不同方法治疗腹壁子宫内膜异位症的临床疗效

doi:10.3877/cma.j.issn.1673-5250.2020.03.015

中华妇幼临床医学杂志(电子版) ›› 2020, Vol. 16 ›› Issue (03) : 351 -357. doi: 10.3877/cma.j.issn.1673-5250.2020.03.015

所属专题：文献；

论著

不同方法治疗腹壁子宫内膜异位症的临床疗效

蔡鑫¹, 林振江², 汤亚兰¹, 林单¹, 罗岳西¹^,^†(

), 徐凡¹, 梁婷¹

^1. 川北医学院第二临床医学院·南充市中心医院妇产科，四川　637000
^2. 遵义医科大学附属医院妇产科，贵州　563000

收稿日期:2019-12-15 修回日期:2020-05-08 出版日期:2020-06-01
通信作者: 罗岳西

Clinical efficacy on treatment of abdominal wall endometriosis by different strategies

Xin Cai¹, Zhenjiang Lin², Yalan Tang¹, Dan Lin¹, Yuexi Luo¹^,^†(), Fan Xu¹, Ting Liang¹

^1. Department of Obstetrics and Gynecology, Second Clinical Medical School of North Sichuan Medical College·Nanchong Central Hospital, Nanchong 637000, Sichuan Province, China
^2. Department of Obstetrics and Gynecology, Affiliated Hospital of Zunyi Medical University, Zunyi 563000, Guizhou Province, China

Received:2019-12-15 Revised:2020-05-08 Published:2020-06-01
Corresponding author: Yuexi Luo
About author:
Corresponding author: Luo Yuexi, Email: 2717378119@ qq.com
Supported by:
Scientific Research Project of Science and Technology Department of Sichuan Province(2016JY0155); Scientific Research Project of Education Department of Sichuan Province(16ZA0239); Municipal-School Cooperative Scientific Research Project of Science and Technology Department of Nanchong(18SXHZ0361)

全文 ( ) 下载PDF ( ) 导出引用

引用本文：

蔡鑫, 林振江, 汤亚兰, 林单, 罗岳西, 徐凡, 梁婷. 不同方法治疗腹壁子宫内膜异位症的临床疗效[J]. 中华妇幼临床医学杂志(电子版), 2020, 16(03): 351-357.

Xin Cai, Zhenjiang Lin, Yalan Tang, Dan Lin, Yuexi Luo, Fan Xu, Ting Liang. Clinical efficacy on treatment of abdominal wall endometriosis by different strategies[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2020, 16(03): 351-357.

目的

探讨对腹壁子宫内膜异位症(AWE)患者采取高强度聚焦超声(HIFU)消融治疗与病灶切除术治疗的临床疗效。

方法

选择2015年1月至2018年10月，在南充市中心医院及遵义医科大学附属医院住院治疗的85例AWE患者为研究对象。按照对AWE患者的治疗方式，将其分为HIFU组(n＝29，采取实时超声引导下HIFU消融治疗)与手术组(n＝56，采取AWE病灶切除术治疗)。对患者的年龄、人体质量指数(BMI)、剖宫产术分娩次数、AWE病灶数量和直径、住院时间，以及HIFU治疗的辐照时间、强度与能量等计量资料，采用t检验进行统计学分析。对治疗时间、术中出血量等计量资料，采用Wilcoxon秩和检验进行统计学分析。对完全缓解(CR)率、临床有效率、1年复发率与并发症发生率等计数资料，采用χ²检验、连续性校正χ²检验及Fisher确切概率法进行统计学分析。本研究遵循的程序符合2013年修订的《世界医学协会赫尔辛基宣言》的要求，并且与受试者签署临床知情同意。

