Pub Date : 2025-06-25DOI: 10.3760/cma.j.cn112141-20241024-00572
S Y Liang, J X Qu, H F Shi, Y Y Zhao
Objective: To investigate the relationship between postpartum hemorrhage (PPH) volume and the risk of adverse clinical outcomes in pregnant women. Methods: This was a retrospective cohort study of 41 494 deliveries at Peking University Third Hospital from 2012 to 2020. With PPH volume as the main exposure, the outcome indicators included: (1) Severe adverse outcomes: shock or embolism, abnormal coagulation function, abnormal liver function, and kidney injury; (2) General adverse outcomes: moderate to severe anemia, hypoalbuminemia, postpartum blood transfusion. Robust Poisson regression was employed to calculate the risk of each outcome index in pregnant women with different PPH volumes under the condition of controlling confounding factors, and to analyze the risk trends of each outcome index with the change of PPH volumes. Results: A total of 41 494 pregnant women were included in the study, including 9 959 cases (24.00%, 9 959/41 494), 23 974 cases (57.78%, 23 974/41 494), 5 235 cases (12.62%, 5 235/41 494), 1 144 cases (2.76%, 1 144/41 494), 508 cases (1.22%, 508/41 494), 208 cases (0.50%, 208/41 494), 207 cases (0.50%, 207/41 494) and 259 cases (0.62%, 259/41 494) pregnant women with PPH volume <250, 250-499, 500-749, 750-999, 1 000-1 249, 1 250-1 499, 1 500-1 999 and ≥2 000 ml, respectively. The risk of any serious adverse outcome, such as shock or embolism, abnormal coagulation function, abnormal liver function and kidney injury, showed a "J-shaped" relationship with PPH volume: risks remained stable (0.26%-0.59%) below 1 500 ml but increased significantly to 3.38% (RR=3.43, 95%CI: 1.14-10.35) at 1 500-1 999 ml and 5.02% (RR=4.53, 95%CI: 1.49-13.75) at ≥2 000 ml (all P<0.05). Moderate-to-severe anemia showed threshold effects at 750 ml (RR ranging from 7.21 to 8.53) and hypoalbuminemia at 1 250 ml (RR ranging from 3.24 to 3.83), with risks plateauing beyond these thresholds (all P<0.05). Conclusion: It is suggested that 750 ml, 1 250 ml and 1 500 ml should be used as the key intervention thresholds, corresponding to the initiation thresholds of anemia, hypoalbuminemia management and multidisciplinary intensive care, respectively, so as to provide a new reference for optimizing the clinical diagnosis and treatment strategy of PPH.
{"title":"[Association between postpartum blood loss volume and maternal adverse clinical outcomes].","authors":"S Y Liang, J X Qu, H F Shi, Y Y Zhao","doi":"10.3760/cma.j.cn112141-20241024-00572","DOIUrl":"https://doi.org/10.3760/cma.j.cn112141-20241024-00572","url":null,"abstract":"<p><p><b>Objective:</b> To investigate the relationship between postpartum hemorrhage (PPH) volume and the risk of adverse clinical outcomes in pregnant women. <b>Methods:</b> This was a retrospective cohort study of 41 494 deliveries at Peking University Third Hospital from 2012 to 2020. With PPH volume as the main exposure, the outcome indicators included: (1) Severe adverse outcomes: shock or embolism, abnormal coagulation function, abnormal liver function, and kidney injury; (2) General adverse outcomes: moderate to severe anemia, hypoalbuminemia, postpartum blood transfusion. Robust Poisson regression was employed to calculate the risk of each outcome index in pregnant women with different PPH volumes under the condition of controlling confounding factors, and to analyze the risk trends of each outcome index with the change of PPH volumes. <b>Results:</b> A total of 41 494 pregnant women were included in the study, including 9 959 cases (24.00%, 9 959/41 494), 23 974 cases (57.78%, 23 974/41 494), 5 235 cases (12.62%, 5 235/41 494), 1 144 cases (2.76%, 1 144/41 494), 508 cases (1.22%, 508/41 494), 208 cases (0.50%, 208/41 494), 207 cases (0.50%, 207/41 494) and 259 cases (0.62%, 259/41 494) pregnant women with PPH volume <250, 250-499, 500-749, 750-999, 1 000-1 249, 1 250-1 499, 1 500-1 999 and ≥2 000 ml, respectively. The risk of any serious adverse outcome, such as shock or embolism, abnormal coagulation function, abnormal liver function and kidney injury, showed a \"J-shaped\" relationship with PPH volume: risks remained stable (0.26%-0.59%) below 1 500 ml but increased significantly to 3.38% (<i>RR</i>=3.43, 95%<i>CI</i>: 1.14-10.35) at 1 500-1 999 ml and 5.02% (<i>RR</i>=4.53, 95%<i>CI</i>: 1.49-13.75) at ≥2 000 ml (all <i>P</i><0.05). Moderate-to-severe anemia showed threshold effects at 750 ml (<i>RR</i> ranging from 7.21 to 8.53) and hypoalbuminemia at 1 250 ml (<i>RR</i> ranging from 3.24 to 3.83), with risks plateauing beyond these thresholds (all <i>P</i><0.05). <b>Conclusion:</b> It is suggested that 750 ml, 1 250 ml and 1 500 ml should be used as the key intervention thresholds, corresponding to the initiation thresholds of anemia, hypoalbuminemia management and multidisciplinary intensive care, respectively, so as to provide a new reference for optimizing the clinical diagnosis and treatment strategy of PPH.</p>","PeriodicalId":10050,"journal":{"name":"中华妇产科杂志","volume":"60 6","pages":"422-429"},"PeriodicalIF":0.0,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144526560","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-06-25DOI: 10.3760/cma.j.cn112141-20250102-00001
H D Liu, H L Wu, L L Ma, Y Cui, S W Wang, G H Shen
Objective: To investigate the predictive value of the cancer antigen 125 (CA125) elimination rate constant K (KELIM) score for no visible residual disease (R0) and prognosis in high-grade serous ovarian carcinoma (HGSOC) patients undergoing neoadjuvant chemotherapy (NACT)+interval debulking surgery (IDS). Methods: A retrospective analysis was conducted on 78 HGSOC patients treated with NACT+IDS at Beijing Hospital, from June 2014 to June 2024. The KELIM score was calculated, and its predictive value for R0 resection, chemotherapy response score (CRS), platinum-free interval (PFI), progression-free survival (PFS) time, and overall survival (OS) time was analyzed. Results: (1) The mean age at diagnosis was (61.9±9.9) years. The mean KELIM score was 1.1±0.4, with 44 patients having KELIM score≥1 and 34 having KELIM score <1. (2) Patients with KELIM score ≥1 had significantly higher rates of R0 resection (84% vs 56%; P=0.006), CRS3 grading (41% vs 0; P<0.001), and PFI ≥6 months (84% vs 53%; P=0.04) compared to those with KELIM score <1. Additionally, the median PFS time (18.7 vs 13.2 months; P<0.001) and OS time (34.8 vs 29.9 months; P=0.007) were significantly longer in the KELIM score ≥1 group. Chemosensitivity: patients with PFI <6 months had a significantly lower median KELIM score than those with PFI ≥6 months (0.8 vs 1.2; P=0.005). Surgical outcome: patients achieving R0 resection had a significantly higher median KELIM score than those without R0 (1.2 vs 0.7; P<0.001). (3) Univariate analysis identified non-R0 resection, CRS3 grading, lack of poly adenosine diphosphate ribose polymerase (PARP) inhibitor maintenance therapy, and KELIM score <1 as significant risk factors for OS time (all P<0.05). Multivariate analysis confirmed non-R0 resection (HR=3.78,95%CI: 1.13-12.66; P=0.031), no PARP inhibitor maintenance (HR=7.41,95%CI:1.82-30.15; P=0.005), and KELIM score <1 (HR=5.14,95%CI:1.41-18.72; P=0.013) as independent risk factors for OS time. Conclusions: The KELIM score may serve as a predictive marker for chemosensitivity, R0 resection, PFS time, and OS time in HGSOC patients undergoing NACT+IDS. KELIM score<1 is an independent risk factor for OS.
