Grading evaluation of operative complications and analysis of related risk factors in patients with stage Ⅰ endometrial cancer treated by robotic-assisted and traditional laparoscopic surgery / 中华妇产科杂志

Objective@#To investigate the surgical complications in the treatment of stage Ⅰ endometrial cancer by robotic-assisted laparoscopy, the risk degree of Clavein-Dindo complications and the main risk factors affecting the occurrence of surgical complications.@*Methods@#A retrospective case-control study was conducted in the First Affiliated Hospital of Zhengzhou University from October 2014 to June 2019. The patients were divided into robotic-assisted laparoscopy group and traditional laparoscopy group according to the operation mode, including 131 cases in robot group and 290 cases in traditional laparoscopy group. To compare the complications during and after operation and the risk degree of complications between the two groups by Clavein-Dindo classification standard, the age, body mass index (BMI), comorbidities, past history of pelvic surgery, American Society of Anesthesiologists (ASA) grade, preoperative anemia, number of pelvic lymph node resection, number of abdominal aortic lymph node resection, the total number of lymph node resection, operation time, surgical methods (robot surgery or traditional laparoscopic surgery) and other clinicopathological data were analyzed by logistic regression analysis.@*Results@#(1) Complications of operation: the incidence of operative complications (including intraoperative and postoperative complications) in robot group was significantly lower than that in traditional laparoscopy group [(20.6%, 27/131) vs (34.8%, 101/290); χ2=8.620, P=0.003)]. The incidence of intraoperative complications in robot group was lower than that in traditional laparoscopy group [1.5% (2/131) vs 6.2% (18/290); χ2=4.368, P=0.037]. The incidence of intraoperative vascular injury in robot group was significantly lower than that in traditional laparoscopy group [0.8% (1/131) vs 5.2% (15/290); χ2=4.798, P=0.022]. The incidence of postoperative complications in robot group was also lower than that in traditional laparoscopy group [19.1% (25/131) vs 28.6% (83/290); χ2=4.303, P=0.038], but the incidence of postoperative lymphatic leakage in robot group was higher than that in traditional laparoscopy group [10.7% (14/131) vs 5.2% (15/290); χ2=4.279, P=0.039]. (2) Clavein-Dindo classification: the incidence of Clavein-Dindo Ⅰ, Ⅲ, Ⅲ, Ⅳ and Ⅴ grade between two groups were respectively 3.8% (5/131) vs 11.0% (32/290), 13.7% (18/131) vs 14.5% (42/290), 3.1% (4/131) vs 8.6% (25/290), 0 (0/131) vs 0.3% (1/290), 0 (0/131) vs 0.3% (1/290), and the incidence of grade Ⅰ (χ2=5.684, P=0.015) and Ⅲ (χ2=4.361, P=0.037) complications were statistically significant. The incidence of severe complications in robot group (grade Ⅲ and above) was lower than that in traditional laparoscopy group [3.1% (4/131) vs 9.3% (27/290); χ2=5.179, P=0.023]. (3) Analysis of influencing factors of surgical complications: univariate analysis showed that BMI (χ2=15.801, P=0.000), preoperative anemia (χ2=14.299, P=0.000), total number of lymph node resection (χ2=10.425, P=0.001), surgical methods (χ2=8.620, P=0.003) were related to the occurrence of surgical complications of endometrial carcinoma. Multivariate analysis showed that BMI (OR=0.289, 95%CI: 0.097-0.864, P=0.026), preoperative anemia (OR=0.309, 95%CI: 0.129-0.740, P=0.008), the total number of lymph node resection (OR=0.624, 95%CI: 0.403-0.966, P=0.034) and surgical methods (OR=3.491, 95%CI: 1.030-11.840, P=0.045) were independent risk factors for surgical complications of endometrial carcinoma.@*Conclusions@#Compared with traditional laparoscopic surgery, robot-assisted laparoscopic surgery has fewer complications and lower incidence of severe complications. BMI, preoperative anemia, the total number of lymph node resection and surgical methods are independent risk factors for the occurrence of surgical complications of stage Ⅰ endometrial cancer.

