Impact of uterine artery embolization on ovarian function and pregnancy outcome after uterine-fibroids treatment:A prospective study

Uterine fibroids are benign tumors that originate from smooth muscle cells of the uterus.It is the most common gynecological disorder,affecting up to 80%of women of reproductive age.Uterine fibroids can cause various symptoms such as abnormal uterine bleeding,pelvic pain,infertility,and pregnancy complications.The treatment options for uterine fibroids include medical therapy,surgical intervention,and minimally invasive techniques.AIM To compare ovarian function of women with uterine fibroids who did or did not undergo uterine artery embolization(UAE).METHODS This prospective cohort study enrolled 87 women with symptomatic uterine fibroids who underwent UAE,and 87 women with the same symptoms who did not undergo UAE but received conservative management or other treatments.The two groups were matched for age,body mass index,parity,and baseline characteristics of uterine fibroids.The primary outcome was ovarian function that was evaluated by serum levels of follicle-stimulating hormone(FSH),luteinizing hormone(LH),estradiol(E2),and anti-Müllerian hormone(AMH),as well as ovarian reserve tests,such as antral follicle count(AFC)and ovarian volume(OV).The secondary outcome was fertility that was evaluated based on the menstrual cycle,ovulation,conception,pregnancy,and delivery.The participants were followed-up for 36 months and assessed at 1,3,6,12,24,and 36 months after treatment.RESULTS The study found that the most common minor complication of UAE was postembolization syndrome in 73.6% of women,resolving within a week.No significant differences were observed between the UAE group and the control group in serum levels of reproductive hormones(FSH,LH,E2,AMH)and ovarian reserve indicators(AFC,OV)at any point up to 36 months post-treatment.Additionally,there were no significant differences in conception,pregnancy,or delivery rates,with the average time to conception and gestational age at delivery being similar between the two groups.Birth weights were also comparable.Finally,there was no significant correlation between ovarian function,fertility indicators,and the type or amount of embolic agent used or the change in fibroids posttreatment.CONCLUSION UAE resulted in significantly positive pregnancy outcomes,no adverse events post-treatment,and is a safe and effective treatment for uterine fibroids that preserves ovarian function and fertility.

hucMSC-derived exosomes protect ovarian reserve and restore ovarian function in cisplatin treated mice

Anti-cancer therapy often causes premature ovarian insufficiency and infertility as the ovarian follicle reserve is extremely sensitive to chemotherapy drugs,such as cisplatin.Various fertility preservation methods have been explored for women,especially prepubertal girls undergoing radiotherapy and chemotherapy due to cancer.In recent years,mesenchymal stem cell-derived exosomes(MSC-exos)have been reported to play an important role in tissue repair and the treatment of various diseases.In the current study,we observed that human umbilical cord-derived MSC-exos(hucMSC-exos)after short-term culture improved follicular survival and development while receiving cisplatin treatment.Moreover,intravenous injection of hucMSC-exos improved ovarian function and ameliorated inflammatory environment within the ovary.The underlying mechanism of hucMSC-exos on fertility preservation was associated with the down-regulation of p53-related apoptosis and their anti-inflammatory function.Based on these findings,we propose that hucMSC-exos may be a potential approach to improve fertility in women diagnosed with cancer.

Effect of Acupuncture and Jianpi Bushen Decoction on Ovarian Function and Metabolic Disorders in Patients with PCOS

