Cervical myomas are benign tumors originating from cervical muscle tissue with a very rare incidence of only about 8% of all myomas. The surgical approach depends on the position of cervical myoma. This case report discusses a 44-year-old woman who complained of a lump discharge from her birth canal 6 months ago, and currently discharging from her vagina. We performed vaginal myomectomy, and the cervical myoma measuring 8 × 8 × 6 cm with solid consistency was removed. We continued with total vaginal hysterectomy. Post-operative recovery was progressing well. The histopathology report was consistent with leiomyoma. Large prolapsed cervical myoma can be disturbing and discomforting for many patients. It is relatively rare and can be successfully removed vaginally with minimal morbidity. J Med Cases. 2021;12(7):288-290 doi: https://doi.org/10.14740/jmc3698

Гигантская миома маточных рудиментов при аплазии матки и влагалища

Spontaneous bleeding from uterine leiomyoma is an unusual cause of hemoperitoneum. Fewer than 100 cases have been reported in the literature so far. We report a 30-year-old woman who needed surgical exploration for an acute abdomen. There was massive hemoperitoneum due to bleeding from a subserosal myoma. This case was important because physician should be aware of this rare complication in patient with uterine myoma to avoid any morbidity and mortality. J Med Cases. 2020;11(6):145-147 doi: https://doi.org/10.14740/jmc3049w

We present a rare case of uterine torsion caused by an 18-cm subserosal myoma weighing 3.9 kg in a postmenopausal lady in a tertiary center. A 52-year-old postmenopausal lady presented with abdominal pain and no bowel movements of 3 days duration. Multiplanar computed tomography (CT) of abdomen and pelvis showed uterine torsion, while initial pelvis ultrasound was unremarkable. Patient underwent laparotomy and was found to have torsion of the uterus at the level of the isthmus with a large subserosal myoma. She underwent total hysterectomy and bilateral salpingo-oophorectomy. Post-operatively, patient recovered well. Subserosal myoma causing uterine torsion is extremely uncommon, but in a known case of large subserosal myoma in a postmenopausal lady, high index of suspicion is needed when they present with acute abdominal pain. However, prompt identification with advanced radiological imaging is important to minimize associated morbidity and mortality. J Med Cases. 2019;10(6):164-167 doi: https://doi.org/10.14740/jmc3314

Objective To explore the risk factors of intrauterine adhesions after abortion and the effect of hysteroscopic surgery. Methods Through retrospective analysis method, from January 2014 to October 2016, 80 artificial abortion patients with intrauterine adhesions were collected as adhesion group.During the same period, 80 patients without adhesion after artificial abortion were selected as non-adhesion group.The general data of the two groups were compared.By logistic multivariate analysis, the influencing factors of intrauterine adhesions were analyzed.And the effect of surgical treatment of hysteroscopic adhesion was analyzed. Results The adhesion group and the non-adhesion group had statistically significant differences in the times of pregnancy(t=6.848, P<0.001), missed abortion(t=12.004, P<0.001), painless curettage times(t=7.24, P<0.001), painless abortion history(χ2=5.079, P=0.024). Multivariate logistic regression analysis indicated that number of missed abortion(OR: 7.083, 95% CI: 2.406-17.392; P=0.002), curettage times(OR: 9.147, 95% CI: 2.875-32.068; P=0.014), painless abortion of history(OR: 5.276, 95% CI: 1.973-13.492; P=0.029) were the independent risk factors for uterine cavity adhesions (P<0.05). The total effective rate of the mild-to-moderate uterine cavity adhesions was significantly higher than that of the severe uterine cavity adhesions (χ2=16.449, P<0.001). Conclusion The number of missed abortion, curettage, painless history are independent risk factors for intrauterine adhesion, the effect of treatment is related to the degree of adhesion, hysteroscopic intrauterine adhesions after treated with the combination therapy of estrogen and Foley balloon catheter, IUD and absorbable membrane can help reduce the risk of readhesion, it is worthy of clinical attention. Key words: Abortion, induced; Postoperative complications; Risk factors; Prognosis

