目的 比较真实世界研究条件下中国Ⅰ A1(LVSI+)～Ⅰ B1期子宫颈癌患者腹腔镜与开腹手术长期肿瘤学结局.方法 基于中国子宫颈癌临床诊疗大数据库,纳入Ⅰ A1(LVSI+)～Ⅰ B1期子宫颈癌腹腔镜与开腹手术病例,在真实世界及1∶1倾向性评分匹配(PSM)条件下比较两种手术途径的5年总体生存率(OS)及无病生存率(DFS).结果 (1)从数据库中纳入2009年1月1日至2016年12月31日的全部Ⅰ A1 (LVSI+)～Ⅰ B1期子宫颈癌腹腔镜或开腹手术病例8490例,其中腹腔镜组3247例,开腹组5243例.匹配前两组5年OS无差异,但腹腔镜组5年DFS低于开腹组(88.3％ vs.90.5％,P=0.008),Cox多因素分析提示腹腔镜手术是患者复发/死亡的独立危险因素[HR(危险比)=1.329,95％ CI 1.129～1.564,P=0.001].经1∶1PSM匹配后两组各纳入3077例,两组5年OS无差异,腹腔镜组5年DFS低于开腹组(87.9％vs.90.6％,P=0.015),Cox多因素分析提示腹腔镜手术是患者复发/死亡的独立风险因素(HR=1.277,95％CI 1.062～1.535,P=0.009).(2)进一步纳入术式为QM-B型或QM-C型子宫切除术的病例,共7952例(腹腔镜组3115例,开腹组4837例).匹配前两组5年OS无差异,但腹腔镜组5年DFS低于开腹组(87.9％ vs.90.3％,P=0.013),Cox多因素分析提示腹腔镜手术是患者复发/死亡的独立危险因素(HR=1.326,95％CI 1.123～1.567,P=0.001).1∶1PSM匹配后两组各纳入2957例,两组5年OS无差异,但腹腔镜组5年DFS低于开腹组(88.4％ vs.90.7％,P=0.033),Cox多因素分析提示腹腔镜手术是患者复发/死亡的独立危险因素(HR=1.267,95％ CI 1.048～1.532,P=0.015).结论 在真实世界研究下,经多层次分析显示,对于中国Ⅰ A1(LVSI+)～Ⅰ B1期子宫颈癌患者,腹腔镜手术5年无病生存率低于开腹手术,腹腔镜手术与更高的复发/死亡风险相关.

Objective To analyze the clinical characteristics and trends of neoadjuvant chemotherapy (NACT) for cervical cancer by investigating the clinical pathological data of cervical cancer in some hospitals in China,and provide the research basis and data support for the standardized diagnosis and treatment of cervical cancer in China.Methods A retrospective study was performed on the clinical and pathological data of 4503 cases of neoadjuvant chemotherapy from 31 599 cervical cancer cases from 2004 to 2016 in the large database of cervical cancer from 34 hospitals in China.Results In total,31 599 cases were included in the current analysis.There were 25 542 surgical cases,and 4503 cases of neoadjuvant chemotherapy,accounting for 17.6％.The average age of NACT in 4503 cases was 46.82± 8.97 years old.In the past 13 years,the age of treatment has been on the rise.Locally advanced(Ⅰ B2,Ⅱ A2,Ⅱ B)were the main components of NACT cases (accounting for 27.7％,15.5％,23.4％,respectively).Among them,the proportion of Ⅰ B2,ⅡA2 stage (mass type)has an upward trend with time.According to tumor diameter,the cases with diameter of ＞ 4-6.0cm accounted for the highest proportion in NACT and the proportion appeared an upward trend.The ratio of squamous carcinoma 、adenocarcinoma 、adenosquamous carcinoma、neuroendocrine carcinoma,clear cell carcinoma、other pathological types (such as melanoma,lymphatic epithelial carcinoma) were 82.3％、6.8％、1.1％、0.8％、0.2％、0.8％,respectively.There was no linear trend change.The ratio of poorly differentiated showed a trend of increase in neoadjuvant chemotherapy of cervical cancer,The ratio of artery,intravenous,and arteriovenous chemotherapy were 21.3％,21.3％ and 21.3％ respectively.Over time,the rate of intravenous chemotherapy has been on the rise.Chemotherapy drug was mostly based on platinum-based.The number of arterial chemotherapy courses was 1-3,1 course was highest accounted for 90.1％,Intravenous chemotherapy included 1-4 courses,2 course was highest accounted for 58.6％.Conclusion In China,neoadjuvant chemotherapy in the treatment of cervical cancer occupies an important position.Nearly 13 years,the clinical stage,pathological grade,routes of administration,chemotherapy,medication and other aspects have undergone changes.According to the clinical characteristcs and trends of neoadjuvant chemotherapy in cervical cancer,it is more necessary to explore a standard treatment mode.