目的：探讨癌抗原125 （CA125）消除速率常数K （KELIM）评分对高级别浆液性卵巢癌（HGSOC）患者新辅助化疗(NACT)+间期减容手术（IDS）无可见残留病（R0）及预后的预测价值。方法：回顾性分析2014年6月至2024年6月北京医院接受NACT+IDS治疗的78例HGSOC患者。计算KELIM评分，并分析其对R0切除、化疗反应评分（CRS）、无铂期（PFI）、无进展生存期（PFS）时间、总生存期（OS）时间的预测价值。结果：(1)平均诊断年龄为（61.9±9.9）岁。平均KELIM评分为1.1±0.4，其中KELIM评分≥1者44例，KELIM评分P=0.006者34例)，CRS3分级(41% vs 0；（PP=0.04）与KELIM评分≥1组（PP=0.007）相比，病程明显延长。化疗敏感性：PFI患者P=0.005)。手术结果：完成R0切除的患者的中位KELIM评分显著高于未完成R0切除的患者(1.2 vs 0.7；PPHR = 3.78, 95% ci: 1.13—-12.66;P=0.031)，无PARP抑制剂维持(HR=7.41,95%CI:1.82 ~ 30.15；P=0.005)， KELIM评分HR=5.14,95%CI:1.41 ~ 18.72；P=0.013)为OS时间的独立危险因素。结论：KELIM评分可作为HGSOC患者接受NACT+IDS化疗敏感性、R0切除、PFS时间和OS时间的预测指标。编织毯得分
{"title":"[Application of CA<sub>125</sub> elimination rate constant K score in prognostic forecast of patients undergoing interval debulking surgery for high grade serous ovarian cancer].","authors":"H D Liu, H L Wu, L L Ma, Y Cui, S W Wang, G H Shen","doi":"10.3760/cma.j.cn112141-20250102-00001","DOIUrl":"https://doi.org/10.3760/cma.j.cn112141-20250102-00001","url":null,"abstract":"<p><p><b>Objective:</b> To investigate the predictive value of the cancer antigen 125 (CA<sub>125</sub>) elimination rate constant K (KELIM) score for no visible residual disease (R0) and prognosis in high-grade serous ovarian carcinoma (HGSOC) patients undergoing neoadjuvant chemotherapy (NACT)+interval debulking surgery (IDS). <b>Methods:</b> A retrospective analysis was conducted on 78 HGSOC patients treated with NACT+IDS at Beijing Hospital, from June 2014 to June 2024. The KELIM score was calculated, and its predictive value for R0 resection, chemotherapy response score (CRS), platinum-free interval (PFI), progression-free survival (PFS) time, and overall survival (OS) time was analyzed. <b>Results:</b> (1) The mean age at diagnosis was (61.9±9.9) years. The mean KELIM score was 1.1±0.4, with 44 patients having KELIM score≥1 and 34 having KELIM score <1. (2) Patients with KELIM score ≥1 had significantly higher rates of R0 resection (84% vs 56%; <i>P</i>=0.006), CRS3 grading (41% vs 0; <i>P</i><0.001), and PFI ≥6 months (84% vs 53%; <i>P</i>=0.04) compared to those with KELIM score <1. Additionally, the median PFS time (18.7 vs 13.2 months; <i>P</i><0.001) and OS time (34.8 vs 29.9 months; <i>P</i>=0.007) were significantly longer in the KELIM score ≥1 group. Chemosensitivity: patients with PFI <6 months had a significantly lower median KELIM score than those with PFI ≥6 months (0.8 vs 1.2; <i>P</i>=0.005). Surgical outcome: patients achieving R0 resection had a significantly higher median KELIM score than those without R0 (1.2 vs 0.7; <i>P</i><0.001). (3) Univariate analysis identified non-R0 resection, CRS3 grading, lack of poly adenosine diphosphate ribose polymerase (PARP) inhibitor maintenance therapy, and KELIM score <1 as significant risk factors for OS time (all <i>P</i><0.05). Multivariate analysis confirmed non-R0 resection (<i>HR</i>=3.78,95%<i>CI</i>: 1.13-12.66; <i>P</i>=0.031), no PARP inhibitor maintenance (<i>HR</i>=7.41,95%<i>CI</i>:1.82-30.15; <i>P</i>=0.005), and KELIM score <1 (<i>HR</i>=5.14,95%<i>CI</i>:1.41-18.72; <i>P</i>=0.013) as independent risk factors for OS time. <b>Conclusions:</b> The KELIM score may serve as a predictive marker for chemosensitivity, R0 resection, PFS time, and OS time in HGSOC patients undergoing NACT+IDS. KELIM score<1 is an independent risk factor for OS.</p>","PeriodicalId":10050,"journal":{"name":"中华妇产科杂志","volume":"60 6","pages":"461-468"},"PeriodicalIF":0.0,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144526559","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-06-25DOI: 10.3760/cma.j.cn112141-20250205-00040
W N Yu, S Y Pan, C Wang, Z D Huang, X L Wang, S Zhu, Y Ding, X L Wang
<p><p><b>Objective:</b> To explore the clinicopathological characteristics and prognosis of fumarate hydratase-deficient uterine leiomyoma (FH-dUL). <b>Methods:</b> Clinical data and follow-up information for 117 patients with FH-dUL diagnosed through surgical pathology and immunohistochemistry in the First Affiliated Hospital of Nanjing Medical University from January 2020 to December 2024, were collected. A control group of 130 patients with common uterine leiomyomas was also included. The differences between the two groups in clinical, imaging, and pathological characteristics were compared. Additionally, recurrence rates, fertility outcomes for FH-dUL patients, and the incidence of renal cancer in FH germline mutation carriers were monitored. <b>Results:</b> (1) Comparison of clinicopathological characteristics: the median age of 117 FH-dUL patients was 35 years, and the median age at first diagnosis of uterine leiomyomas was 29 years, both significantly younger than the control group (41 and 36 years; both <i>P</i><0.01). The FH-dUL group showed significantly higher incidences of uterine myomectomy, multiple leiomyomas, diffusion restriction on pelvic magnetic resonance imaging diffusion weighted imaging, and typical pathological features (candelabra-like vessels, bizarre nuclei, cytoplasmic eosinophilic globules, perinuclear halo, cellular atypia) and higher ultrasound blood flow score (all <i>P</i><0.05). Of the 30 FH-dUL patients who underwent genetic testing, 9 had germline mutations, 3 had somatic mutations, and 6 had mutations of unclear origin. Among the 9 FH gene germline mutation patients, 2 had already developed renal cell carcinoma. (2) Recurrence analysis: among the 56 patients who underwent uterine myomectomy, 22 (39.3%, 22/56) experienced recurrence during follow-up, compared to 12 (21.8%, 12/55) of the 55 patients in the control group, the difference between the two groups was statistically significant (<i>P</i>=0.046). Multivariate binary logistic regression analysis showed that cellular leiomyomas (<i>OR</i>=9.489, 95%<i>CI</i>: 1.740-51.755; <i>P</i>=0.009) and multiple uterine leiomyomas (<i>OR</i>=10.709, 95%<i>CI</i>: 1.354-84.683; <i>P</i>=0.025) were significant risk factors for recurrence in FH-dUL. (3) Fertility analysis: among the 66 FH-dUL patients who underwent fertility-preserving surgery, 16 had the intention to have fertility desire, only 2 (2/16) completed their fertility plans during follow-up. <b>Conclusions:</b> Clinicopathological features and imaging features help to differentiate FH-dUL from common type uterine fibroids, but lack specificity, and the diagnosis of FH-dUL is based on immunohistochemistry. The recurrence rate after resection of FH-dUL is high, and cellular and multiple leiomyomas are important predictors of recurrence. It is crucial to perform genetic testing, genetic counseling, drug treatment to prevent recurrence, fertility guidance, and long-term comprehensive management after surgery f