Objective To investigate the correlation between oxidative stress and pain after laparoscopic myomectomy. Methods 84 patients with uterine myoma who were treated in Changsha Hospital of traditional Chinese Medicine from March 2014 to March 2017 were enrolled in the study. The patients were divided into the control group (n=42) and the observation group (n=42) according to the random number table method. The patients in the control group were treated with conventional laparotomy hysteromyoma expetion, and the patients in the observation group were treated by laparoscopic myomectomy. The levels of oxidative stress indexes[reactive oxygen species (ROS), malondialdehyde (MDA), advanced oxidation protein products (AOPP)] and pain indexes [interleukin-6 (IL-6), substance P (SP), prostaglandin E2 (PGE2) and visual analogue scale (VAS) score] were compared between two groups before operation, 1 d after operation and 3 d after operation. Pearson correlation analysis was used to analyze the correlation between oxidative stress and pain. Results The levels of plasma ROS, MDA and AOPP in the two groups 1 d after operation and 3 d after operation were higher than those before operation (all P<0.05), the levels of plasma ROS, MDA and AOPP in observation group 1d after operation and 3 d after operation were significantly lower than in the control group (all P<0.05). The levels of serum IL-6, SP, PGE2 and VAS score in the two groups 1d after operation and 3 d after operation were all higher than those before operation (all P<0.05), the levels of serum IL-6, SP, PGE2 and VAS score in observation group after 1 d and 3 d after operation were all lower than those in control group (all P<0.05). The results of Pearson correlation analysis showed that ROS, MDA and AOPP was positively correlated with PGE2 (P<0.05). Conclusions Laparoscopic myomectomy can effectively reduce the oxidative stress response to postoperative hysteromyoma and relieve postoperative pain, and oxidative stress is positively correlated with PGE2 after operation. Key words: Uterine neoplasms/SU; Leiomyoma/SU; Laparoscopy; Oxidative stress; Pain, postoperative

