Clinical efficacy of modified vaginal hysterectomy in the treatment of uterine prolapse / 中国基层医药

Objective:To investigate the clinical efficacy of modified vaginal hysterectomy in the treatment of uterine prolapse.Methods:A total of 60 patients with uterine prolapse who received treatment in Fengtai County People's Hospital from July 2017 to October 2021 were included in this study. They were divided into control and observation groups ( n = 30/group) according to different treatment methods. The patients in the control group were treated with traditional vaginal hysterectomy (vaginal hysterectomy + vaginal anterior and posterior wall repair). The patients in the observation group were treated with modified vaginal hysterectomy (vaginal hysterectomy + vaginal anterior and posterior wall repair + autologous ligament suspension). The changes in surgical indicators and treatment effectiveness were evaluated between the two groups. All patients were followed up at 3, 6, and 12 months. Vaginal fornix prolapse and quality of life score were compared between the two groups. Results:The average drainage volume, average anal exhaust time, the average time to get out of bed, and the average length of hospital stay in the observation group were (520.13 ± 52.14) mL, (36.47 ± 5.72) hours, (32.48 ± 7.12) hours, and (16.48 ± 2.67) hours, respectively, which were significantly less or shorter than those in the control group ( t = 19.35, 18.25, 17.56, 17.35, all P < 0.05). The total response rate in the observation group was 93.3% (28/30), which was significantly higher than 80.0% (24/30) in the control group ( χ2 = 6.32, P = 0.005). At 3, 6, and 12 months after surgery, vaginal fornix prolapse did not occur in any patient in the observation group, but it occurred in two, three, and seven patients in the control group at the corresponding time points. Treatment efficiency was superior in the observation group to that in the control group ( χ2 = 4.21, P = 0.001). At 3, 6, and 12 months after surgery, quality of life score in the observation group was significantly higher than that in the control group [3 months: (60.71 ± 7.58) points vs. (50.69 ± 2.89) points; 6 months: (76.42 ± 3.50) points vs. (63.31 ± 8.67) points; 12 months: (81.30 ± 2.64) points vs. (70.72 ± 6.51) points], and the differences were statistically significant ( t = 7.21, 7.10, 6.31, all P < 0.05). Conclusion:The modified vaginal hysterectomy for the treatment of uterine prolapse has an ideal effect. It can effectively reduce the amount of drainage, shorten the exhaust time and the length of hospital stay, improve quality of life, and thereby is worthy of clinical promotion.

Teratoma de ligamento redondo, reporte de caso y revisión de la bibliografía / Round ligament teratoma, case report and literature review

Resumen ANTECEDENTES: El teratoma es un tumor casi siempre benigno, con una amplia variabilidad en su localización, extremadamente rara, en el ligamento redondo. CASO CLÍNICO: Paciente de 30 años, con antecedente de un embarazo a término. En la revisión ecográfica se reportó una lesión quística paraovárica izquierda de 46 x 35 mm, sin componente sólido, graso ni calcificaciones. En el examen ginecológico se palpó una masa por encima del útero, orientada hacia el lado izquierdo, no dolorosa. El resto del examen físico trascurrió sin otras alteraciones. La impresión diagnóstica inicial fue de teratoma abdominopélvico sustentada en la ecografía transvaginal en la que los ovarios se observaron normales, con una masa de ecogenicidad mixta de 50 x 40 x 46 mm, con áreas ecolúcidas y ecogénicas de intensidad variable hacia la fosa iliaca izquierda superior, sin contacto con el ovario. El ligamento redondo se seccionó a ambos lados de la masa y se extrajo sin complicaciones; el reporte histopatológico fue de: teratoma quístico maduro. CONCLUSIONES: El ligamento redondo es una localización infrecuente de los quistes dermoides que debe considerarse en los diagnósticos diferenciales de las masas pélvicas; es susceptible de tratamiento quirúrgico por vía laparoscópica.

