Pub Date : 2025-02-25DOI: 10.3760/cma.j.cn112141-20241118-00607
Malipati Maerdan, X Y Wang, C Y Shi, L J Wang, R H Zhao, J F Liang, X Sun, X X Zhang, M Y Zhang, H X Yang
Objective: To explore the surgical efficacy of cervical cerclage with cervical length (CL) <10 mm and emergency cerclage. Methods: From January 2013 to June 2022, a total of 98 singleton pregnant women who underwent ultrasound-indicated cervical cerclage because of CL<10 mm in the second trimester and underwent emergency cervical cerclage because of cervical dilation found by physical examination in Peking University First Hospital were enrolled. The differences in clinical data between the <34 weeks delivery group (25 cases) and the ≥34 weeks delivery group (73 cases) were compared. Meanwhile, according to different cervical status, they were divided into CL<10 mm group (43 cases) and cervical dilatation group (55 cases), and the cervical dilatation group was further divided into cervical dilatation <4 cm group and cervical dilatation ≥4 cm group. The clinical data and pregnancy outcomes of pregnant women with different cervical status were compared. Results: (1) There were significant differences in the proportion of preoperative CL<10 mm and the degree of preoperative cervical dilation between the <34 weeks delivery group and the ≥34 weeks delivery group (all P<0.05). (2) After cervical cerclage, compared with women in the cervical dilatation group, the prolonged gestational age in the CL<10 mm group was longer [(10.5±4.6) vs (14.3±3.4) weeks], the gestational age at delivery was later (median: 35.7 vs 38.0 weeks), the preterm birth rates before 37 and 34 weeks were lower, the late abortion rate was lower [9% (5/55) vs 0 (0/43)], and the newborn birth weight was higher, the differences were statistically significant (all P<0.05). (3) Compared with the cervical dilation ≥4 cm group, the prolonged gestational age of the cervical dilatation <4 cm group was longer [(7.5±5.3) vs (11.1±4.2) weeks], the gestational age at delivery was later (median: 29.2 vs 36.0 weeks), and the birth weight of the newborn was higher (all P<0.05). The late abortion rate of cervical dilatation <4 cm group was lower than that of cervical dilatation ≥4 cm group [7% (3/45) vs 2/10; P=0.220]. Conclusions: Timely cervical cerclage in individuals with CL<10 mm could reduce preterm birth rate before 34 weeks gestation, and the pregnancy outcome is better than that of individuals with cervical dilation. Moreover, the pregnancy outcome of cervical cerclage in women with cervical dilation <4 cm is significantly better than that in women with cervical dilatation ≥4 cm.
{"title":"[Effectiveness and pregnancy outcomes of emergency cervical cerclage versus cerclage with cervical length <10 mm: a retrospective study].","authors":"Malipati Maerdan, X Y Wang, C Y Shi, L J Wang, R H Zhao, J F Liang, X Sun, X X Zhang, M Y Zhang, H X Yang","doi":"10.3760/cma.j.cn112141-20241118-00607","DOIUrl":"10.3760/cma.j.cn112141-20241118-00607","url":null,"abstract":"<p><p><b>Objective:</b> To explore the surgical efficacy of cervical cerclage with cervical length (CL) <10 mm and emergency cerclage. <b>Methods:</b> From January 2013 to June 2022, a total of 98 singleton pregnant women who underwent ultrasound-indicated cervical cerclage because of CL<10 mm in the second trimester and underwent emergency cervical cerclage because of cervical dilation found by physical examination in Peking University First Hospital were enrolled. The differences in clinical data between the <34 weeks delivery group (25 cases) and the ≥34 weeks delivery group (73 cases) were compared. Meanwhile, according to different cervical status, they were divided into CL<10 mm group (43 cases) and cervical dilatation group (55 cases), and the cervical dilatation group was further divided into cervical dilatation <4 cm group and cervical dilatation ≥4 cm group. The clinical data and pregnancy outcomes of pregnant women with different cervical status were compared. <b>Results:</b> (1) There were significant differences in the proportion of preoperative CL<10 mm and the degree of preoperative cervical dilation between the <34 weeks delivery group and the ≥34 weeks delivery group (all <i>P</i><0.05). (2) After cervical cerclage, compared with women in the cervical dilatation group, the prolonged gestational age in the CL<10 mm group was longer [(10.5±4.6) vs (14.3±3.4) weeks], the gestational age at delivery was later (median: 35.7 vs 38.0 weeks), the preterm birth rates before 37 and 34 weeks were lower, the late abortion rate was lower [9% (5/55) vs 0 (0/43)], and the newborn birth weight was higher, the differences were statistically significant (all <i>P</i><0.05). (3) Compared with the cervical dilation ≥4 cm group, the prolonged gestational age of the cervical dilatation <4 cm group was longer [(7.5±5.3) vs (11.1±4.2) weeks], the gestational age at delivery was later (median: 29.2 vs 36.0 weeks), and the birth weight of the newborn was higher (all <i>P</i><0.05). The late abortion rate of cervical dilatation <4 cm group was lower than that of cervical dilatation ≥4 cm group [7% (3/45) vs 2/10; <i>P</i>=0.220]. <b>Conclusions:</b> Timely cervical cerclage in individuals with CL<10 mm could reduce preterm birth rate before 34 weeks gestation, and the pregnancy outcome is better than that of individuals with cervical dilation. Moreover, the pregnancy outcome of cervical cerclage in women with cervical dilation <4 cm is significantly better than that in women with cervical dilatation ≥4 cm.</p>","PeriodicalId":10050,"journal":{"name":"中华妇产科杂志","volume":"60 2","pages":"114-120"},"PeriodicalIF":0.0,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143514848","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 : 2025-02-25DOI: 10.3760/cma.j.cn112141-20241020-00562
