Expression of adipokines in children with primary nephrotic syndrome and its association with hyperlipidemia / 中国当代儿科杂志

OBJECTIVES@#To study the expression of adipokines in children with primary nephrotic syndrome (PNS) before and after treatment and its correlation with blood lipids, as well as the role of adipokines in PNS children with hyperlipidemia.@*METHODS@#A total of 90 children who were diagnosed with incipient PNS or recurrence of PNS after corticosteroid withdrawal for more than 6 months were enrolled as subjects. Thirty children who underwent physical examination were enrolled as the control group. Venous blood samples were collected from the children in the control group and the children with PNS before corticosteroid therapy (active stage) and after urinary protein clearance following 4 weeks of corticosteroid therapy (remission stage). ELISA was used to measure the levels of adipokines. An automatic biochemical analyzer was used to measure blood lipid levels.@*RESULTS@#Compared with the control group, the children with PNS had a significantly lower level of omentin-1 in both active and remission stages, and their level of omentin-1 in the active stage was significantly lower than that in the remission stage (@*CONCLUSIONS@#Omentin-1 may be associated with disease activity, dyslipidemia, and proteinuria in children with PNS. Blood lipid ratios may be more effective than traditional blood lipid parameters in monitoring early cardiovascular risk in children with PNS.

X-linked congenital renal diabetes insipidus caused by AVPR2 gene mutation: a case report / 天津医药

@#Objective A case of congenital renal diabetes insipidus caused by mutation of arginine vasopressin receptor 2 (AVPR2) gene was reported to explore the clinical significance of AVPR2 gene mutation in congenital nephrotic diabetes insipidus and improve the understanding of the disease. Methods The clinical data of proband and his parents were retrospectively analyzed, and the related literature was reviewed. All exons of AVPR2 were amplified by PCR, and the amplified products were purified and sequenced in two directions. Results The clinical manifestations of the children were recurrent fever and hypernatremia, and hyperchloremia was difficult to correct. There was no abnormality in pituitary nuclear magnetic resonance in the child at the beginning. Short T1 signal disappeared in the posterior pituitary lobe after reexamination. Central diabetes insipidus was not excluded from clinical practice. However, vasopressin test supported renal diabetes insipidus, which caused troubles in clinical diagnosis. The treatment of vasopressin acetate tablets was ineffective. The results of gene analysis confirmed that mutations were found in the subregion of AVPR2 gene in the proband: c.359T (thymine)>G (guanine) caused amino acid changes: p.Met120Arg, which was located on the X chromosome, and the mother of the patient was the carrier of the mutation of AVPR2 gene. Clinical application of hydrochlorothiazide and amiloride in the treatment of the child with urinary volume significantly reduced, confirmed as congenital renal diabetes insipidus. Conclusion Congenital renal diabetes insipidus in infants and young children is rare and its clinical manifestations are not specific. It can only be manifested by repeated fever and electrolyte disturbance, which causes troubles in clinical diagnosis. AVPR2 gene detection can be used for screening and gene diagnosis of congenital renal diabetes insipidus.

Theoretical and Clinical Research Review of Sanjiao / 中国中医药信息杂志

This article reviewed the relevant research on concept, substance, functions, and clinical application of Sanjiao during recent years. The study believed that Sanjiao is the "big viscera" integrating functions of viscus;"Sanjiao is invisible" means it couldn't be described; "Sanjiao is visible" theory has made certain achievements;Sanjiao is secondary channel for running of primordial qi; Qi transformation of lower-jiao is the foundation of blood, essence, bones and brain; The function of Sanjiao is the function of autonomic nervous system; The dysfunction of qi transformation and the disorder of qi activity of Sanjiao are generally deemed as pathogenesis of various diseases. This study also pointed out that researchers should pay more attention to physiological characteristics and functions of Sanjiao, with a purpose to help guide clinical practice.

