2018年 · 第53卷第05期

Uterine fibroids are the most common tumors of the reproductive system in women of childbearing age. Adenomyosis is a benign lesion caused by the invasion of the endometrium and interstitium into the myometrium. Both diseases tend to occur in women of childbearing age between 30 and 50 years old. For symptomatic patients, there are various diagnosis and treatment options according to the patient's age, physiological and psychological needs. Traditional treatment methods include lesion removal, subtotal hysterectomy or total hysterectomy. However, for young patients with uterine fibroids who need to preserve the uterus, the two-year recurrence rate after lesion excision is higher, and the implementation of secondary surgery has greater risk and damage. For patients with adenomyosis, the age of onset is generally younger, and there is a need to preserve the uterus. In addition to the above-mentioned lesion removal, oral contraceptives, levonorgestrel intrauterine sustained-release system (LNG-IUS), gonadotropin-releasing hormone agonist (GnRH-a) and other conservative treatments are alternative options; However, lesion removal is not effective in the treatment of diffuse adenomyosis, the compliance with long-term oral contraceptives is poor, the irregular vaginal bleeding after intrauterine placement of LNG-IUS leads to decreased tolerance of patients, and the high price of GnRH-a, inhibiting ovarian function and thus unable to be used for a long time, etc., make it only a temporary treatment plan.

chlamydia trachomatis (CT) infection in the genital tract is one of the common sexually transmitted diseases. A study of CT infections in people aged 15 to 45 in several countries found that the CT infection rate in low or low-middle-income countries was 2% to 3%, in middle and high-income countries 4% to 7%, and in high-income countries 2% to 3%^[1]。 The latest epidemiological survey found that the number of CT infections in the United States in 2014 was 1,441,789^[2]。 The rate of CT infection among adults in China is also high, but at present, the epidemiological investigation of female CT infection in China mainly focuses on infertility and STD outpatients, and there are few reports on CT infection among pregnant women. CT infection can lead to a variety of complications, especially involving the reproductive tract. CT infection during pregnancy can lead to a variety of adverse pregnancy outcomes (such as miscarriage, chorionic infection, premature rupture of membranes, endometritis, premature birth, and neonatal respiratory infection, etc.). The CDC suggests that CT infection has become one of the main causes of sexually transmitted diseases in pregnant women in the United States^[3]； CT screening of pregnant women is not routinely carried out in domestic obstetric clinics. Therefore, it is of clinical significance to understand the CT infection rate, genotype distribution and vertical transmission of mother-to-child pregnant women in China. The CT infection rate and infection genotypes of some pregnant women and newborns in Shenzhen Baoan District Maternal and Child Health Hospital in the past five years are reported as follows.

The chorionic and zygotic properties of twin pregnancies determine different perinatal outcomes, but the chorionic and zygotic properties of twin pregnancies are a confusing issue. At present, clinically, the chorionicity suggested by ultrasound examination in early pregnancy is often used to help judge the zygotic nature. It is generally believed that all bizygous twins are bichorionic, while monozygous twins are divided into monochorionic twins (approximately 66%) and bichorionic twins (approximately 33%) depending on the time of germ division. In other words, monochorionic twins can be regarded as monozygous twins, and bichorionic twins cannot be defined as monozygous or bizygous^[1]。 In recent years, monochorionic dizygous twins (MCDZ) have been reported abroad, most of which are related to assisted reproductive technology^[2,3,4,5]。 Because 100% of monochorionic twins have placental vascular anastomosis, but there are differences in number, this is the main pathophysiological basis of special complications of twin pregnancy such as twin transfusion syndrome and high perinatal mortality. Due to the misunderstanding that monochorionic twins can be regarded as monozygous twins, in clinical work, twin pregnancies with inconsistent fetal sex are found in the second and third trimester of pregnancy, which is easy to be misdiagnosed as bichorionic twins, which easily leads to misdiagnosis and mistreatment. In this study, 4 cases of MCDZ diagnosed in Chongqing Maternal and Child Health Hospital in recent years were analyzed and summarized.