Z Zhang, X N Zong, H H Bai, L Y Fan, T Li, Z H Liu
Objective: To investigate the association between high-risk human papillomavirus (hrHPV) persistent infection and vaginal microecology. Methods: A total of 53 women were enrolled in the gynecological clinic of Beijing Obstetrics and Gynecology Hospital from January 2020 to January 2021, including 7 women without HPV and 46 women with hrHPV infection. Among the hrHPV infected women, 24 woemn who did not use any drugs were classified as the observation group and the other 22 women who were given standardized interferon vaginal administration for 3 months were regarded as the treatment group. Vaginal secretions of all women were taken for Gram-stained microecological test at the time of enrollment and at the 4, 8, and 12 month follow-up. HPV turning negative was taken as the end point of follow-up. Results: (1) Women of hrHPV persistent infection in the observation and treatmnet groups had more times of abortions (P=0.180). (2) The hrHPV negative conversion rate was 17% (4/24) in the observation group and 36% (8/22) in the treatment group, but the difference was not significant (P=0.183). The median hrHPV negative conversion time were 11.0 months and 7.5 months in the observation and treatment groups, respectively, and the difference was statistically significant (P=0.001). (3) Vaginal microecology was generally normal at the time of enrollment and at the end of follow-up in women with HPV natural negative conversion in the observation group. While vaginal microecological disorders were more common in women with hrHPV persistent infection in the observation and treatmnet groups, including high vaginal pH value, poor vaginal cleanliness, poor grade of Lactobacillus and increased vaginal clutter bacteria, and the vaginal microecological situation did not improve after the 12-month follow-up. (4) In the treatment group, women who turned HPV negative within six months all had normal vaginal microecology when enrollment (5/5). While those who turned negative six months later had a higher proportion of vaginal clutter bacteria (2/3), a poor grade of Lactobacillus (2/3) and a higher proportion of vaginal dysbiosis (2/3). Conclusions: (1) Interferon therapy could shorten the negative turning time of hrHPV. (2) Women with normal vaginal microecology have the ability to naturally clear hrHPV. (3) The vaginal microecological Gram-stain test has limited value in predicting hrHPV clearance, perhaps due to its inability to detect Lactobacillus subtypes.
{"title":"[Association between HPV outcome and vaginal microecology in women with persistent high-risk HPV infection: a prospective cohort study].","authors":"Z Zhang, X N Zong, H H Bai, L Y Fan, T Li, Z H Liu","doi":"10.3760/cma.j.cn112141-20241020-00562","DOIUrl":"10.3760/cma.j.cn112141-20241020-00562","url":null,"abstract":"<p><p><b>Objective:</b> To investigate the association between high-risk human papillomavirus (hrHPV) persistent infection and vaginal microecology. <b>Methods:</b> A total of 53 women were enrolled in the gynecological clinic of Beijing Obstetrics and Gynecology Hospital from January 2020 to January 2021, including 7 women without HPV and 46 women with hrHPV infection. Among the hrHPV infected women, 24 woemn who did not use any drugs were classified as the observation group and the other 22 women who were given standardized interferon vaginal administration for 3 months were regarded as the treatment group. Vaginal secretions of all women were taken for Gram-stained microecological test at the time of enrollment and at the 4, 8, and 12 month follow-up. HPV turning negative was taken as the end point of follow-up. <b>Results:</b> (1) Women of hrHPV persistent infection in the observation and treatmnet groups had more times of abortions (<i>P</i>=0.180). (2) The hrHPV negative conversion rate was 17% (4/24) in the observation group and 36% (8/22) in the treatment group, but the difference was not significant (<i>P</i>=0.183). The median hrHPV negative conversion time were 11.0 months and 7.5 months in the observation and treatment groups, respectively, and the difference was statistically significant (<i>P</i>=0.001). (3) Vaginal microecology was generally normal at the time of enrollment and at the end of follow-up in women with HPV natural negative conversion in the observation