2024年 · 第104卷第20期

Chronic endometritis (CE) is a chronic persistent endometrial inflammation with atypical clinical symptoms, characterized by endometrial interstitial plasma cell infiltration, mainly by molecular microbiology, CD138 immunohistochemistry, hysteroscopy and other means to assist in diagnosis. This article focuses on the research on the pathogenesis of CE, its impact on reproductive prognosis and the principle of treatment. The mechanisms of CE include changes in uterine cavity microbial environment, impacts on endometrial decidualization, abnormal expression of immune cells and cytokines, changes in uterine contraction, disturbance of villous vascular differentiation, etc., which are related to infertility, recurrent abortion and repeated embryo implantation failure. Oral antibiotic treatment of CE can improve adverse pregnancy outcomes. In the future, large-scale prospective randomized controlled studies are still needed to find specific microbial infections in CE patients and provide targeted treatment, so as to reduce the impact of CE on fertility and provide theoretical basis and new ideas for the early diagnosis and treatment of CE on fertility-related diseases.

The patient, a 60-year-old male, went to the outpatient department of respiratory and critical care medicine of Qingdao Municipal Hospital for "discovering pulmonary nodules for more than 10 days". He had a history of chronic obstructive pulmonary disease and respiratory failure in the past, and was treated with long-term non-invasive ventilator-assisted treatment. Specialist physical examination: There was no deformity in the thorax, voice-free in the percussion of both lungs, coarse breathing sounds in both lungs, and no dry and wet rales were heard. Blood gas analysis at admission indicated type II respiratory failure. Enhanced chest CT showed that a solid nodular shadow protruding from the lumen in the bronchi of the lower lobe of the left lung, about 8 mm in diameter, with a pedicled root connected to the cartilage ring of the airway (Figures A and B), and no enlargement of the mediastinal lymph nodes and hilar lymph nodes. For bronchoscopy, see: neogenesis of the orifice of the basal segment of the left lung (Figure C), and the tumor was resected by a trap. The texture of the pedicle was found to be hard in the trap. After the trap, the tumor was found to be as hard as a jujube nucleus, and a cartilage ring-like structure was seen at the connection between the pedicle of the tumor and the trachea (Figure D). Pathological report: ossifying tracheobronchopathy with squamous metaplasia of the mucosal epithelium (neoplasm of the left lower lobe orifice). Ossifying tracheobronchiopathy is a special benign lesion with multiple bone or cartilage nodular hyperplasia under the tracheal mucosa. The nodules originate from the cartilage ring of the airway, so the posterior wall of the airway is often not involved. The typical CT features are high-density shadows of the anterior and lateral walls of the tracheobronchus, and some of them are multiple nodules protruding into the lumen, which can lead to stenosis or deformation of the lumen in severe cases. The macroscopic appearance of nodules is covered by normal mucosa, and the texture is hard and difficult to biopsy, which is helpful for differential diagnosis from other nodular diseases. At present, the literature reports are multiple, and single ones are very rare.