Resection and repair of large abdominal wall lesions in gynecologic patients / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The techniques of resection and repair of large lesions in the abdominal wall are very challenging in the area of gynecology. We explored the techniques of resection and plastic surgical repair of large abdominal wall lesions in gynecologic patients.</p><p><b>METHODS</b>Twenty-six patients with large lesions in the abdominal wall underwent resection by the gynecologists and repair through abdominal plasty and V-Y plasty with or without fascia patch grafting by the gynecologists or plastic surgeons from March 2003 to October 2010.</p><p><b>RESULTS</b>All patients had a history of cesarean section. One patient had an infected sinus tract after cesarean section, one patient had an inflammatory nodule, and the others had lesions of endometriosis, including one cancer. The average largest lesion diameter was (4.79 ± 4.18) cm according to the ultrasonography results. The lesions of all patients were completely resected with pretty abdominal contour. A polypropylene biological mesh was added to the fascia in 20 patients. One patient underwent groin flap repair, and one underwent V-Y advanced skin flap repair on the left of the incision to relieve the suture tension.</p><p><b>CONCLUSIONS</b>Multi-department cooperation involving the gynecology and plastic surgery departments, and even the general surgery department, is essential for patients with large lesions in the abdominal wall. This cooperative effort enabled surgeons to completely resect large lesions. Abdominal wall plastic surgical repair can ameliorate large wounds of the abdominal wall.</p>

Clinical analysis of laparoscopic surgery for ovarian masses under different conditions during the second trimester / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Laparoscopic surgery in pregnant women has become increasingly more common; however, the safety of laparoscopy in this population has been widely debated in emergent situations and big size at bigger pregnant weeks. This study was to determine the characteristics of laparoscopic surgery for adnexal masses in different conditions during the second trimester of pregnancy.</p><p><b>METHODS</b>Between April 2002 and December 2011, 24 patients with suspected ovary cyst during the second trimester underwent laparoscopic surgery at the Peking Union Medical College Hospital retrospectively. Clinical data were collected retrospectively and patient's outcomes were analyzed.</p><p><b>RESULTS</b>The incidence of laparoscopic surgery for ovarian cysts during pregnancy was 0.12% of all laparoscopic gynecological surgeries performed at the hospital. No patients required conversion. There were 9 (37.5%) patients whose gestational age was no less than 16 weeks, and 15 patients whose gestational age was less than 16 weeks; no difference was noted in the operation time between the two groups (P > 0.05). Emergency surgery due to abdominal pain was performed in 4 (16.7%) patients, 2 (8.3%) of whom underwent simple salpingo-oophorectomy because of ovarian necrosis. The other patients underwent enucleation of the ovarian cyst. There were no severe complications. Twenty (83.3%) pregnant women delivered healthy term infants and 4 (16.7%) cases were lost to follow up.</p><p><b>CONCLUSION</b>Laparoscopic surgery for ovary masses is a safe and feasible procedure for the treatment of ovary cyst in different conditions during the second trimester, even if gestational age reaching 16-19 weeks or in emergency.</p>

Ureteral injury during gynecological laparoscopic surgeries: report of twelve cases / 中国医学科学杂志(英文版)

<p><b>OBJECTIVE</b>To investigate ureteral injury during gynecological laparoscopic surgeries.</p><p><b>METHODS</b>From January 1990 to December 2005, 12 868 gynecological laparoscopic surgeries were conducted in Peking Union Medical College Hospital with 12 ureteral injuries reported. The present study investigated several aspects, including surgical indications, uterine size, pelvic adhesion, operative procedures, symptoms, diagnostic time and methods, injury site and type, subsequent treatment, and prognosis.</p><p><b>RESULTS</b>The incidence of ureteral injury was 0.093% (12/12 868) in all cases, 0.42% (11/2 586) in laparoscopic hysterectomy [laparoscopically assisted vaginal hysterectomy (LAVH) or total laparoscopic hysterectomy (TLH)], and 0.01% (1/10 282) in non-LAVH surgeries. Enlarged uterus, pelvic adhesion, and endometrosis were risk factors associated with ureteral injury. Only one injury was found intraoperatively while others were found postoperatively. The injury sites were at the pelvic brim (2 cases) or the lower part of ureter (10 cases). Patients were treated with ureteral stenting (effective in 2 cases) or laparotomy and open repair. Prognoses were favorable in most cases.</p><p><b>CONCLUSIONS</b>Most laparoscopic ureteral injuries occur during laparoscopic hysterectomy. Further evaluation is required when ureteral injury is suspected, and surgical repair is the major treatment for ureteral injury.</p>

