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02 April 2015, Volume 31 Issue 4 Previous Issue    Next Issue

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The female pelvic floor anatomy and the assessment of pelvic organ prolapse. ZHOU Jiang-yan,HUANG Ou-ping. 2015, 31(4): 281-285.  DOI: 10.7504/fk2015030103 Abstract ( )   Abstract:Mastering the female pelvic floor anatomy is the key to understanding the pathogenesis of pelvic organ prolapse,and the diagnosis and assessment of relevant anatomy of the pelvic floor defect is the precondition of setting individualized treatment plan. This article reviews the female pelvic floor anatomy in order to explore the diagnosis and assessment of pelvic organ prolapse and surgical treatment.

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The application prospect of tissue-engineered mesh with 3D printing technique in the pelvic floor reconstructive surgery. SUN Xiu-li，CHANG Yue，WANG Jian-liu. 2015, 31(4): 285-288.  DOI: 10.7504/fk2015030104 Abstract ( )   Abstract:Mesh surgery is the main therapy method for pelvic organ prolapse(POP).Synthetic mesh has the advantage of low recurrence rate but has the risk of erosion, exposure and infection.Biological mesh has better histocompatibility but is not strong enough. Tissue-engineered mesh with 3D printing technique is the key research point currently. Here we overview the studies and application prospect of tissue-engineered mesh.

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The present analysis about synthetic mesh in pelvic floor reconstruction. LUO Xin,HUANG Chen-ling-zi,LIN Xin-zi. 2015, 31(4): 288-291.  DOI: 10.7504/fk2015030105 Abstract ( )   Abstract:To reduce the rate of postoperative recurrence, over the past more than 10 years synthetic mesh has been widely used in pelvic floor reconstruction .Comprehensive understanding of the value of synthetic mesh will be of great importance in the development of pelvic floor reconstruction.

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Prevention and treatment of pelvic reconstruction complication. YIN Yi-tong, XIA Zhi-jun. 2015, 31(4): 292-295.  DOI: 10.7504/fk2015030106 Abstract ( )   Abstract:Total pelvic reconstruction is an effective method in curing severe pelvic organ prolapse. With its wide use people should pay more attention to its complications. This essay will talk about the reason,treatment and precaution of these common complications,such as bleeding , injury, mesh exposure, pelvic organ reprolapse, urinary incontinence,intercourse pain and so on.

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Application of imaging and 3D reconstruction in the diagnosis and treatment of pelvic organ prolapse. LIU Ping,CHEN Lan. 2015, 31(4): 295-301.  DOI: 10.7504/fk2015030107 Abstract ( )   Abstract:Understanding the anatomy of the pelvic floor is the premise of diagnosis, treatment and prevention of pelvic organ prolapse. Imaging examinations is usually used as one of the important methods to diagnose the disease in hospital, which includes the X-ray angiography, ultrasound and magnetic resonance imaging. While as a new assessment tool used in the diagnosis and treatment of pelvic organ prolapse, the three-dimensional reconstruction skill is being widely used. This paper reviews the value of the various imaging techniques and three-dimensional reconstruction technique in helping with the diagnosis and treatment of pelvic organ prolapse, looking forward to provide a reference of selecting the proper assessment method for pelvic organ prolapse.

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Application status and thinking of laparoscopic sacrocolpopexy and sacrohysteropexy. ZHANG Xiao-wei. 2015, 31(4): 301-304.  DOI: 10.7504/fk2015030108 Abstract ( )   Abstract:Laparoscopic sacrocolpopexy has been the gold standard procedure for the middle pelvic defects reconstruction, which is gradually replacing the abdominal procedure. The indicatioin of laparoscopic sacrocolpopexy is continually expanding with the progress of the surgical technique. It can remedy not only the middle pelvic defects, but also the severe bladder or rectum prolapse. The long-term operation effect shows that the subjective and objective cure rate is high, the recurrence rate of the apical vaginal prolapse is extremely low, the impact on the patients’ life quality is less, and the complications of mesh is in the acceptable range. Although the transrectal mesh erosion is rare, the long-term follow-up postoperatively should also be emphased. The long-term efficacy of laparoscopic sacrohysteropexy remains to be further studied.

