Risk Factors for Recurrence of Ovarian Endometriosis in Chinese Patients Aged 45 and Over / 中华医学杂志(英文版)

<p><b>Background</b>When considering the issue of recurrence, perimenopausal women may have more dilemma during management comparing with young women, for example, whether to retain the uterus and ovary during surgery, whether it is necessary to add adjuvant medicine treatment after operation, and there is no evidence for reference about using of gonadotropin-releasing hormone agonist. This study aimed to study the risk factors for the recurrence of ovarian endometriosis (EM) in patients aged 45 and over.</p><p><b>Methods</b>This is a retrospective nested case-control study. We reviewed the medical records of patients aged over 45 years who underwent surgical treatments for ovarian EM from 1994 to 2014, in Peking Union Medical College Hospital of Chinese Academy of Medical Sciences. By following up to January 2016, 45 patients were found to have relapses and regarded as the recurrence group. The patients with no recurrence during the same follow-up period were randomly selected by the ratio of 1:4 as the nonrecurrence group (180 patients in total). Stratified Cox regression was used to analyze the risk factors of the recurrence.</p><p><b>Results</b>Univariate analysis showed that there was a significant difference in the postoperative treatment (the percentage of patients who received postoperative treatment in non-recurrence group and recurrence group, 23.9% vs. 40.0%, χ = 4.729, P = 0.030) and ovarian preservation (the percentage of patients who received surgery of ovarian preservation in non-recurrence group and recurrence group, 25.0 % vs. 44.4%, χ = 19.462, P < 0.001) between the nonrecurrence group and the recurrence group. There was no correlation between recurrence and the following factors including patient's age, menarche age, gravidity, parity, CA125 level, ovarian lesions, menopausal status, combined benign gynecological conditions (such as myoma and adenomyoma) and endometrial abnormalities, and surgical approach or surgical staging (all P > 0.05). Multivariate analysis indicated that whether to retain the ovary was the only independent risk factor of recurrence for patients aged 45 years and over with ovarian EM (odds ratio: 5.594, 95% confidence interval: 1.919-16.310, P = 0.002).</p><p><b>Conclusion</b>Ovarian preservation might be the only independent risk factor of recurrence for patients aged 45 years and over with ovarian EM.</p>

Reevaluating the role of dilation and curettage in the diagnosis of ectopic pregnancy / 中国医学科学院学报

<p><b>OBJECTIVE</b>To evaluate the clinical role of dilation and curettage (DC) in the diagnosis of ectopic pregnancy (EP).</p><p><b>METHODS</b>We retrospectively reviewed the clinical data of 108 patients with pregnancy of unknown location who underwent a DC with an abnormal rise in β-human chorionic gonadotropin (β-HCG) level and without visible intrauterine pregnancy (IUP) on transvaginal ultrasound and 24 patients who did not receive DC with β-HCG>5 000 IU/L.The final diagnosis depended on β-HCG trend review after DC and the pathologic and laparoscopic findings.</p><p><b>RESULTS</b>Overall, 65.3% of the patients were finally diagnosed with EP and 34.7% were found to have a nonviable IUP.Those with EP had significantly higher initial β-HCG than those with nonviable IUP.IUP patients were more likely to have had a history of delivery.Among the patients with β-HCG<2 000 IU/L, 40.0% of EP and 11.0% of IUP had endometrial echo complex no more than 5 mm (P=0.035). In β-HCG<2 000 IU/L and 2 000 IU/L<β-HCG<5 000 IU/L groups, the diagnostic rate of EP was 42.6% and 68.3% respectively (P=0.012). Among the patients with β-HCG>5 000 IU/L, there was no significant difference between those with DC and those without DC (96.7% vs.96%, P=0.915).</p><p><b>CONCLUSIONS</b>Ultrasound findings such as a thin endometrial echo complex and the presence of pelvic mass are associated with but are not diagnostic of an ectopic pregnancy.The patients with the suspected diagnosis of EP are 2 000 IU/L<β-HCG<5 000 IU/L, whereas DC remains important valuable to differentiate EP from nonviable IUP and to avoid misdiagnosis and unnecessary exposure to methotrexate. Because EP is the common final diagnosis in most of the patients with β-HCG>5 000 IU/L and pelvic mass and without intrauterine gestational sac, the value of DC decreases and laparoscopy can be considered directly.</p>

