子宫特殊部位妊娠18例分析

目的：探讨子宫特殊部位妊娠的临床诊断及处理。方法：回顾性分析2005年7月至2010年12月我院收治的18例子宫特殊部位妊娠患者的临床表现、诊断、处理及预后。结果：宫颈妊娠6例、宫角妊娠6例、残角子宫妊娠2例、子宫剖宫产瘢痕处妊娠4例。宫颈妊娠通过子宫动脉介入栓塞后清宫术治愈;宫角妊娠经MTX保守治疗后在超声或官腔镜引导下清宫术痊愈。残角子宫妊娠均行残角子宫切除术治愈。子宫剖宫产瘢痕处妊娠根据分型分别行超声引导下清宫＋水囊压迫、局部注射MTX保守治疗治愈。结论：子宫特殊部位妊娠病情凶险,临床表现各异,但有其特异性,超声辅助检查有助于早期诊断,MTX、子宫动脉介入栓塞治疗后刮宫是有效治疗手段。     

子宫动脉栓塞术对剖宫产术后瘢痕部位妊娠的治疗价值

目的：随着剖宫产率的不断攀升,剖宫产术后瘢痕部位妊娠的发生率已日趋增多。本研究将探讨子宫动脉栓塞术对剖宫产术后瘢痕部位妊娠的治疗价值。方法：选择我院2009年03月至2013年03月剖宫产术后瘢痕部位妊娠的患者共28例,均行双侧子宫动脉栓塞治疗,收集其主要临床资料,包括术中出血量、血HCG下降情况、住院时间、住院费用、月经复潮时间及不良反应,并进行回顾性分析。结果：28例患者均治疗有效,24例患者栓塞治疗后行清宫术,术中出血量5-200（平均36．5±4．8）mL,另4例栓塞治疗后未行清宫术。平均住院时间为13．6±4．7天。28例血β-HCG于栓塞后7～38天降为正常,超声检查示子宫复旧的平均时间为20—36天,栓塞后28-44天月经复潮。结论：28例患者采用UAE联合MTX灌注化疗治疗后出血量少,恢复快,疗效显著。子宫动脉栓塞术能有效防止和控制出血,保留妇女生育功能,是一种安全、有效的治疗方法。     

剖宫产瘢痕妊娠治疗方案的探讨

目的:探讨剖宫产瘢痕妊娠(CSP)的合理治疗方案。方法:回顾性分析2007年1月至2013年12月我院收治的26例CSP患者的临床资料,对其病史、临床表现、处理及结局进行总结分析,重点探讨其治疗方案与预后的关系。结果:采用的治疗方式包括口服米非司酮配伍米索前列醇后超声监测下清宫术6例、超声监测下局部甲氨蝶呤注射3例、全身甲氨蝶呤注射后清宫术2例、子宫动脉(化疗)栓塞后清宫术16例、经腹病灶切除术1例、经腹全子宫切除术1例。前三种方法尽管具有一定的成功率,但均有较高的术后大出血风险。子宫动脉(化疗)栓塞在CSP的初始及抢救治疗中均具有很高的成功率。结论:CSP治疗方案的选择需根据患者的病情、妊娠部位、生育要求等多方面进行综合考虑。在现有的治疗方案中,子宫动脉(化疗)栓塞后清宫术具有较大的优势。     

剖宫产子宫切口瘢痕妊娠的治疗方法及临床疗效分析

目的探讨介入栓塞后清宫术联合甲氨蝶呤治疗剖宫产子宫切口瘢痕妊娠的临床疗效。方法选取我院收治的70例剖宫产子宫切口瘢痕妊娠患者作为研究对象,根据患者治疗方式的不同分为对照组和研究组各35例,对照组在介入栓塞后行清宫术治疗,研究组先应用甲氨蝶呤后再行介入栓塞及清宫术治疗,观察比较两组的治疗效果。结果研究组的术中出血量明显低于对照组,血β-HCG恢复正常时间、术后住院时间均显著短于对照组,差异均有统计学意义(P0.05)。两组患者的术后月经来潮时间比较,差异无显著统计学意义(P0.05)。研究组术前1天及术后1天的血β-HCG水平均显著低于对照组,治疗总有效率显著高于对照组,差异均有统计学意义(P0.05)。结论甲氨蝶呤联合介入栓塞后行清宫术治疗剖宫产子宫切口瘢痕妊娠的疗效确切,且具有出血量少、住院时间短的优点。     

