2018年 · 第53卷第10期

Normal fetal growth and development is the common wish of obstetricians and pregnant women. One of the most important contents of pregnancy health care is the screening of fetal malformations. Through the examination of specific contents in a specific period, most of the abnormalities of fetal structure and/or development can be found. Once fetal structural and/or developmental abnormalities are found, the obstetrician should conduct a comprehensive analysis and give corresponding evaluation; Pregnant women make informed choices according to the recommendations of their physicians.

Examination of the fetal gallbladder in the second trimester of pregnancy has become part of prenatal screening for malformations of the fetal system. It has been reported in the literature that abdominal ultrasound can detect the gallbladder in 95% of fetuses between 24 and 32 weeks of gestation^[1]While transvaginal ultrasound detected fetal gallbladder at 14 to 16 weeks of gestation, the showing rate was 99.9%^[2]。

Cervical cancer is a common malignant tumor of female reproductive system. Its incidence rate ranks second among female malignant tumors in the world, and its mortality rate ranks fourth^[1]。 The incidence of cervical cancer in Uygur women in Xinjiang Uygur Autonomous Region is high, with more patients in middle and advanced stage and high mortality rate. It is listed as one of the extremely high incidence tumors in this region. Metastasis is one of the important biological characteristics of cervical cancer^[2]It is an important cause of poor prognosis and death of patients. MicroRNAs (miRNAs) are non-coding single-stranded RNAs with a length of 18-24 nucleotides and are widely found in eukaryotes^[3]。 miRNA plays an important role in the biological process of tumor cells. For example, miRNA can regulate the proliferation, differentiation, migration and invasion of tumor cells; And miRNA has dual functions of suppressing and promoting cancer. Previous studies of our research group found that miRNA-101 was low expressed in cervical cancer cells, and the migration and invasion ability of cervical cancer cells were inhibited after upregulation of miRNA-101 expression. The migration and invasion of tumor cells are closely related to the rearrangement of cytoskeletal proteins, and filamentous pseudopod is an important structure of cytoskeletal rearrangement. Therefore, in this study, the cervical cancer cell line HeLa and SiHa cells were cultured and transfected with lentiviral vector carrying miRNA-101, and the formation of filamentous pseudopods in cervical cancer cells after transfection was observed by scanning electron microscopy, which further confirmed the effects of miRNA-101 on the proliferation, migration ability and filamentous pseudopods formation of cervical cancer cells.

The 36-year-old patient went to our hospital for emergency treatment on May 12, 2018 due to "menopause for 32 days and lower abdominal pain for more than 1 hour". Self-tested urine pregnancy test 3 days ago was positive, there was fertility requirement, and there was no obvious early pregnancy reaction. Abdominal pain occurred without obvious trigger more than 1 h ago, severe and persistent on the left side, accompanied by nausea, vomiting, anemia, and blood pressure 90/62 mmHg (1 mmHg =0.133 kPa); Gynecological color ultrasound examination showed that the endometrium was about 0.6 cm thick, cystic echoes of about 2.3 cm ×2.1 cm in the right adnexal area, cystic echoes of 2.0 cm ×1.5 cm in the left adnexal area, pelvic effusion depth of 1.3 cm, liver and kidney crypts of about 4.0 cm liquid dark area. Blood hCG was 76 906.8 U/L; Blood routine: white blood cells 12.2×10⁹/L, the hemoglobin content was 127 g/L. Gynecological examination: uterus anterior, normal size, full, medium quality, good mobility, no tenderness, mild tenderness in the left adnexal area, and no obvious abnormality in the right adnexal area. Posterior fornix puncture was negative. Admission diagnosis: cause of abdominal pain to be investigated (ectopic pregnancy rupture?). After admission, laparoscopic exploration was performed in the emergency department. During the operation, about 1 500 ml of free blood in the pelvic and abdominal cavity was found, and the uterus was soft and slightly larger. Endometriosis lesions were seen in rectal uterine depression and bilateral uterosacral ligaments; Corpus luteum cyst with a diameter of about 1.5 cm was seen in the left ovary and corpus luteum cyst with a diameter of about 2.0 cm was seen in the right ovary. All of them were intact and no active bleeding was seen. They were removed but no pregnancy tissue was found. Uterine curettage was performed to scrape out about 10 g of decidual tissue. Exploring the upper abdominal cavity, blood accumulation and a large number of blood clots were seen in the spleen area, and active bleeding was seen after removing the clots; Urgent consultation with a surgeon. Exploration shows active bleeding in the spleen area. Considering spleen rupture, it is recommended to switch to open exploration. After explaining the condition with the patient's family, open exploration is agreed. An incision was taken under the left costal margin, and a rupture was seen on the diaphragmatic surface of the spleen in the abdomen, with an area of about 3.0 cm ×3.0 cm and a depth of about 3.0 cm, accompanied by active bleeding. Gestational villus tissue was seen floating around the spleen, with a diameter of about 2.0 cm. Splenectomy was performed, with intraoperative bleeding of about 1 500 ml. The operation was smooth, and he was transferred to ICU after operation, where he was given blood transfusion, blood replenishment and supportive treatment. After recovering well, he was transferred back to the general ward. Blood β-hCG was 39 310.2 U/L on the day of surgery and 1 252.6 U/L on 5 days after surgery. Return of pathological examination results: A large number of placental villus tissue with bleeding was found at the spleen rupture; Bilateral ovaries conform to corpus luteum cyst; In the secretory phase of the uterine cavity, the endometrium and the interstitium showed decidual changes. SeeFigure 1，Figure 2。