group. While vaginal microecological disorders were more common in women with hrHPV persistent infection in the observation and treatmnet groups, including high vaginal pH value, poor vaginal cleanliness, poor grade of Lactobacillus and increased vaginal clutter bacteria, and the vaginal microecological situation did not improve after the 12-month follow-up. (4) In the treatment group, women who turned HPV negative within six months all had normal vaginal microecology when enrollment (5/5). While those who turned negative six months later had a higher proportion of vaginal clutter bacteria (2/3), a poor grade of Lactobacillus (2/3) and a higher proportion of vaginal dysbiosis (2/3). <b>Conclusions:</b> (1) Interferon therapy could shorten the negative turning time of hrHPV. (2) Women with normal vaginal microecology have the ability to naturally clear hrHPV. (3) The vaginal microecological Gram-stain test has limited value in predicting hrHPV clearance, perhaps due to its inability to detect Lactobacillus subtypes.</p>","PeriodicalId":10050,"journal":{"name":"中华妇产科杂志","volume":"60 2","pages":"121-127"},"PeriodicalIF":0.0,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143514843","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 : 2025-02-25DOI: 10.3760/cma.j.cn112141-20241018-00560
L H Wang, M Pan
<p><p><b>Objective:</b> To investigate the clinical effect of cervical cerclage at different gestational weeks in twin pregnancy with cervical length (CL)≤15 mm. <b>Methods:</b> This was a retrospective cohort study. Eighty-three twin pregnant women with CL≤15 mm detected by transvaginal ultrasound at 16-27<sup>+6</sup> weeks of gestation in Fujian Maternity and Child Health Hospital from January 2017 to December 2023 were enrolled. According to different treatment methods, they were divided into cervical cerclage group (47 cases) and conservative treatment group (36 cases), and stratified according to the gestational age of CL≤15 mm diagnosis (<26 weeks, ≥26 weeks). The differences in pregnancy outcomes between the two groups were compared. Multivariate logistic regression was used to analyze the effect of cervical cerclage on preterm birth in twin pregnant women with different CL≤15 mm diagnosis weeks. <b>Results:</b> (1) The gestational age at delivery and prolonged gestational age in the cervical cerclage group were longer than those in the conservative treatment group (median gestational age at delivery: 35.3 vs 33.0 weeks; median prolonged gestational age: 10.4 vs 7.2 weeks), and preterm birth rates before 34, 32 and 28 weeks were lower than those in the conservative treatment group [34 weeks: 23% (11/47) vs 53% (19/36); 32 weeks: 15% (7/47) vs 39% (14/36); 28 weeks: 4% (2/47) vs 25% (9/36)], the differences were statistically significant (all <i>P</i><0.05). There were no significant differences in the rates of preterm birth before 37 weeks of gestation and preterm premature rupture of membranes between the two groups (all <i>P></i>0.05). (2) When gestational age at CL≤15 mm diagnosis was <26 weeks, pregnancy outcomes in the cervical cerclage group were better than those in the conservative treatment group, including gestational age at delivery (median: 35.4 vs 31.3 weeks) and prolonged gestational age (median: 11.1 vs 5.6 weeks), neonatal birth weight [(2 246±519) vs (1 594±691) g], incidence of adverse neonatal outcomes [19% (13/68) vs 56% (19/34)], and proportion of live births [100% (68/68) vs 82% (28/34)], respectively; the differences were statistically significant (all <i>P</i><0.05). When the gestational age of CL≤15 mm diagnosis was ≥26 weeks, there were no statistically significant difference in pregnancy outcomes between the two groups (all <i>P</i>>0.05). (3) Multivariate logistic regression analysis showed that when the gestational age of CL≤15 mm diagnosis was <26 weeks, cervical cerclage reduced the risk of preterm birth before 34 weeks (a<i>OR</i>=0.10, 95%<i>CI</i>: 0.02-0.51; <i>P</i><0.05), 32 weeks (a<i>OR</i>=0.11, 95%<i>CI</i>: 0.02-0.58; <i>P</i><0.05) and 28 weeks (a<i>OR</i>=0.04, 95%<i>CI</i>: 0.01-0.65; <i>P</i><0.05). When the gestational age of CL≤15 mm diagnosis was ≥26 weeks, cervical cerclage did not reduce the risk of preterm birth before 34, 32 and 28 weeks of gestation (all <i>P</i>>0.05). <b>Conclusions:
{"title":"[Analysis of clinical effect of cervical cerclage in twin pregnancies with cervical length ≤15 mm at different gestational ages].","authors":"L H Wang, M Pan","doi":"10.3760/cma.j.cn112141-20241018-00560","DOIUrl":"10.3760/cma.j.cn112141-20241018-00560","url":null,"abstract":"<p><p><b>Objective:</b> To investigate the clinical effect of cervical cerclage at different gestational weeks in twin pregnancy with cervical length (CL)≤15 mm. <b>Methods:</b> This was a retrospective cohort study. Eighty-three twin pregnant women with CL≤15 mm detected by transvaginal ultrasound at 16-27<sup>+6</sup> weeks of gestation in Fujian Maternity and Child Health Hospital from January 2017 to December 2023 were enrolled. According to different treatment methods, they were divided