2017年 · 第52卷第02期

Laparoscopic technology uses electronic and optical equipment to complete complex surgery through small holes, which has the characteristics of fewer complications, safety, rapid recovery, fewer adhesions and mild incision pain. Traditional two-dimensional (2D) laparoscopy has been widely used in benign and malignant gynecological diseases. With the continuous expansion of laparoscopy in various complicated and difficult surgery of benign and malignant diseases in the field of gynecology, higher and higher technical requirements are put forward for traditional 2D laparoscopy. The biggest disadvantage of traditional 2D laparoscopy is that the surgical field of vision is a planar image, which lacks the perception of depth. Surgeons can only judge the depth of field according to the perceptual factors such as laparoscopic movement, anatomical size, texture gradient, line perspective, defocus blurring, etc. Therefore, 2D laparoscopic surgery requires surgeons to have rich surgical experience and skilled operating skills, and surgeons need a long learning curve to master it. In recent years, the development of three dimensions (3D) laparoscopy has effectively solved the above disadvantages. The surgical field is clearer, the anatomical level is more obvious, and the operability and safety of gynecological laparoscopic surgery are greatly improved^[1]。 In order to promote the standardized application of 3D laparoscope in the field of gynecology in China, by gathering the clinical experience of domestic gynecological laparoscope experts and analyzing the advantages and disadvantages of clinical application of 3D laparoscope, the development of 3D laparoscope and the current application status of 3D laparoscope in gynecological surgery are expounded, and this "Expert Opinion on the Application of 3D laparoscope in gynecological surgery" is formed, which provides a reference for the standardized application of 3D laparoscope in China.

Endometriosis (endometriosis) and uterine leiomyoma are common diseases in women of reproductive age. With the continuous understanding of these two diseases, health economics and humanized and individualized treatment are paid more and more attention, and the diagnosis and treatment guidelines of various countries are constantly updated. But there is still a large lack of consensus on pharmacological and surgical treatment of endometriosis and uterine leiomyoma. Based on the regional standardized guidelines and published research results on the application of gonadotropin-releasing hormone agonist (GnRH-a) in the above two diseases in the past five years, the comprehensive "Guidelines for the Diagnosis and Treatment of Endometriosis"^[1]The present "Expert Opinion on the Application of Gonadotropin-Releasing Hormone Agonist in the Treatment of Endometriosis and Uterine Leiomyoma" has been discussed with experts in related fields in China.

Preventing mother-to-child transmission of hepatitis B virus (HBV) is the key to controlling chronic hepatitis B. At present, all newborns in China are vaccinated with hepatitis B vaccine free of charge, and newborns delivered by HBsAg-positive pregnant women are injected with 100 U hepatitis B immunoglobulin (HBIG) free of charge within 12 hours of birth^[1]However, there are still prophylactic failures, mainly due to high maternal viral load, i.e. HBV DNA ≥10⁶Copies/ml. Recently, oral anti-HBV drugs to reduce mother-to-child transmission in the third trimester of pregnancy have become a research hotspot, and the related issues are discussed as follows.

In recent 30 years, various factors have led to the rapid increase of cesarean section rate in China. The national sample survey of cesarean section rate in 2011 shows that the total cesarean section rate is 54.5%, and the hospitals with the highest cesarean section rate reach 81.6%^[1]。 High cesarean section rate has become a serious medical and social problem in China, and various short-term and long-term complications after cesarean section are increasingly apparent. Through clinical investigation, this study explores the short-term and long-term effects of parturients after cesarean section, so as to correctly understand the advantages and disadvantages of cesarean section.

