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    02 May 2015, Volume 31 Issue 5 Previous Issue    Next Issue

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    The present situation and prospects of hysteroscopic complications in diagnosis and therapy.
    XIA En-lan.
    2015, 31(5): 369-373.  DOI: 10.7504/fk2015040101
    Abstract ( )   PDF (1027KB) ( )  

    Abstract: Hysteroscopic diagnosis and treatment for intrauterine lesions is minimally invasive and effective. But serious complications such as uterine perforation, bleeding, fluid overload, hyponatremia, air embolism and rupture of pregnant uterus after hysteroscopic metroplasty occur frequently. In order to improve the hysteroscopic operation safety hysteroscopic complications which occurred in recent years were reviewed in this paper to investigate the cause and prevention method of complications of hysteroscopic surgeries.

    Pay attention to prevention of complications in gynecologic laparoscopy surgery.
    LI Guang-yi.
    2015, 31(5): 374-377.  DOI: 10.7504/fk2015040102
    Abstract ( )   PDF (948KB) ( )  

    Abstract: Gynecological laparoscopic surgery has been very popular.At present,it has become a gynecologist's necessary skill.Although laparoscopic surgery has the advantage of less trauma, less bleeding and faster recovery,but due to lack of exposure to a limited field of vision and touch feeling,it will increase the risk of injury.In this paper,technical training, mastering the operation indications, getting familiar with all kinds of equipment operation, intraoperative judgment, mastering the operation details,getting familiar with the basin and abdominal cavity anatomy and surgery group tacit cooperation were reviewed to analyze laparoscopic surgery complications.

    Reasons of laparoscopic entry injuries and the prevention strategy.
    ZHOU Ying-fang.
    2015, 31(5): 385-388.  DOI: 10.7504/fk2015040103
    Abstract ( )  

    Abstract:Laparoscopic entry injuries,which occur during the establishment of pneomoperitoneum by Veress needle or trocar inserting,are specific complications associated with laparoscopy only. These include the vessel injuries of the abdominal wall,intraperitoneal and retroperitoneal as well as those of the gastrointestinal tract. At present, the laparoscopic surgeries are so advanced that the percentage of laparoscopic entry injuries is decreasing among total laparoscopic complications. The laparoscopic entry injuries, yet, may be still severe and fatal, remaining to be one of the main reasons of conversion to open surgery. In this article, the reasons of laparoscopic entry injuries and the prevention strategy are discussed through literature review as well as author’s clinical experience.

    Complications of laparoscopic treatment for bowel endometriosis: prevention and treatment.
    LIANG Yan-chun, YAO Shu-zhong.
    2015, 31(5): 388-392.  DOI: 10.7504/fk2015040104
    Abstract ( )  

    Abstract:Bowel endometriosis (BE) is one of the common types of deep infiltrating endometriosis. The preferred treatment for BE is laparoscopic surgery. There is a close relationship between the endometriotic foci of BE and the reproductive tract, the urinary tract. Different kind of complications may arise during and after laparoscopic treatment for BE. This article analyses the reasons of these complications and suggests some practical and effective methods in the prevention and treatment of this complications.

    Management and prevention of laparoscopic urinary injuries during gynecologic operation.
    YE Ming-xia,MENG Yuan-guang,LI Li-an,ZHANG Wei-yi.
    2015, 31(5): 392-395.  DOI: 10.7504/fk2015040105
    Abstract ( )  

    Abstract:The purpose of this paper is to discuss the prevention and treatment of urinary system injury, which including traditional mechanical and thermal damage, during the process of gynecological laparoscopic surgery for clinical practice. The surgeon has to fully understand the pelvic anatomy and anatomical feature in the screen of laparoscope and master the clinical manifestations of urinary system injury during the intraoperative and postoperative period, and be familiar with the working principle and functional characteristics of laparoscopic energy equipment to avoid vice-damage of energy equipment. we need to pay attention to the early discovery and early treatment when injured. We choose the therapy method according to the overall consideration of the surgeon's experience, ability and objective conditions. The therapeutic principle is to relieve symptoms with minimal trauma.