Objective:To study the effects of acupuncture combined with Jianpi Bushen Decoction on ovarian function and metabolic disorders in patients with polycystic ovary syndrome(PCOS).Methods:A total of 100 PCOS patients admitted in our hospital from October 2018-January 2020 were selected,and the patients were divided into the Jianpi Bushen Decoction group and the combined group with 50 patients each according to a completely random method.The patients in the Jianpi Bushen Decoction group were given Jianpi Bushen Decoction;the combined group was given acupuncture on the basis of the Jianpi Bushen Decoction group.Detection of follicle stimulating hormone(FSH),testosterone(T),pituitary prolactin(PRL),estradiol(E2),fasting insulin(FIN),fasting blood glucose(FBG),insulin resistance index(HOMA-IR),triglyceride Ester(TG),total cholesterol(TC),high density lipoprotein cholesterol(HDL-C),low density lipoprotein cholesterol(LDL-C),endometrial thickness,ovarian volume,number of ovarian sinus follicles,C-reactive protein(CRP),procalcitonin(PCT).Statistical treatment is effective.Results:After treatment,FSH,T,PRL,FIN,FBG,HOMA-IR,TG,TC and LDL-C were lower in Jianpi Bushen Decoction group,and E2 and HDL-C levels were higher than Jianpi Bushen Decoction group(P<0.05).The endometrial thickness of the combined group was higher than that of Jianpi Bushen Decoction group,and the ovarian volume and the number of ovarian sinus follicles were lower than that of Jianpi Bushen Decoction group(P<0.05).The levels of CRP and PCT in the combination group were lower than those in the Jianpi Bushen Decoction group(P<0.05).The total effective rate of patients in combination group was higher than that in Jianpi Bushen Decoction group(P<0.05).Conclusion:Acupuncture combined with Jianpi Bushen Decoction has significant therapeutic effects on patients with PCOS,effectively improves patients'ovarian function,improves endocrine and metabolic disorders,and reduces inflammatory reactions,which deserves clinical promotion.

Regulation of ovarian function by the matrix metalloproteinase system

In most organs of mammals, cyclic remodelling of tissues after morphogenesis is minimal; however, reproductive tissues of female animals including endometrium, mammary gland, ovarian follicle and corpus luteum undergo growth, maturation and involution at various stages in the reproductive cycle or lifespan of the animal. Reconstruction of the extracellular matrix (ECM) is required for the dynamic tissue reorganization characteristic of these tissues. The ECM consists of proteinaceous and nonproteinaceous molecules that provide the tissue-specific, extracellular architecture to which cells attach. Furthermore, interaction of cellular receptors with proteins of the ECM can regulate cellular structure, second messenger generation and gene expression. Mainte-

Effects of chitooligosaccharide-zinc on the ovarian function of mice with premature ovarian failure via the SESN2/NRF2 signaling pathway

Chitooligosaccharide-zinc(COS·Zn)is a powerful anti-oxidant and anti-aging scavenger,whose anti-oxidative ability immensely exceeds vitamin C.Therefore,this study was aimed to investigate the protective effects of COS·Zn against premature ovarian failure(POF)and potential mechanisms.Female KM adult mice were divided into the following groups:a treatment group(150 mg·kg^(−1)·d^(−1) COS·Zn),a treatment group(300 mg·kg^(−1)·d^(−1) COS·Zn),a prevention group,two control groups and two CY/BUS groups.COS·Zn(150,300 mg·kg^(−1)·d^(−1))and COS·Zn(300 mg·kg^(−1)·d^(−1))were therapeutically and preventatively administered to POF mice in the treatment and prevention studies,respectively.All the groups were administered for 21 days.Fewer primary and secondary follicles were observed in the COS·Zn-treated groups(including the treatment and prevention groups)than those of the control groups.Meanwhile,the ovarian index and the levels of FSH and LH notably increased in the treatment and prevention groups compared with those in the CY/BUS group.The levels of MVH,OCT4 and PCNA in the treatment group(300·kg^(−1)·d^(−1) COS·Zn)and MVH in the prevention group remarkably increased compared with those in the CY/BUS groups.Meanwhile,the levels of P53 and P16 protein were down-regulated in the treatment and prevention groups compared with those in the CY/BUS groups.Additionally,the amounts of Sestrin2(SESN2)and SOD2 protein were obviously higher in the treatment group(150 mg·kg^(−1)·d^(−1) COS·Zn)than those in the CY/BUS groups.Similarly,the amounts of NRF2 and SESN2 protein were up-regulated in the prevention group.Besides,an increased GSH level was observed in the two treatment groups,compared with that in the CY/BUS groups,and the same trend was also present in the prevention group.Taken together,COS·Zn improves the ovarian and follicular development through regulating the SESN2/NRF2 signaling pathway.These results suggest the role of COS·Zn as a novel agent for the treatment and prevention of POF.

