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OBJECTIVE: To investigate difference in the extraction of specimens between via the middle part incision of posterior vagina and via morcellation.METHODS: A retrospective analysis was performed in 70 cases of laparoscopic hystero myomectomy admitted to the gynecological ward from June 2017 to June 2018 in Shenyang Women and Children's Hospital;tissue extraction was accomplished in a specimen retrieval bag via middle part incision of posterior vagina in 36 cases,while 34 cases through morcellation.RESULTS: All the 70 patients with uterine fibroids underwent laparoscopic surgery successfully.The specimen was extracted via middle part incision of posterior vagina or through morcelation.The retrieval bags were not damaged and no complications occurred.The operation time and blood loss were compared between the two groups,and there was no significant difference[(106.58±10.24)min vs.(104.32±10.58)min,(88.89±41.60)mL vs.(88.82±46.76)mL,P>0.05].The vaginal incision healed well in follow-up.CONCLUSION: The middle part incision of posterior vagina took great advantage of the nature path.The way of the extraction is an efficacious and minimally morbid technique for removing the intact entrapped specimen after laparoscopic myomectomy.It is feasible and easy to grasp.
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Objective: To explore the pathological diagnosis features and differential diagnosis of one case of patient with solid pseudopapUlary neoplasm (SPN) of pancreas occurred in the majus omentum, and to improve the understanding of extra-pancreatic SPN. Methods : One female patient was admitted to hospital because of abdominal mass found 20 d ago. The patient was diagnosed as multiple hysteromyoma by gynecological color ultrasound, and the results of abdominal ultrasound had no obvious abnormity. The patient underwent hysterotomy, and a well-defined mass in the majus omentum was found during operation, so the patient received hysterectomy and omental tumor resection. Results : The patient was confirmed as multiple hysteromyoma by the postoperative pathological examination. The patient was clearly diagnosed as SPN arising from the majus omentum on the basis of pathological characteristics and immunohistochemical staining results. There were no ectopic pancreas tissue arround the tumor and no SNP metastasis in examination of ultrasound and CT. No recurrence and metastasis were found in the follow-up of 3 years. Conclusion: SPN arising from the majus omentum is extremely rare. The tumor has clear boundary, typical morphology and immunohistochemical appearances.
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Objective To study and observe the effects of cold knife excision by hysteroscopy for the local microcirculation and inflammatory reaction of patients with hysteromyoma.Methods 86 patients with hysteromyoma admitted in our hospital from March 2016 to July 2017 were selected as the research objects,and the patients were divided into control group with 43 cases and observation group with 43 cases according to the method of random number table.The control group were treated with monopolar electric knife excision by hysteroscopy,while the observation group treated with cold knife excision by hysteroscopy.Then the local microcirculation and inflammatory reaction indexes of two groups at different time before and after the operation were detected.Results The local microcirculation and inflammatory reaction indexes of two groups before the operation were compare,no significant differences found (P＞0.05);the local microcirculation indexes of observation group after the operation were significantly better than those of the control group,the inflammatory reaction indexes were significantly lower than those of the control group,both with statistical significance (P＜0.05) .Conclusion The cold knife excision by hysteroscopy has better clinical effects in the control of local microcirculation and inflammatory reaction in patients with hysteromyoma,so it has higher application value in the patients with hysteromyoma.
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Objective To observe the effect of the long-term low-dose mifepristone on the treatment of hysteromyoma.Methods From March 2016 to December 2016 in Haiyan maternal and child health-care center,120 cases with hysteromyoma were selected as the object study and were given long term oral low-dose mifepristone.The uterus size, follicle stimulating hormone, myoma size, luteinizing hormone, estrogen and endometrium were observed Resultsafter treatment, the patients with uterine fibroids situation improved markedly, and appeared amenorrhea.At the same time, in patients with clinical symptoms were improved to a certain extent, six months after a drug follicle-stimulating hormone, luteinizing hormone and estrogen levels significantly decreased, and there is no other significant side effects.In addition, on the analysis of the effectiveness of the treatment,86 cases were markedly improved,28 cases effective,6 cases ineffective, the total effective rate was 95%.Conclusion Long-term low-dose mifepristone has worked well in the treatment of uterine fibroids, can effectively reduce uterine fibroids, high security, in the process of follow-up of patients, no recurrence no satisfaction related data, the result can't reach this Conclusion , the authors modify please.Is the ideal way of conservative treatment of uterine fibroids, and is worth popularizing in the process of clinical application.