Grading evaluation of operative complications and analysis of related risk factors in patients with stage Ⅰ endometrial cancer treated by robotic-assisted and traditional laparoscopic surgery / 中华妇产科杂志

Objective:To investigate the surgical complications in the treatment of stage Ⅰ endometrial cancer by robotic-assisted laparoscopy, the risk degree of Clavein-Dindo complications and the main risk factors affecting the occurrence of surgical complications.Methods:A retrospective case-control study was conducted in the First Affiliated Hospital of Zhengzhou University from October 2014 to June 2019. The patients were divided into robotic-assisted laparoscopy group and traditional laparoscopy group according to the operation mode, including 131 cases in robot group and 290 cases in traditional laparoscopy group. To compare the complications during and after operation and the risk degree of complications between the two groups by Clavein-Dindo classification standard, the age, body mass index (BMI), comorbidities, past history of pelvic surgery, American Society of Anesthesiologists (ASA) grade, preoperative anemia, number of pelvic lymph node resection, number of abdominal aortic lymph node resection, the total number of lymph node resection, operation time, surgical methods (robot surgery or traditional laparoscopic surgery) and other clinicopathological data were analyzed by logistic regression analysis.Results:(1) Complications of operation: the incidence of operative complications (including intraoperative and postoperative complications) in robot group was significantly lower than that in traditional laparoscopy group [(20.6%, 27/131) vs (34.8%, 101/290); χ 2=8.620, P=0.003)]. The incidence of intraoperative complications in robot group was lower than that in traditional laparoscopy group [1.5% (2/131) vs 6.2% (18/290); χ 2=4.368, P=0.037]. The incidence of intraoperative vascular injury in robot group was significantly lower than that in traditional laparoscopy group [0.8% (1/131) vs 5.2% (15/290); χ 2=4.798, P=0.022]. The incidence of postoperative complications in robot group was also lower than that in traditional laparoscopy group [19.1% (25/131) vs 28.6% (83/290); χ 2=4.303, P=0.038], but the incidence of postoperative lymphatic leakage in robot group was higher than that in traditional laparoscopy group [10.7% (14/131) vs 5.2% (15/290); χ 2=4.279, P=0.039]. (2) Clavein-Dindo classification: the incidence of Clavein-Dindo Ⅰ, Ⅲ, Ⅲ, Ⅳ and Ⅴ grade between two groups were respectively 3.8% (5/131) vs 11.0% (32/290), 13.7% (18/131) vs 14.5% (42/290), 3.1% (4/131) vs 8.6% (25/290), 0 (0/131) vs 0.3% (1/290), 0 (0/131) vs 0.3% (1/290), and the incidence of grade Ⅰ (χ 2=5.684, P=0.015) and Ⅲ (χ 2=4.361, P=0.037) complications were statistically significant. The incidence of severe complications in robot group (grade Ⅲ and above) was lower than that in traditional laparoscopy group [3.1% (4/131) vs 9.3% (27/290); χ 2=5.179, P=0.023]. (3) Analysis of influencing factors of surgical complications: univariate analysis showed that BMI (χ 2=15.801, P=0.000), preoperative anemia (χ 2=14.299, P=0.000), total number of lymph node resection (χ 2=10.425, P=0.001), surgical methods (χ 2=8.620, P=0.003) were related to the occurrence of surgical complications of endometrial carcinoma. Multivariate analysis showed that BMI ( OR=0.289, 95% CI: 0.097-0.864, P=0.026), preoperative anemia ( OR=0.309, 95% CI: 0.129-0.740, P=0.008), the total number of lymph node resection ( OR=0.624, 95% CI: 0.403-0.966, P=0.034) and surgical methods ( OR=3.491, 95% CI: 1.030-11.840, P=0.045) were independent risk factors for surgical complications of endometrial carcinoma. Conclusions:Compared with traditional laparoscopic surgery, robot-assisted laparoscopic surgery has fewer complications and lower incidence of severe complications. BMI, preoperative anemia, the total number of lymph node resection and surgical methods are independent risk factors for the occurrence of surgical complications of stage Ⅰ endometrial cancer.