结果

① HIFU组患者年龄为(31.6±4.7)岁，小于手术组的(34.8±4.8)岁，并且差异有统计学意义(t＝－2.958、P＝0.004)。但是，2组患者BMI、剖宫产术分娩次数、末次经腹子宫手术至出现AWE临床症状间隔时间，既往因AWE接受药物治疗者、腹壁区域出现不同程度周期性疼痛者所占比例及AWE病灶数量、直径等比较，差异均无统计学意义(P>0.05)。② HIFU组患者中位术中出血量和住院时间分别为0和(4.6±1.0)d，均少于和短于手术组的10.0 mL(10.0～10.0 mL)和(6.3±1.8) d，2组比较，差异有统计学意义(Z＝－8.306、P<0.001, t＝－5.692、P<0.001)。HIFU组治疗时间为52.0 min(33.5～62.5 min)，长于手术组的30.0 min(25.0～43.8 min)，并且差异亦有统计学意义(Z＝－3.546、P<0.001)。但是，2组患者的CR率、临床有效率和1年复发率比较，差异均无统计学意义(P>0.05)。③ HIFU组患者不良反应率为10.3%(3/29)，手术组为7.1%(4/56)，2组比较，差异无统计学意义(P>0.05)。

结论

HIFU消融治疗AWE安全性、有效，但是仍需多中心、前瞻性、随机对照试验进一步验证。

关键词: 子宫内膜异位症, 腹壁子宫内膜异位症, 高强度聚焦超声消融, 瘢痕, 腹部伤口周期性疼痛, 复发, 疗效比较研究, 妇女

Objective

To analyze clinical efficacy on treatment of abdominal wall endometriosis (AWE) by high-intensity focused ultrasound (HIFU) ablation and surgical resection.

Methods

From January 2015 to October 2018, 85 patients with AWE admitted to Nanchong Central Hospital and Affiliated Hospital of Zunyi Medical University were included into this study. According to different treatment methods, 29 patients treated with HIFU ablation were included in HIFU group while 56 patients who underwent resection of AWE lesions were included in surgery group. The age, body mass index (BMI), number of cesarean deliveries, number and diameter of lesions, length of hospital stay, irradiation time, treatment intensity and treatment energy of two groups were statistically compared by independent-samples t test. The treatment time, intraoperative blood loss and treatment power were statistically compared by Wilcoxon rank sum test. The chi-square test was used to statistically analyze the complete remission rate, clinical response rate, 1-year recurrence rate and complication rate. This study met the requirements of the World Medical Association Declaration of Helsinki revised in 2013.

Results

① The age of patients in HIFU group was (31.6±4.7) years old, which was younger than that of patients in surgery group (34.8±4.8) years old. There was significant difference between the two groups (t=-2.958, P=0.004). However, there were no significant differences in BMI, number of deliveries by cesarean section, interval from surgery to the occurrence of clinical symptoms, proportion of patients previously treated with drugs, proportion of patients with different degrees of pain, number of lesions, and lesion diameter between two groups (P>0.05). ② The median intraoperative blood loss and hospital stay of patients in HIFU group were 0 and (4.6±1.0) d, respectively, which were less than 10.0 mL (10.0-10.0 mL) and (6.3±1.8) d in HIFU group, and the differences between two groups had statistical significance (Z=-8.306, P<0.001; t=-5.692, P<0.001). The treatment time in HIFU group was 52.0 min (33.5-62.5 min), which was longer than the 30.0 min (25.0-43.8 min) in surgery group, and the difference between two groups was also statistically significant (Z=3.546, P<0.001). However, there were no significant differences in the complete remission rate, clinical response rate and 1-year recurrence rate between two groups (P>0.05).

Conclusions

HIFU ablation is safe and effective for AWE, but it still needs to be further verified by multicenter, prospective and randomized controlled trials.

Key words: Endometriosis, Abdominal wall endometriosis, High-intensity focused ultrasound ablation, Cicatrix, Abdominal wound pain, Recurrence, Comparative effectiveness research, Women

表1 2组AWE患者一般临床资料比较

组别	例数	年龄(岁，±s)	BMI (kg/m²，±s)	剖宫产术史(次，±s)	末次经腹子宫手术至出现临床症状间隔时间[月，M(P₂₅～P₇₅)]	既往因AWE接受药物治疗[例数(%)]
组别	例数	年龄(岁，±s)	BMI (kg/m²，±s)	剖宫产术史(次，±s)	末次经腹子宫手术至出现临床症状间隔时间[月，M(P₂₅～P₇₅)]	无	有
HIFU组	29	31.6±4.7	21.8±2.4	1.2±0.4	30(18～48)	22(75.9)	7(24.1)
手术组	56	34.8±4.8	21.8±2.3	1.1±0.3	24(12～45)	45(80.4)	11(19.6)
检验值		t＝—2.958	t＝0.297	t＝0.589	Z＝—0.824	χ² ＝ 0.231
P值		0.004	0.767	0.557	0.416	0.631
组别	例数	腹壁伤口周期性疼痛[例数(%)]			AWE数量(个，±s)	AWE直径(mm，±s)
组别	例数	轻度	中度	重度	AWE数量(个，±s)	AWE直径(mm，±s)
HIFU组	29	2(6.9)	23(79.3)	4(13.8)	1.07±0.26	26.6±7.0
手术组	56	12(21.4)	34(60.7)	10(17.9)	1.04±0.33	31.0±13.7
检验值		Z＝－0.793			t＝0.474	t＝－1.619
P值		0.428			0.636	0.109

