2018年 · 第53卷第03期

In the past 10 years, the application of synthetic grafts in pelvic floor reconstruction surgery has promoted the development of female pelvic floor reconstruction. However, at the same time, the adverse event reports of complications related to synthetic medical mesh implantation made of polypropylene have also attracted the attention of gynecologists at home and abroad. The US Food and Drug Administration (FDA) issued safety warnings on the complications related to transvaginal mesh implantation twice in 2008 and 2011. At present, there is no international consensus on the clinical management of complications related to synthetic grafts in pelvic floor reconstruction surgery. Combined with the latest literature and expert experience at home and abroad, the Gynecological Pelvic Floor Group of Obstetrics and Gynecology Branch of Chinese Medical Association reached the following consensus on the treatment of complications related to the application of mesh in the surgical treatment of pelvic organ prolapse (POP) and the application of sling in the surgical treatment of stress urinary incontinence, in order to help clinicians correctly deal with related complications.

Hypertension [systolic blood pressure ≥140 mmHg (1 mmHg =0.133 kPa) and/or diastolic blood pressure>90 mmHg], proteinuria (24 h urine protein volume>0.3 g) after 20 weeks of gestation, which is called pre-eclampsia (PE); The incidence rate of PE is 2% ~8%, which is one of the main causes of maternal mortality^[1]。 Currently, although it has been demonstrated that placental growth factor^[2]placental protein 13,^[3]Soluble endothelial factor^[4]etc. can be used to monitor the occurrence and development of PE, but their sensitivity and specificity are poor. Therefore, it is urgent to develop and apply new diagnostic markers in clinical practice.

The 59-year-old patient was seen in Peking University People's Hospital on March 11, 2015 due to menopause for 2 years and irregular vaginal bleeding for 6 months. The ultrasound examination of the patient outside the hospital on February 7th showed that the solid space of the uterine fundus was 49 mm ×35 mm ×39 mm, which was closely related to the endometrium, and steatosis of uterine fibroids was considered. Diagnosis and curettage were performed on February 10; Postoperative pathology: Individual tumor-like hyperplasia glands can be seen in a few tissues of uterine cavity, with nipples, but tumors are not excluded. The patient was 17 years old and had regular menstruation; Pregnancy 1 delivery 1, full term natural delivery, no history of hydatidiform mole disease. Gynecological examination: vulva married multipartum type, prolapse of anterior vaginal wall; Anterior uterus, enlarged as 6 weeks pregnant, medium quality, poor activity, no tenderness; No abnormalities were observed in bilateral adnexes. Auxiliary examination: Blood hCG level was 30 318.00 U/L. Transvaginal color ultrasound examination: the anterior position of the uterus is 72 mm ×67 mm ×42 mm, the endometrium of the uterus cavity is not clear, there is a moderate echo mass, the range is 19 mm ×21 mm ×10 mm, and the distance from the serous layer is 11 mm. Orthographic radiography of the chest: multiple metastases of both lungs. On March 15, 2015, he was admitted to the hospital with "trophoblastic tumor (stage III:11)", and received 6 courses of intravenous chemotherapy with etoposide + cisplatin (EP) regimen from March to August 2015. In September 2015, the blood hCG level decreased to 0.95 U/L. Laparoscopic assisted total vaginal hysterectomy + bilateral adnexectomy was performed on October 8, 2015. Postoperative pathological examination showed that adenoid tumor tissue was seen in the left uterine corner, and some glandular epithelium was accompanied by mucus differentiation (Figure 1), large areas of necrosis can be seen in the focal area, between which foam-like histiocytes can be seen, a few multinucleated giant cells are scattered, and individual binucleated large cells can be seen (Figure 2）； Foam-like tissue cells were accumulated in the left fallopian tube, and tumor thrombus was seen in the mesangial vascular lumen of the right fallopian tube. Immunohistochemical staining results showed that ER and cytokeratin (CK) were positive (+), PR and p53 were focal (+), proliferation-associated nuclear antigen (Ki-67) 40% (+), and hCG was negative (-) in endometrioid adenocarcinoma. Postoperative pathological diagnosis: Endometrioid adenocarcinoma stage Ia (G₂) with mucus differentiation and trophoblastic nests (trophoblastic components basically disappear after chemotherapy); The size of the tumor was 20 mm ×15 mm and the depth of invasion of the muscle wall<1/2。 On October 29, 2015, the blood hCG level was 7.61 U/L, and I received one course of EP regimen chemotherapy the next day; After chemotherapy, nausea, vomiting, numbness of limbs and other reactions occurred, and 2 courses of chemotherapy were changed to paclitaxel + cisplatin regimen; Later, due to abnormal renal function, the chemotherapy regimen was changed to paclitaxel + carboplatin regimen for 2 courses of chemotherapy, and the last chemotherapy time was April 26, 2016. After chemotherapy, the patient was reviewed regularly. At present, the patient survived without recurrence and is still being followed up.

