RESUMO
Energy devices have been widely used in gynecological surgeries. From the overall development trend, energy devices improve the efficiency of surgery. The continuous updating and upgrading of energy devices also reduces surgical complications and improves the safety of surgery. The injury caused by energy devices is not only related to the complexity of the operation or the disease itself, but also closely related to whether the operator can reasonably choose and master the use of energy instruments, as well as the surgical skills and experience of the operator. Surgeons should establish the concept of " prevention is better than remedy" when using energy instruments. We should take the initiative to learn and master the working principle of different energy devices, understand the design characteristics of each product and improve the skills of device use, so as to minimize the complications caused by various energy instruments and bring real benefits to doctors and patients.
RESUMO
Objective:To investigate the value of positron emission tomography/computed tomography (PET/CT) in diagnosis of retroperitoneal lymph node metastasis for early cervical cancer.Methods:Retrospectively analyze the preoperative PET/CT examination results and postoperative pathological results of patients with early cervical cancer who underwent surgical treatment from May 5, 2019 to August 31, 2020, and analyze the clinical characteristics, so as to explore the high risk factors of PET/CT in the diagnosis of retroperitoneal lymph node metastasis.Results:The accuracy, sensitivity, specificity and area under the curve (AUC) of PET/CT in the diagnosis of retroperitoneal lymph node metastasis were 75.2%, 60.0%, 81.3% and 0.707, respectively. Univariate analysis showed that 2009 International Federation of Gynecology and Obstetrics (FIGO) stage, tumor diameter >4 cm, lymphovascular space involvement (LVSI) positive, depth of invasion, high squamous cell carcinoma antigen (SCC-Ag) level and cytological grade were important factors for PET/CT in the diagnosis of retroperitoneal lymph node metastasis ( P<0.05); Multivariate analysis showed that tumor diameter >4 cm was an independent risk factor for PET/CT diagnosis of retroperitoneal lymph node metastasis ( P=0.015). Conclusions:PET/CT has a certain diagnostic value in the evaluation of retroperitoneal lymph node metastasis, but it can not fully reflect the facticity of lymph node metastasis; tumor diameter > 4cm is an independent risk factor for PET/CT in the diagnosis of retroperitoneal lymph node metastasis.
RESUMO
Since 2018,the controversy between laparotomy and minimally invasive surgery for cervical cancer has been paid attention widespread,In addition,we should analyze the other problems in cervical cancer surgery objectively and comprehensively.Laparoscopic surgery has been rapidly popularized in China due to its advantages over the past 10 years.However,there are still many points in the treatment of cervical cancer in China,such as not paying attention to the concept of tumor-free,not strictly grasping the indications for surgery,inadequate surgical scope,and lack of oncologist training,etc,which needs we pay more attention.In order to obtain the best therapeutic effect,we not only pay attention to the discuss of laparotomy and minimally invasive of the cervical cancer,but should also pay attention to the nature of tumor treatment.
RESUMO
Objective Systematic pelvic lymph node ( SPLN) +abdominal paraaortic lymph node ( APLN) dissection re-mains controversial in the treatment of endometrial carcinoma , especially in the early stage of the tumor .This study aims to investigate the value and safety of APLN dissection in the treatment of early-stage endometrial carcinoma . Methods We retrospectively ana-lyzed the clinical data about 109 cases of early-stage endometrial adenocarcinoma , 56 treated by SPLN dissection ( group A ) and the other 53 by SPLN+APLN dissection ( group B ) .We compared the postoperative complications , recurrence and metastasis , and progno-sis-related factors between the two groups of patients . Results No statistically significant difference was found in the incidence rate of postoperative complications between groups A and B ( 19.64% vs26.41%, P>0.05).Recurrence and metastasis were found in 12 of the 109 patients, 10 in group A and 2 in group B (17.86%vs 3.77%, P=0.019).Multivariate logistic regression analysis showed that the independent factors of recurrence and metastasis includ -ed the differentiation degree (OR=7.385, 95%CI:1.877-29.062), pathologic stage (OR=5.444, 95%CI:1.673-17.720), range of lymph mode dissection (OR=19.171, 95%CI:2.242 -163.946), and range of lesion focus (OR=12.524, 95%CI:1.186-132.280), with the range of lymph mode dissection as the greatest influencing factor on prognosis . Conclusion SPLN+APLN dissection can reduce the recurrence and metastasis and improve the prognosis of early -stage endometrial adenocarcinoma , and therefore is safe and feasible for the treatment of the tumor .
