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1.
Artigo em Inglês | MEDLINE | ID: mdl-33410204

RESUMO

AIM: Optimizing perfusate for static cold storage is one of the key ways of reducing organ dysfunction and rejection in organ transplantation. Here, we tested the effectiveness of the three different solutions for hypothermic uterus preservation. METHODS: Twenty rats were divided into four groups, five in each group. Uterine grafts were retrieved and perfused in situ. The uteri were preserved at 4°C in normal saline as control group (group NS), hypertonic citrate adenine (group HCA), histidine-tryptophan-ketoglutarate (group HTK), or university of Wisconsin solutions (group UW) for 0, 12, 24, and 48 h, respectively. HE, electron microscopy, TUNEL staining, and Cleaved Caspase3 immunohistochemical staining were assessed at each time point. RESULTS: There was no significant difference in the uterine retrieval time, perfusion time, and the amount of perfusion solution in NS, HCA, HTK, and UW groups (p > 0.05). HCA and HTK can well preserve the pathological morphology of rat uterine tissues for up to 24 h, and the apoptosis rates of the two groups are 7.2% and 7.1%, respectively, with no statistical difference (p > 0.05). Still, the protective effect of HTK on the ultrastructure of cells was much better than HCA. There was a significant difference in the apoptosis rate of UW (6.5%), HTK (8.8%), and HCA (9.4%) at 48 h, with mitochondrial and endoplasmic reticulum structure well preserved only in UW. CONCLUSION: At 4°C, normal saline is not suitable to preserve rat uterus for more than 12 h. The morphologic results would favor the use of HTK rather than HCA for short-term hypothermic uterus preservation (≤24 h). UW is better than HTK and HCA for 48 h hypothermic uterus preservation.

2.
Eur J Obstet Gynecol Reprod Biol ; 256: 256-262, 2020 Nov 11.
Artigo em Inglês | MEDLINE | ID: mdl-33259994

RESUMO

OBJECTIVES: This study aimed to investigate the predictive value of laparoscopy for the prediction of optimal cytoreduction and prognosis of epithelial ovarian cancer (EOC) in a Chinese population. STUDY DESIGN: This study enrolled 162 EOC patients in Obstetrics and Gynecology Hospital of Fudan University from January 2015 to December 2016. All patients underwent preoperative CT scans and laparoscopic assessments. Each patient was scored according to the CT-based predictive model by Bristow and laparoscopy-based predictive model by Fagotti. The specificity, sensitivity, positive predictive value (PPV), negative predictive value (NPV) and area under the curve (AUC) of each model were calculated. The predictive scores and clinicopathologic factors were all analyzed using the Kaplan-Meier method and multivariate Cox analysis. A prognostic predictive nomogram was formulated in R software. RESULTS: The AUCs of the laparoscopy-based predictive model and CT-based predictive model was 0.955 and 0.755 respectively. At a laparoscopic score ≥ 10, the possibility of optimal cytoreduction was 0, and the risk of unnecessary explorative attempts was 6%. Additionally, laparoscopic score, independent of residual tumor size and FIGO stage, was an independent prognostic factor for both overall survival (OS) and recurrence-free survival (RFS) in EOC. Notably, the predictive nomogram that we established further confirmed the prognostic value of laparoscopy for prognostic predictions in EOC. CONCLUSIONS: Laparoscopy has a better discriminating performance than CT in the prediction of optimal cytoreduction in EOC. Moreover, the laparoscopic score is directly correlated with the survival of EOC patients. The laparoscopic score-based nomogram we established showed good potential to predict the prognosis of EOC patients.

3.
J Gynecol Obstet Hum Reprod ; : 101906, 2020 Sep 12.
Artigo em Inglês | MEDLINE | ID: mdl-32927106

RESUMO

PURPOSE: To investigate the elasticity of the levator ani musle (LAM) with the patients suffering from stress urinary incontinence (SUI) by transperineal elastography. METHODS: Conventional transperineal ultrasound and elastography were performed in the patients with SUI on quiescent condition and maximal Valsalva. Transperineal ultrasound and elastography were repeated after Kegel exercises. The scoring system and strain ratio (SR) values were recorded and analyzed. RESULTS: After Kegel exercises, the ratio of subjective improvement or cure was 81 % (102/126). Mean elasticity score (ES) and SR of LAM were significantly higher than the value before on maximal Valsalva, respectively. Mean ES and SR of LAM after Kegel exercises were similar with the value before on quiescent condition, respectively. CONCLUSION: The improvement of SUI was associated with the stiffer LAM assessed by elastography. Women with SUI who have softer LAM were more likely to have symptoms of SUI and Kegel exercise could strengthen the stiffness of LAM. BRIEF SUMMARY: The improvement of SUI was associated with the stiffer LAM assessed by elastography.