Objective To investigate the expressions of tumor necrosis factor-alpha (TNF-α), tumor necrosis factor receptor (TNFR)1 and TNFR2 in different cervical lesions and their relationships with clinicopathological characteristics. Methods Forty-one cases of cervical squamous cell carcinoma (CSCC) patients (CSCC group) treated in 254th Hospital of People′s Liberation Army from January 2015 to December 2017 were selected as the subjects. Forty-nine cases of high grde squmous intrepithelial lesion (HSIL) (HSIL group) and fifty cases of uterine myoma (normal group) were selected as control groups. The expression of TNF-α in cervical tissues of different lesions was detected by immunohistochemistry. The expressions of TNF-α mRNA, TNFR1 mRNA and TNFR2 mRNA were detected by quantificational real-time polymerase chain reaction (qRT-PCR). The expression level of TNFR1 and TNFR2 proteins are measured by Western blotting. The relationships between the expression level of TNF-α mRNA, TNFR1 mRNA and the clinicopathological characteristics of patients were analyzed. Results The positive rates of TNF-α in the normal group, the HSIL group and the CSCC group were 8.0% (4/50), 59.2% (29/49) and 73.2% (30/41). The difference between three groups was statistically significant (χ2=44.786, P<0.001). The positive rates of the HSIL group and the CSCC group were significantly higher than that in the normal group, the difference was statistically significant (χ2=29.175, P<0.001; χ2=40.883, P<0.001), but there was no statistical difference in the positive rates of TNF-α in CSCC group and HSIL group (χ2=1.934, P=0.164). The results of qRT-PCR showed that the expressions of TNF-α mRNA in normal group, HSIL group and CSCC group were 1.32±0.21, 3.64±0.41 and 7.51±1.42. The difference of TNF-α mRNA expression among three groups was statistically significant (F=655.800, P<0.001). The expressions level of TNF-α mRNA in HSIL group and CSCC group were significantly higher than that in normal group (t=31.747, P<0.001; t=51.012, P<0.001), and the expression level of CSCC group was significantly higher than that in HSIL group (t=20.039, P<0.001). The expression levels of TNFR1 mRNA in the normal group, the HSIL group and the CSCC group were 0.42±0.13, 0.89±0.21 and 2.23±0.46. The relative expression of TNFR1 mRNA between the three groups was statistically significant (F=465.900, P<0.001). The expression levels of TNFR1 mRNA in group HSIL and CSCC were significantly higher than that in normal group (t=13.357, P<0.001; t=26.587, P<0.001), and the expression level of CSCC group was significantly higher than that in HSIL group (t=18.407, P<0.001). The expression of TNFR2 mRNA in the normal group, the HSIL group and the CSCC group were 0.38±0.14, 0.41±0.11 and 0.44±0.12. There was no significant difference between three groups (F=2.633, P=0.075). Western blottting showed that the expression intensity of TNFR1 in the normal group, the HSIL group and the CSCC group were 0.84±0.18, 1.95±0.21 and 3.38±0.73, the difference was statistically significant (F=398.000, P<0.001). The expression intensity of TNFR1 in group HSIL and CSCC were significantly higher than that in normal group (t=18.273, P<0.001; t=39.894, P<0.001), and the expression in CSCC group was also significantly higher than that in group HSIL (t=22.357, P<0.001). The expression intensity of TNRF2 in normal group, HSIL group and CSCC group were 0.98±0.15, 1.02±0.17, 1.07±0.21, and the difference was not statistically significant (F=2.938, P=0.056). The results of protein detection were in accordance with the results of mRNA detection. The expression of TNF-α mRNA in the CSCC tissues was related to the size of the tumor (t=-8.868, P<0.001), the degree of differentiation (t=-5.644, P<0.001), the clinical stage (t=-19.329, P<0.001), the depth of infiltration (t=-11.170, P<0.001), and lymph node metastasis (t=-8.339, P<0.001). The expression of TNFR1 mRNA was closely related to the tumor size (t=-13.309, P<0.001), degree of differentiation (t=-13.449, P<0.001), clinical stage (t=-12.949, P<0.001), depth of infiltration (t=-18.124, P<0.001), and lymph node metastasis (t=-20.506, P<0.001). Conclusion In cervical cancer tissues, the expression intensity of TNF-α and TNFR1 increased abnormally, while TNFR2 did not change significantly. The expre-ssions of TNF-α and TNFR1 are positively correlated with the malignancy of cervical cancer. They are potential signals of cervical cancer and are expected to become new therapeutic targets. However, the activation of TNFR2 to downstream signaling pathway is significantly weaker than that of TNFR1. Key words: Uterine cervical neoplasms; Tumor necrosis factor-alpha; Receptors, tumor necrosis factor

By analyzing the characteristics of the traditional teaching in Obstetrics and Gynecology and taking myoma of uterus as an example, we put forward the flipped classroom teaching mode based on WeChat platform: teachers provide teaching resources and set questions before the class; students report in groups and teachers comment on their report during the class; and teachers give comprehensive evaluation and feedback after the class. To deal with the deficiencies in the traditional teaching methods, this mode breaks the limitation of time and space, enabling students to learn more autonomously, to think proactively, and to get answers timely when they have doubts. The flipped classroom teaching mode based on WeChat platform fully embodies student-oriented teaching strategies, especially emphasizing knowledge internalization and knowledge imparting process, and providing reference for improvement of teaching methods in obstetrics and gynecology. Key words: WeChat; Obstetrics and gynecology; Teaching; Flipping class

