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Objective To investigate the related factors of de novo stress urinary incontinence after pelvic floor reconstruction.Methods Retrospectively analyzed the clinical data of 714 patients who acceptted pelvic reconstruction surgery in our hospital from November 30,2005 to November 30,2015.Among the 714 cases,there were 544 cases without preoperative urinary incontinence.The possible related factors of de novo SUI caused by operation were statistically analyzed.Results There were 151 cases of de novo stress urinary incontinence after pelvic floor reconstruction,the incidence was about 30.5%.With a history of diabetes,fetal delivery,pelvic surgery and POP surgery(laparoscopic vaginal apical fixation of sacrum) were the risk factors for de novo stress urinary incontinence after pelvic floor reconstruction,and the OR values were 2.575,5.286,1.671 and 1 respectively.There was no correlation between other general data and POP stage(P<0.05).Conclusion When performing pelvic floor reconstruction surgery for POP patients with high risk factors,it's better to have urinary incontinence surgery simultaneously according to individual circumstances and wishes.
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Objective To study the desired therapeutic effect of vaginoplasty using sigmoid colon or peritoneum for entire vaginal atre-sia.Methods From May 2015 to October 2015,8 patients with complete vaginal atresia in our hospital performed vaginoplasty using sigmoid colon or peritoneum successfully.The operation methods,prognosis and therapeutic effect and quality of sexual life of two groups were com-pared and analyzed to investigate a perfect operative method and ideal nursing.Results Laparoscopic vaginoplasty using the peritoneum compared with that using sigmoid colon has advantages of shorter time of operation,less bleeding,less trauma and quicker recovery.However, artificial vagina using sigmoid colon was much more similar to a natural vagina in morphological and physiological characteristics,merely ac-companied by excessive mucus discharge during the postoperative period.At lower risk of vaginal adhesion and stenosis,laparoscopically as-sisted vaginoplasty using sigmoid colon graft also puts high technical requirements.Two patients normally developed uterus menstruate regular-ly.Four patients without uterus and 2 patients with rudimentary uterus experienced good sexual intercourse after vaginoplasty.Conclusion Patients with complete colpatresia who have normal womb should creat a patent and functional vagina until adolescence to restore its physio-logical and reproductive function.Anatomical reconstructive treatment of vaginal agenesis for patients with absent or hypoplastic uterus can be postponed till the late teens or in the adult.Both laparoscopic sigmoid vaginoplasty and peritoneal vaginoplasty achieve a minimal-invasive, cosmetic,natural lubricous, smooth artificial vagina for patient’ s sex life satisfactory.
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Objective To summarise the clinical characteristics, treatment and prognostic analysis of relapse in vaginal stump after treatment of cervical cancer and endometrial cancer, and to offer assistance to clinical diagnosis and treatment. Methods Clinical data of 28 patients (admitted in our hospital from Sepetember 2002 to July 2014) with cervical cancer and endometrial cancer after a simple hysterecto-my were retrospectively analyzed. According to the illness, the 28 cases were given partial vagina resection, total vaginal resection and ex-panded vaginal resection. Observe whether the prognostic is in correlation with lymph node metastasis, adjacent organs involvement, interval of recurrence and tissue differentiation degree. Results Median survival time of patients with well or poor differentiation were 40 and 15 months respectively(P<0. 05);and the 3 year survival rates were 66. 1% and 30. 7% respectively (P=0. 03). Median survival time of pa-tients with or without lymph node metastasis were 18 and 40 months respectively (P< 0. 05);and the 3 year survival rates were 0 and 24%respectively(P<0. 05). Median survival time for interval of recurrence of more than 24 months and less than or equal to 24 months were 28 and 16 months respectively (P<0. 05). Conclusion The surgical treatment of vaginal stump carcinoma is safe and effective, and the prog-nostic is in correlation with lymph node metastasis, adjacent organs involvement, interval of recurrence and tissue differentiation degree.