表1 2组AWE患者一般临床资料比较

组别	例数	年龄(岁，±s)	BMI (kg/m²，±s)	剖宫产术史(次，±s)	末次经腹子宫手术至出现临床症状间隔时间[月，M(P₂₅～P₇₅)]	既往因AWE接受药物治疗[例数(%)]
组别	例数	年龄(岁，±s)	BMI (kg/m²，±s)	剖宫产术史(次，±s)	末次经腹子宫手术至出现临床症状间隔时间[月，M(P₂₅～P₇₅)]	无	有
HIFU组	29	31.6±4.7	21.8±2.4	1.2±0.4	30(18～48)	22(75.9)	7(24.1)
手术组	56	34.8±4.8	21.8±2.3	1.1±0.3	24(12～45)	45(80.4)	11(19.6)
检验值		t＝—2.958	t＝0.297	t＝0.589	Z＝—0.824	χ² ＝ 0.231
P值		0.004	0.767	0.557	0.416	0.631
组别	例数	腹壁伤口周期性疼痛[例数(%)]			AWE数量(个，±s)	AWE直径(mm，±s)
组别	例数	轻度	中度	重度	AWE数量(个，±s)	AWE直径(mm，±s)
HIFU组	29	2(6.9)	23(79.3)	4(13.8)	1.07±0.26	26.6±7.0
手术组	56	12(21.4)	34(60.7)	10(17.9)	1.04±0.33	31.0±13.7
检验值		Z＝－0.793			t＝0.474	t＝－1.619
P值		0.428			0.636	0.109

表2 2组AWE患者治疗情况比较

组别	例数	治疗时间[min，M(P₂₅～P₇₅)]	术中出血量[mL，M(P₂₅～P₇₅)]	住院时间(d，±s)	临床疗效[例数(%)]
组别	例数	治疗时间[min，M(P₂₅～P₇₅)]	术中出血量[mL，M(P₂₅～P₇₅)]	住院时间(d，±s)	CR	临床有效	1年复发
HIFU组	29	52.0(33.5～62.5)	0(0～0)	4.6±1.0	21(72.4)	28(96.6)	2(6.9)
手术组	56	30.0(25.0～43.8)	10.0(10.0～10.0)	6.3±1.8	51(91.0)	56(100.0)	1(1.8)
检验值		Z＝－3.546	Z＝－8.306	t＝－5.692	—	—	—
P值		<0.001	<0.001	<0.001	0.052	0.341	0.267

表2 2组AWE患者治疗情况比较

组别	例数	治疗时间[min，M(P₂₅～P₇₅)]	术中出血量[mL，M(P₂₅～P₇₅)]	住院时间(d，±s)	临床疗效[例数(%)]
组别	例数	治疗时间[min，M(P₂₅～P₇₅)]	术中出血量[mL，M(P₂₅～P₇₅)]	住院时间(d，±s)	CR	临床有效	1年复发
HIFU组	29	52.0(33.5～62.5)	0(0～0)	4.6±1.0	21(72.4)	28(96.6)	2(6.9)
手术组	56	30.0(25.0～43.8)	10.0(10.0～10.0)	6.3±1.8	51(91.0)	56(100.0)	1(1.8)
检验值		Z＝－3.546	Z＝－8.306	t＝－5.692	—	—	—
P值		<0.001	<0.001	<0.001	0.052	0.341	0.267

表3 HIFU组29例患者的HIFU消融治疗参数

项目	参数
治疗时间[min，M(P₂₅～P₇₅)]	52.0(33.5～62.5)
辐照时间(s，±s)	313.6±194.6
治疗设备输出功率[W，M(P₂₅～P₇₅)]	95.0(80.0～112.0)
治疗强度(s/h，±s)	316.3±109.9
治疗能量(J，±s)	31 807.7±19 655.1