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Principles and choice of operation methods in the treatment of pelvic organ prolapsed in the old. SONG Yan-feng. 2015, 31(4): 304-307.  DOI: 10.7504/fk2015030109 Abstract ( )   Abstract:Pelvic organ prolapse is the descent or herniation of pelvic organs to or beyond vaginal walls. As age is a significant risk factor, pelvic organ prolapse is particularly prevalent in elderly population. Many factors affect the treatment scheme including age, urinary and rectal symptoms, the desire to maintain or restore vaginal anatomy to accommodate sexual intercourse,and so on. A detailed preoperative assessment and a thorough discussion of the desires of the patient are required. Pessaries are internationally recommended first-line conservative treatment in elderly patients with POP.With the advantage of short operative time, reduced morbidity and quicker recovery, colpocleisis has become a popular treatment option for elderly patients, especially those with higher risks because of comorbidities.

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The clinical application and assessment of nonsurgical management for pelvic organ prolapse. GAO Wei，XIE Zhen-wei，JIN Hang-mei. 2015, 31(4): 307-310.  DOI: 10.7504/fk2015030110 Abstract ( )   Abstract:The first-line treatment for pelvic organ prolapse is nonsurgical therapy, which includes lifestyle intervention, pelvic floor muscle training, biofeedback and pessary. To provide guidelines for standard nonsurgical treatment of pelvic organ prolapse, this article describes their clinical applications, operational approaches and assessment of effectiveness.

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Female pelvic floor function and its evaluation methods. SU Yuan-yuan, HAN Yan-hua, LI Dan-yan. 2015, 31(4): 310-313.  DOI: 10.7504/fk2015030111 Abstract ( )   Abstract:At present, pelvic floor rehabilatation has become one of the main methods in pelvic floor dysfunction prevention and treatment. Understanding the significance of pelvic floor function assessment and the correct choice of the assessment methods is critical to develop personalized pelvic floor rehabilitation programs and will improve the therapeutic effects. We summarized the pelvic floor function and its evaluation methods in this article.

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Mid-term clinical efficacy evaluation of using transvaginal mesh repair systems for severe pelvic organ prolapse. ZHANG Xiao-wei, XIAO Shu-yao, LI Yan-xia, XU Li-zhen, DU Pei. 2015, 31(4): 322-326.  DOI: 10.7504/fk2015030113 Abstract ( )   Abstract： Objective To study the efficacy of transvaginal mesh repair systems for severe pelvic organ prolapse, identify the complications of the surgery and to assess the effectiveness and safety. Methods A retrospective analysis was performed on the clinical data, from January 2007 to June 2014 in the First Affiliated Hospital of Guangzhou Medical University, in a total of 110 patients who did the total pelvic floor reconstruction due to severe pelvic organ prolapse, and a comparison was carried out between before and after the surgery on each indication point of the pelvic organ prolapse quantification (POP-Q) indexing, and an objective evaluation was made on the overall cure rate and recurrence rate. Pelvic floor dysfunction symptom questionnaire summary table (PFDI-20) and other relevant evaluation questionnaire scores were used to indicate subjective cure rate and improvement of symptoms. Results The 110 patients were followed up, and 98 patients (98/110, 89.09%) were reached. The other 12 patients (12/110, 10.91%) were lost in touch, including one patient passing away because of cardiovascular disease after 1-year follow-up. Follow-up time: 6-90 months,the median follow-up time: 48 months. The average age of the patients in 110 cases was (65.30 ± 8.00) years; mean menopause age was (14.01 ± 9.08) years.Fifteen patients (15.31%) had recurrence after surgery, including 11 patients diagnosed with POP-Q Ⅱ stage without surgery intervention and 4 cases of vaginal vault recurrence (POP-Q Ⅲ stage) which required reoperation. The subjective cure rate was 95.92% (94/98) and the objective cure rate is 84.69%