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Objective: To investigate the molecular maechanism and potential active constituents population of Guizhi Fuling Capsule (GFC) for the treatment of dysmenorrhea, pelvic inflammatory disease (PID), and hysteromyoma. Methods: One handred and thirty target proteins related with dysmenorrhea, PID, and hysteromyoma were selected through mining literature, retrieving in DrugBank and TTD database, the main active constituents and potential target proteins from GFC were computed and analyzed by DOVIS2.0 and Cytoscape 3.0. The potential target proteins were then projected into the KEGG databases to illustrate the molecular mechanism of GFC. Results: The results of data analysis showed that the 115 active molecules with stronger interaction with protein were distributed in Cinnamomi Ramulus and Poria. The High network degree and betweenness of molecules were found to be pentacyclic triterpenes and steroids by further analysis of network characteristics. The most of the potential target proteins (78.57%) interacted wth the compounds in GFC were from 15 biological pathways closely related with dysmenorrhea, PID, and hysteromyoma in KEGG database, which was involved in cell proliferation, angiogenesis, coagulation, dysregulation of inflammatory process, uterine contractions, and release of estrogen or progesterone in uterus. As well as the synthesis or release of inflammatory factors such as prostaglandin and the regulation of calcium channels and so on. Conclusion: GFC has the function by the interaction of pentacyclic triterpenes and steroids with multi target proteins, such as arachidonic acid metabolism, calcium signaling pathway, GnRH signaling pathway, complement and coagulation cascades, and progesterone-mediated oocyte maturation, to alleviate the pain of dysmenorrhea and PID, or improve the quality of life for the patients with hysteromyoma through inhibiting uterine contractions, improving microcirculation, and reducing the release of estrogen or promegestone and inflammatory response (such as PGE2, PGF2α, and leukotriene B4).
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Objective To explore the targeted distribution of flurbiprofen axetil (FA) in hysteromyoma and its influence on prostaglandin E2 (PGE2).Methods A total of 40 female patients undergoing myomectomy (ASA-Ⅱ) were enrolled in the present study. The patients were randomly divided into blank control group and FA groups of three different doses. The four groups were injected with normal saline, 0.5, 1, or 1.5 mg/kg of FA 15 min before the operation. Tumor tissues and normal tissues were collected by surgical operation and the sampling time was recorded. The concentration of flurbiprofen (FP), which was the active metabolite of FA, was detected in the tumor tissues and normal tissues by HPLC. The concentrations of PGE2 were detected by ELISA in the two samples. Results FP was not detected in the tumor tissues or normal tissues of the blank group. With the increase of FA dose in the three groups, the concentration of FP had an increasing tendency in the tumor tissues, with significant differences found among the three groups (P 0.05). The concentrations of FP in the tumor tissues were significantly higher than those in the normal tissue in the three FA groups (P2 had a tendency to decrease in the tumor tissues; and there were significant differences between blank group and 1, 1.5 mg/kg FA groups (P 2 in the tumor tissues were significantly higher than those in the normal tissues in the four groups (P 0.05). Conclusion FA has a certain targeted distribution in hysteromyoma and can reduce the level of PGE2.