into cervical cerclage group (47 cases) and conservative treatment group (36 cases), and stratified according to the gestational age of CL≤15 mm diagnosis (<26 weeks, ≥26 weeks). The differences in pregnancy outcomes between the two groups were compared. Multivariate logistic regression was used to analyze the effect of cervical cerclage on preterm birth in twin pregnant women with different CL≤15 mm diagnosis weeks. <b>Results:</b> (1) The gestational age at delivery and prolonged gestational age in the cervical cerclage group were longer than those in the conservative treatment group (median gestational age at delivery: 35.3 vs 33.0 weeks; median prolonged gestational age: 10.4 vs 7.2 weeks), and preterm birth rates before 34, 32 and 28 weeks were lower than those in the conservative treatment group [34 weeks: 23% (11/47) vs 53% (19/36); 32 weeks: 15% (7/47) vs 39% (14/36); 28 weeks: 4% (2/47) vs 25% (9/36)], the differences were statistically significant (all <i>P</i><0.05). There were no significant differences in the rates of preterm birth before 37 weeks of gestation and preterm premature rupture of membranes between the two groups (all <i>P></i>0.05). (2) When gestational age at CL≤15 mm diagnosis was <26 weeks, pregnancy outcomes in the cervical cerclage group were better than those in the conservative treatment group, including gestational age at delivery (median: 35.4 vs 31.3 weeks) and prolonged gestational age (median: 11.1 vs 5.6 weeks), neonatal birth weight [(2 246±519) vs (1 594±691) g], incidence of adverse neonatal outcomes [19% (13/68) vs 56% (19/34)], and proportion of live births [100% (68/68) vs 82% (28/34)], respectively; the differences were statistically significant (all <i>P</i><0.05). When the gestational age of CL≤15 mm diagnosis was ≥26 weeks, there were no statistically significant difference in pregnancy outcomes between the two groups (all <i>P</i>>0.05). (3) Multivariate logistic regression analysis showed that when the gestational age of CL≤15 mm diagnosis was <26 weeks, cervical cerclage reduced the risk of preterm birth before 34 weeks (a<i>OR</i>=0.10, 95%<i>CI</i>: 0.02-0.51; <i>P</i><0.05), 32 weeks (a<i>OR</i>=0.11, 95%<i>CI</i>: 0.02-0.58; <i>P</i><0.05) and 28 weeks (a<i>OR</i>=0.04, 95%<i>CI</i>: 0.01-0.65; <i>P</i><0.05). When the gestational age of CL≤15 mm diagnosis was ≥26 weeks, cervical cerclage did not reduce the risk of preterm birth before 34, 32 and 28 weeks of gestation (all <i>P</i>>0.05). <b>Conclusions:","PeriodicalId":10050,"journal":{"name":"中华妇产科杂志","volume":"60 2","pages":"99-104"},"PeriodicalIF":0.0,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143514774","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 : 2025-02-25DOI: 10.3760/cma.j.cn112141-20240823-00467
S Zhu, X Yan, J C Song, X H Huang
Objective: To investigate the effectiveness, safety and feasibility of transumbilical laparoendoscopic single-site surgery (TU-LESS) for abdominal wall endometriosis (AWE) lesion resection. Methods: A total of 11 patients who underwent AWE lesion resection via TU-LESS at The First Affiliated Hospital of Nanjing Medical University from January 2022 to May 2024 were enrolled. The size, invasion depth of the lesion, horizontal distance from the lesion center to the original surgical scar, vertical distance from the lesion to the skin, body mass index (BMI), the thickness of abdominal wall fat, operative time, intraoperative blood loss, perioperative complications, postoperative pathology, postoperative incision healing and recurrence were recorded and analyzed. Results: All 11 patients in this study had a history of cesarean section, 10 of whom had transverse incision and 1 had longitudinal incision. The age was (35.0±6.2) years old. BMI was (25.0±4.0) kg/m2, with the highest being 33.9 kg/m2. The lesion size was (24.7±12.1) mm, with an average horizontal distance from the lesion center to the original surgical scar of (11.6±6.0) mm. The abdominal wall fat thickness was (21.4±5.8) mm, and the vertical distance from the lesion to the skin was (14.5±7.9) mm. There were a total of 12 lesions in the 11 patients. Among them, 1 lesion extended to the peritoneum inferiorly, 5 lesions extended to the rectus abdominis inferiorly, 5 lesions reached the anterior sheath of the rectus abdominis inferiorly, and 1 lesion was completely located within the abdominal wall fat. The operative time was (84.2±35.4) minutes, and the intraoperative blood loss was (9.0±4.2) ml. The postoperative incision healing of all patients was grade A. The anatomical structure of their umbilical region remained normal, free from any scarring, which contributed to the high satisfaction levels expressed by the patients. Postoperative pathological examination confirmed endometriosis with negative surgical margins, and no recurrence had been observed during follow-up. Conclusion: TU-LESS for AWE lesion resection is safe and feasible, particularly suitable for patients with lesions located far from the original surgical scar, deep lesion location, thick abdominal wall fat, and multiple focal leisons.