Abstract BACKGROUND: Teratoma is an almost always benign tumor, with a wide variability in its location; its location in the round ligament is extremely rare. CLINICAL CASE: 30-year-old patient, with a history of a full-term pregnancy. On routine ultrasound examination, a 46 x 35 mm left paraovarian cystic lesion was reported, with no solid, fatty component or calcifications. In the gynecological examination a mass was palpated above the uterus, oriented to the left side, non-painful. The rest of the physical examination passed without other alterations. The initial diagnostic impression was of abdomino-pelvic teratoma supported by transvaginal ultrasound in which the ovaries were normal, with a mass of mixed echogenicity of 50 x 40 x 46 mm, with echolucent and echogenic areas of variable intensity towards the left superior iliac fossa, without contact with the ovary. The round ligament was sectioned on both sides of the mass and removed without complications; the histopathologic report was: mature cystic teratoma. CONCLUSIONS: The round ligament is an infrequent location of dermoid cysts that should be considered in the differential diagnoses of pelvic masses; it is amenable to surgical treatment laparoscopically.

3.0T MR unilateral hip scanning and arthroscopy in diagnosis of ligamentum teres tears / 中国医学影像技术

Objective: To investigate the value of 3.0T MR unilateral hip scan in the diagnosis of ligamentum teres tears. Methods: Data of preoperative MRI and hip arthroscopy of 41 patients with chronic hip pain were retrospectively analyzed. Preoperative MRI included bilateral hip scans and unilateral hip scans. Taken arthroscopy as the gold standard, the differences of diagnosis of ligamentum teres tears were compared between bilateral and unilateral MR hip scans. Results: Hip arthroscopy confirmed ligamentum teres tears in 34 hips, while unilateral hip MRI showed normal in 4 hips, 7 hips were normal, while unilateral hip MRI showed partial tear of ligamentum teres in 1 hip. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of bilateral hip MR scanning was 58.82% (20/34), 88.24% (30/34), 57.14% (4/7), 85.71% (6/7) and 86.96% (20/23), while of unilateral hip MR scan were 96.77% (30/31), 22.22% (4/18), 60.00% (6/10), 58.54% (24/41) and 87.80% (36/41), respectively for diagnosing ligamentum teres tears. Unilateral hip scanning had larger AUC than bilateral hip scan (P=0.02). Conclusion: 3.0T MR unilateral hip scan is has good value for diagnosis of ligamentum teres tears.

Hip Arthroscopy of a Painful Hip with Borderline Dysplasia / 대한고관절학회지

PURPOSE: Hip arthroscopy has been considered for treating hip dysplasia; however, its efficacy is still a matter of controversy. Here, we report outcomes of patients with borderline dysplasia treated with a contemporary hip arthroscopy technique. MATERIALS AND METHODS: Forty-seven hips with borderline hip dysplasia were treated using hip arthroscopy. Patients underwent procedures to correct torn labrums or ligamentum teres with additional procedure on the acetabular capsule. Patient outcomes were assessed using visual analogue scale (VAS), modified Harris Hip Score (mHHS), Nonarthritic Hip Score (NAHS) and patient satisfaction. Risk factors for poor prognosis were also investigated. RESULTS: The mean follow up period was 25.9 months. At the last follow up, mean VAS score decreased from 6.1±1.6 to 3.5±2.8 (P=0.016). The mHHS and NHAS at the last follow up improved from 61.0±7.6 to 78.6±19.5 (P=0.001) and 62.1±7.5 to 80.0±18.5 (P=0.002), respectively. While significant improvement was observed in all patient reported outcome measures tested, 19 (40.4%) hips indicated that “the operation was unsatisfactory.” The only factor shown to influence outcomes was preoperative VAS (i.e., worse scores potentially an indicator of poor outcomes). CONCLUSION: The results of the current study indicate that arthroscopic management may be beneficial for a subset of patients with borderline dysplasia; however, the dissatisfaction rate associated with this treatment approach may be as high as 40%. The poor preoperative pain score appears to be the sole indicator for poor outcomes.