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Objective To investigate the relationships between baseline R2? of blood oxygenation level-dependent magnetic resonance imaging(BOLD-MRI) and Semi-quantitative parameters of dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI) in cervical cancer,to lay a foundation for the further development of assessing tumor hypoxia techniques. Methods Twenty-four patients with cervical cancer were subjected to DCE-MRI and BOLD-MRI before treatment,Semi-quantitative parameters(SI-I、MER、Tmax、IAUC) of DCE-MRI and the baseline R2?of BOLD-MRI produced by special post-processing softwares,the relationships between baseline R2?of BOLD-MRI and Semi-quantitative parameters of DCE-MRI were analyzed. Results Significant positive correlations were observed between baseline R2?and Tmax(r=0.423,P=0.014),there were no correlation between baseline R2? and SI-I、MER or IAUC(P>0.05). Conclusion Semi-quantitative parameters of DCE-MRI and baseline R2? of BOLD-MRI respectively reflected the oxygenation of tumor in different principle. The combined use of the above parameters is expected to improve the performance for defining tumor hypoxia.
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Objective To evaluate the biocompatibility of acellular bladder matrix patch as the pelvic floor repair alternative ma-terial .Methods The combination of in vivo and in vitro biological experiments including cytotoxicity ,haemolysis and vaginal im-plant tests were employed to evaluate the biocompatibility of this material .Results In the cytotoxicity test ,the material toxicity was the grade 0-1 .The hemolysis rate of the material extract liquid was 1 .5% .The general and histological observation showed that the material did not cause the host immunologic rejection and led to slight foreign body reaction after implanting ,which was ba-sically degraded in 12 weeks after transplantation .Conclusion Acellular bladder matrix exhibits better biocompatibility ,but needs to adjust its degradation rate in order to adapt to the requirements of pelvic floor repair operation .
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Objective To investigate the clinical features ,diagnosis and treatment of cesarean scar pregnancy (CSP) .Methods We retrospectively analyzed the medical history ,clinical manifestation ,diagnoses ,treatments and outcomes of 42 patients with ec‐topic pregnancy in the cesarean scar .Results All cases got diagnosed by transvaginal ultrasound .The error rate of first diagnosis was 40 .4% (17/42) .There were 25 cases of conservative therapy ,in which 12 cases were resolved with laparoscopic surgery and 1 case resolved with open surgery ;in the first process 15 cases were carried out laparoscopic surger in which 1 case were converted to laparotomy ;abdominal surgery were underwented in 1 case and were cured .Only one case underwent abdominal total hysterectomy as of failure after uterine artery embolization .After initial conservative treatment 3 cases were hospitalized again and 2 cases under‐went reoperation .41 patients were successfully retained the uterus and normal menstrual cycle returned at two months after opera‐tion .Conclusion The early diagnosis for CSP mainly depended on ultrasound and the thickness of incision muscle layer is an impor‐tant basis for choice of treatment .Checking the thickness of incision muscle layer for CSP mainly depended on ultrasound ,and lapa‐roscopic surgery is an ideal method for diagnosis and treatment of CSP .
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Objective To study the effects of muscular trumatic fluid on the biological properties of muscle-derived stem cells (MDSCs) in rats.Methods MDSCs were isolated and purified by the preplate technique,muscle injury was made for the extraction of muscular traumatic fluid.Bradford colorimetric was used to detect the protein content in the muscular traumatic fluid,and the fluid with the highest protein was used to co-culture with MDSCs.Methyl thiazolyl tetrazolium (MTT) assay and wound model of monolayer of cells were used to observe the effects of wound fluids on the proliferation and mobility of MDSCs.The expressions of α-SMA and Vimentin were tested by immunohistochemistry and Western blot technique.Results MTT assay showed that wound fluid with concentration of 10% could most significantly increase the proliferation of MDSCs.The increased expressions of α-SMA and Vimentin were found in MDSCs after cultrue with muscular traumatic fluid in vitro,and the time-dependent relation exists.Conclusions Wound environment can directly participate in the muscle regeneration by inducing the proliferation,mobility of MDSCs;on the other hand,MDSCs can differentiate into fibrotic cells under stimulation of muscular traumatic fluid.