4.
Cancer Med ; 9(16): 5908-5921, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32628356

RESUMO

OBJECTIVE: To compare survival outcomes of minimally invasive surgery (MIS) and laparotomy in early-stage cervical cancer (CC) patients. METHODS: A multicenter retrospective cohort study was conducted with International Federation of Gynecology and Obstetrics (FIGO, 2009) stage IA1 (lymphovascular invasion)-IIA1 CC patients undergoing MIS or laparotomy at four tertiary hospitals from 2006 to 2017. Propensity score matching and weighting and multivariate Cox regression analyses were performed. Survival was compared in various matched cohorts and subgroups. RESULTS: Three thousand two hundred and fifty-two patients (2439 MIS and 813 laparotomy) were included after matching. (1) The 2- and 5-year recurrence-free survival (RFS) (2-year, hazard ratio [HR], 1.81;95% confidence interval [CI], 1.09-3.0; 5-year, HR, 2.17; 95% CI, 1.21-3.89) or overall survival (OS) (2-year, HR, 1.87; 95% CI, 1.03-3.40; 5-year, HR, 2.57; 95% CI, 1.29-5.10) were significantly worse for MIS in patients with stage I B1, but not the cohort overall (2-year RFS, HR, 1.04; 95% CI, 0.76-1.42; 2-year OS, HR, 0.99; 95% CI, 0.70-1.41; 5-year RFS, HR, 1.12; 95% CI, 0.76-1.65; 5-year OS, HR, 1.20; 95% CI, 0.79-1.83) or other stages (2) In a subgroup analysis, MIS exhibited poorer survival in many population subsets, even in patients with less risk factors, such as patients with squamous cell carcinoma, negative for parametrial involvement, with negative surgical margins, negative for lymph node metastasis, and deep stromal invasion < 2/3. (3) In the cohort treated with (2172, 54%) or without adjuvant treatment (1814, 46%), MIS showed worse RFS than laparotomy in patients treated without adjuvant treatment, whereas no differences in RFS and OS were observed in adjuvant-treatment cohort. (4) Inadequate surgeon proficiency strongly correlated with poor RFS and OS in patients receiving MIS compared with laparotomy. CONCLUSIONS: MIS exhibited poorer survival outcomes than laparotomy group in many population subsets, even in low-risk subgroups. Therefore, laparotomy should be the recommended approach for CC patients.

5.
J Gynecol Obstet Hum Reprod ; : 101761, 2020 Apr 20.
Artigo em Inglês | MEDLINE | ID: mdl-32325268

RESUMO

OBJECTIVE: To identify the risk factors associated with dysmenorrhea in adenomyosis and to discuss the potential hormone-based understanding of pain mechanisms. STUDY DESIGN: Adenomyosis patients with mild or no dysmenorrhea (n = 40, Group 1) and moderate-to-severe dysmenorrhea (n = 80, Group 2) were recruited. Charts of all patients were recorded. An immunohistochemistry (IHC) analysis was performed to detect the cellular levels of estrogen receptor-α (ER-α), estrogen receptor-ß (ER-ß), gonadotropin-releasing hormone receptor (GnRH-R), and neurofilaments (NFs) in 60 cases. RESULTS: A history of cesarean section (CS) was positively related to the degree of dysmenorrhea in adenomyosis (OR (95 % CI): 4.397 (1.371-14.104)). The ER-α levels in the eutopic endometrium (EUE) of Group 2 were higher than those in the ectopic endometrium (ECE) of Group 1. Group 2 had higher NF levels in the ECE than in the EUE. CONCLUSION: A history of CS is a risk factor for adenomyosis with moderate-to-severe dysmenorrhea. For patients with adenomyosis, high ER-α levels in the EUE and high NF levels in the ECE may be related to moderate-to-severe dysmenorrhea. These hormone-based mechanisms may contribute to our understanding of the pathogenesis of dysmenorrhea in adenomyosis.