{"title":"[Preliminary discussion on transumbilical laparoendoscopic single-site surgery for abdominal wall endometriosis lesion resection].","authors":"S Zhu, X Yan, J C Song, X H Huang","doi":"10.3760/cma.j.cn112141-20240823-00467","DOIUrl":"10.3760/cma.j.cn112141-20240823-00467","url":null,"abstract":"<p><p><b>Objective:</b> To investigate the effectiveness, safety and feasibility of transumbilical laparoendoscopic single-site surgery (TU-LESS) for abdominal wall endometriosis (AWE) lesion resection. <b>Methods:</b> A total of 11 patients who underwent AWE lesion resection via TU-LESS at The First Affiliated Hospital of Nanjing Medical University from January 2022 to May 2024 were enrolled. The size, invasion depth of the lesion, horizontal distance from the lesion center to the original surgical scar, vertical distance from the lesion to the skin, body mass index (BMI), the thickness of abdominal wall fat, operative time, intraoperative blood loss, perioperative complications, postoperative pathology, postoperative incision healing and recurrence were recorded and analyzed. <b>Results:</b> All 11 patients in this study had a history of cesarean section, 10 of whom had transverse incision and 1 had longitudinal incision. The age was (35.0±6.2) years old. BMI was (25.0±4.0) kg/m<sup>2</sup>, with the highest being 33.9 kg/m<sup>2</sup>. The lesion size was (24.7±12.1) mm, with an average horizontal distance from the lesion center to the original surgical scar of (11.6±6.0) mm. The abdominal wall fat thickness was (21.4±5.8) mm, and the vertical distance from the lesion to the skin was (14.5±7.9) mm. There were a total of 12 lesions in the 11 patients. Among them, 1 lesion extended to the peritoneum inferiorly, 5 lesions extended to the rectus abdominis inferiorly, 5 lesions reached the anterior sheath of the rectus abdominis inferiorly, and 1 lesion was completely located within the abdominal wall fat. The operative time was (84.2±35.4) minutes, and the intraoperative blood loss was (9.0±4.2) ml. The postoperative incision healing of all patients was grade A. The anatomical structure of their umbilical region remained normal, free from any scarring, which contributed to the high satisfaction levels expressed by the patients. Postoperative pathological examination confirmed endometriosis with negative surgical margins, and no recurrence had been observed during follow-up. <b>Conclusion:</b> TU-LESS for AWE lesion resection is safe and feasible, particularly suitable for patients with lesions located far from the original surgical scar, deep lesion location, thick abdominal wall fat, and multiple focal leisons.</p>","PeriodicalId":10050,"journal":{"name":"中华妇产科杂志","volume":"60 2","pages":"128-135"},"PeriodicalIF":0.0,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143514849","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 : 2025-02-25DOI: 10.3760/cma.j.cn112141-20240726-00416
Y F Chen, P Bai, Y Q Zhao, L N Cong, N Li, J Zuo, G Y Zhang, Y C Sun, S M Li, Q Li
Objective: To investigate the application of pedicled or perforator flaps transfer in the stage Ⅰ tissue defect repair after vulvar cancer surgery. Methods: From January 2005 to December 2023, 20 patients with vulvar cancer who underwent extensive episiectomy or extended episiectomy±inguinal lymph node resection+vulvar defect flap transfer were collected in Huanxing Cancer Hospital of Chaoyang District and Cancer Hospital and Peking Union Medical College, Chinese Academy of Medical Sciences. The survival status, appearance structure, sexual function satisfaction, tumor recurrence, and survival were analyzed. Results: (1) The median age of the 20 patients was 59 years (ranged: 29-73 years). There were 14 patients with recurrence and 6 patients with initial treatment. Pathological types: 14 cases of squamous cell carcinoma, 4 cases of Paget's disease, 1 case of malignant melanoma, 1 case of adenoid cystic carcinoma (salivary gland type carcinoma). (2) Among the 20 patients, 6 cases underwent extensive episiotomy and 14 underwent extended episiotomy (1 of them underwent extensive excision of inguinal masses). Simultaneous inguinal lymphadenectomy (or dissection) were performed in 11 cases, including 7 cases of bilateral inguinal lymph node resection (or dissection) and 4 cases of unilateral inguinal lymph node resection (or dissection). Flap source: pedicled flap in 12 cases, perforator flap in 8 cases. All the 20 patients were removed at 10-14 days after operation, and all of them survived with rosy skin color and good elasticity. Seventeen cases of transferred flaps healed at stage Ⅰ, 2 cases healed at about 6 weeks due to incision leakage, and 1 case healed at 6 weeks after incision infection debridement. Six months after the operation, 2 cases felt that the pubic mound was thick and swollen. The other 18 cases showed vulva fullness and elasticity, no displacement of urethral opening, no deviation of urethra during urination, no stenosis of vaginal opening, no vulvar scar pain. In addition to 1 unmarried 29-year-old patient and 6 patients over 65 years old who had no sexual life before and after surgery, the other 13 patients had normal sexual life after surgery. (3) The follow-up period were 6 to 100 months, and 9 cases (45%, 9/20) relapsed during the follow-up period. There were 5 deaths (25%, 5/20), who were due to recurrence of vulvar cancer. The 5-year survival rate of 20 patients was 75%, including 83% in 6 patients with initial treatment and 71% in 14 patients with recurrence and reoperation. Conclusions: The combination of flap transfer for episioplasty with vulvar cancer surgery does not affect the wound healing. Because the external structure of the vulva is repaired, it could effectively improve the local wound healing ability and improve the organ function, and has good clinical application value.