Metástasis poco frecuente del carcinoma renal de células claras / Unusual metastasis of clear cell renal cell carcinoma

El ligamento falciforme es una reflexión peritoneal abdominal relacionada con la superficie anterior del hígado, que en su borde inferior libre contiene el ligamento redondo (LR); las lesiones únicas en este son infrecuentes. Presentamos un caso de metástasis única en el ligamento redondo en un paciente con antecedente de carcinoma renal de células claras. Realizamos una búsqueda bibliográfica para identificar casos similares. Nuestro paciente es un varón de 71 años con antecedente de carcinoma renal de células tratado con nefrectomía radical izquierda laparoscópica (estadio pT3a). En tomografía computarizada (TC) control a los 5 años se evidencia lesión focal en la periferia del segmento IVa, ante la sospecha de malignidad, se realiza laparotomía exploradora revisando toda la cavidad abdominal sin evidenciar otros implantes peritoneales. Se halla un nódulo de 1 cm en el ligamento redondo y se realiza su exéresis completa, con diagnóstico anatomopatológico de metástasis de células claras. El LR generalmente está afectado en casos de carcinomatosis peritoneal y solo existen dos casos publicados de metástasis únicas.

The falciform ligament is a peritoneal reflection that attaches the liver to the anterior abdominal wall; its lower edge contains the round ligament (RL). Single lesions in the RL are rare and usually correspond to perivascular epithelioid cell tumors. We present a case report of a single metastasis in the RL in a patient with clear cell renal cell carcinoma who underwent surgery five years ago. We conducted a literature review to identify similar cases and we found two case reports of single metastasis in the RL. Our patient was a 71-year-old man with a history of renal cell carcinoma who underwent left laparoscopic radical nephrectomy (stage pT3a), laparoscopic right adrenalectomy and total thyroidectomy due to multinodular goiter. The pathological examination revealed metastases of renal cell carcinoma. A computed tomography (CT) scan performed at 5-year follow-up showed a focal lesion in segment IVa with no FDG uptake in the PET scan, but as malignancy was suspected, the patient underwent exploratory laparatomy with no evidence of peritoneal implants. A 1-cm node was found in the round ligament that was completely resected. The pathological examination revealed metastatic clear cell renal cell carcinoma. The RL is involved in cases of peritoneal carcinomatosis and only two cases of single metastasis have been reported: in one patient with papillary renal cell carcinoma pT1aN0 and another one with left breast adenocarcinoma.

Oophoropexy to the round ligament after recurrent adnexal torsion / Ooforopexia ao ligamento redondo em um caso de torção anexial recorrente

Abstract Recurrent adnexal torsion is a rare gynecological emergency. We report a case of recurrent ipsilateral adnexal torsion in a woman with polycystic ovaries, previously submitted to a laparoscopic plication of the utero-ovarian ligament. Due to the recurrence after the plication of the utero-ovarian ligament, the authors performed a laparoscopic oophoropexy to the round ligament, which is an underreported procedure. The patient was asymptomatic for 1 year, after which she had a new recurrence and needed a unilateral laparoscopic adnexectomy. Since then, she regained the quality of life without any gynecological symptoms. Oophoropexy to the round ligament may be considered when other techniques fail or, perhaps, as a first option in selected cases of adnexal torsion, as it may allow the prevention of recurrence without increasing morbidity while preserving the adnexa.

Resumo A torção anexial recorrente é uma emergência ginecológica rara. Os autores descrevem um caso de torsão anexial unilateral recorrente em uma paciente com síndrome de ovário policístico, previamente submetida a plicatura do ligamento utero-ovárico por laparoscopia. Nesta circunstância, os autores decidiram realizar uma ooforopexia laparoscópica ao ligamento redondo, uma técnica pouco descrita na literatura. A paciente manteve-se assintomática durante 1 ano, período após o qual teve nova recorrência, tendo-se decidido realizar uma anexectomia laparoscópica unilateral. Desde então, ela recuperou a qualidade de vida sem qualquer sintoma ginecológico. A ooforopexia ao ligamento redondo é uma técnica que deverá ser considerada quando outras falham e, em casos selecionados de torsão anexial recorrente, poderá ser considerada a primeira abordagem, para prevenir a recorrência e preservar o anexo.

