目的:将白蛋白结合型紫杉醇联合顺铂应用于晚期和复发子宫颈癌患者的治疗,探讨其临床应用价值.方法:选择解放军总医院妇产科2015年1月至2018年1月期间诊治的晚期和复发子宫颈癌患者作为研究对象,采用前瞻性队列研究,根据化疗方案不同分为两组,观察组(n=52)采用白蛋白结合型紫杉醇+顺铂的治疗方案,对照组(n=49)采用紫杉醇脂质体+顺铂的治疗方案,比较两组的疗效和不良反应发生情况.结果:观察组的客观缓解率高于对照组[35例(67.3％)vs 23例(46.9％),P ＜0.05];两组疾病稳定、疾病进展和疾病控制率比较差异无统计学意义(P＞0.05);观察组治疗费用高于对照组(25138.8±3540.7元vs 14971.6±1633.5元,P＜0.05).观察组骨髓抑制[20例(38.5％)vs 31例(63.3％)]、周围神经症状[3例(5.8％)vs 11例(22.4％)]和过敏反应[0例(0)vs 4例(8.2％)]的Ⅲ～Ⅳ级不良反应发生率低于对照组,差异均有统计学意义(P＜0.05);两组肝功能损害、肾功能损害和胃肠道反应的Ⅲ～Ⅳ级不良反应发生率比较差异无统计学意义(P＞0.05).结论:白蛋白结合型紫杉醇与顺铂联合用于治疗晚期和复发子宫颈癌,其疗效和安全性较紫杉醇脂质体联合顺铂更有优势,但昂贵的费用是其推广使用最大的障碍.

目的:探究腹腔镜下卵巢囊肿剥除术后缝合与电凝止血对卵巢功能的影响.方法:选择2014年5月～2015年12月期间我院收治卵巢囊肿患者78例为研究对象,两组患者均行腹腔镜下卵巢囊肿剥除术,根据患者术中止血方式的不同将其分为观察组(41例)和对照组(37例);观察组术中采用双极电凝止血,对照组患者性术中采用缝合止血;观察并比较术后4周、12周两组患者促卵泡生长激素(FSH)、促黄体激素(LH)、雌二醇(E2)及窦状卵泡计数(Shape of sinus follicle count,AFC),对比两组术后12周卵巢功能恢复情况.结果:术后4周两组患者FSH、LH水平较术前升高,E2及AFC水平较术前降低,差异均有统计学意义(P＜0.05);术后12周对照组FSH、LH、E2及AFC水平与术前比较,差异无统计学意义(P＞0.05),观察组患者FSH、LH水平较术前升高,E2及AFC水平较术前降低,且观察组患者FSH、LH水平高于对照组,E2及AFC水平低于对照组,差异均有统计学意义(P＜0.05);术后12周,观察组患者出现排卵异常、经量过少及经期延长的发生率均高于对照组(P＜0.05).结论:缝合止血在腹腔镜下卵巢囊肿剥除术止血对患者卵巢功能的损伤作用小于电凝止血,术后卵巢功能恢复快,临床上应当优选缝合止血,降低对卵巢功能的影响.

Objective To investigate the efficacy of laparoscopic surgery in the treatment of large ovarian cysts(diameter > 12 cm).Methods A retrospective analysis on 67 patients with large ovarian cysts(diameter > 12 cm),who underwent cystectomy or enucleation by laparoscopy(37 cases) or laparotomy(30 cases) in our hospital.No significant difference existed between laparoscopy and laparotomy groups in the diameter of the tumor and surgical procedures(both P>0.05).The operation time,intraoperative blood loss,volume of cystic fluid,and postoperative hospital stay were compared between the two groups.ResultsLaparoscopy group showed significantly less intraoperative blood loss,shorter hospital stay,less overflow of cystic fluid than laparotomy group [(89.6±10.2) ml vs.(200.5±50.0) ml,t=-13.179,P=0.000;(3.9±1.8) days vs.(8.9±1.2) days,t=-13.037,P=0.000;11%(4/37) vs.33%(10/30),χ2=5.084,P=0.024].No significant difference was detected in the operation time and volume of cystic fluid between the two groups(P>0.05).Neither of the groups reported complications.Conclusion With strict indications,laparoscopy is effective for ovarian cysts larger than 12 cm in diameter,and is superior in controlling intraoperative hemorrhage,and postoperative recovery.

目的 探讨腹腔镜手术治疗直径＞ 12 cm卵巢囊肿的价值. 方法 回顾性分析2004年6月～2010年12月直径＞12 cm的卵巢囊肿的临床资料.腹腔镜组37例,开腹组30例.2组囊肿直径、术式差异无显著性(P＞0.05).比较2组手术时间、术中出血量、囊液量及术后住院时间. 结果 与开腹组相比,腹腔镜组术中出血量少[(89.6 ±10.2)ml vs.(200.5±50.0)ml,t=-13.179,P=0.000],术后住院时间短[(3.9±1.8)d vs.(8.9±1.2)d,t=-13.037,P=0.000],囊液外溢少[11％ (4/37) vs.33％(10/30),x2=5.084,P=0.024].2组手术时间、囊液量差异无显著性(P＞0.05).2组均无并发症发生. 结论 在严格选择病例的前提下,对直径＞ 12 cm的卵巢囊肿进行腹腔镜手术出血少,术后恢复快,有较大的应用价值.