{"title":"[Application of pedicle or perforator flaps transfer in the stage Ⅰ tissue defect repair after vulvar cancer surgery].","authors":"Y F Chen, P Bai, Y Q Zhao, L N Cong, N Li, J Zuo, G Y Zhang, Y C Sun, S M Li, Q Li","doi":"10.3760/cma.j.cn112141-20240726-00416","DOIUrl":"10.3760/cma.j.cn112141-20240726-00416","url":null,"abstract":"<p><p><b>Objective:</b> To investigate the application of pedicled or perforator flaps transfer in the stage Ⅰ tissue defect repair after vulvar cancer surgery. <b>Methods:</b> From January 2005 to December 2023, 20 patients with vulvar cancer who underwent extensive episiectomy or extended episiectomy±inguinal lymph node resection+vulvar defect flap transfer were collected in Huanxing Cancer Hospital of Chaoyang District and Cancer Hospital and Peking Union Medical College, Chinese Academy of Medical Sciences. The survival status, appearance structure, sexual function satisfaction, tumor recurrence, and survival were analyzed. <b>Results:</b> (1) The median age of the 20 patients was 59 years (ranged: 29-73 years). There were 14 patients with recurrence and 6 patients with initial treatment. Pathological types: 14 cases of squamous cell carcinoma, 4 cases of Paget's disease, 1 case of malignant melanoma, 1 case of adenoid cystic carcinoma (salivary gland type carcinoma). (2) Among the 20 patients, 6 cases underwent extensive episiotomy and 14 underwent extended episiotomy (1 of them underwent extensive excision of inguinal masses). Simultaneous inguinal lymphadenectomy (or dissection) were performed in 11 cases, including 7 cases of bilateral inguinal lymph node resection (or dissection) and 4 cases of unilateral inguinal lymph node resection (or dissection). Flap source: pedicled flap in 12 cases, perforator flap in 8 cases. All the 20 patients were removed at 10-14 days after operation, and all of them survived with rosy skin color and good elasticity. Seventeen cases of transferred flaps healed at stage Ⅰ, 2 cases healed at about 6 weeks due to incision leakage, and 1 case healed at 6 weeks after incision infection debridement. Six months after the operation, 2 cases felt that the pubic mound was thick and swollen. The other 18 cases showed vulva fullness and elasticity, no displacement of urethral opening, no deviation of urethra during urination, no stenosis of vaginal opening, no vulvar scar pain. In addition to 1 unmarried 29-year-old patient and 6 patients over 65 years old who had no sexual life before and after surgery, the other 13 patients had normal sexual life after surgery. (3) The follow-up period were 6 to 100 months, and 9 cases (45%, 9/20) relapsed during the follow-up period. There were 5 deaths (25%, 5/20), who were due to recurrence of vulvar cancer. The 5-year survival rate of 20 patients was 75%, including 83% in 6 patients with initial treatment and 71% in 14 patients with recurrence and reoperation. <b>Conclusions:</b> The combination of flap transfer for episioplasty with vulvar cancer surgery does not affect the wound healing. Because the external structure of the vulva is repaired, it could effectively improve the local wound healing ability and improve the organ function, and has good clinical application value.</p>","PeriodicalId":10050,"journal":{"name":"中华妇产科杂志","volume":"60 2","pages":"136-143"},"PeriodicalIF":0.0,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143514704","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 : 2025-02-25DOI: 10.3760/cma.j.cn112141-20241105-00586
Y W Fan, G C Zhao, S Y Yang, W H Chen, N N Zhao, H Y Liu
<p><p><b>Objective:</b> To explore the clinical efficacy of three different surgical timings of modified cervical cerclage in twin pregnant women with cervical insufficiency. <b>Methods:</b> The clinical data of 73 twin pregnant women who underwent modified cervical cerclage and had pregnancy outcomes in Qilu Hospital of Shandong University (Qingdao) from April 2014 to July 2023 were retrospectively analyzed. According to the different timings of surgery, they were divided into prophylactic cerclage group, ultrasound-indicated cerclage group (further divided into cervical length (CL)≤15 mm and 15 mm<CL<25 mm subgroups) and emergency cerclage group. The differences in pregnancy and neonatal outcomes among the three groups were compared. The clinical data and pregnancy outcomes of pregnant women delivered at <34 weeks and ≥34 weeks were compared, and multivariate logistic regression was used to analyze the influencing factors of preterm birth before 34 weeks. <b>Results:</b> (1) The prolonged gestational age and postoperative CL in the prophylactic cerclage group were longer than those in the ultrasound-indicated cerclage group; the gestational age at delivery, prolonged gestational age, postoperative CL, live birth rate and neonatal birth weight in the prophylactic cerclage group were higher than those in the ultrasound-indicated cerclage group, and the preterm birth rate before 34, 32 and 28 weeks of gestation and premature rupture of membranes were lower than those in the emergency cerclage group; the gestational age of delivery, prolonged gestational age, postoperative CL, live birth rate and the rate of neonatal birth weight of the pregnant women in the ultrasound-indicated cerclage group were higher than those in the emergency cerclage group, and the rate of premature birth before 34, 32 and 28 weeks of gestation and late neonatal birth weight <1 500 g were lower than those in the emergency cerclage group; the differences were statistically significant (all <i>P</i><0.05). (2) The gestational age and postoperative CL in the 15 mm<CL<25 mm group were longer than those in the CL≤15 mm group, and the gestational age at delivery and neonatal birth weight in the CL≤15 mm group were higher than those in the emergency cerclage group. The incidence of preterm birth before 32 weeks of gestation and birth weight <1 500 g in the cervical dilatation group were significantly lower than those in the emergency cerclage group (all <i>P</i><0.05). (3) The incidence of abnormal cervicovaginal discharge and postoperative C-reactive protein (CRP) level of pregnant women with delivery gestational age <34 weeks were significantly higher than those of pregnant women with delivery gestational age ≥34 weeks, while preoperative CL and postoperative CL were significantly shorter than those of pregnant women with delivery gestational age ≥34 weeks (all <i>P</i><0.05). Multivariate logistic regression analysis showed that postoperative CRP>10 mg/L was a risk factor for p
