2017年 · 第52卷第12期

Uterine fibroids are benign tumors formed by the proliferation of uterine smooth muscle tissue, and are the most common benign tumors in women. The incidence of uterine fibroids is difficult to accurately count. It is estimated that the prevalence of women of childbearing age can reach 25%, and the incidence according to autopsy statistics can reach more than 50%. At present, there is no consensus or guideline on the diagnosis and treatment of uterine fibroids in China.

maternal mortality rate (MMR) and perinatal mortality rate (PMR) are the only and very important indicators for assessing obstetric quality in the past. From 1990 to 2015, the global total MMR decreased by 44% (from 385 per 100,000 to 2.16 million per 100,000)^[1]； China's MMR dropped from 88.8/100,000 in 1990 to 20.1/100,000 in 2015, a remarkable achievement. In 2016, China's MMR dropped to 19.9/100,000, which is close to the MMR of developed countries; PMR dropped to 7.5‰^[2]。 Maternal death has become a rare clinical event, and the level of MMR can no longer fully represent the clinical quality of obstetrics in a certain hospital and a certain area. It is worth noting that data from 2015 show that there are still 4.8 million perinatal deaths worldwide, of which 2.6 million are stillbirths. The incidence of stillbirths in China is 1% to 4%^[3,4,5]Compared with maternal death, stillbirth is more common, and stillbirth is an important cause of maternal anxiety, depression and post-traumatic stress disorder. At present, the incidence of stillbirth has become a new index to judge the quality of obstetrics and evaluate the comprehensive strength of the country or region^[6]It deserves the attention of obstetric medical workers.

chronic pelvic pain (CPP) is a group of diseases caused by various functional and organic causes, with pain in the pelvic cavity and its surrounding tissues as the main symptom, and the course of disease exceeds 3 to 6 months^[1]。 CPP is a common disease in women, and the incidence of CPP is 5.7% ~26.6% in women during reproductive period^[2]。 CPP generally refers to chronic pelvic pain with clear etiology and related to specific organ diseases, while chronic pelvic pain with unclear etiology is called chronic pelvic pain syndrome (CPPS), which is a branch of CPP. Myofascial-derived CPP is classified as CPPS^[3]。 CPP is difficult to diagnose and treat due to its complex etiology, which often seriously affects the physical and mental health of patients, and can lead to problems such as decline in patients' quality of life, sexual dysfunction and increase in medical expenditure. This study aimed at evaluating the efficacy of transcutaneous electrical nerve stimulation (TENS) combined with endorphins, biofeedback and manual massage in patients with myofascial CPP by using pressure pain threshold and pain score methods, and explored new methods and ideas for treating such diseases.

A 27-year-old patient underwent cesarean section in a foreign hospital in June 2012. During the operation, a right mesangial mass was found, the size of 7 cm x 5 cm x 4 cm; Postoperatively, the pathology department of Qilu Hospital of Shandong University was consulted and diagnosed as low-grade serous carcinoma of the right mesangial tube. One month later, he was admitted to our hospital for right adnexectomy + left fallopian tube resection + omentectomy + pelvic and abdominal para-aortic lymphadenectomy. No tumor was found in postoperative pathological examination, and he was treated with paclitaxel + cisplatin (TP) chemotherapy for 3 courses. Two years later, the patient had abdominal distension, and B-ultrasound examination showed cyst in the right adnexal area and cystic mass in the posterior uterus; Pelvic CT showed multiple cystic lesions in the pelvic cavity; Serum CA₁₂₅The level was 15.47 kU/L. The outpatient clinic receives "pelvic mass" in our hospital. Gynecological examination: a mass with a size of 5 cm ×4 cm can be palpable behind the uterine body. Laparoscopic exploration revealed extensive adhesion of the left ovary to the posterior lobe of the broad ligament and sigmoid colon, and two cystic-solid masses in the recto-uterine depression. Intraoperative rapid frozen pathological examination revealed granulosa cell tumor, which was changed to total transabdominal hysterectomy + left ovariectomy + retroperitoneal lesion resection. Postoperative pathology: (recto-uterine depression, mesenteric) juvenile granulosa cell tumor, no tumor in uterus and left ovary. Immunohistochemical detection: CD₉₉, calcium binding protein (CR), vimentin (vimentin), CD₅₆, cytokeratin (CK), Wilms tumor gene 1 (WT-1) were all strongly positive (+ + ~ + + +), α-inhinbin (α-inhinbin), p53, CK7 were scattered positive (+), cell proliferation-related nuclear antigen (Ki-67) 10% ~15% (+), synaptophysin (Syn) was weakly positive (±), CA₁₂₅CD₁₁₇, CK20, and chromaffin A (CgA) were all negative (-). Two consultations with the Pathology Department of the Cancer Hospital of the Chinese Academy of Medical Sciences showed that: (right mesangial tube, rectal uterine depression, mesenteric) malignant tumor, the tumor cells are short fusiform, arranged in a solid, tubular, microcapsular sieve shape (Figure 1，Figure 2), diagnosed as a malignant Wolffian adnexal tumor (WAT). Six courses of TP regimen chemotherapy were performed postoperatively. In September 2015 (7 months after discontinuation of chemotherapy), the patient was admitted to Qilu Hospital due to abdominal mass. Postoperative pathological diagnosis: small mesenteric malignant tumor, combined with medical history, tending to malignant WAT. Three courses of chemotherapy were followed by cyclophosphamide + doxorubicin + cisplatin (CAP) regimen. In October 2016, ascites was discovered, and malignant tumor cells were found in cytological examination. Please consult the Department of Pathology, Peking University People's Hospital, and be diagnosed as malignant WAT. In November of the same year, the patient was admitted to the oncology department of our hospital, and received intraperitoneal perfusion of cisplatin 60 mg and medroxyprogesterone 200 mg/d for endocrine therapy. After 3 months of treatment, ascites was significantly reduced. In June 2017, B-ultrasound showed a small amount of ascites but the patient had no conscious symptoms.

