Background Ovarian cancer is the deadliest gynecological malignancy, with platinum-based chemotherapy being the standard treatment. However, most patients develop resistance to platinum treatment, making it essential to evaluate chemotherapy sensitivity. Methods Patient-derived ovarian cancer organoids (OCOs) from primary or metastatic tumor tissues and malignant effusions were validated by histopathological and molecular profiling. The correlation between organoid drug sensitivity test results and clinical outcomes was evaluated based on longitudinal follow-up data. An AI model integrating multimodal omics data and treatment trajectories was developed to predict platinum-sensitive versus resistant recurrence following therapy. Aldehyde Dehydrogenase 1 Family Member A1 (ALDH1A1) -related analysis identified genes associated with chemotherapy prognosis, and these findings informed AI-assisted high-throughput screening of candidate inhibitors, which were subsequently validated in cell lines and OCOs. Results A total of 191 patient-derived organoid models were generated from 123 ovarian cancer patients, including those from primary tumors, metastatic lesions, and malignant effusion. In vitro sensitivity testing with platinum-based chemotherapy agents was conducted with follow-ups. Organoids derived from primary tumors showed the highest predictive accuracy, followed by metastatic lesions, while ascites-derived organoids demonstrated lower predictive ability. Additionally, long-term organoid culture and chemotherapy resistance were strongly associated with tumor stem cell ALDH1A1 expression, then inhibitors against ALDH1A1 were screened and validated in ovarian cancer cells and organoids. Conclusions Ovarian cancer organoid drug sensitivity testing represents a potential precision medicine tool for predicting platinum response in patients, which could serve as a preclinical model for drug screening and validation. ALDH1A1, a key molecular marker of cancer stem cells, presents a viable therapeutic target; its inhibitors demonstrate potential efficacy against platinum-resistant ovarian tumors.

To develop a context-aware multi-instance learning (TransMIL) model based on whole-slide pathological images and integrate it with clinical parameters, thereby constructing a multimodal model for prognostic prediction in postoperative cervical cancer patients. Data (including pathological images and clinical information) were collected from patients diagnosed with cervical cancer via pathological examination who underwent surgery at the First Medical Centre of the Chinese People's Liberation Army General Hospital between May 2017 and May 2023. After integration and screening, 374 patients were enrolled. To maximize the use of all available samples and obtain a robust performance estimate, we employed a rigorous patient-level nested five-fold cross-validation strategy for model development and evaluation. The CLAM algorithm was employed for attention-based, interpretable foreground segmentation. By integrating TransMIL with global context encoding techniques, spatial dependencies of tissue structures were captured to extract deep image features. And fused them with clinical features to predict the prognosis of patients. The predictive performance of each model was evaluated using the C-index. Overall survival (OS) and disease-free survival (DFS) were assessed via the Kaplan-Meier method. Model performance was further evaluated using calibration curves and decision curve analysis (DCA) curves. The predictive model integrating clinical-pathological characteristics demonstrated favourable prognostic capability. Models based on pathological images alone and combined clinical-Pathomics Models were used to predict 3-year and 5-year disease-free survival (DFS) and overall survival (OS), respectively. For OS prediction, the clinical-Pathomics Model achieved a C-index of 0.700, outperforming the pathomic model (C-index: 0.631) and the clinical model(C-index: 0.690). Similarly, for DFS prediction, the clinical-Pathomics Model (C-index: 0.626) surpassed the pathomic model (C-index: 0.549). Based on model nomogram scores, patients were effectively stratified into high-risk and low-risk cohorts, with Kaplan-Meier curves revealing statistically significant differences in survival rates between groups. Further evaluation via time-dependent ROC analysis, calibration curves, and decision curve analysis confirmed the model's robust predictive accuracy and clinical applicability. A clinical-Pathomics Model was developed to predict 3-year and 5-year DFS and OS in postoperative cervical cancer patients. This model represents a promising approach for for patient risk stratification.