Clinical application of interventional therapy in the treatment of gestational trophoblastic neoplasia / 实用放射学杂志

Objective To investigate the effect and clinical value of interventional therapy in the treatment of gestational trophoblastic neoplasia(GTN).Methods 28 cases of GTN were selected,of which 18 cases were treated with fluorouracil +dactinomycin(5-Fu+KSM)for 2 courses,however,the level of β-HCG and uterine lesions did not significantly reduced.The remained 10 cases were treated with etoposide+actinomycin-D+ methotrexate+ tetrahydrofolate+ vincristine+ cyclophosphamide(EMA-CO)chemotherapy for 2 courses,Ⅳ degree of myelosuppression and severe gastrointestinal reactions appeared and had to cease the next cycle of treatment. All patients were treated with uterine artery and/or ovarian arterial infusion(cisplatin,etoposide,bleomycin)for 2 courses,meanwhile, the gelatin sponge particles were used for embolization of uterine arteries and/or ovarian arteries.The β-HCG level,tumor volume, and the changes of sex hormones were tested before and one year after interventional therapy.Results 28 patients underwent transcatheter uterine arterial and/or ovarian arterial chemoembolization and embolization,the internal iliac arteriography showed significant tumor staining.20 patients underwent double uterine arterial infusion and embolization,and 8 patients underwent bilateral uterine arterial and unilateral ovarian arterial infusion and embolization.β-HCG and lesion size were measured on the 18th day after intervention.The results showed that the β-HCG decreased significantly after 2 courses of treatment,and the uterine lesion was reduced or disappeared,with a significant statistical difference,however,sex hormone levels did not changed significantly before interventional therapy and during one year follow-up.Conclusion The interventional treatment of GTN is less invasive,effective,and worthy of clinical application.

Clinical analysis of leiomyomatosis peritonealis disseminate after laparoscopic uterine myomectomy in ten cases / 中华妇产科杂志

Objective To investigate the clinicopathological features,treatment and prognosis of leiomyomatosis peritonealis disseminata (LPD).Methods A total of 10 patients suffered from LPD after laparoscopic uterine myomectomy were collected in the First Affiliated Hospital of Zhengzhou University from September 2012 to September 2016,and all clinical database were retrospectively analyzed.Results (1)Clinical features:the age of 10 cases was 25-50 years old,and 8 cases of them were in child-bearing age,while 2 cases were in perimenopausal period.Of 10 cases,2 cases manifested as discontinuous lower abdominal pain,and the other cases were seen the doctor for the examinations found tumors of pelvis or abdomen.All 10 cases had a history of laparoscopic uterine myomectomy under went power morcellation with an average of (4.0±2.2) years (range 1.3 to 8.1 years),2 cases of them had a history of oral hormone treatment after the first myoma morcellation.(2) Treatment methods and postoperative pathologic diagnosis:during intraoperative exploration,LPD nodules were most distributed in Douglas pouch (10 cases),and next in mesentery (7 cases),abdominal peritoneum (6 cases) and omentum majus (4 cases),etc.Seven of the 8 cases of child-bearing age were performed laparoscopic LPD nodules removal,1 case gone combined with laparotomy and resecting LPD nodules;2 cases in perimenopausal period done laparotomy oophorotomy and resected all LPD nodules and omentum.(3) Postoperative relapse and reproductive outcomes:the follow-up time of all cases was 2.8 years,and no recurrence was found during the follow-up period;2 cases had natural conception and term vaginal birth during the follow-up period.Conclusions LPD is mainly related to iatrogenic planting and spreading,which is a benign disease and characterized by multiple smooth muscle nodules throughout abdominopelvic cavity,and the nodules of LPD is commonly located in Douglas pouch,mesenteric and omentaum majus,etc.The preferred method of LPD should be individual operative treatment according to different situations,and in which patients may be have better prognosis.