6.
Eur J Obstet Gynecol Reprod Biol ; 248: 71-76, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32199295

RESUMO

OBJECTIVE: To evaluate the clinical outcomes of vaginectomy and laser ablation for the treatment of vaginal high-grade squamous intraepithelial lesion (HSIL) patients who underwent previous hysterectomy for cervical HSIL or cancer. STUDY DESIGN: The clinicopathologic data and follow-up information of 167 post-hysterectomy vaginal HSIL patients who underwent laser ablation or vaginectomy were retrospectively reviewed from 2010 to 2018 at the Obstetrics and Gynecology Hospital of Fudan University. RESULTS: Of the 167 vaginal HSIL patients enrolled, 74 patients underwent vaginectomy, and 93 patients underwent laser ablation. At a median follow-up of 15 months, 13 (7.8 %) patients experienced progression to vaginal cancer, and 22 (13.2 %) patients had persistent/recurrent disease. Upon multivariate analysis, laser ablation (OR: 5.16, p = 0.02), cytology indicating HSIL (OR: 25.45, p = 0.00), and a shorter interval between previous hysterectomy and vaginal HSIL diagnosis (< 24 vs ≥ 24 months, OR: 0.10, p = 0.02) were associated with disease persistence/recurrence. In post-hysterectomy for cervical HSIL patients, the vaginectomy group had a significantly higher recurrence-free survival rate (RFS, 94.5 % vs 69.0 %, p = 0.00) and a similar progression-free survival rate (PFS, 96.4 % vs 91.4 %, p = 0.17) compared with the laser ablation group. Among post-hysterectomy for cervical cancer patients, RFS (89.5 % vs 65.7 %, p = 0.04) and PFS (100.0 % vs 82.9 %, p = 0.05) were both higher in the vaginectomy group than in the laser ablation group. CONCLUSION: Compared with laser ablation, vaginectomy resulted in better clinical outcomes among vaginal HSIL patients who had undergone previous hysterectomy for cervical neoplasia.

7.
Fertil Steril ; 113(3): 681-682, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32192600

RESUMO

OBJECTIVE: To introduce an innovation that combines single port laparoscopic and Wharton-Sheares-George cervicovaginal reconstruction using a small intestinal submucosa (SIS) graft in a patient with congenital cervical atresia, absence of vagina, and incomplete uterine septum (U2aC4V4). DESIGN: Video article introducing a new surgical technique. SETTING: University hospital. PATIENT(S): A 15-year-old patient with congenital cervical atresia, absence of vagina, and incomplete uterine septum had primary amenorrhea and cyclic lower abdominal pain. The magnetic resonance imaging did not show hematometra and the endometrium was 6 mm when she had lower abdominal pain. INTERVENTION(S): A neovagina (depth, 7 cm; width, 2.5 cm) was created using the Wharton-Sheares-George neovaginoplasty. By single laparoscopy, the bladder was separated from the anterior surface of the uterus. With the mold in the neovagina created by the assistant, the apex of neovagina was opened. Then the lower uterine segment was exposed and incised. A T-shaped intrauterine device was connected to an 8-cm-long catheter scissored from a 14-F Foley catheter and was inserted into the uterus to prevent cervical or vaginal stenosis. The upper end of the graft was applied onto the lower uterine segment with delayed absorbable sutures. The lower end was sutured to the high vaginal or vestibular mucosa. MAIN OUTCOME MEASURE(S): The feasibility and effect of combination single port laparoscopic with vaginal cervicovaginal reconstruction in the congenital atresia of cervix. RESULT(S): The operation was successful. The operating time was 90 minutes. Hospitalization was 3 days. There were no intraoperative and postoperative complications. The patient had resumption of menses at three cycles postoperatively, and she had no dysmenorrhea. No cervical or vaginal stenosis occurred because of the Foley catheter. CONCLUSION(S): Single port laparoscopic combined with vaginal cervicovaginal reconstruction provided a minimally invasive, safe, and effective surgical option for the young patient with congenital atresia of cervix. It was successful and without complications or cervical or vaginal stenosis.


Assuntos
Colo do Útero/anormalidades , Colo do Útero/cirurgia , Anormalidades Congênitas/cirurgia , Laparoscopia/métodos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Útero/cirurgia , Vagina/anormalidades , Adolescente , Amenorreia/etiologia , Amenorreia/cirurgia , Colo do Útero/patologia , Anormalidades Congênitas/patologia , Feminino , Procedimentos Cirúrgicos em Ginecologia/métodos , Humanos , Mucosa Intestinal/patologia , Mucosa Intestinal/transplante , Intestino Delgado/patologia , Intestino Delgado/transplante , Dor Pélvica/etiologia , Dor Pélvica/cirurgia , Estruturas Criadas Cirurgicamente , Anormalidades Urogenitais/complicações , Anormalidades Urogenitais/cirurgia , Vagina/patologia , Vagina/cirurgia
8.
J Obstet Gynaecol Res ; 46(3): 357-368, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31997549

RESUMO

Uterus transplantation (UTx) is an emerging surgical treatment for patients with absolute uterine factor infertility. However, the initial low surgical success of human UTx from the teams worldwide has revealed the difficulty of the surgery and called for preparatory team training in large animals. Also, the team who carried out the human UTx without previous systematic research in large animals or deceased donors encountered transplant failures, which was controversial and even deprived them of further trials. Various UTx studies in large animals, including dogs, pigs, sheep and macaques have been performed in China from different teams, compared to other countries around the world. However, among over 70 UTx that have been carried out worldwide, only three were carried out in China, with one live baby achieved. In this paper, we explore the possible challenges for human UTx in China. We conclude that it is critical to learn the lessons from the international team and adopt the international ethic views regarding UTx on humans. Also, it would be positive for the Chinese groups to establishing an academic society for UTx with regular meetings, which will raise public awareness of UTx, and guide the proper development of human UTx in China.