Tear Up the Paper Tiger and Rediscover Fertility and Ovarian Function

Follicle-stimulating hormone(FSH), as the main indicator of ovarian function, plays an important role in the clinical activities of gynecologic endocrinology. Although anti-Miillerian hormone and antral follicle count are also the indictors evaluating ovarian function, many clinicians are still relentless in their decision to impose the death penalty of ovaries when high FSH levels(especially more than 40 IU/L) are observed.We recently encountered four patients whose FSH levels were inconsistent with actual fertility because all patients had successfully conceived after treatment. In our study, we found the culprit(macro-FSH) of false-positive FSH levels by applying the polyethylene glycol protein precipitation technique. The biological functions of macro-FSH were further evaluated by using Gene Ontology and Kyoto Encyclopedia of Genes and Genomes pathway analysis. This study suggests that ovarian reserve function should be comprehensively assessed in clinic, and the causes of serum test indicators inconsistent with clinic should be identified.

Laparoscopic coring-type resection of noncommunicating broadly attached rudimentary horn with recurrent large ovarian endometriomas:A report of two cases

Rudimentary horn of the uterus is a rare congenital malformation that is characterized by significant anatomic variability.We report two cases involving women who presented with a broadly attached rudimentary horn and large ovarian endometriomas that were innovatively treated by laparoscopic coring-type dissection of the rudimentary horn of the uterus.This novel surgical approach ensured the integrity of the myometrium of the unicornuate uterus and avoided uterine rupture during pregnancy and ipsilateral ovarian function impairment.

Clinical observation of Kuntai capsule combined with Fenmotong in treatment of decline of ovarian reserve function

BACKGROUND Decreased ovarian reserve function is an ovarian hypofunction disease that occurs in women before 40 years of age,leading to a decline in fertility and perimeno-pausal symptoms,such as irregular menstruation,amenorrhea,infertility,de-creased libido,and autonomic nervous dysfunction.Fenmatong(FMT)is a com-pound mixture of estradiol tablets and estradiol didroxyprogesterone tablets,which can improve ovarian reserve function by supplementation of exogenous estrogen.However,this treatment has also been shown to cause breast pain,gastrointestinal discomfort,irregular vaginal bleeding,and changes in sexual desire.In severe cases,FMT can promote the development of breast cancer,endometrial cancer,and venous embolic disease.AIM To observe the effects of Kuntai capsules and FMT on endocrine indexes and uterine artery blood circulation in patients with decreased ovarian reserve func-tion.METHODS Patients(130)with decreased ovarian reserve function,who were treated in our hospital from May 2018 to May 2020,were divided into two groups:The FMT group,in which patients were treated with FMT,and the observation group,in which patients were treated with Kuntai capsules.Chinese medicine symptom scores,uterine artery blood flow parameters,ovarian ultrasound test indexes,pictorial blood loss assessment chart(PBAC)scores,and hormone levels were recorded,and total effective rates were calculated for both groups.RESULTS The total effective rate in the observation group was higher than that in the FMT group(P<0.05).After treatment,primary symptoms,including low menstrual volume,delayed menstruation,red color and thick consistency of menses,di-zziness,palpitation,weakness at the waist and knee,insomnia and excessive dreaming,irritability,and dryness and astringency of the pudendal canal in the observation group decreased,and scores for primary and secondary symptoms in the observation group were significantly lower than those in the FMT group(P<0.05).The systolic peak flow rate(PSV),end-diastolic flow rate(EDV),ovarian diameter,sinus follicle count,and resistance index(RI)of the uterine arteries in the observation group and FMT group increased after treatment.Notably,the PSV,EDV,ovarian diameter,and antral follicle count in the observation group were higher than those in the FMT group,whereas the RI in the observation group was lower than that in the FMT group(P<0.05).The PBAC scores in the observation and FMT groups increased after treatment,with that in the ob-servation group becoming significantly higher than that in the FMT group(P<0.05).After treatment,estradiol(E2)and anti-Mullerian hormone(AMH)levels increased,whereas follicle-stimulating hormone(FSH)levels decreased in the observation group and FMT group;E2 and AMH levels became significantly higher and FSH levels became significantly lower in the observation group than in the FMT group(P<0.05).CONCLUSION Compared with FMT,Kuntai capsules promoted uterine artery blood circulation,improved menstruation,relieved symptoms,regulated endocrine function,and improved curative effects.

