2017年 · 第52卷第10期

venous thromboembolism (VTE), including deep venous thrombosis (DVT) and pulmonary embolism (PE), is the primary factor that threatens patients' life safety during the perioperative period. VTE after gynecological surgery is not uncommon, but it has not attracted widespread attention from medical institutions and medical staff in China, and no corresponding prevention guidelines have been formed. Therefore, according to the existing experience of prevention and treatment of VTE after gynecological surgery in China, and with reference to domestic and foreign diagnosis and treatment guidelines, mainly including the 9th edition guidelines of the American College of Chest Physicians (ACCP) and the 2007 guidelines of the American Association of Obstetricians and Gynecologists (ACOG), for patients who did not suffer from VTE before surgery, after discussion by domestic experts, a consensus on the prevention of DVT and PE after gynecological surgery in China was formulated.

venous thromboembolism (VTE) includes deep venous thrombosis (DVT) and pulmonary embolism (PE), where PE is an important cause of sudden death after surgery. In unprevented medical and surgical patients, the incidence of DVT is as high as 10% to 40%, while PE secondary to DVT causes 10% of inpatient deaths and 40% of deaths after gynecological surgery^[1,2]。 Studies in the population showed that 40.9% of PE patients died within 7 d and 45.4% within 30 d^[3]。 In western countries, VTE has been highly valued, and corresponding guidelines for screening and prevention have been formed. However, in China, the "hijab" of the characteristics of VTE after gynecological surgery has only been gradually unveiled in the past 10 years. The release of the Expert Consensus on the Prevention of Deep Vein Thrombosis and Pulmonary Embolism after Gynecological Surgery indicates that the screening and prevention of VTE after gynecological surgery in China is no longer without evidence.

cesarean scar diverticulum (CSD), also known as cesarean scar defect, is a secondary defect of the lower segment of the uterus. It is a local muscle layer loss state formed by poor scar healing at the uterine incision of previous cesarean section, forming a cavity at the original uterine incision position and communicating with the uterine cavity^[1]。 At present, the risk of re-pregnancy after cesarean section has been widely concerned, but the perinatal outcome of re-pregnancy in pregnant women with CSD is rarely mentioned. This article summarizes the repregnancy situation of CSD pregnant women in the Hospital of Obstetrics and Gynecology affiliated to Zhejiang University School of Medicine, in order to analyze the impact of CSD on repregnancy of pregnant women and explore the management of such pregnant women during pregnancy.

Miller-Dieker syndrome (MDS) is a rare teratogenic and fatal chromosome microdeletion syndrome. Most children die before the age of 2 years, and only a very small number of children can survive to adulthood. Its clinical features include anencephaly and/or megalencephaly, facial structural abnormalities, growth retardation, severe mental retardation, etc^[1]。 Because the prognosis of children with MDS is extremely poor, its prenatal diagnosis is very important; However, the formation time of fetal cerebral sulcus is relatively late, and it is difficult to diagnose anencephaly and megalencephaly before 24 weeks of pregnancy^[2]。 This paper summarizes the clinical data of 2 cases of MDS newly mutated fetuses diagnosed in the second trimester of pregnancy, and summarizes the anencephaly and/or megalencephaly and other non-specific ultrasound findings of MDS fetuses reported in the literature, aiming to provide clinical ideas for early screening and diagnosis of MDS fetuses.

Induced abortion can quickly and effectively terminate pregnancy, is a remedy for contraceptive failure, and is also the main means of terminating unwanted pregnancy. However, after induced abortion, uterine atony and tissue residue often lead to persistent bleeding, anemia, intrauterine infection and other symptoms. These complications affect the physical and mental health and quality of life of patients. Baoshan Branch of Shanghai First People's Hospital treated 100 women with induced abortion from December 2015 to November 2016 with oxytocin nasal spray to reduce bleeding after induced abortion, and the curative effect was positive. The results are reported as follows.

The incidence of ovarian epithelial carcinoma (ovarian cancer) accounts for the first of the ovarian malignant tumors. Metastasis of ovarian cancer is an important part of its biological characteristics, and most ovarian cancer-related deaths are caused by tumor metastasis^[1]。 MicroRNAs (miRNAs) are highly conserved and tissue-specific and are important factors in post-transcriptional regulation^[2]。 With the in-depth research on miRNA, the functions of miRNA clusters have attracted researchers' attention. Previous studies of our research group found that the expression of miRNA-424 (miR-424) and miRNA-503 (miR-503) in serum and cancer tissues of patients with advanced ovarian cancer was significantly high^[3]。 Bioinformatics analysis (www.targetscan.org) showed that miR-424 and miR-503 are members of the same miRNA cluster, and mitogen-activated protein kinase (MAPK) 1 and MAPK3 are target genes for miR-424 and miR-503, respectively. It was found that extracellular signal-regulated kinase (ERK) 1/2 activation can alter Ca²⁺The ERK1/2/MAPK1/MAPK kinase (MEK) 1/2 signaling pathway may be closely related to the proliferation and migration of ovarian cancer cells^[4,5]。 In this study, A2780 cells of ovarian cancer cell line with moderate metastatic ability and low expression level of miR-424 and miR-503 were selected for transfection of target miRNAs (i.e. miR-424 and miR-503). The regulatory effects of overexpression of miR-424 and miR-503 on the proliferation and migration ability of ovarian cancer cells were investigated, and the possible mechanism of action was explored by studying the relationship between this miRNA cluster (i.e. miR-424 and miR-503 clusters) and MAPK signaling pathway.