9.
Int J Cancer ; 146(9): 2588-2598, 2020 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-31577838

RESUMO

Peritoneal metastasis is a critical feature and clinical challenge in epithelial ovarian cancer (EOC). We previously identified a novel long noncoding RNA (lncRNA, TC0101441) in epithelial ovarian cancer (EOC) using microarrays. However, the impact of TC0101441 on EOC metastasis and prognosis remains unclear. TC0101441 expression in EOC tissues and its correlation with clinicopathological factors and prognosis were examined. A series of in vitro and in vivo assays were performed to elucidate the roles and mechanism of TC0101441 in EOC metastasis. We found that TC0101441 levels were elevated in EOC tissues compared with those in normal controls and significantly correlated with an advanced clinical stage and lymph node metastasis. TC0101441 was determined to be an independent prognostic predictor of overall survival (OS) and disease-free survival (DFS). Furthermore, loss-of-function assays showed that TC0101441 promoted the invasive and metastatic capacities of EOC cells both in vitro and in vivo. Mechanistically, the prometastatic effects of TC0101441 were linked to the induction of epithelial-mesenchymal transition (EMT). Importantly, KiSS1 was identified as a downstream target gene of TC0101441 and was downregulated by TC0101441 in EOC cells. After TC0101441 was silenced, the corresponding phenotypes of EOC cell invasion and EMT were reversed by the overexpression of KiSS1. Taken together, our data suggest that TC0101441 functions as a potential promigratory/invasive oncogene by promoting EMT and metastasis in EOC through downregulation of KiSS1, which may represent a novel prognostic marker and therapeutic target in EOC.


Assuntos
Biomarcadores Tumorais/metabolismo , Carcinoma Epitelial do Ovário/patologia , Transição Epitelial-Mesenquimal , Regulação Neoplásica da Expressão Gênica , Kisspeptinas/metabolismo , Neoplasias Peritoneais/secundário , RNA Longo não Codificante/genética , Animais , Apoptose , Biomarcadores Tumorais/genética , Carcinoma Epitelial do Ovário/genética , Carcinoma Epitelial do Ovário/metabolismo , Movimento Celular , Proliferação de Células , Feminino , Humanos , Kisspeptinas/genética , Metástase Linfática , Camundongos , Camundongos Endogâmicos BALB C , Camundongos Nus , Invasividade Neoplásica , Neoplasias Ovarianas/genética , Neoplasias Ovarianas/metabolismo , Neoplasias Ovarianas/patologia , Neoplasias Peritoneais/genética , Neoplasias Peritoneais/metabolismo , Prognóstico , Células Tumorais Cultivadas , Ensaios Antitumorais Modelo de Xenoenxerto
10.
J Obstet Gynaecol ; 40(5): 715-717, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31609140

RESUMO

The purpose of this study was to explore the long-term follow-up of treatment of congenital partial vaginal agenesis using the Wharton-Sheares-George technique. The technique was performed on 52 patients with congenital partial vaginal atresia from January 2009 to December 2017. As a result, the mean operating time of the Wharton-Sheares-George technique procedure was 25.6 ± 2.2 min. The mean estimated blood loss was 16.7 ± 4.7 mL. The average length of stay in hospital for the patients was 2.3 ± 0.2 days. There were no intraoperative and postoperative complications. The median duration of follow-up was 58 months. All of the patients experienced a resumption of menses. The mean vaginal length at 3 months was 7.3 ± 0.8 cm. Vaginal stenosis and adhesion did not occur in any cases during the follow-up. Twenty patients had sexual activities and the mean value of the FSFI questionnaire was 31.2 ± 4.0. Six cases became pregnant. There were four cases who each delivered one child and two cases who both delivered two children.IMPACT STATEMENTWhat is already known on this subject? It has been reported that the Wharton-Sheares-George technique provides, functionally and anatomically, very satisfactory results for the patients with Mayer-Rokitansky-Küster-Hauser syndrome. However, a study of the Wharton-Sheares-George technique in patients with congenital partial vaginal agenesis has not been reported previously in the medical literature.What the results of this study add? Our results have indicated that the Wharton-Sheares-George technique provides short operation time and length of stay, little blood loss intraoperatively, a satisfactory vaginal length and sexual activity in patients with congenital partial vaginal agenesis.What the implications are of these findings for clinical practice and/or further research? The study suggests that the Wharton-Sheares-George technique provides very satisfactory results in function and anatomy for congenital partial vaginal agenesis.