    Complications and their management in lymphadenectomy for laparoscopic gynecologic malignancies.
    KANG Shan .
    2015, 31(5): 395-398.  DOI: 10.7504/fk2015040106
    Abstract ( )  

    Abstract:Laparoscopic pelvic and para-aortic lymphadenectomy, which is more and more widely used in surgeries of the three most common gynecologic malignant tumors, is known for its clean and fully exposing surgical field, thorough dissection and less surgical bleeding. However, its compilations have not decreased, especially intraoperative vein injuries. Methods of laparoscopic repairing include direct suture and posterior peritoneum suture after padding hemostatic materials,which can repair most vein injuries during laparoscopy without additional open surgery.

    Problems related to laparoscopic myomectomy and their management.
    WANG Dan-dan, YANG Qing.
    2015, 31(5): 399-402.  DOI: 10.7504/fk2015040107
    Abstract ( )  

    Abstract:Laparoscopic myomectomy (LM) has been suggested as one of the effective treatments for patients with symptomatic myomas,being advantageous for limited pain,less blood loss,clear surgical field,cosmesis,faster recovery and so on. Surgeons should be more experienced and skilled to do LM.With the development of techniques, LM has broadened indications and been more widely used clinically. However, at the same time, we should highlight the related complications such as hemorrhage,fibroids missing and recurrence,distant pregnant uterine rupture,latent malignancy implantation and dissemination, and propose strategy for prevention and cure.

    The prevention of the vascular injury by using the digital three dimensional model of in vivo pelvic vessels.
    CHEN Chun-lin, DUAN Hui.
    2015, 31(5): 402-407.  DOI: 10.7504/fk2015040108
    Abstract ( )  

    Abstract:Once the large vessels were injured during laparoscopic surgery, it will lead to serious complications. Although it is important to repair the damage immediately, but prevention is more critical. We can prevent the vascular injury by reconstructing digital three dimensional models of patients’ in vivo vascular network to understand the individual anatomy after analyzing the reasons and positions of the vascular injury. Through the models we can develop preoperative injury prevention strategies, guide procedure and standardize physician training.

    Prevention and management of the complications due to the use of common power devices in gynecological laparoscopic operation.
    CUI Man-hua, XU Tian-min, YANG Ru-lin.
    2015, 31(5): 407-411.  DOI: 10.7504/fk2015040109
    Abstract ( )  

    Abstract:The present study reviewed the species and the working principles of the common power devices used in the gynecological laparoscopic operations. The organs that were always involved in thermal damage related to power devices, the reason of thermal damage and the characteristics of the complications due to the use of power devices were also analyzed in detail.Based on this ,the authors put forwards the prevetion and the treatments of the complications due to the use of common power devices in gynecological laparoscopic operation.

    Prevention and management of air embolism in hysteroscopy.
    FENG Li-min,ZHAO Shuo.
    2015, 31(5): 411-414.  DOI: 10.7504/fk2015040110
    Abstract ( )  

    Abstract:Air Embolism is a potentially fatal complication,and the gynecologist plays a key role in the management of air embolism,from diagnosis to treatment.The article reviews the literature on air embolism regarding its incidence,etiology,diagnosis and therapy aiming at emphasizing the importance of comprehensive mamagement.

    Standardized managemene of endoscopic operation in gynecology.
    LU An-wei, QIN Juan.
    2015, 31(5): 414-418.  DOI: 10.7504/fk2015040111
    Abstract ( )  

    Abstract:With rapid development of gynecological endoscopic techniques, iatrogenic complications increased accordingly. The key to reducing the complications is to emphasize the standardized training. Standardized training of basic theory and clinical skills is essential to being an endoscopic surgeon. Standardized training plays an important role in the prevention and treatment of surgical complications to ensure the surgical safety.

