Uterine mesenchymal tumours: recent advances

Almost all uterine mesenchymal tumours have been historically classified as either smooth muscle or endometrial stromal neoplasms. Recent application of molecular techniques has identified numerous lesions with distinctive genetic abnormalities and clinicopathological characteristics. Newly discovered uterine sarcoma subtypes include high-grade endometrial stromal sarcomas with BCOR genetic abnormalities, fibrosarcoma-like uterine sarcomas with NTRK rearrangements and COL1A–PDGFRB fusions, as well as undifferentiated uterine sarcomas with SMARCA4 mutations. Novel PLAG1 and PGR fusions have been identified in subsets of myxoid and epithelioid leiomyosarcomas. Some uterine tumours resembling ovarian sex-cord tumour harbour GREB1 and ESR1 rearrangements. Histological and immunophenotypical features as well as underlying genetic abnormalities defining these lesions are discussed.     

经阴道三维超声评价未破裂卵泡黄素化综合征患者卵巢储备功能分析

目的 分析经阴道三维超声对于未破裂卵泡黄素化综合征患者卵巢储备功能评价的价值。 方法 选择不孕症患者100例作为研究对象，根据相关评价标准将确诊为未破裂卵泡黄素化综合征者200例作为研究组，其他正常排卵不孕者80例作为对照组，对比2组各卵泡期子宫内膜厚度、血清性激素6项水平、各卵泡期优势侧卵巢血流参数及围排卵期成熟卵泡血流分级情况。 结果 2组血管化指数、血流指数及血管化血流指数在组间、时点间及组间·时点间交互作用差异均有统计学意义（P＜0.01）。对照组围排卵期成熟卵泡血流多为3~4级，研究组多为1~2级，差异有统计学意义（P＜0.01）。 结论 血流量低、成熟卵泡新生血管数量少是未破裂卵泡黄素化综合征的血流灌注特点，经阴道三维超声检查，更利于早期评价卵巢储备功能，指导临床识别、预测卵泡发育不良及早期排卵障碍。     

Bronchogenic cyst of the stomach:A case report

BACKGROUND Gastric bronchogenic cysts(BCs)are extremely rare cystic masses caused by abnormal development of the respiratory system during the embryonic period.Gastric bronchial cysts are rare lesions first reported in 1956;as of 2019,only 37 cases are available in the MEDLINE/PubMed online databases.BCs usually have no clinical symptoms in the early stage,and their imaging findings also lack specificity.Therefore,they are difficult to diagnose before histopathological examination.CASE SUMMARY A 55-year-old woman presented at our hospital with intermittent epigastric pain.She had a slightly high level of serum carbohydrate antigen 72-4(CA 72-4).Endoscopic ultrasound found that a cystic mass originated from the submucosa of the posterior gastric wall near the cardia,indicating a diagnosis of cystic hygroma of the stomach.Furthermore,a computed tomography scan demonstrated a quasi-circular cystic mass closely related to the lesser curvature of the gastric fundus with a low density.Because the imaging examinations did not suggest a malignancy and the patient required complete resection,she underwent laparoscopic surgery.As an intraoperative finding,this cystic lesion was located in the posterior wall of the fundus and contained some yellow viscous liquid.Finally,the pathologists verified that the cyst in the fundus was a gastric BC.The patient recovered well with normal CA 72-4 levels,and her course was uneventful at 10 mo.CONCLUSION This is a valuable report as it describes an extremely rare case of gastric BC.Moreover,this is the first case of BC to present with elevated CA 72-4 levels.     

常规综合性护理和循证护理在腹腔镜下行卵巢囊肿剥离术患者中的应用效果

目的探讨常规综合性护理和循证护理在腹腔镜下行卵巢囊肿剥离术患者中的应用效果。方法选取在我院采用腹腔镜进行卵巢囊肿剥离术的80例患者作为研究对象,随机将其分为研究组与对照组,各40例。对照组采用常规综合性护理干预,研究组患者在对照组基础上采用循证护理干预。比较两组的治疗依存性、护理质量评分及术后并发症发生情况。结果研究组的治疗依从率明显高于对照组(P<0.05)。研究组的心理舒适、知识掌握、住院须知、护理巡视评分均高于对照(P<0.05)。研究组的并发症总发生率显著低于对照组(P<0.05)。结论循证护理应用于腹腔镜下行卵巢囊肿剥离术患者中,能提高护理依从性和护理质量,降低术后并发症发生率。     