{"title":"[Clinicopathological features and prognosis of 117 cases of fumarate hydratase-deficient uterine leiomyomas].","authors":"W N Yu, S Y Pan, C Wang, Z D Huang, X L Wang, S Zhu, Y Ding, X L Wang","doi":"10.3760/cma.j.cn112141-20250205-00040","DOIUrl":"https://doi.org/10.3760/cma.j.cn112141-20250205-00040","url":null,"abstract":"<p><p><b>Objective:</b> To explore the clinicopathological characteristics and prognosis of fumarate hydratase-deficient uterine leiomyoma (FH-dUL). <b>Methods:</b> Clinical data and follow-up information for 117 patients with FH-dUL diagnosed through surgical pathology and immunohistochemistry in the First Affiliated Hospital of Nanjing Medical University from January 2020 to December 2024, were collected. A control group of 130 patients with common uterine leiomyomas was also included. The differences between the two groups in clinical, imaging, and pathological characteristics were compared. Additionally, recurrence rates, fertility outcomes for FH-dUL patients, and the incidence of renal cancer in FH germline mutation carriers were monitored. <b>Results:</b> (1) Comparison of clinicopathological characteristics: the median age of 117 FH-dUL patients was 35 years, and the median age at first diagnosis of uterine leiomyomas was 29 years, both significantly younger than the control group (41 and 36 years; both <i>P</i><0.01). The FH-dUL group showed significantly higher incidences of uterine myomectomy, multiple leiomyomas, diffusion restriction on pelvic magnetic resonance imaging diffusion weighted imaging, and typical pathological features (candelabra-like vessels, bizarre nuclei, cytoplasmic eosinophilic globules, perinuclear halo, cellular atypia) and higher ultrasound blood flow score (all <i>P</i><0.05). Of the 30 FH-dUL patients who underwent genetic testing, 9 had germline mutations, 3 had somatic mutations, and 6 had mutations of unclear origin. Among the 9 FH gene germline mutation patients, 2 had already developed renal cell carcinoma. (2) Recurrence analysis: among the 56 patients who underwent uterine myomectomy, 22 (39.3%, 22/56) experienced recurrence during follow-up, compared to 12 (21.8%, 12/55) of the 55 patients in the control group, the difference between the two groups was statistically significant (<i>P</i>=0.046). Multivariate binary logistic regression analysis showed that cellular leiomyomas (<i>OR</i>=9.489, 95%<i>CI</i>: 1.740-51.755; <i>P</i>=0.009) and multiple uterine leiomyomas (<i>OR</i>=10.709, 95%<i>CI</i>: 1.354-84.683; <i>P</i>=0.025) were significant risk factors for recurrence in FH-dUL. (3) Fertility analysis: among the 66 FH-dUL patients who underwent fertility-preserving surgery, 16 had the intention to have fertility desire, only 2 (2/16) completed their fertility plans during follow-up. <b>Conclusions:</b> Clinicopathological features and imaging features help to differentiate FH-dUL from common type uterine fibroids, but lack specificity, and the diagnosis of FH-dUL is based on immunohistochemistry. The recurrence rate after resection of FH-dUL is high, and cellular and multiple leiomyomas are important predictors of recurrence. It is crucial to perform genetic testing, genetic counseling, drug treatment to prevent recurrence, fertility guidance, and long-term comprehensive management after surgery f","PeriodicalId":10050,"journal":{"name":"中华妇产科杂志","volume":"60 6","pages":"450-460"},"PeriodicalIF":0.0,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144526561","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-05-25DOI: 10.3760/cma.j.cn112141-20241022-00566
H Y Cheng, C M Sang, Y J Kang, L Zhao, K Ding, S P Zhao
Objective: To explore the effectiveness and application value of focused ultrasound ablation surgery (FUAS) combined with hysteroscopic surgery in treating solitary type Ⅱ submucosal uterine fibroids with maximum diameter >5 cm. Methods: Clinical data of 35 patients with a single type Ⅱ submucosal uterine fibroid with maximum diameter greater than 5 cm who underwent FUAS combined with hysteroscopic surgery at Qingdao Women and Children's Hospital from June 2020 to December 2023 were collected. The clinical characteristics, treatments and treatment outcomes were retrospectively analyzed. Results: (1) Clinical characteristics: the mean age of the 35 patients was (36.7±6.6) years, with a median maximum diameter of fibroids of 56 mm (range: 51-80 mm). All patients presented with symptoms of menorrhagia, median menstrual bleeding score was 5 points (ranged from 3 to 5 points), and 34 cases (97.1%, 34/35) had concomitant anemia, the mean hemoglobin was (83.1±13.8) g/L of 35 patients. (2) Treatments: all 35 patients underwent FUAS treatment initially, with a lesion ablation rate ranging from 69.7% to 97.9% (median:90.7%), and no complications occurred. After FUAS treatment, the volume of fibroids decreased in all patients, with a volume reduction rate ranging from 30.57% to 87.22% (median:76.03%). Hysteroscopic surgery was performed 3-14 months (median: 5 months) after FUAS to remove the necrotic fibroid tissue, achieving a 100.0% (35/35) fibroid resection rate. Only 1 patient developed complications of hyperhyderation syndrome during hysteroscopic surgery, and no complications occurred in the remaining patients. (3) Evaluation of efficacy: after FUAS pretreatment, the maximum diameter of fibroids in the 35 patients decreased significantly (Z=-5.171, P<0.001), as did the volume of fibroids (Z=-5.159, P<0.001). The hemoglobin level increased significantly compared to the level before FUAS in all cases (t=-8.657, P<0.001), and median menstrual bleeding score decreased to 2 points (range: 1-3 points), significantly lower than original level (Z=-5.292, P<0.001). At the 3-month follow-up after hysteroscopic surgery, all patients were free of anemia symptoms, with menstrual bleeding scores totally decreased to 1 point, significantly lower than that before hysteroscopic surgery (Z=-4.786, P<0.001); hemoglobin level [(118.7±5.6) g/L] significantly increased compared to that before hysteroscopic surgery (t=-9.258, P<0.001). All patients underwent gynecological transvaginal ultrasound re-examination, which did not reveal any residual fibroids. Conclusion: FUAS combined with hysteroscopic surgery is effective in treating solitary type Ⅱ submucosal uterine fibroids with maximum diameter >5 cm, providing a new treatment option for patients.