Intrauterine combined with extrauterine pregnancy refers to intrauterine pregnancy combined with one or multiple ectopic pregnancies. There are few reports of such cases at home and abroad, and most of them are individual cases. Therefore, there is a lack of clinical experience in diagnosis and treatment, which is easy to be misdiagnosed and mistreated, and even can endanger patients' lives. Ectopic pregnancy is still the main cause of death in women in the first trimester. With the increase of pelvic inflammatory diseases, especially the widespread application of assisted reproductive technology, the incidence of ectopic pregnancy has increased significantly, which brings new challenges to clinicians. Therefore, this study retrospectively analyzed the clinical data of 16 patients with intrauterine and extrauterine pregnancy admitted to Peking Union Medical College Hospital of Chinese Academy of Medical Sciences from January 2002 to April 2017, and searched the relevant literature in the past 20 years to explore their diagnosis and management strategies, so as to provide reference for the diagnosis and treatment of such diseases.

Hydatidiform mole is an abnormal pregnancy characterized by choriointerstitial edema and lack of embryonic development or abnormal embryonic development. In patients with a history of hydatidiform mole birth, the risk of developing hydatidiform mole again after one hydatidiform mole was 1.6%, and the risk of developing hydatidiform mole again after two hydatidiform mole increased by 20.3%, suggesting that there may be some genetic susceptibility to hydatidiform mole^[1]。 familial recurrent hydatidiform mole (FRHM) is a rare genetic disease, which refers to the recurrent occurrence of hydatidiform mole (≥2 times) in 2 or more members of a family^[2]。 Whole exome sequencing has the advantages of high sensitivity to common and rare disease-causing genes, can detect most disease-related variants in the exon region, and only needs to sequence about 1% of the genome. It has become the most effective strategy for identifying the causal genes of Mendelian genetic diseases with unknown etiology, and can also be applied to clinical diagnosis of genetic diseases^[3,4]。 In this study, a patient with clinical suspicion of FRHM was directly sequenced by whole exome and verified by Sanger sequencing. The causative gene and its variation in this FRHM family were found. The results are reported below.

Cervical cancer is a common malignant tumor of the female reproductive system, ranking fourth. According to the global cancer statistics analysis in 2017, there were 527,600 new patients with cervical cancer in 2012, and 265,700 patients died of cervical cancer^[1]。 Although, in recent years, the prevalence of cervical cancer has been greatly reduced due to the popularity of cervical cancer prevention screening, in China, cervical cancer is still the most common malignant tumor of female reproductive system, and the onset age is getting younger and younger^[2]。 Early cervical cancer is mainly treated by surgery, and there is no good treatment for patients with intermediate and advanced and recurrent metastatic cervical cancer at present. Therefore, finding suitable targets in cervical cancer can provide a new and effective treatment for the treatment of cervical cancer. Glioma-associated oncogene homolog 1 (Gli1) is an important terminal transcription factor in hedgehog signaling pathway, and activation of Gli1 is the main marker reflecting its pathway activity^[3,4]GANT61 is an inhibitor of the transcription factor Gli1 at the end of the hedgehog signaling pathway, and can inhibit tumor growth by inhibiting the expression of Gli1. Studies have shown that GANT61 can inhibit cholangiocarcinoma^[5]glioma,^[6]And breast cancer^[7]Growth of; Forkhead box protein M1 (Fox M1), cyclin 1 (cyclin D1) and proliferation-associated nuclear antigen 67 (Ki-67) are closely related to cell proliferation. In this study, the effect of GANT61 on the growth of cervical cancer transplanted tumors in nude mice was observed, and the expression of cell proliferation-related molecules Fox M1, cyclin D1 and Ki-67 protein was detected, and the mechanism of action of GANT61 was preliminarily analyzed, so as to provide a new theoretical basis for targeted therapy of cervical cancer.

Cervical cancer is one of the common gynecological malignancies. HPV detection combined with cytology is an important method for early detection of cervical cancer in clinic, but HPV detection lacks specificity^[1]For this reason, an effective detection and monitoring means is needed. It has been reported that chemokine 13 (CXCL13) and its receptor chemokine receptor 5 (CXCR5) are involved in the occurrence and development of malignant tumors such as prostate cancer, oral squamous cell carcinoma and colorectal cancer^[2]。 Another study found that in chronic viral infections, follicular CD₈₊T lymphocytes as a key cytotoxic T lymphocyte subset^[3]； CXCR5⁺CD₈₊T lymphocytes may also play a role in anti-tumor immunity^[4]。 CXCR5⁺CD₈₊T lymphocytes in colorectal cancer, HBV-associated liver cancer and pancreatic cancer showed more than CXCR5^-CD₈₊More significant cytotoxic effects of T lymphocytes^[5,6,7]。 But CXCR5⁺CD₈₊The study of T lymphocytes in cervical cancer has been rarely reported. Therefore, this study examined the expression changes of CXCL13 and CXCR5 in cervical cancer tissues and CXCR5⁺CD₈₊The clinical significance of T lymphocyte infiltration in cervical cancer was discussed in order to provide experimental basis for the prevention, diagnosis and prognosis monitoring of cervical cancer.