{"title":"[Clinical study of modified cervical cerclage at different surgical timings in twin pregnant women with cervical insufficiency].","authors":"Y W Fan, G C Zhao, S Y Yang, W H Chen, N N Zhao, H Y Liu","doi":"10.3760/cma.j.cn112141-20241105-00586","DOIUrl":"10.3760/cma.j.cn112141-20241105-00586","url":null,"abstract":"<p><p><b>Objective:</b> To explore the clinical efficacy of three different surgical timings of modified cervical cerclage in twin pregnant women with cervical insufficiency. <b>Methods:</b> The clinical data of 73 twin pregnant women who underwent modified cervical cerclage and had pregnancy outcomes in Qilu Hospital of Shandong University (Qingdao) from April 2014 to July 2023 were retrospectively analyzed. According to the different timings of surgery, they were divided into prophylactic cerclage group, ultrasound-indicated cerclage group (further divided into cervical length (CL)≤15 mm and 15 mm<CL<25 mm subgroups) and emergency cerclage group. The differences in pregnancy and neonatal outcomes among the three groups were compared. The clinical data and pregnancy outcomes of pregnant women delivered at <34 weeks and ≥34 weeks were compared, and multivariate logistic regression was used to analyze the influencing factors of preterm birth before 34 weeks. <b>Results:</b> (1) The prolonged gestational age and postoperative CL in the prophylactic cerclage group were longer than those in the ultrasound-indicated cerclage group; the gestational age at delivery, prolonged gestational age, postoperative CL, live birth rate and neonatal birth weight in the prophylactic cerclage group were higher than those in the ultrasound-indicated cerclage group, and the preterm birth rate before 34, 32 and 28 weeks of gestation and premature rupture of membranes were lower than those in the emergency cerclage group; the gestational age of delivery, prolonged gestational age, postoperative CL, live birth rate and the rate of neonatal birth weight of the pregnant women in the ultrasound-indicated cerclage group were higher than those in the emergency cerclage group, and the rate of premature birth before 34, 32 and 28 weeks of gestation and late neonatal birth weight <1 500 g were lower than those in the emergency cerclage group; the differences were statistically significant (all <i>P</i><0.05). (2) The gestational age and postoperative CL in the 15 mm<CL<25 mm group were longer than those in the CL≤15 mm group, and the gestational age at delivery and neonatal birth weight in the CL≤15 mm group were higher than those in the emergency cerclage group. The incidence of preterm birth before 32 weeks of gestation and birth weight <1 500 g in the cervical dilatation group were significantly lower than those in the emergency cerclage group (all <i>P</i><0.05). (3) The incidence of abnormal cervicovaginal discharge and postoperative C-reactive protein (CRP) level of pregnant women with delivery gestational age <34 weeks were significantly higher than those of pregnant women with delivery gestational age ≥34 weeks, while preoperative CL and postoperative CL were significantly shorter than those of pregnant women with delivery gestational age ≥34 weeks (all <i>P</i><0.05). Multivariate logistic regression analysis showed that postoperative CRP>10 mg/L was a risk factor for p","PeriodicalId":10050,"journal":{"name":"中华妇产科杂志","volume":"60 2","pages":"105-113"},"PeriodicalIF":0.0,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143514846","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 : 2025-02-25DOI: 10.3760/cma.j.cn112141-20240829-00481
J H Lang
{"title":"[Do not injury, please！].","authors":"J H Lang","doi":"10.3760/cma.j.cn112141-20240829-00481","DOIUrl":"https://doi.org/10.3760/cma.j.cn112141-20240829-00481","url":null,"abstract":"","PeriodicalId":10050,"journal":{"name":"中华妇产科杂志","volume":"60 2","pages":"81-82"},"PeriodicalIF":0.0,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143514847","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 : 2025-02-25DOI: 10.3760/cma.j.cn112141-20241119-00612
C Y Shi, H X Yang
{"title":"[Challenges and considerations in diagnosis and treatment of cervical insufficiency].","authors":"C Y Shi, H X Yang","doi":"10.3760/cma.j.cn112141-20241119-00612","DOIUrl":"10.3760/cma.j.cn112141-20241119-00612","url":null,"abstract":"","PeriodicalId":10050,"journal":{"name":"中华妇产科杂志","volume":"60 2","pages":"94-98"},"PeriodicalIF":0.0,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143514844","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 : 2025-02-25DOI: 10.3760/cma.j.cn112141-20250106-00012