剖宫产疤痕妊娠30例临床分析

摘要目的：探讨子宫剖宫产疤痕妊娠（CSP）的诊断和最佳治疗方法,为后续的临床研究工作提供理论依据和临床资料。方法：回顾性分析我院2010年2月．2012年2月收治的30例CSP患者的临床资料。结果：30例患者中,有25例行双侧子宫动脉栓塞（UAE）＋MTX灌注术后,再行清宫术,手术均获得成功,术后无任何并发症出现;另外5例患者因误诊为宫内妊娠后行人工流产术时发生大出血转至我院进行抢救,其中,4例成功实施了子宫动脉栓塞术,达到了止血目的,1例因子宫破裂直接行全子宫切除术。结论：对子宫剖宫产疤痕妊娠（CSP）患者实施双侧子宫动脉栓塞术＋MTX灌注术后,借助B超监测,再行刮宫术,是治疗剖宫产切口妊娠的有效方法。     

剖宫产术后切口妊娠介入治疗与保守治疗效果的临床研究

目的:研究子宫动脉介入化疗栓塞术在临床上对剖宫产切口妊娠的治疗效果.方法:回顾性分析我院2007年1月至2012年12月的收治的切口妊娠患者53例.并将53例患者随机分为介入治疗组28例、保守治疗组25例,介入治疗组患者采用双侧子宫动脉栓塞术后进行刮宫术的治疗,保守治疗组患者采用口服米非司酮以及肌内注射MTX后进行刮宫术的治疗.对两组患者的临床资料包括出血量,住院时间,降血HCG时间等进行统计学分析.结果:介入治疗组患者的出血量,住院时间,降血HCG时间明显低于保守治疗组患者的情况,差异具有显著性(P＜0.05).介入治疗组和保守治疗组间的不良反应差异无统计学意义(P＞0.05).结论:对患者采用子宫动脉介入对剖宫产切口妊娠进行治疗的方式,可以对切口妊娠大出血进行有效的控制,同时也可以对妊娠物进行有效的杀死.     

剖宫产瘢痕妊娠60例的临床治疗体会

目的:探讨不同类型剖宫产瘢痕妊娠(CSP)的治疗方法。方法:选择经临床确诊为CSP的患者60例,根据CSP的类型分为内生型组(Ⅰ组)19例和外生型组(Ⅱ组)41例,每组再根据不同治疗方法各分为两个亚组,Ⅰ组包括:ⅠA组应用甲氨喋呤(MTX,Methotrexate)后超声引导下清宫术(7例);ⅠB组应用MTX及双侧子宫动脉灌注化疗栓塞术(UACE,Uterine aytery embolization chemotherapy)后超声引导下清宫术(12例)。Ⅱ组包括:ⅡA组行超声引导下清宫术+/-MTX(11例);ⅡB组应用MTX+UACE+超声引导下清宫术(30例)。以妊囊大小、术中出血量、人绒毛膜促性腺激素(β-human chorionic gonadotropin,β-HCG)恢复正常时间、首次治愈率、二次治愈率、住院时间、住院费用及月经恢复正常时间、术后妊娠率作为疗效评估参数比较两组中亚组间相关数据的差异。结果:Ⅰ组中,两亚组妊囊大小、术中出血量、住院天数、血HCG及月经恢复时间、首次治愈率比较差异无统计学意义(P0.05);ⅠA组住院花费明显少于ⅠB组(P0.05)。Ⅱ组中,两亚组住院天数、住院费用及妊囊大小比较差异无统计学意义(P0.05);ⅡA组术中出血量及月经恢复时间明显多于ⅡB组,血HCG下降率及首次治愈率明显低于ⅡB组(P0.05)。结论:CSP可根据类型选用合适的治疗方法。内生型适用于MTX+超声引导下清宫术,而外生型适用于MTX+UACE+超声引导下清宫术。     