Pregnant woman 25 years old, 1 pregnancy and 0 birth, due to "32 weeks gestation⁺⁵On July 31, 2017, she was transferred to the Second Hospital of Hebei Medical University from a foreign hospital. The pregnant woman had regular menstruation in the past, and regular prenatal examination was performed during pregnancy, and there were no obvious abnormalities. 3 days ago, due to binocular vision loss, right ear hearing loss and unstable walking, she performed a cranial MRI examination in a foreign hospital, which showed that "the right cerebellopontine angle area occupied space" and was diagnosed as "meningioma". The pregnant woman had no history of hypertension or diabetes. Physical examination at admission: vital signs were stable, and blood pressure was 98/82 mmHg (1 mmHg =0.133 kPa). Obstetric examination: abdominal swelling, uterine height 29 cm, abdominal circumference 101 cm, fetal orientation occipital left anterior position (LOA), fetal heart rate 124 beats/min, no uterine contractions, low uterine tension, and fetal presentation did not enter the pelvis. Preliminary diagnosis: (1) 32 weeks of intrauterine pregnancy⁺⁵, LOA; (2) Pregnancy complicated by meningioma?

The patient was 46 years old, pregnant and delivered 1. She was admitted to the hospital on September 1, 2016 due to "abnormal uterine bleeding for 7 years, dysmenorrhea for 3 years, and progressive aggravation for 8 months". In 2009, there was no obvious trigger for irregular menstruation, with a period of 20-60 days and a period of 15 days. The menstrual volume increased about 2 times compared with before, and the visual analog scale (VAS) of dysmenorrhea was 0. Diagnosis and curettage were performed, and pathological examination showed endometrium; After diagnosis and curettage, menstruation was still irregular, but no further treatment was made. In 2013, dysmenorrhea (VAS was 2~3 points) with continuous bleeding began to occur, and curettage and curettage were performed in another hospital, and pathological examination showed endometrium; After diagnosis and curettage, abnormal bleeding still occurred, and norethindrone was given to hemostatic treatment. However, norethindrone was given repeatedly because massive bleeding continued again after stopping the drug. In 2014, ultrasound examination revealed adenomyosis (uterine size 7.8 cm ×7.4 cm ×6.9 cm), and levonorgestrel intrauterine sustained-release system (LNG-IUS) was placed in 2014 and 2015, respectively. Both of them fell off spontaneously after 3 months, and the symptoms of irregular bleeding and dysmenorrhea did not alleviate during and after placement, so norethindrone was used for hemostasis treatment at the same time. In January 2016, the dysmenorrhea progressively worsened with a VAS of 10, and there was repeated massive bleeding after norethindrone reduction that could not be reduced. In May 2016, I started gonadotropin-releasing hormone agonist (GnRH-a) treatment for 4 times, and the last time was in August 2016. During the 4-month period of GnRH-a treatment, there was still irregular and massive bleeding, so I continued to treat with norethindrone hemostasis at the same time, and bleeding again after the dose of norethindrone was reduced and could not be reduced, so I was admitted to the hospital for treatment. B-ultrasound examination 1 week before admission showed that the uterus was 8.1 cm ×7.8 cm ×7.1 cm, the endometrium was about 0.7 cm thick, and the muscle layer echoed unevenly, suggesting adenomyosis. Blood estradiol levels during norethindrone hemostatic treatment 3 days before admission were 51.24 pmol/L (i.e. 14 pg/ml). Admission diagnosis was: abnormal uterine bleeding: adenomyosis? Ovulation disorders? There was no vaginal bleeding at the time of admission, and 4 tablets of norethindrone (0.625 mg per tablet) every 8 hours were maintained, and then the dose was gradually reduced to 4 tablets per day. Due to heavy bleeding, diagnosis and curettage were performed on September 7, 2016. Postoperative pathological examination reported a small fractured endometrium with exudative necrosis. After consultation and discussion, an attempt was made to place etonogestrel subcutaneous implants. Outpatient follow-up or telephone follow-up was performed 2 weeks, 1 month, 3 months, 6 months and 10 months after the placement of subcutaneous implant. During the placement of subcutaneous implant, there was almost amenorrhea, occasionally a very small amount of vaginal drip bleeding, no complaint of lower abdominal pain, breast distension, headache, dizziness and other discomfort, and there was no obvious change in body mass.

