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期刊信息/Journal information
中华妇产科杂志
中华医学会杂志社
中华妇产科杂志

中华医学会杂志社

郎景和

月刊

0529-567X

cjog@cma.org.cn

010-85158215

100710

北京市东城区东四西大街42号

中华妇产科杂志/Journal Chinese Journal of Obstetrics and GynecologyCSCD北大核心CSTPCD
查看更多>>1953年4月创刊，中华医学会主办。本刊是我国妇产科学界学术水平最高、影响力最大的专业期刊。以广大妇产科医师为主要读者对象，致力于刊登妇产科学及其相关学科在临床及基础研究中具有创新性的优秀论文。近年来，在中国科技期刊统计源期刊中，本刊的影响因子一直在本学科领域中名列前茅。2006至2011年本刊连续获得中国科协精品期刊工程项目资助。2005年在第三届国家期刊奖评比中，本刊荣获“百种重点期刊”称号。自1992年以来多次荣获新闻出版总署、国家科技部及中国科协优秀科技期刊奖。本刊一直被美国国立医学图书馆医学索引(Medline)、中国科学引文数据库等国内外30余个重要的检索系统收录。
正式出版
收录年代

    重视妇产科手术并发症的防治;Attaching importance to prevention and treatment in complications of obstetrical and gynecological surgery

    郎景和沈平虎
    177-178页
    查看更多>>摘要：关于手术并发问题的论述较少，而成为专著者更少。但手术并发症的发生、预防和处理对于提高医疗质量、促进学科发展，对于人才培养、队伍建设都是非常必要的。因此，很值得重视和讨论。
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    子宫内膜癌FIGO 2023分期的更新及其临床病理意义

    宋艳刘爱军姚红萍
    179-183页
    查看更多>>摘要：子宫内膜癌作为我国女性生殖系统第二常见恶性肿瘤，近年来发病率呈上升趋势，准确的分期对于患者预后判断和治疗方式选择至关重要。国际妇产科联盟（FIGO）2009分期系统在10余年的使用过程中暴露出明显的不足，如子宫内膜癌的病理类型未列入分期、忽视淋巴脉管间隙浸润、缺乏淋巴结转移灶大小的细化、累及子宫内膜和卵巢的子宫内膜样癌患者的分期不明确以及分子分型未纳入分期等。更新的FIGO 2023分期系统旨在纠正这些局限性，进一步完善子宫内膜癌分期的预后价值。本文对子宫内膜癌FIGO 2023分期从病理学的角度进行解读；与FIGO 2009分期进行比较，分析病理类型、子宫肌层浸润深度、淋巴脉管间隙浸润、分子分型等对FIGO分期的影响，重点关注两个分期系统之间的差异，了解子宫内膜癌分期的演变及其对患者管理的影响；探讨FIGO 2023分期在临床实践中可能出现的潜在问题，如分类亚组数量的增加很可能使妇科医师、病理科医师和研究人员之间的沟通变得复杂，某些免疫组化指标或分子检测项目在不同医疗机构病理实验室的可及性可能会限制详细分期的实施，从而影响分期标准的应用等。
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    妊娠中期口服葡萄糖耐量试验异常模式与大于胎龄儿的关联分析