{"title":"[Clinical application value of combined focused ultrasound ablation surgery and hysteroscopy in the treatment of solitary type Ⅱ submucosal uterine fibroids with maximum diameter more than 5 cm].","authors":"H Y Cheng, C M Sang, Y J Kang, L Zhao, K Ding, S P Zhao","doi":"10.3760/cma.j.cn112141-20241022-00566","DOIUrl":"https://doi.org/10.3760/cma.j.cn112141-20241022-00566","url":null,"abstract":"<p><p><b>Objective:</b> To explore the effectiveness and application value of focused ultrasound ablation surgery (FUAS) combined with hysteroscopic surgery in treating solitary type Ⅱ submucosal uterine fibroids with maximum diameter >5 cm. <b>Methods:</b> Clinical data of 35 patients with a single type Ⅱ submucosal uterine fibroid with maximum diameter greater than 5 cm who underwent FUAS combined with hysteroscopic surgery at Qingdao Women and Children's Hospital from June 2020 to December 2023 were collected. The clinical characteristics, treatments and treatment outcomes were retrospectively analyzed. <b>Results:</b> (1) Clinical characteristics: the mean age of the 35 patients was (36.7±6.6) years, with a median maximum diameter of fibroids of 56 mm (range: 51-80 mm). All patients presented with symptoms of menorrhagia, median menstrual bleeding score was 5 points (ranged from 3 to 5 points), and 34 cases (97.1%, 34/35) had concomitant anemia, the mean hemoglobin was (83.1±13.8) g/L of 35 patients. (2) Treatments: all 35 patients underwent FUAS treatment initially, with a lesion ablation rate ranging from 69.7% to 97.9% (median:90.7%), and no complications occurred. After FUAS treatment, the volume of fibroids decreased in all patients, with a volume reduction rate ranging from 30.57% to 87.22% (median:76.03%). Hysteroscopic surgery was performed 3-14 months (median: 5 months) after FUAS to remove the necrotic fibroid tissue, achieving a 100.0% (35/35) fibroid resection rate. Only 1 patient developed complications of hyperhyderation syndrome during hysteroscopic surgery, and no complications occurred in the remaining patients. (3) Evaluation of efficacy: after FUAS pretreatment, the maximum diameter of fibroids in the 35 patients decreased significantly (<i>Z</i>=-5.171, <i>P</i><0.001), as did the volume of fibroids (<i>Z</i>=-5.159, <i>P</i><0.001). The hemoglobin level increased significantly compared to the level before FUAS in all cases (<i>t</i>=-8.657, <i>P</i><0.001), and median menstrual bleeding score decreased to 2 points (range: 1-3 points), significantly lower than original level (<i>Z</i>=-5.292, <i>P</i><0.001). At the 3-month follow-up after hysteroscopic surgery, all patients were free of anemia symptoms, with menstrual bleeding scores totally decreased to 1 point, significantly lower than that before hysteroscopic surgery (<i>Z</i>=-4.786, <i>P</i><0.001); hemoglobin level [(118.7±5.6) g/L] significantly increased compared to that before hysteroscopic surgery (<i>t</i>=-9.258, <i>P</i><0.001). All patients underwent gynecological transvaginal ultrasound re-examination, which did not reveal any residual fibroids. <b>Conclusion:</b> FUAS combined with hysteroscopic surgery is effective in treating solitary type Ⅱ submucosal uterine fibroids with maximum diameter >5 cm, providing a new treatment option for patients.</p>","PeriodicalId":10050,"journal":{"name":"中华妇产科杂志","volume":"60 5","pages":"363-371"},"PeriodicalIF":0.0,"publicationDate":"2025-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144149572","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-05-25DOI: 10.3760/cma.j.cn112141-20241118-00609
E N Liu, F Miao, Y F Zhou, Y Huang, L Zhang, C Peng
<p><p><b>Objective:</b> To analysis the safety and feasibility of laparoscopic total hysterectomy in patients with obliterated rectouterine pouch. <b>Methods:</b> A retrospective analysis was conducted on 197 patients who underwent laparoscopic total hysterectomy at Peking University First Hospital, from July 2022 to July 2024. According to intraoperative observations, 197 patients were categorized into two groups: 58 cases with completely obliterated rectouterine pouch (obliterated group) and 139 cases with non-obliterated pouch (control group). General clinical characteristics, perioperative outcomes and 3-month follow-up after surgery were compared between two groups. <b>Results:</b> (1) Baseline characteristics: the age of the obliterated group was (45.7±3.7) years, and the control group was (48.0±3.8) years (<i>P</i><0.001). Primary complaint: dysmenorrhea prevalence was 53.4% (31/58) in the obliterated group, and was 35.3% (49/139; <i>P</i><0.05) in the control group. Surgical indications: the proportion of adenomyosis and ovarian endometrioma was 77.6% (45/58) in the obliterated group, and was 51.1% (71/139; <i>P</i><0.001) in the control group. No significant differences in body mass index, pelvic surgical history, or preoperative medication between the two groups (all <i>P</i>>0.05). (2) Intraoperative outcomes: the obliterated group demonstrated significantly higher rates of surgical interventions compared to the control group. Superficial endometriosis resection was performed in 91.4% (53/58) of the obliterated group versus 33.8% (47/139) in the control group (<i>P</i><0.001). Deep infiltrating endometriosis excision was required in 82.8% (48/58) of the obliterated group, contrasting sharply with 10.1% (14/139) in the control group (<i>P</i><0.001). Ureterolysis procedures were similarly elevated in the obliterated group (77.6%, 45/58) compared to the control group (7.9%, 11/139; <i>P</i><0.001). Operative metrics revealed substantial intergroup disparities: the obliterated group exhibited a median surgical duration of 149.0 minutes (interquartile range: 114.0, 180.0 minutes), significantly prolonged relative to the control group's 91.0 minutes (77.0, 107.0 minutes; <i>P</i><0.001). Estimated blood loss followed a parallel pattern, with median volumes of 50.0 ml (20.0, 100.0 ml) in the obliterated group versus 20.0 ml (10.0, 20.0 ml) in the control group (<i>P</i><0.001). (3) Postoperative outcomes: the uterine weight of the obliterated group was 200.0 g (132.5, 260.0 g), and the control group was 240.0 g (180.0, 336.0 g; <i>P</i><0.05). Hospital stay was prolonged in the obliterated group compared with the control group [7.0 days (6.0, 8.3 days) vs 6.0 days (5.0, 7.0 days); <i>P</i><0.001]. The incidences of postoperative fever in the obliterated group and the control group were 20.7% (12/58) vs 12.2% (17/139; <i>P</i>>0.05). The incidences of minor complications in the obliterated group and the control group were 3.4% (2/58) vs 0 (0/
