Objective To investigate the diagnostic value of hysteroscopy combined with B -ultrasonography for uterine incision diverticulum after secondary cesarean section . Methods From May 2012 to May 2013, hysteroscopy check was performed in 38 cases with a history of two times of caesarean sections . The hysteroscopic results and ultrasound images were analyzed retrospectively . Results Incision diverticulum was diagnosed in 34 cases by using diagnostic hysteroscopy combined with B-ultrasonography, with a diagnosis rate of 89.5%(34/38).There were 18 cases of mild diverticulum (47.4%), 16 cases of severe diverticulum (42.1%), and 4 cases of good healing (10.5%).Of the 16 cases of severe diverticulum , the distance from top to serosal surface was 1.6-6.0 mm, and the width was 3-17 mm.Preoperative transvaginal ultrasonography ( TVS) showed only 10 cases of uterine incision diverticulum in patients with severe diverticulum , providing a diagnosis rate of 26.3% (10/38).Compared TVS with hysteroscopy combined with B-ultrasonography , there was a significant difference (χ2 =31.091, P=0.000) in the diagnosis rate for uterine incision diverticulum . Conclusion Hysteroscopy combined with B-ultrasonography has a high diagnosis rate for the diagnosis of uterine incision diverticulum in patients with two times of cesarean sections , being worthy of clinical application as a minimally invasive examination method after cesarean sections .

Objective To study the concentration of adhesion-related cytokines,transforming growth factor (TGF) β1,platelet-derived growth factor (PDGF) BB,b-fibroblast growth factor (bFGF) in intrauterine fluid and their roles in the intrauterine-adhesion reformation.Methods From August 2009 to February 2010,18 patients with moderate or severe intrauterine adhesions underwent transcervical resection of intrauterine adhesion as study group,in the mean time,20 patients with incomplete septate uterus underwent transcervical resection of septum as control group.The charge of each patient's intrauterine fluid was collected at the time of 3,6,9,12,24,48 and 72 hours,respectively,then the concentration of the three cytokines was measured by enzyme-linked immunosorbent assay(ELISA).Results The concentration of the expression of TGF-β1 in the intrauterine fluid at 3,6,9,12 hours after operation in study group was (3.6±0.9),(10.4±1.1),(7.6±1.2),(7.2±1.3) ng/ml,respectively; PDGF-BB was(2.6±0.6),(3.5 ±0.5),(5.4±1.0),(5.7 ±0.8) ng/ml,respectively; bFGF was(16.9±1.3),(95.8±17.8),(330.9 ± 70.5),(1303.3 ± 117.4) ng/ml,respectively.The expression of TGF-β1 in control group was (3.0 ± 0.6),(7.5 ± 0.6),(5.4 ± 0.6),(4.6 ± 0.8) ng/ml,respectively ; PDGF-BB was (2.5 ± 0.4),(2.6±0.5),(4.7±0.6),(4.4±0.4) ng/ml,respectively; bFGF was (19.1 ±2.4),(82.9±21.8),(249.0 ±54.2),(775.6 ± 178.8) ng/ml,respectively.The concentration of TGF-β1,PDGF-BB and bFGF reached the peak during the time of 3-24 hours,6-48 hours,6-72 hours after surgery,respectively.The concentration of TGF-β1,PDGF-BB and bFGF in study group were significantly higher than that in control group (P ＜0.05).Conclusions Concentration of TGF-β1,PDGF-BB and bFGF was positively associated with area of transcervical resection of intrauterine adhesion,those cytokines might be involved in reformatin of intrauterine-adhesion.

Objective To analyze clinical characteristics and treatment experience for late complications after hysteroscopic transcervical resection of endometrium ( TCRE) . Methods Clinical data of 13 cases of late complications after hysteroscopic TCRE for dysfunctional uterine bleeding from January 2006 to June 2014 were retrospectively analyzed .A re-operation of hysteroscopic exploration and resection were required . Results The re-operation in the 13 patients found 6 cases of hematocele in uterine cavity (4 cases in the uterine horn, 2 cases in the uterine cavity) and 7 cases of focal or whole uterine endometrial hyperplasia (including 1 cases of PASS syndrome and 1 case of endometrial pathology of grade Ⅰatypical hyperplasia ) .Postoperative symptoms were relieved in 7 cases (53.8%).Laparoscopic total hysterectomy was performed in 3 cases of adenomyosis complicated with secondary progressive dysmenorrhea (23.1%), 2 cases of endometrial proliferation associated with a breast cancer history (15.4%), and 1 case of endometrial atypical hyperplasia grade Ⅰ (7.7%). Conclusion After hysteroscopic TCRE, residual functional endometrium or future regeneration of endometrium may lead to late complications , which need further clinical diagnosis and treatment .

Objective To explore the efficacy of hysteroscopy combined with laparoscopy in the diagnosis and treatment of Herlyn-Werner-Wunderlich syndrome (HWWS).Methods The clinical data of 23 patients with HWWS from January 2009 to December 2015 treated with combination of laparoscopy and hysteroscopy were retrospectively analyzed.The patients had different degrees of dysmenorrhea (17 cases),abnormal vaginal discharge (17 cases),and infertility (4 cases) before surgery.During followup,we observed the symptom and pregnancy outcomes after surgery.Results The patients were followed up for 3-36 months (average,24 months).The vaginal irregular bleeding and abnormal secretions disappeared in 17 patients;dysmenorrhea relieved partly in 17 cases;4 patients who had fertility requirements gave birth to babies.Conclusion Combination of hysteroscopy and laparoscopy sufficiently clears genital malformation of HWWS and solves the lower genital tract obstruction.