穴位埋线对两种肥胖类型PCOS患者生殖指标及炎症因子的影响

目的探究穴位埋线对两种肥胖类型PCOS患者炎性因子及生殖指标的影响。方法将2020年1月—2021年1月于山东中医药大学附属医院妇科门诊诊断为多囊卵巢综合征(肾虚痰湿证)肥胖患者63例作为研究对象。将患者按照不同肥胖类型分为均匀性肥胖组(A组,WC<80cm,n=33)和腹型肥胖组(B组,WC≥80,n=31)。两组均给予穴位埋线配合炔雌醇环丙孕酮治疗,对比3个月后两组的性激素(E_(2)、T、FSH、LH),炎症因子(TNF-α、hs-CRP、APN、IL-6),卵巢功能(卵巢体积、AMH、INHB),子宫内膜容受性(子宫内膜厚度、PI、RI),并统计治疗后患者的体质量、BMI、治疗后2个月排卵率、妊娠率。结果治疗后,均匀性肥胖组(A组)和腹型肥胖组(B)组T(0.74±0.07 VS 1.05±0.13)ng/mL,LH(10.43±1.07 VS 14.08±0.95)mIU/mL,IL-6(17.84±0.36 VS 21.06±1.34)ng/L,TNF-α(16.19±1.61 VS 19.95±0.95)ng/L,hs-CRP(4.75±0.35 VS 6.66±0.27)ng/L,卵巢体积(10.7±0.64 VS 11.31±0.62)cm^(3),PI(2.33±0.10 VS 2.55±0.13),RI(0.62±0.04 VS 0.74±0.03),体质量(63.83±2.87 VS 69.47±3.29)kg,BMI(24.23±1.46 VS 26.35±1.31)kg/m^(2)均显著降低(P<0.05),且均匀性肥胖组(A组)降低明显(P<0.05)。均匀性肥胖组(A组)和腹型肥胖组(B)组APN(57.15±3.6 VS 48.16±1.52)pg/L,FSH(7.24±0.86 VS 6.66±0.81)mIU/mL,E_(2)(98.75±4.63 VS 70.19±23.61)pg/mL,子宫内膜厚度(8.95±0.22 VS 8.29±0.29)cm,AMH(8.60±0.54 VS 7.56±0.55)ng/dL均显著提高(P<0.05),且A组(均匀性肥胖组)提高明显(P<0.05)。A组(均匀性肥胖组)的排卵率为80%,高于B组(腹型肥胖组)的40%(χ^(2)=10.00,P=0.000)。A组(腹型肥胖)的妊娠率60%,高于B组(腹型肥胖组)的33.3%(χ^(2)=4.29,P=0.04)。结论穴位埋线联合炔雌醇环丙孕酮能够改善PCOS(肾虚痰湿证)肥胖患者的性激素、卵巢功能、子宫内膜容受性,其机制可能与改善机体炎症状态相关。均匀性肥胖组改善更明显。提示,穴位埋线治疗均匀性肥胖PCOS效果更好,临床应针对腹型肥胖PCOS患者特点,采取更精准的治疗措施。

Ovarian Endometrioid Adenocarcinoma with Functioning Stroma Accompanied with Endometrial Endometrioid Adenocarcinoma: Immunohistochemical Study and Literature Review

Background: The ovarian tumors with functioning stroma are defined by the morphological presence of endocrine active cells in stroma, and the clinical, biochemical or pathological evidence of endocrine function. Case Report: The ovarian endometrioid adenocarcinoma with functioning stroma accompanied with endometrial endometrioid adenocarcinoma was found in 64-year-old post-menopausal woman complaining abnormal genital bleeding and mammary distention. Her preoperative serum 17?-estradiol level was high (53.2 pg/ml) while human chorionic gonadotropin (hCG) level was within normal limit. Her right ovary with 8.8 × 5.3 cm in size and tan-yellow in color mostly consisted of solid tumor. Histologically, tumor was composed of estrogen receptor (ER)- and progesterone receptor (PgR)-positive, and androgen receptor (AR)-negative cancerous endometrial cells with aggregates of vacuolated foamy stromal cells resembling luteinized cells. These stromal cells contained lipid droplets, and was immunopositive for α-inhibin and 17?-estradiol. After surgery, serum 17?-estradiol level decreased and became normal (14.2 pg/ml). These findings indicate the production of steroid hormone (17?-estradiol) from the foamy stromal cells and may be correlated with the clinical symptoms. Furthermore, ER- and PgR-positive endometrial endometrioid adenocarcinoma developed synchronously. However, ovary and uterus were totally immunonegative for human chorionic gonadotropin (hCG). Four other cases from the literature including ours are reviewed. Conclusion: Cancer cells were positive for ER and PgR in both ovary and uterus responded to steroid hormone produced by foamy stromal cells, which played a role in proliferation and progression of ovarian and endometrial endometrioid adenocarcinoma, respectively.