Effects of medical treatment on apoptosis in eutopic endometrium of patients with endometriosis / 中国医学科学院学报

<p><b>OBJECTIVE</b>To investigate the apoptosis-related mechanisms of levenorgestrel-releasing intrauterine system (LNG-IUS), oral medroxyprogesterone (MPA), and injective gonadotrophic hormone releasing hormone agonist (GnRHa) on eutopic endometrium of patients with endometriosis. Methods We collected the samples of endometrium from patients with endometriosis before operation and after insertion of LNG-IUS, administration of oral MPA, or injection of GnRHa. The ultrastructure of endometria was observed and compared by electron microscopy. Apoptotic cells were assessed by the terminal deoxynucleotidyl transferase-mediated deoxy-UTP nick-end labeling (TUNEL) assay, and the expressions of Bax, Fas, and Fas-L mRNA were determined by semi-quantitative reverse transcription-polymerase chain raction. Results After have been exposured to LNG-IUS, the apoptotic rate of endometrial epithelial cells and stromal cells increased from (24. 4 +/- 35.0)% to (51.0 +/- 37.8)% (P = 0.027) and (35.3 +/- 30.2)% to (76.4 +/- 11.2)% (P = 0.008), respectively. The degree of apoptosis under transmission electron microscopy was in an order of GnRHa > LNG-IUS > MPA. The expression of Fas-L mRNA in eutopic endometrium of patients with endometriosis was significantly higher than that of the normal control (P < 0.05). The expressions of three apoptosis-related proteins had no significant difference.</p><p><b>CONCLUSION</b>Medical treatments can increase the apoptosis of eutopic endometrial cells, and such effect was strongest in GnRHa and relatively weaker in LNG-IUS and MPA.</p>

Effects of progesterone and progestin on expression of regulated on activation, normal T cell expressed and secreted in eutopic endometrium from patients with endometriosis / 中国医学科学院学报

<p><b>OBJECTIVE</b>To investigate the effects of progesterone and progestin on the expressions of regulated on activation, normal T cell expressed and secreted (RANTES) in eutopic endometrium from patients with endometriosis.</p><p><b>METHODS</b>We collected the samples of endometrium from patients with endometriosis before operation or after insertion of levenorgestrel releasing intrauterine system (LNG-IUS), administration of oral medroxyprogesterone (MPA), or injection of gonadotrophic hormone releasing hormone agonist (GnRHa). Reverse transcription-polymerase chain raction was used to assay the expression of RANTES mRNA. On the other hand, progesterone (Po) and tumor necrosis factor-alpha (TNFalpha) of different concentrations and different manners were used to treat cultured cells in vitro. RANTES secretion was evaluated in the culture medium using ELISA. In order to evaluate the effect of Po on the secretion of RANTES under stimulation of TNFalpha, the cells were cultured in medium containing 100 U/ml TNFalpha and Po of different concentrations for 24 hours. After the pretreatment of Po for 48 hours at different concentrations, TNFalpha (100 U/ml, 16 h) was added to observe whether Po inhibits RANTES or not.</p><p><b>RESULTS</b>The expression of RANTES mRNA in eutopic endometrium of patients with endometriosis was significantly higher than in control group (28.0 +/- 9.0 vs. 22.0 +/- 5.6, P < 0.05). Following the exposures to LNG-IUS (24.0 +/- 4.2 vs. 25.9 +/- 4.2, P > 0.05) or GnRHa (23.0 +/- 12.9 vs. 26.9 +/- 5.2, P > 0.05), the expression of RANTES mRNA had no change. MPA significantly increased the expression of RANTES mRNA (42.6 +/- 3.1 vs. 24.3 +/- 5.7, P < 0.05). Po itself had no significant effect on the secretion of RANTES. Stimulated by Po and TNFalpha at the same time, the secretion of RANTES significantly increased. After pretreatment with Po for 48 hours, the reaction of RANTES to the stimulating effect of TNFalpha was down-regulated.</p><p><b>CONCLUSION</b>The eutopic endometrium of patients with endometriosis has high chemotactic activity. It may be feasible to prevent and treat endometriosis with progestins.</p>