    Qualitative study on the fine structure of the cervical cancer.
    CHEN Chun-lin*, HUANG Zhi-xia*, LIU Ping*, LI Wei-li*, ZHANG Yan, WANG Li-ling*,WANG Jun*,MO Ke-xin*, LIU Yun-lu*.
    2015, 31(5): 440-444.  DOI: 10.7504/fk2015040115
    Abstract ( )  

    Abstract: Objective To investigate the fine structure of cervical cancer, in order to elucidate tissue components. Methods Thirty-three fresh specimens of cervical cancer were collected from cervical biopsy and radical hysterectomy from June to October 2014 at Nanfang Hospital, and were used for qualitative research by HE staining, special staining and a variety of immunohistochemical staining. Results 1.In addition to lots of cancer cells with different differentiation, cervical cancer was rich in fibrous connective tissue, including collagen and elastic fibers, no muscle fiber; it also contained a lot of blood vessels, including microvascular vessels;it contained many lymphatic vessels, no lymph nodes; lymphatic and vascular invasion was found in a part of cervical cancer. 2. In addition to the basic structure, nerve fibers were found in some cervical cancer. (1) The positive cases of nerve-specific marker S-100 were 14 and the ratio was 42.42%.(2) The positive cases of sympathetic nerve-specific marker TH were 7, with the ratio of S-100 positive cases in 50%. The positive cases of parasympathetic nerve-specific marker VIP were 5, with the ratio of S-100 positive cases in 35.71%. (3) The positive cases of newborn nerve-specific marker GAP-43 were 11, with the S-100 positive in 78.57%. Conclusion In addition to the basic structure of the cancer cells, fibrous connective tissue, blood vessels and lymphatic vessels, cervical cancer also contains nerve fibers, and most of the nerve fibers are newborn nerve,with the content of sympathetic nerve slightly higher than parasympathetic nerve.

    Maternal and fetal outcomes in placenta increta managed by a multidisciplinary care team.
    WANG Xiao-yi,SUN Wen, LI Zhi-hua, ZHOU Yan-mei, XIAO Xue,YU Lin, LIN Lin, SU Chun-hong, CHEN Dun-jin.
    2015, 31(5): 445-448.  DOI: 10.7504/fk2015040116
    Abstract ( )  

    Abstract: Objective To investigate maternal and fetal outcomes in placenta increta managed by a multidisciplinary care team. Methods A retrospective study was performed in 81 cases of placenta increta between January 2005 and January 2014 in the Third Affiliated Hospital of Guangzhou Medical University.The women were divided into multidisciplinary care team group in whole process,multidisciplinary care team group in the stage of delivery and standard obstetric care team group. The maternal and fetal outcomes in placenta accreta was evaluated.Results The blood loss[(1453.2±991.2)mL and (1536.4±1001.3)]mL,packed red blood cells (pRBCs) transfusion[(592.1±301.2 )mL and (632.4±279.8)mL] and early composite morbidity[26.5%(9/34) and 31.8%(7/22)] in multidisciplinary care team group in whole process and multidisciplinary care team group in the stage of delivery were lower than standard obstetric care team group[(1889.3±1403.4) mL、(721.4±298.1) mL and 60.0%(15/25)](P<0.05). Conclusion multidisciplinary care team management can improve maternal outcomes of placenta increta, but not neonatal ones.

    Application of suturing technique in partial placenta previa adhesions or implanted.
    GAO Wen-yan,CHEN Hai-ying,SUN Man-ni,MENG Tao.
    2015, 31(5): 449-452.  DOI: 10.7504/fk2015040125
    Abstract ( )  

    Abstract: Objective To investigate the safety and effectiveness of suturing technique used in partial placenta previa adhesions or implanted. Methods From January 2009 to January 2013 ,there were 4306 cases of delivery in the First Affiliated Hospital of China Medical University, including 82 cases of placenta previa (incidence 1.90%). Excluding dangerous placenta previa, twins, marginal placenta previa and other pregnant women with bleeding disorders,totally 64 pregnant women with placenta previa accepted cesarean section,in which partial placenta adhesions or implanted were found intraoperatively;these women were divided into two groups (parity grouping method respectively). Experimental group: suturing technique was used to deal with placenta adhesions or implanted. Control group:with placenta adhesions or implanted were routinely handled and then hemostatic measures used. Comparatively analyze postoperative condition of pregnant women in two groups. Results There were statistically significant differences in the reduction of Hb,operation time,the proportion of uterine artery ligation.Both groups had no incidence of residual placenta and trophoblastic disease after surgery.