11.
Arch Gynecol Obstet ; 301(2): 533-544, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31776706

RESUMO

PURPOSES: We aim to develop a rabbit model system for studies on uterus transplantation. METHODS: Six sexually mature female New Zealand white rabbits of proven fertility were used for harvesting the uterine allograft with an aortic-caval macrovascular patch (including the aorta, inferior vena cava, common and internal iliacs, and uterine arterial and venous tree). The patches were transplanted in the six recipients orthotopically using aorta and cava anastomoses. Tacrolimus (0.5 mg twice daily, p.o.) was administered postoperatively for immunosuppression. RESULTS: Surgical survival was 100% (n = 6), and the graft survival rate was 83.3% (n = 5). No rabbits died intraoperatively, but only one achieved short-term survival (for 8 days). Four rabbits (#1, #2, #3 and #4) died within the first 24 h as a result of veno-vena anastomosis breakdown, bradycardia, intestinal necrosis, and respiratory failure, respectively. Rabbits #5 (30 h) and #6 (8 days) died from intestinal obstruction and pneumonia, respectively. Uterine morphology was normal in rabbit #6, and rejection was not observed in the grafted uterus, which was further verified by H&E and immunohistochemistry. CONCLUSIONS: Aorta and cava anastomoses can be used to ensure a viable transplanted uterus by reconstructing an adequate blood supply to the transplanted uterine graft in a rabbit model. We have demonstrated the feasibility of tacrolimus monotherapy in suppressing the rejection of an allotransplanted uterus in a rabbit model. However, UTx in a rabbit model seems difficult to achieve long-term survival.


Assuntos
Anastomose Cirúrgica/métodos , Aorta/cirurgia , Transplante Homólogo/métodos , Útero/cirurgia , Animais , Modelos Animais de Doenças , Feminino , Coelhos
12.
Int J Gynaecol Obstet ; 149(1): 31-36, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31883106

RESUMO

OBJECTIVE: To evaluate the feasibility of laparoscopic metroplasty for the treatment of unicornuate uterus with a functional noncommunicating rudimentary horn. METHODS: Laparoscopic metroplasty was performed in one patient using traditional laparoscopy and four patients using robot-assisted laparoscopy from December 2013 to December 2017 at the Obstetrics and Gynecology Hospital of Fudan University. The records of the five patients were analyzed retrospectively. RESULTS: In all five patients the unicornuate uterus and functional noncommunicating rudimentary horn were unified into a single cavity without intraoperative or postoperative complications. Average operative time was 281 minutes (range, 204-330 minutes) and average blood loss was 180 mL (range, 100-300 mL). Postoperative hospital stay was 7 days (range, 5-11 days) and there was no re-admission. All patients were relieved of pain and had regular menstruation after surgery. Average follow-up time was 44 months (range, 22-70 months). One patient conceived by in vitro fertilization and embryo transfer 2 years after the operation and delivered twins by cesarean at 33 weeks. CONCLUSION: Laparoscopic metroplasty, with or without robotic assistance, is an acceptable alternative to resection for a noncommunicating rudimentary horn with a functional endometrium.


Assuntos
Laparoscopia/métodos , Procedimentos Cirúrgicos Robóticos/métodos , Anormalidades Urogenitais/cirurgia , Útero/anormalidades , Adolescente , Adulto , Estudos de Casos e Controles , Feminino , Humanos , Tempo de Internação , Duração da Cirurgia , Gravidez , Estudos Retrospectivos , Útero/cirurgia
13.
J Gynecol Obstet Hum Reprod ; 49(4): 101663, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31812792

RESUMO

OBJECTIVE: To explore whether operation can change the elasticity of levator ani in deep infiltrating endometriosis (DIE) with operation and pharmacotherapy using transperineal elastography. METHODS: Total thirty-four patients who were diagnosed as DIE were included in the study. Transperineal elastography were performed in all cases preoperatively and postoperatively. The levator ani was evaluated by means of the scoring system and strain ratio (SR) values on maximal Valsalva and quiescent condition, respectively. RESULTS: On quiescent condition, the preoperative mean elastography scores and SR of the levator ani were statistically significantly higher than the postoperative ones in both shaving technique group and segmental colorectal resection group. And on maximal Valsalva, the preoperative mean elastography scores and SR of the levator ani were statistically significantly lower than the postoperative ones in both groups. After surgery and 6 cycles of GnRHa therapy, the mean elastography score and SR of the levator ani were statistically significantly lower than before GnRHa therapy in shaving technique group on quiescent condition. And on maximal Valsalva, the mean elastography score and SR were statistically higher than before GnRHa therapy. However, in segmental colorectal resection group, the differences were not observed before and following 6 cycles of GnRHa therapy. CONCLUSION: The elasticity of levator ani of DIE was changed by both shaving technique and segmental colorectal resection. And transperineal elastography could access the alterations.

