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02 December 2012, Volume 28 Issue 12 Previous Issue    Next Issue
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2012, 28(12): 890-892.  Abstract ( )   PDF (911KB) ( )   Hysteroscopic myomectomy is the first choice in treating submucous myoma. The successful operation and the treatment effect depend on the type of submucous myoma and the operation skills. The indications for surgery， fibroids in diameter and the myometrial free margin are still controversial issues. The latest view: the myometrial free margin is no longer a limiting factor for hysteroscopic resection of submucous myoma，it is not a static parameter but a dynamic index.

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2012, 28(12): 895-898.  Abstract ( )   PDF (931KB) ( )   Laparoscopic myomectomy has become one of the most important surgeries for uterine leiomyoma with miniinvasive superiority. However due to the technological characters and application limitations of laparoscope，it’s very important to select proper indications and apply favorable techniques in order to guarantee treatment outcomes，which is very important to prevent and decrease complications of short and long term.

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2012, 28(12): 901-902.  Abstract ( )   PDF (897KB) ( )   myoma of uterus is the most common tumor of the female genitalia systems. Surgery is the principal method to treat myoma ，transvaginal therapy include transvaginal hysterectomy and transvaginal myomectomy. To compare with abdominal and laparoscopic operations，transvaginal operations have advantage and limitations. Sufficient evaluation and make correct choice about operation，it is the necessary avoid injury conditions to avoid injurg and ensure medical treatment safe.

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Study of bone mineral density in complete androgen insensitivity syndrome: estrogen alone or estrogen with bisphosphonates treatment after orchiectomy. 2012, 28(12): 915-917.  Abstract ( )   PDF (921KB) ( )   Objective:To explore the characteristics and treatment effects of bone mineral density (BMD) in complete androgen insensitivity syndrome (CAIS) of Chinese patients. Methods:Twentysix cases of CAIS (1994-04～2010-07) were studied retrospectively through comparing BMD of pre and postorchiectomy with normal Chinese men and women. The treatment effect of estrogen alone (group A, 10 cases) was compared with estrogen plus alendronate (group B, 3 cases) in the patients of postorchiectomy. BMD at the lumbar spine/the femur neck were measured by dual energy X-ray absorptiometry (DXA). Results:Twentysix cases of CAIS had preorchiectomy DXA，in which 15 cases had significantly reduced lumbar 2～4 BMD [(0.94±0.07)g/cm2] compared with the normal male or female (P<0.001), and 15 cases had significantly reduced femur neck BMD [(0.84±0.07)g/cm2] compared with the normal male (P<0.05). Ten cases in A group had 15 postorchiectomy DXA，in which femur neck BMD in subjects aged >19～<30 years old [(0.92±0.09)g/cm2] was not significantly differ from the normal control(P>0.05)，but lumbar 2～4 BMD in subjects aged >19～<30 years old [(0.97±0.05)g/cm2, P<0.01] and aged 30～39 years old [(0.98±0.03)g/cm2, P<0.05] was lower than that of the normal control. Three cases in B group had 10 postorchiectomy DXA, in which femur neck BMD in subjects aged >19～<30 years old [(1.00±0.03)g/cm2] and aged 30～39 years old [(0.99±0.03)g/cm2] was not significantly differ from the normal control (P>0.05). The lumbar 2～4 BMD in subjects aged >19～<30 years old [(0.98±0.02)g/cm2, P<005] and aged 30～39 years old [(1.00±0.01)g/cm2, P<0.01] were lower than that of the normal control. Conclusions:Patients of CAIS exhibited the decreased BMD values，especially in lumbar vertebra. This suggests that estrogen and androgen play important roles in the acquirement and maintenance of bone mass. The treatment effect of estrogen plus alendronate on increasing femur neck BMD is better than estrogen alone.