    Clinical value of recombinant human adenovirus type 5 in transarterial chemoembolization in patients with cervical cancer.
    ZHANG Ping, CHEN Long, ZHANG Wei-na, ZHANG Sheng-miao.
    2015, 31(5): 453-457.  DOI: 10.7504/fk2015040117
    Abstract ( )  

    Abstract: Objective To evaluate the clinical value of recombinant human adenovirus type 5 in transarterial chemoembolization in patients with cervical cancer. Methods A total of 92 patients with cervical cancer (ⅠB2-ⅡB) from June 2008 to December 2014 were divided into two groups. Experimental group (47 patients) received recombinant human adenovirus type 5 and transarterial chemoembolization,while the control group (45 patients) received transarterial chemoembolization only.Totally 84 cases received operation therapy after 3-4 weeks. The tumor size, levels of SCC-Ag and HR-HPV,operation situation, postoperative pathology and toxicity of the two groups were compared respectively. Results  Compared with control group(84.44%), the tumor regression rate of the experimental group(89.36%) had no significant difference(χ2=0.49,P=0.484);there was no significant difference (χ2=2.31,P=0.128) between experimental group(78.72%) and control group(64.44%) in terms of the decreased level of SCC-Ag;the expression level decrease of HR-HPV in experimental group(57.45%) was significantly more than that of the control group(28.89%) (χ2=7.63,P=0.006).  Blood lose(t=3.57,P<0.001)and vascular tumors bolt(χ2=7.11,P=0.008) decreased significantly, but the total positive rate of lymph nodes(χ2=0.70,P=0.404), parametrium invasion (χ2=1.74,P=0.188) and parametrial infiltration (χ2=1.30,P=0.254) had no significant difference between the two groups. The incidence of the high fever had significant difference(χ2=9.21,P=0.002). Conclusions   In the treatment of transarterial chemoembolization for the cervical cancer, recombinant human adenovirus type 5 can be beneficial to the operation and reinforce the treatment effect, and do not increase the adverse reaction rate. It is a treatment method worthy of being explored in the research field of  cervical cancer.

    The mechanism of SATB1 over-expression in protecting human trophoblast from oxidative stress injury.
    LUO Xin*, ZHUANG Bai-mei*, LI Qing-shu, RAO Hai-ying*, LIU Xi-ru*, QI Hong-bo*,CHEN Dun-jin.
    2015, 31(5): 458-462.  DOI: 10.7504/fk2015040118
    Abstract ( )  

    Abstract: Objective To investigate the mechanism of SATB1 overexpression in protecting human trophoblast from oxidative stress injury. Methods Immunohistochemistry and Western blotting were used to determine the expression of SATB1 in placental tissue. Construct the overexpression lentivirus vectors of SATB1 (LV-SATB1) and negative control vectors (LV-NC). Cell treatment and classification of each group were as follows: normal culture group, H/R culture group, LV-SATB1+ H/R culture group, LV-NC+ H/R culture group. The expression and localization of SATB1 were detected by WB and indirect immunofluorescence. Flow cytometry was adopted to identify the level of reactive oxygen species (ROS) and the apoptotic index of cells. Changes of cell invasion rates were identified by transwell matrigel invasion assay. Results The level of SATB1 protein decreased in placental tissues of preeclamptic compared to that in normal third trimester (0.24±0.02 vs. 0.12±0.01, t=9.35,P<0.05) . Transfected LV-SATB1 increased the expression of SATB1 notably in H/R group (0.92±0.17 vs. 0.58±0.15,P<0.01). The apoptosis index and accumulation of ROS in HTR8/SVneo cells induced by H/R could be reversed by transfected LV-SATB1 effectively (P<0.01) . The invasion rates of cells decreased significantly in H/R group, while transfected LV-SATB1 could enhance the invasion rates in cells exposed to H/R (34.33±10.08 vs. 19.33±6.52,P<0.05) . Conclusions Up-regulation of SATB1 can reverse the oxidative stress injury of trophoblast. SATB1 is expected to be the new target for the pathogenesis of preeclampsia.