14.
Arch Gynecol Obstet ; 300(6): 1633-1636, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31667605

RESUMO

OBJECTIVE: To compare using the acellular porcine small intestinal submucosa (SIS) graft or the Interceed in patients with MRKH syndrome undergoing creation of a neovagina. METHODS: In this retrospective study, patients with MRKH syndrome undergoing creation of a neovagina from 2016 to 2018 were retrospectively investigated. Wharton-Sheares-George neovaginoplasty was performed using the acellular porcine SIS graft or the Interceed. RESULTS: Overall, 67 patients were included for analysis. The operating time, the estimated blood loss and return of bowel activity were similar between the two groups. However, the total cost in the SIS group was significantly higher than that in the Interceed group due to the cost of the SIS graft. The mean length and width of the neovagina were similar between the two groups. However, the incidence of granulation in vaginal apex was higher in the SIS graft group than that in the Interceed group. There was no statistically significant difference in the total FSFI scores between the two groups who became sexually active postoperatively. CONCLUSIONS: Our results demonstrated that Wharton-Sheares-George method provided the patients to have satisfactory sexual intercourse. The Interceed played a role in the reconstruction of neovagina no less than the SIS graft.


Assuntos
Transtornos 46, XX do Desenvolvimento Sexual/cirurgia , Anormalidades Congênitas/cirurgia , Mucosa Intestinal/transplante , Ductos Paramesonéfricos/anormalidades , Procedimentos Cirúrgicos Reconstrutivos/métodos , Vagina/cirurgia , Adulto , Animais , Feminino , Humanos , Ductos Paramesonéfricos/cirurgia , Estudos Retrospectivos , Estruturas Criadas Cirurgicamente , Suínos
15.
J Gynecol Obstet Hum Reprod ; 48(10): 849-853, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31067498

RESUMO

OBJECTIVE: To explore the effects of GnRHa on adenomyosis by transvaginal elastography. METHODS: A prospective observational study included patients who were diagnosed as adenomyosis by conventional transvaginal ultrasound and infertility. The sonographic characters of elastography, the degree of dysmenorrhea and the values of serum CA125 before and following GnRHa (Triptorelin 3.75 mg were administered every 28 days) plus add-back therapy were reviewed and analyzed. Each case had a 6 months follow up and the information of pregnancy were recorded. RESULTS: 45 patients who completed the 6 months follow-up were included in the analysis. Twelve cases (group 1) were pregnancy during the follow-up and the other thirty-three cases (group 2) failed their attempts. The numerical rating scale and CA125 of all the cases were both significantly reduced 6 months after therapy. All of enlarged uterus decreased to accessible normal size. In group 1, the mean elasticity score was significantly higher for the uterine after therapy than before (3.6 ± 0.3 vs 2.3 ± 0.5, p = 0.004). In group 2, the mean elasticity score did not change for the uterine after therapy than before (2.2 ± 0.5 vs 2.5 ± 0.6, p = 0.77). CONCLUSION: Elasticity of adenomyosis is increased after GnRHa therapy. And the higher elasticity of adenomyosis after GnRHa therapy is associated with spontaneous pregnancy in infertile patents.


Assuntos
Adenomiose/diagnóstico por imagem , Técnicas de Imagem por Elasticidade/métodos , Elasticidade/efeitos dos fármacos , Infertilidade Feminina/tratamento farmacológico , Luteolíticos/farmacologia , Pamoato de Triptorrelina/farmacologia , Adenomiose/sangue , Adenomiose/tratamento farmacológico , Adulto , Antígeno Ca-125/sangue , Dismenorreia/tratamento farmacológico , Feminino , Hormônio Liberador de Gonadotropina/agonistas , Humanos , Infertilidade Feminina/sangue , Luteolíticos/administração & dosagem , Gravidez , Taxa de Gravidez , Estudos Prospectivos , Pamoato de Triptorrelina/administração & dosagem
16.
Arch Gynecol Obstet ; 299(5): 1321-1330, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30850851

RESUMO

PURPOSE: To evaluate the relationship between the uterine size measured by pelvic magnetic resonance and reproductive outcome in women with a unicornuate uterus. METHODS: This was a retrospective study including 140 patients affiliated with unicornuate uterus diagnosed by the pelvic MR prior to their first pregnancy in the Obstetrics and Gynecology Hospital of Fudan University from April 2010 to December 2017. All the length of the unicornuate uterus were re-measured and recorded by skilled radiologists during the study period. We divided all the 140 participants with complete pelvic MR imaging into four groups by the best reproductive outcomes, which refers to Group 1 (primary infertility, n = 21), Group 2 ( < 24 weeks' gestation, n = 34), Group 3 (preterm delivery, 24-35 weeks' gestation, n = 13), Group 4 ( ≥ 35 weeks' gestation, n = 72), followed them up and then analyzed the data. RESULTS: Measurements of 140 patients with hemi-uteri were retrieved for analysis. The mean length of the uterine was 4.90  ± 0.56 cm. There were no significant differences in the uterine cavity length, cervical length, endometrial thickness and uterine wall thickness between the four groups while the uterine length (P = 0.001) was statistically significant. Women with uterine lengths ≥  4.5 cm were more likely to experience full-term delivery compared with the other group (P = 0.001). Ordinal multiple logistic regression analysis showed that the uterine length [OR = 9.03 (95% CI: 2.90-28.13)] and uterine cavity length [OR = 0.32 (95% CI: 0.06-2.04)] were independent protective factors for better obstetric outcomes CONCLUSION: The uterine length is a reliable prognostic factor for the gestational week of delivery and an appropriate antenatal surveillance factor of women with unicornuate uterus.