Role of laparoscopy in the diagnosis and treatment of adnexal masses / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Laparoscopy has been accepted for years as a management of benign ovarian tumors. The aim of this study was to estimate the feasibility and safety of laparoscopy in diagnosis and management of adnexal masses.</p><p><b>METHODS</b>A total of 2083 patients with benign adnexal mass were treated by laparoscopy at Peking Union Medical College Hospital from January 2000 to December 2003. Their clinical data were reviewed retrospectively. All the adnexal masses suspicious of malignancy at the time of laparoscopy were sent for frozen section evaluation intraoperatively. The rates of unexpected intracystic vegetation and low malignant potential (LMP) tumor or malignancy were investigated. The sensitivity, specificity, positive predictive value, and negative predictive value of laparoscopic diagnosis for LMP or ovarian malignancies were calculated. The ratios were compared by Chi-square test and the continuous variables were tested using two-tailed t test.</p><p><b>RESULTS</b>Of the 2083 patients, 16 had LMP or invasive tumors (0.77%), among which 14 were diagnosed histologically intraoperatively and 2 postoperatively. Fifty-five (2.6%) of the 2083 patients had unexpected intracystic vegetations. Their frozen sections showed benign tumors in 41 (74.5%), LMP tumors in 8 (14.5%), and focal invasive ovarian cancers (stage Ic) in 6 (10.9%). The final pathological diagnosis were benign tumors in 41 (74.5%), LMP tumors 7 (12.7%), and focal invasive ovarian cancers (stage Ic) in 7 (12.7%). Laparoscopy achieved a sensitivity of 87.5%, specificity of 98%, positive predictive value of 25.5%, and negative predictive value of 99.9% in the diagnosis of ovarian malignancies. 2067 cases with benign adnexal masses underwent laparoscopy successfully. No conversion to laparotomy, or intra- and postoperative complications in this series. Of the 16 patients with LMP or invasive ovarian cancer, seven underwent laparoscopic surgery including immediate staging laparoscopy in 3. The mean follow-up was 17.3 months for the 16 patients. Among them, 1 developed a recurrent LMP tumor in the contralateral ovary 36 months after laparoscopic salpingo-oophorectomy, and received subsequent laparoscopic cystectomy and pelvic lymph node sampling; the others had no evidence of recurrent tumor during the follow-up.</p><p><b>CONCLUSION</b>Laparoscopy is feasible for diagnosis of adnexal masses, and the surgery is safe for patients with benign ovarian tumors.</p>

Fallopian tube prolapse following hysterectomy / 中国医学科学杂志(英文版)