    张澳苏敏仪郑丽娟陈丽...
    184-191页
    查看更多>>摘要：目的 探讨妊娠中期75 g口服葡萄糖耐量试验（OGTT）异常模式对孕妇分娩大于胎龄儿（LGA）风险的影响。 方法 收集2016年12月24日至2022年7月26日在广东省妇幼保健院定期产前检查并分娩的66 290例孕妇的一般临床资料包括OGTT结果。根据OGTT结果，将孕妇分为8组，血糖正常组（空腹、服糖后1 h、2 h血糖均正常，共54 518例）、妊娠期糖尿病（GDM）0组（仅空腹血糖异常，共1 430例）、GDM 1组（仅服糖后1 h血糖异常，共2 150例）、GDM 2组（仅服糖后2 h血糖异常，共3 736例）、GDM 0+1组（空腹、服糖后1 h血糖均异常，共371例）、GDM 0+2组（空腹、服糖后2 h血糖均异常，共280例）、GDM 1+2组（服糖后1 h、2 h血糖均异常，共2 981例）、GDM 0+1+2组（空腹、服糖后1 h、2 h血糖均异常，共824例）。采用多因素logistic回归分析不同OGTT异常模式对LGA的影响。此外，将OGTT检测3个时间点的血糖测量指标进行组合，并作为连续性变量应用到受试者工作特征（ROC）曲线中，以评估各血糖测量模式对LGA的预测价值并对曲线下面积（AUC）进行比较。 结果 （1）多因素logistic回归分析结果显示，GDM 0组（OR=1.76，95%CI为1.50~2.08）、GDM 0+1组（OR=2.29，95%CI为1.72~3.04）、GDM 0+1+2组（OR=1.98，95%CI为1.61~2.43）孕妇分娩LGA的风险显著升高（P均<0.001）。（2）ROC曲线分析结果显示，空腹血糖、服糖后1 h血糖、服糖后2 h血糖、空腹+服糖后1 h血糖、空腹+服糖后2 h血糖、服糖后1 h+2 h血糖、空腹+服糖后1 h+2 h血糖测量模式对LGA均具有一定的预测价值（P均<0.001）。空腹血糖测量模式较服糖后2 h血糖测量模式预测LGA的AUC高，差异有统计学意义（P<0.05）；空腹血糖与其他血糖测量模式预测LGA的AUC分别比较，差异均无统计学意义（P均>0.05）。 结论 OGTT异常模式中，空腹血糖异常、空腹+服糖后1 h血糖异常、空腹+服糖后1 h+2 h血糖异常的孕妇分娩LGA的风险增加。空腹血糖检测对LGA的预测具有重要意义，临床上可作为评估LGA风险的优选指标。 Objective To investigate the impact of abnormal patterns of 75 g oral glucose tolerance test (OGTT) in the second trimester on the risk of large for gestational age (LGA) newborn deliveries. Methods General clinical data and OGTT results of 66 290 pregnant women who received regular prenatal care and delivered in Guangdong Maternal and Child Health Hospital from December 24, 2016 to July 26, 2022 were collected. According to the results of OGTT, the pregnant women were divided into 8 groups: normal blood glucose group (normal fasting blood glucose, 1-hour and 2-hour after oral glucose, 54 518 cases), gestational diabetes mellitus (GDM) 0 group (only abnormal fasting blood glucose, 1 430 cases), GDM 1 group (only abnormal blood glucose at 1-hour after oral glucose, 2 150 cases), GDM 2 group (only abnormal blood glucose at 2-hour after oral glucose, 3 736 cases), GDM 0+1 group (both fasting blood glucose and 1-hour after oral glucose were abnormal, 371 cases), GDM 0+2 