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Nowadays several minimally invasive techniques such as laparoscopy, hysteroscopy, uterine artery embolization and high-intensity focused ultrasound ( HIFU) have extended deeply into many aspects in the treatment of gynecological diseases.In practice, minimally invasive techniques have many advantages which are not available in conventional technology.In the treatment of adenomyosis, minimally invasive techniques also show superior advantages to other techniques.This paper reviews and summarizes literatures on laparoscopic excision of adenomyosis lesion, laparoscopic excision of adenomyosis lesion combined with uterine artery embolization, hysteroscopic endometrial and endometrial-myometrial junction resection, uterine artery embolization, and high-frequency focused ultrasound in the treatment of uterine adenomyosis.
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Objective To investigate the clinical characteristics of pre-malignant and malignant polyps in postmenopausal patients and to evaluate the diagnositic value of hysteroscopy in this disease. Methods From June 2005 to October 2014, 403 postmenopausal patients with polyps were treated in the Gynecologic Minimally Invasive Center, Beijing Obstetrics and Gynecology Hospital. There were 27 patients including 22 patients with pre-malignant and 5 patients with malignant polyps. All malignant lesions were endometrioid adenocarcinoma. The clinical data were retrospectively analyzed. Based on pathology, the diagnostic value of hysteroscopy was evaluated. Results (1) Clinical characteristics: there were 27 cases with pre-malignant and malignant polyps (group 1) and 376 cases with benign polyps (group 2). Compared the two groups, the average age was (60 ± 8) vs (58 ± 6) years old, the period of menopause was (9.8 ± 8.1) vs (8.3 ± 6.9) years. Thirteen cases (48.1%, 13/27) in group 1 and 159 cases (42.3%, 159/376) in group 2 had clinical symptoms including postmenopausal bleeding and vaginal discharge. Twelve cases (44.4%, 12/27) in group 1 and 140 cases (37.2%, 140/376) in group 2 were with hypertension. Five cases (18.5%, 5/27) in group 1 and 43 cases (11.4%, 43/376) in group 2 were with diabetes. The measures above were no significant differences(P>0.05)(2) Ultrasound features:the average thick of endometrium in group 1 and group 2 were respectively (1.3±0.7) and (0.8±0.4) cm, which had statistical significance (t=4.98, P=0.001). (3) Hysteroscopic diagnosis:the average diameters of polyp in group 1 and group 2 were respectively (2.4 ± 1.0) and (1.6 ± 1.0) cm, which had statistical significance (t=2.93, P=0.004). Six cases in group 1 were diagnosed by hysteroscopy including 4 cases of malignant polyp and 2 cases of pre-malignant polyp. The sensitivity, specificity, positive predictive value, negative predictive value and the accuracy were 22.2%(6/27), 100.0%(376/376), 100.0%(6/6), 94.7%(376/397) and 94.8%(382/403), respectively. Conclusions Pre-malignant and malignant endometrial polyps are more common in the subjects with the larger diameters and the thicker endometrium. All polyps should be under complete resection by hysteroscopy and through pathology examination.
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Objective To investigate the application of hysteroscopy combined ultrasonography and laparoscopy in the diagnose and treatment of post-cesarean section scar diverticulum (PCSD). Methods From March 2011 to February 2013, 27 patients with PCSD were diagnosed and treated in Beijing Obstetrics and Gynecology Hospital. All patients were diagnosed by hysteroscopy and ultrasonography. Treatment protocols were decided by the thickness of the diverticulum. The clinical data of all patients were analysed fully. Results (1)All patients were diagnosed by hysteroscopy combined ultrasound, of which only 17 cases were diagnosed by preoperative ultrasound, the coincidence rate was 63%(17/27). (2)The thickness of diverticulum was measured by hysteroscopy combined ultrasound. Thickness of less than 3 mm in 19 cases, were treated by hysteroscopy combined with laparoscopy diverticulectomy repair;no less than 3 mm in 8 cases, were used hysteroscopy diverticulum incision. (3)The effective rate was 7/8 after hysteroscopy, and which was 16/19 after laparoscopy combined with hysteroscopy surgery. There was no difference in the treatment effect (P=0.663). The ineffective rate was 1/8 after hysteroscopy, and which was 3/19 after laparoscopy combined with hysteroscopy surgery. The size of the PCSD was smaller and the thickness of diverticulum was thicker than preoperation in the later one, which has no difference in the former one. Conclusions (1)Hysteroscopy combined ultrasound is an accurate method for the diagnose of PCSD. (2)According to the thickness of the diverticulum operation method is choosed, which is beneficial to reduce the trauma, and relieve symptoms. (3)Diverticulum poor positioning and incomplete resection are the main causes of postoperative recurrence of the diverticulum.