Endometriosis (endometriosis) is a common disease in women with hormone-dependent and organ-dependent characteristics. According to the 2015 Guidelines for the Diagnosis and Treatment of Endometriosis^[1]endometriosis is divided into peritoneal endometriosis (PE), endometriosis cysts of the ovary, and deep infiltrating endometriosis (DIE). And other types. The etiology of endometriosis is unknown, the manifestations are diverse, and the pain is difficult to cure, which has brought serious impact on the physical and mental health of patients. It has been found that increased nerve fiber density and focal macrophage infiltration play an important role in endometriosis-related pain, and increased nerve fiber density is inseparable from the role of neurotrophin (NT). Regarding the mechanism of action of NT in endometriosis-related pain, most studies focus on nerve growth factor (NGF), but less on brain derived neurotrophic factor (BDNF), NT-3, NT-4, NT-5, etc. This article reviews the relevant literature at home and abroad to explore the research progress of BDNF in endometriosis-related pain, in order to deeply understand the role of BDNF in endometriosis-related pain.

Epithelial ovarian cancer (ovarian cancer) is the most lethal malignant tumor of the female reproductive system. Cancer statistics in the United States show that in 2015, there were 21,290 new cases of ovarian malignant tumors and 14,180 deaths in the United States^[1]； China's cancer statistics show that in 2015, the incidence of ovarian malignancies in China was 52.1 per 100,000, and the mortality rate was 22.5 per 100,000^[2]。 Among ovarian malignancies, ovarian cancer is the most common, up to 70%. The onset of ovarian cancer is insidious, and 70% of patients are advanced at the time of consultation. At present, tumor cytoreductive surgery combined with platinum-based chemotherapy is still the first-line treatment for ovarian cancer. The sensitivity of initial chemotherapy for ovarian cancer is high, ranging from 60% to 80%, but 25% of early-stage patients and nearly 70% of advanced patients will relapse^[3]。 Since the 1990s, after 30 years of treatment exploration, the 5-year survival rate of ovarian cancer has always hovered around 30%, with no obvious improvement. The main reasons are the difficulty of early diagnosis of ovarian cancer and the emergence of chemotherapy resistance. The effective rate of chemotherapy after recurrence of ovarian cancer was significantly lower than that of the newly treated patients, especially the interval between no treatment<For 6-month platinum drug-resistant relapsed patients, the effective rate of second-line regimen single-agent or combined chemotherapy is only 20% ~30%, while more than 70% of patients with advanced ovarian cancer will develop platinum drug resistance within 5 years Drug resistance or even multidrug resistance^[4,5]It has become an important factor affecting the survival of patients. There are different subsets of tumor cells, with obvious individual differences. With the use of chemotherapy drugs, tumor cells can evolve biologically, become more aggressive, and appear acquired drug resistance. How to capture the most aggressive ovarian cancer cell subsets, reveal their characteristic molecular spectrum, and find possible gene therapy targets has become an important means to reverse drug resistance and improve the prognosis of ovarian cancer patients. In recent years, the detection technology of circulating tumor cell (CTC) has developed rapidly, with convenient materials, which can dynamically display the molecular biological characteristics of tumor cells. It has broad application prospects in early screening, treatment monitoring, prognosis assessment, molecular typing and individualized tumor treatment^[6,7]。 This article reviews the application of CTC in ovarian cancer.

Endometriosis (endometriosis) is one of the common obstetrics and gynecology problems, a group of syndromes, a chronic disease. Scholars have conducted a lot of research and accumulated rich experience. In 2007 and 2015, respectively, the "Standards for the Diagnosis and Treatment of Endometriosis" (Chinese Journal of Obstetrics and Gynecology, Issue 9, 2007) and "Guidelines for the Diagnosis and Treatment of Endometriosis" (Chinese Journal of Obstetrics and Gynecology, Issue 3, 2015) were released, which promoted the standardized diagnosis and treatment of endometriosis. The number of experts participating in the 2015 "Guide" increased from the original 15 to 30, taking into account all aspects of technological development, especially in the management of pain, mass and infertility, and also in-depth elaboration on surgery, deep infiltrative endometriosis (DIE), malignant transformation and postoperative management. In view of this, we have organized some experts to carry out focused and delicate interpretation for the reference of fellow peers.

The 13th World Congress on Endometriosis (WCE) was held in Vancouver, Canada on May 17-20, 2017. The conference presented, discussed and exchanged major scientific issues such as the epidemiological characteristics, pathogenesis, clinical diagnosis, treatment and endometriosis infertility of endometriosis (endometriosis). The content features of this conference include: further research on the pathogenesis of endometriosis; A deeper understanding of the nature of endometriosis; Pay attention to the immune abnormalities and comorbidities of patients with endometriosis; Pay attention to the quality of life of patients, especially abnormal sexual life; Focus on basic and assisted reproductive treatment of endometriosis infertility; Drug and surgical treatment of endometriosis remained one of the main contents of the conference.