group (both fasting blood glucose and 2-hour after oral glucose were abnormal, 280 cases), GDM 1+2 group (abnormal blood glucose at 1-hour and 2-hour after oral glucose, 2 981 cases) and GDM 0+1+2 group (abnormal fasting blood glucose, 1-hour and 2-hour after oral glucose, 824 cases). Multivariate logistic regression was used to analyze the effects of different abnormal OGTT patterns on LGA. In addition, the blood glucose measurements at the three time points of OGTT were combined and used as continuous variables in the receiver operating characteristic (ROC) curve to evaluate the predictive value of each blood glucose measurement mode for LGA and the area under the curve (AUC) was compared. Results (1) Multivariate logistic regression analysis showed that the risks of LGA were significantly increased in GDM 0 group (OR=1.76, 95%CI: 1.50-2.08 P<0.001), GDM 0+1 group (OR=2.29, 95%CI: 1.72-3.04 P<0.001), and GDM 0+1+2 group (OR=1.98, 95%CI: 1.61-2.43 P<0.001). (2) ROC curve analysis showed that fasting blood glucose, 1-hour after oral glucose, 2-hour after oral glucose, fasting+1-hour after oral glucose, fasting+2-hour after oral glucose, 1-hour+2-hour after oral glucose, and fasting+1-hour+2-hour after oral glucose had certain predictive value for LGA (allP<0.001). The AUC of fasting blood glucose measurement was higher than that of 2-hour blood glucose measurement in predicting LGA, and the difference was statistically significant (P<0.05). There was no significant difference in the AUC between fasting blood glucose and other blood glucose measurement modes for predicting LGA (allP>0.05). Conclusions In the abnormal OGTT patterns, pregnant women with abnormal fasting blood glucose, abnormal fasting+1-hour after oral glucose, and abnormal fasting+1-hour+2-hour after oral glucose have an increased risk of LGA. Fasting blood glucose measurement is of great significance for the prediction of LGA, and could be used as an optimal indicator to evaluate the risk of LGA in clinical practice.

