diameter of bilateral ovarian follicles after treatment tended to increase, but only the number of bilateral follicles and the maximum diameter of bilateral ovarian follicles in patients with perimenopausal syndrome showed statistical significance ( P=0.008, P=0.047). Conclusion:The present study suggested that autologous bone marrow nuclear cell therapy could improve ovarian function to some extent, and is expected to be a new treatment method for patients with premature ovarian insufficiency, perimenopausal syndrome, and repeated assisted reproduction failure. However, further studies with larger sample sizes are needed to corroborate the findings.

目的探讨宫腔镜在治疗年轻的多囊卵巢综合征(PCOS)合并子宫内膜不典型增生(EAH)或早期子宫内膜样腺癌(EEC)患者的临床疗效及安全性。方法本研究为回顾性研究,患者分为2组,早期12例患者(9例EAH,3例EEC)采用单纯药物治疗(单纯药物组):达英-35联合二甲双胍,每3个月采用诊断性刮宫+病理检查,了解子宫内膜病变转化情况;后期32例患者(21例EAH,11例EEC)采用宫腔镜治疗(宫腔镜治疗组):达英-35联合二甲双胍,每3个月行宫腔镜直视下病灶完全切除+全面诊断性刮宫+病理检查了解子宫内膜病变转化情况。结果所有患者经病理证实子宫内膜病变均成功转化,单纯药物组EAH成功转化时间为(6.6±3.1)个月;宫腔镜治疗组(4.1±1.3)个月,组间比较差异有统计学意义(P=0.025);单纯药物组早期EEC成功转化时间为(6.3±2.8)个月;宫腔镜治疗组为(4.7±1.7)个月,组间比较差异有统计学意义(P=0.020)。单纯药物组2例EAH已足月分娩获活婴,此2例为自然受孕;宫腔镜治疗组9例(5例EEC,4例EAH)已足月分娩均获活婴,另外有8例EEC转化成功者目前仍在妊娠中。结论达英-35联合二甲双胍药物治疗能使PCOS合并胰岛素抵抗(IR)的子宫内膜癌前病变及EEC完全转化,宫腔镜能准确、彻底切除子宫内膜病灶,能最大可能达到"无瘤"的治疗要求,所以能明显缩短药物的转化时间(P<0.05),并能增加子宫内膜病灶对药物保守治疗的反应性,从而保留了此类患者的生育能力。

目的:了解围绝经期及绝经后妇女宫内节育器(IUD)的取出情况及实际使用年限.方法:以在黄浦区居住且末次使用避孕方法为IUD的45～60岁妇女为研究对象,于2011.08～12期间开展横断面调查,共调查2 167人,其中2 054人纳入分析.结果:研究对象平均年龄52.4±4.0岁.1 160例已绝经的妇女中,63例(5.4％)使用的IUD仍未取出,其中15例IUD已放置至绝经后5年以上;IUD的平均宫内放置时间为18.9±5.7年,50.2％的IUD使用者宫内放置时间＞20年.732例未绝经的妇女中,IUD的平均使用年限为17.3±5.7年,有51.1％的女性使用IUD已超出建议使用期限.结论:绝经后IUD过期使用情况严重,相当一部分正在使用的IUD已超过了使用期限.

目的:探讨重度妊娠高血压综合征的临床特点和有效治疗方案。方法:通过对45例重度妊娠高血压综合征病例进行回顾分析,总结重度妊高征的药物治疗方法及观察终止妊娠时机和方式对母儿的影响。结果:先兆子痫15例,产前子痫3例,产后子痫1例,母亲全部存活,均为剖宫产,新生儿窒息2例,围生儿死亡1例。结论:妊娠高血压综合征患者应认真做好产前检查,在解痉、降压、镇静为原则积极的治疗基础上,适时采用剖宫产终止妊娠是抢救重度妊娠高血压综合征的有效手段。