{"title":"[Feasibility analysis of laparoscopic total hysterectomy in patients with obliterated rectouterine pouch].","authors":"E N Liu, F Miao, Y F Zhou, Y Huang, L Zhang, C Peng","doi":"10.3760/cma.j.cn112141-20241118-00609","DOIUrl":"https://doi.org/10.3760/cma.j.cn112141-20241118-00609","url":null,"abstract":"<p><p><b>Objective:</b> To analysis the safety and feasibility of laparoscopic total hysterectomy in patients with obliterated rectouterine pouch. <b>Methods:</b> A retrospective analysis was conducted on 197 patients who underwent laparoscopic total hysterectomy at Peking University First Hospital, from July 2022 to July 2024. According to intraoperative observations, 197 patients were categorized into two groups: 58 cases with completely obliterated rectouterine pouch (obliterated group) and 139 cases with non-obliterated pouch (control group). General clinical characteristics, perioperative outcomes and 3-month follow-up after surgery were compared between two groups. <b>Results:</b> (1) Baseline characteristics: the age of the obliterated group was (45.7±3.7) years, and the control group was (48.0±3.8) years (<i>P</i><0.001). Primary complaint: dysmenorrhea prevalence was 53.4% (31/58) in the obliterated group, and was 35.3% (49/139; <i>P</i><0.05) in the control group. Surgical indications: the proportion of adenomyosis and ovarian endometrioma was 77.6% (45/58) in the obliterated group, and was 51.1% (71/139; <i>P</i><0.001) in the control group. No significant differences in body mass index, pelvic surgical history, or preoperative medication between the two groups (all <i>P</i>>0.05). (2) Intraoperative outcomes: the obliterated group demonstrated significantly higher rates of surgical interventions compared to the control group. Superficial endometriosis resection was performed in 91.4% (53/58) of the obliterated group versus 33.8% (47/139) in the control group (<i>P</i><0.001). Deep infiltrating endometriosis excision was required in 82.8% (48/58) of the obliterated group, contrasting sharply with 10.1% (14/139) in the control group (<i>P</i><0.001). Ureterolysis procedures were similarly elevated in the obliterated group (77.6%, 45/58) compared to the control group (7.9%, 11/139; <i>P</i><0.001). Operative metrics revealed substantial intergroup disparities: the obliterated group exhibited a median surgical duration of 149.0 minutes (interquartile range: 114.0, 180.0 minutes), significantly prolonged relative to the control group's 91.0 minutes (77.0, 107.0 minutes; <i>P</i><0.001). Estimated blood loss followed a parallel pattern, with median volumes of 50.0 ml (20.0, 100.0 ml) in the obliterated group versus 20.0 ml (10.0, 20.0 ml) in the control group (<i>P</i><0.001). (3) Postoperative outcomes: the uterine weight of the obliterated group was 200.0 g (132.5, 260.0 g), and the control group was 240.0 g (180.0, 336.0 g; <i>P</i><0.05). Hospital stay was prolonged in the obliterated group compared with the control group [7.0 days (6.0, 8.3 days) vs 6.0 days (5.0, 7.0 days); <i>P</i><0.001]. The incidences of postoperative fever in the obliterated group and the control group were 20.7% (12/58) vs 12.2% (17/139; <i>P</i>>0.05). The incidences of minor complications in the obliterated group and the control group were 3.4% (2/58) vs 0 (0/","PeriodicalId":10050,"journal":{"name":"中华妇产科杂志","volume":"60 5","pages":"355-362"},"PeriodicalIF":0.0,"publicationDate":"2025-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144149573","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-05-25DOI: 10.3760/cma.j.cn112141-20241130-00636
{"title":"[Guideline for the prediction and prevention of pre‑eclampsia (2025)].","authors":"","doi":"10.3760/cma.j.cn112141-20241130-00636","DOIUrl":"10.3760/cma.j.cn112141-20241130-00636","url":null,"abstract":"","PeriodicalId":10050,"journal":{"name":"中华妇产科杂志","volume":"60 5","pages":"329-342"},"PeriodicalIF":0.0,"publicationDate":"2025-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144149574","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-05-25DOI: 10.3760/cma.j.cn112141-20241106-00592
Q Liu, P Peng, W L Chen, C Y Li, L R Teng, X Y Liu
Objective: To explore the treatment methods and prognosis of pregnancy-related uterine arteriovenous malformation (UAVM). Methods: A retrospective analysis was conducted on clinical data from 81 patients with UAVM treated at Peking Union Medical College Hospital between March 2019 and March 2024. Clinical manifestations, diagnostic approaches, treatment strategies and prognosis were evaluated. Results: (1) General Information: the age of patients with UAVM was (32.7±4.6) years, with median gravidity and parity of 1 (quartile range: 1, 2) and 0 (0, 1), respectively. Pregnancy termination methods included surgical abortion or curettage in 46 cases (57%, 46/81), medical induction in 17 cases (21%, 17/81), spontaneous abortion in 16 cases (20%, 16/81), vaginal delivery in 1 case (1%, 1/81), and laparoscopic pregnancy tissue removal in 1 case (1%, 1/81). (2) Clinical manifestations: clinical presentations comprised vaginal bleeding in 59 cases [73%, 59/81; median blood loss: 740 ml (440, 1 360 ml)], massive hemorrhage in 9 cases (11%, 9/81, and bleeding combined with lower abdominal pain in 8 cases (10%, 8/81). Ultrasonography revealed intrauterine masses in 65 cases [80%, 65/81; median size: 2.5 cm (1.8, 4.2 cm)]. Elevated serum human chorionic gonadotrophin-β subunit (β-hCG) levels were observed in in 55 cases [85%, 55/65; median: 62.6 U/L (14.9, 300.1 U/L)]. The median time to UAVM diagnosis via ultrasound was 30.0 days (16.0, 52.0 days) after pregnancy termination, with median peak systolic velocity (PSV) and resistance index of 59.8 cm/s (45.0, 79.6 cm/s) and 0.39 (0.36, 0.43), respectively. (3) Treatment and prognosis: treatment modalities included expectant management in 49 cases (36%, 29/81), medication in 13 cases (16%, 13/81), lesion resection in 31 cases (38%, 31/81), and uterine artery angiography in 8 cases (10%, 8/81; 5 confirmed as arteriovenous fistula). The median time of PSV returning to normal after treatment was 53.8 days (36.0, 93.4 days). The average time for β-hCG returning to normal was (60.4±20.4) days. The median return time of menses was 59.0 days (43.0, 75.4 days). Conclusions: Pregnancy-related UAVM carries a high risk of life-threatening hemorrhage, necessitating management in centers equipped for emergency uterine artery embolization. Informed consent must emphasize disease progression risks and prognosis. Treatment stratification should integrate clinical parameters and imaging features.
{"title":"[Analysis of clinical characteristics of pregnancy-related uterine arteriovenous malformation].","authors":"Q Liu, P Peng, W L Chen, C Y Li, L R Teng, X Y Liu","doi":"10.3760/cma.j.cn112141-20241106-00592","DOIUrl":"https://doi.org/10.3760/cma.j.cn112141-20241106-00592","url":null,"abstract":"<p><p><b>Objective:</b> To explore the treatment methods and prognosis of pregnancy-related uterine arteriovenous malformation (UAVM). <b>Methods:</b> A retrospective analysis was conducted on clinical data from 81 patients with UAVM treated at Peking Union Medical College Hospital between March 2019 and March 2024. Clinical manifestations, diagnostic approaches, treatment strategies and prognosis were evaluated. <b>Results:</b> (1) General Information: the age of patients with UAVM was (32.7±4.6) years, with median gravidity and parity of 1 (quartile range: 1, 2) and 0 (0, 1), respectively. Pregnancy termination methods included surgical abortion or curettage in 46 cases (57%, 46/81), medical induction in 17 cases (21%, 17/81), spontaneous abortion in 16 cases (20%, 16/81), vaginal delivery in 1 case (1%, 1/81), and laparoscopic pregnancy tissue removal in 1 case (1%, 1/81). (2) Clinical manifestations: clinical presentations comprised vaginal bleeding in 59 cases [73%, 59/81; median blood loss: 740 ml (440, 1 360 ml)], massive hemorrhage in 9 cases (11%, 9/81, and bleeding combined with lower abdominal pain in 8 cases (10%, 8/81). Ultrasonography revealed intrauterine masses in 65 cases [80%, 65/81; median size: 2.5 cm (1.8, 4.2 cm)]. Elevated serum human chorionic gonadotrophin-β subunit (β-hCG) levels were observed in in 55 cases [85%, 55/65; median: 62.6 U/L (14.9, 300.1 U/L)]. The median time to UAVM diagnosis via ultrasound was 30.0 days (16.0, 52.0 days) after pregnancy termination, with median peak systolic velocity (PSV) and resistance index of 59.8 cm/s (45.0, 79.6 cm/s) and 0.39 (0.36, 0.43), respectively. (3) Treatment and prognosis: treatment modalities included expectant management in 49 cases (36%, 29/81), medication in 13 cases (16%, 13/81), lesion resection in 31 cases (38%, 31/81), and uterine artery angiography in 8 cases (10%, 8/81; 5 confirmed as arteriovenous fistula). The median time of PSV returning to normal after treatment was 53.8 days (36.0, 93.4 days). The average time for β-hCG returning to normal was (60.4±20.4) days. The median return time of menses was 59.0 days (43.0, 75.4 days). <b>Conclusions:</b> Pregnancy-related UAVM carries a high risk of life-threatening hemorrhage, necessitating management in centers equipped for emergency uterine artery embolization. Informed consent must emphasize disease progression risks and prognosis. Treatment stratification should integrate clinical parameters and imaging features.</p>","PeriodicalId":10050,"journal":{"name":"中华妇产科杂志","volume":"60 5","pages":"348-354"},"PeriodicalIF":0.0,"publicationDate":"2025-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144149560","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-05-25DOI: 10.3760/cma.j.cn112141-20250120-00030
M R Zhao, Y Q Yang, L Yu, L Zhang, Q J Chang, W W Cheng
<p><p><b>Objective:</b> To analyze the characteristics of BRCA gene mutations in patients with ovarian epithelial carcinoma and fallopian tube carcinoma, and to investigate the impact of mutations in the functional domains of the BRCA genes on the prognosis of patients. <b>Methods:</b> This research collected a total of 273 patients diagnosed with primary ovarian epithelial carcinoma or fallopian tube carcinoma by pathological examination at the First Affiliated Hospital of Nanjing Medical University between January 2009 and December 2023.Data on their BRCA gene mutation status, clinicopathological data, and follow-up information were collected. A retrospective analysis was conducted to evaluate the association between BRCA gene mutations and patients' prognosis, including progression free survival (PFS) and overall survival (OS) time. <b>Results:</b> Among the 273 patients with ovarian or fallopian tube carcinoma, 101 cases (37.0%, 101/273) were positive for BRCA gene mutations (BRCA-positive group), while 172 cases (63.0%, 172/273) were negative for BRCA gene mutations (BRCA-negative group). (1) Clinicopathological characteristics: compared with the BRCA-negative group, the BRCA-positive group had a younger age at diagnosis, lower proportion of postmenopausal status, and lower recurrence rate (all <i>P</i><0.05). Additionally, the BRCA-positive group showed a higher prevalence of family history of gynecological malignancies and a higher rate of no visible residual disease (R0) resection, all with statistical significance (all <i>P</i><0.05). (2) Characteristics of BRCA gene mutations: among the 101 BRCA-positive patients, 74 cases (27.1%, 74/273) had BRCA1 gene mutations, 26 cases (9.5%, 26/273) had BRCA2 gene mutations, and 1 case (0.4%, 1/273) had indeterminate mutation records. According to the American College of Medical Genetics and Genomics (ACMG) 2015 guideline, mutations of uncertain significance accounted for 22.8% (23/101), likely pathogenic mutations accounted for 10.9% (11/101), and pathogenic mutations accounted for 59.4% (60/101), with 5.9% (6/101) unclassifiable. BRCA1 and BRCA2 genes have three (RING, DBD, BRCT) and two (RAD51-BD, DBD) major functional domains, respectively. Among the 89 BRCA-positive patients with detailed domain mutation data, the overall domain mutation rate was 40.4% (36/89), distributed as follows: DBD 14.6% (13/89), BRCT 12.4% (11/89), RING 4.5% (4/89), and RAD51-BD 9.0% (8/89). (3) Association between BRCA gene functional domain mutations and prognosis: among 77 patients with advanced stage (Ⅲ-Ⅳ) ovarian epithelial carcinoma in the BRCA-positive group with functional domain mutation data, the median PFS time was significantly longer in the 31 patients with domain mutations compared to the 46 patients with non-domain mutations (not reached during the follow-up period, vs 26.0 months; <i>P</i>=0.035). However, there was no significant difference in median OS time between the two groups (not reached during t
{"title":"[Association analysis on BRCA gene functional domain mutations and prognosis in patients with ovarian epithelial carcinoma and fallopian tube carcinoma].","authors":"M R Zhao, Y Q Yang, L Yu, L Zhang, Q J Chang, W W Cheng","doi":"10.3760/cma.j.cn112141-20250120-00030","DOIUrl":"https://doi.org/10.3760/cma.j.cn112141-20250120-00030","url":null,"abstract":"<p><p><b>Objective:</b> To analyze the characteristics of BRCA gene mutations in patients with ovarian epithelial carcinoma and fallopian tube carcinoma, and to investigate the impact of mutations in the functional domains of the BRCA genes on the prognosis of patients. <b>Methods:</b> This research collected a total of 273 patients diagnosed with primary ovarian epithelial carcinoma or fallopian tube carcinoma by pathological examination at the First Affiliated Hospital of Nanjing Medical University between January 2009 and December 2023.Data on their BRCA gene mutation status, clinicopathological data, and follow-up information were collected. A retrospective analysis was conducted to evaluate the association between BRCA gene mutations and patients' prognosis, including progression free survival (PFS) and overall survival (OS) time. <b>Results:</b> Among the 273 patients with ovarian or fallopian tube carcinoma, 101 cases (37.0%, 101/273) were positive for BRCA gene mutations (BRCA-positive group), while 172 cases (63.0%, 172/273) were negative for BRCA gene mutations (BRCA-negative group). (1) Clinicopathological characteristics: compared with the BRCA-negative group, the BRCA-positive group had a younger age at diagnosis, lower proportion of postmenopausal status, and lower recurrence rate (all <i>P</i><0.05). Additionally, the BRCA-positive group showed a higher prevalence of family history of gynecological malignancies and a higher rate of no visible residual disease (R0) resection, all with statistical significance (all <i>P</i><0.05). (2) Characteristics of BRCA gene mutations: among the 101 BRCA-positive patients, 74 cases (27.1%, 74/273) had BRCA1 gene mutations, 26 cases (9.5%, 26/273) had BRCA2 gene mutations, and 1 case (0.4%, 1/273) had indeterminate mutation records. According to the American College of Medical Genetics and Genomics (ACMG) 2015 guideline, mutations of uncertain significance accounted for 22.8% (23/101), likely pathogenic mutations accounted for 10.9% (11/101), and pathogenic mutations accounted for 59.4% (60/101), with 5.9% (6/101) unclassifiable. BRCA1 and BRCA2 genes have three (RING, DBD, BRCT) and two (RAD51-BD, DBD) major functional domains, respectively. Among the 89 BRCA-positive patients with detailed domain mutation data, the overall domain mutation rate was 40.4% (36/89), distributed as follows: DBD 14.6% (13/89), BRCT 12.4% (11/89), RING 4.5% (4/89), and RAD51-BD 9.0% (8/89). (3) Association between BRCA gene functional domain mutations and prognosis: among 77 patients with advanced stage (Ⅲ-Ⅳ) ovarian epithelial carcinoma in the BRCA-positive group with functional domain mutation data, the median PFS time was significantly longer in the 31 patients with domain mutations compared to the 46 patients with non-domain mutations (not reached during the follow-up period, vs 26.0 months; <i>P</i>=0.035). However, there was no significant difference in median OS time between the two groups (not reached during t","PeriodicalId":10050,"journal":{"name":"中华妇产科杂志","volume":"60 5","pages":"372-382"},"PeriodicalIF":0.0,"publicationDate":"2025-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144149562","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-05-25DOI: 10.3760/cma.j.cn112141-20250102-00002