目的:探讨曼月乐在子宫疤痕憩室治疗中的临床疗效.方法:选取50例接受曼月乐治疗子宫疤痕憩室的临床资料并跟踪观察12个月.结果:(1)50例子宫疤痕憩室病例放置曼月乐治疗后,第1个月总有效率为88％,第3个月总有效率92％,第6个月总有效率94％,第12个月总有效率96％,不同放置时间总有效率比较差异均无统计学意义(P>0.05);(2)放置后第1、3、6、12个月时的月经周期天数明显减少,分别与放置前天数比较差异有统计学意义(P<0.05);其中放置后第1、3个月的月经周期天数与放置前的比较差异呈显著性差异(P<0.01);从放置后第3个月分别与第6、12个月天数比较差异无统计学意义(P>0.05).结论:曼月乐作为无创的方法治疗子宫疤痕憩室经期延长具有良好效果,值得在临床进行推广.

目的 探讨宫腔镜电切技术在阴道斜隔综合征诊治中的应用价值及特点. 方法 选择2014至2017年在广州市第一人民医院进行宫腔镜电切技术治疗阴道斜隔综合征6例,记录患者术前、术中及术后情况并进行回顾性分析. 结果 6例患者均行阴道内的宫腔镜下阴道斜隔电切术,术后无处女膜损伤、切缘粘连、复发. 结论 经阴道的宫腔镜电切技术治疗阴道斜隔简单、安全、有效.

子宫肌瘤是育龄期妇女最常见的生殖系统肿瘤,子宫腺肌病是由于子宫内膜及问质侵入子宫肌层引起的良性病变,两种疾病均好发于30 - 50岁育龄期妇女.传统的治疗方法有病灶剔除术、子宫次伞切除术及子宫伞切除术等.但是对于年轻、有保留子宫需求的子宫肌瘤患者,病灶剔除术后的两年复发率较高,二次手术的实施有较大的风险及损害.而对于子宫腺肌病患者,一般发病年龄较年轻,有保留子宫的需求,除病灶剔除术以外,可选择LI服避孕药、左炔诺孕酮宫内缓释系统( INC-IUS)及促性腺激素释放激素激动剂(GnRH-a)等保守治疗.

患者35岁,因“停经40+4周,入院待产”.孕39周时B超提示:胎盘低置状态(下缘距宫颈管内口约52 mm).入院后予人工破膜及静脉滴催产素后顺娩一活女婴,体重3350 g.产后出现大出血,失血性休克,经保守治疗后阴道流血不止.患者强烈要求保留子宫,遂行双侧子宫动脉栓塞术(uterine arterial embolization,UAE),术中予左右各1.0g的500～ 700 μm海藻微球颗粒+明胶海绵颗粒栓塞子宫动脉,术后阴道出血立即减少.产后6h患者诉左腿痛,行下肢静脉彩超未见异常,产后12 h患者诉左下肢疼痛,感觉迟钝,左小腿下段皮温低,左侧足背动脉搏动弱,且左大脚趾及第二脚趾皮肤呈紫色,白细胞19.16 G/L,血红蛋白74 g/L,血小板140 G/L,D-二聚体1 663 μg/L.

目的 探讨子宫动脉栓塞术(UAE)治疗子宫肌瘤术后疗效合适的判定时间点.方法 选取南方医科大学南方医院及广州市第一人民医院1999-2012年因子宫肌瘤行UAE治疗的具有相对完整随访资料的397例病例,术前及术后1、3、6、9个月、1年分别观察并记录子宫肌瘤体积变化及月经量改变情况.结果 UAE术后各时间点较术前相比,子宫肌瘤体积均显著缩小(P=0.000);UAE术后6个月较术后1个月及3个月时子宫肌瘤体积均显著缩小(P=0.000;P=0.002),而与术后9个月及1年相比,差异无统计学意义(P=0.673,P=0.104).UAE术后6个月时月经量过多的患者月经量改善百分比与术后1个月、3个月差异均有统计学意义(P=0.026,P=0.044),但与术后9个月及术后1年相比,差异无统计学意义(P=0.495;P=0.099).结论 UAE术后6个月是评价子宫肌瘤UAE术后疗效较为合适的时间.

