妇科肿瘤标志物的分类

肿瘤标志物(tumor marker)是指由肿瘤组织产生的存在于肿瘤组织本身,或分泌至血液或其它体液,或因肿瘤组织刺激,由宿主细胞产生而含量明显高于正常组织,并与肿瘤的发生、发展密切相关的一类物质.目前发现的肿瘤标志物有80余种,较为常用的有30余种,随着肿瘤标志物研究的不断深入,估计肿瘤标志物的种类和所涉及的肿瘤将会不断增加.有关肿瘤标志物的分类尚无统一的分类标准.     

Umbilical fistulas in Crohn's disease

Four patients with enteroumbilical fistulas complicating Crohn's disease are described herein. We recommend that, in such patients, the affected small intestine be excised and the umbilical sinus debrided.     

Stapler stricturoplasty for Crohn's disease

The operation of stricturoplasty for Crohn's disease is now widely accepted as a procedure that has enabled the preservation of the small intestine that would otherwise have been resected. This is particularly important when there are multiple and scattered strictures, in which short intestinal syndrome can be avoided. We have used automatic staplers for this technique with excellent results for 30 strictures in nine patients.     

Crohn's disease and pregnancy.

Crohn's disease is occasionally associated with pregnancy, but only rarely does the firth manifestation of Crohn's disease appear during pregnancy. Two cases of Crohn's disease commencing during pregnancy are reported. The English-language literature reveals eight others-a total of 10. Review of these 10 cases indicates that surgery was required during pregnancy or shortly afterward in six. The 10 pregnancies yielded 11 infants, six of whom died. In this unusual situation there is an increased risk to both mother and infant. Progress of the intestinal disease may make surgical treatment during pregnancy urgently necessary.     

Rectourethral fistulas in Crohn's disease

Rectourethral fistula is an uncommon complication of Crohn's disease. When the rectum is apparently spared of active Crohn's disease, repair by an advancement flap of the rectum may be used, with or without temporary fecal diversion. Three such fistulas were reported successfully using this technique.     

Lymphangioleiomyomatosis suspected to be a gynecologic disease

Lymphangioleiomyomatosis (LAM) is a rare, systemic disorder that predominantly affects women. Although patients with LAM mostly present with pulmonary symptoms, some patients may present initially with extrapulmonary symptoms. We present a case of a 30-year-old Japanese female with abdominal pain during menstrual periods was suspected of having ovarian cancer due to exaggerated ascites observed at a local clinic. Subsequently, she was transferred to our hospital for further investigations, and was diagnosed with LAM. Three years after diagnosis, she had a girl by cesarean section to avoid the progression of pulmonary LAM by vaginal delivery. The patient is undergoing follow-up treatment with the administration of gonadotropin-releasing hormone-analog. Though LAM is rare, gynecologists should know about it because it may occur with gynecological symptoms in young women.     

A surgical experience with Crohn's disease

From 427 histories of patients with Crohn's disease admitted to St. Michael's Hospital between 1 January 1974 and 31 March 1983, 152 patients were studied as each had at least one operation related to the disease. The age at onset of symptoms, the interval between onset of symptoms and operation, the site of disease, operations performed, the type and frequency of repeat operations and the morbidity, mortality and follow-up period were studied. The small intestine only was involved in 55 per cent of the patients, the large intestine only in 16 per cent, and both the small and large intestine in 29 per cent. The most frequent indication for operation was obstruction (29 per cent); the next was perianal disease (18 per cent). The most common procedure was resection of the lowest segment of the small intestine with adjacent colon (37 per cent). The second most common operation was perianal operation (19 per cent). There were three deaths (2 per cent mortality rate). One hundred and thirty patients (93 per cent) have been examined within the past three years. Life tables show the cumulative chance of having an operation for Crohn's disease.     

Crohn's disease of the vulva.

Over the past 10 years, it has been well established that Crohn's disease may involve any segment of the gastrointestinal tract from the mouth to the anus and may also cause destructive extraintestinal lesions. Extensive cutaneous ulceration has recently been recognized as one of the rare extraintestinal complications. A case of chronic vulvar ulceration due to Crohn's disease is reported. The clinical manifestations and management of such a lesion are discussed.     

Von Willebrand's disease in gynecologic practice: Number 263, December 2001

Von Willebrand's disease is one of the most common inherited bleeding disorders. Inherited and acquired disorders of coagulation and hemostasis should be considered in the differential diagnosis of menorrhagia and abnormal uterine bleeding. This Committee Opinion provides screening recommendations for von Willebrand's disease and describes treatment options.     

"Nongynecologic" surgical procedures performed on a gynecologic oncology service

One thousand fifty-eight patients had major surgery in a community-based, university-affiliated gynecologic oncology service. Of these, 233 underwent a total of 275 "nongynecologic" surgical procedures. Two hundred twenty patients suffered from gynecologic malignancies, whereas 13 had surgery for benign disorders. Eighty-two procedures were performed on the gastrointestinal tract, 44 on the urinary tract, and 149 on extrapelvic lymph nodes. Except for ovarian carcinoma and benign conditions the majority of gastrointestinal or urinary tract operations were preceded by radiation therapy. When the nongynecologic operation was necessitated at a time subsequent to initial therapy of the malignancy, a high incidence of recurrent disease was discovered. Of the 275 procedures, reoperation because of early or late complications was necessary in only 8 instances. Only one postoperative death was caused by complications of surgery. Other mild postoperative complications were transient and responded to routine noninvasive care. The complication rate and morbidity of nongynecologic surgical procedures performed on a gynecologic oncology service are low and should encourage gynecologic oncologists to continue their present comprehensive approach to patient care.     

Minilaparotomy in the management of benign gynecologic disease

BACKGROUND: Considering the enormous advantages of minimally invasive surgery, attempts to explore less invasive trans-abdominal incisions could represent an alternative to laparoscopic gynecologic surgery. The aim of this study was to assess the feasibility and clinical outcome of minilaparotomy in a large series of patients. METHODS: In this retrospective study we describe our 6-year experience on 252 patients undergoing surgery by minilaparotomy for benign adnexal or uterine disease. Surgical treatments included total abdominal hysterectomy, myomectomy, mono or bilateral salpingo-oophorectomy and adnexal surgery. RESULTS: The mean population age and BMI were 39.2 years (+/-13.2 S.D.) and 23.6 (+/-3.31 S.D.), respectively. The mean operative time was 75.4 min (+/-31.8) and the estimated blood loss was never significant except in two cases (0.8%). The mean duration of ileus was 1.58 days (+/-0.6 S.D.) and the mean days until discharge were 3.06 (+/-1.14 S.D.), with a significantly lower duration of recovery in the group of simple adnexal surgery with respect to the others (p = 0.0001). No severe early post-operative morbidity was observed. CONCLUSIONS: The current report describes minilaparotomy as a feasible surgical approach in benign gynecological diseases. The operative time is quite similar or shorter than reported for laparoscopy, laparotomy and vaginal surgery. The estimated blood loss is not significant as well as the duration of the ileus and discharge. Moreover, a prospective randomised study, already ongoing in our department, will better answer the question of whether minilaparotomy could be an alternative to laparoscopic and vaginal surgery.