Background and objectiveDiagnosis and treatment strategies for adenomyosis are influenced by multiple factors, including patient preferences, adenomyosis subtype, and disease progression, with no standardized protocol currently established. In 2012, Kishi proposed four subtypes of adenomyosis based on magnetic resonance imaging (MRI) to guide clinical treatment. This study focuses on patients with severe adenomyosis who do not desire future fertility but wish to preserve their uterus. It investigates the clinical efficacy of subtotal adenomyotic lesion resection based on the Kishi classification, combined with sequential levonorgestrel-releasing intrauterine system (LNG-IUS) and gonadotropin-releasing hormone agonist (GnRH-a) therapy, in the management of severe adenomyosis, and evaluates the clinical outcomes and safety of this approach.MethodsWe used a descriptive case series design. A retrospective analysis was performed on 34 patients with severe adenomyosis who underwent this treatment protocol at the Department of Gynecology, the Changzhou Second People’s Hospital Affiliated to Nanjing Medical University from December 2017 to October 2022. Clinical parameters, including hemoglobin concentrations, dysmenorrhea severity scores, and menstrual blood loss scores, before and after treatment, were observed and recorded.ResultsAll 34 patients successfully underwent surgery. Comparisons of postoperative and preoperative values showed significant improvements in dysmenorrhea severity score, menstrual blood loss score, hemoglobin concentration, serum cancer antigen-125 (CA125) level, and uterine volume (all p < 0.001). Only one patient experienced downward displacement of the intrauterine device, and a transvaginal ultrasonography revealed that the upper end of the device was approximately 1.5 cm away from the uterine fundus. One patient exhibited a mild elevation in CA125, accompanied by an increase in dysmenorrhea severity score to 3 points, without a significant increase in menstrual blood loss being observed. No disease progression was noted in any patient.ConclusionIn patients with severe adenomyosis who do not desire future fertility, who have a strong preference for uterine preservation, and who have failed multiple conservative treatments, this combined regimen was associated with significant improvements in dysmenorrhea severity, menstrual blood loss, anemia, CA125 levels, and uterine volume over a 12-month observation period, without any serious adverse events. This finding suggests that the regimen may be a safe and effective treatment option. However, its exact efficacy still requires validation through prospective controlled studies.

Thoracic endometriosis syndrome is a rare form of endometriosis in which endometrial tissue is thought to migrate to the lungs and, with the onset of menstruation, the ectopic foci bleed, causing a range of pulmonary manifestations. In this paper we have collected the clinical data of two patients with thoracic endometriosis syndrome, both of whom presented with haemoptysis as the first symptom and had a history of endometriosis. After 6 courses of treatment with gonadotropin-releasing hormone analogues followed by maintenance treatment with dienogest, the patients’ haemoptysis symptoms were relieved, the CT lesions in the lungs were significantly resorbed compared with the previous ones, and no recurrence was observed at long-term follow-up.

The abdominal wall is one of the rare sites of endometriosis, and its clinical incidence is increasing year by year with the increasing cesarean section rate nowadays. A retrospective analysis was made on patients with abdominal wall endometriosis who attended Changzhou Second Hospital of Nanjing Medical University from January 2013 to December 2022. They were grouped by depth of infiltration of lesion and direction of incision, and the differences between the groups were compared. A total of 228 patients aged 32.7 ± 4.2 with abdominal wall endometriosis were included in this study, including 210 cases with a history of abdominal transverse incision surgery, 16 cases with a history of vertical incision surgery, 1 case with a history of uterine fibroids surgery, and 1 case with primary abdominal endometriosis, and 178 cases with the primary symptom of cyclic pain. The patients were classified as solitary and complex ones according to the number of lesions. Both groups were statistically significant for BMI, number of caesarean sections, operation time, bleeding, and postoperative hospital stay (p < 0.05). According to the depth of infiltration, the patients were divided into fascial, rectus abdominis, and peritoneal types, with differences in latency time, CA125, maximum diameter of the lesion, operation time, bleeding, and postoperative hospital stay (p < 0.05). The direction of incision for caesarean section had no significant effect on the development of endometriosis in the abdominal wall or whether the lesions were multiple (p > 0.05). On imaging, magnetic resonance imaging was more accurate for lesion typing. AWE should be diagnosed early and treated surgically. The clinical manifestations of the same type are different, and CA125 testing and abdominal wall ultrasound can be used preoperatively for lesion typing. Nuclear magnetic resonance (NMR) may be used to improve preoperative preparations for difficult diagnosis or typing.

