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Objective:To verify the efficacy and safety of daily oral minodronate in postmenopausal women with established osteoporosis.Methods:In this randomized, double-blinded, placebo-controlled trial, 262 postmenopausal women were enrolled. Patients were randomized to receive daily oral minodronate 1 mg with supplements of 500 mg calcium and 200 U vitamin D 3 ( n=130) or placebo ( n=132) with daily supplements of 500 mg calcium and 200 U vitamin D 3, for 48 weeks. The primary endpoint was the average bone mineral density (BMD) change in the lumbar vertebrae 48 weeks post-treatment. Secondary outcome measures was the incidence of vertebral fractures. Safety assessments included the rate of adverse events. Results:At the end of 48 weeks treatment, the average BMD change rate from baseline were: full analysis set results: (3.52±4.82)% in the minodronate group and (2.00±5.74)% in the placebo group; per-protocol set results: (3.99±5.05)% in the minodronate group and (2.07±6.20)% in the placebo group; the differences were all significant (all P<0.05). Vertebral fracture occured in 3 patients (2.3%, 3/132) in the placebo group, and 1 case (0.8%, 1/130) in the minodronate group ( P>0.05). The incidence of adverse events was 71.5% (93/130) in the minodronate group and 78.0% (103/132) in the placebo group ( P>0.05). Conclusion:Minodronate is effective and safe in the treatment of postmenopausal osteoporosis without severe side effects.
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Objective:To investigate the diagnosis, treatment and prognosis of ureteral endometriosis with hydronephrosis.Methods:A retrospective study was performed of 92 cases diagnosed as ureteral endometriosis with surgery confirmed in Peking University First Hospital from January 2000 to January 2021.Results:The incidence of ureteral endometriosis was 0.9% (92/10 222), with an average age of (40.0±6.0) years. Among 92 cases, urological symptoms and pelvic pain including dysmenorrheal, periodic abdominal pain were the main forms of clinical characteristics, while 11 patients (12%, 11/92) were asymptomatic. All patients with ureteral endometriosis had hydronephrosis and hydroureter before surgery, hydronephrosis were left sided in 48 (52%, 48/92) patients, right sided in 39 (42%, 39/92) patients, both sided in 5 (5%,5/92) patients. The distal and middle sections of ureteral obstructions existed in 73 (79%, 73/92) patients and 19 (21%, 19/92) patients, respectively. Out of the 92 ureteral lesions 71 (77%, 71/92) patients were extrinsic lesions, 21 (23%, 21/92) patients presented intrinsic lesions. Of the 38 cases who took preoperative radionuclide renal dynamic imaging examination, there were 6 (16%, 6/38) cases of mildly damaged, 7 (18%, 7/38) cases of moderately dameged, 14 (37%, 14/38) cases of severely damaged, and 11 (29%, 11/38) cases of normal renal function. Laparotomy was decided in 25 (27%, 25/92) patients, and laparoscopic surgery in 67 (73%, 67/92) patients. In cases of ureteral surgery, ureterolysis, partial ureteral resection and ureterocystoneostomy, partial ureteral resection and end-to-end ureteral anastomosis and nephroureterectomy were undertaken in 52 (57%, 52/92), 20 (22%, 20/92), 12 (13%, 12/92) and 8 (9%, 8/92) patients separately. The median follow up was 108 months (range: 6 to 240 months). During the follow-up period, 68 (87%, 68/78) patients took urinary ultrasound after surgery, and 60 (88%, 60/68) cases of hydronephrosis disappeared, and 8 (12%, 8/68) cases were better than before.Conclusion:Most of the patients with ureteral endometriosis are impaired with renal function, and early surgical treatment could effectively relieve urinary obstruction and promote the recovery of renal function.
