2018年 · 第53卷第09期

Termination of second trimester pregnancy is mainly used in cases where continuation of pregnancy is undesirable for medical reasons and unintended pregnancy. Due to the high cesarean section rate in recent years, coupled with the implementation of the "two-child policy", the proportion of pregnant women with a history of cesarean section has increased; Once placenta previa occurs, the risk of placenta implantation is also relatively increased. During the second trimester of pregnancy with termination of placenta previa with implantation, the placenta cannot be stripped by itself or can only be partially stripped, which can lead to massive bleeding, infection, uterine rupture, and even life-threatening. This kind of disease is a difficult point in the clinical work of family planning, and there are often three major problems in clinic: (1) How to choose the way to terminate pregnancy? (2) How to prevent and treat massive bleeding? (3) How to prevent and manage placental residue?

gestational diabetes mellitus (GDM) is one of the common comorbidities during pregnancy. Diagnostic criteria according to GDM^[1]The incidence of GDM among pregnant women in China from 2010 to 2012 was 18.9%^[2]。 GDM pregnant women with well-controlled blood glucose levels after blood glucose management still have a higher incidence of adverse perinatal outcomes than normal glucose tolerance (NGT) pregnant women^[3]。 The reasons for this difference are overweight before pregnancy, excessive weight gain during pregnancy, and other risk factors. Whether blood glucose levels themselves have an independent effect on adverse perinatal outcomes and the intensity of its effect is not clear. In clinical practice, pregnant women with normal blood glucose levels do not need to receive blood glucose therapy, and their blood glucose levels are continuously linear positively correlated with adverse perinatal outcomes; As the "hyperglycemia and adverse pregnancy outcome (HAPO) Study" has demonstrated a continuous linear positive correlation between blood glucose levels during pregnancy and adverse pregnancy outcomes with no risk threshold^[4]。 Therefore, there should be a continued linear correlation between blood glucose levels and adverse perinatal outcomes in pregnant women with GDM prior to treatment. In this study, pregnant women with NGT were selected as controls to evaluate the intervention effects of current traditional glucose management strategies on blood glucose levels and adverse perinatal outcomes in pregnant women with GDM.

Peutz-Jeghers (P-J) syndrome, also known as black spot polyp syndrome, is an autosomal dominant genetic disease, mainly manifested by skin and mucosal melanosis and multiple hamartomatous polyps in the digestive tract. The risk of cancerous digestive polyps and other malignant tumors is higher than that of the general population. Female reproductive system tumors closely related to P-J syndrome are ovarian sex cord tumors with annular tubules (SCTAT), endometrial carcinoma and cervical micro-deviated adenocarcinoma^[1]。 Through medical record inquiry, a total of 2 patients with P-J syndrome with cervical adenocarcinoma were diagnosed and treated in Peking Union Medical College, Peking Union Medical College, Chinese Academy of Medical Sciences, which are reported as follows in combination with literature review.

Acute myelomonocytic leukemia with eosinophilia after treatment of gynecological malignancies (acute myelomonocytic leukemia with eosinophilia, AML-M₄E₀) are relatively rare. In 2016, 2 cases of gynecological malignant tumors were admitted to the Department of Hematology of Shanxi Cancer Hospital with AML-M after surgery, radiotherapy and chemotherapy₄E₀In this paper, the relevant literature review was conducted to identify AML-M after treatment of gynecological malignant tumors₄E₀The diagnostic points of are reported below.

The patient was 24 years old and was menopaused for 23 weeks on 7 Mar 2016.⁺³, repeated vaginal bleeding for 4 days, aggravated for half a day ", emergency department with" threatened abortion "admitted to hospital, pregnancy 3 delivery 1, 2012 full term natural delivery of a healthy girl, 2013 early pregnancy medical abortion and uterine curettage. This pregnancy prenatal examination no abnormalities, admission physical examination: vital signs stable, lower abdomen mild tenderness, no rebound pain, fetal heart rate of 136 beats/min; abdominal ultrasound examination did not suggest obvious abnormalities; Check the hemoglobin level to 91 g/L. The patient complained of aggravation of right lower abdominal pain 14 h after admission. Physical examination: abdominal muscle tension, tenderness and rebound pain, mobile voicing positive; Reexamination of hemoglobin level was 70 g/L; The ultrasound revealed a large amount of peritoneal effusion, and 10 ml of bloody fluid was extracted by abdominal puncture. Exploratory laparotomy was performed immediately under general anesthesia. During the operation, about 2 000 ml of pelvic and peritoneal hemorrhage was found. The area of the posterior wall of the right uterine horn was about 5.0 cm ×5.0 cm. The muscle layer was thin and the blood vessels were abundant. Two bleeding spots (0.2 and 0.3 cm respectively) were seen, seeFigure 1。 Intraoperative diagnosis of "penetrating placental implantation and uterine rupture", cesarean section + partial uterine binding (placental attachment) + bilateral uterine artery ascending branch ligation were performed, and the operation was smooth. Postoperative placental pathological examination revealed villointerstitial fibrosis. On April 29th, the patient was followed up in the outpatient department of our hospital after operation. Ultrasound examination showed heterogeneous echoes in uterine cavity and rich color blood flow signals; The decrease of blood HCG levels in outpatient monitoring was not ideal. On May 18th and 24th, the patient had blood in the stool twice; Emergency CT showed local thickening of rectal wall with signs of intestinal obstruction, and there was more rectal content at the upper end of obstruction, so blood clot shadow was considered; The gynecological examination showed no abnormalities. Digital subtraction angiography after multidisciplinary consultation showed that the distal branch of the ileal artery was thickened and supplied blood to the base of the uterus, and the bilateral uterine artery was thickened and showed obvious vascular lake-like changes. Considering the fusion of intestinal blood vessels with uterine blood vessels, the possibility of residual placental cells penetrating the uterus and invading the intestine, exploratory laparotomy should be performed immediately; During the operation, the blood vessels at the base of the uterus were abundant and the adhesion to the intestinal tube bled turbulently and could not be separated. During the operation, the diagnosis of "placental implantation penetrated the uterus and eroded the small intestine" was performed. Because the patient's family requested to preserve the uterus, hysterectomy and partial resection of the eroded small intestine were performed. Postoperative pathological examination showed that one section of small intestine with two perforations, and metamorphic placental tissue was seen at the serous surface of the intestinal wall rupture, seeFigure 2。 The patient recovered and was discharged from the hospital after surgery. Since the follow-up, there is no complaint of discomfort.