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Objective To study the ultrastructural features of myocytes in uterine junctional zone (JZ).Methods From August 2010 to August 2013,there were 16 pre-menopause patients who suffered from cervical neoplasm to be performed hysterectomy.Samples of JZ and outer myometrium (OM) of hysterectomy specimens were collected.There were 8 specimens from the proliferative-phase and 8 specimens from the secretory-phase of endometrium.Ultrastructural features of JZ and OM were examined by using transmission electron microscopy and the related indices of myocytes were compared by using Student's t test.Results At JZ,there were more cytoplasmic process in the myocytes.The myocytes of JZ exhibited significant difference compared with those of OM.Firstly,the contractile structural components,such as the dense patches,dense bodies and the myofilaments were less abundant.In contrast,the perinuclear cell organelles were more distinct.The mitochondria,endoplasmic reticulum and Golgi apparatus were more prominent,denoting active protein synthesis.Secondly,the mean diameter of cell and nuclei demonstrated cyclic change.In proliferative phase of endometrium,the cell diameters of JZ and OM were (4.70_±0.52) and (4.69± 1.20) μm,respectively,which there were no significant difference(P=0.987).While in secretory phase,the cell diameters of JZ and OM were (3.75±0.36) and (4.92±0.51) μm,which there were significant difference (P=0.006).In proliferative phase,the nuclei diameters of JZ and OM were (3.24±0.41) and (2.90±0.62) μm,and in secretory phase,the nuclei diameters of JZ and OM were (2.44±0.27) and (2.92±0.44) μm.There were no significantly different in both phases (P=0.374,P=0.097).The diameters of cell and nuclei had cyclical changes (P ＜ 0.05).However,the cyclical changes were absent in OM (P＞ 0.05).Thirdly,the myofilaments/cytoplasm ratio of JZ in proliferative and secretory phases were 0.27±0.04 and 0.34±0.03,which were significantly less than those of OM in respective phases (0.49±0.03and 0.54±0.03;P=0.000,P=0.000).The myofilaments/cytoplasm ratio exhibited cyclical changes in JZ (P=0.029),but in OM,the cyclical changes were absent (P=0.083).Conclusions Compared with OM,ultrastructures associated with synthetic organelles are prominent,whereas the contractile organelles are reduced.And there are the cyclical changes in ultrastructural characteristics.The ultrastructural features of JZ are the basis of its physiology.
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[Summary] From February 2008 to June 2008, two cases of old ectopic pregnancy were misdiagnosed: Case 1 was misdiagnosed as gestational trophoblastic disease (GTD), and Case 2 was misdiagnosed as cornual pregnancy.In order to further confirm the diagnosis, two cases were all given laparoscopic exploration.Surgery confirmed interstitial chronic ectopic pregnancy, leading to a resection of the fallopian tubes and mass lesions.Embryo tissue was pathologically confirmed postoperatively.The diagnosis of old ectopic pregnancy is difficult.Serum hCG determination is often found no positive, and ultrasound examination has no specificity.The clinical images are varied.Detailed medical history inquiry and attention to differential diagnosis are key for the diagnosis of old ectopic pregnancy.
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Objective To evaluate effect of clinical study combined with short-term intensive simulation on training of hysteroscopy technology. Methods Trainees receiving training of hystero-scopy technology from the January to December 2012 in Gynecology Minimally Invasive Center, Bei-jing Gynecology and Obstetrics Hospital Affiliated to Capital Medical University were enrolled and di-vided into two groups depending on the different training modes. Twenty-four trainees in group1 par-tic-ipated in three-month hysteroscopic clinical study program. Twenty-two trainees in group2 partici-pated in three-month clinical study program including one-week short term intensive simulation. After the training, the effect was evaluated by the rating scale and the Rank sum test was used for statisti-cal analysis. P<0.05 signifies statistically significant difference. Results The operation time(P=0.03), forward planning (P=0.02), instrument handing (P=0.00) and knowledge of specific procedure (P=0.04) were improved significantly in group 2 compared with those in group 1. Conclusions The training mode of clinical study combined with the short-term intensive simulation can improve hys-teroscopy technology effectively and should be widely applied.