Objectives: The expression of GSDMD and GSDME in ovarian cancerous tissues, adjacent tissues, and cancer cell lines remain poorly characterized. The contribution of pyroptosis to the synergistic therapeutic effects of PI3K-AKT-mTOR inhibitors and cell cycle inhibitors in ovarian carcinoma is unknown. Method: GSDME and GSDMD expression were quantified in ovarian cancer tissues, adjacent tissues, and cancer cell lines. The cytotoxic effects of temsirolimus (an PI3K-AKT-mTOR inhibitor) and 5-fluorouracil (5-FU, a cell cycle inhibitor) were assessed. Results: Both GSDMD and GSDME were detected in ovarian cancer tissues and adjacent tissues. However, the N-terminals of GSDME and GSDMD were only expressed in cancerous tissues, with the GSDME-N terminal being particularly prominent. Similarly, in ovarian cancer cell lines, only GSDME-N terminal was increased when treated by temsirolimus and 5-FU, together with significantly suppressed cell proliferation. Synergistic treatment with temsirolimus and 5-FU further reduced cancer cell viability and enhanced pyroptosis by upregulating GSDME-N terminal expression. RNA interference confirmed that GSDME-mediated pyroptosis is essential for the cytotoxic effects of monotherapy and combination chemotherapy. 5-FU fails to induce complete conversion of pyroptosis to ferroptosis when combined with temsirolimus, even at extremely high concentrations. The drug combination also promoted apoptosis and ferroptosis, which were significantly attenuated by N-acetyl-L-cysteine (NAC). Conclusion: GSDME is the principal executor of spontaneous pyroptosis in ovarian cancer tissues. In chemotherapy employing cell cycle-targeting agents or PI3K-AKT-mTOR pathway inhibitors (alone or in combination) is beneficial, and pyroptosis is an indispensable cell death mechanism. Reactive oxygen species act as a nodal regulator orchestrating pyroptosis, apoptosis, and ferroptosis.

BackgroundThis real-world study evaluated short-term survival outcomes and potential risk factors in patients with locally advanced cervical cancer (LACC) who achieved optimal pathological response (OPR) following neoadjuvant chemoimmunotherapy and radical surgery.MethodsA retrospective analysis was conducted on LACC patients treated at a high-volume tertiary medical system between 2022 and 2025. All eligible patients received neoadjuvant chemoimmunotherapy followed by radical hysterectomy. Pathological response was categorized as pathological complete response (pCR; no residual tumor) or major pathological response (MPR; ≤10% residual tumor). Clinical data, treatment details, and follow-up information were systematically collected. Additionally, transcriptomic profiling and multi-algorithm immune infiltration consensus analyses were performed on matched pre- and post-treatment tumor specimens to uncover treatment-induced microenvironmental remodeling.ResultsAmong 89 eligible patients who underwent surgery, 32 (35.9%) achieved an OPR, comprising 18 (20.2%) with pCR and 14 (15.7%) with MPR. Over a median follow-up of 13 months, the estimated 2-year disease-free survival was 90.7% with an estimated overall survival of 100%. No specific baseline clinicopathological factor emerged as a significant predictor of recurrence in univariable analysis. The regimen was well-tolerated, with grade 3 treatment-related adverse events occurring in 21.9% and no grade 4–5 events reported. Transcriptomic profiling of 10 paired pCR specimens revealed preliminary microenvironmental remodeling post-treatment, characterized by the activation of the NFAT signaling pathway and extracellular matrix reorganization.ConclusionLACC patients attaining pCR or MPR after neoadjuvant chemoimmunotherapy and surgery demonstrated excellent short-term survival outcomes. These findings provide a rationale for considering de-escalated adjuvant therapy in this highly responsive subgroup. Validation through larger prospective cohorts with extended follow-up is warranted.