Objectives To investigate the feasibility and safety of Transvaginal Natural Orifice Transluminal Endoscopic Surgery (V-NOTES) panhysterectomy. Methods A retrospective analysis was conducted on the data of 75 patients who underwent panhysterectomy for hysteromyoma in the Department of Obstetrics and Gynecology of Tongxiang Maternal and Child Health Hospital; Department of Gynecology, The Affiliated Changzhou Second People's Hospital of Nanjing Medical University and Department of Gynecology, The First Affiliated Hospital of USTC from June 2019 to June 2020. According to the operation mode, the patients were divided into two groups: the traditional multi-port laparoscopic surgery (MPLS) group (n = 45) and the Transvaginal Natural Orifice Transluminal Endoscopic Surgery (V-NOTES) group (n = 30). The operation duration, intraoperative blood loss, postoperative exsufflation time, postoperative activity time, hospital stay, treatment cost, 6 h activities of daily living (ADL) score after the operation, cosmetic score, visual analog score, and complications were observed in the two groups. Results Perioperative period related indicators: Compared with the MPLS group, the total treatment cost and cosmetic score of the V-NOTES group were significantly better than those of the MPLS group, but the operation duration was longer, and the HB decreased more significantly (P < 0.05). However, there was no significant difference in intraoperative blood loss, postoperative exsufflation time, postoperative activity time, 6 h ADL score after the operation, and hospital stay between the two groups (P > 0.05). Postoperative pain: The VAS score 1 h, 6 h, 12 h, and 24 h after the operation was lower in the V-NOTES group than in the MPLS group (P < 0.05). Postoperative complications: The complication rate of the V-NOTES group was significantly lower than that of the MPLS group (P < 0.05). Conclusions In treating panhysterectomy patients, both V-NOTES and MPLS can achieve satisfactory efficacy and prognosis, and both have advantages and disadvantages. Specifically, the V-NOTES surgery has significant advantages such as a lower treatment cost, lower incidence of postoperative complications, less pain, and more beautiful wounds.

Objective To establish a rat model of pharmacological ovariectomy by GnRH-a injection and to preliminarily investigate the reproductive endocrine effects of Xiangshao granules on pharmacologically ovariectomized rats. Methods: A rat model of pharmacological ovariectomy was established by injecting female rats with Gonadotropin-releasing hormone agonist(GnRH-a).The rats were randomly divided into four groups: GnRH-a injected saline group (GnRH-a + NS); GnRH-a injected oestradiol group (GnRH-a + E2); GnRH-a injected Xiangshao granule group (GnRH-a + Xiangshao), and the control group of saline-injected rats (NS + NS). The number of rats per group was 6.According to observations of the rats' vaginal smears, modelling was determined as successful. Then corresponding drug gavage intervention was administered for 28 days, and rat body weight and anal temperature were measured every other day to adjust the drug intervention amount according to body weight changes. Plasma sex hormone levels (E2, FSH, LH), uterine weight, uterine index and endometrial histomorphological changes, ovarian weight, and ovarian index and ovarian histomorphological changes were measured in each group after the gavage. Results (1) Plasma sex hormone levels (E2, FSH, LH) of the GnRH-a + NS, GnRH-a + E2, and GnRH-a + Xiangshao granule groups were significantly lower than the NS + NS group (P < 0.001), while the E2 level of the GnRH-a + E2 group was higher than that of the GnRH-a + Xiangshao granule group (P < 0.05). The FSH level of the GnRH-a + E2 group was significantly lower than that of the GnRH-a + Xiangshao granule group (P < 0.05). The LH level of the GnRH-a + E2 group was significantly lower than those in the GnRH-a + NS and GnRH-a + Xiangshao granule groups (P < 0.001, P = 0.001). The LH and FSH levels of the GnRH-a + NS and GnRH-a + Xiangshao granule groups were not significantly different (P > 0.05). (2) Compared with the NS + NS group, the uterine weight and uterine index, and ovarian weight and ovarian index of GnRH-a injected rats in each model all significantly decreased (P < 0.001). Between the groups, the uterine weight and uterine index, and ovarian weight and ovarian index of GnRH-a + E2 and GnRH-a + Xiangshao granule groups were all significantly higher than those of the GnRH-a + NS group (P < 0.001, P < 0.05). The uterine weight and uterine index, and ovarian weight and ovarian index of the GnRH-a + E2 group increased compared with the GnRH-a + Xiangshao granule group (P < 0.05). (3) Compared with the NS + NS group, the number of primordial follicles of the GnRH-a + NS, GnRH-a + E2, and GnRH-a + Xiangshao granule groups increased significantly and the number of growing follicles and mature follicles significantly decreased. (4) Rats' uterine wall of the NS + NS and various GnRH-a groups was significantly thinner, with the endothelial layer atrophied, while the uterine wall of the GnRH-a + E2 and GnRH-a + Xiangshao granule groups was thicker obviously, with the number of vaginal folds and blood vessels also increasing. Specifically, the uterus and vagina improvements in the GnRH-a + E2 group were more obvious than in GnRH-a + NS and GnRH-a + Xiangshao granule groups. Conclusion GnRH-a injection can reduce the levels of sex hormones E2, FSH, and LH in rats, causing perimenopausal symptoms such as hot flashes, while Xiangshao and E2 granules could significantly improve such symptoms and exert a slight oestrogenic effect, to a lesser extent than E2 does. Trial registrationNot applicable.