Variation In The Histological Structure Of Round Ligament Of Uterus At Uterine Cornu With Age

Introduction: The aim of present study is to evaluate the microscopic structure of the round ligament of uterusat the uterine cornu to examine the changes in the structure in different age groups i.e.adult females inreproductive age group, pregnancy & menopause.Materials and Methods: Twenty two round ligaments of uterus (25-70 yrs) were taken for the study of themicroscopic structure at the uterine cornu. The specimens were collected from adult females of reproductive agegroup, pregnant females and menopausal females. Microscopic structure was studied under light microscopeusing haematoxylin and eosin and Van Gieson’s stain was used to differentiate muscle from fibrous tissue.Results: The round ligament showed changes at the two ends of age spectrum chosen for the study (25-70 yrs). Inadult females of reproductive age group (25-40 yr old) it was predominantly muscular and the smooth muscleof the ligament was found to be continuous with that of the myometrium. In pregnant females markedhypertrophied smooth muscle bundles with increased collagen bundles and vascularity were seen. In menopausalage group, tendency towards fibrosis was seen and blood vessels were reduced in number.Conclusion: Variations seen in the ligament in different age groups and continuation of the smooth muscle ofthe round ligament with the myometrium at the uterine cornu may explain the role played by it in keeping theuterus in anteverted position. Role of the ligament would become clearer through a further study of microscopicstructure of a larger sample size including different age groups.

Handling methods of uterus round ligament in laparoscopic inguinal hernia repair in females / 中华消化外科杂志

Laparoscopic inguinal hernia repair has been widely used in adult inguinal hernia.The spermatic cord,as an important reproductive organ in male patients,should be deperitonealized to avoid injury in order to prevent fertility from being affected.However in female patients,the uterine round ligament not the spermatic cord goes across the inguinal canal,which extends from intraperitoneal and extraperitoneal,banding tightly with the peritoneum.It is difficult to completely strip the uterus round ligament from peritoneum to achieve deperitonealization.Hence there is still controversy about how to handle the uterus round ligament.There is no uniform guidance document for the handling of the uterus round ligament in laparoscopic inguinal hernia repair around the world.Handling methods are investigated in this article based on the summary of related literatures.

Pedicled ligamentum teres hepatis in the prevention of duodenal stump fistula after gastrectomy / 中华普通外科杂志

Objective To explore the clinical effects of pedicled ligamentum teres hepatis in preventing duodenum stump fistula after resection of gastric cancer.Methods The clinicopathological data of 563 patients with gastic cancer who underwent resection from Jan.2013 to Dec.2016 were analyzed.Results Fourteen patients in the control group developed duodenum stump fistula.Four patients in the experimental group developed duodenum stump fistula.The incidence of duodenum stump fistula in the control group was 4.6％,while that in the experimental group was 1.5％ (x2 =4.356,P =0.037).All the 14 patients in the control group had high fever and 2 died of multiple organ failure,8 were cured with conservative treatment,and 4 received reoperation.For patients in the experimental group,moderate fever was observed in 2 patients and all were cured by conservative treatment.Conclusion Pedicled ligamentum teres hepatis was safe and effective to prevent duodenum stump fistula after resection of gastric cancer.

Expression change of PTGFR gene in articular capsule and ligamentum teres in DDH and its correlation with pathogenesis of DDH / 重庆医学

Objective To analyze the expression change of PTGFR gene in hip joint tissues of development dysplasia of the hip (DDH) and its correlation with DDH pathogenesis .Methods Eight age-and gender-matched children with DDH (DDH group) and control children (control group) were enrolled for conducting the compaison .The real-time quantitative PCR method and West-ern-blot method were adopted to detect the PTGFR mRNA and protein expression levels .Results PTGFR mRNA expression level in the hip articular capsule and ligamentum teres of the DDH group were significantly decreased compared with those of the control group (t=3 .472 ,2 .887 ,P<0 .05 ,) .The PTGFR protein expression level in the hip articular capsule and ligamentum teres of the DDH group were significantly decreased compared with those of the control group (t=5 .488 ,3 .942 ,P<0 .05) .Conclusion PTG-FR could play an important role in DDH pathogenesis and may be one of DDH pathogenic genes .