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Objective:To measure the coagulation function of patients with adenomyosis so as to explore its relationship with increased menstrual amount and its clinical significance.Methods:From January 2014 to May 2019, clinical data of patients with hysterectomy in which 111 pathologically diagnosed adenomyosis (case group) and 115 with uterine myoma (control group) in Peking University First Hospital were retrospectively analyzed. The changes in coagulation function of the two groups were compared, and the correlation between coagulation and uterine volume in the adenomyosis group was analyzed.Results:(1) The activated partial thromboplastin time (APTT) was longer in the adenomyosis group than that in the uterine myoma group [(30.4±3.1), (29.6±2.5) s, respectively; P<0.05], while the thrombin time (TT) was shorter than that in the control group [(14.2±1.2), (14.6±1.0) s, respectively; P<0.05]. (2) According to the results of the Pearson correlation test, there was a positive correlation between prothrombin time (PT; r=0.135, P=0.042) and fibrinogen (FIB-C; r=0.139, P=0.036). (3) Platelet counts were higher in the anemia group of adenomyosis than that in the non-anemia group [(323±79)×10 9/L, (274±56)×10 9/L, respectively; P<0.05]. (4) FIB-C in non-anemia group of adenomyosis was lower than non-anemia group of uterine myoma [(2.8±0.5), (3.0±0.6) g/L, respectively; P<0.05], the anemia group of adenomyosis shortened TT compared with the anemia group of uterine myoma [(14.4±1.2), (15.2±0.9) s, respectively; P<0.05]. Conclusion:Patients with adenomyosis have abnormal coagulation function, which may be related to the increase amount of menstruation, and anemia may also be involved in coagulation disorders.
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Objective:To evaluate the incidence of deeply infiltrating endometriosis (DIE) among patients of pelvic endometriosis confirmed by pathology and to make analysis of its clinical and pathological characteristics.Methods:From January 1, 2018 to December 31, 2018, clinical data of 240 cases of pelvic endometriosis diagnosed by laparoscopy and pathology hospitalized in Peking University First Hospital were analyzed retrospectively for the characteristics of symptoms, pelvic examination and anatomic distribution of endometriosis foci.Results:(1) Among 240 cases of pelvic endometriosis, 94 were diagnosed with DIE with an incidence of 39.2% (94/240); of them the diagnosis were made preoperatively in 44 cases (46.8%, 44/94). (2) Compared with those without DIE, patients with DIE had higher rates of secondary dysmenorrhea [53.2% (50/94) versus 38.4% (56/146), P=0.033], anal pain [43.6% (41/94) versus 28.1% (41/146), P=0.013], dyspareunea [39.4% (37/94) versus 18.5% (27/146), P=0.001] and frequent bowel movement [33.0% (31/94) versus 15.8%(23/146), P=0.002]. (3) Patients with DIE had higher rates of bad movement of uterus [21.3% (20/94) versus 6.8% (10/146), P=0.001], painful nodularity on uterosacral ligaments [26.6% (25/94) versus 6.2% (9/146), P<0.01], painful nodularity of posterior fornix [19.1% (18/94) versus 4.8% (7/146), P<0.01], blue nodule in vaginal wall [6.4% (6/94) versus 0 (0/146), P=0.003] by pelvic examination compared with those without DIE. (4) Ninety-four patients with DIE had a total of 162 nodules, of those 88 (54.3%, 88/162) located in uterosacral ligaments, 14 (8.6%, 14/162) in the rectum, 7 (4.3%, 7/162) in vaginal wall, 6 (3.7%, 6/162) in ureter, 4 in bladder (2.5%, 4/162), 2 (1.2%, 2/162) in Douglas pouch. Forty-three DIE patients (45.7%, 43/94) had more than one nodules. Patients with DIE had concomitant ovarian endometriosis in 69 cases (73.4%, 69/94), with a total of 103 endometrial cysts. (5) Patients with DIE had a higher rate of obliterated Douglas pouch [76.6% (72/94) versus 19.2% (28/146), P<0.01]. Conclusions:More than one third of patients with pelvic endometriosis have concomitant DIE with a lower rate of preoperative diagnosis. Pelvic pains, bad movement of uterus and painful nodulirity around cervix suggest the presence of DIE.