Mesonephric-like adenocarcinoma is a new class of rare subtypes of the female reproductive system. Its clinical symptoms are similar to other types of ovarian tumors. The diagnosis is based on pathological and immunohistochemical methods. The main treatment option is surgery combined with chemotherapy. Few cases have been reported at home and abroad. We reported a case of a 45-year-old woman with a cystic solid mass in the left adnexa. The postoperative pathological diagnosis was mesonephric-like adenocarcinoma of the left ovary and mature cystic teratoma (partial infiltration of the small intestine). This case had no specific clinical symptoms. Immunohistochemical findings showed positive results of GATA3, TTF1, CD10, ER, and PR. Paclitaxel and carboplatin chemotherapy were given after the operation. Currently, no specific criteria are available for diagnosis and treatment of the disease. This article aims to improve the understanding of clinicians in this disease and create a basis for clinical diagnosis and treatment.

Background: Single-port laparoscopic surgery offers unique minimally invasive and cosmetic results and facilitates the patient's postoperative recovery.In transumbilical single-port laparoscopic myomectomy, suturing of the uterine wound is a critical intraoperative step.Due to the difficulty of operating with a single hole, it takes longer to suture the uterine wound, which somewhat increases the potential risk and limits the development of this procedure.This study describes the technique of the "suture formula" and compares it with the traditional randomized suture pattern. Materials and Methods:The author's team summarized the uterine incision selection and suture pattern in single-port laparoscopic myomectomy, conceptualizing the steps of uterine incision selection and suture closure to reduce unnecessary intraoperative backstitching and thread winding operations.In this study, we retrospectively analyzed 91 patients who underwent transumbilical single-port laparoscopic myomectomy and compared the intraoperative and postoperative indices between the two groups. Results:Surgical time, intraoperative bleeding, and hemoglobin drop were lower in the "suture mode" group than in the traditional randomized suture group (p<0.05).There was no statistically significant difference between the "suture formula" group and the traditional randomized suture group in terms of the number of days of postoperative hospitalization, the time to the first postoperative anal evacuation, the VAS score at 12h postoperatively, the VAS score at 24h postoperatively, and the postoperative complications (P > 0.05).Suture pattern (Beta: -19, P=0.043), number of leiomyosarcomas (Beta: 43, P=0.002), maximum diameter of the tumor (Beta: 6.2, P=0.032), and BMI (Beta: 4.0, P=0.018) were the factors influencing the duration of surgery.Suture pattern (Beta: -46, p=0.011), and maximum tumor diameter (Beta: 13, p=0.027) were the factors influencing intraoperative bleeding. Conclusion:The "Suture Formula" technique conceptualizes the selection of the uterine incision and the suture steps, which reduces the difficulty of the operation and ensures the hemostatic effect while reducing the unnecessary inverted needle and thread wrapping during the operation, thus shortening the operation time and improving the efficiency of the operation.The use of the "suture formula" does not increase the risk of surgery or the incidence of surgical complications compared with conventional single-port laparoscopic myomectomy.This suture pattern provides a new breakthrough in single-port laparoscopic myomectomy.

Lymphoma is a malignant tumour of the lymphatic system with an incidence rate of about 6.6 per 100,000 people. Among the many lymphoma types, the most common is non-Hodgkin’s lymphoma. Lymphomas are common in the gastrointestinal tract, breast, neck, etc., while those in female genital tracts are rare. In this article, we report four cases of primary female genital system lymphoid malignancies diagnosed and treated at our hospital from 2018 to 2023, with a systematic review.

Objective: Myomas of the uterus are the most common benign tumors of the female reproductive system. This article presents a detailed review of the suturing methods and ancillary techniques for uterine incision used in transumbilical single-port laparoscopic myomectomy in order to provide a reference for beginners and a research direction for the future development of this surgery. Mechanism: The authors reviewed credible search engines and literature databases (such as PubMed) for the period 2000–2023, extracted published data and content, and summarized the collected information. This was combined with the authors own surgical experience to provide a detailed description of the suture methods and ancillary techniques for uterine incision used in transumbilical single-port laparoscopic myomectomy. Findings in Brief: This review provides a comprehensive understanding of the suture methods and ancillary techniques for uterine incision commonly used in transumbilical single-port laparoscopic myomectomy. The advantages and limitations of different methods are also recognized. Conclusions: Suture methods for uterine incision in transumbilical single-port laparoscopic myomectomy include: simple interrupted suture, figure-of-eight suture, interrupted mattress suture, simple continuous suture and baseball type suture. Ancillary techniques for uterine incision in transumbilical single-port laparoscopic myomectomy include: needle hook assisted method, suspended line method, one-handed operation method and the modified operative method.