To investigate the clinical factors predicting outcomes of leiomyoma treated with uterine artery embolization (UAE).

Objective: To investigate the related factors on effects of uterine artery embolization(UAE)in the treatment of dysmenorrhea in patients with adenomyosis, and to construct and validate the efficacy prediction model. Methods: A total of 127 cases of adenomyosis patients with symptoms of dysmenorrhea in Guangzhou No.1 People's Hospital and Nanfang Hospital of Southern Medical University from June 1999 to December 2009 were reviewed. The evaluation standard was to improve the degree of dysmenorrhea, the related factors of efficacy were analysed. Combined with artificial neural network theory, the effect prediction model was constructed, and the effectiveness of the model was evaluated using receiver operating characteristic(ROC)curve, and the effectiveness of the cut-off point was calculated. The model was validated by 68 cases of patients with adenomyosis in the Nanfang Hospital from January 2010 to November 2014. Results: (1)In 127 cases of dysmenorrhea patients, UAE treatment was effective in 98 cases, effective rate was 77.2%(98/127).(2)Age was an independent predictor of effective UAE treatment(HR= 1.129, P=0.026); in the range of this study, the greater the age, the higher the UAE treatment efficiency.(3)The developing situation of ovary branches of uterine artery was an independent predictor of effective UAE treatment(HR=0.460, P=0.020), the efficiency of patients whose intraoperative bilateral uterine artery ovarian branch did not develop was 89.7%(35/39), the efficiency of patients whose unilateral uterine artery ovarian branch was developing was 84.1%(37/44)and the efficiency of patients whose bilateral uterine artery ovarian branch were developing was 59.1%(26/44).(4)Blood supply of adenomyosisis was an independent predictor of effective UAE treatment(HR=0.313, P=0.001). Type Ⅰ(bilateral predominated)patients, efficiency was 93.5%(43/46); type Ⅱ(bilateral balanced)patients, efficiency was 78.0%(39/50); type Ⅲ(unilateral predominated)patients, efficiency was 51.6%(16/31).(5)UAE for the treatment of adenomyosis efficacy of artificial neural network prediction model was constructed, the model's area under the ROC curve was 0.808, the optimal cut-off point was 0.669 13. Actual verification of the model, sensitivity was 96.5%, specificity was 81.8%, positive predictive value was 96.5% and negative predictive value was 81.8%, the total accuracy was 94.1%. Conclusions: (1)Age, the developing situation of ovary branches and blood supply of adenomyosis are the independent predictors of effective UAE treatment.(2)The artificial neural network prediction model is satisfied with the accuracy and the accuracy of prediction.

目的 探讨不同种类及规格的栓塞剂对子宫肌瘤动脉栓塞术后疗效的影响.方法 选取贵州医科大学第二附属医院、南方医科大学南方医院及广州市第一人民医院1999-2012年因子宫肌瘤使用规格为300～900μm的聚乙烯醇(PVA)、海藻酸钠微球(KMG)及新鲜明胶海绵颗粒(GF)3种栓塞剂行子宫动脉栓塞术(UAE)治疗的296例病例,术前及术后1、3、6个月、1～8年分别观察记录子宫肌瘤体积变化及月经量改变情况.结果 (1)不同种类及规格栓塞剂间UAE术后3年内疗效差异无统计学意义.术后4年以上单一使用PVA或KMG的疗效差异有统计学意义(x2=4.744,P=0.029).(2)使用PVA栓塞后加用GF的疗效亦好于单一使用PVA的疗效(x2=22.342,P＜0.01),使用KMG栓塞后加用GF的疗效好于单一使用KMG的疗效(x2=8.750,P=0.003),而均加用GF后,PVA与KMG的疗效差异无统计学意义(x2=0.076,P=0.782).(3)使用颗粒直径300～500μm的栓塞剂术后4年以上疗效好于＞500～700μμm(x2=18.674,P＜0.01)及＞700～900μm(x2=23.963,P＜0.01)的栓塞剂,而＞500～700μm的栓塞剂疗效与＞700～900μm间差异无统计学意义(x2=2.735,P=0.098).结论 单一使用KMG术后疗效较PVA更好;KMG或PVA与GF联合使用行UAE术后疗效好于单一使用;使用颗粒直径为300～500μm的栓塞剂行UAE术后疗效更佳.