The patient was 38 years old, pregnant 3 and gave birth 1. He was admitted to our hospital on March 6, 2018 due to "lower abdominal pain for 8 h". The patient usually has irregular menstruation, and her last menstruation was in January 2018 (the specific time is unknown). Before 8 hours before admission, there was no obvious trigger for lower abdominal pain, which was persistent, severe and unbearable. There was no nausea and vomiting, no vaginal bleeding, no fear of cold and fever. When I went to the local hospital, the abdominal pain did not improve significantly, so I came to the emergency department of our hospital, and the urine hCG test was positive. Color Doppler ultrasound showed that there was a mixed mass in the right adnexal area with abdominal and pelvic effusion, and the possibility of rupture and bleeding of corpus luteum cyst was high. Physical examination in the hospital: painful appearance, stable vital signs, flat abdomen, slightly tense abdominal muscles, tenderness in the whole abdomen, and rebound pain. Gynecological examination: cervical lifting pain is obvious; The uterus is anterior, full, tender; There is a cystic mass in the right adnexal area, about 4 cm ×5 cm in size, with clear boundaries, movable, and tenderness; There was no mass in the left adnexal area, and there was no tenderness. Laboratory test: high sensitivity C-reactive protein 0.6 mg/L; Blood β-hCG was 229.2 U/L; Blood routine: white blood cells 20.6×10⁹/L, neutrophils 86%, hemoglobin content 97 g/L, platelets 299×10⁹/L. Admission diagnosis: abdominal pain (ectopic pregnancy rupture hemorrhage? ovarian corpus luteum cyst rupture hemorrhage?). After admission, laparoscopic exploration was performed in the emergency department. During the operation, blood accumulation and clots in the abdominal cavity and pelvic cavity of about 1,300 ml were found. There was no abnormality in the appearance of the right fallopian tube, the size of the corpus luteum cyst in the right ovary was about 4 cm ×4 cm, which was not ruptured, and there was no abnormality in the uterus and left adnexus. No villi and bleeding spots were found in the pelvic cavity. When the clots between intestines were aspirated, a purple-blue nodule of about 1 cm ×1 cm was found near the intestinal tube of the descending colon mesentery, with rupture on the surface and active bleeding, seeFigure 1。 Intraoperative resection of descending colonic mesenteric nodules, bipolar electrocoagulation and suture to stop hemorrhage, seeFigure 2。 At the same time, the right ovarian cyst was removed. The mesenteric nodule was incised, and villus-like tissue was seen inside. The results of postoperative pathological examination showed that it was in line with "mesenteric pregnancy", with luteinized follicular cyst in the right ovary. The β-hCG was 143.4 U/L on the first postoperative day and 59.3 U/L on the fourth postoperative day, and they were discharged for follow-up.

Endometriosis (endometriosis) is a common gynecological disease that seriously affects the quality of life of patients^[1]。 At present, conservative laparoscopic surgery is mostly used for treatment, but for endometriosis patients whose endometriosis staging criteria (r-AFS) revised by the American Fertility Society are stage III and IV, their pelvic adhesions, congestion and edema are often severe, the lesions are extensive, the microscopic surgery is difficult, the preoperative staging is unclear, the preoperative preparation is insufficient, and the communication between doctors and patients on surgical risks is insufficient, resulting in prolonged intraoperative time, increased bleeding, increased risk of collateral injury, and increased postoperative recurrence rate. Especially for patients with ovarian endometriosis, surgical treatment will inevitably cause the destruction of ovarian function^[2]。 Therefore, for those with severe lesions and estimated difficulty in operation, the 2015 "Guidelines for the Diagnosis and Treatment of Endometriosis"^[3]It is suggested that gonadotropin-releasing hormone agonist (GnRH-a) can be used briefly for 3 months before surgery to reduce pelvic congestion and reduce the lesion focus, so as to reduce the difficulty of surgery to some extent and improve the surgical safety. This article reviews how to assess the severity of endometriosis before surgery, hoping to improve the surgical outcome and prognosis of patients through targeted preoperative management.

Ovary is an important organ for maintaining female reproductive and endocrine function. Chemotherapy, radiotherapy and hematopoietic stem cell transplantation (HSCT) in patients with malignant tumors can cause diminished ovarian reserve (DOR), premature ovarian insufficiency (POI), premature ovarian failure (POF) and related infertility, which seriously affect the quality of life of patients. With the development of medicine, 80% of children with malignant tumors can survive and gradually enter the reproductive period, and 31% of them develop POF^[1]。 It has become one of the hotspots of clinical tumor treatment to preserve the reproductive function of children with malignant tumor without affecting the treatment of malignant tumor. The research progress of chemotherapy, radiotherapy and HSCT on ovarian function and preventive measures in surviving children with malignant tumors in recent years is summarized as follows.