ABSTRACT
Objective To explore the effect of Neiyi recipe on the reproductive ability of mice with endometriosis (EM) and its mechanisms. Methods The EM mouse model was established and divided into Neiyi recipe group (n＝26), gestrinone group (n＝25), EM model group (n＝26), and sham operation group (n＝24). After 15 days of continuous drug intervention, 6 proestrous mice were randomly selected from each group for histomorphological observation. The remaining mice were mated at the ratio of male to female of 41 for 15 days. The pregnancy, endometriosis, pelvic adhesions and follicular development were observed and recorded in the 4 groups. The histomorphology of the liver, kidney and spleen of the mice were observed in each group. The concentrations of IL-2, IL-6 and IL-10 in peritoneal fluid of the mice were detected by enzyme-linked immunosorbent assay. Results The pregnancy rate, volume of lesions and pelvic adhesion of the mice were significantly improved in the Neiyi recipe group compared with the gestrinone group and the EM model group (P0.05, P0.01). The ovarian histomorphological observation showed that the follicular development of the mice was better in the Neiyi recipe group than that in the gestrinone group and the EM model group. The mice in the Neiyi recipe group had significantly better outcome in improving follicular development compared with the gestrinone group (P0.05). Compared with the sham operation group, the levels of IL-2 and IL-6 in the peritoneal fluid of the mice were significantly increased in the EM model group (all P0.01), and the level of IL-10 was significantly decreased (P0.05). Compared with the EM model group, the levels of IL-2 in the peritoneal fluid of the mice were significantly decreased in the Neiyi recipe group and the gestrinone group (P0.01), the level of IL-6 in the peritoneal fluid of the mice was significantly decreased in the gestrinone group (P0.05) and the level of IL-10 was significantly increased (P0.01). The pregnancy rate of the mice was not improved in the gestrinone group, and the body mass and the wet mass of liver and kidney were significantly decreased after drug treatment (all P0.05), while the mice in the Neiyi recipe group showed no obvious damages of the liver, spleen or kidney. Conclusion Neiyi recipe can improve the pelvic microenvironment, promote follicular development and improve the reproductive ability of EM mice by inhibiting the growth of EM lesions and reducing pelvic adhesion, with no serious adverse effects and with good safety.
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Objective To establish and evaluate a rat model of endometriosis with pelvic adhesions. Methods To establish a rat model of endometriosis and pelvic adhesions by autologous transplantation of endometrial tissue to the mesenterium. After modeled, eight rats were randomly selected for examination at 1, 3, 5, 7, 14, 21 and 28 days after op-eration. The American Society for Reproductive Medicine Classification of Endometriosis and Haber Adhesion Score were used to evaluate the pelvic adhesions. At the same time, the lesions and surrounding peritoneal adhesions were taken for pathological examination using HE staining. The tissue-type plasminogen activator (tPA) content was detected at 5, 7, 14, 21 and 28 days after operation. Results The two adhesion scoring methods showed that typical pelvic adhesions were formed 5 days after modeling. Compared with the blank control group and the sham operation group, the tPA content in the pelvic adhesions of the model group was significantly decreased after 5 days ( P< 0. 01 ) , and increased at 28 days after model establishment, but still significantly lower than that of the blank control group and sham operation group ( P <0. 01). Conclusions The autologous transplantation method is successfully used to establish a rat model of pelvic adhe-sions of endometriosis in the mesenterium. The model is matured at 5 days after surgery. The tPA is correlated with the formation of pelvic adhesions of endometriosis.
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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
ABSTRACT
El dolor pélvico crónico es una manifestación de muchas enfermedades y un síntoma muy frecuente en la consulta de ginecología. Para entender más completamente su presentación clínica, se explican los mecanismos neuroanatómicos y neurofisiológicos implicados y las causas más comúnmente diagnosticadas. Se resalta la necesidad de un abordaje multidisciplinario, ya que a pesar de su alta prevalencia no existe una clara aproximación de su abordaje primario en forma integral. El objetivo de este estudio es realizar una revisión de la literatura que permita definir los puntos más relevantes para el abordaje diagnóstico y terapéutico de esta patología. Se presentan los estudios disponibles y recomendados según la clínica de las pacientes, adicionalmente puntos clave y signos útiles para evaluar integralmente la consulta motivada por esta condición.
Chronic pelvic pain is a manifestation of many diseases and a frequent symptom in gynecology. To understand completely as the clinical presentation neuroanatomical and neurophysiological mechanisms involved and the most commonly diagnosed causes are explained. In addition, the need for a multidisciplinare approach is emphasized because, despite its high prevalence there is no clear approach to its primary approach comprehensively. The objective of this study is to review the literature to define the most relevant diagnostic and therapeutic approach to this condition. We propose available studies and good options according to clinic of the patients; additionally we comment key points and useful signs at the moment of an integral approach of this condition.