unexplained recurrent spontaneous abortion (URSA) is a common clinical abnormal pregnancy, which seriously endangers women's reproductive health. Current studies generally suggest that the occurrence of most early URSA is related to the imbalance of immune tolerance caused by abnormal immunoregulation at the maternal-fetal interface^[1]。 Type 1 helper T lymphocytes (Th) and Th2 cytokines play an important role in immune regulation in early pregnancy. Th1/Th2 balance plays an important role in normal pregnancy. Th1/Th2 balance imbalance may be an important cause of miscarriage^[2]。 Natural killer T lymphocytes (NKT cells) are a large class of special immune cells with both the function of natural killer (NK) cells and the characteristics of T lymphocytes. After activation, they can produce a large number of cytokines, which can regulate the immune balance of Th1/Th2^[3]。 NKT cells are classified into three categories: constant NKT cells, non-constant NKT cells, and NKT-like cells. Existing studies have found that NKT cell activation can induce abortion in pregnant mice^[4]； Increased pregnancy success in URSA patients with reduced NKT-like cells following immunotherapy^[5]。 Whether there is a correlation between the occurrence of URSA and NKT-like cells, and which subtype of NKT-like cells are related to URSA, it is still unclear. This study aimed at this problem, and analyzed the expression of NKT-like cell subtypes and related Th1-type and Th2-type cytokines in peripheral blood and decidual tissues of patients with URSA to explore the correlation between NKT-like cells and URSA.

recurrent spontaneous abortion (RSA) refers to two or more spontaneous abortions with the same sexual partner. It is a common pregnancy complication, with an incidence rate of 1% to 5% in women of childbearing age^[1]。 Because the probability of miscarriage in RSA patients is significantly increased when pregnant again, RSA has attracted much attention. Normal pregnancy depends on the normal differentiation of trophoblasts and the construction of uteroplacental vascular network. In this process, if trophoblasts are excessively apoptotic or have abnormal infiltration ability, and the uteroplacental vascular network is poorly constructed, the embryo may stop developing, and then miscarriage may occur. FK506-binding protein 4 (FKBP52), a member of the immunosuppressive tacrolimus (also known as FK506) -binding protein family, is an essential regulator of PR and is involved in blastocyst implantation^[2]。 Studies suggest that the abnormal expression of FKBP52 may be related to the pathogenesis of RSA. The expression of FKBP52 in the villi of RSA patients was significantly lower than that of normal pregnant women^[3]。 Low expression of FKBP52 may affect blastocyst implantation and embryo development, and even cause abortion. However, the regulatory mechanism causing the decrease of FKBP52 expression in RSA patients is still unclear, and microRNA (miRNA) may play a role in it. In this study, we analyzed the expression differences of FKBP52 and miRNA-29a-5p (miR-29a-5p) in trophoblast cells of RSA patients, investigated the molecular mechanism of the decrease of FKBP52 expression in RSA patients, and preliminarily explored the relationship between miR-29a-5p and RSA.

Epithelial ovarian cancer (ovarian cancer) is one of the most common malignant tumors in women. Due to the problems of high toxicity and drug resistance of synthetic chemical drugs, the treatment effect of ovarian cancer is not ideal. At present, there is an urgent need for high-efficiency, low toxicity and specific ovarian cancer treatment drugs^[1]。 Polyadenosine diphosphate ribose polymerase (PARP) is a cleavage substrate of cysteine aspartate protease (caspase), a core member of apoptosis. It plays an important role in DNA damage repair and apoptosis, and may be a new targeted therapeutic target for ovarian cancer^[2,3]。 Clauszoline-Ⅰ is a carbazole alkaloid isolated from Yellowcortex pilosus and has anti-tumor activity^[4,5]It is of great significance to conduct in-depth research on the pharmacodynamics and mechanism of action of Clauszoline-Ⅰ. In this study, the anti-tumor effects of Clauszoline-Ⅰ on eight ovarian cancer cell lines (including HO8910, ES-2, SKOV3, OV1, OV2, 3AO, OVCA420 and CAOV3 cells) were screened, and the most potent inhibitory effect of HO8910 cells was selected as the research object. The effect of Clauszoline-Ⅰ on the proliferation and apoptosis of HO8910 cells was investigated, and its anti-ovarian cancer effect and its possible mechanism were discussed.