The disease of venous return disorder caused by abnormal blood coagulation in deep veins is deep venous thrombosis (DVT), while thrombus shedding can cause pulmonary embolis (PE). The two are the same disease at different stages. The manifestations are collectively referred to as venous thromboembolism (VTE). Studies have confirmed that the risk of developing VTE in pregnant women is significantly increased, which is 5 times that of non-pregnant women. VTE is one of the important causes of maternal mortality^[1,2,3]。 At present, a standard VTE diagnosis and treatment process has been established for non-pregnant people; For pregnant people, due to their special hypercoagulable state, the influence of radiation exposure during pregnancy on the fetus and many other problems, the diagnostic methods of laboratory and imaging are limited to a certain extent, and a widely recognized diagnosis and treatment standard has not yet been formed. Therefore, this article combs the diagnosis and treatment of pregnancy-related VTE, and provides reference for clinical diagnosis and treatment.

Endometriosis (endometriosis) is a common disease in women of childbearing age. The incidence rate is 10% ~15%, accounting for 5% ~15% of gynecological surgery, and there is an increasing trend. 40% ~60% of patients with endometriosis are combined with severe pain or chronic pelvic pain, 20% ~30% of patients have impaired fertility, which affects the reproductive health of patients^[1]。 In recent years, the recurrence of endometriosis has been paid more and more attention, and the treatment of recurrent endometriosis is more difficult, and it has become a common problem faced by doctors and patients. The purpose of this paper is to summarize the high risk factors and then guide the prevention and treatment.

Cervical cancer is one of the common malignant tumors in women. It is reported that the number of new cases and deaths of cervical cancer in China has increased from 2002 to 2011^[1]。 External irradiation combined with brachytherapy, combined with chemotherapy according to the situation, is the standard treatment plan for locally advanced cervical cancer. External irradiation combined with intracavitary brachytherapy (ICBT) is effective in the treatment of locally advanced cervical cancer. The advantages of ICBT are simple and non-invasive, and it is still the most commonly used brachytherapy mode. The local control rate of ICBT for small tumors is 75% ~95%, and the local control rate for locally advanced cervical cancer is 45% ~80%^[2]。 Some studies have pointed out that when the 90% volumetric dose (D90) of the high-risk clinical target (CTV) of cervical cancer is ≥87 Gy, the local control rate can reach more than 95%^[3]。

The number of microorganisms in the human body is about 10 times the total number of human cells, and most of them are normal intestinal flora. The total number of coded genes of these microorganisms is 50~100 times the number of coded genes of humans. They are collectively called metagenome (metagenome), also known as the "second genome" of humans.^[1]。 Intestinal flora is involved in polysaccharide metabolism and inflammation regulation, and is closely related to obesity, diabetes and other metabolic diseases. In recent years, it has attracted great attention of scholars at home and abroad. In 2007, the Human Microbiome Project was proposed^[2], to understand the composition and changes of health-related microorganisms.

Vulvar lichen disease is a class of chronic inflammatory diseases of the skin and mucous membranes of the vulva, including lichen sclerosus, squamous epithelial hyperplasia (i.e., chronic lichen simplex) and lichen planus. Vulvar lichen disease often recurs, which seriously affects the quality of life of patients. Early diagnosis and early intervention can slow down the progression of such lesions and improve the prognosis. At present, there is no very effective treatment for vulvar lichen diseases, and general comprehensive treatment based on local treatment is adopted. Among them, topical glucocorticoid (topical glucocorticoid) has become the main treatment for vulvar lichen diseases. Recent studies have shown that the application of topical glucocorticoids has completely changed the therapeutic effect of vulvar lichen diseases, and it is safe and cheap^[1,2,3,4]。 However, which glucocorticoid to choose, how to prevent drug side effects, reduce recurrence, and whether maintenance treatment is needed have become issues of concern for clinicians. This article reviews the mechanism of action and efficacy classification of topical glucocorticoids on vulvar lichen diseases, drug selection and use methods, adverse reactions and prevention, so as to guide clinical medication.

The 4th annual meeting of the Society of Endometriosis and Uterine Disorders (SEUD) was held in Florence, Italy from April 25 to 28, 2018. The SEUD Annual Meeting is held once a year and focuses on academic exchanges around the latest basic and clinical research results in the fields of endometriosis (endometriosis) and benign uterine diseases. The theme of this annual conference is "Endometriosis: A Multigene and Multifactor Syndrome". More than 1,500 scholars from more than 70 countries around the world attended the conference. This annual conference has a special session in Europe, Asia (including China) and Latin America. There are 24 special lectures, 80 conference speeches, 12 surgical video displays and 279 electronic poster exchanges. The content not only focuses on endometriosis, but also conducts in-depth discussions on benign uterine diseases such as adenomyosis, uterine fibroids and abnormal uterine bleeding (AUB). The main contents of this annual meeting are summarized as follows.