“卵巢相吻征”:中至重度子宫内膜异位症的超声征象

To evaluate whether the presence of kissing ovaries at ultrasound is a marker for endometriosis and whether it correlates with the severity of the disease. Prospective observational study. Gynecologic departments of two university hospitals. A total of 722 consecutive premenopausal women who had laparoscopic surgery for an adnexal mass or suspected pelvic endometriosis. Preoperative ultrasound evaluation and laparoscopic surgery. Diagnostic and predictive value of ultrasound identification of kissing ovaries in the detection of endometriosis. Kissing ovaries were diagnosed at ultrasound and confirmed laparoscopically in 32 patients. Of these, 27 had moderate to severe endometriosis and five others had benign adnexal masses. Bowel (18.5% vs. 2.5% ) and fallopian tube (92.6% vs. 33% ) endometriosis were significantly more frequent in patients with kissing ovaries than in patients without kissing ovaries. In infertile patients (n = 145), kissing ovaries were associated with a higher proportion of women with fallopian tube obstruction (80% vs. 8.6% ). Considering patients with moderate to severe endometriosis (n = 189), the median (range) revised American Fertility Society score (74 [32- 148] vs. 35 [16- 146]) and the operative time (115 minutes [65- 245 minutes] vs. 50 [15- 180 minutes]) were significantly higher in patients with than in those without kissing ovaries. The detection of kissing ovaries at ultrasound is strongly associated with the presence of endometriosis and is a marker of the most severe form of this disease.

一种治疗有症状子宫肌瘤的新方法:腹腔镜下射频热凝

Objective: The purpose of this study was to evaluate the feasibility and efficacy of laparoscopic radiofrequency ablation of uterine fibroids. Study design: Eighteen women with symptomatic intramural uterine myomas underwent radiofrequency ablation under laparoscopic guidance. Postoperative sonographic evaluations of the fibroids size were scheduled at 1, 3, 6, 9, and 12 months. The impact of myoma- related symptoms on quality of life (QOL) was assessed using a validated questionnaire. Results: The median number of myomas treated per patient was 1 (1- 3). The median baseline volume of the dominant myoma was 67.2 cm3 (14.8- 332.8). No intraoperative or postoperative complications occurred. The median reductions in myomas volume were 41.5% , 59% , and 77% at 1, 3, and 6- months, follow- up evaluation, respectively. No further change in fibroid size was observed at 9 months and 1 year. A significant improvement in the symptoms score and QOL score was observed at 3 and 6 months, follow- up. Conclusion: In this pilot study, laparoscopic radiofrequency ablation successfully reduced fibroid symptoms and fibroid volume in short- term follow- up. Additional studies are needed before its efficacy and safety can be confirmed.

腹腔镜下输尿管松解术治疗输尿管子宫内膜异位症的效果

Objective:To evaluate the adequacy of laparoscopic ureterolysis as a primary treatment option for ureteral endometriosis. Design:Prospective collaborative cohort study. Setting:Gynecologic departments of three university hospitals. Patient(s):Women with ureteral endometriosis exhibiting moderate-to-severe hydronephrosis on preoperative intravenous pyelography. Intervention(s):Laparoscopic ureterolysis. Main Outcome Measure(s):Cure rate,disesase recurrence. Result(s):Thirty-three patients underwent laparoscopic ureterolysis during the study period. Bilateral involvement of ureters was found in 4 (12.1%) cases. In women with unilateral lesions the left ureter was more frequently affected (24/29 vs. 5/29). Ureteral involvement was associated with uterosacral ligaments endometriosis in 65.5%(22/34) of cases. No inadvertent ureteral injuries occurred during ureterolysis. A partial wall resection of the ureter was necessary in one case and a segmental ureteral resection with vescicopsoas hitch was required in a women with intrinsic ureteral endometriosis. The median (range) follow-up time was 16 months (range:3-53 months). Thirty-two patients (96.7%) had a patent ureter on the 3-month postoperative intravenous pyelography. The recurrence rate of ureteral lesions was 12.1%(4/33). Conclusion(s):Our findings suggest that a conservative laparoscopic approach is an effective treatment option in most patients with ureteral endometriosis exhibiting moderate-to-severe hydronephrosis.

胎儿胸腺萎缩:胎儿炎症反应综合征的超声标志

Objective: The purpose of this study was to evaluate whether there is a relationship between the sonographic fetal thymus size and the presence of an intrauterine infection in patients with preterm labor. Study design: Thirty-one women who had been admitted with preterm labor and intact membranes between 24 and 32 weeks of gestation were included. Fetal thymus perimeter was measured sonographically, and amniocentesis for the microbiologic assessment of the amniotic cavity was performed. Placentas and umbilical cords were examined for the presence of chorioamnionitis/funisitis. Results: The prevalence of preterm delivery and intra-amniotic infection was 51.6%(16/31 women) and 32.3%(10/31women), respectively. In all cases with intrauterine infection and in 23.8%of cases without intrauterine infection, the fetal thymus perimeter was below the 5th percentile for gestational age (10/10 women vs 5/21 women; P < .01). Isolated histologic chorioamnionitis and funisitis were found in 22.6%and 25.8%of fetuses, respectively. The fetal thymus was below the 5th percentile for gestational age in 100%, 71.4%, and 12.5%of patients with histologic signs of funisitis and isolated chorioamnionitis and without histologic signs of infection, respectively. Conclusion: Fetal thymus involution in preterm labor patients is strongly associated with funisitis, which is the histologic manifestation of the fetal inflammatory response syndrome.

腹腔镜下经阴道子宫切除术与经腹子宫切除术治疗子宫内膜癌的比较

Objective:To see whether laparoscopy provides exact staging and effective treatment of endometrial cancer patients,compared with total abdominal hysterectomy,with shorter hospital stay,prompter recovery,and better quality of life. Method:This retrospective study identified 110 patients scheduled for surgery for early-stage endometrial cancer. Fifty-five (50%)-were treated by laparoscopic-assisted vaginal hysterectomy (LAVH) and 55 (50%) by total abdominal hysterectomy (TAH). All patients underwent pelvic lymphadenectomy. The majority of patients (79%) had stage I disease. Results:The mean number of lymph nodes removed was 17 for the LAVH group and 18.5 for the TAH group (p = 0.294). Compared with TAH,LAVH required a significantly longer operating time (220 vs. 175 min; p < 0.01); but shorter hospital stay (4 vs. 8.5 days; p < 0.001) and less estimated blood loss (177 cm3 vs. 285 cm3; p = 0.02). Overall,there were fewer post- operative complications in the LAVH group (6 vs. 11 cases; p < 0.001). Three TAH patients (5.4%) had recurrence of disease. No LAVH patients had recurrences and all are currently disease-free. Conclusion:These findings suggest LAVH gives correct staging of endometrial disease,like TAH,but with fewer complications and a slightly longer operating time.

补充叶酸与否对激素治疗后血浆高半胱氨酸水平影响的随机研究

Sequential transdermal estrogen- progestin therapy induced a significant reduction in fasting serum homocysteine levels in postmenopausal women. The addition of folic acid supplementation for 6 months did not further lower the homocysteine concentrations.