子宫动脉栓塞术是妇产科放射介入治疗的一个核心技术.应用于子宫恶性肿瘤、重度产后出血、子宫肌瘤、子宫腺肌病等多种妇科疾病治疗中,取得良好的临床效果.但同时临床上也有各种栓塞并发症的报道,有些严重并发症甚至可致残、致死.常见的严重并发症包括闭经、子宫严重感染坏死、输尿管损伤、膀胱坏死、下肢肢体坏死、肺动脉栓塞和神经损伤.合理选择子宫动脉栓塞术适应证及栓塞剂,栓塞时注意置管到位避免误栓及栓塞剂反流是避免严重并发症发生的关键.

目的：探讨补肾健脾活血中药治疗子宫肌瘤行子宫动脉栓塞（ UAE）后月经减少的临床疗效。方法选择因子宫肌瘤行UAE治疗后出现月经减少育龄妇女40例，分为治疗、对照两组，观察组用左归饮加味治疗，监测比较两组妇女月经、女性激素及子宫内膜厚度。结果观察组UAE后3个月血雌二醇（ E2）水平比对照组明显增高（P＜0.05），UAE后半年子宫内膜厚度比对照组明显增加（P＜0.05）；UAE后1年，两组月经评分比较差异有统计学意义（ P＜0.05），观察组月经减少明显改善。结论补肾健脾活血中药可改善子宫肌瘤UAE治疗后月经减少症状，补充西药治疗不足。

目的:探讨以盆腔肿物为表现的腹膜假黏液瘤(pseudomyxoma peritonei,PMP)的临床表现和诊治.方法:收集2007年1月至2012年7月广东省第二人民医院和广州市第一人民医院妇产科的7例腹膜假黏液瘤患者,通过对该7例以盆腔肿物为表现的PMP病例资料,分析其临床特点、影像学特征、诊断和治疗、随访和预后.结果:7例患者临床主要表现均为腹胀、腹痛,术前超声检查、CT、MRI提示盆腔包块和不均质腹水,肿瘤标记物有不同程度升高,所有患者均经手术病理确诊为腹膜假黏液瘤,术后辅助治疗包括化疗,术后随访率100％.结论:女性PMP在临床上容易误诊为盆腔肿物,从而误诊和延误治疗,通过术前腹部B超、CT、MRI、肿瘤标记物检查结合腹腔穿刺细胞学检查、术中快速冰冻病理检查,可以提高诊断率.及时与正确处置对患者的预后和生存期的提高都有重要的意义.

To investigate the characteristics of the vascular supply to uterine leiomyomas based on digital subtraction angiography.

Objective To evaluate the dysmenorrhea score of uterine adenomyosis with or without uterine leiomyomata after uterine artery embolization (UAE)and explore the technique of UAE.Methods 167 women with symptomatic uterine adenomyosis with or without combined uterine leiomyomata diagnosed by magnetic resonance imaging underwent UAE between June 1999 and November 2005.They were divided into two groups .Group A was adenomyosis with combined uterine leiomyomata and group B was not.Dysmenorrhea score of patients five years after UAE were collected.Results Patients were followed for a median of 72 months(range 3–120 months) ,The follow-up rate of 1 to 5 years after UAE was 85.6%(143/167),82%(137/167),78.4%(131/167),71.9%(120/167),64.7%(108/167),respectively.The Clinical effect rate of 1 to 5 years after UAE of group A was 85.71%,85%,78.95%,80.55%,79.41%,respectively.It was 78.21%,72.16%,66.67%,65.47%,58.11% in group B, respectively(P=0.30,0.11,0.16,0.10,0.03).The efficient rate of two groups were tending to decline.Significant difference between women with pure uterine adenoymosis and women with uterine adenomyosis combined with uterine leiomyomata was observed in the fifth year.Conclusion We should select different diameter and dose of embolic agents according to the blood supply features when uterine artery embolization treat for simple adenomyosis and adenomyosis with hysteromyoma,in order to achieve complete embolism and to improve clinic effects.