It is usually difficult to diagnose female reproductive tract malformations before surgery, especially complex reproductive tract malformations or even multiple malformations combined with urinary system. Three-dimensional (3D) printing is an emerging technology that helps to create accurate anatomical models. The basic principle is to create a data set from CT or MRI, and the data of CT or MRI scanned images are saved in DICOM format and input to image processing software; After that, the image data processed by these software are transmitted into the 3D printing system, and the printed materials are used to realize the 3D reproduction of the original anatomy. In the field of healthcare, as early as 1997, 3D printing technology was first applied to orthopedic oral and maxillofacial surgery. The use of 3D printing technology has been extended to vascular surgery, orthopedics, oncology and other majors, and is used for anatomical evaluation of preoperative lesions, as well as individualized customization of prefabricated bone models or creation of patient-specific implant prostheses. The application in the field of gynecology is still limited. This study attempts to perform 3D image reconstruction and complete 3D printed models based on thin-slice MRI data to assist in the preoperative diagnosis of complex reproductive tract malformations.

hypertensive disorders complicating pregnancy (HDCP) is a pregnancy-specific disorder characterized by increased blood pressure after 20 weeks of pregnancy [systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90 mmHg, 1 mmHg =0.133 kPa], proteinuria and edema, and may be accompanied by systemic multiple organ damage. In severe cases, it can affect the health of mother and child and even be life-threatening. Studies have found that HDCP has common risk factors with cardiovascular diseases, such as chronic hypertension, obesity, fat metabolism disorders and insulin resistance^[1]。 It is currently considered that advanced age, overweight before pregnancy [body mass index (BMI) ≥24 kg/m²], abnormal glucose metabolism, pregnant women with chronic kidney disease are more likely to develop HDCP^[2]。 Although HDCP has always been a hot spot in obstetrics, its exact pathogenesis is not very clear, which limits the understanding of the nature of HDCP disease and its effective diagnosis and treatment^[3]。 In 2012, the Sleep Apnea Group of the Respiratory Branch of the Chinese Medical Association formulated the Guidelines for the Diagnosis and Treatment of Obstructive Sleep Apnea Hypopnea Syndrome.^[4], mentioned that obstructive sleep apnea (OSA) may cause lesions including hypertension during pregnancy or preeclampsia. In the same year, the Group of Hypertensive Disorders in Pregnancy of the Obstetrics and Gynecology Branch of Chinese Medical Association formulated the Guidelines for the Diagnosis and Treatment of Hypertensive Disorders in Pregnancy (2012 Edition)^[5], which was revised in 2015^[6]The revised HDCP diagnosis and treatment guidelines include the classification, diagnosis, management, prevention and management of diseases. However, none of the relevant contents involve OSA. In recent years, a large number of studies have shown that HDCP and OSA have a close relationship. This paper discusses the related research progress of the two.

Endometriosis (endometriosis) is a benign disease of endometriosis beyond the uterine cavity. In the pathogenesis of endometriosis, ectopic endometrium not only undergoes important pathological processes such as adhesion, invasion and angiogenesis, but also undergoes periodic exfoliation and proliferation under the action of hormones, and there is a damage repair process similar to fibrotic diseases. Moreover, through the observation of pathological tissues, it is found that endometriosis has an important histological feature, namely, there is a large number of dense fibrous tissue around ectopic lesions, which has the same characteristic manifestation as fibrotic diseases. Therefore, it is believed that endometriosis may be a fibrotic disease, and fibrosis formation is also an important pathological process in the pathogenesis of endometriosis. As the most critical cells in tissue damage repair, myofibroblasts can participate in the formation of fibrosis by secreting a large amount of extracellular matrix and activating fibrosis signaling pathways. At present, it has been confirmed that it plays an important role in pathological processes such as liver cirrhosis, renal interstitial fibrosis and myocardial fibrosis. This article reviews the origin of myofibroblasts in endometriosis and their role in the formation of endometriosis fibrosis, in order to elucidate the mechanism of endometriosis fibrosis formation and find the target of anti-fibrosis therapy.

Cervical cancer is one of the common gynecological malignant tumors, and lymph node metastasis is the most important metastasis mode. Although lymph node metastasis is not involved in clinical staging, patients with lymph node metastasis often suggest poor prognosis. Radiotherapy, as one of the main treatments for cervical cancer, is suitable for all stages, especially locally advanced patients. extended-field radiation therapy (EFRT) for cervical cancer, also known as extended-field radiation therapy, refers to radiation therapy with the upper boundary of the irradiation field above the bifurcation of the abdominal aorta. It is mainly used for patients with para-aortic lymph node (PALN) or high common iliac lymph node metastasis, aiming to control or kill the metastatic lesions in the PALN drainage area, reduce regional recurrence and distant metastasis, improve the local control rate of tumor, and prolong the overall survival time. This article reviews the application of EFRT in cervical cancer, and provides reference for clinical work and related research.