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Objective:To further understand the current status of diagnosis and treatment of endometriosis in China, the implementation of guideline in different levels of hospitals, and the need for continuing education in endometriosis among primary doctors.Methods:The survey was conducted in the form of convenience sampling questionnaire among the Wechat public platform. The doctors were free to participate in the investigation without any reward. All questions answered were assessed as valid questionnaire. The datas were collected on the questionnaire network platform and analyzed by SPSS 19.0.Results:Totally 1 494 valid questionnaires were collected in this survey. 60.17% (899/1 494) of them were from tertiary hospital, and 32.60% (487/1 494) were from grade two hospital. Only the hospitals where 9.97% (149/1 494) participants based opened the specialist clinic for endometriosis. 70.35% (1 051/1 494) of participants said they had read the second edition of guideline for the diagnosis and treatment of endometriosis which published in 2015. The American Society for Reproductive Medicine (ASRM) staging system was adopted in the clinical practices of only 25.03% (374/1 494) participants. And 18.74% (280/1 494) participants used the endometriosis fertility index (EFI) scoring during the laparoscopic surgery for endometriosis with infertility. 45.18% (675/1 494) of participants said they had not attended any academic conference on endometriosis in the past six months. 64.46% (963/1 494) of the participants believed their diagnosis and treatment in practice should be improved and standardized. 87.15% (1 302/1 494) of the participants expressed the hope that more conferences or workshops on endometriosis would be held.Conclusions:At presents, the diagnosis and treatment of endometriosis in China has been greatly improved, but the implementation of guidelines and the new concept is still a long-term job. The specialist clinic are held only in a few hospitals. It’s the expectation and voice of primary doctors to the association to organize the more academic congresses on endometriosis.
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Objective To evaluate the effects of parthenolide on estradiol?synthesizing enzyme, steroidogenic acute regulatory protein (StAR), and ER isoforms,VEGF in human endometriotic stromal cells. Methods Primary endometriotic stromal cells were treated with different concentrations (1, 5, 10 and 20 μmol/L) of parthenolide. The mRNA of StAR, ER isoforms (ERα and ERβ), PR, vascular endothelial growth factor (VEGF), interleukin?6 (IL?6), tumour necrosis factor?α (TNFα), tumour necrosis factor receptor (TNFR) 1, TNFR2 were measured by real?time PCR. The levels of estradiol and progesterone in the cell supernatant were measured by ELISA. Results Different concentrations of parthenolide could up?regulate the mRNA of StAR in primary endometriotic stromal cells (F=5.722, P<0.05); the mRNA of StAR in the group of 20 μmol/L was significantly higher than that of the control group [2.6 ± 0.3 versus 1.0, P<0.01]. Different concentrations of parthenolide could down?regulate the mRNA of ERα (F=6.921, P<0.01); the mRNA of ERα in the group of 20 μmol/L and 10 μmol/L were significantly lower than those of the control group [0.2 ± 0.3 versus 0.3 ± 0.3 versus 1.0, all P<0.05]. Different concentrations of parthenolide could down?regulate the ratios of ERα/ERβ mRNA levels (F=4.209, P<0.05). Different concentrations of parthenolide could up?regulate the mRNA of VEGF and TNFR1 (F=10.964, P<0.01; F=7.286, P<0.01). There were no statiscal significances with different concentrations of parthenolide on the mRNA of ERβ, PR, IL?6, TNFα and TNFR2, and the levels of estradiol and progesterone in the cell supernatant (all P>0.05). Conclusions Parthenolide may regulate the expression of estradiol?synthesizing enzyme, ER isoforms and angiogenesis in endometriotic stromal cells. Parthenolide may promote the development of endometriosis.
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Objective To compare the expression of leukemia inhibitory factor (LIF), interleukin-6 (IL-6) and vascular endothelial growth factor (VEGF) in tissue and fluid samples from patients with endometriosis, and investigate whether LIF and IL-6 regulate VEGF in human endometriotic stromal cells (ESC). Methods The levels of VEGF, LIF, IL-6 in serum, peritoneal fluid of patients with and without endometriosis were measured by ELISA. The mRNA of these three factors in the ectopic and eutopic endometrial tissue and stromal cells were measured by real-time PCR. ESC derived from ovarian endometriomas were cultured using the method of primary cell culture with LIF and IL-6, and the level of VEGF mRNA and protein were measured by the method of real-time PCR and ELISA respectively.Results VEGF and IL-6 concentration were 1.2 and 1.3 times higher in the serum of patients with endometriosis than in the control group [(94±19) versus (78±17) ng/L; (45±14) versus (35±9) ng/L; all P<0.05]. VEGF and IL-6 concentration were 1.2 and 1.4 times higher in the peritoneal fluid of patients with endometriosis than in the control group [(110±25) versus (91±21) ng/L; (69±20) versus (49±15) ng/L; all P<0.05]. VEGF and IL-6 concentrations in peritoneal fluid of patients with endometriosis were 1.2 and 1.5 times higher than in serum (all P<0.01). VEGF, LIF and IL-6 mRNA expression were 2.2, 8.6, 44.7 times higher in ESC compared with the matching eutopic endometrial stromal cells (all P<0.01). LIF and IL-6 mRNA were 2.0 and 64.8 times higher in ectopic endometrial tissue than the matching eutopic endometrial tissue (all P<0.05).ESC cultured with LIF, IL-6 and LIF+IL-6 induce VEGF protein secretion [(106±18), (124±30), (140±27) ng/L] by 1.3 , 1.5 and 1.7 times (all P<0.05). Conclusion Overexpression of LIF and IL-6 may synergistically contribute to upregulation of VEGF in ESC and promote development of endometriosis.
