Objective To evaluate the feasibility and advantages of transvaginal hysterectomy (TVH) for enlarged uterus without prolapse. Methods Six hundred and ninety-six patients underwent TVH for gynecological disorders from Sept, 1998 to Dec, 2002. Meanwhile, the method of operation, complications of surgery, operation time, estimated operative blood loss, postoperative recovery and hospital stay days were retrospectively analyzed. Results The operation was successful in 693 out of 696 cases (99.6%). The mean operative time was 49.3 minutes (11-125 minutes). The estimated blood loss was 69.7ml (15-450ml). Operative injuries were found in 3 patients (0.4%). Complications attributable to surgery were found in 6 cases (1%). The mean time of subsidence of fever was 1.2 days (0-5 days) and the time of passing flatus was 22.6 hours (8-32 hours). The average hospital stay was 5.3 days (4-15 days). Conclusion TVH can be performed safely for most of non-prolapsed large uterus. Because it has the advantages of less bleeding, short operating time, rapid recovery and less cost compared to TAH and LAVH, it is our opinion it should be the first option for enlarged uterus.

Objective To evaluate the advantages and feasibility of transvaginal excision of ovarian tumor. Methods A series of 62 patients with ovarian benign tumors had the tumors excised transvaginally from Dec 2001 to Oct 2003. The indications of transvaginal surgery, the method of operation, the complications following the operation, the overall operation time, the estimated blood loss during operation, the postoperative complications, and hospital stay days were analyzed retrospectively. Results Transvaginal ovarian tumor excision was successfully completed with neither the aid of laparoscopy or shift to laparotomy. No intra-abdominal spillage of cystic contents occurred. The mean operation time was 39.4 minutes. The estimated blood loss was 37.5ml. No postoperative complications occurred. The mean length of a low fever was 1.3 days, and the time of recovery of bowel movement was 20.1 hours. The average hospital stay was 4.2 days. Conclusion For free benign ovarian tumors, the transvaginal route should be considered to minimize trauma. There would be no skin incision, and it could be carried out in patients who had relatively large ovarian tumors with no intra-abdominal spillage. There would be less blood loss, shorter operation time, shorter hospital stay and lower cost.

Objective To evaluate the feasibility and advantages of the excision of uterine fibroids by vaginal myomectomy. Methods A series of 58 patients with uterine fibroids were managed with myomectomy from May 2001 to Dec 2003. Meanwhile, the indications of vaginal surgery, the methods of operation, the complications of surgery, the overall operating time, the estimated operative blood loss, the postoperative recovery and hospital stay were explored. Results Myomectomy were successfully completed vaginally without shifting laparotomy in 57 patients. The successful rate was 98 3%. The mean operative time was 48 16 minutes. The estimated blood loss was 70 58ml. The postoperative complication was occurred in one patient with uterine infection. The mean length of lower fever was 1 8 days and the bower movement was 1 3 days. The average hospital stay was 4 9 days. Conclusions For uterine fibroids, the vaginal myomectomy is a good choice when the indication of operation are managed properly. It can be used in patients who have numerous, relatively large, and intramural fibroids with micro invasive surgery, little interfering with abdominal organs, less blood loss, less operating time, less cost and less hospital stay in comparison with abdominal myomectomy or laparoscopic myomectomy

Objective To study the improvement in the surgical technique of vaginal hysterectomy and salpingo-oophorectomy. Methods The LigaSure TM System has been used in vaginal hysterectomy and salpingo-oophorectomy in 582 patients of group one. The result was compared with the 430 patients of group two, for whow the operation was done by the same medical team in our hospital using the traditional technie, in order to evaluate the two techniques. Results With a smaller incision in the new method, thus the time of operation was shorter, the amount of blood loss was less, post-operative hospital stay days were less, and post-operative complication was less (P