Study objective: To evaluate the effectiveness of using vascular clips to seal targeted lymphatics in gynecological malignancies for the prevention of postoperative pelvic lymphocele and symptomatic lymphocele after laparoscopic pelvic lymphadenectomy. Design: Retrospective analysis. Setting: Single-center academic hospital. Patients: In total, 217 patients with gynecological malignancies were included. Interventions: Patients were classified into two groups: group 1 (vascular clips were used to seal the targeted lymphatics) and group 2 (electrothermal instruments were used to seal the targeted lymphatics). The patients were followed up 4-6 weeks after surgery to evaluate the incidence of lymphoceles by ultrasound or CT. Symptomatic lymphoceles are defined as those that cause infection, deep vein thrombosis with or without swelling of the extremities, edema (swelling) of the extremities or perineum, hydronephrosis, and/or moderate to severe pain. Measurements and main results: One hundred and thirteen patients were enrolled in group 1, and 104 patients were enrolled in group 2. Lymphoceles were observed in 46 (21.2%) patients. Fewer lymphoceles occurred in group 1 than in group 2 (8 [7.1%] vs. 38 [36.5%], p <.001). The percentage of significantly sized lymphoceles was lower in group 1 than that in group 2 (4 [3.5%] vs. 30 [28.8%], p <.001]. Symptomatic lymphoceles occurred in 18 patients (8.3%), and only one (1.0%) occurred in group 1, while 17 (16.3%) occurred in group 2 (p <.001). A multivariate analysis revealed that vascular clips were the only independent factor for preventing lymphocele (OR = 7.65, 95% CI = [3.30-17.13], p <.001) and symptomatic lymphocele (OR = 22.03, 95% CI = [2.84-170.63], p = .003). Conclusion: The results indicate that the use of vascular clips may be useful for the prevention of the development of lymphocele and symptomatic lymphocele secondary to pelvic lymphadenectomy performed via laparoscopy.

Background The incidence and mortality of cervical cancer remain high in female malignant tumors worldwide. There is still a lack of diagnostic and prognostic markers for cervical carcinoma. This study aimed to screen differentially expressed genes (DEGs) between normal and cervical cancer tissues to identify candidate genes for further research. Methods Uterine cervical specimens were resected from our clinical patients after radical hysterectomy. Three patients’ transcriptomic datasets were built by the next generation sequencing (NGS) results. DEGs were selected through the edgeR and DESeq2 packages in the R environment. Functional enrichment analysis, including GO/DisGeNET/KEGG/Reactome enrichment analysis, was performed. Normal and cervical cancer tissue data from the public databases TCGA and GTEx were collected to compare the expression levels of 10 selected DEGs in tumor and normal tissues. ROC curve and survival analysis were performed to compare the diagnostic and prognostic values of each gene. The expression levels of candidate genes were verified in 15 paired clinical specimens via quantitative real-time polymerase chain reaction. Results There were 875 up-regulated and 1,482 down-regulated genes in cervical cancer samples compared with the paired adjacent normal cervical tissues according to the NGS analysis. The top 10 DEGs included APOD, MASP1, ACKR1, C1QTNF7, SFRP4, HSPB6, GSTM5, IGFBP6, F10 and DCN. GO, DisGeNET and Reactome analyses revealed that the DEGs were related to extracellular matrix and angiogenesis which might influence tumorigenesis. KEGG enrichment showed that PI3K-Akt signaling pathway might be involved in cervical cancer tumorigenesis and progression. The expression levels of selected genes were decreased in tumors in both the public database and our experimental clinical specimens. All the candidate genes showed excellent diagnostic value, and the AUC values exceeded 0.90. Additionally, APOD, ACKR1 and SFRP4 expression levels could help predict the prognosis of patients with cervical cancer. Conclusions In this study, we selected the top 10 DEGs which were down-regulated in cervical cancer tissues. All of them had dramatically diagnostic value. APOD, ACKR1 and SFRP4 were associated with the survivals of cervical cancer. C1QTNF7, HSPB6, GSTM5, IGFBP6 and F10 were first reported to be candidate genes of cervical carcinoma.