腹腔镜子宫肌瘤剔除术对子宫肌瘤患者盆底功能、卵巢功能的影响

目的探讨腹腔镜子宫肌瘤剔除术(LM)对子宫肌瘤患者盆底功能、卵巢功能的影响。方法纳入2021年1月至2022年10月濮阳市安阳地区医院收治的80例子宫肌瘤患者,按抽签法分两组。对照组40例行开腹子宫肌瘤剔除术(AM),研究组40例行LM,对比两组手术前后疼痛因子[心肌细胞P物质(SP)、前列腺素E_2(PGE_2)]、应激反应指标[去甲肾上腺素(NE)、皮质醇(COR)]、免疫功能指标(CD3^(+)、CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+))、盆底功能指标[盆底障碍影响简易问卷7(PFIQ-7)]及卵巢功能指标[雌二醇(E_2)、促黄体生成素(LH)、促卵泡激素(FSH)]。结果术后1 d、术后3 d时,研究组血清SP、PGE_2、NE、COR水平低于对照组,差异有统计学意义(P<0.05)。术后1d时,两组CD3^(+)、CD4^(+)及CD4^(+)/CD8^(+)功能指标与术前相比均有所降低,但研究组明显高于对照组,差异有统计学意义(P<0.05);而两组的CD8^(+)功能指标与术前相比有所升高,但研究组明显低于对照组,差异有统计学意义(P<0.05)。术后1个月、术后3个月时,两组PFIQ-7评分均有所升高,但研究组明显低于对照组,差异有统计学意义(P<0.05)。术后3个月、术后6个月时,研究组血清E_2水平高于对照组,而血清LH、FSH水平低于对照组,差异有统计学意义(P<0.05)。结论对子宫肌瘤患者行LM可有效减轻机体疼痛程度、应激反应及对免疫、盆底和卵巢功能的负面影响,优势较为显著,具有进一步的使用价值。

路径式护理对卵巢癌术后患者胃肠功能恢复及预后的影响

目的:探讨路径式护理对卵巢癌术后患者胃肠功能恢复及预后的影响。方法:选取126例卵巢癌手术患者为研究对象,按照护理干预方式不同分为观察组和对照组,每组各63例。对照组患者予以手术常规护理干预;观察组患者在对照组基础上予以路径式护理干预,干预时间均为3个月。比较两组患者术后(胃肠功能恢复时间及住院时间、肠鸣音恢复、首次排便时间)、疲乏症状[癌症疲乏量表(CFS)]、心理状态[焦虑自评量表(SAS)及抑郁自评量表(SDS)评分]、生活质量[癌症生命质量核心量表(QLQ-C30)及卵巢癌患者生活质量问卷评分(QLQ-OV28)]。结果:干预后,观察组患者术后胃肠功能恢复时间及住院时间短于对照组(P<0.05);CFS各项评分、SAS及SDS评分、QLQ-OV28中消化道症状、外在形象和治疗依从性评分均低于对照组(P<0.05);QLQ-C30总分高于对照组(P<0.05)。结论:路径式护理可改善卵巢癌患者术后胃肠功能及心理状况,缓解癌性疲乏,改善患者生活质量。