表3 HIFU组29例患者的HIFU消融治疗参数

项目	参数
治疗时间[min，M(P₂₅～P₇₅)]	52.0(33.5～62.5)
辐照时间(s，±s)	313.6±194.6
治疗设备输出功率[W，M(P₂₅～P₇₅)]	95.0(80.0～112.0)
治疗强度(s/h，±s)	316.3±109.9
治疗能量(J，±s)	31 807.7±19 655.1

图2 AWE患者接受AWE病灶切除术后切口愈合不良

表4 2组AWE患者术后并发症发生率比较[例数(%)]

组别	例数	血尿	腹壁伤口处皮肤热痛	腹壁伤口处皮肤灼伤	腹壁伤口愈合不良	合计
HIFU组	29	1(3.4)	1(3.4)	1(3.4)	0(0)	3(10.3)
手术组	56	1(1.8)	0(0)	0(0)	3(5.4)	4(7.1)
χ²值		—	—	—	0.421^a	0.009^a
P值		1.000	0.341	0.341	0.516	0.926

表4 2组AWE患者术后并发症发生率比较[例数(%)]

组别	例数	血尿	腹壁伤口处皮肤热痛	腹壁伤口处皮肤灼伤	腹壁伤口愈合不良	合计
HIFU组	29	1(3.4)	1(3.4)	1(3.4)	0(0)	3(10.3)
手术组	56	1(1.8)	0(0)	0(0)	3(5.4)	4(7.1)
χ²值		—	—	—	0.421^a	0.009^a
P值		1.000	0.341	0.341	0.516	0.926