本文报道1 例基于5G技术的相隔4000 km的远程机器人辅助腹腔镜全子宫切除术.患者52 岁,牧民,因"不规则阴道出血1 年,保守治疗效果不满意"入院新疆维吾尔自治区皮山县人民医院妇产科.宫腔镜检查+诊刮病理提示"子宫内膜复杂性增生".性激素六项提示卵巢功能衰退.因居住偏远,就医困难,患者要求子宫切除手术.术前诊断子宫内膜复杂性增生,卵巢功能衰退.经解放军总医院第七医学中心妇产医学部会诊,决定施行远程机器人辅助腹腔镜全子宫双附件切除术.网络连接与保障通过公共5G无线网络(中国电信)和5G客户端设备(CPE)连接医生控制台与患者手术平台,然后通过5G核心网将数据从该站传输到目的站.北京电信和皮山电信通过在北京医生控制台上方和皮山县人民医院手术间均安装室分基站(华为)来增强信号质量,保障5G网络信号传输.现场由两地电信人员术中实时监测和保障网络信号,测试信号覆盖率100%,驻留比100%,空口时延20 ms.北京端网络带宽下行177 Mbps,上行 101 Mbps,新疆端网络带宽下行 282 Mbps,上行145 Mbps.2023 年6 月21 日,由位于北京市的解放军总医院第七医学中心的医师,采用国产图迈四臂腔镜手术机器人系统,通过5G网络连接,为4000 km外的新疆维吾尔自治区皮山县人民医院的患者实施机器人辅助腹腔镜全子宫双附件切除术,手术顺利完成,手术时间62 min,出血5 ml,术中延时148.481～268.742 ms,平均161.959 ms,丢包率0.20%,未出现机器人及网络不良事件.术后第1 天排气并进食,第2 天拔除尿管,第3 天出院,无术后并发症.术后病理:子宫内膜复杂性增生.术后4 周门诊复查,患者无不适主诉,腹壁切口及阴道断端愈合良好.经系统查新,该例手术为5G远程机器人辅助腹腔镜全子宫切除术的首例报道.本例填补了5G远程机器人手术在妇科领域应用的空白,也初步探讨了远程机器人手术为偏远地区群众服务的可行性.

This study compared the survival outcomes of abdominal radical hysterectomy (ARH) (N = 32), laparoscopic radical hysterectomy (LRH) (N = 61), robot-assisted radical hysterectomy (RRH) (N = 100) and vaginal radical hysterectomy (VRH) (N = 45) approaches for early-stage cervical cancer to identify the surgical approach that provides the best survival. Disease-free survival (DFS) and overall survival (OS) were calculated using the Kaplan–Meier method, and survival curves were compared using the log-rank test. The volume of intraoperative blood loss was greater in the ARH group than in the LRH group, the RRH group or the VRH group [(712.50 ± 407.59) vs. (224.43 ± 191.89), (109.80 ± 92.98) and (216.67 ± 176.78) ml, respectively; P < 0.001]. Total 5-year OS was significantly different among the four groups (ARH, 96.88