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Objective To elucidate whether metformin could regulate the mRNA expression level of estrogen synthetase and ER in human uterine leiomyoma tissues. Methods (1) Seventeen pairs of uterine leiomyoma tissues and adjacent myometrium (>2 cm) were collected from patients underwent hysterectomy in Peking University First Hospital between December 2016 and January 2017. Real-time PCR was used to measure the mRNA expression level of estrogen synthetase [including cytochrome P450 cholesterol side chain cleavage enzyme (P450scc), cytochrome P450 17 α-hydroxylase (P450c17), 3-beta-hydroxysteroid dehydrogenase type 2 (3β-HSD-2), 17-beta-hydroxysteroid dehydrogenase type 1 (17β-HSD-1) and aromatase cytochrome P450 (P450arom)] and ER (including ERα and ERβ) in the uterine leiomyoma tissues and adjacent myometrium. (2) Uterine leiomyoma cells derived from uterine leiomyoma tissues were identified by immunocytochemistry method and cultured to the third generation. The treatment groups were cultured with different concentrations of metformin (10, 50 and 100 μmol/L) for 48 hours, and the control group was cultured with deionized water for 48 hours. The mRNA expression level of estrogen synthetase and estrogen receptor subtypes were measured by real-time PCR. Results (1) P450scc, P450c17, 3β-HSD-2, 17β-HSD-1, P450arom mRNA median expression levels were 112, 4, 13, 42 and 194 in the uterine leiomyoma tissues, and were respectively 114, 5, 11, 32 and 6 in the myometrium. Compared to those of the myometrium, 3β-HSD-2 and P450arom mRNA expression levels in the uterine leiomyoma tissue were significantly higher (P<0.05), while there were no significant change of mRNA expression levels among P450scc, P450c17 and 17β-HSD-1 (P>0.05). ERα and ERβ mRNA median expression levels were 208 and 116 in the uterine leiomyoma tissues, and were 24 and 95 in the myometrium. Compared to that of the myometrium, ERα mRNA level in the uterine leiomyoma tissue was significantly higher (P=0.001), while there were no significant change of ERβ mRNA level (P=0.193). (2) After cultured with different concentrations of metformin (10, 50 and 100 μmol/L), the P450arom mRNA levels in the uterine leiomyoma tissues were 9 ± 4, 8 ± 5 and 8 ± 3 respectively in the treatment groups and was 16 ± 5 in the control group. Compared to that of the control group, P450arom mRNA expression levels in the treatment groups were significantly declined (P<0.05). There were no significant different change of mRNA expression levels among 3β-HSD-2, ERα and ERβ between the treatment groups and the control group (P>0.05). Conclusions Metformin could down-regulate the mRNA expression level of aromatase in the uterine leiomyoma cells. These results indicate that metformin may inhibit the local estrogen synthesis and therefore suppress the development of uterine leiomyoma.