Objective To explore the clinical effects of magnetic resonance guided high intensity focused ultrasound(MRgHIFU) and gonadotropin releasing hormone agonist(GnRH-a) combined with levonorgestrel-releasing intrauterine system (LNG-IUS) in the treatment of recurrent uterine fibroids. Methods Eighty patients of recurrent uterine fibroids from April 2015 to June2017 in the First Hospital of Harbin were collected and randomly divided into the observation group and control group.MRgHIFU was used in the observation group were employed, and patients in the control group were treated with ING-IUS after first injecting GnRH-a.The tumor volume, hemoglobin level, menstrual quantity and adverse reactions were compared before and at 3 months, 6 months after treatment. Results After 6 months, the size of the uterine myoma in the observation group was ((80.23±4.35) cm3), significantly lower than that of the control group ((135.46±9.25) cm3), and the difference was statistically significant (t=6.01, P<0.05). At 3 and 6 months after treatment, the amount of menstruation in the observation group was significantly lower than that of the control group( (66.37±12.12)points vs.(40.46±10.15) points; (98.42±14.12) points vs.(68.26±11.38) points). The difference was statistically significant (t at 3 months after treatment=4.52, P<0.05, t at 6 months after treatment=3.53, P<0.05). After 6 months of treatment, the hemoglobin value of the observation group was significantly higher than that of the control group ((142.12±4.24) g/L vs.(108.27±3.09) g/L), the difference was statistically significant (t=5.02, P<0.05), while the adverse reactions such as vaginal bleeding, hot flashes and night sweats were lower than those of the control group (2.5% (1/40) vs.7.5% (3/40)) (χ2=3.99, P<0.05). Conclusion Magnetic resonance guided high intensity focused ultrasound was considered as safe and effective in treating uterine fibroids, which is a new and noninvasive therapeutic methed, Key words: Magnetic resonance guided high intensity focused ultrasound; Gonadotropin releasing hormone agonist; Levonorgestrel-releasing intrauterine system; Recurrent uterine fibroids

Gebelikte akut karın bugün en zorlu tanı ve tedavi ikilemlerinden biri olmaya devam etmektedir. Karın ağrısı obstetrik nedenlerle olabileceği kadar karın içi organlar nedeniyle de gelişebilmektedir. Gebelikte miyom dejenere olarak, saplı miyomun torsiyone olmasıyla veya kitle etkisine bağlı uterusun torsiyonuna yol açarak ağrıya yol açabilir. Bu olgu sunumunda eski sezaryenlı gebede gelişen karın ağrısının obstetrik bir acil mi yoksa cerrahi bir acil mi ayrımı yapılmasının zorluğu tartışılmıştır. Mukerrer sezaryenli G3 P2 olan 38 yaşında hasta, gebelik haftasında karın ağrısı ile başvurdu. Fizik muayenede batında yaygın hassasiyet mevcuttu. Ultrasonografi de her iki over normal olarak değerlendirildi. Plesanta dekolmanı ön tanısı ile sezaryen uygulandı. İntraoperatif gözlemde uterus sağ kornual yüze yakın ince pediküllü subserozal miyomun torsiyone olduğu tespit edildi. Hastaya sezaryen sırasında miyomektomi uygulandı.

The decision of myomectomy is not usually taken by OBG specialist for uterine fibroids during pregnancy because of its complications which become life threatening at times. This is why it is generally delayed until after delivery. The current case was a large, asymptomatic subserous uterine myoma of 17 cm diagnosed during pregnancy by ultrasound and successfully managed by antepartum myomectomy retaining the fetus alive in utero at 13–14 weeks' gestation. This case demonstrates that myomectomy during pregnancy in special circumstances in selected cases to prevent forthcoming events adversely affecting mother and fetus can be considered.

Intramural partial molar ectopic pregnancy is among the rarest sites of molar changes, may mimic intramural myoma and seriously threaten maternal life. The diagnosis and treatment of this unusual site molar ectopic pregnancy present a clinical challenge. We report the case of a partial molar intramural ectopic pregnancy in a 44-year-old patient presented with multiple intramural myoma and confirmed on final histopathology examination.

