OBJECTIVE: To investigate the prognostic factors of early stage adenocarcinoma of uterine cervix.METHODS: Totally 176 cases of early stage adenocarcinoma of uterine cervix who were admitted to Liaoning Cancer Hospital from January 2003 to May 2013 were analyzed retrospectively.RESULTS: The median age of 176 cases was 45(20-73),The 5-year overall survival rate was 81%. The 5-year tumor-free survival rate was 74.0%. The median survival time was 85 months.In univariate analysis,prognostic factors of patients with early cervical adenocarcinoma were clinical stage and lymph node metastasis.The five-year survival rate of ⅠB1,ⅠB2 and ⅡA1 was 86.0%,74.0% and 66.0%,and there were statistical differences(P<0.05).Compared with patients of ⅠB stage,the risk of death inⅡA1 patients was significantly increased(HR=2.92,95%CI 1.37-6.21).Totally 151 cases were pathologically proved with negative lymph node metastasis and 25 cases positive. The 5-year survival rates of them were 87.0% and 32.0% respectively and there were statistical differences between them(P<0.05).Multivariate analysis showed that only lymph node metastasis was an independent factor for survival(HR=5.86,95%CI 2.85-12.05).CONCLUSION: The 5-year survival rate of early-stage adenocarcinoma of uterine cervix is high;lymphnode metastasis is an important prognostic factor of early stage adenocarcinoma of uterine cervix.

OBJECTIVE: To evaluate the clinical significance of laparoscopic extraperitoneal para-aortic lmphadenectomy(PAL)in high para-aortic lymphadenectomy.METHODS: A non-randomized controlled method was used to analyze the clinical data of laparoscopic extraperitoneal PAL in 35 patients(extraperitoneal group)and laparoscopic transabdominal PAL in 40 patients(transabdominal group)in the Gynecological Department of the First Affiliated Hospital of Xiamen University from March 2018 to April 2019.RESULTS: All the 35 cases of laparoscopic extraperitoneal PAL reached the level of renal vein.Endometrial cancer accounted for the largest proportion,with an average age of 47.57 years and an average body mass index of 23.77.The average operation time was 109 minutes in the first 6 cases and 74.73 minutes in the other 29 cases.The amount of hemorrhage was 15.19 mL,and the average number of para-aortic lymph nodes(PALN)resected was 17.87.There were 5 cases of positive PALN metastasis,and the average gastrointestinal recovery time was13.43 hours.The average postoperative pelvic drainage was 76.57 hours and the average postoperative hospital stay was8.24 days.Intraoperative and postoperative complications included 1 case of inferior vena cava rupture,1 case of chyle leakage,and 1 case of vulvar edema.None of the 40 cases of laparoscopic transabdominal PAL reached the level of renal vein,and endometrial cancer accounted for the largest proportion,with the average age of 46.78 years and the average body mass index of 24.03.The average operation time was 90.55 min;the average intraoperative blood loss was 67.40 mL The average number of para-aortic lymph nodes was 3.30.There was one case of PALN metastasis.The average gastrointestinal recovery time was 22.35 hours,and the average postoperative pelvic drainage time was 75.75 hours.The average length of hospital stay was 8.90 days.There were 2 cases of rupture of the inferior mesenteric artery,3 cases of chyle leakage,and 2 cases of vulvar edema.The number of PALN resection,intraoperative blood loss,and operation time in the extraperitoneal group were not related to the body mass index,but the number of PALN in obese patients in the laparoscopic transabdominal group was significantly reduced,the operation time was longer,the intraoperative blood loss was more,and postoperative gastrointestinal recovery time is longer(P<0.05).CONCLUSION: Laparoscopic extraperitoneal PAL can solve the problems of laparoscopic transabdominal PAL lymph node resection,which is difficult to reach the level of renal vein,intraoperative intestinal tube interference,and the number of lymph nodes resected.It is especially suitable for obese patients.Laparoscopic extra-peritoneal high-grade PAL is safe,feasible,and recommended.