    糖尿病,妊娠葡糖耐量试验出生体重妊娠中期婴儿,大于胎龄

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    聚焦超声消融手术治疗腹壁子宫内膜异位症的临床应用价值探讨

    丁琨康彦君赵蕾桑昌美...
    192-199页
    查看更多>>摘要：目的 分析聚焦超声消融手术（FUAS）治疗腹壁子宫内膜异位症（AWE）的有效性、安全性。 方法 收集2019年11月至2022年10月青岛市妇女儿童医院收治的行FUAS治疗的AWE患者共34例，回顾性分析其临床特征、影像学特征、FUAS治疗的相关情况及治疗后不良反应，并随访其症状改善及复发再干预情况。 结果 （1）患者的临床资料特点：34例AWE患者的年龄为（32.8±3.8）岁，病灶最大径的中位数为24 mm（最小值为15 mm，最大值为48 mm）；治疗前腹壁病灶周期性疼痛为中、重度者30例（88%，30/34）；治疗前行磁共振成像检查显示浅表型19例（56%，19/34），中间型8例（24%，8/34），深部型7例（21%，7/34）。（2）FUAS治疗参数：手术时间为（64±18）min，辐照时间为（385±108）s，治疗功率为（103±11）W，治疗总能量为（38 819±16 309）J，治疗区域体积为（3.11±1.42）cm3，治疗强度为（377.79±106.34）s/h。（3）有效性结果：FUAS治疗后1个月、3个月、6个月、1年疼痛较治疗前明显缓解，疼痛评分较治疗前显著下降（Z=-4.66、-5.13、-5.11、-4.91，P均<0.01）。随访至FUAS治疗后1年，疼痛基本缓解及有效缓解者的占比为74%（25/34），临床治疗有效率为85%（29/34）。随访至治疗后1年，共5例患者复发，其中3例复发后行经腹AWE病灶切除术，2例予药物治疗。FUAS治疗后1个月病灶最大径较治疗前无明显变化（P>0.05），但治疗后3个月、6个月、1年病灶最大径较治疗前显著缩小（Z=-2.15、-2.67、-3.41，P均<0.05）。不同分型的AWE患者疼痛缓解情况无差异（P>0.05），病灶最大径的缩小情况存在显著差异（P均<0.01）。（4）安全性结果：FUAS治疗中34例患者均诉皮肤热烫感，19例（56%，19/34）患者出现术后治疗区疼痛，2例（6%，2/34）患者术后即刻血尿，经相应处理后均好转或症状消失。 结论 FUAS治疗AWE是有效、安全的，初步验证了其临床应用价值。 Objective To explore the effectiveness and safety of focused ultrasound ablation surgery (FUAS) for abdominal wall endometriosis. Methods From November 2019 to October 2022, a total of 34 patients with abdominal wall endometriosis who underwent FUAS were collected, and their clinical features, imaging features, intraoperative treatment and side effects after treatment were analyzed retrospectively, and the improvement of symptoms and re-intervention were followed up. Results (1) Characteristics of clinical data: the average age of 34 patients with abdominal wall endometriosis was (32.8±3.8) years old. The largest diameter of the lesion was 48 mm, and the median lesion diameter was 24 mm. Thirty cases (88%, 30/34) had moderate to severe periodic pain in abdominal incision before FUAS. All patients were diagnosed by preoperative magnetic resonance imaging, including 19 cases (56%, 19/34) of superficial type, 8 cases (24%, 8/34) of intermediate type and 7 cases (21%, 7/34) of deep type. (2) FUAS treatment parameters: ablation was completed with average operation time of (64±18) minutes, average sonication time was (385±108) s, (103±11) W of average power, (38 819±16 309) J of average total energy, the average treatment area volume of (3.11±1.42) cm3, and (377.79±106.34) s/h of average treatment intensity. (3) Efficiency: the pain of patients after FUAS was significantly relieved, and the pain scores of patients after 1 month, 3 months, 6 months and 1 year after FUAS were significantly decreased (Z=-4.66, -5.13, -5.11 and -4.91, all P<0.01). One year after FUAS, the near relief and effective pain relief rate was 74% (25/34), and the clinical effective rate was 85% (29/34). Five patients recurred after one year, including 3 patients who underwent abdominal wall endometriosis lesion resection and 2 patients who received drug treatment. One month after FUAS, the size of the lesion did not change significantly compared with that before FUAS (P>0.05), and the size of the lesion decreased significantly after FUAS at 3 months, 6 months and 1 year (Z=-2.15, -2.67 and -3.41, all P<0.05). It has no difference in pain relief among different types (P>0.05), but has significant difference in focus reduction among three types (P<0.01). (4) Safety: there were 34 cases (100%, 34/34) of skin burning sensation, 19 cases (56%, 19/34) of pain in the treatment area and 2 cases (6%, 2/34) of hematuria. All patients got better after corresponding treatments. Conclusion FUAS is safe and effective for the treatment of abdominal wall endometriosis, which has clinical application value.