A 40-year-old pregnant woman with 1 pregnancy and 0 delivery was admitted to hospital on April 16, 2015 due to 21 weeks of menopause with nausea and vomiting for 2 days. Physical examination after admission: body temperature 37.1 ℃, pulse 70 beats/min; Soft abdomen, no obvious tenderness, no rebound pain and muscle tension. The abdominal swelling is as big as 21 weeks of pregnancy, the fundus of the uterus is located in a transverse finger under the umbilicus, no uterine contractions are palpable, and the fetal heart rate is 130 beats/min. Blood routine: WBC 12.7×10⁹/L, with a neutrophil ratio of 78.3%. Blood biochemistry: sodium 128.6 mmol/L, potassium 3.2 mmol/L, calcium 2.2 mmol/L; Serum amylase was 403 U/L (normal range, 0-110 U/L) and lipase was 207 U/L (normal range, 0-60 U/L). Abdominal B-ultrasound examination showed that there was no obvious abnormality in liver, gallbladder and pancreas. General surgery consultation was initially diagnosed as hyperamylase and hyperlipasaemia (acute pancreatitis is likely), and he was admitted to the pancreatic center of our hospital. After admission, he was given conservative treatment such as fasting, fluid rehydration and antiemetic, and his nausea and vomiting improved without abdominal pain. After 5 days, serum amylase was 526 U/L and lipase was 225 U/L. Abdominal B-ultrasound examination showed no abnormalities in biliary tract and pancreas. It is considered that hyperamylase hyperlipasemia in pregnant women is not caused by acute pancreatitis, but may be related to hyperemesis gravidarum. On the 8th day of admission, the serum amylase was 327 U/L and lipase was 154 U/L. The pregnant woman was generally in good condition, so she was discharged on the same day. After 1 month follow-up, the pregnant women had no nausea and vomiting, and the serum amylase and lipase levels were normal.

Gynecological malignant tumors mainly metastasize through direct infiltration of surrounding tissues and hematogenous or lymphatic routes. Whether para-aortic lymph node (PALN) is involved is crucial to the prognosis evaluation and treatment plan formulation of gynecological malignant tumors, especially for locally advanced cervical cancer and endometrial cancer patients with high risk factors (including myometrial infiltration>1/2, poorly differentiated adenocarcinoma and pathological type of serous adenocarcinoma, clear cell carcinoma or carcinosarcoma)^[1,2]。 At present, the commonly used imaging tests to judge whether PALN has metastasis mainly include CT, MRI and positron emission tomography (PET) -CT examination, but MRI and CT examination are very important for the diameter<The sensitivity of 1 cm metastatic PALN was low, but the false negative rate of PET-CT was 10% ~12%^[3,4]。 It can be seen that the imaging examination is not sufficient to fully and effectively identify PALN involvement. With the continuous improvement and innovation of laparoscopic technology, the feasibility and effectiveness of laparoscopic para-aortic lymphadenectomy (PAL) have been confirmed. Its surgical and tumor outcomes are comparable to those of open surgery, and it has the advantages of fewer surgical complications and fast recovery, and the quality of life of patients in the early postoperative period is better^[5,6]。 There are two surgical routes for laparoscopic PAL, i.e. the transperitoneal approach and the extraperitoneal approach. Since 2000 Dargent et al.^[7]It is reported that laparoscopic extraperitoneal PAL has been widely used abroad since it was applied to cervical cancer. In recent years, single-port laparoscopic extraperitoneal PAL and robot-assisted extraperitoneal PAL have gradually been developed in clinical practice, but the research and application of extraperitoneal PAL in China is still rare. In this paper, the approach methods, advantages, complications and limitations of laparoscopic extraperitoneal PAL are described.