Evaluating the feasibility and safety of vaginal myomectomy in China / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Classically, myomectomy has been performed via laparotomy, but laparoscopic myomectomy has now become a valuable treatment option. Vaginal myomectomy as a minimal invasive procedure has also been evaluated; however, its feasibility and safety are controversial with few clinical trials published. This study was designed to evaluate the feasibility of vaginal myomectomy in China and to document any associated complications.</p><p><b>METHODS</b>From January 2005 to December 2010, 43 patients with symptomatic myomas were admitted for vaginal myomectomy in Peking Union Medical College Hospital (PUMCH). The indications, operative performance, postoperative complications and outcome of these patients were analyzed retrospectively.</p><p><b>RESULTS</b>Myomectomy was performed vaginally in all patients. The mean operating time was (66.4 ± 22.6) minutes and the mean operative blood loss and hospital stay were (78.3 ± 64.4) ml and (4.9 ± 3.3) days, respectively. Five (12%) patients developed febrile morbidity and experienced a high postoperative temperature (mean 38.4°C). Postoperative fever was associated with greater operative trauma, longer operative time and greater weight of the tumor (all P < 0.01). The cost of surgery was RMB (820.6 ± 339.1) Yuan ((124.3 ± 51.4) US dollars) and the total medical cost was RMB (4880.4 ± 1088.4) Yuan ((739.5 ± 164.9) US dollars). Three patients later conceived spontaneously and had uneventful vaginal deliveries. Only one patient had a tumor recurrence during the following-up period.</p><p><b>CONCLUSION</b>Vaginal myomectomy is a feasible and safe surgical procedure with low recurrence and complication rates.</p>

Unilateral sacrospinous ligament fixation for treatment of genital prolapse / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Genital prolapse affects 30% of middle-aged and older women and is becoming a major public health concern. Sacrospinous ligament fixation is an effective and safe procedure for vaginal vault prolaps with a low recurrence and complication rate. This study aimed to investigate the efficacy and safety of unilateral sacrospinous ligament fixation (SSLF) for the management of pelvic organ prolapse (POP).</p><p><b>METHODS</b>Forty patients with severe prolapse of pelvic organ undergoing unilateral SSLF were retrospectively studied. In this study, all patients were staged by the value of POP-Q. All procedures were performed by a senior physician. The characteristics of these patients and their immediate and short-term post-operative outcome were recorded. All patients were seen six weeks and six months after the surgery. The evaluation included standardized questionnaire and site-specific vaginal examination by one physician.</p><p><b>RESULTS</b>The average operation time was 65-92 minutes. The average blood loss was 83-188 ml. The average hospitalization time was 6.1 days. The average cost was 5885 yuan. The average day of urethral catheter removal after the operation was 2.1 days. The incidence of postoperative morbidity was 17.1%. One (2.4%) patient had hematoma in the right pelvic. The mean length of postoperative follow-up for 35 patients was 13.1 months. The rate of follow-up was 87.5%. One (2.9%) patient showed recurrent vaginal vault prolapse six months after the surgery. The objective success rate of pelvic organ prolapse was 85% (34/40). There was significant difference between the POP-Q of Aa, Ba, Ap, Bp, and D before and after operation (P < 0.001). Five (14.3%) patients complained lower back pain, gluteal pain or right groin pain. Three (8.6%) patients developed de novo stress incontinence. Vaginal disabsorbable sutures were found in three (8.6%) patients. One (2.9%) patient had de novo urge incontinence.</p><p><b>CONCLUSIONS</b>Unilateral SSLF was both cost and treatment effective management for severe pelvic organ prolapse, especially for severe ovaginae anterior prolapse and uterus prolapse of POP I, II or III. Main complications from this procedure included lower back pain, gluteal and groin pain and new onset of stress incontinence.</p>