Ovarian cancer (OC) is characterised by heterogeneity that complicates the prediction of patient survival and treatment outcomes. Here, we conducted analyses to predict the prognosis of patients from the Genomic Data Commons database and validated the predictions by fivefold cross-validation and by using an independent dataset in the International Cancer Genome Consortium database. We analysed the somatic DNA mutation, mRNA expression, DNA methylation, and microRNA expression data of 1203 samples from 599 serous ovarian cancer (SOC) patients. We found that principal component transformation (PCT) improved the predictive performance of the survival and therapeutic models. Deep learning algorithms also showed better predictive power than the decision tree (DT) and random forest (RF). Furthermore, we identified a series of molecular features and pathways that are associated with patient survival and treatment outcomes. Our study provides perspective on building reliable prognostic and therapeutic strategies and further illuminates the molecular mechanisms of SOC. Impact statement What is already known on this subject? Recent studies have focussed on predicting cancer outcomes based on omics data. But the limitation is the performance of single-platform genomic analyses or the small numbers of genomic analyses. What do the results of this study add? We analysed multi-omics data, found that principal component transformation (PCT) significantly improved the predictive performance of the survival and therapeutic models. Deep learning algorithms also showed better predictive power than did decision tree (DT) and random forest (RF). Furthermore, we identified a series of molecular features and pathways that are associated with patient survival and treatment outcomes. What are the implications of these findings for clinical practice and/or further research? Our study provides perspective on how to build reliable prognostic and therapeutic strategies and further illuminates the molecular mechanisms of SOC for future studies.

Abstract: Objective Patients’ demographics, perioperative data and reasons of using MDT pattern were all analyzed to report preliminary application experiences of an MDT pattern using in the robotic-assisted gynaecological surgery at a single institution. Design Retrospective and descriptive study. Setting Tertiary referral center with one surgical team. Population All the 39 patients who have undergone robotic-assisted MDT gynaecological surgeries from 2018 to 2021 in Chinese PLA General Hospital. Methods Various types of robotic-assisted MDT gynaecological surgeries were carried out by the Da Vinci SI Surgical System. Patients’ demographics, perioperative data and reasons of applying MDT surgeries were described. Main Outcome Measures Patients’ demographics, perioperative data and reasons of applying MDT surgeries. Results Most patients undergone robotic-assisted MDT gynaecological surgeries have at least one abdominal surgery before. The operation cost and hospital expense were higher than common laparoscopy. Hospital stays ranged from 7 to 42 days. General surgery department and urological surgery department were the top two familiar departments involved in robotic-assisted MDT gynaecological surgeries. Only 4 cases appeared intraoperative complications in these surgeries. However, postoperative infection needed to be closely monitored. Conclusions It was indicated that robotic-assisted MDT gynaecological surgeries applied in severe diseases could provide both safety and precision, and the pattern was proved to demonstrate the concept of patient-centered and holistic treatment. Simultaneously, the MDT pattern could cultivate teamwork in various departments in the hospital, thus it was beneficial to both patients and hospitals. Keywords Multi-Disciplinary Teamwork; Robotic-Assisted Surgery; Minimally Invasive Surgery; Gynaecology

Objective:To explore the application effect of Da Vinci robot SIMNOW simulation surgery system in gynecological surgery training.Methods:From Jun. 2018 to Jan. 2022, 56 gynecology and obstetrics residents without experience in robotic surgery were randomly divided into simulated surgical group (experimental group) and video learning group (control group). All doctors accept theory training and training before examination. The experimental group received 3 hours of SIMNOW simulation learning, and the control group received 3 hours of video learning. The two groups of doctors were assessed after training, and the training effect of the two groups of doctors was compared.Results:The ferruling numbers, knotting numbers and operating scores of the experimental group were higher than those of the control group, with statistically significant differences (P< 0.05), and there was no statistically significant difference in the theoretical assessment scores between the two groups (P=0.070).Conclusions:SIMNOW simulation surgery system is more beneficial to improve gynecologist robot operation skills than video learning.

Objective:To summarize the technical experience of one case da Vinci robot multi-disciplinary team (MDT) model of total pelvic exenteration for advanced cervical cancer and to explore the feasibility of this medical model in the treatment of such diseases.Methods:The clinical data and treatment process of a patient with stage ⅣA cervical cancer in the Department of Obstetrics and Gynecology of the PLA General Hospital in Sep. 2021 were retrospectively analyzed.Results:After MDT consultation and preoperative preparation, the patient underwent robotic total pelvic contouring (extensive total hysterectomy, bilateral adnexal resection + parietal aortic lymph node biopsy + total bladder, partial urethra, right kidney and right ureter resection + anterior rectal resection) with smooth operation and no serious complications in the perioperative period, and good recovery without recurrence in the six-month postoperative follow-up.Conclusions:Minimally invasive da Vinci robotic surgery is safe and feasible for the treatment of some patients with indicated advanced cervical cancer, capable of achieving R0 resection, and the use of MDT medical model can help benefit such patients and is worthy of reference.

