2015年 · 第50卷第05期

Our country is a "big country of abortion" in the world. How to ensure the implementation of safe abortion technology has always been the focus of our family planning workers. At present, the routine of medical abortion in China is only limited to terminating pregnancy with menopause ≤49 days, which is far from meeting the actual clinical needs. How to ensure the safety of terminating 8~16 weeks of pregnancy is the focus of research at home and abroad after anti-early pregnancy drugs. Domestic clinical research on drug termination of pregnancy over 8 weeks began in the early 1990s^[1]Hundreds of related research papers have been published^[2]。 In 1996, the Shanghai Municipal Science and Technology Commission funded a large-sample study of more than 2,000 cases, "Shanghai Clinical Multicenter Study on Drug Termination of Pregnancy at 10-16 Weeks", which formed a clinical routine in Shanghai^[3]。 Since then, the clinical multi-center drug research conducted in 2007, with the participation of 11 hospitals across the country, further confirmed that mifepristone combined with misoprostol is a safe, effective and non-invasive drug to terminate 8~16 weeks of pregnancy, which can replace forceps and curettage with high technical requirements and more complications. The total number of pregnancy terminations over 8 weeks in my country every year is still quite large. Making full use of domestic clinical research results to formulate guidelines for drug termination of pregnancy over 8 weeks in my country will not only meet the current clinical needs, but also contribute to the safe termination of pregnancy in the world.

Pelvic abscess during pregnancy is extremely rare clinically and easy to miss diagnosis, often leading to spontaneous abortion, premature delivery, premature rupture of membranes, chorioamnionitis, infection and death of pregnant women and perinatal infants and other adverse pregnancy outcomes^[1]。 It is the key to improve perinatal outcome and reduce maternal and infant morbidity and mortality for clinicians to recognize the characteristics and high risk factors of the disease, make early diagnosis and take appropriate treatment measures^[2]。 Tianjin Medical University General Hospital recently treated a patient with ruptured fallopian tube and ovarian abscess during pregnancy, which is now reported in combination with the literature review as follows.

Endometrial cancer is one of the three common gynecological tumors, accounting for 20% ~30% of malignant tumors of female reproductive system. It has the characteristics of easy recurrence and metastasis. In recent years, its incidence rate has increased significantly and the incidence has a tendency of younger age, which has become an important factor harming women's health. S100A4 is a member of calcium binding protein family, which is expressed in many kinds of tumor cells and a few normal tissues. Recent studies have shown that S100A4 gene plays an important role in tumor invasion and metastasis. In this study, the expression of S100A4 gene in endometrial carcinoma HEC-1B cells was silenced by RNA interference technique, and the changes of cell invasion and metastasis after transfection were observed, which provided a theoretical basis for the mechanism of endometrial carcinoma occurrence and development.

The patient was 48 years old. He was admitted to the hospital on April 16, 2014 due to the discovery of a pelvic mass for more than 2 months and 1 month after the operation. The patient had regular menstruation and no menstruation in the past. She was married at the age of 29. She was pregnant with 3 deliveries and 1 delivery, and menopaused for 2 years. The patient found a mass in the left lower abdomen more than 2 months before admission. He went to a local hospital. Pelvic CT examination showed: multiple masses in the left iliac vascular area, blood CA₁₂₅The level was not significantly increased. Considering benign lesions, transabdominal pelvic mass resection was performed. During the operation, it was found that the mass was located in the vascular area of the left internal and external iliac arteries, and it was tightly adhered to the blood vessels. Only part of the mass was removed. Postoperative pathological examination showed adenocarcinoma in the left iliac vascular area. For further diagnosis and treatment, we went to our hospital. Gynecological examination: the uterus was anterior, mobile, without tenderness, a 5 cm mass was palpable in the left adnexal area, with poor boundary, slightly poor mobility, without tenderness, and the right adnexal area was thickened, without tenderness. Serum CA₁₂₅: 9.10 kU/L. On April 21st, an exploratory laparotomy was performed under general anesthesia. During the operation, the left peritoneum was opened, and a tough mass about 5 cm ×4 cm in size was palpable in the left iliac vascular area. The mobility was slightly poor, and the lateral boundary was still clear. The medial side extended into the obturator fossa, and the adhesion to the left external iliac vein was tight. The adhesion was carefully separated and the mass was free. It was found that the mass was formed by the fusion of multiple masses. The lateral mass (about 5 cm in diameter) was completely removed. The medial mass was deep and extended below the obturator nerve, located between the internal and external iliac arteries and veins. The surgical risk was high, so the resection was not continued. Four silver clips were given to facilitate postoperative radiotherapy. The tumor tissue of the obturator fossa and the left external iliac lymph node were taken for pathological examination. The pathological diagnosis showed that the fibrous tissue of "tumor tissue in the left iliac vascular area" was accompanied by old hemorrhage and cystic hematoma formation, the cyst wall was transparent and degenerated, and adenocarcinoma infiltration was seen in the cyst wall, which was endometrioid adenocarcinoma (grade I); Immunohistochemical results: Cytokeratin (CK) positive, cell proliferation-associated nuclear antigen Ki-67 positive (approximately 10%), CA₁₂₅Negative, ER-negative, PR-negative, minority positive for p53 protein. Combined with the clinical manifestations and immunohistochemical results of the patient, there were no tumors in the uterus and bilateral appendages of the patient, and endometrioid adenocarcinoma in the left iliac vascular area was considered to be caused by the carcinogenesis of endometriosis (endometriosis) lesions. Because the patient's mass was large and located in the iliac vascular area, some of the mass could not be removed, so he was marked with silver clip. After operation, he was given 4 courses of paclitaxel + carboplatin chemotherapy, and local radiotherapy for 60 Gy (divided into 30 times) of the tumor site in the left iliac vascular area. No recurrence was found after follow-up.