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The study of applying cervical vaulation in pelvic reconstruction surgery. HU Qing, XIA Zhi-jun, XU Hai-nan,ZHAO Ying. 2015, 31(4): 327-331.  DOI: 10.7504/fk2015030114 Abstract ( )   Abstract： Objective To study the value of cervical vaulation in pelvic reconstruction surgery with uterus reservation.Methods Choose 109 patients who took surgery of pelvic reconstruction with uterus reservation in Shengjing Hospital because of Ⅲ~Ⅳ degree pelvic organ prolapsed from January 2011 to January 2012, and divide them into two groups.Experimental group: 50 patients receiving cervical vaulation in pelvic reconstruction surgery with uterus reservation;Control group: 59 patients receiving traditional pelvic reconstruction surgery with uterus reservation. The general condition, peri-operative outcomes and follow up data were compared between two groups. Results 18 months after operation, some parameters are compared, the point C ,D is higher in experimental group than in control group[C: 6 months（-6.75±1.83）cm vs（-4.63±1.07）cm，12 months（-6.75±1.83）cm vs（-4.03±1.57）cm，18 months（-7.01±1.83）cm vs（4.03±1.77）cm], [D: 6 months（-7.13±1.41）cm vs（-5.00±1.41）cm，12 months（-7.12±1.41）cm vs（-4.52±1.51）cm，18 months（-7.13±

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Specific expression and significance of endocrine gland-derived vascular endothelial growth factor gene in ectopic and eutopic endometrium of patients with endometriosis. MA Yue,LI Yan,LIU Kui-ran，WANG Dan-bo. 2015, 31(4): 332-335.  DOI: 10.7504/fk2015030115 Abstract ( )   Abstract： Objective To investigate the expression and significance of endocrine specific vascular endothelial growth factor (EG-VEGF) in endometriosis and its lateral tissue.Methods Detected the expression of EG-VEGF by immunohistochemistry in 32 cases of endometriosis, eutopic and ectopic endometrium, the lateral tissue of endometriosis, control group 1 (32 case of normal endometrium) and control group 2 (15 cases of normal ovaries).Results The expression and positive expression rate of EG-VEGF in ectopic endometrium were higher than eutopic endometrium[1.99±0.26(84.3%),1.65±0.34(65.6%),respectively](P<0.05 and P<0.01);the expression and positive expression rate of EG-VEGF in eutopic endometrium were higher than control group1[1.65±0.34 (65.6%),0.85±0.29(21.9%),respectively](P<0.05);the expression and positive expression rates of EG-VEGF in ectopic endometrium was higher than ovarian of ectopic lesion side[1.99±0.26(84.3%),[1.45±0.28(56.2%),respectively](P<0.05);the expression and positive expression rates of EG-VEGF in ovarian of ectopic lesion side were higher than control ovarian[1.45±0.28(56.2%), 0.89±0.31(40.0%)respectively](P<0.01 and P<0.05); between the two groups, the differences were highly statistically significant.Conclusion The abnormally high level of EG-VEGF in endometriosis lesions, its side tissue and eutopic endometrium is associated with the occurrence and development of endometriosis.