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Objective To measure the uterine volume by ultrasonic imaging in nullipara patients with endometriosis and analyze its clinical significance. Methods From July 1st, 2016 to August 1st, 2017, 107 cases of nullipara patients with endometriosis hospitalized in Peking University First Hospital were selected as endometriosis group. Among 107 cases, 59 cases were in proliferative phase of menstrual cycle, 48 cases were in secretory phase; and 10 cases had an abortion history.Totally 101 cases of patients without endometriosis operated for other benign disease during the same period were chosen as the control group. All patients underwent laparoscopic surgery, and the diagnosis was confirmed by pathology. The uterine size was measured by transvaginal or transrectal color Doppler ultrasound, and the uterine volume was calculated according to the known formula. Results The uterine volume of the endometriosis group [(69±26) cm3] was larger than that of the control group [(54±18) cm3, P<0.01]. In the endometriosis group, the uterine volume of patients with pregnant history [(78±34) cm3] was larger than that of patients without pregnant history [(68± 25) cm3]. The endometrial thickness in endometriosis group was higher than that of the control group [(9.1± 3.5) versus (7.8±2.9) mm, P<0.05], and positively correlated with the uterine volume (r＝0.39, P<0.05). The hemoglobin in endometriosis group was lower than that in the control group [(124±12) versus (131±10) g/L, P<0.01], and was negatively correlated with the uterine volume in the two groups (rendometriosis=-0.12, rcontrol=-0.21; both P<0.05).The uterine volume of dysmenorrhea patients in the endometriosis group [(73±28) cm3] was greater than that of patients without dysmenorrhea [(62 ± 19) cm3, P<0.01]; both uterine volumes of patients with and without dysmenorrhea in endometriosis group were larger than those of patients with or without dysmenorrhea in the control group (P<0.05). The degree of dysmenorrhea in endometriosis group was positively correlated with the uterine volume (r=0.20, P=0.042). The uterine volume of stageⅣendometriosis patients [(79±30) cm3] was greater than that of stage Ⅲpatients in endometriosis group [(58±14) cm3, P<0.01]. Conclusion Patients with endometriosis are of increased uterine volume, which may be related to dysmenorrhea, menorrhagia and infertility.
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Objective To compare Masson staining,van Gieson staining,and Sirius red staining for evaluation of an intrauterine adhesion(IUA)model in rats. Methods In total,24 female adult Sprague-Dawley rats were selected and bilateral uteri exposed. To establish an IUA rat model, the left uterus was cut and the endometrium scraped using a scalpel. The right uterus was used as a control. Fourteen days after surgery, all uteri were collected for histological evaluation of IUA by hematoxylin and eosin(HE)staining,Masson staining,van Gieson staining,and Sirius red staining. Results HE staining showed that the endometrial epithelial layer of the uterus was absent, with a smaller number of endometrial glands than the control uterus(P < 0.01). Collagen fibers were clearly visible using all special staining method. The fibrotic area rate of uteri by Masson staining(using toluidine blue)was higher than Masson staining(using light green),van Gieson staining,and Sirius red staining(P< 0.01). Under polarized light,type I and type III collagen fibers were clearly distinguished by Sirius red staining,but not using Masson and van Gieson staining. Conclusions Sirius red staining is a superior method than Masson and van Gieson staining for evaluation of fibrosis in IUA and can also differentiate collagen fiber types.
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The non-surgical treatment of adenomyosis of the uterus is to relieve dysmenorrhea,to reduce heavy menstrual flow,and to retain or enhance fertility.The main therapeutic methods include medical therapy,uterine artery embolization,and focal ablation therapy (ultrasound-guided percutaneous microwave as well as high intensity focused ultrasound coagulation).For women who are not seeking pregnancy,the levonorgestrel-releasing intrauterine system (LNG-IUS) is the first-line medical therapy for heavy menstrual bleeding,with combined hormonal contraceptives as second choice and gonadotropin-releasing hormone agonist (GnRH-a) serving as preoperative treatment as well as postoperative treatment.For the patients with infertility,prolonged GnRH-a protocol with in vitro fertilization-embryo transfer (IVF-ET) may be the best choice.In this article,non-surgical treatment of adenomyosis of the uterus is discussed through literature review as well as author's clinical experience.