Ligamentum Teres Injuries of the Hip / 대한정형외과학회잡지

PURPOSE: The purpose of this study is to identify functions of ligamentum teres during multi-planar movement of the hip joint and to evaluate the correlation between arthroscopic findings and preoperative magnetic resonance imaging (MRI) of ligamentum teres rupture. MATERIALS AND METHODS: With four fresh-frozen cadavers that were dissected for removal of all soft tissue from around the hip, leaving only the ligamentum teres intact, tension of ligamentum teres at each position of the hip during multiplanar movement of the hip joint was identified. Among patients who underwent arthroscopic treatment for hip joint lesion from June 2006 to December 2012, arthroscopic findings of 26 patients who showed ligamentum teres rupture on arthroscopy were compared retrospectively with finding of preoperative MRI and visual analogue scale pain score and modified Harris hip score preoperatively and at final follow-up were evaluated. RESULTS: The ligamentum teres was maximal taut at flexion with external rotation. Ligamentum teres rupture was suspected according to preoperative MRI in 20 cases (76.9%). All cases underwent arthroscopic debridement and thermal shrinkage for the ruptured ligamentum teres. At final follow-up, visual analogue scale pain score and modified Harris hip score had improved from 6.1 (4-9) and 63.7 (36.3-86.9) to 2.0 (0-5) and 88.4 (72.6-100), respectively (all p<0.001). CONCLUSION: The ligamentum teres is maximal taut at flexion with external rotation and contributes to internal stability. Ruptured ligamentum teres should be treated by arthroscopic debridement and thermal shrinkage.

Ultrasonographic diagnosis of round ligament varicosities mimicking inguinal hernia: report of two cases with literature review

Round ligament varicosities are rare, and the mass mimics an inguinal hernia. Round ligament varicosities should be considered in the differential diagnosis of a groin swelling in a female, especially during pregnancy. The diagnosis of round ligament varicosities can be established on grayscale and color Doppler ultrasonography. We report two cases of round ligament varicosities in a 33-year-old non pregnant woman and a 28-year-old pregnant woman, and these patients were diagnosed using ultrasonography. We also reviewed the literature on round ligament varicosities including the present cases. Ultrasonography is diagnostic and can prevent unnecessary surgical intervention and associated morbidity.

Inguinal endometriosis in a patient without a previous history of gynecologic surgery

Endometriosis, defined as growth of endometrial stroma and glands outside the uterine cavity, is a chronic and recurrent disease that affects patients' quality of life. Ectopic endometrial tissue can proliferate at any location in the body, but the pelvic organs and peritoneum are the most frequent implantation sites. Among extrapelvic endometriosis, inguinal endometriosis is a very rare gynecologic condition usually associated with previous pelvic surgery. Endometriosis should be preoperatively distinguished from other inguinal masses using computed tomography, magnetic resonance imaging, or ultrasonography. Here, we report a case of right inguinal endometriosis in a patient with no previous history of gynecologic surgery; in addition, we have provided a brief review of relevant literature.

Round Ligament Varicosities During Pregnancy: Case Report

There are various causes of a painful palpable mass in the groin during pregnancy. The differential diagnoses of an inguinal mass include hernia, lymphadenopathy, mesothelial cyst, cystic lymphangioma, neoplasms (lipoma, leiomyoma and sarcoma), endometriosis, embryonic remnants and round ligament varicosities. Among them, round ligament varicosities can be easily misdiagnosed as an inguinal hernia in a pregnant woman. These lesions should be managed conservatively because they resolve spontaneously during the postpartum period. Ultrasonography can help make the diagnosis of round ligament varicosities and so prevent unnecessary surgical intervention and the associated morbidity. Herein we report on a case of round ligament varicosities that presented during pregnancy and this condition was readily diagnosed via Doppler sonography.