Objective To evaluate the value of hysteroscopy in elder women with abnormal uterine bleeding (AUB) and asymptomatic postmenopausal women with a thickened endometrium. Methods Fifty-three cases in the AUB group and seventy-eight cases in the endometrial hyperplasia group underwent hysteroscopy examination and hysteroscopy-guided biopsy, then the hysteroscopic and histopathological results were compared between the two groups. Results Of the 131 cases, the normal endometrium accounted for 29.8% (n=39), endometrial polyp for 49.6% (n=65), submucous myomas for 4.6% (n=6), hyperplasia endometrii for 6.1%(n=8) and endometrial carcinoma for 9.9% (n=13). Both the AUB group and the endometrial hyperplasia group had 8 cases of endometrial carcinoma (15.1%, 6.4%, respectively). For the diagnosis of normal endometrium with hysteroscopy, the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were 88%, 97%, 94% and 95%, respectively, in the AUB group, versus 82%, 95%, 86% and 93%, respectively, in the endometrial hyperplasia group. For the endometrial polyps, hysteroscopy showed a sensitivity, specificity, PPV and NPV of 100%, 79%, 74%, 100%, respectively, in the AUB group and 98%, 88%, 92%, 97%, respectively, in the endometrial hyperplasia group. For the endometrial cancer, hysteroscopy had a sensitivity, specificity, PPV and NPV of 75%, 100%, 100% and 96%, respectively, in the AUB group; while in the endometrial hyperplasia group, the sensitivity was 80%, the specificity and PPV were 100%, and the NPV was 99%. Conclusions In elder females, hysteroscopy allows for an accurate diagnosis in endometrial disease, and hysteroscopically directed sampling is mandatory, even if the uterine cavity appears normal at hysteroscopy, to rule out endometrial neoplasms. Key words: Hysteroscopy; Endometrial; Uterine hemorrhage

Objective To determine the dose-response relationship of sufentanil combined with midazolam for high intensity focused ultrasoun(HIFU) treatment of uterine adenomyosis and myoma. Methods Thirty two patients have uterine adenomyosis and 30 patients have uterine myoma, ASA classⅠ,Ⅱ, were enrolled. The patients were injected 30 μg/kg midazolam for sedation. Sufentanil was injected intravenously 5 min before the onset of operation. In addition, the sequential method was used in this study. The first dose of sufentanil was 0.10 μg/kg, set geometric series r=1.4 to calculate five step doses, the doses of sufentanil in the next patient was increased or decreased by a step dose according to the analgesia effect of the previous patient. Probit analysis was applied to calculated the ED50(95%CI) and 95% effective dose(ED95)(95%CI) of sufentanil. Results The ED50(95%CI) of sufentanil for uterine adenomyosis is 0.18(0.08-0.26) μg/kg. ED95 (95%CI) of sufentanil for uterine adenomyosis is 0.35(0.26-1.30) μg/kg. The ED50(95%CI) of sufentanil for uterine myoma is 0.13(0.04-0.20) μg/kg. The ED95(95%CI) of sufentanil for uterine myoma is 0.34(0.22-1.20) μg/kg. Conclusions Combined with midazolam 30 μg/kg, sufentanil has different ED50 and ED95 for uterine adenomyosis and myoma. Key words: High intensity focused ultrasound; Midazolam; Sufentanil; Adenomyosis; Myoma; Dose-response relationship