子宫动脉栓塞术后并发血栓的临床病例分析和诊治探讨

目的:探讨剖宫产瘢痕妊娠(CSP)患者经子宫动脉栓塞术(UAE)后并发下肢深静脉血栓(DVT)的临床病例的诊断治疗要点。方法:回顾性分析2014年-2016年我院收治的剖宫产瘢痕妊娠患者经子宫动脉栓塞术后并发下肢深静脉血栓(DVT)5例患者的临床特点及诊断、治疗方法。结果:2014年-2016年,我院CSP患者经UAE治疗后发生DVT的发病率为1.63%,患者平均年龄35.2岁。DVT临床症状出现于UAE术后3-6天,多表现为下肢的疼痛及酸胀,深静脉血栓均出现在介入穿刺处肢体。用彩色多普勒血流显像诊断深静脉血栓安全可靠。采用低分子肝素皮下注射抗凝治疗均取得较好效果。结论:剖宫产瘢痕妊娠患者经子宫动脉栓塞术治疗后有发生下肢深静脉血栓风险,DVT发生与穿刺处肢体制动,血管受压,血液回流障碍有关。手术前后应采取预防措施,低分子肝素钠抗凝对DVT治疗有效。     

介入栓塞术联合清宫术对子宫切口妊娠的治疗价值研究

目的探讨子宫切口妊娠患者行介入栓塞术、清宫术联合治疗的应用效果。方法对我院收治的34例切口妊娠患者的临床资料进行回顾性分析,均行介入栓塞术治疗,术后行清宫术。结果 34例患者均成功实施介入栓塞术、清宫术,术中出血量为40~75ml,术后1~3周内血β-HCG水平恢复正常,住院时间平均为(8.5±2.6)天,无严重并发症发生。结论介入栓塞术联合清宫术治疗子宫切口妊娠的效果明显,创伤小,保留了患者的生育功能,且住院时间短,是一种安全、有效的治疗方法。     

不同治疗方案治疗瘢痕部位妊娠的临床疗效分析

目的:探讨不同治疗方案治疗瘢痕部位妊娠(CSP)的临床疗效。方法:选取2010年1月至2017年9月西安交通大学第一附属医院妇产科收治的CSP患者89例,按治疗方案不同分为A、B、C三组。A组患者19例,采用药物甲氨喋呤保守治疗;B组患者30例,行B超引导下人工流产术治疗;C组患者40例,行子宫动脉栓塞术联合清宫术治疗。比较三组患者的阴道出血情况以及治疗效果。结果:C组患者治愈率最高、血清β-HCG恢复至正常时间最短、治疗后阴道出血量最少,其次为B组,最后是A组,差异具有统计学意义(P0.05);治疗后第4d、7d,B、C两组血清β-HCG下降幅度显著高于A组(P0.05),尤其是C组在治疗后第7d的下降幅度最大;B组患者住院时间及住院费用均低于C组及A组,但输血率高,差异具有统计学意义(P0.05)。结论:子宫动脉栓塞术联合清宫术治疗CSP具有治愈率高、损伤小、术后恢复快等优势,在经济情况允许的情况下其临床疗效最佳。     

子宫动脉化疗栓塞术治疗子宫瘢痕妊娠

目的：本文采用双侧子宫动脉化疗栓塞术治疗子宫瘢痕妊娠,通过讨论其临床疗效、术后并发症及愈后情况,旨在为临床治疗子宫瘢痕妊娠提供一种安全、有效、合理的治疗方法。方法：对27例确诊为子宫瘢痕妊娠的患者采用seldinger技术穿刺股动脉,在DSA监视下,分别超选择双侧子宫动脉,各灌注甲氨蝶呤20mg,再注入明胶海绵颗粒栓塞至子宫动脉完全闭塞。3～5天后,在硬膜外麻醉及彩超监视下行宫腔镜病灶切除术。术后随访3～6个月,观察月经恢复情况。结果：本组所有患者均一次性栓塞治疗成功,造影显示子宫动脉闭塞良好,患者阴道不规则出血迅速停止。宫腔镜病灶切除术中出血极少,无子宫破裂、大出血等严重并发症发生。术后5～10天,所有患者血hCG均恢复至正常水平;随访3～6个月,所有患者月经均恢复正常。结论：子宫动脉化疗栓塞术治疗子宫瘢痕妊娠损伤小、安全有效,可以减少子宫破裂、大出血等严重并发症发生,保留患者子宫及附件的正常解剖及生理功能,尤其适用于有生育要求的妇女,适合临床广泛应用。     