Clinical assessment for three routes of hysterectomy / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Hysterectomy is a very common surgery in gynecology. Ideal surgery for hysterectomy is microinvasive with few complications. There are three major routes of hysterectomy that are currently used. The aim of this study was to identify the differences of peri-operative outcome among the patients who underwent the three different approaches.</p><p><b>METHODS</b>One hundred and one women undergoing hysterectomy for myoma had the procedure performed by laparoscopic assisted vaginal hysterectomy (LAVH), total vaginal hysterectomy (TVH) or total abdominal hysterectomy (TAH) in a randomized study. We compared the course of peri-operative and post-operative outcome for the three different approaches.</p><p><b>RESULTS</b>were evaluated by linear regression analysis, Fisher's exact test and Student's t test for independent samples.</p><p><b>RESULTS</b>The operation time among the three procedures was not significantly different (P > 0.05). The amount of blood loss in the TVH group was less than in the LAVH and TAH groups (P < 0.05). The pain score 3 hours after operation in the LAVH group was significantly lower than in the TAH and TVH groups (P < 0.001). The pain scores in the LAVH and TVH groups were lower than in the TAH group at 24 and 48 hours after operation (P < 0.01). The women who underwent LAVH and TVH had a shorter hospitalization stay (P < 0.001). The highest body temperature after operation in the TAH group was higher than that in LAVH and TVH groups (P < 0.001).</p><p><b>CONCLUSIONS</b>LAVH and TVH are better procedures for women requiring hysterectomy. The peri-operative and post-operative courses of TVH are better than LAVH, excluding the pain score 3 hours after operation. Vaginal hysterectomy is the most cost-effective approach but the final choice for the route of hysterectomy can depend on many factors such as gynecological disease, patients' health status and experiences of the gynecologist.</p>

Modified total pelvic floor reconstruction for repair of severe pelvic organ prolapse / 中国医学科学院学报

<p><b>OBJECTIVE</b>To evaluate the clinical outcome of a novel approach for pelvic floor reconstruction using synthetic mesh (modified total pelvic floor reconstruction) for treatment of pelvic organ prolapse.</p><p><b>METHODS</b>Modified total pelvic floor reconstruction was performed in 30 patients with severe pelvic organ prolapse (including vault prolapse). The clinical outcome of each patient was assessed.</p><p><b>RESULTS</b>The mean operation time was (74.2 +/- 21.5) minutes, and the mean blood loss was (103.3 +/- 40.1) ml. Among them, 23 patients (76.7%) were able to micturate spontaneously the next morning after surgery, with residual urine less than 100 ml. The mean post-operative hospital stay was (4.2 +/- 1.8) days. All patients were followed up for a medium of 6 months. Totally 93.3% and 96.7% of patients were objectively (according to Pelvic Organ Prolapse Quantitive Examination score) and subjectively (according to Prolapse Quality of Life) cured, respectively. During follow-up, only one patient was found to have asymptomatic erosion, and de novo urgent urinary incontinence was seen in 6.7% of patients. The most prominent complication was dyspareunia (66.7%). Although the post-operative sexual function was reported to be worse, no significant difference between patients' pre- and post-operative Pelvic Organ Prolapse/ Urinary Incontinence Sexual Function Questionnaire-12 scores was noted.</p><p><b>CONCLUSION</b>Modified total pelvic floor reconstruction is a safe, effective, and micro-invasive approach for severe pelvic organ prolapse repair; however, dyspareunia remains a main concern.</p>

Mutations in the D-loop region of mitochondrial DNA in ovarian tumors / 中国医学科学院学报

<p><b>OBJECTIVE</b>To investigate mutations in the D-loop region of mitochondrial DNA in ovarian tumors.</p><p><b>METHODS</b>The D-loop region of 25 epithelial ovarian tumors together with the adjacent normal tissues were amplified by PCR and sequenced.</p><p><b>RESULTS</b>Among the 25 ovarian tumors, 26 mutations were identified with the mutation rate of 32%. 19 mutations were detected in two cases of borderline carcinoma which was a special type of epithelial ovarian carcinoma. There were 6 microsatellite instabilities among the mutations and 11 new polymorphisms which were not reported previously in the GenBank.</p><p><b>CONCLUSIONS</b>The D-loop region of mitochondrial DNA is a highly polymorphoric and mutable region and the mutation rate is relatively high in patients with ovarian tumors.</p>