Assuntos
Imagem por Ressonância Magnética/métodos , Anormalidades Urogenitais/diagnóstico por imagem , Anormalidades Urogenitais/diagnóstico , Útero/anormalidades , Útero/diagnóstico por imagem , Adulto , Feminino , Humanos , Gravidez , Estudos Retrospectivos
17.
J Med Ultrason (2001) ; 46(1): 123-128, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30361789

RESUMO

PURPOSE: To assess the elasticity of the pelvic floor muscle (PFM) affected by deep infiltrating endometriosis (DIE) with transperineal elastography. METHODS: This prospective observational study included 88 patients who were diagnosed with DIE, ovarian endometrioid cyst, or ovarian teratoma. All the patients were assigned to one of the three groups and underwent transperineal elastography. The scoring system and strain ratio (SR) values were recorded and analyzed. Assessments were conducted at maximal Valsalva and under quiescent condition, respectively. RESULTS: The mean elastography score was statistically significantly higher for the levator ani of group I than groups II and III under quiescent condition. In addition, SR of the levator ani in group I was higher than that in groups II and III. However, at maximal Valsalva, the mean elastography score of group I was lower than that of groups II and III. In addition, SR of group I was lower than that of groups II and III. CONCLUSION: The elasticity of the PFM in DIE patients could be qualitatively evaluated by transperineal elastography. The coordination of the PFM was injured and decreased elasticity appeared in DIE patients.


Assuntos
Técnicas de Imagem por Elasticidade , Endometriose/diagnóstico por imagem , Diafragma da Pelve/diagnóstico por imagem , Adulto , Cistos/diagnóstico por imagem , Elasticidade , Endometriose/fisiopatologia , Feminino , Humanos , Imageamento Tridimensional , Pessoa de Meia-Idade , Neoplasias Ovarianas/diagnóstico por imagem , Diafragma da Pelve/fisiopatologia , Estudos Prospectivos , Teratoma/diagnóstico por imagem
18.
J Minim Invasive Gynecol ; 26(3): 396-397, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-29890355

RESUMO

STUDY OBJECTIVE: To introduce a creation that combines laparoscopic and Wharton-Sheares-George cervicovaginal reconstruction using a small intestinal submucosa (SIS) graft in a patient with Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome who had a rudimentary cavity (U5aC4V4) [1]. DESIGN: A video article introducing a new surgical technique. SETTING: A university hospital. PATIENTS: A 24-year-old patient had primary amenorrhea and irregular lower abdominal pain for 9 years. The patient was Tanner stage 3 for pubic hair and Tanner stage 4 for breast development. The physical examination revealed no vagina. A primordial uterus and a uterus with a rudimentary cavity were detected by magnetic resonance imaging [2,3]. However, the rudimentary cavity had no hematometra. Magnetic resonance imaging also found a left solitary kidney. The diagnosis was MRKH syndrome with a rudimentary cavity (U5aC4V4) [4]. The patient desired resumption of menses and possible future fertility. INTERVENTIONS: Combined laparoscopic and Wharton-Sheares-George cervicovaginal reconstruction using an SIS graft was performed. MEASUREMENTS AND MAIN RESULTS: With the Wharton-Sheares-George neovaginoplasty, a vaginal mold with a surrounding SIS graft was inserted into the newly created cavity [5]. Using laparoscopy, the lower uterine segment was incised by shape dissection. The proximal segment of the SIS graft to the lower uterine segment was sutured. A T-shaped intrauterine device with a Foley catheter was fixed in the uterine cavity by the delay of absorbed sutures to prevent cervical or vaginal stenosis. The distal segment of the SIS graft was sutured with the high vaginal or vestibular mucosa vaginally. The operation was successfully completed. The operating time was 2 hours. Hospitalization was 4 days. There were no blood transfusions or complications. The patient had resumption of menses for 2 cycles postoperatively, and she had no dysmenorrhea. The patient did not have sexual intercourse because of the mode in the vagina to prevent vagina stenosis. No cervical stenosis occurred because of the Foley catheter. CONCLUSION: In the past, a uterus with a rudimentary cavity in patients with MRKH was always excised, and patients lost the chance of menstrual onset and fertility. Combined laparoscopic and Wharton-Sheares-George cervicovaginal reconstruction using an SIS graft provided a minimally invasive, safe, and effective surgical option for the young patient with MRKH syndrome with a rudimentary cavity. The technique is not complex, is easy to learn and perform, and provided a result with functional and anatomic satisfaction. No special surgical apparatus is needed with this technique.


