2015年 · 第50卷第06期

Postoperative adhesion refers to the abnormal fibrous connection between tissues and organs caused by surgical trauma, which has become the most common complication of obstetrics and gynecology surgery. Depending on the site and tissue involved, adhesions can remain "stationary" or cause pathological complications, and in severe cases can even lead to life-threatening intestinal obstruction.

pelvic organ prolapse (POP) is a common disease that affects the quality of life of middle-aged and elderly women. It belongs to pelvic floor dysfunction disease (PFD) and is the main disease solved by pelvic floor reconstruction surgery (PFRS). The incidence of POP in women aged 50-79 is 30%-41%^[1]Recent data show that the probability of a woman's lifetime surgery for POP or stress urinary incontinence by the age of 80 is 20%^[2]。 With the deepening of clinical anatomy research and the development of medical biomaterials, PFRS has established new concepts and new surgical methods, and has developed rapidly. All kinds of new operations are constantly introduced, which to some extent suggests that there is no "gold standard" surgical procedure for pelvic floor reconstruction. How to correctly grasp the different pelvic floor reconstruction surgery and surgical indications of POP is a huge challenge for gynecologists at present.

Cervical cancer is a common malignant tumor of female reproductive system. There are about 470,000 new cases of cervical cancer worldwide every year, about 230,000 women die from this disease, and most of the new cases and deaths (about 80%) occur in developing countries^[1]。 The Twist gene was first discovered in 1983 while studying abnormal embryonic development in Drosophila^[2]。 Many studies have shown that Twist gene plays a key role in tumor growth, metastasis, invasion, drug resistance and anti-apoptosis. In this study, the expression of Twist protein in early cervical cancer and cervical intraepithelial neoplasia (CIN) tissues was detected by immunohistochemistry, and its clinical significance was analyzed.

Beta thalassemia (beta thalassemia) is one of the most common autosomal recessive hereditary diseases, which is distributed regionally. Its population carriage rate is 2% ~25%, and its incidence rate is very high in the south of the Yangtze River in China. Children with beta thalassemia major, who develop anemia symptoms 4 to 6 months after birth, need to receive blood transfusion treatment, and mostly die in childhood. At present, prenatal diagnosis of beta thalassemia gene is an effective method to prevent the birth of children with beta thalassemia major. prenatal diagnosis includes both invasive and non-invasive prenatal diagnosis methods. The former mainly obtains sufficient fetal material through puncture technology for fetal genetic detection, but it has the risk of complications such as miscarriage, premature rupture of membranes and infection^[1,2]。 Non-invasive prenatal diagnosis refers to the isolation and collection of free fetal nucleated red blood cells (FNRBC) or cell-free fetal nuleic acid (cffNA) from maternal peripheral blood Prenatal diagnosis can avoid complications such as abortion caused by puncture surgery. Therefore, non-invasive prenatal diagnosis is an important research direction in the field of prenatal diagnosis.

In recent years, the research on stem cells has attracted much attention. In 1998, the University of Wisconsin in the United States successfully isolated the world's first human embryonic stem cell^[1]Stem cells can differentiate into all cell types that make up the body, theoretically form any tissue and organ, and even develop into complete individuals, which has started the research of pluripotent stem cells. In 2006, Japanese scientists overexpressed four pluripotent genes-OCT4, Sox2, Klf4, and c-Myc genes (i.e. OSKM genes) to reverse the dedifferentiation of mouse somatic cells and obtain pluripotent stem cells, which were named induced pluripotent stem cells (iPSC)^[2]。 This new type of cell, which is similar in morphology to embryonic stem cells, also possesses the basic characteristics of pluripotent stem cells that renew themselves and differentiate into three germ layers. Because there is no need to separate from the inner cell mass of early mammalian embryos, the emergence of iPSC technology avoids the ethical controversy brought about by embryonic stem cells; At the same time, compared with other types of stem cells, iPSC itself is derived from autologous somatic cells, so it can avoid immune rejection caused by allogeneic transplantation. Therefore, the research and application prospect of iPSC technology has attracted more and more attention of researchers and clinicians.

pelvic floor dysfunction (PFD), that is, pelvic organ prolapse (POP), stress urinary dysfunction (SUI), and sexual intercourse disorders caused by various etiologies, seriously affects women's physical and mental health and daily life. Current treatment modalities include conservative treatment (e.g. pelvic floor function exercises, medication, pessary placement) as well as surgical treatment. Surgery is the main treatment for severe PFD, and the recurrence rate of traditional repair surgery is as high as 40%. Mesh can provide sufficient support for pelvic floor tissue, better restore pelvic floor anatomy and reduce recurrence. However, with the widespread application of mesh, mesh-related complications have gradually appeared, such as mesh exposure, mesh erosion, infection, painful intercourse, etc., with an incidence rate of about 10%. In 2007 and 2011, the U.S. Food and Drug Administration (FDA) warned about the widespread use of synthetic mesh. Therefore, avoiding recurrence and reoperation of PFD and reducing complications have become hot issues at present. Scholars are constantly exploring new materials, improving the structure and weaving methods of mesh, making lightweight synthetic mesh with large apertures, and improving the flexibility, biocompatibility and mechanical properties of mesh^[1]However, the ideal mesh to meet the needs of pelvic floor reconstruction has not been constructed. Over the past decades, regenerative medicine has developed rapidly, and has been successfully applied to the construction of bones, ligaments, blood vessels and other tissues and organs, and has been initially applied to clinical practice; Research is also gradually being carried out in the field of pelvic floor functional restoration. The core of regenerative medicine is to use cells, extracellular matrix, cytokines and biological materials to construct tissue structures, and then replace, repair or enhance the anatomical structure and function of tissues and organs. Based on the pathogenesis and pathological changes of PFD, this paper discusses the feasibility of regenerative medicine and tissue engineering application in PFD, and reviews the basic research and clinical application status and prospect.

Epithelial ovarian carcinoma (ovarian cancer) is the most fatal gynecological malignant tumor. It is expected that there will be 21,980 new ovarian cancer patients and 14,270 deaths in the United States in 2014, which is significantly higher than that of cervical cancer and endometrial cancer^[1]。 Among them, about 70% of patients who die from ovarian cancer are advanced high-grade serous ovarian cancer (HGS-OvCa). Although standardized treatment of ovarian cancer has been widely carried out in clinical practice, including tumor cytoreductive surgery and postoperative combination chemotherapy based on platinum drugs, most ovarian cancer patients eventually die of tumor recurrence and drug resistance.

small cell neuroendocrine carcinoma of uterine cervix (SCNECUC) is a rare and unique cervical malignant tumor, which belongs to a type of neuroendocrine tumor and is one of the most aggressive gynecological malignant tumors. The incidence of SCNECUC is low, accounting for only 1% to 3% of cervical cancer^[1]。 In recent years, with the continuous deepening of research, people's understanding of SCNECUC and its clinical diagnosis and treatment have made certain progress, which are summarized as follows.

November 17-21, 2014, the 43rd AAGL global congress on minimally invasive gynecology, the Americam Association of Gynecologic Laparoscopists (AAGL) Held in Vancouver, Canada, thousands of endoscopists and gynecologists from all over the world attended the conference. This conference includes multi-faceted information such as conference exchange, poster display, surgical video broadcast and new product introduction.