Objective: To obtain human insulin like growth factor 1(hIGF-1) expressed in solubility in prokaryotic system and detect its biological activity.Methods: hIGF-1 gene was obtained by PCR and was cloned into pET-DsbC fusion vector.After induction,expression and purification,the antigenicity and biological activity of the product were examined by Western blot and MTT assay.Results: DsbC-hIGF-1 was expressed in solubility in Escherichia coli and its expression quantity was about 30%～35% to bacterial total protein with IPTG induction,which also showed a strong antigenic ability and stimulate proliferation of NIH/3T3 cells evidently.Conclusion: The results suggest that the DsbC-hIGF-1 protein has the similar biological activity to wide type hIGF-1 and could express in solubility in E.coli.It provides a futher investigation of the IGF-1 structure and function and build the foundation for the large scale production of IGF-1.

Clinical application value of gynaecological laparoscope technology is investigated.602 gynaecological surgical abdomen through applying laparoscopical emergency operation with video-laparoscope technique are treated.Diagnose were confirmed by operation and pathology check.All laparoscopic operation have gained success.In gynaecological surgical abdomen,laparoscope not only can diagnose promptly and correctly but also can treat in time.There are many merit in laparoscopic operation,for example,trauma is little,pain is light,recovery is fast,complication is few.Laparoscope can treat most gynaecological surgical abdomen replacing abdomen operation,it's applying prospect is good.

Objective:To explore the changes and clinical significance of interleukin-12(IL-12)in the peritoneal fluid and serum of patients with endometriosis.Methods:IL-12 in the peritoneal fluid and serum of 39 patients with endometriosis and 16 controls were detected by enzyme linked immunosorbent assay(ELISA).Results:IL-12 levels in the peritoneal fluid and serum of the endometriosis group were lower than those of the control group(P0.01).IL-12 levels in the peritoneal fluid [(62.37±13.7)ng/L] and in the serum [(53.64±17.4)ng/L] of patients with stageⅢ-Ⅳ endometriosis were lower than those in the peritoneal fluid[(76.38±13.5)ng/L]and in the serum [(75.67±12.3)ng/L] of patients with stageⅠ-Ⅱendometriosis(P0.01).Conclusions:IL-12 may play an important role in the pathogenesis of endometriosis.Determining the IL-12 levels in patients with endometriosis could help to the diagnosis and treatment.

To study the changes of tumor necrosis factor(TNF)in peritoneal fluid and serum of patients with endometriosis.TNF in peritoneal fluid and serum of 39 pa-tients with endometriosis and 16 control cases were detected by enzyme linked immunosorbent assay(ELISA).It is Resulted that TNF levels in peritoneal fluid and serum of endometriosis group were lower than those in control group.TNF levels of both groups in peritoneal fluidwere lower than those in serum(P 0.05).TNF in peritoneal fluid [(62.37±13.7)pg/mL] and TNF in serum [(53.64±17.4)pg/mL] of stageⅢ-Ⅳin endometriosis group were lower than TNF in peri-toneal fluid [(76.38±13.5)pg/mL] and in serum [(75.67±12.3)pg/mL] of stageⅠ-Ⅱ(both P 0.01).Conclusion:TNF may play an important role in the athogenesis of endometriosis.The detection of TNF will be helpful in the diagnosis and treatment of this disease.

Objective To investigate occurring reasons.Preventing measures of late puerperal hemorrhage after cesarean.Methods 11 patients from 1991.1 to 2002.1 were performed with a retrospective study.Results 11 case all were treated(conservation treatment:1 case,subtotal hysterectomy:7 case,total hystereetomy:3 case).Successfully without DIC,Sheehan's syndrome and other complication.Bleeding happened on 8～35th day after operation [meantime:(18±6)day] with a volume of 500～2500ml(mean flow:1000ml).In operation we saw disruption of uterine wound(n=4),2~3cm hematom forming(n=3),necrosis and disruption of subtotal cicatrix organine with a lot remained catgut(n=1)inflammation appearing with no absorbed catgut on 19th day after operation in uterine wound(n=1)catgut dissloving and abscission with arteria throbbing hemorrhage in a side corner of uterine wound(n=2).Conclusion To master strictly conditions of ceasarean section,apply reasonably enough antibioties,improve suturing technigre,correct antenatal and puerperal anemia,strengthen ersistance,select reasonablg place of uterine Nicking can validly puevent late puerperal hemorrhage after cesarean section.And it shouldn't treated with a conservation method in addition to placenta remains and uncomplete uterine contract of placental site.