OBJECTIVE: To investigate the value of HE4,CA125 and ovarian malignant tumor risk prediction models(ROMA)in the diagnosis of ovarian epithelial malignant tumors.METHODS: The clinical and pathological data of 247 patients with ovarian tumors(EOC 139 cases,BOT 18 cases,and benign ovarian tumor 90 cases)and 39 patients with uterine fibroids in Liaoning Tumor Hospital from September 2016 to August 2017 were retrospectively analyzed. The levels of serum CA125 and HE4 were measured before operation. The ROMA values were calculated and the relationship between CA125,HE4,ROMA values and clinical pathological parameters were analyzed. The diagnostic evaluation index was calculated,the receiver operating characteristic(ROC)curve was drawn,and the AUC value was also calculated.RESULTS: The positive rate of HE4 in the ovarian epithelial malignant tumor group was significantly higher than that in other groups before and after menopause,the difference being statistically significant(P<0.05).The positive rate of CA125 in the group of malignant epithelial tumor of ovary was significantly higher than that in other groups after menopause,the difference being statistically significant(P<0.05),but there was no statistical difference before menopause(P>0.05).There was no significant statistical difference in the positive rate of ROMA before or after menopause(P>0.05).The sensitivity of CA125 was higher than that of HE4 and ROMA. Specificity of HE4 was higher than that of CA125 and ROMA.Correct diagnosis index of ROMA was higher than that of HE4 and CA125.CONCLUSION: For the diagnosis of ovarian malignant epithelial tumors,the combined detection of serum HE4 and CA125 and ROMA model is superior to the individual detection of HE4 and CA125.

OBJECTIVE: To analyze clinical outcome of high-grade squamous intraepithelial lesion(HSIL)half a year after loop electrosurgical excision procedure(LEEP).METHODS: The retrospective study was carried out on 752 patients who underwent LEEP,with HSIL in the LEEP histopathology from January 2018 to December 2018 at Shanghai First Maternity and Infant Hospital Affiliated to Tongji University to confer the difference between residual group and non-residual group after 6 months of the LEEP conization.TCT,cervical biopsy and high risk HPV test were performed on all patients.RESULTS: Among 752 cases,57(7.6%)cases suffered HSIL residual disease while 695 cases in non-residual group. Before LEEP,HR-HPV 16/18 positive were less in HSIL lesion group showed no difference than those in non-residual group(P>0.05).The residual rate of post-LEEP specimens:CIS and invasive cancer identified only microscopically was higher than that in the AIS group(P<0.05).After LEEP,238 cases with positive margins and 514 cases with negative margins.The residual rate in patients with positive margin and negative margin were 21.1% and 1.4%,(P<0.05).The residual rate in patients with positive endocervical margin,ectocervical margin,unilateral margin and fibrous margin were28.7%,18.9%,17.2% and 26.3%,respectively(P<0.05). The residual rate in patients with second LEEP and non-second LEEP were 29.7% and 6.4%,respectively(P<0.05).The residual rate in patients with TCT≥ ASCUS and normal were 21.9% and 4.4%,respectively(P<0.05).Multivariate regression analysis using the logistic regression model showed CIS,abnormal cytology TCT≥ ASCUS and LEEP with positive margins to be independent risk factors for residual lesions after LEEP(P<0.05).CONCLUSION: Histopathology CIS after LEEP,abnormal cytology(TCT≥ ASCUS)and positive margin are predictors of residual lesion after LEEP with HSIL.