anti-Mullerian hormone (AMH), also known as Mullerian inhibition substance (MIS), is a peptide growth factor belonging to the tissue growth factor beta superfamily^[1]。 In women, AMH is specifically produced by granulosa cells in follicles after initiation of growth within the primordial follicular pool, and is mainly secreted by pre-sinus follicles and small sinus follicles^[2], from the original follicle and continued until the follicle was approximately 8 mm in diameter, and its levels were very low in the larger sinus follicles^[3], there was no AMH formation in FSH-dependent dominant follicles and in atresia follicles; Its main physiological role is to play a regulatory role in the early stage of follicular recruitment and inhibit the primary recruitment of follicles from primordial follicles to sinus follicles^[4]。 AMH secreted by granulosa cells into follicular fluid can enter the blood circulation, so serum samples can be taken to detect AMH. AMH was almost undetectable in the serum of female infants at birth. AMH levels increased gradually before puberty, reached a peak at 25~30 years old, and then decreased gradually with age, until it fell below the detection range after spontaneous menopause^[5]。

Endometriosis (endometriosis) is a common and frequently occurring disease in women of childbearing age^[1]It can cause dysmenorrhea and chronic pelvic pain, and is also one of the main causes of infertility^[2]But the mechanism of its occurrence and development is still unknown^[3]。 In recent years, a large number of in vitro and in vivo studies have confirmed that ectopic endometrial implantation is associated with abnormal immune surveillance and inflammatory response in the intraperitoneal environment^[4]。 Therefore, the role of immune factors in the pathogenesis of endometriosis has been widely concerned. natural killer cell (NKC), as the first line of defense of the body's natural barrier, has become a hot spot in the research of endometriosis. Studying the role of NKC in endometriosis is of great significance to elucidate the related immunological mechanism of endometriosis.

Locally advanced cervical cancer refers to stage Ⅰb2~ Ⅳa cervical cancer in a broad sense, and in a narrow sense refers to stage Ⅰ ~ Ⅱa cervical cancer with a local tumor diameter ≥4 cm, namely stage Ⅰb2 and Ⅱa2 cervical cancer. The locally advanced cervical cancer referred to herein is stage Ⅰb2 and Ⅱa2 cervical cancer in a narrow sense. Although locally advanced cervical cancer still belongs to early cervical cancer, its local tumor is difficult to control, easy to recurrence and metastasis, poor prognosis and low 5-year survival rate. It has been reported that the 5-year survival rate of stage IB1 cervical cancer patients is 80% to 95%, the 5-year survival rate of stage IIA1 is 79.7%, and the 5-year survival rate of stage IB2 and IIA2 has dropped to 50% to 60%^[1]。 Seeking the best treatment for locally advanced cervical cancer in order to improve the survival rate has been a hot topic in gynecological oncology, but the choice of the best treatment plan is still very controversial, and the treatment plan used in different medical institutions is different. Therefore, this article will review the treatment progress of locally advanced cervical cancer, the advantages and disadvantages of each regimen and its development trend.

Notch signaling pathway is one of the important signaling pathways in contact between cells. It maintains the dynamic balance between cell differentiation, proliferation and apoptosis, and plays a key role in the direction of cell differentiation. In recent years, a large number of literatures have reported that Notch signaling pathway is closely related to the occurrence and development of endometrial cancer. In this paper, the composition and regulatory characteristics of Notch signaling pathway, the carcinogenic mechanism of Notch signaling pathway, the role of Notch signaling pathway in the occurrence and development of endometrial carcinoma, and the tumor treatment targeting Notch signaling pathway are briefly discussed.

Weight gain during pregnancy not only affects pregnancy outcome, but also affects the long-term health of mother and child. Based on the pre-pregnancy body mass index (BMI), abnormal body mass gain during pregnancy can affect maternal and infant outcomes. The clinical significance of weight gain during pregnancy is presented as follows.

In recent years, with the continuous improvement of laparoscopic instruments, as well as the unremitting efforts and bold practice of endoscopic scholars, gynecological endoscopic technology has become more and more mature and made great progress. Academician Lang Jinghe predicted that "there is no surgery that cannot be performed under laparoscopy". However, even with the vigorous development of laparoscopic surgery today, there is still a certain complication rate and conversion rate to open laparotomy, and there are many reasons for their occurrence, among which the most common and most important is severe pelvic and abdominal adhesion. Severe pelvic adhesions, which used to be a contraindication for laparoscopic surgery, have gradually evolved into a relative contraindication in recent years, and some experienced doctors even recommend that they no longer be used as a contraindication. However, laparoscopic surgery for severe pelvic and abdominal adhesions is difficult and risky, which can easily lead to pelvic and abdominal organ damage, increase postoperative morbidity and mortality, prolong the operation time and hospitalization time, and increase medical expenditure, which is a considerable burden for patients individually and society. Therefore, how to accurately judge the degree of adhesion before surgery, successfully establish pneumoperitoneum, safely place the first puncture cannula (Trocar), successfully separate adhesion, and achieve the purpose of surgery on the premise of minimally invasive is a problem that gynecological endoscopists need to solve.