反向添加疗法联合醋酸亮丙瑞林在子宫内膜异位症病灶切除术后的应用效果及对机体Th1/Th2漂移现象的影响

目的探讨反向添加疗法联合醋酸亮丙瑞林在子宫内膜异位症(EM)病灶切除术后的应用效果及对机体Th1/Th2漂移现象的影响。方法选取2016年6月至2018年1月本院收治的96例EM患者作为研究对象,采用随机抽签法将其分为对照组(46例)与观察组(50例)。两组均接受腹腔镜下EM病灶切除手术,术后,对照组给予皮下注射醋酸亮丙瑞林治疗,观察组给予反向添加疗法联合醋酸亮丙瑞林治疗。比较两组的治疗效果。结果治疗后,两组的血清LH、AMH和腰椎BMD水平均明显下降,但观察组高于对照组(P<0.05)。治疗后,两组的血清IFN-γ水平及IFN-γ/IL-4均升高,IL-4水平均降低,观察组优于对照组(P<0.05)。随访18个月,观察组复发率明显低于对照组(P<0.05)。结论反向添加疗法联合醋酸亮丙瑞林应用于EM病灶切除术后,可有效纠正机体生殖激素表达,减少骨量丢失,促进患者卵巢功能恢复,纠正Th1/Th2漂移现象,预防疾病复发。     

Timing of Uterine Artery Embolization for Leiomyoma during the Menstrual Cycle

PurposeTo investigate differences in outcomes of uterine artery embolization (UAE) for leiomyoma when performed during different phases of the menstrual cycle.Materials and MethodsIn this single-institution retrospective analysis, 111 premenopausal patients (median [range] age, 44 [33–52] years) undergoing UAE for symptomatic leiomyoma between June 2014 and February 2020 were included. Twenty-one patients underwent UAE in the menstrual phase (the early follicular phase), 27 in the late follicular phase, and 63 in the luteal phase. Baseline characteristics and technical and peri-procedural outcomes were compared among groups. Leiomyoma infarction on contrast-enhanced magnetic resonance imaging 1 week after UAE and 4-month outcomes, including changes in the Uterine Fibroid Symptom and Quality of Life questionnaire scores, the volume reduction rates of the uterus and largest leiomyoma, follicle stimulating hormone values, adverse events, and amenorrhea, were compared among groups.ResultsA 4-month follow-up was completed for all patients. No significant differences were observed among groups in baseline characteristics or technical and peri-procedural outcomes. There were no significant differences in the multivariate-adjusted 1-week infarction rates of all leiomyoma volumes (P = .161) or multivariate-adjusted 4-month outcomes, including changes in the Uterine Fibroid Symptom and Quality of Life questionnaire symptoms and total scores (P = .864 and P = .798, respectively), the volume reduction rates of the uterus and the largest leiomyoma (P = .865 and P = .965, respectively), and follicle stimulating hormone values (P = .186) among the groups. No significant differences were noted in the 4-month adverse events (P = .260) or amenorrhea (P = .793) among the groups.ConclusionsThe present study demonstrated no significant differences in the outcomes of UAE for leiomyoma when performed during different phases of the menstrual cycle.     

Robotic treatment of bowel endometriosis

Endometriosis describes a condition with the presence of ectopic endometrial glands and stroma outside the endometrial cavity that affects up to 15% of reproductive-aged women. Of women affected with endometriosis, 3.8–37% will have endometriosis involving the bowel, primarily the rectosigmoid colon. While medical management is often recommended as a first-line therapy, it is not curative, and surgery is often required as an adjunct for the management of symptoms. Minimally invasive surgery has become the standard of care for managing these patients. The use of robotic-assisted laparoscopy offers benefits that may allow surgeons to perform these challenging surgical cases using a minimally invasive technique. For lesions that affect the colon, there are three primary techniques used for removal which include: 1) rectal shaving, 2) discoid excision and 3) segmental resection. The decision to pursue one approach over another is largely dependent on the number of lesions present, a lesion's size and depth of invasion as well as the involved circumference of the bowel. The available evidence of using robotic-assisted laparoscopy in cases of bowel endometriosis is limited in the literature. In this review, we will summarize the role of robotic-assisted laparoscopy in the management of bowel endometriosis.     

关节镜手术与开放手术治疗腘窝囊肿临床疗效的meta分析

目的 运用meta分析的方法探讨关节镜手术与开放手术治疗腘窝囊肿的临床疗效。方法 计算机检索PubMed、EBSCO、The Cochrane Library数据库、中国知网、万方数据库,检索内容为关节镜手术和开放手术治疗膝关节腘窝囊肿的临床随机对照试验(randomized controlled trial,RCT)半随机对照试验 (qRCT),检索时限为2000年1月至2017年9月。按纳入、排除标准进行文献筛选和质量评估,然后采用Newcastle Ottawa Scale(NOS)文献质量评价量表对文献进行质量评估,应用Rev Man 5.3软件进行meta分析。结果 纳入8篇文献,499例患者,关节镜手术组259例,开放手术切除组240例。本次meta分析表明,两组之间在术后复发率、术后感染率、术后好转率及手术切口长度之间相比,关节镜手术组相对于开放手术组有一定优势;而在手术时间及术后Lysholm评分之间关节镜组和开放手术组相比无明显优势,差异无统计学意义。结论 关节镜手术治疗膝关节腘窝囊肿与开放手术治疗腘窝囊肿相比,具有手术创伤小、术后并发症少、复发率低、恢复快等优势,同时还具有可处理伴发的关节内病变等优势。