{"title":"[Chinese expert consensus on the role of hysteroscopic morphological characteristics in the fertility preservation treatment for endometrial cancer].","authors":"","doi":"10.3760/cma.j.cn112141-20250106-00012","DOIUrl":"10.3760/cma.j.cn112141-20250106-00012","url":null,"abstract":"","PeriodicalId":10050,"journal":{"name":"中华妇产科杂志","volume":"60 2","pages":"83-93"},"PeriodicalIF":0.0,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143514845","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 : 2025-01-25DOI: 10.3760/cma.j.cn112141-20240511-00272
L Li, H Y Wang, J Qiao, R Li, P Liu
Objective: To explore biomarkers for the efficacy of lymphocyte immunotherapy (LIT) treating women with unexplained recurrent spontaneous abortion (URSA). Methods: Serum samples from 24 URSA potients who received LIT were collected at Peking University Third Hospital from December 2014 to June 2015. Semiquantitative sandwich-based antibody arrays containing 40 cytokines were used to screen target immune cytokines in the peripheral blood of URSA patients before and after LIT. Multifactor quantitative microsphere flow cytometry detection validated the levels of target cytokines. Based on the final pregnancy outcome after LIT, 24 URSA patients were divided into the full-term delivery group (15 cases) and the abortion group (9 cases). Furthermore, linear regression analysis were applied to evaluate the relationship between target cytokines and pregnancy outcomes. Results: Semiquantitative sandwich-based antibody arrays suggested that, among all 24 URSA patients included in this study, the intensities of the fluorescence signal were significantly lower post-LIT versus pre-LIT for the following cytokines: interleukin-15 (IL-15), monokine induced by γ-interferon (MIG), C-C motif chemokine ligand (CCL) 1 (all P<0.05). In the full-term delivery group, the intensities of the fluorescence signal post-LIT were significantly lower than pre-LIT for the following cytokines: IL-15, CCL1, macrophage inflammatory protein (MIP) 1α (all P<0.05). In the abortion group, the intensities of the fluorescence signal post-LIT were significantly lower than pre-LIT for the following cytokines: MIG, MIP-1δ (all P<0.05). Linear regression analysis showed that the intensity of the fluorescence signal of CCL11 was increased and the intensity of the fluorescence signal of soluble tumor necrosis factor receptor 2 (sTNFR2) was decreased in the full-term delivery group after LIT, the differences were statistically significant (P=0.012, 0.029). Validation results of multifactor quantitative microsphere flow cytometry detection showed that the level of CCL11 was significantly increased (P=0.001) and the level of sTNFR2 was significantly decreased (P=0.001) in the full-term delivery group after LIT. Conclusion: CCL11 and sTNFR2 maybe serve as potential biomarkers that could predict pregnancy outcomes after LIT in women with URSA.
{"title":"[Exploration of CCL11 and sTNFR2 as potential biomarkers for the efficacy of lymphocyte immunotherapy in women with unexplained recurrent spontaneous abortion].","authors":"L Li, H Y Wang, J Qiao, R Li, P Liu","doi":"10.3760/cma.j.cn112141-20240511-00272","DOIUrl":"10.3760/cma.j.cn112141-20240511-00272","url":null,"abstract":"<p><p><b>Objective:</b> To explore biomarkers for the efficacy of lymphocyte immunotherapy (LIT) treating women with unexplained recurrent spontaneous abortion (URSA). <b>Methods:</b> Serum samples from 24 URSA potients who received LIT were collected at Peking University Third Hospital from December 2014 to June 2015. Semiquantitative sandwich-based antibody arrays containing 40 cytokines were used to screen target immune cytokines in the peripheral blood of URSA patients before and after LIT. Multifactor quantitative microsphere flow cytometry detection validated the levels of target cytokines. Based on the final pregnancy outcome after LIT, 24 URSA patients were divided into the full-term delivery group (15 cases) and the abortion group (9 cases). Furthermore, linear regression analysis were applied to evaluate the relationship between target cytokines and pregnancy outcomes. <b>Results:</b> Semiquantitative sandwich-based antibody arrays suggested that, among all 24 URSA patients included in this study, the intensities of the fluorescence signal were significantly lower post-LIT versus pre-LIT for the following cytokines: interleukin-15 (IL-15), monokine induced by γ-interferon (MIG), C-C motif chemokine ligand (CCL) 1 (all <i>P</i><0.05). In the full-term delivery group, the intensities of the fluorescence signal post-LIT were significantly lower than pre-LIT for the following cytokines: IL-15, CCL1, macrophage inflammatory protein (MIP) 1α (all <i>P</i><0.05). In the abortion group, the intensities of the fluorescence signal post-LIT were significantly lower than pre-LIT for the following cytokines: MIG, MIP-1δ (all <i>P</i><0.05). Linear regression analysis showed that the intensity of the fluorescence signal of CCL11 was increased and the intensity of the fluorescence signal of soluble tumor necrosis factor receptor 2 (sTNFR2) was decreased in the full-term delivery group after LIT, the differences were statistically significant (<i>P</i>=0.012, 0.029). Validation results of multifactor quantitative microsphere flow cytometry detection showed that the level of CCL11 was significantly increased (<i>P</i>=0.001) and the level of sTNFR2 was significantly decreased (<i>P</i>=0.001) in the full-term delivery group after LIT. <b>Conclusion:</b> CCL11 and sTNFR2 maybe serve as potential biomarkers that could predict pregnancy outcomes after LIT in women with URSA.</p>","PeriodicalId":10050,"journal":{"name":"中华妇产科杂志","volume":"60 1","pages":"24-33"},"PeriodicalIF":0.0,"publicationDate":"2025-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143037212","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}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号