[1]	Grigore M, Socolov D, Pavaleanu I, et al. Abdominal wall endometriosis: an update in clinical, imagistic features, and management options [J]. Med Ultrason, 2017, 19(4): 430-437. DOI: 10.11152/mu-1248.
[2]	Morales Martínez C, Tejuca Somoano S. Abdominal wall endometriosis [J]. Am J Obstet Gynecol, 2017, 217(6): 701-702. DOI: 10.1016/j.ajog.2017.07.033.
[3]	Kang J, Baek JH, Lee WS, et al. Clinical manifestations of abdominal wall endometriosis: a single center experience [J]. Arch Gynecol Obstet, 2013, 287(2): 301-305. DOI: 10.1007/s00404-012-2565-2.
[4]	Ding Y, Zhu J. A retrospective review of abdominal wall endometriosis in Shanghai, China [J]. Int J Gynaecol Obstet, 2013, 121(1): 41-44. DOI: 10.1016/j.ijgo.2012.11.011.
[5]	Khan Z, Zanfagnin V, El-Nashar SA, et al. Risk factors, clinical presentation, and outcomes for abdominal wall endometriosis [J]. J Minim Invasive Gynecol, 2017, 24(3): 478-484. DOI: 10.1016/j.jmig.2017.01.005.
[6]	Bektas H, Bilsel Y, Sari YS, et al. Abdominal wall endometrioma; a 10-year experience and brief review of the literature [J]. J Surg Res, 2010, 164(1): e77-81. DOI: 10.1016/j.jss.2010.07.043.
[7]	张文，冷金花. 腹壁子宫内膜异位症诊断和治疗的研究进展 [J]. 现代妇产科进展，2019, 28(5): 391-392. DOI: 10.13283/j.cnki.xdfckjz.2019.05.017.
[8]	Horton JD, Dezee KJ, Ahnfeldt EP, et al. Abdominal wall endometriosis: a surgeon′s perspective and review of 445 cases [J]．Am J Surg, 2008, 196(2): 207-212. DOI: 10.1016/j.amjsurg.2007.07.035.
[9]	Vaz-de-Macedo C, Gomes-da-Costa A, Mendes S, et al. Abdominal wall endometriosis excision with mesh closure-report of two cases [J]. Surg Technol Int, 2016, 28: 196-201.
[10]	Zhang J, Liu X. Clinicopathological features of endometriosis in abdominal wall--clinical analysis of 151 cases [J]. Clin Exp Obstet Gynecol, 2016, 43(3): 379-383.
[11]	Zhao XY, Duan H, Wang JJ, et al. Clinical analysis of high-intensity focussed ultrasound ablation for abdominal wall endometriosis: a 4-year experience at a specialty gynecological institution [J]. Int J Hyperthermia, 2019, 36(1): 87-94. DOI: 10.1080/02656736.2018.1534276.
[12]	任卫华，王建宏，张华，等. 超声引导下高强度聚焦超声对腹壁子宫内膜异位症的治疗效果研究 [J]. 饮食保健，2016, 3(2): 207.
[13]	Luo S, Zhang C, Huang JP, et al. Ultrasound-guided high-intensity focused ultrasound treatment for abdominal wall endometriosis: a retrospective study [J]. BJOG, 2017, 124 (Suppl 3): 59-63. DOI: 10.1111/1471-0528.14741.
[14]	Zhang L, Rao F, Setzen R. High intensity focused ultrasound for the treatment of adenomyosis: selection criteria, efficacy, safety and fertility [J]. Acta Obstet Gynecol Scand, 2017, 96(6): 707-714. DOI: 10.1111/aogs.13159.
[15]	Shi S, Ni G, Ling L, et al. High-intensity focused ultrasound in the treatment of abdominal wall endometriosis[J]. J Minim Invasive Gynecol, 2020, 27(3): 704-711. DOI: 10.1016/j.jmig.2019.06.012.
[16]	Cozzolino M, Magnolfi S, Corioni S, et al. Abdominal wall endometriosis on the right port site after laparoscopy: case report and literature review [J]. Ochsner J, 2015, 15(3): 251-255.
[17]	赵玲，彭松，张家文，等. 手术与高强度聚焦超声对腹壁瘢痕子宫内膜异位症治疗疗效初步对比研究 [J]. 重庆医学，2016, 45(28): 3928-3930. DOI: 10.3969/j.issn.1671-8348.2016.28.013.
[18]	Zhu X, Chen L, Deng X, et al. A comparison between high-intensity focused ultrasound and surgical treatment for the management of abdominal wall endometriosis[J]. BJOG, 2017, 124 Suppl 3: 53-58. DOI: 10.1111/1471-0528.14737.
[19]	Zhao L, Deng Y, Wei Q, et al. Comparison of ultrasound-guided high-intensity focused ultrasound ablation and surgery for abdominal wall endometriosis [J]. Int J Hyperthermia, 2018, 35(1): 528-533. DOI: 10.1080/02656736.2018.1511836.
[20]	Carsote M, Terzea DC, Valea A, et al. Abdominal wall endometriosis (a narrative review) [J]. Int J Med Sci, 2020, 17(4): 536-542. DOI: 10.7150/ijms.38679.
[21]	Sosa-Durán EE, Aboharp-Hasan Z, Mendoza-Morales RC, et al. Clear cell adenocarcinoma arising from abdominal wall endometriosis[J]. Cir Cir, 2016, 84(3): 245-249. DOI: 10.1016/j.circir.2015.06.024.
[22]	Gentile J, Migliore R, Kistenmacker F, et al. Malignant transformation of abdominal wall endometriosis to clear cell carcinoma: case report [J]. Sao Paulo Med J, 2018, 136(6): 586-590. DOI: 10.1590/1516-3180.2017.0103300417.
[23]	Lai Y, Hsu H, Kuo K, et al. Clear cell carcinoma of the abdominal wall as a rare complication of general obstetric and gynecologic surgeries: 15 years of experience at a large academic institution [J]. Int J Environ Res Public Health, 2019, 16(4): 552-564. DOI: 10.3390/ijerph16040552.
[24]	Hensen JH, Van Breda Vriesman AC, Puylaert JB. Abdominal wall endometriosis: clinical presentation and imaging features with emphasis on sonography [J]. AJR Am J Roentgenol, 2006, 186(3): 616-620. DOI: 10.2214/AJR.04.1619.
[25]	Sedhain N, Dangal G, Karki A, et al. Caesarean scar endometriosis [J]. J Nepal Health Res Counc, 2018, 15(3): 292-294. DOI: 10.3126/jnhrc.v15i3.18859.
[26]	Huber M, Grosel J, Showen C. Recognizing abdominal wall endometriosis [J]. JAAPA, 2019, 32(7): 30-33. DOI: 10.1097/01.JAA.0000558237.67863.aa.
[27]	Pas K, Joanna SM, Renata R, et al. Prospective study concerning 71 cases of caesarean scar endometriosis (CSE) [J]. J Obstet Gynaecol, 2017, 37(6): 775-778. DOI: 10.1080/01443615.2017.1305333.
[28]	Xiong Y, Yue Y, Shui L, et al. Ultrasound-guided high-intensity focused ultrasound (USgHIFU) ablation for the treatment of patients with adenomyosis and prior abdominal surgical scars: a retrospective study [J]. Int J Hyperthermia, 2015, 31(7): 777-783. DOI: 10.3109/02656736.2015.1071436.