Objective To observe the curative effect of Chinese herbal medicine decoction combined with mifepristone in the treatment of uterine fibroids and the effects on hormone levels. Methods 100 patients with uterine fibroids were divided into the treatment group and control group according to random number table, 50 cases in each group. The treatment group was given the liquid form joint mifepristone, the control group was given mifepristone. The two groups were treated for a course of 3 months. The sex hormone levels before and after treatment, the symptoms and signs integral related indicators were compared. The clinical efficacy was evaluated. Results The total effective rate of the treatment group was 84%, which was obviously higher than 66% of the control group (χ2=9.88, P<0.05). Compared with before treatment[the control group, LH: (57.2±9.6)U/L, E2: (17.9±6.9)pmol/L, FSF: (32.7±8.5)g/L, P: (17.5±5.2)nmol/L; the treatment group, LH: (56.7±10.2)U/L, E2: (17.3±7.9)pmol/L, FSF: (33.5±7.9)g/L, P: (18.4±3.2)nmol/L], after treatment the levels of sex hormones in the two groups significantly reduced[the control group, LH: (47.5±8.3)U/L, E2: (12.5±3.8)pmol/L, FSF: (18.3±6.9)g/L, P: (14.8±3.2)nmol/L; the treatment group, LH: (38.7±8.1)U/L, E2: (7.5±4.3)pmol/L, FSF: (10.2±5.2)g/L, P: (10.5±4.8)nmol/L], the differences were statistically significant(all P<0.05). Conclusion Chinese herbal medicine decoction combined with mifepristone in the treatment of uterine fibroids has good clinical curative effect, by increasing the body's immunity, lowering levels of sex hormones in the body, inhibition of smooth muscle tissue, thus to narrow the myoma, improve clinical symptoms, it is worthy of promoting. Key words: Leiomyoma; Mifepristone; T lymphocyte

مقدمه: کمبود ویتامین Dدر سنین باروری امری شایع است. مطالعات اخیر نشان می­دهد که کمبود ویتامین Dبا کارکردهای ضعیف تولید‌مثل در زنان و مردان سنین باروری همراه است. لذا مطالعه حاضر با هدف تعیین نقش ویتامین D بر برخی عملکردهای تولید مثلی انسان (مانند سندرم تخمدان پلی‌کیستیک، آندومتریوز، میوم، نارسایی زودرس تخمدان‌ها، ناباروری مردان و IVF) انجام شد. روش‌کار: در این مطالعه مروری، مطالعات انجام شده فارسی و انگلیسی در طی سال‌های 1378 تا آبان ماه 1395، با استفاده از کلید واژه‌های فارسی ویتامین D، باروری، ناباروری و کلید واژه‌های انگلیسی fertility، infertility، vitamin D، در پایگاه‌های اطلاعاتی معتبر SID، Iranmedx، Scopus، Irandoc، PubMed، Magiran و Google scholar جستجو شدند. یافته‌ها: 35 مقاله استخراج شده از 302 مطالعه در ارتباط با نقش ویتامین D در عملکرد تولید مثلی انسان مورد بررسی قرار گرفت. نتایج حاصل از آخرین مطالعات انجام شده دراین زمینه مورد بحث قرار گرفت و خلاصه شد. نتیجه­گیری: کمبود ویتامین Dکه به عنوان سطح سرمی کمتر از 20 نانوگرم در میلی‌لیتر در نظر گرفته می‌شود، در سنین باروری شایع است و کمبود ویتامین D در عملکردهای تولید مثل مانند سندرم تخمدان پلی‌کیستیک، فیبروم رحمی، پارامترهای نامناسب اسپرم و در شکست درمان IVF نقش دارد، بنابراین مکمل ویتامین Dدر درمان ناباروری زنان و مردان توصیه می‌شود.

Objective To explore the effect of mifepristone combined with Gongliuxiao for patients with hysteromyoma.Methods 90 patients with hysteromyoma treated at our department from July,2014 to June,2015 were selected and divided into a control group (45 cases) and an observation group (45 cases) using random number table method.The control group were treated with mifepristone and the observation group with mifepristone and Gongliuxiao capsule.The short-term treatment effect was evaluated in both groups.Before and after the treatment,the maximum myoma volume,uterine volume,cell factors and sex hormone levels were compared between these two groups.Results The total effective rate was 93.33％ in the observation group and 77.78％ in the control group (P ＜ 0.05).The maximum myoma volume and uterine volume were (105.62±23.17) cm3 and (34.63±13.56) cm3 in the observation group and were (118.29±25.46) cm3 and (48.72±15.68) cm3 in the control group (P ＜ 0.05).The serum levels of TNF2 alpha and IL-22 were (21.29±10.43) ng/L and (20.36±8.56) ng/L in the observation group and were (16.69±3.17) ng/L and (33.25±13.05) ng/L in the control group,with statistical differences (P ＜ 0.05).The levels of E2 and P were (160.37±44.93) pmmol/L and (9.03±2.85) μg/L in the observation group and were (227.66±54.63) pmmol/L and (15.92±2.66) μg/L in the control group (P ＜ 0.05).There was no statistical difference in the incidence of clinical adverse reactions during the treatment period between these two groups (P ＞ 0.05).Conclusions Mifepristone combined with Gongliuxiao for patients with hysteromyoma is obviously effective and can improve the patients' endocrine function and prognosis.