Overweight and obesity are now one of the major disease burdens worldwide, and with it, the incidence of overweight and obesity among women of reproductive age is also increasing. A recent systematic retrospective study showed that the global incidence of overweight and obesity among adult women increased from 29.8% to 38.0% between 1980 and 2013^[1]。 The national health and nutrition examination survey (NHANES) found that from 2011 to 2012, the incidence of obesity among adult women aged 20 to 39 in the United States reached 31.8%^[2]。 However, China is also facing the severe problem of overweight and obesity of adult women. A national cross-sectional survey found that from 1993 to 2009, the incidence of overweight and obesity among adult women in China increased from 10.7% and 5.0% to 14.4% and 10.1%, respectively^[3]。

Vaginal relaxation is one of the common conditions in gynecology. Due to the changes of connective tissue and pelvic floor muscles around the vagina, it is manifested as vaginal opening and/or vaginal wall relaxation. Its occurrence and development are mainly related to vaginal delivery and aging, which can significantly affect women's sexual life satisfaction^[1,2]。 The clinical incidence of vaginal laxity is high, but the diagnosis rate and treatment rate are low, which has not attracted enough attention^[3,4,5]。 The diagnosis of vaginal relaxation mainly depends on the patient's subjective sensation and questionnaire scale. At present, there is still a lack of widely used objective evaluation indexes and diagnostic methods^[1]； The existing treatment methods mainly include pelvic floor rehabilitation therapy, radiofrequency therapy, laser therapy and surgical intervention. Among them, radiofrequency therapy has developed rapidly and has been confirmed by multi-center randomized controlled studies. It is the most promising treatment method for clinical widespread use at present. This paper discusses the etiology, diagnosis and treatment of vaginal relaxation, aiming to provide reference for clinical work and related research.

Our country is gradually entering an aging society. Nearly 20% of the population is over 55 years old, including 140 million elderly women^[1]。 Statistics from domestic cancer data in 2015 show that there are about 70,000 new cases of cervical cancer in people over 45 years old, accounting for 70% of the total^[2]。 Therefore, the diagnosis and treatment of postmenopausal cervical lesions is still the focus of cervical cancer prevention and control. Post-screening management and treatment of cervical precancerous lesions are different or controversial because the decline in estrogen levels in postmenopausal women makes cervical cytology screening results and colposcopic precancerous lesions different from those in women of childbearing age. This article reviews the epidemiological characteristics of postmenopausal HPV infection and cervical precancerous lesions, screening and management of cervical cancer, colposcopy and treatment of cervical precancerous lesions as follows.

The Society of Obstetricians and Gynaecologists of Canada (SOGC) issued guidelines for the management of natural labor in healthy term pregnant women in September 2016^[1]。 This guideline aims to provide guidance on the management of labor in healthy pregnant women with full-term pregnancy, singleton, cephalic position, and spontaneous labor, so as to increase their probability of spontaneous labor and improve their labor outcome. The guide includes 4 summaries and 25 recommendations, and this article explains its key points.

From October 27th to 29th, 2017, the 13th National Obstetrics and Gynecology Academic Conference of Obstetrics and Gynecology Branch of Chinese Medical Association was held in Xiamen, Fujian Province. The conference received a total of 1,861 conference submissions, with 3,414 registered participants, 199 special reports and 192 conference speeches. Academician Fan Daiming, Academician Ning Guang and Academician Felix Wang respectively gave wonderful reports on today's medical system theory and integration view, discipline construction and the development of minimally invasive technology, which enabled the participants to broaden their horizons and increase their knowledge. Academician Lang Jinghe, Chairman of Obstetrics and Gynecology Branch of Chinese Medical Association, gave a special report on "Learning Osler's Medical Thoughts", emphasizing the importance of medical humanities. This conference is divided into five sub-venues: obstetrics and hypertensive disorders during pregnancy, gynecological endoscopy, gynecological oncology and gynecological pathology, gynecological endocrinology, menopause and family planning, and gynecological pelvic floor and gynecological infection. The contents are introduced as follows.