RESUMO
Objective To explore the outcomes of the oncology, the fertility and pregnancy on patients with early-stage cervical cancer after undergoing fertility-sparing treatments, and to investigate its value on clinical treatment. Methods A total of 29 patients with cervical cancer (stage Ⅰa2-Ⅰb1) who had undergone the fertility-sparing treatments in Renji Hospital, School of Medicine, Shanghai Jiaotong University from February 2010 to September 2015 were analyzed retrospectively. Surgical procedures included transvaginal cervical cold knife conization (CKC)+laparoscopic pelvic lymphadenectomy (PLD) or total laparoscopic uterine cervix extensive resection (RT; contains PLD); 48 patients with early cervical cancer under going laparoscopic uterine extensive resection (RH; contains PLD) by the same group of physicians in the same period were chosen as the control group. The perioperative related indicators, postoperative specimen examination, pregnancies after surgery and postoperative tumor follow-up results were retrospectively analyzed and compared between the two groups. Results (1) Among these 29 patients in the study group, 26 cases were underwent the fertility-sparing surgery quick frozen pathological examinations were positive in 3 cases, which underwent total laparoscopic RT eventually. (2) The perioperative related indicators: compared with the study group and the control group, the operation time [(182 ± 21), (147 ± 24) minutes, respectively] has significant difference (t=6.563, P0.05) in intra-operative blood loss [(102±26), (99±34) ml], postoperative aerofluxus time [(1.3±0.4), (1.1±0.9) days], the average length of hospital stay [(11.2 ± 2.1), (10.6 ± 3.5) days], rate of urine retention [10%(3/29), 10%(5/48)] and rate of postoperative infection [3%(1/29), 2%(1/48)]. (3)Postoperative specimen examination:compared with the study group and the control group, there were no significant difference (P>0.05) innumber of removed lymphatic nodes (23.4 ± 4.1, 22.8 ± 3.9), length of cardinal ligament [(2.9 ± 0.5), (3.0 ± 0.6) cm], lengthof uterosacral ligament [(2.6±0.7), (2.8±0.4) cm], length of removed vaginal [(3.4±0.3), (3.5±0.3) cm]. (4) Pregnancies after surgery and postoperative tumor follow-up results:in the study group, only 14 patients had fertility requirement after treatments. Pregnancies occurred in 5 women (5/14), which included1 case of full-term labor, 1 case of preterm labor, and 3 cases of spontaneous abortion. The Average follow-up time in postoperative patients of the study group and control group was 29.4, and 30.2 months respectively. In follow-up period, compare with study group and the control group, there was no significant difference (χ2=0.004, P>0.05) in the recurrence rate [4%(1/26), 4%(2/48)]. Conclusion Fertility-sparing surgery of early-stage cervical cancer is safe but the outcome of the fertility and pregnancy is still need toimprove.
RESUMO
Background and purpose:A variety of measures are taken preoperatively to reduce the tumor size of stageⅠb2 bulky cervical cancer before surgery. Which one is safer and more effective, currently, there is no consensus. This article compared the effect in 3 different treatment methods (neoadjuvant chemotherapy, neoadjuvant chemoradiotherapy and operation) on patients with stageⅠb2 bulky cervical cancer, and provided evidence for clinical decision. Methods:Retrospective analysis the clinical date of 133Ⅰb2 bulky cervical cancer patients, who received preoperative neoadjuvant chemotherapy, neoadjuvant chemoradiotherapy and direct operation from Apr. 2006 to Oct. 2010 in our hospital. Results: The effective rates of neoadjuvant chemotherapy, neoadjuvant chemoradiotherapy group were 91.8% and 92.5%, respectively, there was no statistical difference(P>0.05). The tumor size got smaller after treatment compared with the size before treatment (P0.05). The bleeding volume of neoadjuvant chemo radio therapy group was significantly higher than those in the other 2 groups (158.9±50.7 vs 116.8±45.5, 123.1±30.2;P0.05);Pathological examination showed that vascular invasion in surgery group had statistical differences than other 2 groups (P0.05);Besides, there were no statistical difference on vascular invasion between the 3 groups (P>0.05);And on 3-year overall survival, disease-free survival there was no statistical difference between the 3 groups (P>0.05). Conclusion:Neoadjuvant chemotherapy can effectively reduce tumor size for patients with stage Ⅰb2 bulky cervical cancer before operation, it is better than direct surgery or preoperative chemoradiotherapy in improving the resection rate, and reducing postoperative pathological positive rate, and infection. Neoadjuvant chemotherapy can improve the pathological complete remission rate. The combination of radiation and chemotherapy might produce synergistic effect on huge cervical tumor, but it can’t improve the survival rate. Therefore, neoadjuvant chemotherapy is the best choice for the stageⅠb2 cervical cancer patients. Therefore, a long-term follow-up or large sample randomized controlled trials is necessary to assess the prognosis of preoperative neoadjuvant chemotherapy and neoadjuvant chemoradiotherapy.