<p><b>OBJECTIVE</b>To investigate the clinical diagnosis, treatment, and prevention of fallopian tube prolapse (FTP) after hysterectomy.</p><p><b>METHODS</b>A total of 7949 patients received hysterectomy from January 1983 to August 2005 in Peking Union Medical College Hospital, and 9 cases (including 1 case from other hospital) of FTP after hysterectomy were involved during this period. All of them were diagnosed according to pathological results and were followed up. The symptoms, diagnosis, and treatment of the FTP patients were analyzed retrospectively.</p><p><b>RESULTS</b>The incidence of FTP after hysterectomy was 0.1% (8/7949), with the incidence of FTP after transabdominal hysterectomy being 0.06% (4/6229), after trans-vaginal hysterectomy being 0.5% (4/780), after laparoscopic assistant vaginal hysterectomy being 0 (0/940). There was no symptom in 3 cases. The pelvic examination revealed the typical prolapsed fimbrial end of a fallopian tube in 3 cases and the other 6 cases revealed red granulation tissue. All of them were excised vaginally and cauterized. The results were proved by pathological examination. No recurrence was reported during follow-up.</p><p><b>CONCLUSIONS</b>FTP is a rare complication after hysterectomy. The prognosis is well after proper diagnosis and treatment Fixation of accessories onto the pelvic wall and complete peritonealization at the time of hysterectomy are the most important methods to prevent FTP after hysterectomy.</p>

Magnetic resonance imaging of congenital vaginal anomalies / 中国医学科学院学报

<p><b>OBJECTIVE</b>To describe the magnetic resonance (MR) imaging manifestations in vaginal anomalies, and to discuss the utility and limit of MR imaging in diagnosis of this abnormality.</p><p><b>METHODS</b>Nine female patients with congenital vaginal anomalies who required surgical intervention were studied. MR imaging and ultrasound of the pelvic was performed before surgery. MR imaging features were retrospectively analyzed correlating with surgery.</p><p><b>RESULTS</b>The vaginal anomalies were categorized into three groups: (1) congenital absence of the vagina and uterus, i.e. Mayer-Rokitansky-Küster-Hauser syndrome (MRKH syndrome) (n=3); (2) vaginal atresia (n=2); and (3) transverse vaginal septum (n=2). There was also one case of absence of vaginal with complicated urinogenital abnormality, and 1 case of obstructed hymen.</p><p><b>CONCLUSIONS</b>MRI is a reliable method for evaluating vaginal anomalies. An accurate MRI examination can be helpful for surgical management.</p>

Laparoscopic surgery in patients with hypovolemic shock due to ectopic pregnancy / 中国医学科学杂志(英文版)

<p><b>OBJECTIVE</b>To evaluate the feasibility and safety of operative laparoscopy for ectopic pregnancy with hypovolemic shock.</p><p><b>METHODS</b>Two hundred and fifteen women with ectopic pregnancy underwent operative laparoscopy. These patients were divided into two groups. The study group included 21 patients with shock and intraperitoneal hemorrhage more than 1000 mL, and control group included 194 patients, hemodynamically stable, with blood loss less than 1000 mL. Clinical data of perioperative periods in two groups were retrospectively analyzed.</p><p><b>RESULTS</b>All patients were tubal pregnancies. The occurrence rate of tubal rupture was higher in study group than in control group (80.95% vs. 15.98%, P < 0.001). Intraabdominal blood loss was significantly higher in study group than in control group (1900 mL vs. 300 mL, P < 0.001), and autologous blood transfusions were given to 95.24% and 9.3% of patients in study and control group, respectively (P < 0.001). Laparoscopic salpingectomy was performed on 85.7 % and 50.5% of patients in study and control group (P < 0.001). The operative time was somewhat longer in study group than that in control group (60 minutes vs. 45 minutes), but with no significant difference. All patients had no perioperative complications.</p><p><b>CONCLUSION</b>Operative laparoscopy in patients with hopovolemic shock can be safely and effectively performed by experienced laparoscopists with the aid of optimal anesthesia, advanced cardiovascular monitoring, and autologous blood transfusion.</p>

Postoperative evaluation of tension-free vaginal tape procedure / 中国医学科学杂志(英文版)