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Objective To investigate the effect of Yiqihuayu herb on serum NF-κB p65 and myocardin in patients with hysteromyoma. Methods 56 cases patients with hysteromyoma were selected and divided into two groups.The control group of 28 cases were treated with mifepristone, and the experiment group of 28 cases were treated with Yiqihuayu herb.The clinical curative effect, uterine myoma volume, expression of NF-κB p65 and myocardin level were compared after treatment.Results The clinical curative effect of the experiment group was 89.29%, which was higher than 67.86% of control group(χ2 =3.82,P<0.05).Compared with control group, NF-κB p65 expression level was lower(P<0.05), myocardin expression level was higher ( P<0.05 ) , the volume of uterus and uterine myoma were smaller ( P<0.05 ) .Conclusion Yiqihuayu recipe could reduce the expression of NF-κB p65 in serum, increase myocardin level, and reduce the volume of uterus and myoma, which has good clinical curative effect in the treatment of patients with hysteromyoma.
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Objective:To study the inflammation stress reaction between laparoscopic operation and open operation in treating hysteromyoma.Methods: hysteromyoma patients in our hospital from January 2011 to December 2012 were enrolled and randomly divided into observation group given laparoscopic operation and control group given open operation. Then inflammatory factors levels were detected, operation trauma index were observed and the correlation were analyzed.Results: (1)After treatment, inflammatory factor levels of two groups were higher than those before treatment and IL-1(t=5.892,P0.05), intraoperative bleeding volume(t=7.842,P<0.05), postoperative anal exhaust time(t=7.283,P<0.05), bed time(t=8.213,P<0.05) and NRS pain scores(t=7.883,P<0.05) of observation group were lower than control group(P<0.05); (3) Intraoperative bleeding volume, postoperative anal exhaust time, bed time and NRS pain scores were positively correlated with IL-1,r2 were separately 0.485, 0.521, 0.442, 0.451; and positively correlated with TNF-α levels,r2 were separately 0.556, 0.513, 0.423, 0.458, the difference was statistical significance(P<0.05).Conclusion: Laparoscopic operation is helpful to reduce the operation wound and relieve postoperative inflammatory reaction; and there was close correlation between inflammatory stress and operation trauma.
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Objective To evaluate the safety of myomectomy by extrusion in cesarean section , in comparison with routine cesarean delivery. Methods From January 2008 to December 2010, a total of 128 operations of myomectomy by extrusion in cesarean section were performed (Myoma Group), while another group of 128 cases undergoing caesarean section , which respectively followed every cases of the Myoma Group but had no hysteromyoma , was selected as the control group .The amount and rate of postpartum hemorrhage , the level of postpartum fever , and postoperative hospital stay between the two groups were compared , respectively. Results In the two groups:the amount of postpartum hemorrhage was (233.6 ±58.9) ml vs.(228.5 ±90.9) ml (t=0.530, P=0.597); the rate of postpartum hemorrhage was 0% (0/128) vs.0.8% (1/128) (P=1.000); the decrease of haemoglobin was (6.17 ±2.83) g/L vs.(6.89 ±3.09) g/L (t=-1.944, P=0.053); the decrease of hematocrit was 2.22%± 0.98%vs.2.27%±1.02% (t=-0.400, P=0.690); the rate of postpartum fever was 2.3% (3/128) vs.5.5% (7/128) (χ2 =1.665, P=0.197);the length of postoperative hospital stay was (4.2 ±0.8) d vs.(4.1 ±1.2) d (t=0.706, P=0.481). There were no significant differences between the two groups in the abovementioned parameters . Conclusions The myomectomy by extrusion in cesarean section does not increase the level of postpartum hemorrhage and the rate of postpartum infections .It is a simple, minimally invasive , safe and feasible surgical method , being worthy of clinical application .