补肾健脾方治疗卵巢储备功能减退相关不孕脾肾两虚证临床观察

目的:研究补肾健脾方治疗卵巢储备功能减退相关不孕脾肾两虚证的临床疗效。方法:纳入60例卵巢储备功能减退相关不孕脾肾两虚证患者,采用随机数字法分成治疗组和对照组,每组30例。治疗组患者给予补肾健脾方治疗,对照组患者给予芬吗通治疗,两组均连续治疗6个周期。检测性激素指标[基础卵泡刺激素(bFSH)、基础黄体生成素(bLH)、血清雌二醇(E2)、抗米勒管激素(AMH)]、超声指标[卵巢体积、窦卵泡(AFC)数量],比较两组患者中医证候积分、总有效率、妊娠率、流产率,并监测安全性指标。结果:治疗组总有效率为79.31%(23/29),对照组总有效率为82.14%(23/28),差异无统计学意义(P>0.05)。经过6个月经周期治疗后,两组治疗后中医证候积分、bFSH均较治疗前下降(P<0.05),AMH较治疗前升高(P<0.05),且治疗组优于对照组(P<0.05)。治疗组治疗后bLH较治疗前下降(P<0.05);对照组治疗前后bLH比较,差异无统计学意义(P>0.05)。两组治疗后E2较治疗前有明显升高(P<0.05),两组患者治疗后E2比较,差异无统计学意义(P>0.05)。治疗组治疗后卵巢体积明显增大(P<0.05),窦卵数量明显增多(P<0.05),治疗组明显优于对照组(P<0.05)。治疗组妊娠率[34.48%(10/29)]高于对照组[21.43%(6/28)](P<0.05),治疗组流产率[10.00%(1/10)]低于对照组[33.30%(2/6)(P<0.05)]。两组患者治疗前后安全性指标未发现异常,未发生不良反应。结论:补肾健脾方能安全有效地治疗卵巢储备功能减退相关不孕脾肾两虚证,改善卵巢相关激素水平,提高妊娠率,降低流产率,缓解临床症状。

桂枝茯苓丸联合亮丙瑞林对子宫内膜异位症患者卵巢功能及血清VEGF和MCP-1的影响

目的:观察桂枝茯苓丸联合亮丙瑞林对子宫内膜异位症患者卵巢功能及血清血管内皮生长因子(VEGF)和单核细胞趋化蛋白-1(MCP-1)的影响。方法:选取佳木斯市中心医院2021年1月—2023年4月收治的87例子宫内膜异位症患者,按照随机数字表法分为研究组和对照组。对照组(n=43)采用亮丙瑞林治疗,研究组(n=44)在对照组的基础上联用桂枝茯苓丸。比较两组临床疗效、卵巢功能、免疫代谢、细胞因子及子宫动脉血流参数。结果:研究组治疗总有效率高于对照组,子宫动脉阻力指数(RI)、搏动指数(PI)及VEGF、MCP-1、卵泡刺激素(FSH)、黄体生成素(LH)均低于对照组,差异均有统计学意义(P<0.05)。结论:桂枝茯苓丸联合亮丙瑞林治疗子宫内膜异位症的效果较好,能够改善患者卵巢功能、免疫代谢。

超声引导介入治疗卵巢子宫内膜样囊肿患者疗效及血清肿瘤标志物水平的研究

目的:探究超声引导介入治疗卵巢子宫内膜样囊肿患者的疗效及血清肿瘤标记物水平。方法:将本院2019年5月至2022年5月收治的80例卵巢子宫内膜样囊肿患者随机分为两组。对照组40例行腹腔镜囊肿剔除术,研究组40例行超声引导介入穿刺治疗。比较两组的临床疗效、手术时间、抗生素使用时间及住院时间;评价两组手术前后的血清肿瘤标志物水平及卵巢功能指标变化,观察两组术后1年的复发率。结果:研究组的临床疗效高于对照组(P<0.05);研究组的手术时间、抗生素使用时间及住院时间短于对照组(P<0.05);术后6个月,研究组的血清糖类抗原125(CA125)、糖类抗原199(CA199)、人附睾蛋白4(HE4)水平均低于对照组(P<0.05);术后6个月,研究组的雌激素(E2)水平低于对照组,卵泡刺激素(FSH)、黄体生成素(LH)水平高于对照组(P<0.05);研究组术后1年的复发率低于对照组(P<0.05)。结论:对卵巢子宫内膜样囊肿患者应用超声引导介入穿刺治疗可增强疗效,降低血清肿瘤标记物水平,改善卵巢功能,降低术后复发率。