X W Shi, D F Wang, G N Zhang, M Shi, Y Liu, J Zhang
Objective: To investigate the incidence of port-site metastasis (PSM) after laparoscopic surgery in patients with epithelial ovarian cancer and prognostic factors influencing outcomes in those with abdominal wall PSM. Methods: Clinicopathological and follow-up data of 22 ovarian epithelial cancer patients diagnosed with abdominal wall PSM after laparoscopic surgery, who were treated in the Sichuan Cancer Hospital between May 2014 and July 2023, were retrospectively collected. A retrospective analysis of PSM characteristics and prognostic factors influencing outcomes, was conducted in these patients. Results: (1) Between May 2014 and July 2023, a total of 369 ovarian cancer patients with a history of laparoscopic surgery performed at other hospitals were admitted. Among them, 24 cases (6.5%, 24/369) were diagnosed with tumor lesions at the abdominal wall port sites via postoperative pathological examination, with a median interval time of 25.5 days (interquartile range: 19.5, 32.0 days) after laparoscopic surgery. Of these, 22 cases with complete clinicopathological and follow-up data were included in this study. (2) The age of the 22 PSM patients was (53.0±8.6) years, and the median follow-up time was 37.6 months (24.7, 63.4 months). Surgical-pathological staging revealed stage Ⅰ-Ⅱ disease in 4 cases and stage Ⅲ-Ⅳ disease in 18 cases. Histopathological differentiation included 5 cases of well-to-moderately differentiated tumors and 17 cases of poorly differentiated tumors. Pathological subtypes comprised 11 cases of high-grade serous adenocarcinoma, 5 cases of low-grade serous adenocarcinoma, and 6 cases of clear cell carcinoma or cystadenocarcinoma. Lymph node status was as follows: negative for lymph node metastasis (n=16), positive (n=5), and no lymphadenectomy performed (n=1). Postoperative residual disease was categorized as no macroscopic residual disease (n=13), residual disease ≤1 cm (n=7), and residual disease >1 cm (n=2). (3) Following secondary cytoreductive surgery combined with postoperative adjuvant therapy, the median progression-free survival and overall survival (OS) time of the patients were 8.8 months (4.6, 14.3 months) and 27.7 months (15.5, 38.4 months), respectively. Univariate Cox regression analysis demonstrated that surgical-pathological stage, histopathological differentiation grade, and lymph node metastasis status were significantly associated with OS time in patients with abdominal wall PSM (all P<0.05). In contrast, age, Eastern Cooperative Oncology Group performance status score, histopathological subtype, preoperative serum cancer antigen 125 level, presence of residual lesions after surgery and poly adenosine diphosphate ribose polymerase inhibitor usage showed no significant correlation with OS time (all P>0.05). Multivariate Cox regression analysis identified surgical-pathological stage (HR=4.579，95%CI：1.111-18.866；<
目的：探讨卵巢上皮性癌腹腔镜术后port site metastasis （PSM）的发生率及影响其预后的因素。方法：回顾性收集2014年5月至2023年7月在四川省肿瘤医院腹腔镜手术后诊断为腹壁PSM的22例卵巢上皮癌患者的临床病理及随访资料。回顾性分析这些患者的PSM特征和影响预后的因素。结果：(1)2014年5月至2023年7月，我院共收治有其他医院腹腔镜手术史的卵巢癌患者369例。其中24例（6.5%,24/369）经术后病理检查诊断为腹壁端口部位肿瘤病变，腹腔镜术后中位间隔时间为25.5天（四分位数间距：19.5天，32.0天）。其中22例有完整的临床病理和随访资料纳入本研究。(2) 22例PSM患者年龄为（53.0±8.6）岁，中位随访时间为37.6个月（24.7,63.4个月）。手术病理分期为Ⅰ-Ⅱ期4例，Ⅲ-Ⅳ期18例。组织病理分化包括5例高分化至中分化肿瘤和17例低分化肿瘤。病理亚型包括高级别浆液腺癌11例，低级别浆液腺癌5例，透明细胞癌或囊腺癌6例。淋巴结状态：淋巴结转移阴性（n=16），阳性（n=5），未行淋巴结切除术（n=1）。术后残留病变分为无宏观残留病变（n=13）、残留病变≤1 cm （n=7）和残留病变>1 cm （n=2）。(3)二次细胞减少手术联合术后辅助治疗后，患者的中位无进展生存期为8.8个月（4.6、14.3个月），总生存期为27.7个月（15.5、38.4个月）。单因素Cox回归分析显示，腹壁PSM患者手术病理分期、组织病理分化分级、淋巴结转移状态与生存时间显著相关（p < 0.05）。多因素Cox回归分析发现手术-病理分期（HR=4.579,95%CI:1.111 ~ 18.866， P=0.035）和组织病理分化分级（HR=5.307,95%CI:1.042 ~ 27.031， P=0.045）是影响PSM患者生存时间的独立危险因素。结论：上皮性卵巢癌腹腔镜手术后腹壁PSM可能对患者预后产生不良影响，尤其是对肿瘤晚期和低分化患者，值得临床重视。
{"title":"[Analysis of the incidence and prognostic factors of port-site metastasis following laparoscopic surgery in patients with ovarian epithelial carcinoma].","authors":"X W Shi, D F Wang, G N Zhang, M Shi, Y Liu, J Zhang","doi":"10.3760/cma.j.cn112141-20250102-00002","DOIUrl":"https://doi.org/10.3760/cma.j.cn112141-20250102-00002","url":null,"abstract":"<p><p><b>Objective:</b> To investigate the incidence of port-site metastasis (PSM) after laparoscopic surgery in patients with epithelial ovarian cancer and prognostic factors influencing outcomes in those with abdominal wall PSM. <b>Methods:</b> Clinicopathological and follow-up data of 22 ovarian epithelial cancer patients diagnosed with abdominal wall PSM after laparoscopic surgery, who were treated in the Sichuan Cancer Hospital between May 2014 and July 2023, were retrospectively collected. A retrospective analysis of PSM characteristics and prognostic factors influencing outcomes, was conducted in these patients. <b>Results:</b> (1) Between May 2014 and July 2023, a total of 369 ovarian cancer patients with a history of laparoscopic surgery performed at other hospitals were admitted. Among them, 24 cases (6.5%, 24/369) were diagnosed with tumor lesions at the abdominal wall port sites via postoperative pathological examination, with a median interval time of 25.5 days (interquartile range: 19.5, 32.0 days) after laparoscopic surgery. Of these, 22 cases with complete clinicopathological and follow-up data were included in this study. (2) The age of the 22 PSM patients was (53.0±8.6) years, and the median follow-up time was 37.6 months (24.7, 63.4 months). Surgical-pathological staging revealed stage Ⅰ-Ⅱ disease in 4 cases and stage Ⅲ-Ⅳ disease in 18 cases. Histopathological differentiation included 5 cases of well-to-moderately differentiated tumors and 17 cases of poorly differentiated tumors. Pathological subtypes comprised 11 cases of high-grade serous adenocarcinoma, 5 cases of low-grade serous adenocarcinoma, and 6 cases of clear cell carcinoma or cystadenocarcinoma. Lymph node status was as follows: negative for lymph node metastasis (<i>n</i>=16), positive (<i>n</i>=5), and no lymphadenectomy performed (<i>n</i>=1). Postoperative residual disease was categorized as no macroscopic residual disease (<i>n</i>=13), residual disease ≤1 cm (<i>n</i>=7), and residual disease >1 cm (<i>n</i>=2). (3) Following secondary cytoreductive surgery combined with postoperative adjuvant therapy, the median progression-free survival and overall survival (OS) time of the patients were 8.8 months (4.6, 14.3 months) and 27.7 months (15.5, 38.4 months), respectively. Univariate Cox regression analysis demonstrated that surgical-pathological stage, histopathological differentiation grade, and lymph node metastasis status were significantly associated with OS time in patients with abdominal wall PSM (all <i>P</i><0.05). In contrast, age, Eastern Cooperative Oncology Group performance status score, histopathological subtype, preoperative serum cancer antigen 125 level, presence of residual lesions after surgery and poly adenosine diphosphate ribose polymerase inhibitor usage showed no significant correlation with OS time (all <i>P</i>>0.05). Multivariate Cox regression analysis identified surgical-pathological stage (<i>HR</i>=4.579，95%<i>CI</i>：1.111-18.866；<","PeriodicalId":10050,"journal":{"name":"中华妇产科杂志","volume":"60 5","pages":"383-390"},"PeriodicalIF":0.0,"publicationDate":"2025-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144149561","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-04-25DOI: 10.3760/cma.j.cn112141-20240924-00524