RESUMO
Objective To compare theshort-term efficacy and safety between TP and PVB scheme chemoradiation for advanced cervical cancer. Methods Between January 2012 and January 2014, 187 Xinjiang uygur patients with advanced cervical cancer (stageⅡb to Ⅳa) who received concurrent chemoradiotherapy in Xinjiang medical university affiliated tumor hospital were analyzed. A1l cases were divided into two groups receiving radiotherapy concomitant (n = 104), PVB group (n = 83). Theshort-term efficacy and toxicity was evaluated four weeks aftertreatment. Results For squamous cell carcinomas, the response rates were 85.9% and 73.5% in TP and PVB group respectively (P > 0.05). For Non-squamous cell carcinomas (adenocarcinoma and adenosquamous), the response rates were 75.7% and 40% in TP and PVB group respectively (P 0.05). Conclusions For cervical squamous cell carcinomas, theshort-term efficacy of two chemotherapy regimens is similar while forNon-squamous cell carcinomas, TP regimengroup is superior toBone marrow suppression and neurotoxicity in TP regimengroup is significantly higher than PVB group (P < 0.05), while gastrointestinal adverse reaction lower than PVBgroup.
RESUMO
Objective:This study constructs networks and screens potential early-warning plasma biomarkers specific for cervical cancer in Uygur women based on the proteomic data of a previous study by using MetaCoreTM Analysis. This study also explains the canceration mechanism of cervical cancer. Methods:A total of 43 plasma differential core proteins, which were analyzed and identified by proteomic techniques, underwent enrichment analysis of protein functional annotation, biological process, cellular component, GeneGo network distribution and network construction, and biomarker assessment by using MetaCoreTM online bioinformatics software. Results:The result of the MetaCoreTM analysis shows that the negative regulation of cellular component organization, reverse cholesterol transport, and negative regulation of response to stimulus were the most frequently identified functions of the selected differential proteins. The regulation of metabolism, bile acid regulation of lipid metabolism, negative farnesoid X-activated receptor-dependent regulation of bile acid concentration, inflammation complement system, cytoskeleton actin filaments, signal transduction estrogen receptor 1 membrane pathway, and inflammation interleukin-6 signaling were identified as the canonical pathways that are overrepresented in cervical cancer. The MetaCore network of selected proteins, which was constructed using the shortest path algorithm with four plasma proteins (antithrombinⅢ(ATⅢ), clusterin (CLU), villin1 (VIL1), and immunoglobulin kappa locus (IGK@)) as candidate biomarkers, was screened. Conclusion:The proteins ATⅢ, CLU, VIL1, and IGK@can be considered candidate plasma biomarkers of cervical cancer. The mechanism of occurrence and de-velopment of cervical cancer was further explained by MetaCoreTM bioinformatics analysis, thereby enhancing the early-warning system for cervical cancer.
RESUMO
Objective To establish differential protein expression profile specific for serum proteome of cervical carcinoma in Uighur women by protein 2-dimensional liquid phase chromatogra-phy. Methods We collected and prepared sera of cervical carcinoma from Uighur women, and sepa-rated and processed data using 2-dimensional liquid phase chromatography system specific for protein (ProteomeLabTM PF-2D ). Results A differential expression profile of serum proteome based on characteristics of protein isoelectrie point and hydrophobic features was successfully established. Fifty-six differentially expressed protein spots were found, among which there was an obvious difference in 12 peaks. Conclusion Two-dimensional liquid phase chromatography is an effective and feasible method to establish differential expression profile of serum proteome and to offer a new way for the screening of serum protein markers of Uighur women with cervical carcinoma.
RESUMO
Objective To investigate the clinical value of the YSZ-1 uterine manipulator in total laparoscopic hysterectomy.Methods Total laparoscopic hysterectomy was employed in a total of 78 women by using the LigaSure,ultrasonic scalpel,and the YSZ-1 uterine manipulator.The anterior fornix was opened and the manipulator was placed on the lip of the cervix.Then the uterus was completely removed.Results The operation was completed smoothly in all the 78 patients.The operating time was 45~90 min(mean,63 min),and the intraoperative blood loss was 40~100 ml(mean,65 ml).No urinary tract injuries,vaginal bleeding,or other postoperative complications occurred.The length of postoperative hospital stay was 4~7 d(mean,5.3 d).Follow-up examinations in the 78 patients for 3~6 months(mean,4 months) showed that the vaginal wound normally healed up. Conclusions Use of the YSZ-1 uterine manipulator in total laparoscopic hysterectomy makes the procedure easier and safer.The YSZ-1 uterine manipulator is a useful laparoscopic instrument.