Round ligament varicosities mimicking inguinal hernia in pregnancy / 대한외과학회지

Round ligament varicosities during pregnancy are rare, and can easily be mistaken for an inguinal hernia. On physical examination, round ligament varicosities and groin hernia are difficult to distinguish. The diagnosis of round ligament varicosities can be established on gray-scale and color Doppler sonography. We experienced a case of round ligament varicosities in which a 29-year-old woman presented symptoms at 36 weeks gestation. The patient was diagnosed using Doppler sonography, managed with conservative therapy, and had an uncomplicated vaginal delivery at 40 weeks. The symptoms were resolved completely by two weeks postpartum. We report a case of round ligament varicosities that was diagnosed at 36 weeks of gestation with a review of the literature.

The Ultrasound Diagnosis of Round Ligament Varices That Mimicked Inguinal Hernias During Pregnancy: A Case Report

Round ligament varices during pregnancy are an important part of the differential diagnosis of inguinal hernia as they may cause symptoms and clinical features that are similar to those of inguinal hernia. When this condition is correctly diagnosed, an unnecessary operation may be prevented. The diagnosis of round ligament varices should be considered for pregnant women who present with a palpable mass in the groin. We describe here a case of round ligament varices that presented during pregnancy and this was readily diagnosed with Doppler sonography.

A case of round ligament varicosities during pregnancy / 대한산부인과학회지

Estimated incidence of round ligament varicosities in pregnancy is not known and often times it is confused with inguinal hernia due to their clinical similarities. When a patient is presented with inguinal mass especially in association with varicosity in the genital region or lower extremity, round ligament varicosity must be considered as a plausible diagnosis. Depiction of "bag of worms" on color Doppler ultrasonography is diagnostic of the round ligament varicosity and it is known to resolve spontaneously following delivery. We report a case of round ligament varicosities that was diagnosed at 29 weeks of gestation with a brief review of the literatures.

Mesothelial Cyst of the Round Ligament Mimicking a Metastasis: a Case Report

A mesothelial cyst of the round ligament is a rare cause of an inguinal mass. Clinically, it is frequently misdiagnosed as one of commoner diseases such as an inguinal hernia, femoral hernia, lipoma, and lymphadenopathy upon physical examination. Some previous reports elaborated the sonographic features of a mesothelial cyst of the round ligament. However, to our knowledge, few reports have described the CT features of a mesothelial cyst. We illustrated here the sonographic and multidetector CT features of a case of a mesothelial cyst of the round ligament that presented as an inguinal palpable mass and mimicked a metastasis in a patient with a Sertoli-Leydig cell tumor of the ovary.

Inguinal endometriosis connected to intraperitoneal round ligament: Complete excision with extraperitoneal wide dissection / 대한산부인과학회지

Inguinal endometriosis is a rare gynecologic disease. A 43-year-old woman had felt small nodular mass, which causing cyclic groin pain and fluctuation with menstrual cycle. CT scan revealed the extraperitoneal inguinal mass connected to the left round ligament. During the operation, infiltrative fibrotic mass around the inguinal mass could only be excised with wide groin dissection. After dissection of the abdominal muscles, the intraperitoneal mass could be pulled out and excised at the level of the intact round ligament. Histological diagnosis at the excised mass was endometriosis. After the surgery, the pain disappeared completely. We have reviewed published articles concerning inguinal endometriosis. The mechanism of development of inguinal endometriosis seems to be to that of indirect hernia with a difference of disappearing hernia sac resulting from inflammation of endometriosis. About half of the patients revealed periodicity such as cyclic pain or fluctuation of pain with menstral cycle. We describe the complete surgical excision of extraperitoneal inguinal endometriosis connected to round ligament endometriosis. Successful treatment can be achieved with understanding of the pathophysiology and anatomy related to the inguinal endometriosis.