    子宫内膜异位症治疗结果聚焦超声消融手术腹壁子宫内膜异位症

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    手术联合放化疗在局部晚期子宫颈神经内分泌癌中的价值

    宋晓晨张卉钟森谭先杰...
    200-209页
    查看更多>>摘要：目的 探讨手术联合放化疗在局部晚期［国际妇产科联盟（FIGO）2018分期为Ⅰb3~Ⅳa期］子宫颈神经内分泌癌（NECC）中的价值。 方法 本研究为单中心回顾性队列研究。收集2011年1月至2022年4月中国医学科学院北京协和医院收治的局部晚期NECC患者，按不同初始治疗方式分为同步放化疗组、手术联合放化疗组，比较两组患者的复发率；采用Kaplan-Meier法分析并比较两组患者的无进展生存（PFS）、总生存（OS）情况。 结果 （1）一般情况：共有46例Ⅰb3~Ⅳa期NECC患者纳入本研究，其中同步放化疗组22例、手术联合放化疗组24例。46例患者的诊断年龄为（46.9±10.7）岁，常见症状为阴道不规则流血（83%，38/46）、阴道排液（9%，4/46）、盆腔包块或下腹痛（4%，2/46）；共有16例（35%，16/46）患者行新辅助化疗，有效率为15/16。（2）复发：46例患者治疗后的中位随访时间为27.5个月（范围：10~106个月），随访期内26例（57%，26/46）复发，中位复发时间为11.0个月（范围：5~44个月）。按初始复发部位分类，盆腔内复发4例（9%，4/46）、盆腔外复发25例（54%，25/46），其中3例（7%，3/46）盆腔内、外均有复发。与同步放化疗组相比，手术联合放化疗组患者的盆腔内复发率［分别为14%（3/22）、4%（1/24）］有下降趋势，但两组比较，差异无统计学意义（χ2=1.296，P=0.255）；两组患者的盆腔外复发率［分别为55%（12/22）、54%（13/24）］、总复发率［分别为59%（13/22）、54%（13/24）］相似，两组分别比较，差异均无统计学意义（P均>0.05）。（3）生存结局：46例局部晚期NECC患者中，随访期内死亡22例（48%，22/46），其中同步放化疗组11例（50%，11/22）、手术联合放化疗组11例（46%，11/24），两组比较，差异无统计学意义（χ2=0.080，P=0.777）。与同步放化疗组相比，手术联合放化疗组的中位PFS时间（分别为17.0、32.0个月）和中位OS时间（分别为37.0、50.0个月）均有延长趋势，但两组分别比较，差异均无统计学意义（P=0.287，P=0.125）；两组患者的3年OS率（分别为54.2%、69.9%）、5年OS率（分别为36.1%、38.8%）相似，两组分别比较，差异均无统计学意义（P=0.138，P=0.217）。 结论 本研究支持多模式治疗策略（包括手术、化疗、放疗）是治疗局部晚期NECC的重要组成部分，手术联合放化疗在局部晚期NECC中的治疗可能有优势，但还需多中心大样本量研究证实。 Objective To evaluate the surgery combined chemotherapy and radiation in locally advanced neuroendocrine carcinoma of the cervix (NECC) . Methods This is a single-center retrospective cohort study. Locally advanced NECC patients admitted to Peking Union Medical College Hospital, Chinese Acadmy of Medical Sciences from January 2011 to April 2022 were enrolled. They were divided into concurrent chemoradiotherapy group, and surgery combined with chemotherapy and radiation group. The Kaplan-Meier method was used to analyze the progression free survival (PFS), overall survival (OS), recurrence rate, and mortality rate. Results (1) Forty-six cases were included, 22 in concurrent chemoradiotherapy group, 24 in surgery combined chemotherapy and radiation group. With 16 patients (35%, 16/46) received neoadjuvant chemotherapy (NACT), the NACT effective rate was 15/16. (2) The median follow-up time was 27.5 months (range: 10-106 months), with 26 (57%, 26/46) experienced recurrences. There were 4 (9%, 4/46) pelvic recurrences and 25 (54%, 25/46) distant recurrences, and 3 (7%, 3/46) both pelvic and distant recurrences. Compared with concurrent chemoradiotherapy group, surgery combined chemotherapy and radiation group had lower pelvic recurrence rate [14% (3/22) vs 4% (1/24) χ2=1.296, P=0.255] but without statistic difference. Both groups had similar distant recurrence rate [55% (12/22) vs 54% (13/24) χ2=0.001, P=0.979] and overall recurrence rate [59% (13/22) vs 54% (13/24) χ2=0.113, P=0.736]. (3) During the follow-up period, 22 cases (48%, 22/46) died, with 11 cases (50%, 11/22) in concurrent chemoradiotherapy group and 11 cases (46%, 11/24) in surgery combined chemotherapy and radiation group, without significant difference (χ2=0.080, P=0.777). The postoperative 3-year and 5-year OS rates were 62.3% and 36.9%. Compared with concurrent chemoradiotherapy group, the patients in surgery combined chemotherapy and radiation group showed an extended trend in PFS (17.0 vs 32.0 months) and OS (37.0 vs 50.0 months) but without statistic differences (P=0.287, P=0.125). Both groups had similar 3-year OS rate (54.2% vs 69.9% P=0.138) and 5-year OS rate (36.1% vs 38.8% P=0.217). Conclusions Our study supports the multi-modality treatment strategy (including surgery, chemotherapy and radiation) as an important component in the treatment of locally advanced NECC. The combination of surgery, chemotherapy and radiation seems to have advantages in the treatment of locally advanced NECC, but needs to be confirmed by further multicenter studies.