The patient was 36 years old, pregnant 3 and delivered 0. In 2013, she underwent right salpingectomy due to ectopic pregnancy. On 31 May 2017, the patient had 2 frozen embryos on the fourth day of transplantation in an external hospital, and the color ultrasound was reviewed regularly. No gestational sac was found in the uterus or outside the uterus. Abdominal pain occurred on June 21, and blood β-hCG was tested in the local hospital on June 29: 8 229 U/L; Color ultrasound examination showed no obvious abnormalities in uterus and bilateral appendages; Diagnosis and curettage were performed, and the pathological examination report showed partial decidual changes, no villi and trophoblast cells. On June 30th, the color ultrasound revealed that the intrauterine abnormal dark area was 19 mm ×5 mm, the left adnexal area was suspected mixed mass, the size was 16 mm ×15 mm, and the right adnexal area was not abnormal. On July 1st, blood β-hCG was re-examined: 12 232 U/L, and laparotomy + hysteroscopy was performed in the local hospital. No obvious abnormalities were found in the uterus and outside the uterus during the operation. On July 2, the blood β-hCG was re-examined: 7 910 U/L. After excluding intrauterine pregnancy, the abdominal CT examination on July 4 showed a retroperitoneal mass in the middle of the abdomen, with a size of 32 mm ×31 mm ×30 mm. Combined with clinical considerations, the possibility of retroperitoneal ectopic pregnancy is high, so we were referred to our hospital. On July 7th, blood β-hCG was measured in our hospital: 4 212 U/L, and CT angiography (CTA) of upper abdomen + lower abdomen was performed with enhancement. It showed that a high-density mass was seen between the retroperitoneal inferior vena cava-abdominal aorta-duodenum horizontal segment in the middle abdomen, with a size of about 38 mm ×32 mm, and the boundary was unclear. The boundary between the mass and the adjacent inferior vena cava wall, abdominal aorta and duodenum horizontal segment was unclear. CTA showed that the blood vessels around the mass were pushed and changed, and the mass did not see a clear blood supply artery. Combined with the medical history, the diagnosis of retroperitoneal pregnancy was considered. Then an emergency laparotomy + abdominal aorta and inferior vena cava surface pregnancy removal was performed. During the operation, the right fallopian tube was absent, the right ovary was of normal size, the left fallopian tube appeared and walked normally, adhered to the small intestine and sigmoid colon, the left ovary was of normal size, and a tumor was seen on the surface of the abdominal aorta and inferior vena cava at the lower margin of the duodenum, with a size of about 4 cm ×4 cm. It was sharply separated along the outer edge of the right wall of the inferior vena cava, and a blue-purple mass was seen 5 cm above the bifurcation of the abdominal aorta, fixed about 4 cm ×4 cm, attached to the surface of the inferior vena cava and the abdominal aorta, and the envelope was intact; Open the vascular sheath on the surface of the abdominal aorta, free the inferior mesenteric artery, clamp and cut the inferior mesenteric artery at the root, free the pregnant object from the surface of the abdominal aorta and the surface of the space between the abdominal aorta and the inferior vena cava, and separate the pregnant object on the surface of the inferior vena cava. It is seen that it is closely attached to the anterior wall of the inferior vena cava, with a range of about 2 cm ×2 cm. Consultation with a vascular surgeon, the pregnant object was bluntly and completely stripped from the surface of the inferior vena cava, and the vein wall was intact without damage; Villus tissue, amniotic sac and embryo were seen in anatomical section, and the results of postoperative pathological examination were consistent. The blood β-hCG level decreased to 493 U/L on the second day and 74 U/L on the fifth day after surgery, and the patient was in good general condition.