The decision to delivery interval (DDI) refers to the time from the decision to perform a cesarean section until the fetus is delivered from the mother. DDI is an important index to evaluate the quality of obstetrics and identify medical disputes internationally. In 2000, Lucas et al.^[1]Cesarean section is divided into four categories: (1) Class I cesarean section: that is, cesarean section that directly threatens the life of mother and child and needs to be carried out every second, such as fetal distress, umbilical cord prolapse, placental abruption, placenta previa hemorrhage and other emergencies. (2) Class II cesarean section: there is a high risk for the mother or fetus, but it does not immediately threaten the life of the mother and child. Clinically, the common ones are severe hypertensive disorders during pregnancy (preeclampsia, eclampsia), intrauterine infection, stasis in the active phase, relative cephalopelvic disproportion, and labor of women who plan to undergo elective cesarean section. (3) Class III cesarean section: there is no risk for both mother and child, but the pregnancy still needs to be terminated quickly, such as pregnancy complicated by heart disease and cardiac insufficiency. (4) Class IV cesarean section: choose a cesarean section suitable for both doctors and patients. The common ones are severe pelvic stenosis, macrosomia, precious children, etc. Among them, Class I and Class II cesarean section belongs to emergency cesarean section. Studies have shown that the perinatal outcome of emergency cesarean section is relatively worse than that of elective cesarean section, especially Class I cesarean section^[2]。 Therefore, the optimal time limit for DDI in emergency cesarean section and the impact of DDI on perinatal outcome have been a topic of controversy among scholars.

Pelvic floor dysfunction is a defect or injury disease of pelvic floor supporting tissue, mainly including urinary incontinence, pelvic organ prolapse (POP), sexual dysfunction, fecal incontinence and other diseases. It is a large class of diseases that seriously affect the quality of life of patients. Epidemiological data show that pregnancy and childbirth are independent risk factors for pelvic floor dysfunction^[1,2]。 Physiological changes during pregnancy and childbirth caused by increased abdominal pressure, decreased collagen in pelvic floor supporting structure, etc., reduced pelvic floor muscle strength and relaxed pelvic floor supporting tissue, which is the prone stage of pelvic floor dysfunction disease^[3]； The early changes of pelvic floor dysfunction disease are the biochemical and electrophysiological changes of pelvic floor supporting tissues. If the injury develops further, symptomatic pelvic floor dysfunction disease will appear. Prevention and treatment of pelvic floor dysfunction diseases should start from pregnancy and postpartum. Therefore, to elaborate the prevention and treatment of pelvic floor dysfunction diseases, it is necessary to analyze the relationship between pregnancy and childbirth and the occurrence and development of pelvic floor dysfunction diseases.

Endometrial cancer is one of the common malignant tumors in gynecology. With the increase of obesity rate in the world, its incidence is increasing year by year, and it is showing a young trend. Studies have pointed out that 20% to 25% of endometrial cancer and endometrial dysplasia are seen in premenopausal women, of which 3% to 5% of patients are age<40 years old (70% of whom are still childless)^[1]。 Total hysterectomy + bilateral adnexectomy ± pelvic lymphadenectomy is the traditional treatment for endometrial cancer and endometrial atypical hyperplasia, but it undoubtedly deprives patients of fertility. In order to satisfy the desire of young patients to preserve their reproductive function, pharmacological conservative treatment methods came into being. At present, oral progesterone and levonorgestrel-releasing intrauterine system (LNG-IUS) have positive efficacy. However, due to the lack of randomized prospective studies with a large sample size, a unified plan for conservative treatment has not been reached. There are still controversies about drug dosage, medication duration, follow-up plan, and uterine retention after treatment. This article reviews the classification of endometrial hyperplasia and the progress of conservative treatment of endometrial hyperplasia (including endometrial hyperplasia without dysplasia and endometrial atypical hyperplasia) and early endometrial cancer by reviewing relevant clinical and experimental studies at home and abroad in recent years.