子宫内膜异位症(endometriosis,EMS)影响5％～10％的育龄期女性,异位病灶可侵犯全身任何部位,绝大多数位于盆腔脏器和壁腹膜.Du-buisson等[1]将子宫内膜异位症分成3种类型:腹膜型、卵巢型及深部浸润型,深部浸润型子宫内膜异位症(deep infiltrating endometriosis,DIE)是其中最严重的一种.30％～50％的子宫内膜异位症患者合并不孕.多种机制参与子宫内膜异位症导致不孕,其中包括子宫内膜异位症影响卵巢储备功能.抗苗勒氏管激素(antimüllerian hormone,AMH)由初级卵泡、窦前卵泡和直径2～6 mm窦卵泡的颗粒细胞分泌[2].AMH不受月经周期、口服避孕药、促性腺激素释放素的影响,是评价卵巢储备功能的稳定指标[3].最近研究认为,AMH是功能性卵泡储备的直接反映[4].目前的多数研究认为:卵巢型子宫内膜异位症能使卵巢储备功能降低.但未累及卵巢的子宫内膜异位症对卵巢储备功能的影响尚存在争议,且DIE对AMH水平影响的研究不多.本研究回顾性分析福建省妇幼保健院非卵巢子宫内膜异位囊肿的子宫内膜异位症患者的临床资料,探讨该类子宫内膜异位症对AMH水平的影响因素,及手术对自然妊娠率的影响,并探讨DIE对患者AMH及生育的影响.

OBJECTIVE: To evaluate the impact of ovarian endometrioma on the serum anti-Mullerian hormone (AMH) level and natural postoperative conception outcomes in patients with endometriosis lesions.STUDY DESIGN: A retrospective analysis was conducted of 164 women (<= 35 years) with infertility: 92 patients with ovarian endometrioma (case group) and 72 patients with tubal infertility (control group). All patients underwent laparoscopic treatment. After the surgical procedure the patients were followed up over a period of 12-24 months to assess the frequency of natural pregnancy. Their basal serum AMH levels were compared.RESULTS: The serum AMH level of patients with endometriosis was not significantly lower than that of the control group. However, the serum AMH level was significantly lower in patients with large ovarian endometrioma (>= 5 cm) than in those with small ovarian endometrioma (< 5 cm). The endometriosis fertility index (EFI) score was significantly correlated with pregnancy outcome (p=0.002). Patients with endometriosis reported a cumulative natural pregnancy rate of 53.48% during the 1-2 postoperative years.CONCLUSION: Ovarian endometriomas (>= 5 cm) independently affect the serum AMH level. The EFI score significantly correlates with postoperative pregnancy outcome, which indicates that surgical intervention can efficiently improve the fertility outcomes for patients with endometriosis.

Background: It is very rare for a young woman to experience spontaneous rupture of an unscarred uterus. Clinicians usually have a low clinical index of suspicion and may underestimate the possibility of a uterine rupture, leading to neonatal mortality in particular circumstances. We presented an incidence of spontaneous rupture of an unscarred uterus induced by placenta percreta in the third trimester of pregnancy. Case: A 27-year-old woman with an unscarred uterus, at a gestation of 31 weeks and 4 days, was presented with the right epigastric pain and vomiting after 10 hours of admission. Relevant symptomatic treatment was prescribed but did not release the related symptoms. Furthermore, an emergent exploratory laparotomy and cesarean section were conducted after the presence of hypotension and abnormal fetal heart rate, during which a spontaneous rupture of an unscarred uterus occurred, resulting in stillbirth and intraperitoneal hemorrhage. The pathological examination confirmed placental percreta as the cause of the rupture. Conclusions: IVF-ET may be a risk factor of UR and placental percreta. Potential uterine rupture should be considered for pregnant women receiving IVF-ET when they complain of abdominal pain and abnormal fetal heart rate. This case highlights the importance of identifying the risk factors for placental percreta so that patients at risk would benefit from an antenatal detection of abnormal placentation.

目的 探讨腹腔镜手术治疗小儿及青少年良性卵巢囊肿临床效果.方法 对应用腹腔镜微创手术治疗的46例与传统开腹手术治疗的30例小儿及青少年卵巢囊肿患者的临床资料作回顾性分析,并对手术时间、术中出血、术后恢复情况进行对比分析.结果 微创手术46例中无一例为转开腹手术,均在腹腔镜下顺利完成,无并发症发生.腹腔镜微创手术和开腹手术的时间分别为(77.92±32.82) min和(90.64±21.25)min,两者比较的差异无统计学意义(P＞0.05).但两组术中出血量分别为(15.09±13.36) mL和(33.47±23.12) mL,术后住院天数分别为(4.2±0.8)d和(5.7±1.4)d,两组术中出血量及术后住院时间比较有统计学意义(P＜0.05).结论 腹腔镜微创手术具有损伤小、出血量少、恢复快等优点,是目前治疗卵巢良性肿瘤的最佳手术方式.

目的 探讨宫腔镜在诊治绝经后宫腔占位性病变中的应用效果.方法 对138例应用宫腔镜诊治的绝经后宫腔占位性病变妇女的临床资料作回顾性分析.根据阴道出血情况分为阴道出血组(60例)及无阴道出血组(78例),对两组的一般情况、病理类型及宫腔镜诊断病变的病理符合率进行对比分析.结果 绝经后宫腔占位性病变以子宫内膜息肉最多见,宫腔镜诊断子宫内膜息肉的病理符合率为91.1%(82/90),黏膜下肌瘤病理符合率为100.0%(18/18),癌前病变的病理符合率为70.0%(7/10).34例患者行宫腔镜检查前已行诊刮术,发现诊刮术漏诊率达94.1%(32/34).无阴道出血组子宫内膜息肉及黏膜下肌瘤检出率高于出血组,而阴道出血组癌前病变及内膜癌检出率高于非出血组.结论 宫腔镜能对宫腔直接、近距离及全面观察,能定位取材,提高了宫腔占位性病变的诊断准确性.

目的:观察宫腔粘连(IUA)分解术后宫腔内放入玻璃酸钠联合大剂量雌激素口服预防再粘连的效果.方法:宫腔镜确诊为IUA患者272例,分为A组和B组,A组(n=103)行宫腔镜下IUA分离术及宫腔内节育器(IUD)放置术,术后口服大剂量雌激素及孕激素人工周期3个月;B组(n=169)在A组相同治疗的基础上加宫腔内留置玻璃酸钠;比较A组和B组的疗效.结果:中度粘连患者术后粘连再发率B组显著低于A组(P＜0.05);A、B组的治疗有效率分别为:轻度粘连100％、100％;中度粘连83.3％、94.6％;重度粘连68.2％、83.9％(P均＞0.05);轻、中度IUA的治愈率B组显著高于A组(P＜0.05).结论:IUA分解术后宫腔内留置玻璃酸钠联合大剂量雌激素口服可提高预防再粘连的效果,特别对轻、中度IUA效果显著.