OBJECTIVE: To explore the curative effects of the combined therapy of laparoscopic partial sigmoidectomy and anterior and posterior vaginal wall repair for the treatment of severe pelvic floor dysfunction(PFD).METHODS: The clinical data of 14 severe PDF patients(uterine prolapse in stage Ⅲ-Ⅳ）with dolichasigmoid were studied retrospectively from May 2017 to August 2018 in Shanghai Traditional Chinese Medical University. The surgical way was laparoscopic partial sigmoidectomy and anterior and posterior vaginal wall repair. The objective effects were assessed by comparing the position of each indication points of the preoperative and postoperative pelvic organs' prolapse(in POP-Q scale).Subjective effects were also assessed by comparing Clevel score of constipation,pelvic floor distress inventory-short form 20(PFDI-20),pelvic floor impact questionnaire short form(PFIQ-7)between preoperation and 6 months and 1 year after operation.RESULTS: All 14 patients were successfully operated on without any intra-operative and post-operative complications. The comparion of positions of the POP-Q indication points(AA,Ba,C,D,AP,BP)between preoperation and 1 year after operation showed the difference was statistically significant(P<0.01). PFDI-20,PFIQ-7 and Clevel constipation scores were also significantly different respectively(P<0.01).CONCLUSION: Laparoscopic partial sigmoidectomy combined with pelvic floor repair is an optional method in the treatment for pelvic floor dysfunction, which could effectively improve the constipation caused by dolichasigmoid and pelvic floor defect. It is also with low postoperative morbidity.

OBJECTIVE: To explore the characteristics of CTG(cardiotocography)and discuss pregnancy management of fetal extrasystole.METHODS: It's a retrospective analysis of women who gave birth in May 2011-March 2018 in PekingUniversity Third hospital.A total of 13 cases were diagnosed as fetal extrasystole through echocardiography or M type ultrasound.The characteristics of CTG,delivery weeks,delivery mode,neonatal arrhythmia diagnosis and treatment weresummarized.RESULTS: In 13 cases,except 2 cases with normal CTG,the others showed that normal fetal heart raterhythm and deceleration alternately appeared,but it was different from hypoxia-induced deceleration.Eight of 13 cases underwent cesarean section,and 4 of these cases were with fetal arrhythmia or fetal distress as an indication.All neonates were alive.One case turned into supraventricular tachycardia,which resolved after receiving medicine.For the other cases,the ECGs resolved or returned to normal within two weeks after the birth.CONCLUSION:s The most common type of extrasystole is atrial extrasystole.When premature beats are not transmitted,we call it blocked atrialextrasystole,which causes deceleration.If there is no heart structure abnormality and heart failure,vaginal delivery canbe performed under closely monitoring.

OBJECTIVE: To evaluate the effectiveness of semi-open suturation of vaginal stump in preventing pelvic lym-phocele after pelvic lymphadenectomy during gynecologic cancer surgery.METHODS:This study is a retrospectivestudy.Totally 348 patients with cervic cancer or endometrial cancer who underwent pelvic lymphadenectomy and/or para-aortic lymphadenectomy from January 2012 to September 2018 were divided into two groups according to the suturationof vaginal stump:102 patients were in the semi-open group and 246 patients were in the closed group.The two groupswere compared concerning the surgery time,harvested lymph node,drainage time,albumin level,hemoglobin content,and the incidence of lymphocele and symptomatic lymphocele.RESULTS:There were no differences between two groupswith respect to surgery time,harvested lymph node,drainage time,albumin level or hemoglobin content(P>0.05).Theincidence of lymphocele and symptomatic lyphocele in semi-open group was significantly lower than that in closed group(35.3%versus79.3%,3.9%versus19.5%,P<0.05);the average diameter of lymphocele in semi-open group was also sig-nificantly lower than that in closed group(4.1cm versus 5.9cm,P<0.05).CONCLUSION:The result of this study indicatesthat the application of semi-open saturation of vaginal stump is an effective way to reduce the incidence of pelvic lym-phocele after gynecologic malignancy,which is simple and with reliable effect.It doesn′t increase the incidence of postop-eration complications and deserves clinical application.