Objective To study the histological and immunohistochemical features of primary and metastatic ovarian mucinous adenocarcinoma. Methods 24 cases of primary ovarian mucinous adenocarcinoma and 16 cases of metastatic mucinous adenocarcinoma (5 gastric, 5 appendix, 6 colorectal) with definite diagnosis were included in this study. All the tissue sections with either HE staining or immunohistochemical staining with CK7 and CK20 monoclonal antibodies were studied. Results All the 24 primary mucinous adenocarcinoma were positive for CK7 and only 3 cases showed focal positive for CK20. Among the 16 secondary mucinous adenocarcinoma, 6 colorectal and 5 appendiceal metastatic adenocarcinoma were positive for CK20 and only one metastasis showed focal positiveness for CK7. The five gastric metastatic mucinous adenocarcinoma showed strong CK7 expression and four of them were CK20 positive. Conclusions The primary and secondary mucinous adenocarcinoma of the ovary had different immunohistochemical features. CK7 and CK20 were valuable markers in the differentiation of these two entities.

Objective To evaluate the changes in the epidemiology and clinical characteristics of cervical carcinoma over the past 50 years, and to explore the equitable treatment corresponding to these changes. Methods The clinical and pathological data of 1557 patients with invasive cervical carcinoma from January 1955 to December 2004 were retrospectively analyzed. Results (1) The average age of cervical carcinoma onset gradually decreased over the past 50 years, from 56.27?8.45 in years 1955~1964 to 43.81?8.9 in years 1995~2004. At the same time, the radio of clinically early (stages Ⅰ-Ⅱ) and non-squamous cancer also steadily increased. (2) Young patients (≤35 year old) had higher ratios of non-squamous, poorly differentiated and late stage (Ⅲ-Ⅳ) cancers, with a higher rate of lymphatic metastasis compared with other ages. (3) Because of the changes in epidemiology and clinical characteristics of cervical carcinoma, it′s necessary to alter the traditional model of treatment and to explore equitable therapy corresponding to these changes. Conclusions The average age of cervical carcinoma onset gradually decreased and simultaneously the ratio of clinically early (stages Ⅰ-Ⅱ) and non-squamous cancer also steadily increased over the last 50 years. Patients aged 35 and younger of cervical carcinoma had some obvious clinical characteristics compared with that of older patients. Preservation of reproductive endocrine function ought to be deliberated on in cervical carcinoma treatment of women with fecundity. Neoadjuvant intraarterial chemotherapy (NAIC) is an useful method for cervical carcinoma at present

Objective To evaluate the feasibility and safety of trans-umbilical NOTES to perform abdominal adhesion lysis using a flexible endoscope.Methods A 42-year-old female was admitted to our hospital with a complain of abdominal pain due to abdominal adhesion after hysterectomy.A gastroscope (GIF-2TQ260M,Olympus)was inserted into the peritoneal cavity through an incision(1.5 cm)of the umbilical opening.Pneumoperitoneum was established by the endoscopic air supply system using CO2 instead of air.Abdominal exploration showed that omentum and bowel were stuck to the scar of the low central peritoneum incision.Separation of the abdominal wall adhesions was performed with an IT knife and a hook knife respectively.After most of the adhesions were separated,bleeding was found from the isolated adhesion wound of the omentum and bowel.Hemorrhaged blood vessel was difficult to be found with the flexible gastroscope.Then a 5 mm Trocar was placed at the left lower abdomen and laparoscopic assistance was adopted to search the bleeding point.However,no bleeding site was found and the hemorrhage was stopped automatically.Residual adhesion lysis was conducted with laparoscopic assist.After the procedure,the umbilical incision was closed with absorbable suture,but lower left abdominal incision was left without suturing.Results The operation time was 40 minutes.The patient suffered from minus pain from the umbilical incision without need of treatment.She had normal diet and got out of bed after reconsious.She was discharged 2 days after the procedure without any complaints.Conclusion Trans-umbilical NOTES using a flexible endoscope for peritoneal adhesion lysis is safe and feasible,but the effectiveness remains to be further confirmed.