早期异位妊娠患者经阴道彩色多普勒示可疑妊娠滋养细胞流动与血清甲胎蛋白水平的相关性

摘要 目的：探究早期异位妊娠患者经阴道彩色多普勒示可疑妊娠滋养细胞流动与血清甲胎蛋白水平的相关性。方法：选择2021年1月至12月在本院收治的100例早期异位妊娠患者为观察研究对象。并选择同时期在本院例行正常产检的100例宫内妊娠孕妇为对照组。所有受试者进行阴道超声检查和彩色多普勒检查,并抽血进行甲胎蛋白的定量测定。测定子宫动脉、滋养细胞血流阻力及血清甲胎蛋白含量。结果：观察组腹痛、阴道不规则出血发生率较对照组升高（P<0.05）。观察组收缩期峰值速速、舒张末期速度较对照组升高,观察组滋养细胞血流阻力指数RI较对照组降低（P<0.05）。观察组收缩期峰值速速、舒张末期速度较对照组升高,观察组子宫动脉血流阻力指数RI较对照组降低（P<0.05）。观察组血清甲胎蛋白含量较对照组升高（P<0.05）。异位妊娠患者血清甲胎蛋白与滋养细胞血流RI呈负相关（r=-0.425,P<0.001）。结论：早期异位妊娠患者血清甲胎蛋白升高,经阴道彩色多普勒检查显示滋养细胞存在高流量-低阻力血管,滋养细胞血流阻力RI与血清甲胎蛋白呈负相关。     

Human Uterine Wall Tension Trajectories and the Onset of Parturition

Uterine wall tension is thought to be an important determinant of the onset of labor in pregnant women. We characterize human uterine wall tension using ultrasound from the second trimester of pregnancy until parturition and compare preterm, term and twin pregnancies. A total of 320 pregnant women were followed from first antenatal visit to delivery during the period 2000–2004 at the John Hunter Hospital, NSW, Australia. The uterine wall thickness, length, anterior-posterior diameter and transverse diameter were determined by serial ultrasounds. Subjects were divided into three groups: women with singleton pregnancies and spontaneous labor onset, either preterm or term and women with twin pregnancies. Intrauterine pressure results from the literature were combined with our data to form trajectories for uterine wall thickness, volume and tension for each woman using the prolate ellipsoid method and the groups were compared at 20, 25 and 30 weeks gestation. Uterine wall tension followed an exponential curve, with results increasing throughout pregnancy with the site of maximum tension on the anterior wall. For those delivering preterm, uterine wall thickness was increased compared with term. For twin pregnancies intrauterine volume was increased compared to singletons (), but wall thickness was not. There was no evidence for increased tension in those delivering preterm or those with twin gestations. These data are not consistent with a role for high uterine wall tension as a causal factor in preterm spontaneous labor in singleton or twin gestations. It seems likely that hormonal differences in multiple gestations are responsible for increased rates of preterm birth in this group rather than increased tension.     

Immunosuppressive activity associated with early pregnancy in the bovine

Immunosuppressive activity was assessed in uterine flushings (UF) and uterine vein serum and plasma from nonpregnant and early-pregnant cows, and in media from the short-term culture of Day 18 bovine embryos. The preparations were tested for their ability to inhibit [3H] thymidine (3H-TdR) incorporation into phytohemagglutinin-stimulated bovine lymphocytes. On Days 2-3 (called Day 3), Days 9-10 (called Day 10), and Days 17-19 (called Day 18) of the estrous cycle (estrus = Day 0) and pregnancy, untreated and superovulated cows were anesthesized and jugular vein and uterine vein blood was collected. The uteri were removed and flushed to obtain UF and embryos. Uterine flushings were concentrated and tested for immunosuppressive activity at 400 micrograms uterine protein/ml culture fluid. Uterine flushings from both Day 18 pregnant and Day 18 nonpregnant cows were immunosuppressive (8/8), whereas Day 10 UF were usually not immunosuppressive (7/10). Day 3 UF were usually stimulatory or only marginally suppressive (8/8). Uterine vein serum and plasma from Day 18 cows were not suppressive when compared to jugular vein serum or plasma from the same cow; neither were Day 18 uterine vein serum or plasma suppressive when compared to those same samples taken from Day 3 cows. Embryo culture media obtained from the 48-h culture of Day 18 embryos was consistently suppressive. The activity was lost after dialysis in 1000-Mr cut-off tubing, removed by charcoal, and reduced by protease digestion. These results suggest two mechanisms whereby the embryo could escape immune rejection: 1) the progesterone-induced secretion of a uterine immunosuppressive substance(s) and 2) the production by the embryo of a low molecular weight immunosuppressive substance(s).     

