2015年 · 第50卷第12期

intrauterine adhesions (IUA) are common uterine cavity diseases in gynecology, which are seriously harmful to reproductive function and have poor treatment effect, and seriously affect female reproductive physiology and physical and mental health. After the first publication of IUA in 1894, in 1948, Asherman described in detail 29 cases of IUA caused by abortion or postpartum curettage and curettage, and defined it as "traumatic amenorrhea", also known as Asherman's syndrome. At present, the incidence of IUA in China remains high, and it is increasing year by year with the increase of uterine cavity surgery. Literature reports show that the incidence of IUA caused by multiple induced abortion and curettage is as high as 25% ~30%^[1]It has become the main cause of decreased menstrual flow and secondary infertility. At present, there is no effective treatment for severe IUA to restore fertility function and menstrual physiology; The readhesion rate after hysteroscopic transcervical resection of adhesion (TCRA) was as high as 62.5%^[2]The success rate of pregnancy is only 22.5% ~33.3%^[3,4]。

The first meeting of the 12th editorial board (editorial board) of Chinese Journal of Obstetrics and Gynecology was held in Beijing on November 27th, 2015. The meeting was attended by leaders of the Chinese Medical Association and magazines, editorial board members, consultants and all staff of the editorial department from all over the country. Liu Bing, vice president of Chinese Medical Association Magazine, attended the meeting and delivered a speech. Professor Lang Jinghe, editor-in-chief of Chinese Journal of Obstetrics and Gynecology, delivered a speech and made a keynote speech. The main contents of the meeting are briefly introduced below.

With the rapid development of science and technology, all kinds of science and technology have penetrated into medicine, which has promoted the progress of clinical diagnosis and treatment. Endoscopic technology, new energy and new materials have been continuously developed and applied. The diagnosis and treatment of gynecological tumors has made great progress in such a big environment. Similarly, in such an era of changing concepts, the requirements of minimally invasive, the spiritual and aesthetic needs of patients have become more important. Gynecological oncologists are constantly pursuing better therapeutic effects with minimal surgical trauma. Through continuous practice and efforts, laparoscopic surgery has been applied in the treatment of gynecological malignant tumors, and it has developed rapidly and improved day by day.

perineural invasion (PNI) of malignant tumors, also known as neurophilic phenomenon or perineural invasion of malignant tumors, is one of the pathways of metastasis of malignant tumors. Cruveilheir^[1]It was first reported in 1835 that malignant tumors of the head and neck were found to grow along nerve infiltration and metastasize into the intracranial fossa. Later studies have also shown that PNI exists in many malignant tumors including pancreatic cancer, colorectal cancer, cholangiocarcinoma, prostate cancer, bladder cancer and other tissues, and it has been shown to be an important pathological factor with poor prognosis^[2,3,4]。

HELLP syndrome is a group of clinical syndromes manifested by hemolysis, elevated liver enzymes, and thrombocytopenia, and is a severe stage of hypertensive disorder during pregnancy with high adverse perinatal outcomes such as DIC, placental abruption, acute renal failure, pulmonary edema, subcapsular hematoma of the liver, retinal detachment, etc. Most of these symptoms appear before delivery, and HELLP syndrome, which occurs after delivery, is more difficult to manage. Recently, the Obstetrics and Gynecology Hospital affiliated to Zhejiang University School of Medicine successfully rescued a patient with postpartum HELLP syndrome, ruptured subcapsular hematoma of the liver and postpartum eclampsia due to hypertensive disorder during pregnancy, which is reported as follows in combination with literature review.

Adenomyosis is a common benign disease that affects the quality of life of women of childbearing age, and its main harm is progressive aggravation of dysmenorrhea and increased menstrual flow. Hysterectomy is the main treatment for symptomatic adenomyosis with definite and thorough efficacy. However, conservative treatment is the first choice for patients who want to preserve the uterus, such as oral hormonal drugs, lesion resection, uterine artery embolization, high intensity focused ultrasound (HIFU) ablation, etc^[1,2]。 HIFU ablation is a non-invasive thermal ablation technique, which has been applied in the treatment of adenomyosis. Relevant studies have shown that HIFU ablation can significantly improve the related symptoms of adenomyosis patients, and has a good curative effect in the short term^[3,4,5]However, the long-term efficacy is still unclear. The purpose of this study was to evaluate the long-term symptom relief and recurrence of adenomyosis treated with HIFU ablation, and to provide reference for the clinical treatment of adenomyosis and the selection of patients with HIFU ablation.

cystic adenomyosis refers to the presence of a large (≥5 mm in diameter) cystic cavity lesion filled with ectopic endometrial tissue and blood in the adenomyosis lesion, also known as adenomyosis cyst^[1]。 The incidence rate of this disease is low, and less than 100 cases have been reported at home and abroad, including adolescence and age<Patients aged 30 accounted for 65% to 75%. Due to the lack of understanding of the disease, clinicians often misdiagnose the disease as obstructive malformation of the reproductive tract or degeneration of uterine fibroids, and delay the treatment. In order to provide clinicians with experience in the diagnosis and treatment of cystic adenomyosis, this article retrospectively reviewed 802 cases of adenomyosis aged 12-55 years in Peking Union Medical College Hospital from 2008 to 2014, and collected 3 cases of cystic adenomyosis, which are now reported as follows in combination with literature review.