<p><b>OBJECTIVE</b>To study the outcome of tension-free vaginal tape (TVT) for the treatment of stress urinary incontinence (SUI) in women with cystocele.</p><p><b>METHODS</b>Forty-two patients with SUI confirmed by urodynamics underwent the TVT procedure under local anesthesia. A prolapse repair was done simultaneously.</p><p><b>RESULTS</b>Mean TVT operation time was 26.29 minutes. Mean blood loss was 29.86 mL. Eighty-eight percent of the</p><p><b>PATIENTS</b>were able to micturate spontaneously within 12 hours and residual urine was less than 100 mL. And 12% of the patients had to use indwelling catheter for 3-11 days. Average hospital stay was 2.91 days. Eighty-eight percent of patients were discharged within 2 days. All patients were followed up (an average of 10.26 months). According to subjective and objective assessment of the outcome, 39 patients (93%) were cured, another 3 patients (7%) were significantly improved and none was failed. There were no major complications such as bladder injury occurred.</p><p><b>CONCLUSION</b>TVT procedure is a minimal invasive, effective, and safe surgery for treatment of SUI.</p>

Repairment of the large wound of endometriosis in the abdominal wall / 中国医学科学院学报

<p><b>OBJECTIVE</b>To explore the plastic surgical repairment of the large wound of endometriosis in the abdominal wall.</p><p><b>METHOD</b>Since March 2003 to December 2004, 6 patients were treated with abdominoplasty and V-Y plasty for the wounds of the endometriosis in the abdominal wall.</p><p><b>RESULTS</b>The endometriotic foci were removed thoroughly with pretty abdominal contour. No complications were observed.</p><p><b>CONCLUSION</b>Abdominoplasty and V-Y plasty are good methods to repair the wounds of the endometriosis in the abdominal wall.</p>

Clinical aspects of mature ovarian teratoma: result of 695 cases / 中国医学科学院学报

<p><b>OBJECTIVE</b>To evaluate the clinical aspects of mature ovarian teratoma.</p><p><b>METHOD</b>We retrospectively studied 695 patients operated in PUMC Hospital between January 1990 and December 2000.</p><p><b>RESULTS</b>Laparoscopy surgery had shorter hospitalization day, less blood loss during surgery, shorter operation time compared with laparotomy (P < 0.001). Routine contralateral wedge resection was done in 601 cases, among which 459 had normal inspection and palpatation. Only one (0.22%) was pathologically confirmed bilateral tumor. Torsion was the major complication (7.5%). Average tumor size of torsion was (10.2 +/- 4.5) cm. Probability of torsion increased as the tumor enlarged, which was less than 4.4% when the tumor size was less than 6 cm and greater than 10% if size greater than 8 cm. Rupture, infection, and malignant transformation were rare.</p><p><b>CONCLUSIONS</b>Laparoscopy is superior to laparotomy in the treatment of mature ovarian teratoma. If the contralateral ovarian is within normal configuration, contralateral wedge resection is unnecessary. When the tumor size is greater than 8 cm in diameter, it will have more chance to twist.</p>

Operative approaches, indications, and medical economics evaluation of 4180 cases of hysterectomy / 中国医学科学院学报