[1]	罗丹, 孔为民, 陈姝宁, 赵小玲, 谢云凯. 子宫内膜异位症患者在位及异位内膜上皮细胞-间充质转化相关生物标志物的变化[J]. 中华妇幼临床医学杂志(电子版), 2023, 19(05): 530-539.
[2]	莫波, 王佩, 王恒, 何志军, 梁俊, 郝志楠. 腹腔镜胃癌根治术与改良胃癌根治术治疗早期胃癌的疗效[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 644-647.
[3]	阿冲罗布, 陈颖, 谢德坤. 腹腔镜外囊完整剥离术治疗肝包虫病效果及对患者肝功能、预后的影响[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 666-669.
[4]	索郎多杰, 高红桥, 巴桑顿珠, 仁桑. 腹腔镜下不同术式治疗肝囊型包虫病的临床疗效分析[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 670-673.
[5]	唐浩, 梁平, 徐小江, 曾凯, 文拨辉. 三维重建指导下腹腔镜右半肝加尾状叶切除治疗Bismuth Ⅲa型肝门部胆管癌的临床研究[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 688-692.
[6]	崔占斌, 乔军利, 张丽丽, 韩明强. 尿碘水平与甲状腺乳头状癌患者术后复发危险度分层的相关性[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 615-618.
[7]	陈垚, 徐伯群, 高志慧. 改良式中间上入路根治术治疗甲状腺癌的有效性安全性研究[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 619-622.
[8]	郑泽坤, 刘卓恒, 邹浩, 胡会元, 李妲, 吴巍. 扩大根治性手术切除复发性巨大腹膜后去分化脂肪肉瘤1例[J]. 中华普外科手术学杂志(电子版), 2023, 17(05): 588-590.
[9]	邢晓伟, 刘雨辰, 赵冰, 王明刚. 基于术前腹部CT的卷积神经网络对腹壁切口疝术后复发预测价值[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(06): 677-681.
[10]	姜明, 罗锐, 龙成超. 闭孔疝的诊断与治疗：10年73例患者诊疗经验总结[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(06): 706-710.
[11]	张文华, 陶焠, 胡添松. 不同部位外生型肝癌临床病理特点及其对术后肝内复发和预后影响[J]. 中华肝脏外科手术学电子杂志, 2023, 12(06): 651-655.
[12]	叶文涛, 吴忠均, 廖锐. 癌旁组织ALOX15表达与肝癌根治性切除术后预后的关系[J]. 中华肝脏外科手术学电子杂志, 2023, 12(06): 708-712.
[13]	张政赢, 鞠阳, 刘晓宁. 二甲双胍对2型糖尿病患者大肠腺瘤术后复发的影响[J]. 中华消化病与影像杂志(电子版), 2023, 13(06): 485-488.
[14]	王丁然, 迟洪滨. 自身免疫甲状腺炎对子宫内膜异位症患者胚胎移植结局的影响[J]. 中华临床医师杂志(电子版), 2023, 17(06): 682-688.
[15]	符梅沙, 周玉华, 李慧, 薛春颜. 淋巴细胞免疫治疗对复发性流产患者外周血T淋巴细胞亚群分布与PD1/PD-L1表达的影响及意义[J]. 中华临床医师杂志(电子版), 2023, 17(06): 726-730.

阅读次数

全文

摘要

选择文件类型/文献管理软件名称

选择包含的内容

Clinical efficacy on treatment of abdominal wall endometriosis by different strategies

模态框（Modal）标题

选择文件类型/文献管理软件名称

选择包含的内容

Clinical efficacy on treatment of abdominal wall endometriosis by different strategies