Objective To evaluate the application value of hysteroscopy in the diagnosis and treatment of recurrent spontaneous abortion patients, and to understand the possible pathogenic factors of recurrent spontaneous abortion. Methods A retrospective study was performed to analyze the findings of 192 cases of recurrent spontaneous abortion, who underwent hysteroscopy examination.According to the number of recurrent spontaneous abortion, they were divided into three groups, group A: 2 times abortion group; group B: 3 times abortion group; group C: >3 times abortion group.Then, intrauterine adhesions detection rate was analyzed. Results Of the 192 cases of recurrent spontaneous abortion, the detective rate of uterine abnormality was 54.7%, the intrauterine adhesion was 34.4%, and in group B and group C, the uterine abnormalities and intrauterine adhesions detection rates (group B: uterine abnormalities 67.1%, intrauterine adhesions detection rate 45.6%; group C: uterine abnormalities 77.8%, intrauterine adhesions detection rate 50.0%) were higher than group A(uterine abnormalities 40.0%, intrauterine adhesions detection rate 22.1%), the differences were significant(χAB2=12.69, χAC2=8.69; χAB2=10.78, χAC2=5.47, all P 0.05). Also found other uterine abnormalities, including uterine malformation 14 cases(7.3%), 12 cases(6.3%) of endometrial polyps, endometritis in 9 cases (4.7%), cervical insufficiency in 2 cases(1.0%), submucous myoma in 1 case (0.5%), pregnancy residues in 1 case(0.5%). Conclusion Hysteroscopy is a noninvasive, intuitive, safe and efficient check.Recurrent spontaneous abortion patients should be routinely performed hysteroscopy, timely detection of pathogenic factors may exist in the uterine and give treatment to improve the pregnancy outcome. Key words: Hysteroscopy; Abortion, spontaneous; Uterine abnormalities; Intrauterine adhesion

Особенности экспрессии эндогликозидазы в очагах аденомиоза у пациенток репродуктивного возраста с миомой тела матки

目的 研究不同类型子宫肌瘤超声介入化学消融治疗的临床疗效。 方法 该组63例已婚患者，72个瘤体，年龄23～50岁，肌瘤最小直径约1.25 cm，最大直径约8.5 cm，平均直径(5.0±0.5)cm。均通过腹部或经阴道彩色多普勒超声检查诊断为子宫肌瘤，根据瘤体与子宫肌壁的关系均采用瘤体注射法。在超声引导下将日本扒光经皮超声介入穿刺针(PTC，21G针)刺入瘤体注入硬化剂，硬化剂为无水乙醇，术后对所有患者随访1～6个月，部分患者给予超声复查，根据瘤体缩小率、瘤体回声情况、瘤体内血流信号消失的程度，将治疗结果分为治愈、显效、有效、无效。 结果 72个瘤体，治愈15个、显效54个、有效3个、无效0个。肌瘤体积最大缩小率100%，最小缩小率37%，平均缩小率68%，总有效率100%。 结论 无水乙醇是临床应用广泛的理想硬化剂，在治疗子宫肌瘤时疗效好，不良反应少，易被患者接受。超声介入技术在临床的应用为子宫肌瘤患者开辟一条新的治疗途径，具有广阔的应用价值和前景。