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Objective To investigate feasibility of laparoscopic anatomical nerve sparing radical hysterectomy (LANSRH) used for locally advanced cervical cancer treatment and evaluate early recovery of bladder function postoperatively. Methods From October 2006 to September 2007, 37 cervical cancer patients with stage Ⅰb1 to Ⅱ a underwent LANSRH(LANSRH group) with pelvic lymphadenectomy matched 25 patients with cervical cancer treated by general laparoscopic radical hysterectomy (LRH,LRH group) with pelvic lymphadenectomy. The data of operating time, blood loss, numbers of lymph node, the length of resected vaginal and paracervix tissue were collected and compared. In the mean time, postoperative recovery of bladder function was evaluated. Results The laparoscopic anatomic nerve-sparing procedure was performed successfully and safely among all patients. (1) There was no remarkable difference in the following clinical parameters between LANSRH and LRH group: median operating time [(175±41) min vs. (178±30) min, P=0.72 ], blood loss [(233±104)ml vs. (218±77) ml, P=0.06], numbers of lymph nodes (13±4 vs. 15±6, P=0.16), resected length of paracervix tissue [(3.6±0.5)cm vs. (3.7±0.6) cm, P=0.43], resected length of vaginal tissue [(3.5±1.0)cm vs. (3.5±0.8) cm, P=0.80]. (2) The mean time of the Foley catheter removed was (10.6±2.7)days(7-17 days)in LANSRH group and (17.2±4.2)days(9-25 days)in LRH group (P=0.02). After Foley catheter removed, 95% (35/37) presented bladder fulfilling sense, 86% (32/37) presented automatic micturition and urination emptying in LANSRH group. However, In LRH group, 88% (22/25) presented bladder fulfilling sense, 76% (19/25) presented automatic micturition and urination emptying. The bladder void function recovery were 68% (25/37) in class 0 and 3% (1/37) in class Ⅱ in LANSRH group, when compared with 40% (10/25) in class 0 and 12% (3/25) in class Ⅱ in LRH group, it reached statistical difference (P<0.05). In the mean time, there was no significant difference in Class Ⅰ bladder void function recovery, which were 24% (9/37) and 48% (12/25). (3) No surgery complications and blood transfusion were observed in LANSRH and LRH group. Postoperative pathology suggested that no tumor cell invasion occurred in paracervix tissue and lymph nodes. During the range of 11 to 19 months follow-up, all patients were alive without tumor recurrence and metastasis. Conclusion LANSRH is safe and feasible surgical management for cervical cancer at early stage and would improve the recovery of bladder voiding function postoperatively by sparing anatomical nerve.
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Objective To assess the clinical efficacy of laparoscopic uterine artery blockage for the treatment of adenomyosis. Methods Laparoscopic uterine artery blockage was performed in 38 patients with adenomyosis. Enucleation and excision or vaporization of endometriosis were performed at the same time in patients with chocolate cyst of ovary and endometriosis. Lysis of adhesion and presacral neurectomy were performed in some patients. Symptoms and uterine volumes of all patients were investigated after the treatment. Results Relieved clinical symptoms were found in all 38 patients. Menorrhagia was reduced to (56?16)%. Complete disappearance of dysmenorrhea was found in 17 patients (44.7%), significantly alleviated in 14 patients (36.8%), partially alleviated in 6 patients (15.8%), but ineffectiveness in 1 patient (2.6%). Pain score and classification were decreased significantly (P
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Objective To investigate the possibility and efficacy of laparoscopic peritoneal vaginoplasty for the treatment of congenital absence of vagina. Methods A total of 4 patients with congenital absence of vagina underwent laparoscopic peritoneal vaginoplasty. Results Operations were performed successfully in the 4 cases. The mean operative time was 114 min (range: 90-160 min), and the mean postoperative hospital stay was 5.4 d (range: 5-6 d). There was no complication in all patients. Conclusion Laparoscopic peritoneal vaginoplasty is a safe, minimally invasive, and reliable method for the treatment of congenital absence of vagina.
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Objective To evaluate the effects of different laparoscopic approaches for hysteromyomectomy. Methods Hysteromyomectomy was performed on 126 patients who required surgical treatment and preservation of the uterus from August 2000 to December 2002 with different laparoscopic approaches. A follow-up for 2-28 months was conducted in all patients. Results There were 70 cases of subserous fibroids, 53 cases intramural fibroids, and 3 broad ligament fibroids in those 126 patients. The average diameter of the fibroids was 6.1 cm (3-12 cm). The diameter of the fibroids less than 5 cm was found in 33 patients (26.2%), but equal to or larger than 5 cm in 93 patients (73.8%). A single myoma was found in 57 patients (45.2%), but numerous myomas in 69 patients (54.8%). Hysteromyomectomy, hysteromyomectomy and uterine artery blockage, and hysteromyomectomy and temporary uterine artery blockage were performed on 26, 70, and 30 patients, respectively. Operations were successful in all patients. There were no intra- and post-operative complications. Conclusion Different laparoscopic approaches for hysteromyomectomy can result in satisfactory clinical outcomes when different case properties and different requirements of patients are taken into consideration.