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The relatronship of ERCC1 gene with platinum resistance in epithelial ovarian cancer cells. DU Pei*,WANG Yi-feng, ZHANG Xiao-wei,CHEN Li-quan,GAN Ya-ping. 2015, 31(4): 336-341.  DOI: 10.7504/fk2015030116 Abstract ( )   Abstract： Objective To detect the expression of excision repair cross-complementation group 1 (ERCC1) gene in the cisplatin-resistant human ovarian cancer cell lines SKOV3 / DDP and its parent cell lines SKOV3, in order to explore the significance of ERCC1 gene in ovarian cancer cisplatin resistance and whether the effective ERCC1 gene silencing can effectively reverse the resistance of SKOV3 / DDP cells to DDP. Methods By real-time fluorescent quantitative PCR (RT-PCR) and Western imprinting method,detect the expression of ERCC1 mRNA and protein in SKOV3 / DDP and SKOV3 cell. Construct three artificial short hairpin RNA (shRNA) plasmid expression vector of ERCC1 gene silence, transfect to SKOV3 / DDP cells by slow transfection viral vector method. Detect the level of ERCC1 gene silence,and chose the best silent expression vector by RT-PCR and Western imprinting method. Detect the expression of ERCC1 gene in SKOV3 / DDP cells after stable transfection by RT-PCR and Western imprinting method and detect the resistance of transfection cells to DDP by CCK 8. Results The expression of ERCC1 mRNA and protein in SKOV3 / DDP cells was significantly higher than that of SKOV3, the difference being statistically significant (P< 0.01). The expression of ERCC1 mRNA and protein in SKOV3 / DDP cells was obviously decreased after stable transfection of ERCC1 shRNA, the difference being statistically significant (P<0.01). That suggested the specific ERCC1 gene silence could increase the sensitivity of SKOV3 / DDP cells to cisplat by Cell activity detection (P<0.05). Conclusion The expression of ERCC1 gene in SKOV3 / DDP cells increases significantly.The effective ERCC1 gene silence can effectively reverse the resistance of SKOV3 / DDP cells to cisplatin, increase sensitivity of the ovarian epithelial carcinoma cisplatin resistant cells to cisplatin,and thus provide new targets for the treatment of epithelial ovarian cancer drug resistance.

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Clinical study on perimenopausal dysfunctional uterine bleeding treated by bysteroscopic endometrial radiofrequency ablation and endometrial electroresection. ZHANG Ning-ning, ZHAO Cheng-zhi, YANG Qing. 2015, 31(4): 342-345.  DOI: 10.7504/fk2015030117 Abstract ( )   Abstract： Objective To compare different clinical effects in treating perimenopausal dysfunctional uterine bleeding by hysteroscopic endometrial radiofrequency ablation and endometrial electroresection. Methods Choose the clinical data of 132 patients with climacteric dysfunctional uterine bleeding who were treated by hysteroscopic operation in our hospital, of whom 68 were treated by hysteroscopic endometrial radiofrequency ablation (radiofrequency ablation group), 64 were treated by hysteroscopic endometrial electroresection (electroresection group).Compare the operation time, bleeding volumeduring operation, hospital time, cure rate and operation complications between the two groups, so as to evaluate their clinical efficacy. Results The operation time and hospital time were shorter in ablation group than in electroresection group,which display a significant difference (P<0.05). The blood loss in radiofrequency ablation group was less than electroresection group,which displayed a significant difference (P<0.05).The clinical cure rate in radiofrequency ablation group was 98.5%, which was better than electroresection group (93.8%),but there was no statistically significant difference (P> 0.05).No complications occurred in both groups. Conclusion The clinical effect of hysteroscopic endometrial radiofrequency ablation in the treatment of perimenopausal dysfunctionnal uterine bleeding is good, which is worthbeing widely used in clinical practice.