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Objective To evaluate the results of one-day care for gestational diabetes mellitus (GDM) and pregnancy outcome after application of new diagnostic criteria.Methods We retrospectively analyzed the clinical features of a GDM group (n=841) and a normal glucose metabolism group (n=3 043) who delivered in Department of Obstetrics and Gynecology,Peking University First Hospital between July 1,2011 and June 30,2012,to discuss the difference in maternal and newborn outcomes between these two groups,and to compare the maternal and newborn outcomes between the GDM one-day care group (study group,n=605) and non-GDM one-day care group (control group,n=236).Statistical analysis was performed by t test and x2 test.Results The average age of pregnant women with GDM was (31.5±4.2) years,which was higher than the normal glucose metabolism group (30.0±3.7) years (t=9.13,P＜0.01).The average age of the study group was (31.7±4.2) years,and the average age of the control group was (31.7±4.9) years,which was not a significant difference (t=2.32,P＞0.05).In the oral glucose tolerance test,fasting blood glucose level was (5.2±0.5) mmol/L,which was significantly lower than that in the control group (5.3±0.8) mmol/L (t=2.48,P＜0.05).The difference between 1 and 2 h glucose sugar levels did not differ significantly (P＞0.05) between the two groups.In the GDM and normal glucose metabolism groups of pregnant women,the incidence of macrosomia was 6.5％ (55/841) and 5.9％ (182/3 043),respectively,although the difference was not significant (x2=0.36,P＞0.05).In the GDM group,the rate of premature delivery was significantly higher than in the normal glucose metabolism group [preterm birth:10.1％ (83/841) and 7.4％ (225/3 043),x2=5.56; P＜0.05)].In the GDM group,gestational hypertension and mild pre-eclampsia were significantly more frequent than in the normal glucose metabolism group [gestational hypertension:4.2％ (35/841) vs 2.6％ (82/3 043),x2=4.85; mild pre-eclampsia:1.7％ (14/841) vs 0.9％ (26/3 043),x2=4.24; P＜0.05].The incidence of severe pre-eclampsia was 2.4％ (20/841) and 1.6％ (49/3 043),respectively,which was not significantly different (x2=2.22,P＞0.05) between the two groups.The rate of insulin use was 9.3％ (78/841) in the GDM group.In the study group,the rate of insulin use was 7.9％ (48/605),compared with 11.9％ (28/236) in the control group; this difference was not significant (x2=3.54,P＞0.05).In the study group,the incidence of macrosomia and hypertensive disorder complicating pregnancy (HDP) was similar to that in the control group [macrosomia:6.9％ (42/605) vs 5.3％ (13/236),respectively; x2=0.57; HDP:7.4％ (45/605) vs 9.9％ (24/236),x2=1.68; P＜0.05].The rate of premature delivery in the study group was significantly lower than in the control group [7.2％ (44/605) vs 16.0％ (38/236),x2=15.04,P＜0.05].In the study group,among the 561 cases of term birth,there were 42 cases of macrosomia.The average age of macrosomic and non-macrosomic pregnant women [(31.4±3.9) vs (31.7±4.2) years,t=4.27],pre-pregnancy body mass index [(23.5±3.9) vs (22.6±3.2),t=1.58],gestational weight gain [(16.1±5.6) vs (15.7± 11.4) kg,t=0.22] and pregnant weeks at visit to a one-day care clinic [(27.5 ± 4.3) vs (28.1 ± 2.8) weeks,t=0.86; P＞0.05] showed no significant differences.In women who delivered an infant with macrosomia,glycosylated hemoglobin levels in mid and late pregnancy were higher than in woman who did not deliver an infant with macrosomia [(5.6±0.4) ％ vs (5.4±0.4) ％,t=2.13,P＜0.05].Conclusions Through one-day care for GDM,the rate of preterm labor is reduced.This is a good model for group management of GDM women,and more efforts is required to improve its effect.
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Objective To investigate on the incidence of gynecological laparoscopic operation complications within ten years.Methods From January 2003 to December 2012,clinical data and the complications of 4 897 cases undergoing gynecological laparoscopic operation in First Hospital of Peking University were studied retrospectively.Those surgeries included 876 cases with hysterectomy,662 cases with myoectomy,3 266 cases with adnexa surgery,93 cases of diagnostic laparoscopy operation.Results The complications occurred in 29 cases,the incidence rate was 0.59％ (29/4 897).The Incidence rate in Hysterectomy group was 1.83％ (16/876),which was significantly higher than 0.60％ (4/662) in myoectomy group and 0.28％ (9/3 266) in adnexa surgery group.Twenty nine cases of complications were 14 cases with organ injures (48％,14/29),5 cases with hemorrhage complications (17％,5/29),8 cases with infectious complications (28％,8/29),2 cases with incisional hernia(7％,2/29).Conclusion The major complication of gynecological laparoscopic operation complication was organs injuries,which was associated with difficulty and scope of the operation.