The patient was 33 years old, pregnant 3 and gave birth 2. He was admitted to the hospital on November 2, 2017 due to "recurrence of pelvic cyst". The patient underwent cesarean section in our hospital in June 2016. During the operation, multiple vesicular cysts were found in the anterior and posterior walls of the uterus, adnexes and pelvic cavity, and fibroid protrusions were seen in the posterior walls of the uterus. Cyst removal and fibroid removal were performed. Gynecological examination after admission: a mass in the posterior and right adnexal areas of the uterus, medium quality, mobile, no tenderness, unclear boundary. B-ultrasound showed multiple uterine fibroids and pelvic cystic mass. Serum CA₁25 and other tumor markers were not elevated. Exploratory laparotomy was performed, and the anterior and posterior parts of the uterus, uterorectal depressions, bilateral fallopian tubes and ovary surfaces, colon serosa surface, mesentery and omentum were covered with blister-like and fibroid neoplasms of different sizes. Total hysterectomy + right adnexectomy + left fallopian tube resection + partial omentum resection + pelvic, intestinal and retroperitoneal mass resection was performed. Postoperative pathological examination, macroscopic view: multiple vesicles on the uterine serosa surface, adnexa and pelvic cavity, with a diameter of 1.0~5.0 cm; There are multiple hard nodules on the serosa surface and omentum of the uterus, with a diameter of 0.5~2.0 cm, with clear borders and gray-white cut surface. SeeFigure 1。 Microscopic view: the vesicle is lined with a single layer of cubic epithelial cells, and the luminal surface is ciliated (fallopian tube epithelium). The cells have no heterotype, and there is no mitotic image. The cyst wall is fibrous smooth muscle tissue (Figure 2）； Hard nodules of uterine serosal surface and omentum are leiomyomas. Immunohistochemical assay showed that pairing cassette gene 8 antibody (PAX-8), ER, PR were positive, calreticulin, CD were positive in epithelial cells₃₁CD₃₄Negative, cell proliferation-associated nuclear antigen (Ki-67)<2% positive. Postoperative pathological diagnosis: florid cystic endosalpingiosis (FCE) of uterus and pelvis with leiomyomatosis peritonealis disseminate (LPD). The patient recovered well after surgery and was followed up for 4 months without recurrence.

The patient was 28 years old and was admitted to the hospital on 19 Mar 2017 due to hemorrhage 1 year after sex. One year ago, the patient had a small amount of vaginal bleeding after sex, without abdominal pain, back pain and other discomfort. The patient had regular menstruation, 5 pregnancies and 2 deliveries, and delivered by cesarean section in 2007 and 2016, respectively. Gynecological examination: there is no abnormality in the vulva and the vagina is unobstructed; A cauliflower-like mass about 2.0 cm ×1.5 cm in size was seen on the posterior lip of the cervix, with contact with blood; The uterus was of normal size, without tenderness, and no obvious abnormalities were palpable in bilateral parauterine and adnexal areas. The serum squamous cell carcinoma antigen (SCC-Ag) level was 3.8 μ g/L. High-grade squamous intraepithelial lesion (HSIL) was diagnosed by liquid-based thin-layer cytology (TCT). After colposcopy and cervical biopsy at 3, 6 and 9 points, the pathological diagnosis was: (cervical) HSIL involving glands. Cervical conization was performed on March 23, 2017. Postoperative pathological examination showed diffuse HSIL in the cervix, involving glands (Figure 1）； Part of the gland is composed of stratified epithelium, the cytoplasm of the whole thickness of cells contains mucus, part contains vacuoles, part is transparent, the nucleus is crowded, and the nucleus is mild (Figure 2), mitotic images and apoptotic bodies can be seen. Immunohistochemical assay showed that p16 and p63 proteins were diffusely expressed in HSIL tissues, and p16 protein was diffusely expressed in atypical mucus-producing cells (Figure 3), focally expressing p63 protein (Figure 4）。 The cell proliferation-associated nuclear antigen (Ki-67) index reached 90%. In situ hybridization was used to detect HPV16 and HPV18. Postoperative pathological diagnosis: stratified mucin-producing intraepithelial lesion (SMILE) of the cervix with HSIL and involving glands, negative margin.

In recent years, the relationship between maternal thyroid hormone level during pregnancy and offspring neurodevelopment has become one of the research hotspots in perinatal medicine. It has been shown that hypothyroidism during pregnancy can cause impairment of neurointellectual development in offspring^[1]However, whether gestational hypothyroxinemia (GHT) can also adversely affect fetal brain development, and whether levothyroxine (L-T₄) treatment of GHT, which is debated due to insufficient evidence. "2017 Guidelines for Diagnosis and Treatment of Thyroid Diseases in Pregnancy and Postpartum" issued by the American Thyroid Association^[1]GHT was defined as serum free thyroxine (FT₄) Level<2.5th to 5th percentile of pregnancy-specific reference values, while thyrotrophin (TSH) levels were normal. Even in areas with adequate iodine intake, GHT is very common, with an incidence of 2.3% to 8.5%^[2,3]Previously, it was believed that there was no adverse effect on the development of the fetal nervous system. It is worth noting that the vast majority of pregnant women with this type of GHT are not aware of their thyroid hormone deficiency, and mistake this slight discomfort for physiological changes caused by pregnancy and are ignored. The purpose of this review is to explain the effects of GHT on the cognitive and motor development of offspring. Psychological and behavioral problems such as ADHD, autism or schizophrenia caused by GHT are not included in this review.