    The significance of the digital three-dimensional reconstruction of presacral vessel and pelvic blood vessels based on magnetic resonance imaging.
    ZHANG Xiao-wei, WU Hao, WEN Yan-li,XU Li, CHEN Li-quan.
    2015, 31(5): 463-466.  DOI: 10.7504/fk2015040119
    Abstract ( )  

    Abstract: Objective To explore the significance of the digital three-dimensional reconstruction of presacral vessel and pelvic blood vessels based on magnetic resonance imaging. Methods Between February and May 2012,25 cases who underwent routine MRI examination for benign pelvic diseases were recruited. The ACHIEVA 3. 0TX MR was employed to perform the e? THRIVE3D voxel dynamic contrast?enhanced MRI sequence imaging. The presacral area of the vascular net was reconstructed by using the Software Minics 10.0.Results Presacral vessel three-dimensional reconstruction could clearly display the abdominal aorta, inferior vena cava, bilateral common iliac artery, external iliac and internal iliac artery and vein. The middle sacral artery was displayed in 18 cases, the middle sacral vein was displayed in 6 cases and the lateral stem vein was displayed partly. The middle sacral artery in 18 cases were all the small branches of common iliac artery. The diameter of median sacral artery was 2.3mm(1.2-3.6mm).The middle sacral vein was all opened into the left common iliac vein, and the diameter of median sacral veins was 3mm(1.7-4.6mm).Conclusions The e-THRIVE sequence of MRI used to scan pelvic blood vessel can reconstruct the three-dimensional model of pelvic blood vessel, and the display rate of the middle sacral artery is higher,and the middle sacral vein and lateral stem vein can be displayed in some cases .

    The expression and significance of Sema 3A and its receptors in endometriosis.
    LIANG Yan-chun, WANG Wei, HUANG Jia-ming, TAN Hao, GUO Lu-yan, CHEN Yu-qing, YAO Shu-zhong.
    2015, 31(5): 467-472.  DOI: 10.7504/fk2015040120
    Abstract ( )  

    Abstract: Objective To study the expression of Sema 3A and its receptors (Plexin A1 and NRP-1) in endometriosis, and to explore the role of Sema 3A in the pathogenesis of endometriosis. Methods Samples were collected from 90 women undergoing endometrial biopsy or surgery for endometriosis and 26 controls receiving surgery for myoma or infertility in Department of Obstetrics and Gynecology, First Affiliated Hospital of Sun Yat-sen University (from January 1 to December 31, 2013). Immunohistochemistry was used to detect the expression of Sema 3A, Plexin A1 and NRP-1 in eutopic endometrium from women with (n=22) or without endometriosis (n=26), and in ectopic endometriotic foci of peritoneal (PEM, n=24), ovarian (OEM, n=24) and colorectal (CREM, n=20) endometriosis. The expression of three proteins were compared with those of 22 eutopic endometrium in patients with endometriosis (EuE-EM) and 26 eutopic endometrium in patients with non-endometriosis (EuE-NEM). Results The expression of Sema 3A in EuE-EM was significantly higher than that in EuE-NEM (P<0.01). There were no significant differences between the expression of Sema 3A, Plexin A1 and NRP-1 in ectopic endometrial epithelial cells of PEM, OEM and CREM (P=0.22、P=0.21、P=0.09). The expression of Sema 3A, Plexin A1 and NRP-1 in ectopic endometrial epithelial cells of peritoneal, ovarian and colorectal endometriosis was significantly higher than that of eutopic endometrial epithelial cells from patients with or without endometriosis (all of the p values were less than 0.05). Conclusion Overexpression of Sema 3A, Plexin A1 and NRP-1 in different types of endometriotic foci indicates that Sema 3A and its receptors may play an important role in the pathogenesis of endometriosis.