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Objective-To-investigate-the-feasibility-of-total-laparoscopic-hysterectomy-for-complicated-hysteromyoma-,-such-as-broad-ligament-myoma,-lower-uterine-fibroids,-or-cervical-myoma.-Methods-From-December-2009-to-December-2012,-we-performed-laparoscopic-hysterectomy-on-166-patients-with-complicated-hysteromyoma-and-on-170-patients-with-common-hysteromyoma-.-The-operation-time-,-intraoperative-blood-loss-,-recovery-time-of-gastrointestinal-function-,-postoperative-morbidity-,-and-the-rate-of-conversion-to-laparotomy-were-compared-between-the-two-groups-respectively-.-Results-No-significant-differences-were-detected-in-operation-time-[(112.2-±15.3)-min-vs.(110.3-±16.1)-min,-t=1.088,-P=0.277],-intraoperative-blood-loss-[(117.0-±35.3)-ml-vs.(110.8-±37.8)-ml,-t=-1.525,-P=0.128],-recovery-time-of-gastrointestinal-function-[(20.8-±2.7)-h-vs.(21.3-±2.3)-h,-t=1.797,-P=0.073],-postoperative-morbidity-[6.3%(10/159)-vs.7.3%(12/165),χ2-=0.124,-P=0.725],-and-the-rate-of-conversion-to-laparotomy-(4.2%vs.2.9%,χ2-=0.397,-P=0.529)-between-the-two-groups-.Both-the-groups-were-followed-up-at-1,-2,-and-6-months-after-procedure-,-and-none-of-the-patients-showed-severe-postoperative-complications-.-Conclusions-Total-laparoscopic-hysterectomy-for-complicated-hysteromyoma-is-feasible-.To-prevent-complications-,-it-should-be-converted-to-laparotomy-timely-when-the-myoma-has-a-wide-base-or-is-located-at-lower-position-.
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Objective: To study the MRI signal changes of hysteromyoma before and after treated by high-intensity focused ultrasound (HIFU), evaluate the effects of HIFU treatment and providing the reference for clinical therapy. Methods:MR scan and enhanced-scan were performed by GE SignaHDe 1.5T MR system on 83 patients with hysteromyoma (a total of 117 myomatas) before and after HIFU treatment within one week. Through the observation of whether there were coagulation necrosis and blood supply diminution to evaluate the effects of HIFU treatment. The appearance of coagulation necrosis and blood supply diminution meant a remarkable therapeutic effect, and vice versa. Results:By analyzing the MR images of 83 patients with hysteromyoma (a total of 117 myomata) treated by HIFU from March 2012 and November 2012, we found that 106 myomata’s MRI signals clearly changed, from low signal to slightly high or equal signal on T1WI, from low signal to low or slight high signal on T2WI, which meantcoagulation necrosis and blood supply diminution. Besides, the rest 11 myomata’s MRI signal showed no changes before and after HIFU treatment on both coagulation necrosis and blood supply diminution. Conclusion:MRI is the most effective methods on evaluating the effects of HIFU treatments.
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Objective To investigate the expression of human β defensin-2(hβD-2)in the eutopic and ectopic endometrial tissue in patients with adenomyosis and in women with normal endometrium.Methods Twenty-five hysteromyoma patients with adenomyosis(AM) and 25 hysteromyoma patients without endometriosis (EMS) were selected and divided into three groups:AM ectopic endometrium group,AM eutopic endometrium group and control group( endometrial tissue in patients with hysteromyoma).The level of mRNA expressions of hβD-2,interleukin-1β ( IL-1β ),interleukin-6 ( IL-6 ) and tumor necrosis factor-α (TNF-α) was investigated quantitatively using Real Time PCR (RT-PCR) and the corresponding protein level was detected by immunohistochemistry.Results Comparing the expression of hβD-2,IL-1β,IL-6,TNF-α genes among the three groups,there was no significant difference between ectopic endometrium group and eutopic endometrium group and there was also no significant difference between eutopic endometrium group and the control group.( P ＞ 0.05 ).The expression of hβD-2 and IL-1β were 0.0320 (0.0095 ～ 0.0690 ) and 0.0427 ( 0.0038 ～ 0.0975 ) in the ectopic endometrium group,and they were 0.0034(0.0025 ～0.0424) and 0.0080(0.0040 ～0.0251 ) in the control group,respectively.They were both significantly higher in ectopic endometrium group than in the control group (P ＜ 0.05 ).In the ectopic endometrium group hβD-2 expression was positively correlated with the level of TNF-α ( r =0.857,P =0.014 ),and it had no correlation with both IL-1β and IL-6 ( r =0.750,P =0.052 ; r =0.464,P =0.464; respectively)Conclusion HβD-2 might not play an important role in the formation of adenomyosis.It may be related to no significant up-regulation of inflammatory factors in ectopic lesion tissue.