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Objective To investigate the influence of previous abdominopelvic surgery on gynecological laparoscopic operation.Methods A retrospective analysis of 3 283 cases of gynecological diseases by laparoscopic operation patients in Peking University First Hospital from 2007 January to 2012 December,among them,719(21.90％) patients with previous abdominopelvic surgery history (study Group),2 564 (78.10％) patients have no history of abdominopelvic surgery (control group).Study group 719 patients,previous operation times:one time in 525 cases,194 cases were multiple; previous operation:185 cases of gynecological surgery,305 cases of obstetric surgery,108 cases of general surgery,and 121 complex surgery (include at least two kinds of surgery) ;previous operative approach:650 cases laparotomy and 69 cases laparoscopy.Compared two groups of patients with abdominopelvic adhesion and the gynecologic laparoscopic operation situation,analyzed the influence of previous abdominopelvic surgery on abdominopelvic adhesionon and gynecological laparoscopic operation.Results The incidence of abdominopelvic adhesion in the patients with previous abdominopelvic surgery was 51.2％ (368/719),which was significantly higher than that of 8.2％ (211/2 564) in patients without previous abdominopelvic surgery (P＜0.01).But the study group score (median 3) and the degree of abdominopelvic adhesion [mild 49.7％ (183/368),moderate 36.1％ (133/368),severe 14.1％ (52/368)] compared with the control group score (median 2) and degree [mild 55.0％(116/211),moderate 25.6％(54/211),and severe 19.4％(41/211)] were no statistical difference (P=0.930,P=0.684).Super-umbilical primary trocar site were chosen more common in patients with previous abdominopelvic surgery (23.1％,166/719) was significantly higher than that in the control group (3.3％,85/2 564; P＜0.01).And the rate of conversion to laparotomy was 0.6％ (4/719)significantly more than the control groups(0.l％,2/2 564; P=0.023).Compared with other groups,patients with gynecological or complex surgery or multiple operation history presented more severe abdominopelvic adhesion both in the score and degree (P＜0.01).The rate of super-umbilical primary trocar site,hospitalization time,operation time and bleeding during operation in patients with multiple operation history were significantly higher than those with single operation history (P＜0.05) ; the rate of blood transfusion,postoperative complication and conversion to laparotomy showed no statistical difference between the two groups (P＞0.05).Conclusion The laparoscopic operation could be carried out successfully and safely in patients with a history of various abdominopelvic operations,but the conversion rate increases,for patients with a history of multiple operation because of pelvic adhesion increases the difficulty of the laparoscopic operatio
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Objective To investigate the expression of steroidogenic factor 1 ( SF-1 ) in eutopic endometrium,ovarian endometriosis (EM) and adenomyosis.Methods From Jan.2008 to Dec.2010,30 patients with both ovarian endometriotic cysts and adenomyosis underwent hysterectomy,cystectomy or adenxectomy in Peking University First Hospital.The combination of ovarian EM and denomyosis were confirmed in 17 cases.In the mean time,endometria form 10 patients with cervical intraepithelial neoplasm ( CIN ) Ⅲ underwent hysterectomy were selected as controls.The expression of SF-l in eutopic endometrium,ovarian EM and adenomyosis was detected by immunohistochemistry staining.Results No immunoreactivity of SF-l was observed glandular cell and stromal cell in eutopic endometrium of both groups.14/17 of positive rate of SF-l were observed in lesions of ovarian endometriosis.SF-l protein was not expressed in the endometrial glandular cells of ovarian EM and in adenomyosis foci.Conclusion The differences of SF-l expression in ovarian endometrioma and adenomyosis foci might mediate the development of the disease.