Uterine and placental expression of TRPV6 gene is regulated via progesterone receptor- or estrogen receptor-mediated pathways during pregnancy in rodents

Transient receptor potential cation channel, subfamily V, member 6 (TRPV6) is an epithelial Ca²⁺ channel protein expressed in calcium absorbing organs. In the present study, we investigated the expression and regulation of uterine and placental TRPV6 during gestation in rodents. Uterine TRPV6 peaked at pregnancy day (P) 0.5, P5.5 and, P13.5 and was detected in uterine epithelium and glands of rats, while placental TRPV6 mRNA levels increased in mid-gestation. Uterine and placental TRPV6 mRNA levels in rats appear to cyclically change during pregnancy, suggesting that TRPV6 may participate in the implantation process. In addition, uterine TRPV6 mRNA is only expressed in placenta-unattached areas of the uterus, and uterine TRPV6 immunoreactivity was observed in luminal and glandular epithelial cells. In the placenta, TRPV6 was detected in the labyrinth and spongy zone. These results may indicate that TRPV6 has at least two functions: implantation of the embryo and maintenance of pregnancy. To investigate the pathway(s) mediating TRPV6 expression in rodents, anti-steroid hormone antagonists were injected prior to maximal TRPV6 expression. In rats, TRPV6 expression was reduced by RU486 (an anti-progesterone) through progesterone receptors, and ICI 182,780 (an anti-estrogen) blocked TRPV6 expression via estrogen receptors in mice. The juxtaposition of uterine and placental TRPV6 expressed in these tissues supports the notion that TRPV6 participates in transferring calcium ions between the maternal and fetal compartments. Taken together, TRPV6 gene may function as a key element in controlling calcium transport in the uterus between the embryo and the placenta during pregnancy.     

血清妊娠相关血浆蛋白A在诊断异常妊娠中的临床意义

目的:探讨血清妊娠相关血浆蛋白A(PAPP-A)在诊断异常妊娠中的临床意义,分析其与异常妊振的关系。方法:选取299例5~13周的正常早孕妇为正常早孕组,同期选取稽留流产86例,先兆流产54例,异位妊娠76例为异常妊娠组,用酶联免疫吸附试验(ELASA)测定两组受试者的血清PAPP-A水平,分析两组受试者各个孕周内的血清PAPP-A水平的差异。结果:稽留流产孕妇在各个孕周内(9~13周)的血清PAPP-A水平显著低于同孕周内正常早孕孕妇(t值分别为9.500,8.113,3.511,9.538,8.504,P值均0.05);稽留流产孕妇总的平均血清PAPP-A水平亦低于常早孕孕妇(t=3.651,P值均0.05);异位妊娠孕妇在各个孕周内(9~13周)的血清PAPP-A水平显著低于同孕周内正常早孕孕妇(t值分别为7.976,9.030,9.941,11.625,14.079,12.569,P值均0.05),异位妊娠孕妇总的平均血清PAPP-A水平亦低于常早孕孕妇(t=28.168,P值均0.05);先兆流产孕妇(除孕8周)与正常早孕妊娠血清PAPP-A水平比较无显著统计学意义。结论:血清PAPP-A水平在异常妊娠如异位妊娠、稽留流产中显著降低,可作为诊断异位妊娠、稽留流产及先兆流产辅助诊断的生物学指标。     

Peroxidase activity in the mouse uterus, placenta and fetus during pregnancy

Changes in peroxidase activity during pregnancy were examined in CD-1 mice. Peroxidase activity was measured with guaiacol as the substrate in uterine extracts of nonpregnant mice and in uterine, placental, and fetal extracts of pregnant mice on days 9, 12, 14, 16, and 18 of gestation. Uterine peroxidase activity in nonpregnant mice was high, but declined logarithmically to only 0.2% by day 18 of pregnancy. In contrast to this decline, a concomitant 50-fold logarithmic increase in fetal peroxidase activity was observed between day 12 and 18. Activity in placental extracts did not change significantly throughout the gestational period examined. These results suggest that membrane bound peroxidase in mouse uterus and fetus undergoes major shifts during pregnancy.