Background: The mortality rate of ovarian cancer (OC) ranks first among female genital tract malignant tumors, which seriously threatens women's life and health. Because of its insidious onset and poor prognosis, it has become a thorny problem in the clinic, especially for patients with platinum-resistant recurrent ovarian cancer (PROC). In recent years, the medical treatment of OC has made gratifying results, bringing hope to the patients.Case Description: A 54-year-old OC patient who has failed previous neoadjuvant chemotherapy, cytoreductive surgery, and postoperative chemotherapy was diagnosed with PROC. Then she received combination treatment of fuzuloparib (100mg PO BID), apatinib (250mg PO QD), and camrelizumab (200mg IV Q3W) for every 3-week cycle in a Phase II study for PROC patients. In the phase II study, her condition stabilized, responded well to treatment with a sharp decrease by 91.14% of target lesions and disappearances of non-target lesions, and continued to receive regular treatment with progression-free survival exceeding 15 months and no serious adverse events.Conclusion: The present case proves PROC patients might have a sustained response to triplet combination with camrelizumab, combined with fuzuloparib and apatinib.

Objective This study compares survival of four different surgical approaches including ARH, LRH, RRH and VRH for early-stage cervical cancer in order to define the best effects and survivals for patients. Design Retrospective study. Setting The First Medical Center of the PLA General Hospital. Population 238 women diagnosed early-stage cervical cancer between January 2013 and December 2017 and followed up until September 2020. Methods All patients with early-stage cervical cancer were retrospective collected in the first medical center of the PLA general hospital. Disease free survival (DFS) and overall survival (OS) were calculated using Kaplan-Meier’s method, and survival curves were compared using log-rank test. Main outcome measures Outcomes were the comparison of patients’ DFS and OS between the four different radical hysterectomy approaches. Results The intraoperative blood loss and postoperative exhaust time of LRH, RRH and VRH groups are better than that in ARH group. The total 5-year OS was significant difference among the four groups. However, the difference of 5-year DFS was not statistically significant among the four groups. Furthermore, patients with early-stage cervical cancer had a significantly better DFS and OS in ARH and RRH groups than that in LRH and VRH groups. Conclusions This retrospective study demonstrated that both ARH and RRH obtained higher rate of 5-year DFS and 5-year OS compared with LRH and VRH for early-stage cervical cancer, and the survival outcomes between ARH and RRH were similar. Keywords Cervical cancer, ARH, LRH, RRH, VRH, survival.