Assuntos
Transtornos 46, XX do Desenvolvimento Sexual/cirurgia , Anormalidades Congênitas/cirurgia , Mucosa Intestinal/transplante , Intestino Delgado/transplante , Laparoscopia/métodos , Ductos Paramesonéfricos/anormalidades , Procedimentos Cirúrgicos Reconstrutivos/métodos , Vagina/cirurgia , Amenorreia/etiologia , Amenorreia/cirurgia , Animais , Colo do Útero/anormalidades , Colo do Útero/cirurgia , Terapia Combinada , Feminino , Humanos , Ductos Paramesonéfricos/cirurgia , Suínos , Tecidos Suporte , Transplante Heterólogo , Anormalidades Urogenitais/cirurgia , Vagina/anormalidades , Adulto Jovem
19.
J Surg Oncol ; 118(6): 991-996, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30208206

RESUMO

BACKGROUND AND OBJECTIVES: This study is aimed to investigate the possibility of preoperative oral oil administration in displaying the chylous tubes and preventing chylous leakage in laparoscopic para-aortic lymphadenectomy. MATERIALS AND METHODS: In this retrospective nonrandomized study, of the 30 patients with gynecological malignancies who had indications for laparoscopic para-aortic lymphadenectomy up to renal vessels, 15 were administered preoperative oral oil (oil a administration) (control group) at our hospital between September 2017 and June 2018. The chylous tube displaying rates, incidences of chylous leakage, and other perioperative data of the two groups were compared. RESULTS: Successful display of chylous tubes was observed in 93.3% (14/15) patients in the oil administration group. The chylous leakage was zero in the oil administration group, and 33.3% (5/15) in the control group. The postoperative drainage duration (4.1 ± 1.0 days vs 7.6 ± 1.4 days, P = 0.000), somatostatin application time (0 day vs 5.9 ± 0.8 days), and postoperative hospital stay (6.0 ± 2.3 days vs 9.1 ± 2.1 days, P = 0.001) were significantly shorter in the oil administration group. The total cost is lower in the oil administration group (4972.52 ± 80.54 dollars vs 6260.80 ± 484.47 dollars, P = 0.000). CONCLUSIONS: Preoperative oil administration is a feasible and effective method to display the chylous tubes and to prevent the chylous leakage in para-aortic lymphadenectomy.


Assuntos
Ascite Quilosa/prevenção & controle , Drenagem/métodos , Neoplasias do Endométrio/cirurgia , Excisão de Linfonodo/métodos , Linfonodos/cirurgia , Neoplasias Ovarianas/cirurgia , Óleo de Gergelim/administração & dosagem , Administração Oral , Ascite Quilosa/etiologia , Drenagem/instrumentação , Neoplasias do Endométrio/patologia , Feminino , Humanos , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Excisão de Linfonodo/efeitos adversos , Pessoa de Meia-Idade , Neoplasias Ovarianas/patologia , Estudos Retrospectivos
20.
J Int Med Res ; 46(5): 1855-1865, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29552942

RESUMO

Objective To provide novel insights into the clinical treatment of adenomyosis. Methods Two hundred patients with adenomyosis were enrolled in this prospective, nonrandomized, parallel-controlled study with a 1-year follow-up in our hospital. Group 1 was treated with 3.75 mg leuprorelin acetate (LA) (n = 40), Group 2 was treated with 1.88 mg LA (n = 40), Group 3 underwent Mirena implantation (n = 40), Group 4 underwent Mirena implantation after treatment with 3.75 mg LA (n = 40), Group 5 underwent Mirena implantation after treatment with 1.88 mg LA (n = 20), and Group 6 received San-Jie-Zhen-Tong capsules alone (n = 20). Uterine volume, pain, cancer antigen 125 level, ovary function, adverse effects, and Mirena expulsion were evaluated. Results The uterine volume and pain scores were lower in the groups treated with 1.88 than 3.75 mg LA, but the lower dose was associated with significantly fewer hot flashes and sweating. The 1-year Mirena expulsion rate was higher in Group 3 than in Groups 4 and 5 (10.00% vs. 3.33%, respectively). Costs were significantly higher in Groups 1 and 4 than in Groups 2 and 5. Conclusion Administration of 1.88 mg LA may be an alternative therapy for Asian patients with adenomyosis. The combination of LA and Mirena could enhance the therapeutic effect. Registration number: ChiCTR-IPR-15005971.


Assuntos
Adenomiose/tratamento farmacológico , Adenomiose/economia , Adulto , Custos e Análise de Custo , Feminino , Humanos , Leuprolida/efeitos adversos , Leuprolida/economia , Leuprolida/uso terapêutico , Pessoa de Meia-Idade , Medição da Dor , Estudos Prospectivos , Útero/patologia
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