Objective To investigate the clinical application of uterine arterial chemoembolization combined with curettage used in the treatment of caesarean scar pregnancy(CSP).Method Uterine arterial chemoembolization were done on 12 patients of CSP who menopause 42~61 days and diagnosed by ultrasonography or MR imaging.β-HCG value was monitoring 1,3,5,and 7 days after the treatment,and all the patients were underwent curettage within 3~5 days after uterine arterial chemoembolization.Results 12 patients underwent uterine arterial chemoembolization one time,the level of β-HCG in all patients were significantly decreased 1 week after the treatment.Curettages were done successfully 3~5 days postoperatively with less blood loss.Menstruation recover to normal 1~1.5 months after UAE.Conclusions Uterine arterial chemoembolization combined with curettage used in CSP is effective with less injury and quickly recovery,it is a feasible and effective minimally invasive treatment.

目的:探讨卡铂介入灌注化疗治疗子宫颈妊娠的可行性。方法:回顾性分析2005年4月至2010年12月间我院施行子宫动脉卡铂灌注及动脉栓塞术的8例宫颈妊娠患者的临床资料。结果:8例子宫动脉卡铂灌注及动脉栓塞术后清宫术出血<50mL,β-HCG术后前3d明显下降趋势,术后第5天下降至接近正常水平,5例患者核磁共振成像术后第7天宫颈形态基本恢复正常。结论:使用卡铂灌注和栓塞治疗宫颈妊娠取得良好肯定的治疗效果,可以作为子宫动脉栓塞术中可供选择的新方法。

Objective To investigate the clinical application value of Vascular Intervention Treatment for postpartum hemorrhage caused by abnormal placental implantation.Methods 8 cases of postpartum hemorrhage caused by abnormal placental implantation were undergone Vascular Intervention Treatment,and uterine curettage were done 3~5 days postoperatively.Results All cases were succeed in hemostasis,uterine curettage were required in 3 cases 3 days postoperatively due to part of placenta tissue didn't evacuate,in another 5 cases 5 days after being given intravenous drips of oxytocin,all retained placenta tissue was evacuated.The serum HCG,sex hormone and the menstrual cycle returned to normal within 2~4 months after the placenta tissue was evacuated.Conclusion The Vascular Intervention Treatment is proved to be a safe,effective method for postpartum hemorrhage caused by abnormal placental implantation with fast hemostasis and rare complications.

目的:探讨子宫动脉栓塞术(UAE)治疗子宫腺肌病的临床疗效。方法:回顾性分析23例接受UAE治疗子宫腺肌病的临床资料并跟踪观察18个月。结果:①在痛经程度、子宫体积大小、血红蛋白和月经量变化数据比较,差异有统计学意义(P<0.05);②血清CA125术后明显下降,差异有统计学意义(P<0.05);③血清FSH、LH、E2水平术前术后比较,差异无统计学意义(P>0.05)。结论:UAE治疗子宫腺肌病可改善临床症状,对卵巢功能无明显影响,同时可动态监测血清CA125水平来观察疗效;在UAE治疗中选择KMG颗粒和明胶海绵颗粒作为栓塞剂,取得了良好的治疗效果,可以更广泛的用于子宫腺肌病的治疗。

Objective To investigate the reason and precaution of amenorrhea after UAE used in patients with uterine leiomymoma.Methods UAE(uterine arterial embolization) was done on 203 cases of uterine myoma,age from 28～49,average 35±2.5 years old,during Jan,2005 to Dec,2011.We used KMG、GF or microspheres as embolic agent and track the occurrence of amenorrhea within the followed year.Results Amenorrhea happened in 5 patients 3 to 6 months after UAE,the incidence is 2.42%.Amenorrhea is caused by endomerium damage or intrauterine adhesions during the procedure of ischemic、necrosis、absorb or discharge of myoma after UAE treatment.Co1 nclusions Amenorrhea rarely happen after UAE,the reasons are connected with damage of edometrium or ovarian function.The fomer happens more than the latter.The latter can be prevented by controlling the size of embolization material and avoiding misembolization of overian atery,while the latter need monitoring the endometrial thickness carely by ultrasonography or hysteroscopy so as to find out the damage early and use hormone to treat it.