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Objective To investigate the expression of integrin β3 and osteopontin(OPN) in eutopic and ectopic endometrium of adenomyosis. Methods From January 2007 to July 2008, the endometrium specimens were collected from 43 patients with adenomyosis undergoing hysterectomy in Peking University First Hospital. Eutopic endometrium were 11 in proliferative phase and 32 in secretory phase (18 cases in mid-secretory phase) were collected. Ectopic endometriums were also collected. In the mean time, it was chosen 41 cases with pure subserous uterine myoma or cervical intraepithelial neoplasia (CIN) Ⅱ-Ⅲ treated by hysterectomy as controls including 12 endometrium in proliferative phase and 29 endometrium in secretory phase (19 cases in mid-secretory phase). The expression of Integrin β3 subunit and OPN in the endometrium were assessed by immunohistochemical staining and quantitative real-time polymerase chain reaction. Results (1)Immunohistochemical staining showed that positive staining of integrin β3 and OPN were present predominantly in eutopic and ectopic endometrial glandular epithelium. There was significant different protein expression of integrin β3 and OPN, which were 1.6±0.8 and 1.7±0.7 in eutopic endometrium,1.7±0.7 and 1.8±0.9 in ectopic endometrium,2.1±0.9 and 2.0±0.9 in control endometrium (P<0.05). The protein expression of integrin β3 and OPN in eutopic endometrium of adenomyosis in the proliferative phase(0.8±0.4 and 0.7±0.3) were remarkably lower than those of the secretory phase(1.8±0.8 and 1.9±0.8,P<0.01). The protein expression of integrin β3 and OPN in the endometrium of controls in the proliferative phase(1.0±0.4 and 1.0±0.4) were significantly lower than those of the secretory phase(2.5±0.7 and 2.5±0.7)(P=0.000). In the mid-secretory phase, the protein expression of integrin β3(2.0±0.9) and OPN (2.1±0.8)in eutopic endometrium of adenomyosis were significantly lower than that of control endometrium(2.7±0.5 and 2.7±0.7)(P<0.01). (2)The mRNA expression level of integrin β and OPN in eutopic and ectopic endometrium were assessed by quantitative real-time PCR(result was shown by median index). It was observed that integrin β3 mRNA and OPN mRNA were significantly lower in the eutopic endometrium of adenomyosis (4.69 and 4.23), when compared with ectopic endometrium(7.96 and 14.84)and controls (13.47 and 17.40) (P<0.05). Eutopic endometrium had higher mRNA expression of integrin β and OPN mRNA in the secretory phase (5.54 and 11.40) than that in the proliferative phase(2.69 and 3.30) (P<0.01).The mRNA expression level of integrin β and OPN of control endometrium in the proliferative phase (3.12 and 4.75)were significantly lower than that in the secretory phase(19.94 and 21.00, P=0.000). The mRNA expression of integrin β and OPN were 10.10 and 14.34 in the mid-secretory phase, which were significantly lower than 21.50 and 24.18 in control endometrium(P<0.05). Conclusions High expression of integrin β3 and OPN in ectopic endometrium of adenomyosis may cause endometriotic lesions; abnormal expression of integrin β3 and OPN in the endometrium of adenomyosis during the implantation window may contribute to infertility in some patients.
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Objective To evaluate the effectiveness and safety of triptorelin in the treatment of uterine leiomyoma. Methods A multi-center, prospective, randomly controlled clinical trial was carried out from Dec. 2002 to Mar. 2004 in three university hospitals. A total of 125 qualified patients with uterine leiomyoma were randomly divided into either triptorelin group (63 cases) treated with 3.75 mg triptorelin injected intramuscularly or leuprorelin group (62 cases) treated with 3.75 mg leuprorelin injected subcutaneously. Both drugs were injected every 28 days for a total of 3 months. Results All 125 patients finished the trial. The uterine volumes were similar before treatment between the triptorelin group and the leuprorelin group and were decreased significantly after drug therapy (P0.05).) The volumes of the largest leiomyoma decreased significantly after drug therapy (P0.05). Patients with serum level of 17?-estradiol 0.05). Dysmenorrhea, noncyclic pelvic pain and pressure-like symptoms were relieved quickly and remarkably in both groups after treatment. The rates of adverse event occurred in 71% of patients in both groups. The main side effects included flare-up effects and hypoestrogenic symptoms. Nine patients in the triptorelin group and 6 in the leuprorelin group received add-back therapy with tibolone 1.25-2.50 mg/d because of remarkable climacteric-like symptoms. Conclusion Treatment of uterine leiomyoma with triptorelin for 3 months is both effective and safe in Chinese women.
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Objective To investigate the role of angiogenesis and expression of vascular endothelial growth factor (VEGF) in the pathophysiology of adenomyosis of the uterus. Methods The study included 32 patients with histologically proven adenomyosis and 30 patients with asymptomatic leiomyoma of the uterus. Immunohistochemical staining was used to detect VEGF expression in different parts of the uterus. A computerized morphometric study on the VEGF expression was performed. Results The VEGF H-Score of glandular cells in the endometrium of adenomyosis uterus [proliferative phase (9.6?1.4), secretory phase (11.7?1.6)] was much higher than that of leiomyoma uterus [proliferative phase (8.3?1.7),secretory phase (10.2?1.5)] (P0.05). The VEGF H-Score of myometrium around the ectopic lesions [proliferative phase (9.5?1.3), secretory phase (8.7?1.3)] was higher than that of normal myometrium [proliferative phase (4.8?1.9), secretory phase (4.5?1.4)] (P