腹腔镜术后戈舍瑞林联合戊酸雌二醇治疗育龄期子宫内膜异位症的临床观察

目的 观察腹腔镜术后戈舍瑞林联合戊酸雌二醇治疗育龄期子宫内膜异位症(EMs)的疗效和安全性。方法 回顾性收集2020年1月-2022年12月在我院接受腹腔镜手术治疗的144例育龄期EMs患者资料,根据术后用药方案分为对照组(70例)和联合组(74例)。对照组患者于腹腔镜手术后首次月经来潮的第1~5天给予醋酸戈舍瑞林缓释植入剂,联合组患者在对照组用药的基础上给予戊酸雌二醇片。观察两组患者的近期疗效和远期疗效,记录术前和术后的疼痛评分、卵巢储备功能及不良反应发生情况。结果 两组患者的近期总有效率、术后1年复发率及性欲下降、阴道干涩、胃肠道反应、皮疹、心律失常的发生率比较,差异均无统计学意义(P>0.05);联合组患者术后1年自然妊娠率显著高于对照组,早期流产率及潮热出汗、情绪波动、失眠乏力、关节肌肉疼痛、头晕头痛的发生率均显著低于对照组(P<0.05)。术后6个月,两组患者的疼痛程度评分和抗米勒管激素、卵泡刺激素、黄体生成素、雌二醇水平均显著低于同组术前,窦卵泡计数显著高于同组术前,且联合组的抗米勒管激素、黄体生成素、雌二醇水平和窦卵泡计数均显著高于对照组,疼痛程度评分及卵泡刺激素水平均显著低于对照组(P<0.05)。结论 腹腔镜术后戈舍瑞林联合戊酸雌二醇治疗育龄期EMs疗效显著,且安全性较好。

亮丙瑞林对ER阳性绝经前乳腺癌化疗患者卵巢功能及骨密度的影响

目的:探讨亮丙瑞林对雌激素受体(ER)阳性绝经前乳腺癌化疗患者卵巢功能及骨密度(BMD)的影响。方法:选取2020年1月—2022年8月丰城市人民医院收治的82例ER阳性绝经前乳腺癌患者的病历资料进行回顾性分析,根据治疗方式分为化疗组(n=41)和亮丙瑞林组(n=41)。化疗组患者予以AC-T辅助化疗,亮丙瑞林组在化疗组的基础上联合亮丙瑞林治疗。比较两组患者疗效、卵巢功能、BMD及月经情况。结果:亮丙瑞林组的总有效率高于化疗组(P<0.05)。治疗后,两组血清雌二醇(E2)水平均明显降低,血清促黄体生成素(LH)、卵泡刺激素(FSH)水平均明显升高(P<0.05);亮丙瑞林组患者的血清LH、FSH水平均明显高于化疗组,血清E2水平明显低于化疗组(P<0.05)。治疗后,两组左髋部、腰椎的BMD水平均明显降低(P<0.05);两组比较差异均无统计学意义(P>0.05)。亮丙瑞林组的闭经时间、月经恢复正常时间均较化疗组短,月经复潮率较化疗组高(P<0.05)。结论:亮丙瑞林可保护ER阳性绝经前乳腺癌化疗患者卵巢功能,可有效提高疗效,但可能会导致患者BMD下降,需要在治疗期间注意监测BMD变化,降低骨质疏松发生风险。

针刺联合补肾健脾法治疗多囊卵巢综合征效果观察

目的:探究针刺腹部穴位联合补肾健脾法对多囊卵巢综合征(PCOS)患者月经周期、血清鸢尾素水平及卵巢功能的影响。方法:选取90例多囊卵巢综合征(PCOS)患者为研究对象,随机分为西药组(30例)、中药组(30例)及联合组(30例),其中西药组给予炔雌醇环丙孕酮片治疗,中药组给予补肾健脾法治疗,联合组在中药组的基础上给予腹针治疗。比较治疗后3组月经周期、血清鸢尾素水平及卵巢功能。结果:联合组的总有效率(96.67%)显著高于西药组(73.33%)、中药组(76.67%)(P<0.05);与治疗前比较,治疗后3组促黄体生成素(LH)、睾酮(T)水平显著降低,月经周期显著缩短,且联合组显著低于西药组、中药组(P<0.05);治疗后3组卵泡刺激素(FSH)、雌二醇(E2)水平均显著升高,且联合组显著高于西药组、中药组(P<0.05);与治疗前比较,三组血清鸢尾素水平显著降低,且联合组显著低于西药组、中药组(P<0.05);与治疗前比较,治疗后3组卵巢体积、卵泡个数均显著降低,且联合组显著低于西药组、中药组(P<0.05);与治疗前比较,治疗后3组内膜厚度、搏动指数(PI)均显著增大,且联合组显著大于西药组、中药组(P<0.05);治疗后3组阻力指数(RI)显著降低,且联合组显著低于西药组、中药组(P<0.05);治疗后,随访3组患者6个月,联合组月经正常率、妊娠率均显著高于西药组、中药组(P<0.05)。结论:腹针联合补肾健脾法可有效调节患者性激素水平,促使月经周期恢复正常,促进卵泡发育成熟、正常排卵及妊娠,改善子宫内膜容受性,降低血清鸢尾素水平,效果显著。