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Analysis of the clinical effect of single blastocyst transfer for patients with all the embryos vitrified. HE Qiao-hua, WANG Lu, LIANG Lin-lin, ZHANG He-long, ZHANG Cui-lian. 2015, 31(4): 346-349.  DOI: 10.7504/fk2015030118 Abstract ( )   Abstract： Objective To compare the clinical outcomes of the cleavage stage embryos, double blastocyst and single blastocyst transfer in frozen embyro tranfer(FET) cycles after all embryos frozen. Methods Retrospective analysis was done in infertility patients who underwent in-vitro fertilization & embryo transfer (IVF-ET) in the Reproductive Medicine Center of Henan Provincial People’s Hospital during Jan.2010 and Dec.2012. According to the wishes of patients, the patients were divided into cleavage-stage embryo transfer (group A, n=456), double blastocyst transfer(group B, n=106)and single blastocyst transfer(group C, n=402).Results The number of average frozen embryo and the number of average embryo transfer were less in group B and C compared with group A,while the implantation rate was higher(P< 0.05). The average number of embryo transfer in group C was also less than that in group B(P<0.05). The clinical pregnancy rate and the pregnancy rate of initiated cycles in gruop B were significantly higher than those in group A and C, and the multiple pregnancy rate in group C was significantly lower than those in group A and B (P<0.05); the early abortion rate in group C was significantly lower than that in group A(P<0.05). Conclusion For patients who need to freeze all embryos, cryopreservion of all available blastocysts through vitrification and single blastocyst transfer may be the most cost-effective and achievable strategy.

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The influence of selective intrauterine growth restriction on neonatal cerebral injury in monochorionic twins. LI Jing-zhi，ZHANG Hai-ying，CAI Li-ping，WANG Li-jing，YUAN Hong. 2015, 31(4): 350-353.  DOI: 10.7504/fk2015030119 Abstract ( )   Abstract： Objective To investigate the influence of selective intrauterine growth restriction (sIUGR) on neonatal cerebral injury in monochorionic twins. Methods From June 2011 to June 2014，clinical data of 24 cases of monochorionic diamniotic (MCDA) twins (48 fetuses) with sIUGR and 56 cases of normal MCDA twins (112 fetuses) in the same period were analyzed retrospectively in the Second School of Clinical Medicine of Jinan University. Fetuses with sIUGR were classified into three types according to umbilical artery Doppler flow pattern. There were 11 cases of typeⅠ, 10 cases of typeⅡand 3 cases of type Ⅲ. The babies received transcranial ultrasound scan after delivery and serial ultrasound scanning or MRI were followed-up in cases with abnormal ultrasound findings. Mild cerebral injury was defined with one of the following abnormal cranial scan finding:intraventricular hemorrhage(IVH) gradeⅠor gradeⅡ,lenticulostiate vasculopathy and/or subependymal pseudocysts; while severe cerebral injury was defined as IVH grade Ⅲ or grade Ⅳ, cystic periventricular hemorrhage (PVL) gradeⅡor higher, porencephalic cysts and/or ventricular dilatation. The neonatal cerebral injury was compared between sIUGR and normal MCDA twins, and among the three types of sIUGR as well. Results The incidence of severe and mild cerebral injury was 4.2% (1/24) and 10.4% (5/48) respectively in the sIUGR group, and 0% and 6.3% (7/112) in the control group. No significant difference was noted between the proportion of cerebral injury in two groups (P>0.05). No clinical neural injury symptom was observed in the 12 cases with minor brain scan anomalies. All of them received serial brain scan or MRI. Except for one case without ultrasonography change, the majority (11/12, 91.6%) of cases had signs of improvement. There were 2 cases (2/22，9.1%) in typeⅠand 3 cases (3/26，11.5%) in typeⅡ/Ⅲ presenting minor cerebral injury (P>0.05). There was one neonatal death and one major brain injury in typeⅡ/Ⅲ, while there was no neonatal death and severe brain injury in typeⅠ(P>0.05). Conclusion The incidence of severe and mild cerebral injury rate in neonates of MC twins with sIUGR is not significantly different from that in normal MCDA twins. The majority of cases with mild cerebral injury is transient. But the prognosis is poorer in typeⅡ/Ⅲ. Therefore, it is important to monitor the intrauterine situation closely and terminate the pregnancy in time in order to decrease the rate of major cerebral injury.