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Objective To evaluate the effect of hypophysin and oxytocin on QT interval of the patients undergoing myomectomy. Methods Forty ASAⅠ-Ⅱ female patients scheduled for laparoscopic operation were enrolled. All patients were randomized into hypophysin or oxytocin group, with 20 patients in each group. The blood pressure, heart rate and QT interval were recorded at following time points: before anesthesia (T_1), before injection of hypophysin or oxytocin (T_2), 2 min (T_3), 5 min (T_4), 10 min (T_5), 20 min (T_6), and 30 min (T_7) after injection of hypophysin or oxytocin. Results The QT interval at 2, 5 and 10 min post injection of hypophysin were significantly longer compared to oxytocin group (P<0.01). No significant changes of QT interval were detected in oxytocin group, though the trend of QT interval prolongation were recorded. Conclusions In hysteromyoma operation, injection of hypophysin could prolong the QT interval of patients.
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Objective To assess the effectiveness of uterine arterial embolization for the treatment of hysteromyomas and to discuss the factors related to the clinical results.Methods Super-selective uterine arterial embolization was performed in forty-five patients with hysteromyomas.Of 45 patients,multiple hysteromyomas were seen in 36 and solitary lesion in 9.The lesion was located at the myometrium in 41 cases,among them coexisted endometrioma was found in 5 cases and coexisted submucosal myoma in 2.The lesion was located submucous layer in the remaining 4 cases.The diagnosis was confirmed by imaging study and gynecological examination.After the operation,ultrasonography and laboratory tests were carried out in all patients to observe the tumor size.hormone levels and hemoglobin concentration.Results A total of 91 uterine arteries were found in 45 patients.including double left uterine arteries in one case.Successful catheterization was obtained in 87 arteries(95.6%).All forty-five patients were followed up for 6-36 months.Six months after the procedure the mean reduction of the tumor size was 69.3%.and the lesion completely disappeared in two cases.In the anemic patients the hemoglobin concentration returned to normal level.The main side-effects included low fever and pain at lower abdomen.Conclusion Uterine arterial embolization is a safe and effective treatment for hysteromyomas.
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Objective To explore the influence of psychological intervention on quality of life(QOL) in the hysteromyoma patients underwent surgery. Methods Three hundred and twenty patients with hysteromyoma were divided into the psychological intervened group ( all cases were treated with the comprehensive psychological intervention) and the control group (without intervention). Before and after treatment, the scores of the Olson's Enrich Questionary and the Nottingham Health Poofity (NHP) were assessed in the two groups. Results Before surgery, the scores of N HP and Olson were not significantly different between the psychological intervened group and the control group ( P > 0. 05 ). The scores of NHP of total hysterectomy in the control group after surgery were higher than that before surgery,and the scores of Olson were lower significantly ( P <0. 05 or P <0. 01). The scores of NHP of subtotal hysterectomy, myomectomy and blood vessel involvement treatment in the control group after surgery were significantly lower than that before surgery, and the scores of Olson were higher ( P < 0. 05 or P < 0. 01 ). After surgery,the scores of NHP of all patients in the psychological intervened group were significantly lower than that in the control group,and the scores of Olson were higher significantly (P <0. 05 or P <0. 01). There was no significant difference in ovarian hormones level between pre- and post- surgery (P > 0. 05). Conclusions The comprehensive psychological intervention pre- and post- surgery is good for the quality of life in hysteromyoma patients.