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Clinical analysis of 28 cases of vaginal intraepithelial neoplasia. 阴道上皮内瘤变28例临床分析 2012, 28(12): 918-920.  Abstract ( )   PDF (919KB) ( )   Objective:To investigate the clinical characteristics，risk factors，diagnosis and treatment，prognosis of vaginal intraepithelial neoplasia(VAIN). Methods:A retrospective study was made of 28 patients with VAIN，who were hospitalized at Peking Union Medical College Hospital between 2005 and 2011Those patients’ clinical characteristics，liquidbased cytology，human papillomavirus(HPV) test，correlation to previous hysterectomy and cervical intraepithelial neoplasia，diagnosis and treatments are analyzed respectively. Results: The patients ranged from 29 to 76(median 48)years old 26 cases shown specific clinical manifestation，in 25 patients the VAIN lesions were located in the upper of the vagina，27 cases had abnomal cytology，23 patients had positive HPV infection.15 cases had a history of hysterectomy，10 of them were cervical intraepithelial neoplasia or invasive cervical cancer.The average interval of the VAIN occurrence after hysterectomy with or without cervical disease was 3.1 years and 8.8 years respectively.10 patients were accompanied with cervical intraepithelial neoplasia and cervical cancer.There were no different significant between VAINⅡ and VAINⅢ in age，hysterectomy，accompanied cervical disease，TCT.All cases were treated by surgery，3 cases recurred. Conclusions: Human papillomavirus infection，cervical intraepithelial neoplasia and cervical cancer，previous hysterectomy due to CIN/cervical cancer were risk factors of VAIN.Cytology(HPV DNA test)colposcopic biopsiespathological diagnosis are very important in diagnosis and followup for vaginal intraepithelial neoplasia，after the treatment of CIN/cervical cancer，strict followup are needed，especially the first 3 years.

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The effect of postoperative with adjuvant therapy on reproductive outcome after transcervical resection of septa. ZHOU Qiao-yun，LIU Yu-huan，XIA En-lan，SONG Dong-mei，ZHENG Jie，LIU Lin-lin. 2012, 28(12): 921-923.  Abstract ( )   PDF (915KB) ( )   Objective: To investigate the effect of postoperative with /without adjuvant therapy on reproductive outcome after transcervical resection of septa (TCRS). Methods: 195 out of 216 cases who were performed TCRS were followed up. They were divided into three groups postoperatively:60 cases who were no adjuvant treatment (group1)，33cases who were artificial cyclical treatment(group2) and 102 cases who were artificial cyclical treatment combining with intrauterine device (IUD)(group3). 195 patients were followed up for 20 to 44 months. The rates of spontaneous abortion, premature birth, fetal death and term delivery were recorded. Results: The rates of spontaneous abortion, premature birth, fetal death and term delivery were 28.57%, 2.86%, 2.86% and 60.00% in group 1;14.29%, 5.71%, 0 and 65.71% in group 2; 27.27%, 6.49%, 0 and 48.05% in group 3, respectively. There were no significant difference among three groups in the rates of spontaneous abortion, premature birth, fetal death and term delivery. Conclusion: The effect of postoperative with /without adjuvant treatment on reproductive outcome after TCRS has no significant difference.

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An analysis of maternal thyroid peroxidase autoantibody positivity in the first trimester. LONG Yan，SHI Juan-juan，ZHANG Xiao-lu，LIN Li. 2012, 28(12): 924-927.  Abstract ( )   PDF (929KB) ( )   Objective：To assess the prevalence of thyroid peroxidase autoantibody and relationships between thyroid function and TPOAb in the first trimester of pregnancy. Methods：A total of 611 women during the first trimester from Beijing Friendship Hospital are tested for serum TSH，FT4 and anti-TPO by chemilumino metric immunoanalysis . Women with previous thyroid diseases are excluded. We determine the reference intervals for TSH and FT4 and establish the prevalence of TPOAb by using gestational age-specific interval. The relationships between TSH，FT4 and TPOAb are analyzed. Results：(1)The median value of TPOAb is 38.9 mU/L，ranging from 6.4 to more than1 300 mU/L at 8-12 gestational week .(2)The cutoff value of TPOAb is 206.77 mU/L at the 90th percentile by using gestational age-specific interval. The positive rate of TPOAb is 10.8% (66/611).(3)A simple regression analysis shows that serum titer of TPOAb correlates with the levels of TSH and FT4 (P= 0.000 and 0.000). The median concentration of TSH is significantly greater in TPOAbpositive women than in TPOAbnegative women with increased value of 0.40 mU/L. The risk of abnormally high TSH in former is more than three times than in latter. Conclusion：TPOAb positive rate is 10.8% in first trimester. Determination of the gestational agespecific intervals for TSH，FT4 and TPOAb is of very importance to avoid overestimation of maternal thyroid dysfunction. Pregnant women with TPOAbpositive have a higher level of TSH and should be monitored closely for thyroid function. 