<p><b>OBJECTIVE</b>To examine the operative approaches, major indications, and medical economic parameters of the hysterectomy.</p><p><b>METHODS</b>Data on hysterectomy performed due to benign gynecological disorders in Peking Union Medical College Hospital (PUMCH) from 1996 to 2001 were reviewed. The cases were classified into three groups according to the operative approaches: total abdominal hysterectomy (TAH), vaginal hysterectomy (VH), and laparoscopic assisted vaginal hysterectomy (LAVH). The major indications, length of hospital stay, operative cost, and total medical cost were analyzed.</p><p><b>RESULTS</b>Records of 4,180 women who had hysterectomies in PUMCH were examined. Operations included TAH (78.4%), LAVH (13.0%), and VH (8.6%). The use of LAVH increased from 2.4% in 1996 to 17.3% in 2001. The common indications for surgery included uterine leiomyoma (56.2%), adenomyosis (12.2%), benign ovarian tumor (9.2%), genital prolapse (7.7%), endometriosis (6.9%), atypical endometrial hyperplasia (3.0%), and cervical intraepithelial neoplasm (2.0%). The most common indications for TAH and LAVH were uterine leiomyomas and adenomyosis, whereas the most common indication for VH was genital prolapse, followed by uterine leiomyoma. The lengths of hospital stay in TAH, VH, and LAVH were (11.0 +/- 4.9) d, (10.9 +/- 3.9) d, and (8.9 +/- 3.7) d respectively. The total medical cost was (5,666.6 +/- 1,709.4) RMB Yuan for TAH, (5,027.6 +/- 1,067.0) RMB Yuan for VH, and (7,473.8 +/- 1,464.8) RMB Yuan for LAVH.</p><p><b>CONCLUSIONS</b>The use of LAVH has been increasing. Although the direct medical cost for LAVH is higher than that for TAH, its indirect benefit appeares superior to TAH. The major indications for LAVH and TAH are similar, whereas the indications for VH are different from those for TAH and LAVH.</p>

The chick embryo chorioaUantioc membrane as a model for in vivo research on anti-angiogenesis in endometriosis / 中华妇产科杂志

Objective To establish the chick embryo chorioallantioc membrane(CAM)as a model for in vivo research on endometriosis.The model was used to investigate the mechanism of anti-vascular endothelial growth factor(VEGF)antibody for treatment of endometriosis.Methods Human endometrial fragments were explanted onto the CAM.Then anti-VEGF antibody was used for the endometriosis-like lesions after transplantation of human endometrial fragments.The CAM models were treated respectively as control groups and experimental groups.The terminal deoxynucleotidyl transferase-mediated biotin- deoxyuridine triphosphate(dUTP)nick end labeling(TUNEL),proliferating cell nuclear antigen(PCNA) and microvessel density(MVD)were used in vivo for analysis of anti-angiogenesis.Results The apoptosis intensity of anti-VEGF antibody treated groups(6.7?0,9,6.9?0.8)was significantly higher than that of the control groups(5.0?0.9,5.4?1.1;P

Clinical analysis of fallopian tube prolapse after hysterectomy / 中华妇产科杂志

Objective To investigate the clinical diagnosis,treatment and prevention of fallopian tube prolapse(FTP)after hysterectomy.Methods A total of 7949 patients received hysterectomy from 1983 to Aug 2005 in Peking Union Medical College Hospital,including 6229 cases of trans-abdominal hysterectomy(TAH),780 cases of transvaginal hysterectomy(TVH),and 940 cases of laparoscopic assisted vaginal hysterectomy(LAVH).Nine cases(including 1 case from other hospital)of FTP after hysterectomy were analyzed retrospectively for their symptoms,diagnosis and treatment.All of them were diagnosed according to the results of histology and follow-up.Results The overall incidence of FTP after hysterectomy was 0.11%(9/7949).Incidence of FTP after trans-abdominal hysterectomy was 0.08% (5/6229),after vaginal hysterectomy 0.51%(4/780),and after laparoscopic assisted vaginal hysterectomy 0(0/940).There were no symptoms in 3 cases,but the other 6 cases had symptoms.The pelvic examination revealed the typical prolapsed fimbrial end of a fallopian tube in 3 cases and red granulation tissue in the other 6 cases.All of them were excised vaginally and cauterized.The results were confirmed by histological examination.No recurrent cases were reported in follow up.Conclusions FTP is a rare complication after hysterectomy.The prognosis is well after proper diagnosis and treatment.Salpingectomy or fixation of accessories into the pelvic wall and complete peritonealisation at the time of hysterectomy are important methods to prevent FTP after hysterectomy.