[Summary] Cesarean section scar defect is one of the most common long-term complications after cesarean section .However the indications and efficacy judgment are not definite .The main managements include medical and surgical interventions .The drug generally used in medical management is oral contraceptives , and the surgical management includes vaginal repair of cesarean section scar defect and hysteroscopic or laparoscopic repair of the defect .To minimize the incidence of cesarean section scar defect , the surgical indications should be strictly followed and the operation should be carefully performed , including application of aseptic techniques , complete removal of decidua and placental tissues , effective hemostasis , and proper suturing .

[Summary] There are a variety of treatment methods for stress urinary incontinence ( SUI) .Surgery is effective but has high risks, only to adapt to the limited population .Conservative treatment has a high recurrence rate and poor long-term results.Local injection of stem cell has been proposed as a new minimally invasive therapy of SUI .Stem cells, with the ability to transform into muscle cell , secrete various growth factors , promote local nerve and muscle tissue regeneration , and repair sphincter dysfunction .This article reviewed on therapy of skeletal muscle-derived stem cells and the associated risks of treatment .

Objective To study the clinical characteristics of intrauterine re-adhesions treated by transcervical resection of adhesion (TCRA). Methods Between January 2012 and January 2015, 12 patients with intrauterine re-adhesions after TCRA in other hospitals had fertility requirements , including 10 cases of severe intrauterine adhesions and 2 cases of moderate intrauterine adhesions .In our hospital , the 12 patients underwent laparoscopic exploration and TCRA .After operation the patients were treated with artificial cycle therapy for 3 months and then underwent hysteroscopic examination . Results In the operation, the remaining of 50%endometrium was found in 1 case, the remaining of 30%endometrium was found in 1 case, and the remaining of 20%endometrium in 9 cases.Only petechial and patchy residual endometrial islands were found in 1 case.Uterine dysplasia was found in 3 cases.Re-examinations of hysteroscopy 3 months after surgery showed 4 cases of uterine cavity normal recovery , 6 cases of moderate intrauterine adhesions, and 2 cases of mild intrauterine adhesions .Follow-up for 18-42 months (mean, 28.5 months) in the 12 cases showed 2 cases of term pregnancy and 1 case of spontaneous abortion .The other 9 patients had no pregnancy , 3 of which withdrew the treatment and 6 of which underwent further treatment . Conclusions Patients with intrauterine re-adhesions usually have seriously damaged endometrium and poor recovery .We suggest that TCRA should be completed by experienced professionals to reduce the residual endometrial destruction , so as to improve the treatment outcomes of intrauterine adhesions .

Organ preservation is companied with ischemia,hypothermic injury and reperfusion injury.This article describe basic organ preserve method,developing history,current state of organ,and several research problem.

Objective To evaluate the effect of amniotic products after transcervical resection of uterine adhesions (TCRA). Methods This study was carried out in 57 patients with intensive degree of intrauterine adhesions (IUA) who had been treated by TCRA between Jun. 2013 to Jun. 2014. These patients were devided into two groups randomly. In group amnion, 29 patients were placed amniontic scaffold balloon after TCRA;in group balloon, 28 patients were placed Foley′s balloon after TCRA. The two groups′balloons were taken out after TCRA 7 days. All patients were taken artificial cycle treatment. The uterine cavity form and the menstruation of 2 groups were observed in 3 months after TCRA. Results In group amnion, IUA score dropped from 10.1±0.5 preoperatively to 3.2±1.5 postoperative (P<0.01), in group balloon, IUA score dropped from 10.1 ± 0.5 preoperatively to 6.3 ± 2.5 postoperative (P<0.01). In group amnion, the menstrual score increased from 13.3 ± 4.4 preoperatively to 32.6 ± 5.5 postoperative (P<0.01), in group balloon, the menstrual score increased from 11.1±5.8 to 26.5±5.6 (P<0.01). The menstrual improvement of group amnion was better than that of group balloon significantly (P=0.002). In group amnion, the recurrence rate of adhesion was 21%(6/29), in group balloon, the recurrence rate of adhesion was 36%(10/28). There was no significant difference (P=0.248). The pregnancy rate of group amnion was 28%(8/29), the pregnancy rate of group balloon was 21%(6/28). The difference of pregnancy rate in two groups was not significant (P=0.760). Conclusion This small sample observation indicate that amniotic products used in the treatment of intensive IUA could improve menstrual, reduce the recurrence of adhesion, but the impovement of the pregnancy rate should be confirmed by large sample observation.

[Summary] Endometrial receptivity plays an important role in embryo implantation, and uterine fibroids is the most common benign tumor in reproductive women. In recent years, research has showed that uterine fibroids may have an effect on endometrial receptivity through the change of endometrial morphology and biochemical molecules. From the angle of effects of uterine fibroids on endometrial receptivity, this paper studied infertile patients, which may have a new idea to diagnose and treat infertility caused by uterine fibroids.