Influence of pertussis toxin on GPER-mediated activation of phosphatidylinositol 3-kinase/protein kinase R signaling induced by 17β-estradiol in endometrial carcinoma cells / 中华妇产科杂志

Objective To investigate the influence of pertussis toxin(PTX)on G protein-coupled estrogen receptor(GPER)-mediated activation of phosphatidylinositol 3-kinase(PI3K)/protein kinase B (Akt)signaling activated by 17 β-estradiol(17β-E2)in endometrial carcinoma cells.Methods Expressions of GPER protein were detected by immunohistochemical SP method in Ishikawa and HEC-1A cells.Changes of levels of GPER,ERα and ERβ protein and the activation of Akt protein were observed by western blot in the two cells after they were treated by PTX for 30 minutes at different concentrations(0,0.1,0.5,1.0 μg/ml),and then co-stimulated with with 1 × 10-6 mol/L 17β-E2 respectively at different time (Ishikawa 30 minutes,HEC-1A 15 minutes).Results(1)Immunohistochemical SP method showed that GPER was positive stained in cell cytoplasm of Ishikawa and HEC-1A cell.(2)After co-treated with PTX at different concentrations(0,O.1,0.5,1.0 μg/ml)and 10-6 mol/L 17β-E2,in Ishikawa cell,the ratio of pAkt/Akt was 0.74 ±0.54,0.34 ±0.06,0.18 ±0.03,0.07 ±0.15,the gray values of GPER was 0.872 ± 0.490,0.395 ± 0.054,0.145 ± 0.014,0.034 ± 0.008,and with increasing concentration of PTX,the ratio of p-Akt/Akt and the expression of GPER decreased gradually(P ＜ 0.05),which was most obviously when the concentration was 1.0 μg/ml(F =63.729,P =0.0001;F =160.284,P =0.0001);ERα and ERβ protein had no significant change among different groups(P ＞0.05).In HEC-1A cell,the ratio of pAkt/Akt was 0.73 ±0.09,0.26 ±0.14,0.11 ±0.03,0,the Gray values of GPER is 0.927 ±0.134,0.485 ± 0.022,0.194 ± 0.004,0,and with increasing concentration of PTX,the ratio of p-Akt/Akt and the expression of GPER decreased gradually(P ＜ 0.05),which were also completely inhibited when the concentration was 1 μg/ml(F =1039.321,P =0.0001;F =109.646,P =0.0001),ERα protein had no significant differences(P ＞ 0.05)among different groups.ERβ was negatively expressed.Conclusion The results proposed that the activation of PI3K/Akt signaling in Ishikawa and HEC-1A cells could be inhibited after blocking the role of GPER by PTX.

Effects of plasma from patients with preeclampsia on the proliferation and apoptosis of human umbilical vein endothelial cells and its relationship with lysophosphatidic acid receptors / 中华妇产科杂志