Study Objective To demonstrate a technique for the robot-assisted laparoscopic surgical management of cesarean section scar ectopic pregnancy (CSP) and hysterotomy repair. Design Step-by-step presentation of the procedure using video. Setting CSP is a rare form of ectopic pregnancy. The incidence of CSP has been increasing with rising cesarean deliveries and is estimated to range from 1 of 1800 to 1 of 2500 of all pregnancies. Various management of CSP have been used such as systemic or local methotrexate, surgical resection, and uterine artery chemoembolization. Exogenic or deep CSP occurs when the gestational sac is deeply embedded in the scar and the surrounding myometrium and grows toward the bladder. Surgical resection of this type of CSP seemed reasonable, which could shorten hospitalization and follow-up time and reduce the failure rate of treatment. For its magnification of the 3-dimensional laparoscope, flexibility endo-wrist, and stabilization of instruments within the surgical field, robot-assisted laparoscopic resection can be performed to manage this type of complex procedure. Interventions In this video, we describe our technique for robot-assisted laparoscopic management of a CSP and a hysterotomy repair. We present the case of a 34-year-old gravida 2 para 1 woman with the finding of a 7-week pregnancy embedded in the cesarean section scar. The patient had undergone 1 previous uncomplicated cesarean section at term. On presentation, her β-human chorionic gonadotropin level was 9212 IU/L. In this case, the gestational sac was deeply embedded in the scar and the surrounding myometrium and was growing toward the bladder. A decision was made to proceed with surgical treatment in the form of a robot-assisted laparoscopic resection of the ectopic pregnancy and the hysterotomy repair. The surgery was uneventful, and the patient was discharged home within 48 hours of her procedure. No residual scar defect was visible on follow-up ultrasonography 1 month after surgery. Forty days after surgery, the patient had resumed normal menstruation and was followed up for 3 years with regular menstruation and no abnormal uterine bleeding. Conclusion Robot-assisted laparoscopic excision of CSP and hysterotomy repair is an effective procedure for the management of this increasingly more common condition. The use of a cervix dilator and robot-assisted laparoscopic suturing can prevent hemorrhage and peripheral tissue damage and allow for the safe removal of the ectopic pregnancy with multilayer repair of the uterine defect.

目的 探讨经机器人辅助腹腔镜下阴道骶骨固定术治疗盆腔器官脱垂的效果及安全性.方法 收集2013年1月至2018年12月于解放军总医院第一医学中心妇产科采用经机器人辅助腹腔镜下阴道骶骨固定术治疗盆腔器官脱垂13例患者的临床资料.比较手术前后盆腔器官脱垂治疗效果及安全性,盆腔器官脱垂术后患者采用整体印象改善评分量表(PGI-I)评估主观满意度.结果 13例患者中,平均术中出血量(86.9±98.3) ml(20～300 ml),手术时间(143.5±47.3) min (60～240 min),平均住院时间(10.4±2.1)d(8～16d),平均随访时间(40.8±22.0)个月(6～72个月).脱垂客观治愈率85％,主观治愈率100％,PGI-I评分非常好者9例(9/13),很好者4例(4/13).网片暴露4例(4/13),其中暴露直径小于1 cm且无症状者3例,暴露直径1～2 cm有症状者1例,暴露发生时间均在术后2～12个月,暴露位置均位于阴道缝合范围内.结论 机器人辅助腹腔镜下阴道骶骨固定术治疗盆腔器官脱垂出血量少,住院时间短,术后效果良好,是治疗盆腔器官脱垂可选择的术式之一.

Purpose: The etiology and pathophysiology of endometriosis remain unclear. Current research indicates long noncoding RNA (IncRNA) may play an important role in the pathogenesis and development of endometriosis. However, the molecular mechanism of lncRNA in endometriosis is far from clear. Patients and Methods: The lncRNA and mRNA expression of 8 patients with ovarian endometriosis were determined by high-throughput RNA sequencing (8 ectopic endometria samples vs 8 eutopic endometria samples), and miRNA expression profiles were obtained from our previous study. Then a lncRNA-associated competing endogenous RNA (ceRNA) network was constructed by combining the regulatory interaction and negative co-expression interaction between the differentially expressed lncRNAs/mRNAs and miRNAs by different rules. Results: The constructed lncRNA-related ceRNA network was composed of two separate networks, network 1 including 14,137 dysregulated lncRNA-mRNA interactions, referring to 242 lncRNAs, 55 miRNAs and 1600 mRNAs, network 2 including 4459 dysregulated lncRNA-mRNA interactions, referring to 111 lncRNAs, 39 miRNAs and 1151 mRNAs. The top six hub lncRNAs (LINC01140, MSC-AS1, HAGLR, CKMT2-AS1, JAKM1P2-AS1, AL365361.1) in the significant ternary relationship of mRNA-miRNA-IncRNA in network 1, and the top six hub lncRNAs (PAX8-AS1, MIR17HC, PART1, HOXA-AS3, PLAC4, LINC00511) in the significant ternary relationship of mRNA-miRNA-lncRNA in network 2 were selected. Functional enrichment analysis of these lncRNA-related mRNAs indicated that the lncRNAs in network 1 mainly take part in positive regulation of phagocytosis, myeloid leukocyte activation, and tissue remodeling, while the lncRNAs in network 2 mainly take part in negative regulation of cell proliferation, blood vessel development and regulation of epithelial cell differentiation, which is consistent with the results obtained from the different rules to construct the networks. Conclusion: lncRNA-related ceRNA network analysis recognized key lncRNAs related to the development of endometriosis.