    宫颈肿瘤癌,神经内分泌子宫切除术放化疗,辅助预后回顾性研究

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    卵巢卵黄囊瘤12例临床分析

    刘娟初慧君单玉萍宋文静...
    210-214页
    查看更多>>摘要：目的 探讨卵巢卵黄囊瘤（OYST）的诊断、治疗及预后。 方法 收集2013年1月至2020年12月青岛大学附属医院收治的12例OYST患者的临床病理资料及随访资料进行回顾性分析，总结OYST的诊断、治疗及预后。 结果 （1）12例OYST患者的中位年龄为20岁（范围：11~37岁）；首次就诊时12例患者均有盆腔包块；就诊原因：6例腹胀、腹痛，4例扪及下腹部包块，1例阴道流血，1例因阑尾炎就诊后发现；国际妇产科联盟（FIGO）2014分期：Ⅰa期4例、Ⅰc期2例、Ⅱc期1例、Ⅲc期4例、Ⅳb期1例。（2）12例患者术前均行彩超检查，其中10例提示单侧附件包块、2例提示双侧附件包块；中位肿瘤最大径为16.5 cm（范围：6.0~28.0 cm）。12例患者的术前甲胎蛋白（AFP）水平（均>1 210 μg/L）均明显高于正常值（<25 μg/L），11例有癌抗原125（CA125）检测结果的患者中9例血清CA125水平升高。（3）12例患者中，8例年轻未生育需保留生育功能者行患侧附件切除术；3例无生育要求者行卵巢恶性生殖细胞肿瘤分期手术；仅1例双侧病变、无生育要求者为Ⅳb期，肿瘤广泛转移，无法完成满意的分期手术。12例患者中，11例术后及时给予博来霉素+顺铂+依托泊苷（BEP）方案化疗；1例未化疗者术后3个月出现腹腔转移，给予BEP方案化疗，病情得到控制。（4）随访截止时间为2022年12月31日，中位随访时间为60个月（范围：25~115个月）；12例患者随访期内均无瘤生存，中位无瘤生存时间为84.5个月（范围：25~115个月）。 结论 OYST多发生于少年儿童及年轻女性，彩超检查及血清AFP和CA125检测对OYST有诊断价值。OYST诊断后给予手术治疗（包括保留生育功能手术）及术后及时、规范的化疗，无论分期，患者的预后均良好。 Objective To investigate the diagnosis, treatment and prognosis of ovarian yolk sac tumor (OYST). Methods The clinicopathological data and follow-up data of 12 patients with OYST admitted to the Affiliated Hospital of Qingdao University from January 2013 to December 2020 were retrospectively analyzed, and the diagnosis, treatment and prognosis of OYST patients were summarized. Results (1) The age of 12 patients with OYST ranged from 11 to 37 years, with a median age of 20 years. At the first visit, all 12 patients had pelvic masses. Reasons for seeing a doctor: 6 cases of abdominal distension and abdominal pain, 4 cases of mass in the lower abdomen, 1 case of vaginal bleeding, and 1 case of appendicitis. International Federation of Obstetrics and Gynecology (FIGO) 2014 staging: 4 cases in stage Ⅰa, 2 cases in stage Ⅰc, 1 case in stage Ⅱc, 4 cases in stage Ⅲc, and 1 case in stage Ⅳb. (2) All 12 patients were examined by color Doppler ultrasound before operation, among which 10 cases showed unilateral adnexal masses and 2 cases bilateral adnexal masses. The median maximum diameter of tumor was 16.5 cm (range: 6.0-28.0 cm). The preoperative levels of alpha fetoprotein (AFP) in 12 patients (all >1 210 μg/L) were significantly higher than normal (<25 μg/L). Among the 11 patients with cancer antigen 125 (CA 125) detection results, 9 patients showed elevated serum CA125 levels. (3) Among the 12 patients, 8 young infertile patients who needed to preserve their reproductive function underwent appendectomy, 3 infertile patients underwent staged surgery for ovarian malignant germ cell tumor, and only one bilateral lesion and infertile patient underwent unsatisfactory staged surgery for ovarian malignant germ cell tumor. Of the 12 patients, 11 patients were given combined chemotherapy regimen of bleomycin, cisplatin, and etoposide (BEP) after operation. One patient without chemotherapy developed metastasis 3 months after operation, and was given BEP chemotherapy, and her condition was controlled. (4) The deadline for follow-up was December 31st, 2022, and the median follow-up time was 60 months (range: 25-115 months). All the 12 patients survived without tumor during the follow-up period, and the median disease-free survival time was 84.5 months (range: 25-115 months). Conclusions OYST mostly occurs in children and young women. Color Doppler ultrasound examination and serum AFP and CA125 detection have diagnostic value for OYST. Surgical treatment after diagnosis of OYST includes surgery to preserve reproductive function and timely and standardized chemotherapy after operation. The prognosis of patients is good regardless of stage.