L Liu, J Wang, X R Gao, M L Wang, M Li, C L Shang, H Y Guo
<p><p><b>Objective:</b> To compare the efficacy of dienogest (DNG) and levonorgestrel-releasing intrauterine system (LNG-IUS) in the treatment of intrinsic and extrinsic subtypes of adenomyosis. <b>Methods:</b> Totally 232 patients were enrolled in the study who were diagnosed as adenomyosis by ultrasound or pelvic magnetic resonance imaging (MRI), and were classified into intrinsic and extrinsic subtypes according to different locations of lesions in MRI, treated with DNG (DNG group) or LNG-IUS (LNG-IUS group) in Peking University Third Hospital from July 2019 to December 2023. Clinical data of patients were retrospectively collected to analyze the clinical and imaging characteristics of different MRI subtypes of adenomyosis and whether there were differences in the therapeutic effects of DNG and LNG-IUS. <b>Results:</b> (1) Among the 232 patients enrolled, 129 were intrinsic subtype and 103 were extrinsic subtype. Among the 129 patients treated with DNG, the numbers of intrinsic and extrinsic subtype were 69 and 60, respectively. And among the 103 patients treated with LNG-IUS, the numbers of intrinsic and extrinsic subtype were 60 and 43, respectively. The mean age in DNG group [(37.5±5.6) years] was lower than that in LNG-IUS group [(40.3±4.3) years, <i>P</i><0.001]. There were no significant differences in other clinical features (all <i>P</i>>0.05). (2) The visual analog scale (VAS) scores of dysmenorrhea and cancer antigen 125 (CA<sub>125</sub>) levels in DNG group and LNG-IUS group were significantly decreased after treatment (all <i>P</i><0.001), and hemoglobin levels were increased (both <i>P</i><0.01). Compared between the two groups, the VAS score after treatment was lower in DNG group (<i>P</i><0.001), and the hemoglobin level was increased more significantly in DNG group (<i>P</i>=0.016). The complete remission rates of dysmenorrhea in DNG group and LNG-IUS group were 73.0% (89/122) and 29.5% (28/95), respectively (<i>P</i>=0.039). The incidence of irregular bleeding in DNG group was higher than LNG-IUS group, but there was no statistical significance [62.8% (81/129) vs 52.4% (54/103), <i>P</i>=0.112]. (3) Among patients with intrinsic adenomyosis, the incidence of menorrhagia was significantly higher than in those with extrinsic adenomyosis (<i>P</i><0.001), while the incidence and severity of dysmenorrhea were lower compared to extrinsic adenomyosis (<i>P</i>=0.004, <i>P</i>=0.007, respectively). After treatment with DNG and LNG-IUS, there were no statistically significant differences in VAS scores between patients with intrinsic and extrinsic adenomyosis (all <i>P</i>>0.05). The incidence of irregular bleeding after DNG treatment was 78.3% (54/69) in intrinsic adenomyosis, which was higher than the 45.0% (27/60) observed in extrinsic adenomyosis (<i>P</i><0.01). Similarly, the incidence of irregular bleeding after LNG-IUS treatment was 63.3% (38/60) in intrinsic adenomyosis, higher than the 37.2% (16/43) in extrinsic adenomyosis
{"title":"[Comparative analysis of the efficacy of dienogest and LNG-IUS in the treatment of intrinsic and extrinsic subtypes of adenomyosis].","authors":"L Liu, J Wang, X R Gao, M L Wang, M Li, C L Shang, H Y Guo","doi":"10.3760/cma.j.cn112141-20240924-00524","DOIUrl":"https://doi.org/10.3760/cma.j.cn112141-20240924-00524","url":null,"abstract":"<p><p><b>Objective:</b> To compare the efficacy of dienogest (DNG) and levonorgestrel-releasing intrauterine system (LNG-IUS) in the treatment of intrinsic and extrinsic subtypes of adenomyosis. <b>Methods:</b> Totally 232 patients were enrolled in the study who were diagnosed as adenomyosis by ultrasound or pelvic magnetic resonance imaging (MRI), and were classified into intrinsic and extrinsic subtypes according to different locations of lesions in MRI, treated with DNG (DNG group) or LNG-IUS (LNG-IUS group) in Peking University Third Hospital from July 2019 to December 2023. Clinical data of patients were retrospectively collected to analyze the clinical and imaging characteristics of different MRI subtypes of adenomyosis and whether there were differences in the therapeutic effects of DNG and LNG-IUS. <b>Results:</b> (1) Among the 232 patients enrolled, 129 were intrinsic subtype and 103 were extrinsic subtype. Among the 129 patients treated with DNG, the numbers of intrinsic and extrinsic subtype were 69 and 60, respectively. And among the 103 patients treated with LNG-IUS, the numbers of intrinsic and extrinsic subtype were 60 and 43, respectively. The mean age in DNG group [(37.5±5.6) years] was lower than that in LNG-IUS group [(40.3±4.3) years, <i>P</i><0.001]. There were no significant differences in other clinical features (all <i>P</i>>0.05). (2) The visual analog scale (VAS) scores of dysmenorrhea and cancer antigen 125 (CA<sub>125</sub>) levels in DNG group and LNG-IUS group were significantly decreased after treatment (all <i>P</i><0.001), and hemoglobin levels were increased (both <i>P</i><0.01). Compared between the two groups, the VAS score after treatment was lower in DNG group (<i>P</i><0.001), and the hemoglobin level was increased more significantly in DNG group (<i>P</i>=0.016). The complete remission rates of dysmenorrhea in DNG group and LNG-IUS group were 73.0% (89/122) and 29.5% (28/95), respectively (<i>P</i>=0.039). The incidence of irregular bleeding in DNG group was higher than LNG-IUS group, but there was no statistical significance [62.8% (81/129) vs 52.4% (54/103), <i>P</i>=0.112]. (3) Among patients with intrinsic adenomyosis, the incidence of menorrhagia was significantly higher than in those with extrinsic adenomyosis (<i>P</i><0.001), while the incidence and severity of dysmenorrhea were lower compared to extrinsic adenomyosis (<i>P</i>=0.004, <i>P</i>=0.007, respectively). After treatment with DNG and LNG-IUS, there were no statistically significant differences in VAS scores between patients with intrinsic and extrinsic adenomyosis (all <i>P</i>>0.05). The incidence of irregular bleeding after DNG treatment was 78.3% (54/69) in intrinsic adenomyosis, which was higher than the 45.0% (27/60) observed in extrinsic adenomyosis (<i>P</i><0.01). Similarly, the incidence of irregular bleeding after LNG-IUS treatment was 63.3% (38/60) in intrinsic adenomyosis, higher than the 37.2% (16/43) in extrinsic adenomyosis ","PeriodicalId":10050,"journal":{"name":"中华妇产科杂志","volume":"60 4","pages":"281-288"},"PeriodicalIF":0.0,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143980712","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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