异位妊娠腹腔镜诊治192例分析

目的 探讨腹腔镜下异位妊娠诊治临床意义,手术病例的选择及手术注意事项.方法 对2003年8月至2006年4月我院收治的异位妊娠腹腔镜诊治192例患者的临床资料进行回顾性分析,全部病例均经手术和病理确诊.结果 186例腹腔镜下完成手术,6例中转开腹,术中诊断陈旧性宫外孕6例,术中出血量平均20 mL.术后发生持续性宫外孕4例,3例保守治疗成功,1例改开腹手术切除患侧输卵管,平均住院时间4.5 d.结论 腹腔镜手术微创、及时、准确、安全、易行．对患者损伤小,术后恢复快,成为临床诊治异位妊娠的主流,但注意病例的选择并尽量避免持续性异位妊娠的发生.     

VEGF、ER、PR在异位和在位子宫内膜中的表达

研究血管内皮因子（VEGF）、雌激素受体（ER）和孕激素受体（PR）在子宫内膜异位症（EM）患者的异位和在位内膜中的表达．采用免疫组化SP法分别检测45例EM（研究组）的异位和在位内膜及32例子宫肌瘤（对照组）的在位内膜中VEGF、ER、PR的表达．利用图像分析仪测定的相应密度代表其表达强度．研究组异位和在位内膜中VEGF的表达均显著高于对照组内膜（p〈0．01）。ER／PR则显著低于对照组内膜；ER、PR仅于异位内膜中的表达低于对照组内膜，异位内膜中VEGF与ER呈正相关．异位内膜和在位内膜中高VEGF和低ER／PR以及异位内膜中VEGF与ER正相关的特点可能与EM的发生发展有关．     

异位妊娠误诊的探讨

回顾性总结了1995年1月至2000年12月收治的异位妊娠误诊病例29例，其误诊病种有早孕，先兆流产，盆腔炎，功能失调性子宫出血，急性胃肠炎和急性阑尾炎等，旨在探讨误诊的原因及减少误诊的对策。     

Identification of swelling-activated Cl<Superscript>-</Superscript> current in rabbit cardiac Purkinje cells

The presence and functional role of the swelling-activated Cl^- current (I_Cl(swell)) in rabbit cardiac Purkinje cells was examined using patch-clamp methodology. Extracellular hypotonicity (210 or 135 mOsm) activated an outwardly rectifying, time-independent current with a reversal potential close to the calculated Cl^- equilibrium potential (E_Cl). The magnitude of this current was related to tonicity of the superfusate. The current was blocked by 0.5 mM 4,4-diisothiocyanostilbene-2,2-disulfonic acid (DIDS). These features are comparable to those of I_Cl(swell) found in sinoatrial nodal, atrial, and ventricular myocytes. I_Cl(swell) activation at 210 and 135 mOsm depolarized the resting membrane potential with 6 and 10 mV and shortened the action potential by 18 and 33%, respectively. DIDS partially reversed I_Cl(swell)-induced action potential changes. We conclude that I_Cl(swell) is present in Purkinje cells and its activation leads to action potential shortening and resting membrane potential depolarization, both of which can promote the development of reentrant arrhythmias.Received 20 January 2004; received after revision 17 February 2004; accepted 25 February 2004     

Ultrastructural changes in uterine myometrium of mice with experimentally-induced adenomyosis

Summary Ectopic pituitary transplantation induced a high incidence of adenomyosis in SHN mice. Early signs of the development of adenomyosis were the penetration of stromal connective tissue into myometrium followed by uterine gland invasion. Associated with these changes, the inner layer of myometrium showed the involution of smooth muscle cells and distended intercellular spacesThis work was supported in part by Grant-in-Aid for Scientific Research from the Ministry of Education, Science and Culture of Japan     

经阴道超声诊断宫外孕的临床应用体会

目的:探讨经阴道超声诊断宫外孕的临床价值。方法:采用PHILIPS实时超声诊断仪,对我院经腹部壁声(TAS)和阴道超声(TVS)检查的108例术前宫外孕患者进行回顾性分析。结果:TVS诊断异位妊娠76例,其中完整胎囊型18例,混合包块型51例,实性包块7例;32例异位妊娠经TAS诊断仅12例为异位妊娠。108例术后病理证实,输卵管妊娠103例(占95%),卵巢妊娠1例(占0.92%),宫角妊娠2例(占1.85%),TVS误诊2例(占2.6%)。TVS诊断符合率为96.3%,TAS诊断符合率为25%。结论:TVS诊断异位妊娠操作方便,诊断符合率高,对早期未破裂的输卵管妊娠具有重要诊断意义。     

Mechanism for chronic pain generation

Neuropathic pain and the other abnormalities of sensation induced by axon injury or by peripheral nerve inflammation should result from functional compensations of the injured neurons during their regeneration. Ectopic distribution of proteins related to Na⁺, K⁺ and Ca²⁺ channels as well as of receptors on both membranes of injured axon and its cell body becomes a main pacemaker from which spontaneous ectopic afferent of primary sensatory neurons and crosstalk between neurons occur. Abnormal ectopic afferent activities lead to disorders of the sensation, such as hyperalgesia, allodynia, spontaneous pain and paraesthesia. Administration of some ion channel agents and/or α2-adrenergic blockers has shown efficiency in preventing neuropathic pain development and in relieving neuropathic pain.     

探讨人细小病毒B19与异位妊娠的关系

无菌留取85例异位妊娠妇女和43例妊娠无异常孕妇血清，用聚合酶连反应(PCR)检测的人细小病毒B19DNA，在异位妊娠组中人细小病毒B19DNA有20例阳性，阳性率为23．53％。正常对照组中，人细小病毒B19DNA有2例为阳性，阳性率为4．51％，用x^2检验，x^2＝6．47，P＜0．05，2组有显著性差异。由此总结，人细小病毒B19感染可能是异位妊娠的原因之一。     

宫外孕保守治疗46例体会

目的：介绍宫外孕保守治疗的体会。方法：对46例宫外孕药物保守治疗过程进行病情观察监测及防止副反应的综合分析。结果：保守治疗46例,均采用氨甲喋呤单剂量保守治疗,8例失败后改为手术治疗,其余均治愈。结论：在保守治疗的过程中,对病情观察和指标监测,防止副反应及并发症的发生,是本病保守治疗成功的重要保证。     

输卵管妊娠保守适应证选择的研究

目的探讨彩色多普勒超声（CDFI）筛选合适药物保守治疗异位妊娠的临床价值。方法50例生命体征平稳的异位妊娠患者,在行CDFI检查后接受甲氨蝶呤（MTX）50mg/m。单次肌肉注射配合米非司酮150mg,三日口服,随访直至临床结局．分析成功与失败病例CDFI的特点和绒毛膜促性腺激素（HCG）的水平,并制作CDFI评分。结果CDFI能直接反映胚胎生命力,不同CDFI图像和血清HCG水平的病例,保守治疗成功率有很大差异。结论CDFI评分可应用于适合保守治疗异位妊娠病例的筛选。对评分〉9者,因失败率高,不推荐药物保守治疗。