    卵巢肿瘤内胚层窦瘤保留生育能力治疗结果

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    小檗碱对多囊卵巢综合征小鼠模型的作用及其机制基于肠道菌群分析

    信鸽张凌云邱虹溶王杨淳...
    215-226页
    查看更多>>摘要：目的 探究小檗碱（又名：黄连素）对多囊卵巢综合征（PCOS）模型小鼠的作用，同时探究黄连素对肠道菌群及肠道菌群对PCOS的影响。 方法 以脱氢表雄酮辅以高脂饲料喂养建立PCOS小鼠模型，并给予黄连素进行干预治疗，实验分为C组（即空白对照）、M组（即PCOS模型小鼠）和T组（即PCOS模型小鼠予黄连素治疗），定时对小鼠监测体重、动情周期，行腹腔葡萄糖耐量试验和胰岛素耐量试验；实验结束后，对小鼠肝脏、卵巢及脂肪垫称量湿重，并行HE染色观察，验证是否造模成功及黄连素的效果。同时取粪便样本进行16S rRNA肠道菌群分析。 结果 PCOS造模成功，黄连素缓解了T组小鼠的动情周期紊乱，且显著缓解了小鼠的脂肪积聚和糖代谢异常，T组小鼠脂肪垫细胞截面积为（2 858±146）μm2，显著低于M组［（9 518±347）μm2］，两组比较，差异有统计学意义（P<0.001），T组小鼠的血糖显著低于M组（P<0.05）。M组PCOS模型小鼠与C组相比以及黄连素干预后的T组小鼠与M组相比，肠道菌群组成及结构显著改变，而Alpha多样性在3组间并无显著变化（P>0.05）。 结论 黄连素可能通过干预肠道菌群的变化缓解PCOS症状。 Objective To examine the impact of berberine on polycystic ovary syndrome (PCOS) in mice, and to investigate the effects of berberine on the intestinal flora and the intestinal flora on PCOS. Methods A mouse model of PCOS was established by administering dehydroepiandrosterone in combination with high fat diet, and the mouse model was given a berberine treatment. The study consisted of a blank control group (C group), a PCOS model group (M group) and a berberine treatment group (T group). During the experiment, the mice were closely monitored through timed body weight measurements and estrous cycle monitoring intraperitoneal glucose tolerance test and insulin tolerance test were done. Upon completion of the pharmacological intervention, the wet weights of liver, ovary and fat deposits of mice were assessed and subjected to HE staining to confirm the success of PCOS modeling and the efficacy of berberine. Additionally, fecal samples were analyzed for intestinal flora through 16S rRNA analysis. Results The PCOS model was established successfully, berberine alleviated the disturbance of estrous cycle in mice, and significantly alleviated fat accumulation and metabolic abnormalities of glucose in mice. The cross-sectional area of fat pad cells in T group was (2 858±146) μm², which was significantly lower than that in M group [(9 518±347) μm²], and the difference was statistically significant (P<0.001). The blood glucose levels in T group were significantly lower than those in M group (P<0.05). The composition and structure of intestinal flora in mice of M group with PCOS (compared with C group) and in mice of T group after berberine intervention (compared with M group) were significantly altered. However, alpha diversity did not change significantly among three groups (P>0.05). Conclusion Berberine could alleviate PCOS by intervening in the alterations of gut microbiota.