Study Objective: To show a case of severe pelvic arteriovenous malformation (AVM) treated by laparoscopic internal iliac artery ligation after 2 uterine artery embolization (UAE) procedures, where successful pregnancy was achieved after surgery. Design: Stepwise demonstration of the technique with a video. Setting: Chinese PLA General Hospital Interventions: A 36-year-old woman with heavy menstrual bleeding was diagnosed with pelvic AVM by computed tomography scan. Before surgical intervention, she underwent 2 UAE procedures that temporarily reduced menstrual blood loss. Finally, we performed a laparoscopic internal iliac artery ligation on her. After the surgery, she conceived naturally. During the cesarean section, no AVMs were found. Conclusion: Laparoscopic internal iliac artery ligation can be a choice for patients who still have severe symptoms of AVM after UAE. (C) 2021 AAGL. All rights reserved.

目的 评估阴道病灶切除术在高级别阴道上皮内病变(HG-VaIN)治疗中的价值.方法 回顾性分析38例诊断为HG-VaIN行阴道病灶切除术的患者临床病历及随访资料.结果 21例患者纳入研究,初治者18例,复发者3例.13/15例患者HPV阳性,其中有HPV分型检测患者中70％为HPV16型.20例采用经阴道途径,1例复发者采用机器人辅助腹腔镜手术.手术时长平均(46.0±26.2) min,术中出血量平均(38.2±66.0) ml.经阴道途径手术时长平均(42.4±20.4) min,术中出血量平均(39.1±67.9) ml.1例机器人阴道残端切除术,手术时长120 min,术中出血20 ml.所有21例手术未出现术后出血、感染、脏器损伤等并发症.术后平均术后住院天数为2.7 d.术后病理发现阴道鳞癌4例,术后复发率16.7％.结论 HPV16型是HG-VaIN中最常见的感染型别.阴道病灶切除术安全有效,住院时间短,有利于发现浸润性病变.机器人途径适用于经阴道手术困难者,但需要更多的临床实践.

目的 探讨腹腔镜手术治疗深部浸润型子宫内膜异位症(deep infiltrating endometriosis,DIE)的疗效.方法 回顾性分析解放军总医院第一医学中心2008年1月至2018年7月共225例DIE患者,所有患者均接受彻底的腹腔镜子宫内膜异位病灶切除术并进行长期随访.统计患者的临床资料、围手术期参数、复发及自然受孕率等指标.结果 225例患者中,178例(79.1％)患者有痛经症状,33例(14.7％)患者有性交痛,1例(0.4％)患者伴有便血,2例(0.9％)患者伴有血尿,8例(3.6％)患者伴有便秘,6例(2.7％)患者伴有腹泻,42例(18.7％)患者为无症状.平均术中出血量(94.4 ±191.6)ml,平均手术时间(85.5±51.0)min,平均住院时间(8.4±4.9)d.并发症发生率:1.3％.随访时间1～144个月(中位随访时间57个月),术后24个月复发率8.4％,术后60个月复发率16.4％,至随访截止总体复发率19.6％.自然受孕率67.5％.结论 腹腔镜手术治疗DIE疗效满意.