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Central obesity had adverse effect on in vitro fertilization treatment in women with polycystic ovary syndrome. 2012, 28(12): 928-931.  Abstract ( )   PDF (935KB) ( )   Reproductive Medicine Centre， Department of Gynecology and Obstetrics， Sun Yatsen Memorial Hospital of Sun Yatsen University， Guangzhou 510120， ChinaObjective：To determine whether central obesity has adverse effect on IVF treatment in women with polycystic ovary syndrome (PCOS). Methods：A retrospective study was performed in women undergoing IVF treatment with PCOS.Totally 188 IVF cycles were analyzed，and baseline characteristics，IVF parameters and treatment outcome were compared between women with waist circumstance (WC) of≥80cm (n=70) vs.those with WC of <80cm (n=118). Results：Central obesity women with PCOS had higher BMI and waisthip ratio，elevated free androgen index，more severe insulin resistance according to HOMA-IR and metabolic disorders including impaired fasting glucose，impaired glucose tolerance and dyslipidemia (P<0.05).After controlling BMI，WC was positive correlated with fasting insulin level，HOMA-IR and free androgen index (P<0.01).During IVF treatment they need more dose of gonadotrophin [(2014.8±825.8)U vs.(1491.2±558.9)U] but lower peak estradiol level [(8492.7±4771.2)pmol/L vs.(11918.1±5329.0)pmol/L，P<0.001]and less number of mature follicles (9.6±4.6 vs.11.5±5.2) and oocytes retrieved (11.6±5.7 vs.13.8±7.3)(P<0.05).And after IVF treatment，they had lower implantation rate (24.3% vs.36.3%，P<0.05) and increased early spontaneous miscarriage rate (38.5%vs.7.5%，P<0.05).Their clinical pregnancy rate showed no significantly difference (40.6%vs.55.2%，P=0.07). Fertilization rate，cleavage rate，available embryo and good embryo rates showed no significant differences.After controlling female age and primary infertility diagnosis，Logistic regression analysis showed that HOMAIR was the risk factor of early spontaneous miscarriage for PCOS women after IVF treatment，OR=0.143(95%CI=0.026~0.768，P=0.023). Conclusion：Central obesity deteriorates endocrinal and metabolic disorders,and had adverse effects on ovarian stimulation and pregnancy outcome in women with PCOS after IVF.

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The pregnancy outcome follow-up in 391 women with uterine malformation. CAI Xing-yuan，LU Dan，ZHANG Jian-ping，ZHANG Ya-lan，XIONG Xiao-yan，SHENG Jie，ZHENG 2012, 28(12): 932-934.  Abstract ( )   PDF (915KB) ( )   Objective：To investigate the clinical characteristics of uterine malformation and benefit to improve the prognosis of pregnancy postsurgery. Methods：Subjects of 391 women with uterine malformation were collected，the pregnancy outcome of 185 subjects were followedup after surgery. Results：(1)Among the 391 subjects 9 types were included，246 (62.9%) were septum uterine.(2)Clinical manifestation include spontaneous abortion(21.2%)，infertility(13.0%)，primary amenorrhea (12.8%)，physical examination without symptoms(14.6%).(3) Subjects of 162 septum uterine were followed up after surgery with laparoscope or hysteroscope under ultrasound，the incidence of spontaneous abortion and embryo without growth before surgery is 82.0%，which decrease to 15.4% with surgery，P<0.01; the incidence of pregnancy at term is 5.2% before surgery，which increase 76.5%with surgery，P<0.01; the incidence of live birth is 5.2% before surgery，which increase to 80.2%，P<0.01. Conclusions：Most of uterine malformation is septum uterine，which effects the infertility of women deeply，according the type of uterine malformation and individualization surgery accepted or not and the type of surgery was determined. The infertility prognosis of subjects with septum uterine after surgery was remarkably improved.

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The clinical analysis of 253 cases of intrauterine infection in late pregnancy. LIN Sui-qing, CHENG Wei-wei. 2012, 28(12): 935-937.  Abstract ( )   PDF (919KB) ( )   Objective：Investigate the cause of intrauterine infection in late pregnancy, the main pathogens, its impact on maternal and child outcomes and prevention measures. Methods：International Peace Maternity & Child Health Hospital, Shanghai Jiao Tong University School of Medicine，253 cases was diagnosed of intrauterine infection in late pregnancy between January 1, 2006 and December 31，2011 were analyzed retrospectively. Results：The hospital in the past of six years the number of cases to intrauterine infection accounted for 0.41% of the same period the total number of deliveries, including preterm intrauterine infection accounted for 2.36% of the total number of premature delivery. Intrauterine infection is associated with premature rupture of membranes, to the time of treatment, the production process duration and the number of vaginal examinations and others. The main pathogens of intrauterine infection followed by GBS (20.6%), escherichia coli (19.4%), enterococcus faecalis (18.9%). Of the intrauterine infection patients, rate of cesarean section 76.7%, puerperal infection 14.2%, neonatal infection 20.9%, perinatal mortality 3.2%. Conclusions：To strengthen the health care during pregnancy and the management of treatment, the production process. Active prevention and timely diagnosis and treatment of intrauterine infection can improve the prognosis of female and children.