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Objective To compare the diagnostic value for hysteromyona with trans-abdominal ultrasound (TAS) and trans-virginal ultrasound(TVS). Methods Two empirical doctors detected respectively 82 patients by TAS and TVS in double blind method. The results were compared with pathological results. Result The correct rate of diagnosis in 82 patients with 123 hysteromyoma focus by TVS and TAS was 96.75% and 86.18% respectively.There was statistical difference between TAS and TVS. The correct rate of combining use of the two method was 98. 37%. Couclusion Either TVS or TAS had its own merit and defect, Combining use of the two method could raise the correct rate.
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Objective To discuss the effect of self-clotting cutter radiofrequency ablation in curing the hysteromyoma. Methods 96 patients with hysteromyoma were selected. Their hysteromyomas were cured by self-clotting cutter radiofrequency ablation through virgina under the direction of B-ultrasound. Then they were followed up for one month, three months and six months after the operation. Results Six months after the treatment,42.71% of the patients were eumenorrhea,44.79% of the patients' menstrual bleeding volumes were few, 12.5% has no change. The cure rate of anaemia was 100%. 1 month,3 months ,6 months after the treatment, the bulks of uterus and myoma were reduced,and the myoma reduced most after six months. 35.42% of the patients were cured,47.92% had remarkable effect, 15.6% had effect, 1.04% had no effect. Total effective rate was 98.72%. Conclusion The clinical effect of self-clotting cutter radiofrequency ablation in curing the hysteromyoma was satisfactory. It was a minimally invasive technique which could keep the integrality of uterus and it was rapid recovery,effective and safe,and easy to operate.
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Objective To investigate the expression and significance of IL-6 and IL-6 receptor (IL-6R)in hysteromyoma.Methods The expression of IL-6 in hysteromyoma and homologous normal myometrium of 20 cases undergoing total hysterectomy were detected by fluorescent quantitative PCR and western-blot,respectively while IL6R was examined by western-blot and RT-PCR.Results The expression of IL-6 protein and mRNA in homologous normal myometrium were obviously higher than that in hysteromyoma[(0.7996 ±0.0359)vs (0.6904 ±0.0414)and (0.0470±0.0071)vs(0.0283±0.0045 ),P＜0.05] ;No difference was observed in IL-6R protein and mRNA expression between leiomyomas and myometrium[(0.7105 ±0.0520)vs (0.6904 ±0.0532)and (0.6644 ±0.0537 )vs (0.6465±0.0501),P＞0.05 ].Conclusion The lower expression of IL-6 in leiomyomas may contribute to the pathogenesis of hysteromyoma to some extent,and there is no relationship between IL-6R and hysteromyoma.
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Objective To explore the influence and treatment methods of hysteromyoma pregnancy. Method Through case-control study on 116 cases of hysteromyoma pregnancy and the same number cases of normal pregnan-cy in the same period, in order to observe the outcome of two groups. Results There is no significant difference in the matter of amount of bleeding when hysteromyoma pregnant women give birth to their children, no matter how oper-ation group, non-surgical group and control group(P > 0.05); but there is significant difference between non-surgical group and control group(P <0.05), and in the field of asphyxia neonatorum rate, there is no significant difference in all groups(P > 0.05). Conclusions The amount of bleeding in hysteromyoma pregnant women are more than vagi-nal delivery non-hysteromyoma women. It suggests that myomectomy won' t increase the amount of bleeding when doctors give the hysteromyoma women caesarean section at the same time. And the difficulty of surgery won' t signifi-cantly increase when compared to non-pregnancy and pregnancy.
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Objective To assess the clinical value of ultrasound-guided percutaneous ethanol injection (PEI) in the treatment of hysteromyoma. Methods Fifty patients with hysteromyoma confirmed by pathology were enrolled in this study. Dose of ethanol was identified through tumor size. Ultrasound angiography and biopsy were performed after operation to observe the therapeutic effect of PEI. Results All tumors were treated with PEI 1-4 times. Echo enhancement, disappearance of blood in tumor, tumor atrophy and cavity-like change were observed. Post-operative biopsy indicated necrosis of tumor cells. Conclusion Ultrasound-guided PEI is safe and effective in the treatment of hysteromyoma.