    多囊卵巢综合征小檗碱肠道微生物组疾病模型,动物

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    妊娠相关成人Still病5例临床分析

    王雪莹吴春凤聂庆文方专集...
    227-231页
    查看更多>>摘要：目的 分析妊娠相关成人Still病（AOSD）孕产妇的临床特点及诊疗方法。 方法 回顾性分析2019年1月至2023年6月于广州医科大学附属第三医院诊治的5例妊娠相关AOSD孕产妇的临床资料，包括一般情况、既往史、发病时间、初步诊断、临床表现、治疗及妊娠结局。 结果 （1）发病时间：5例AOSD孕产妇中，1例于孕前确诊，3例于妊娠期确诊，1例于产后确诊。（2）临床表现：主要为发热（4例）、皮疹（4例）、关节痛（3例）及咽喉肿痛（2例）。（3）实验室检查：除例1感染指标升高不明显，其余4例孕产妇感染指标均升高明显，并持续升高；5例孕产妇的肝功能指标均有不同程度升高，铁蛋白有不同程度升高；除例1孕妇抗核抗体阳性外，其余4例免疫学相关指标均未见异常。（4）治疗：4例妊娠相关AOSD孕产妇使用激素抗过敏治疗，4例行抗凝治疗，4例应用免疫抑制治疗。5例治疗后症状均有不同程度好转。（5）妊娠结局及并发症：1例发生胎儿生长受限，1例早产。 结论 妊娠相关AOSD孕妇妊娠早中期容易出现胎儿生长受限和早产等产科并发症，产科医师应加强对该疾病的认识，早期识别和早期诊断至关重要。
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    胎儿肠扭转2例

    金莹吴藤岚宿宓张诗茂...
    232-235页
    查看更多>>摘要：胎儿肠扭转较罕见，本文报道2例产前诊断为胎儿肠扭转的孕妇，经多学科会诊救治、及时产时手术，新生儿最终获得较好结局。例1发病孕周为31+3周，系统超声检查发现胎儿肠管旋涡征、血管螺旋征及肠管扩张。例2发病孕周为34+6周，主诉胎动减少，超声检查提示胎儿肠管扩张及腹腔积液。2例均行磁共振成像检查进一步协助诊断胎儿肠扭转，经胎儿疑难疾病多学科会诊后剖宫产术终止妊娠。新生儿产时手术均发现小肠部分扭转及坏死，术中切除坏死段肠管，例1行一期吻合，例2行肠管造瘘术后再行还纳术。经治疗患儿最终均痊愈出院。
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    经阴道及大腿根部三切口完整取出经闭孔TOT吊带1例

    王文英鲁永鲜赵英延佳佳...
    236-239页
    查看更多>>摘要：聚丙烯吊带尿道中段悬吊带术（MUS）目前已是治疗压力性尿失禁（SUI）的经典术式，其中的由外向内经闭孔尿道中段无张力悬吊带术（TOT）因避开了耻骨后穿刺路径，减少了经耻骨后尿道中段无张力悬吊带术（TVT）易发生的膀胱穿孔、耻骨后血肿等并发症，且操作相对简单，无需常规膀胱镜检查，学习曲线短，而被广泛应用，但其造成的并发症之一大腿根部疼痛程度重，持续时间长，严重影响患者的生命质量，临床处理困难。现在已经认识到TOT术后疼痛并发症的发生主要与闭孔区大腿内收肌肌腱的副损伤相关。闭孔区解剖复杂，富含神经血管和肌肉肌腱组织，极易造成副损伤，且经闭孔TOT吊带的完整取出困难，单一经阴道切口无法到达耻骨降支之后侧方区域进行聚丙烯吊带的切除，致使妇科医师因担心手术副损伤而不敢轻易在大腿根部尝试手术，对TOT术后疼痛患者仅切除阴道部分的吊带常不能完全解除症状。国外至今报道的完整取出TOT吊带的病例尚不足百例，国内目前尚未见报道。本课题组在深入了解了闭孔区解剖的基础上，成功实施了经阴道及大腿根部三切口完整取出TOT吊带的手术，获得了疼痛症状完全缓解的良好结局，证实了经双侧大腿根部切口取出TOT吊带是安全、可行的路径，是解决TOT吊带引起的大腿根部疼痛并发症的有效手段。
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