OBJECTIVE: To investigate the expression of microRNA-622(miR-622)in epithelial ovarian cancer,andanalyze its influence on tumor cell migration and invasion.METHODS:Epithelial ovarian cancer(n=125),benignepithelial ovarian tumors(n=45),and normal ovarian tissues(n=25)were obtained from January 2003 to December 2016 at Dongguan People's Hospital of Southern Medical University.The expression of miR-622 was determined by real-timePCR.The miR-622 mimics were transiently transfected into human ovarian cancer cells,and their influence on cellmigration and invasion was analyzed by Transwell assay.RESULTS:Higher miR-622 expression was found in epithelialovarian cancer tissues than in benign epithelial ovarian tumors and normal ovarian tissues(P<0.05).Expression of miR-622 was correlated with FIGO stage and lymphatic metastasis(P<0.05).Up-regulation of miR-622 promoted theinvasion and migration of SKOV3 cells in vitro.CONCLUSION:The expression level of miR-622 is increased in tumourtissues,which indicates that miR-622 might be involved in the progression of epithelial ovarian cancer by promotingcancer cell migration and invasion.

OBJECTIVE: To investigate the effect of high intensity focused ultrasound(HIFU)on pregnancy outcomes inpatients with uterine fibroids.METHODS:From October 2010 to October 2017,241 patients with uterine fibroids whowere pregnant after HIFU treatment in Suining Central Hospital and Chongqing Haifu Hospital were retrospectivelyanalyzed.The efficacy of HIFU ablation and the patient′s pregnancy outcomes were investigated.RESULTS:Among thesepatients,9 of them were conceived within 2 month after HIFU,24 were conceived between 2 and 4 months after HIFU,33 patients were conceived between 4 and 6 months,and 175 patients were conceived after 6 months of HIFU treatment.The median conception time was 9 months after HIFU(range:1 to 26 months).Among them,152 patients had deliveredbabies successfully,12 patients are still in pregnancy,3 patients had ectopic pregnancy,2 patients had incisionalpregnancy,72 patients had abortions,including 66 cases of induced abortion and 6 cases of spontaneous abortion.Causesof induced abortion included:embryonic development stopping(8 cases),increased vaginal bleeding(5 cases),hypothyroidism(1 case),use of drugs during pregnancy and being fear of fetal malformation(6 cases),and unplannedpregnancy(52 cases).Of the 152 patients who had delivered,147 had 148 full-term deliveries(1 had full-term deliverytwice)and 5 had preterm birth.No uterine rupture occured during pregnancy or childbirth,and the newborn is healthy.Before HIFU treatment,136 of 241 patients had a history of abnormal pregnancy,and only 17 of these patients hadabnormal pregnancy after HIFU treatment.The incidence of spontaneous abortion in patients after HIFU treatment wassignificantly lower than before treatment(P<0.05).CONCLUSION:HIFU is a safe and effective treatment for patients whowish to have children.It can also improve the fertility of patients with a history of abnormal pregnancy,with no additionalobstetric risks.

OBJECTIVE: To explore the infection and distribution characteristics of human papillomavirus(HPV)inWuchang district to obtain the epidemic profile and characteristics of HPV in this area.METHODS:Female patients withsexual life history were randomly selected from Wuchang Hospital in Wuhan from July 2013 to June 2018.The patient′scervical exfoliated cells were collected and tested for HPV infection and genotyping.The infection rates of each type ofHPV were calculated and the differences in HPV infections in different age groups were compared.RESULTS:The HPVinfections rate was 18.8%.Among them,high-risk type accounted for 74.9%,significantly higher than low-risk type,accounting for 15.2%.Young women under 30 years old had the highest high-risk and low-risk infection rate(25.8%,21.0%)respectively.HPV 16(20.0%),HPV18(18.0%),and HPV52(14.0%)were top three genotypes among the high-risk types,and HPV11(33.0%),HPV6(32.0%)and HPV CP8304(26.0%)were top three genotypes among the low-risktypes.Among the positive patients,the infection rate of single and double genotype was 76.2% and 18.0%,and somepatients even had five infections.Most of the genotypes could be detected in multiple infected samples except HPV43.CONCLUSION:The prevalence of HPV in women with sexual life history in Wuchang region is 18.8% and it is mainlyhigh-risk infection.The main genotypes are HPV16,HPV18 and HPV52.The high risk population is the young womenunder 30 years old.It is of great clinical significance to strengthen HPV screening and enhance women′s self-testawareness in this region.