Objective To study the expressions of main subtypes of heat shock protein (HSP) in uterine cervix with different pathological changes. Method 478 cases of cervical biopsy specimen were divided into invasive carcinoma of cervix group (63 cases), cervical intraepithelial neoplasia group (CIN, 106 cases), chronic cervicitis group (293 cases) and normal uterine cervix (16 cases) according to pathological diagnosis. The expression levels of HSP70, HSP90α and HSP90β mRNA were detected by quantitative RT-PCR with specific complex cRNA as internal control. Results (1) The expressions of HSP70, HSP90α and HSP90β mRNA were significantly downtrend stepwise in invasive carcinoma of cervix, CIN, chronic cervicitis and normal cervix tissue. (P＜0.01, respectively). (2)In the invasive carcinoma of cervix group, the expression level of HSP90β mRNA was higher in advanced stage (FIGOⅡb-Ⅳ) compared with incipient (FIGOⅠa-Ⅱa) cancer of the cervix. (P＜0.05). (3)The expressions of HSP70 and HSP90β mRNA were each higher in poorly differentiated tumor than in well-differentiated tumor. (P＜0.05, respectively). (4)The expression levels of all three HSP mRNA had no significant differences were observed with different histological types of cervical cancer. (P＞0.05). Conclusions Heat shock protein may play some important roles in malignant transformation of cervix cell and aggravation of cervix cancer. HSP70 and HSP90α may promote cancer cell transition and proliferation, and HSP90β may participate in cell differentiation.

Purpose:The study was designed to investigate the feasibility of contrast-enhanced ultrasound in the differentiation of benign and malignant adnexal masses.Materials and Methods:Sixty-nine consecutive patients with adnexal masses received trans vaginal contrast-enhanced ultrasound.The image and perfusion features were assessed.Results:All of 26 malignant tumors showed detectable contrast enhancement,including 24 cases with a quick,heterogeneous or branching pattern.Among 39 benign lesions,24 were cystic with circle or half-circle enhancement,including 5 cases with intra-cystic septum or papillae slightly enhanced.The other 15 cases were solid,8 of them had slightly dotted enhancement.There are significant difference in enhancement patterns between benign and malignant masses ( P < 0.0001).The 4 cases of borderline tumors showed progressive,heterogeneous enhancement.Conclusion:Contrast-enhanced ultrasound is of value in the differentiation of benign and malignant adnexal masses.

Objective To analyze the complications of radical vaginal hysterectomy in patients with locally bulky cervical cancer.Methods All 258 patients of early cervical cancer (stage Ⅰ A2-Ⅱ A) selected in our hospital during the period of June 2011 to June 2016 undergoing radical vaginal hysterectomy and laparoscopic pelvic lymph node dissection were analyzed.All cases were divided into observation (locally bulky) and control (conventional) groups.Comparison analysis was performed for complications of the two groups and the influence of neoadjuvant chemotherapy on the complications of local bulky patients.Results The incidence of complications in the observation group was 26 cases (27.9％),higher than that in the control group of 28 cases (17.0％),the difference was statistically significant (P ＜ 0.05).The incidence of bladder injury (5 cases vs 2 cases) in observation group was significantly higher than that in control group (P ＜ 0.05).For patients with locally bulky early cervical cancer,the incidence rate of complications of the neoadjuvant chemotherapy group (15.8％) was significantly lower than the simple operation group (36.4％) (P ＜ 0.05).The incidence rate of ureteral injury in neoadjuvant chemotherapy group (0 cases vs 6 cases) was significantly lower than that in simple operation group (P ＜ 0.05).Conclusions Early cervical cancer patients with locally bulky (stage Ⅰ B2/ 1Ⅱ A2) had higher incidence of complications of radical vaginal hysterectomy,and neoadjuvant chemotherapy can reduce the incidence of surgical complications.