A complex pelvic floor support system composed of multiple layers of muscles, fascias, and ligaments that close the pelvic outlet that interact, support, support, and maintain the normal position of the pelvic organs. Diseases such as pelvic organ prolapse (POP), stress urinary incontinence, sexual dysfunction, etc., collectively referred to as pelvic floor dysfunction disease (PFD), will occur when the pelvic floor tissue is weakened in its supporting function due to degeneration, trauma, congenital development, etc., which affect the daily life and sexual function of patients and reduce the quality of life^[1,2,3]。 Biomechanics is the application of mechanical concepts, principles and methods to study the mechanical problems of living organisms. The interaction of pelvic floor support structures to counter changes in abdominal pressure can be seen as a model of the biomechanical system^[4]。 Therefore, PFD can be regarded as a disease caused by the reduction of biomechanical properties of pelvic floor supporting structures. In recent years, the research of biomechanics in the field of female pelvic floor has gradually increased and transformed into clinical applications, mainly including: (1) using finite element analysis and imaging technology to evaluate pelvic floor supporting structure and PFD; (2) To explore the etiology of PFD through biomechanical study of pelvic floor tissue; (3) Through the biomechanical study of synthetic mesh, guide its application in pelvic floor reconstruction surgery.

Cervical cancer ranks fourth in the world as female malignant tumors, mainly including cervical squamous cell carcinoma and adenocarcinoma of cervix (ACC). The incidence of ACC and its precancerous lesion-cervical glandular intraepithelial neoplasia (CGIN) is significantly lower than that of cervical squamous carcinoma and its precancerous lesion-cervical squamous intraepithelial neoplasia. However, the incidence and mortality of ACC and CGIN have been increasing year by year in recent years^[1]。 ACC and CGIN often occur in the cervical canal, so cervical cytology is not easy to detect^[2]As a result, it is usually discovered at higher-stage lesions. Therefore, finding more effective screening methods for ACC and CGIN has become an urgent clinical problem. In addition, because cervical gland epithelial abnormalities are relatively rare, clinicians often don't know enough about them. Therefore, the clinical significance and management of conventional screening methods for ACC and CGIN, and common cytological and histological abnormalities in glandular epithelial screening are reviewed as follows.

The American Society for Coposcopy and Cervical Pathology (ASCCP) series on colposcopy standards was published in October 2017 inJournal of Lower Genital Tract Disease(Journal of Lower Genital Tract Diseases). This is a comprehensive standard based on evidence-based medicine and is endorsed by the American Association of Obstetricians and Gynecologists (ACOG), the American Institute of Health (ACHA), the American Association for Sexual Health (ASHA), the American Society of Clinical Pathology (ASCP), the Professional Association of Reproductive Health (ARHP), the Association of Women's Health Nurse Practitioners (NPWH), and the American Society of Gynecological Oncology (SGO)^{[1,2,3,4,5,6]}。 This article makes relevant interpretation of the guideline standards based on clinical practice.

Nature is both scientific and artistic, and the two are not diametrically separated. Professor Francis Wells of Cambridge University, England, said in his book Leonardo da Vinci Looks at the Heart, "Scientists, artists and engineers should not be separated, but should remain curious and observant about the world."^[1]。 When a painter draws the human body, it is impossible to draw lively figures without careful study of human anatomy; Without artistic pursuits, a surgeon may lose his ability to observe the complex world in detail, and he will not have an artist's "creative" passion for the surgical procedure and the surgical results. Academician Lang Jinghe, a famous obstetrician and gynecologist, attaches great importance to the drawing ability of surgeons. He said: "Do a beautiful operation, draw a beautiful illustration, and then appreciate it and taste it. There will definitely be benefits, insights and improvements-whether it is surgical technique or painting technique."^[2]。 Gynecology is a subject about "women and children", which is the cradle of vitality and beauty. Leonardo da Vinci, a famous Renaissance master, had a very valuable hand-drawn drawing of uterine section in his extremely limited medical anatomy research, which opened a window for gynecological painting. The following starts with Leonardo da Vinci's painting to explore the method of stickfigure being applied to gynecological surgery, and analyze the combination of stickfigure and gynecological surgery.