针刺联合中西药治疗肝郁肾虚型月经后期的疗效观察

目的 观察针刺联合中西药治疗肝郁肾虚型月经后期的临床疗效。方法 将88例肝郁肾虚型月经后期患者随机分为对照组(29例)、针刺组(29例)和联合组(30例)。对照组给予雌孕激素序贯疗法,针刺组在对照组基础上给予疏肝补肾针刺法,联合组在针刺组基础上给予疏肝益肾通瘀方治疗。观察3组治疗前后中医证候积分、性激素水平[雌二醇(estradial, E2)、促卵泡生成素(follicle-stimulating hormone, FSH)、促黄体生成素(luteinizing hormone, LH)水平、睾酮(testosterone, T)和催乳素(prolactin, PRL)]、卵巢功能(卵巢体积、卵泡最大直径、卵泡数量)和磷脂酰肌醇3-激酶(phosphoinositide 3-kinase, PI3K)/蛋白激酶B(protein kinase B, AKT)/哺乳动物雷帕霉素靶蛋白(mammalian target of rapamycin, mTOR)信号通路相关蛋白的变化,并比较3组临床疗效及安全性。结果 联合组总有效率为96.7%,高于对照组的72.4%(P<0.05);联合组与针刺组、针刺组与对照组比较,差异无统计学意义(P>0.05)。3组治疗后经色暗淡、腰骶酸痛、头晕耳鸣、性欲淡漠及烦躁易怒积分均低于治疗前(P<0.05);且联合组治疗后经色暗淡、腰骶酸痛、头晕耳鸣、性欲淡漠及烦躁易怒积分低于针刺组和对照组(P<0.05),针刺组低于对照组(P<0.05)。3组治疗后E2水平均高于治疗前(P<0.05),FSH、T、LH、PRL水平均低于治疗前(P<0.05);且联合组治疗后E2水平高于针刺组和对照组(P<0.05),针刺组高于对照组(P<0.05);联合组治疗后FSH、T、LH、PRL水平低于针刺组和对照组(P<0.05),针刺组低于对照组(P<0.05)。3组治疗后卵泡最大直径和卵泡数量均大于治疗前(P<0.05);且联合组治疗后卵泡最大直径和卵泡数量大于针刺组和对照组(P<0.05),针刺组大于对照组(P<0.05)。3组治疗前后卵巢体积比较,差异无统计学意义(P>0.05)。3组治疗后PI3K、Akt和m TOR蛋白表达浓度均高于治疗前(P<0.05);且联合组治疗后PI3K、Akt和mTOR蛋白表达浓度高于针刺组和对照组(P<0.05),针刺组高于对照组(P<0.05)。3组不良反应发生率比较,差异无统计学意义(P>0.05)。结论 针刺联合中西药可有效改善月经后期患者临床症状,调节性激素水平与卵巢功能,疗效显著,且安全性高,这可能与调控PI3K/Akt/m TOR信号通路有关。

超声下聚桂醇化学消融联合米非司酮治疗子宫肌瘤的临床价值

目的:探讨超声下聚桂醇化学消融联合米非司酮治疗子宫肌瘤的临床价值。方法:选择2022年4月—2023年4月射阳县人民医院接收的80例子宫肌瘤患者作为研究对象,通过随机数表法分为对照组与观察组,各40例。对照组予以米非司酮治疗,观察组予以超声下聚桂醇化学消融联合米非司酮治疗。比较两组临床疗效及治疗前后肌瘤体积、肌瘤直径、卵巢功能[雌二醇(E_(2))、促卵泡激素(FSH)、黄体生成激素(LH)]。结果:观察组治疗总有效率高于对照组,差异有统计学意义(P<0.05)。治疗前,两组肌瘤体积、肌瘤直径、卵巢功能比较,差异无统计学意义(P>0.05);治疗后,观察组肌瘤体积小于对照组,肌瘤直径短于对照组,E_(2)、FSH、LH水平低于对照组,差异有统计学意义(P<0.05)。结论:相比单独使用米非司酮治疗,超声下聚桂醇化学消融联合米非司酮治疗子宫肌瘤在提高治疗有效率、减小肌瘤体积、缩短肌瘤直径及改善卵巢功能方面效果更显著。