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Clinical analysis of intravenous immunoglobulin combined with anticoagulant therapy in the treatment of combination antiphospholipid syndrome in the first trimester of pregnancy. LIN Lin,ZHANG Dan,WANG Xiao-cai,FENG Xiao-jing,ZHANG Yan-ying,GUO Shuai-shuai. 2015, 31(4): 354-356.  DOI: 10.7504/fk2015030120 Abstract ( )   Abstract： Objective To analyze intravenous immunoglobulin combined with anticoagulant therapy in the treatment of combination antiphospholipid syndrome (APS) in the first trimester of pregnancy. Methods Retrospective analysis was done on 350 women with abnormal pregnancy history. After excluding other common reasons, carry out the measurement on anticardiolipin antibody (ACA) and anti β-glycoprotein 1 (β2-GP1) antibody, and then combine with the abnormal pregnancy history.Totally 79 patients were diagnosed with APS; 38 patients with APS accepted intravenous immunoglobulin with low molecular heparin and aspirin therapy; 26 patients with APS accepted low molecular heparin and aspirin therapy; 15 patients with APS was required to take aspirin orally. Results Among 38 patients with intravenous immunoglobulin and anticoagulant therapy, the pregnancy of 34 patients could last to the end of 13 weeks, and four patients suffered abortion, with the abortion rate of 10.5%; among 26 patients with APS with low molecular heparin and aspirin therapy, the pregnancy of 18 patients could last to the end of 13 weeks, and 8 patients suffered from abortion ,with the rate of 30.8%; among 38 patients with APS taking aspirin orally, the pregnancy of 7 patients could last to the end of 13weeks, and 8 patients suffered from abortion, with the abortion rate of 53.3%. Conclusion Immunoglobulin with anticoagulant therapy in the treatment of combination APS in the first trimester of pregnancy can obviously improve the pregnancy outcome of the early pregnancy, and it is regarded as an effective method to cure the pregnancy combination APS.

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The application of multi-functional airbag abdominal pressure belt midwifery instrument use in midwifery and prevention of postpartum hemorrhage. ZHAO Shao-fei, WEN Ji-ying, NIU Jian-min, XIA Jian-hong, CHEN Bu-yun, ZOU Wen-xia. 2015, 31(4): 357-360.  DOI: 10.7504/fk2015030121 Abstract ( )   Abstract： Objective To explore the effect of the multi-functional airbag abdominal pressure belt in midwifery and prevention of postpartum hemorrhage. Methods Select 100 natural delivery cases of the hospitalized primiparae at the hospital, and divide them randomly into two groups. In the observation group, 50 primiparae used the multi-functional airbag abdominal pressure belts during the second and third stages of labor, and in the control group, 50 did not use the belts. Delivery outcomes of the primiparae and their fetus were observed.Results The average duration of the second stage of labor, head emergence to delivery, placenta delivery and postpartum hemorrhage were all shorter in the observation group (P< 0.05). There was no statistical difference in episiotomy rate, maternal signs 2 hours postpartum, neonatal Apgar score or neonatal cord blood gas analysis (P< 0.05). No statistical difference was found in primipara signs and fetal heart rate change of the primiparae under different internal pressures of the airbag during the second labor stage in the observation group (P> 0.05). Conclusion By closely monitoring and appropriately adjusting the internal pressure of the airbag, the multi-functional airbag abdominal pressure belt can speed up the second and third stages of labor, prevent postpartum hemorrhage and promote natural delivery.

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Progress of research in cesarean scar pregnancy. YIN Li-li,YANG Qing. 2015, 31(4): 361-365.  DOI: 10.7504/fk2015030122 Abstract ( )   Abstract:Cesarean scar pregnancy (CSP) is a specific ectopic pregnancy with the gestational sac implanted in a previous cesarean scar. With the increasing rate of cesarean section deliveries, the rate of CSP had increased exponentially. Due to delayed in diagnosis and treatment,it may result in life-threatening conditions such as massive vaginal bleeding or uterine rupture, or even loss of life. The pathogenesis, diagnosis and treatment of CSP have not unified standard.The research of pathogenesis is conduced to the prophylaxis of CSP.Early diagnosis and rational treatment can avoid severe complication.