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Objective To investigate the significance of endoglin in the angiogenesis of ovarian carcinoma.Methods Immunohistochemical assay was used to investigate 70 tissue samples of pathologically identified epithelial ovarian tumor(including 31 specimen of benign and 39 of malignant)from December 2000 to December 2003 in our department using monoclonal antibodies against CD34 and endoglin.Microvessels density(MVD)was counted by experienced pathologists.Results No significant difference of MVD for CD34 was observed in the ovarian cystadenoma and ovarian carcinoma.In contrast,an increment of MVD for endoglin from low-grade to high-grade dysplasia and that from earlier stage to later stage was statistically significant.Conclusion Endoglin may be a valuable marker for assessing neovascularization in the process of ovarian carcinoma development and for predicting the risk of ovarian carcinoma development.
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Objective To construct a lentiviral vector expressing small-hairpin RNA(shRNA) targeting Smad3 gene.Methods The targeting sequence of Smad3 gene which can be effectively silenced in RNA inference was confirmed in our previous study.The cDNA containing both sense and antisense Oligo DNA fragments of the targeting sequence was designed,synthesized and cloned into the pGCSIL-GFP vector.The obtained lentiviral vector containing Smad3 shRNA was confirmed by PCR and sequencing.293T cells were cotransfected with lentiviral vector GC-shSmad3,pHelper 1.0 and pHelper 2.0.The titer of virus was tested according to the expression level of GFP.Results PCR and DNA sequencing demonstrated that the constructed lentivirus vector GC-shSmad3 produced Smad3 shRNA.The titer of concentrated virus was 3?108 TU/ml.Conclusion The lentivirus RNAi vector targeting Smad3 is constructed successfully.
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Objective To investigate collagen metabolism in stress urinary incontinence(SUI) so as to determine the alteration that contributes to SUI.Methods Biopsy specimens of vaginal wall tissue from 24 women with stress urinary incontinence were collected,with matched specimens from 24 female patients without SUI.Immunohistochenical technique were applied to detect the expression of MMP-1 and TIMP-1.Results SUI group demonstrated a significant increase in MMP-1 expression and a decrease in TIMP-1 expression,with significant difference with control group.Conclusion Patients with SUI were in the predominant status of collagen breakdown,which may contribute to the pathogenesis of SUI.
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Objective To study the relationship between uterine receptivity and estrogen receptor, progesterone receptor on endometrial epithelial cells of LPD. Methods Integrinβ3 subunit, ER,PR on endometrial epithelial cells of LPD swere datermined by immunmohisto chemical analysis. Results Integ rin β3 subunit was significantly decreased, while estrogen receptor and progesterone receptor were significantly elevated in glandular epithelial cells from tissue samples with LPD. Concluslon Uterine receptivity is decreasedin women with LPD, which is closely assosciated with failure of ER、PR downregulation in middle luteal phase.
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Objective To establish a co-culture system between mesenchymal stem cells (MSCs) and smooth muscle cells (SMCs) in vitro, and study the influence of SMCs on the differentiation of bone marrow MSCs (BMSCs) into SMCs in the co-culture system. Methods Density gradient centrifugation was used to separate and culture BMSCs, and collagenase digestion was employed to separate and culture bladder smooth muscle cells(BSMCs). Then the 2 types of cells were identified respectively. Then the cells were divided into 4 groups, BMSCs culture group (positive control), BSMCs cells culture group (negative control), BMSCs and BSMCs co-culture groups with contact or non-contact. The expression of ?-smooth muscle actin (?-SMA) and calponin were detected by immunofluorescence staining. Western blot analysis was employed to determine protein expression of calponin. Results In contact co-culture group, the positive rate of CD90 abd CD44 were 99.78% and 60.27% respectively in BMSCs, while only 0.21% for CD45. Western blotting showed that BMSCs expressed little calponin, but those contacting with BSMCs had an increasingly stronger expression of calponin with the elapse of contact culture time, while there was no significant change in its expression in BMSCs with contact. Immunofluorescence staining indicated that part of BMSCs were calponin positive at the 8th day after culture, but no positive cell was observed in non-contact culture group and BMSCs culture group. Conclusion The contact between BSMCs and BMSCs can promote the differentiation of BMSCs into SMCs.