Preeclampsia refers to the syndrome of hypertension and proteinuria that emerges at 20 weeks of pregnancy and beyond, or diseases without proteinuria but with multi-system dysfunction, such as decreased platelet count, liver and kidney insufficiency, pulmonary edema and cerebrovascular accidents. Preeclampsia, with an incidence of 3% ~5% in pregnant women, is the main cause of maternal and perinatal mortality^[1]。 Preeclampsia can lead to fetal growth restriction (FGR) and premature birth, or develop eclampsia, which is a critical disease in obstetrics and seriously threatens the life safety of mothers and children^[1]。

In recent years, due to the increasing drug resistance of Mycobacterium tuberculosis, the incidence of genital tuberculosis in women of childbearing age has been on the rise. Khanna and Agrawal^[1]It is reported that between 1995 and 2005, the number of genital tuberculosis cases worldwide increased from 22 million to 186 million, mainly concentrated in developing countries, and 80% to 90% occurred in women of childbearing age between 20 and 40 years old^[2]It is one of the important factors causing infertility. The incidence of female genital tuberculosis induced infertility (FGTI) is reported to be 10% to 85% worldwide, especially in developing countries^[3]In 1998, retrospective analysis of the causes of infertility in our hospital showed that infertility caused by fallopian tube tuberculosis accounted for 28.4%^[4]。 However, in the diagnosis and treatment of infertility patients and the exploration of etiology, genital tuberculosis is often neglected by clinicians because of its hidden condition, which does not attract enough attention and in-depth research.

The International Union of Obstetrics and Gynecology (FIGO) staging of ovarian epithelial cancer (ovarian cancer) is the surgical pathological staging, which is formulated by the FIGO Gynecological Oncology Committee, and plays an extremely important role in clinical diagnosis, treatment and prognosis. The last edition of FIGO was released in Rio de Janeiro in 1988. With the continuous development of medical science, new discoveries challenge traditional ideas. Therefore, in order to improve its practicality, FIGO Gynecological Oncology Committee revised it and completed the revision in 2013. It was officially published in January 2014^[1]。 This article analyzes the changes of the new FIGO stage of ovarian cancer in 2013 and its basis.

gestational diabetes mellitus (GDM) refers to different degrees of glucose metabolism abnormalities caused by impaired glucose tolerance that occur or are first discovered during pregnancy^[1]In China, the incidence rate is about 3%. Epidemiological data show that with the change of people's lifestyle and the increase of disease detection rate, the incidence of GDM is increasing year by year^[2]。 Insulin sensitivity during pregnancy is lower than that before pregnancy, and insulin resistance is easy to occur. About 6% of pregnant women can develop GDM^[3]。 It has been determined that Ca²⁺As an important intracellular second messenger, it plays a role in insulin signaling pathway. It is currently believed that insulin resistance is associated with Ca²⁺There is a close relationship between transmembrane operation and metabolism^[4,5,6]。 This article gives a lecture on this topic.

With the development of medical science, laparoscopic technology has played an increasingly important role in the field of gynecological oncology treatment. Laparoscopic surgery is an instrument-dependent surgery, mainly using energy instruments, such as electric hook, electrosurgery, ultrasonic knife, vascular closure system (Ligasure), plasma knife (PK knife), laser knife, 100-gram forceps and other surgical energy instruments. Its advantages are obvious, greatly simplifying the surgical steps, reducing the difficulty of surgical operation, reducing secondary injury and bleeding, significantly shortening the operation time, fully reflecting the concept of minimally invasive, and greatly promoting the surgical technique of gynecological tumors; However, the organ damage caused by energy devices is also gradually increasing. Relevant studies have shown that the incidence of complications in laparoscopic surgery is 0.8% ~2.9%, and the incidence of serious complications such as ureter, bladder, gastrointestinal tract and vascular injury is 0.4% ~1.4%^[1,2]。

In June 2015, the 40th Annual Meeting of the International Urogynecological Association (IUGA) was held in Nice, France. Thousands of experts, scholars and related doctors in the field of gynecological urology from all over the world attended this conference. In this conference, scholars from all over the world discussed the hot spots in the field of gynecological urology. The relevant contents are reported as follows.

Placental implantation refers to the invasion of placental villi into the myometrium to varying degrees. According to the depth of placenta implantation into the myometrium and whether it invades the adjacent organs of the uterus, it is divided into placenta accreta, placenta increta and penetrating placenta implantation. Complete and partial placenta implantation according to implantation area^[1,2]。 In recent years, its incidence has reached 1/533, which is 20 times higher than before^[1]。 Has become an important cause of postpartum hemorrhage, emergency perinatal hysterectomy and maternal death^[3,4]It is a clinical problem that obstetricians must face.