Objectives To investigate the effects of plasma from the patients with preeclampsia on proliferation and apoptosis of human umbilical vein endothelial cells(HUVEC),and to explore the relationship between cell damage and lysophosphatidic acid(LPA)receptors.Methods Sixty patients with preeclampsia were recruited from October 2011 to June 2012 in the First Affilated Hospital of Zhengzhou University.Among them,thirty cases were defined as the mild preeclampsia group and thirty cases were defined as the severe preeclampsia group.The other thirty healthy pregnant women were recruited in the healthy pregnant women group.The levels of plasma LPA in the three groups were measured.The HUVEC were cultured in vitro with plasma from the three groups,and a blank control group was set up as well.Proliferation and apoptosis of HUVEC were measured by MTT assay and flow cytometry.Immunohistochemistry of biotin streptomyces protein peroxidase(SP)method was used to measure the protein expression level of Edg 2,4,7.Results(1)The plasma LPA levels in the healthy pregnant woman group,mild preeclampsia group and severe preeclampsia group were(3.38 ± 2.08)μmol/L,(6.12 ± 0.22)μmol/L,(9.10 ± 0.17)μmol/L,respectively.The plasma levels of LPA in patients with preeclampsia were significantly higher than that in the healthy pregnant women(P ＜ 0.01).(2)The proliferation rate of HUVEC in the mild and severe preeclampsia groups [(65.2 ± 2.7)％ and(51.9 ± 2.8)％] were significantly lower than that in the healthy pregnant women group and the control group [(84.3 ± 3.1)％ and(100.0 ± 0.0)％,P ＜ 0.01].(3)The early apoptosis rate,middle-late apoptosis rate and total apoptosis rate of HUVEC in the mild and severe preeclampsia groups [total apoptosis rate were(30.4 ±2.0)％ and(43.4 ±2.5)％] were significantly higher than those in the healthy pregnant women group and the control group [total apoptosis rate were(18.6 ± 1.6)％ and(8.0 ± 1.5)％,P ＜ 0.01].(4)The expression positive rates of Edg 2,4,7 proteins in the four groups were as following:mild preeclampsia group 83％,80％ and 73％;severe preeclampsia group 97％,93％ and 90％;healthy pregnant women group 40％,40％ and 37％,and the control group 10％,10％ and 7％ respectively.The positive rates of HUVEC in the mild and severe preeclampsia groups were significantly higher than those in the healthy pregnant women group and the control group(P ＜ 0.01).Conclusions The plasma of patients with preeclampsia could inhibit proliferation and promote apoptosis of HUVEC,and induce the expression of Edg 2,4,7 proteins.It suggested that the increase of lysophosphatidic acid in plasma could be one of the reasons of endothelial cell damage in patients with preeclampsia.

Expression and significance of aquaporin 1 in placenta, placental membranes and peritoneum of patients with hypertensive disorder complicating pregnancy / 中华妇产科杂志

Objective To explore the role of aquaporin 1 (AQP1) in the initiation and development of hypertensive disorder complicating pregnancy ( HDCP), and to analyze the relationship between AQP1 expression and ascites formation of patients with eclampsia. Methods Sixty inpatients with HDCP were recruited in the study, including 20 patients with gestational hypertension, 20 with mild preeclampsia, and 20 with severe preeclampsia. And 20 healthy pregnant women were taken as control. Immunohistochemistry was used to analyze AQP1 expressions in placenta, embryolemma and peritoneum, and B-mode uhrasonography was used to detect the ascites level of the patients. Results ( 1 ) AQP1 expression was detected in placenta, embryolemma and peritoneum. AQP1 was mainly located in endotheliocytes of blood vessels and blood capillaries in placenta, endothelial cells of amniotic membrane in embryolemma, and endotheliocytes of blood capillary and small veins in peritoneum- (2)The ascites incidence of HDCP patients ( 63%, 38/60) was higher than that of controls( 10% ,2/20 ; P < 0. O1 ). ( 3 ) The positive expressive rate of AQP1 in placenta of patients with HDCP ( 85% ) was higher than that of controls ( 70%, P < 0. 01 ).Furthermore, the AQP1 positive expressive rate from severe preeclampsia (90%)was obviously higher than that from gestational hypertension patients ( 80%, P <0. 05 ). (4) The AQP1 positive expressive rate in embryolemma from HDCP patients( 87% ) was lower than that of controls ( 95%, P < 0. 05 ). The expressive rate from severe preeclampsia patients (80%) was obviously lower than that from gestational hypertension patients(95%, P <0. 05) and that of controls. (5) The AQP1 expressive rate in peritoneum from HDPC patients(82% )was higher than that of controls(70%, P <0. 01 ). The expressive rate of AQP1 from severe preeclampsia patients ( 90% ) was obviously higher than that from gestational hypertension patients (75%,P <0. 05) and that of controls. Conclusions The expression level of AQP1 of patients with preeclampsia increases in placenta and peritoneum and decreases in embryolemma, and holds correlation with the degree of HDCP. All these suggest that the changes in AQP1 expression may play an important role in the initiation and development of HDCP and may be one of the mechanisms for ascites formation.