Background: To evaluate the clinical efficacy and safety of the modified laparoscopic inverted triangle model for extended lesion resection in treating dysmenorrhea focal adenomyosis in women who have completed childbirth. Methods: A total of 52 patients with dysmenorrhea focal adenomyosis treated in the Department of Gynecology of the Affiliated Changzhou Second People’s Hospital of Nanjing Medical University from July 2014 to August 2020 were retrospectively analyzed. They underwent the modified laparoscopic inverted triangle model for extended lesion resection. The scope of resection included the focal adenomyosis lesions and along with part of the surrounding normal myometrial tissue and endometrium in order to ensure full resection of adenomyosis lesions without residual. Surgical outcome and adverse effects on ovarian functions were evaluated through the retrospective analysis compared the changes of dysmenorrhea visual analog scale (VAS) score changes, uterine volume changes, changes in serum CA125 level, and serum anti-mullerian hormone (AMH) level changes prior to surgery as well as 3, 6, 12, and 24 months after surgery. Results: All operations were completed by laparoscopy without conversion to laparotomy. No serious complications occurred during or after surgery. The dysmenorrhea VAS score, uterine volume, and serum CA125 level at 3, 6, 12, and 24 months after surgery were significantly lower than baseline and the difference was statistically significant. The serum AMH level showed a downward trend 3 months after surgery compared with the pre-surgery level, but the difference was not statistically significant (p = 0.27). The response rates at 3, 6, 12, and 24 months after surgery were 98.1%, 98.1%, 96.1%, and 88.5%, respectively, and the complete response rates were 30.8%, 34.6%, 34.6%, and 21.1%, respectively. Conclusions: Modified laparoscopic inverted triangle model for extended lesion resection is a safe and effective conservative surgical method for treating dysmenorrhea focal adenomyosis.

本手术方式患者取膀胱截石位,气管插管全身麻醉,消毒铺单后采用常规腹腔镜术式,用超声刀逐渐分离左侧乙状结肠、部分小肠与左侧髂窝致密粘连处.探寻脓腔并逐渐扩大其窗口,吸尽脓液后剥除脓腔炼乳样囊壁,游离左侧闭孔神经,反复冲洗脓腔,局部出血予电凝或可吸收线缝扎.最后于左侧盆腔深处置入盆腔引流管,关闭腹腔完成腹腔镜开窗引流术.

Uterine fibroids are benign gynecologic tumors, and women aged between 30 to 50 years are known to have a high incidence of uterine fibroids. A growing number of pharmacotherapies and minimally invasive organ-preserving treatments have been designed and conducted over the past few years. However, there has not been any therapeutic drugs exhibiting an ideal therapeutic effect and low recurrence rate, such that the surgical treatment continues to be primarily employed in the actual clinical treatment. In general, surgical treatment has been performed as the organ-and fertility -preserving hysteroscopic or laparoscopic resections of the fibroids. Minimally invasive surgical equipment (e.g., hysteroscopy, traditional porous laparoscopy, trans-umbilical laparoscopy, transvaginal laparoscopy, as well as robot-assisted laparoscopy) has been extensively applied to clinical treatment. Compared with traditional laparotomy, minimally invasive surgical equipment is characterized by minimally invasive surgery, high efficiency and safety. As medical technology has been leaping forward, interventional therapy and radiofrequency ablation can also be employed for treating uterine fibroids. In accordance with the research progress worldwide, the current situation, limitations, and advantages of the treatment of uterine fibroids in patients with fertility requirements are reviewed in this study.

With the development and progress of society, people’s average life expectancy has increased, and relevant literature reports that the number of postmenopausal women in China continues to increase. With lifespans extended, the transition period and post-menopause period have become the longest essential period in every woman’s life. The life quality of women troubled by perimenopausal syndrome has been significantly reduced, which also places a burden on families and society. It is well known that hormone replacement therapy plays a vital role in improving women’s menopause-related symptoms and is the most effective medical measure. With research ongoing into the treatment of menopausal symptoms in different patients, dose size, treatment duration, and medication regimens for hormones are still hot topics of discussion. This article reviews the definition, clinical diagnosis, staging, clinical manifestations, and treatment of menopause and explores the current diagnosis and treatment scenarios of perimenopausal syndrome.

Objective: The purpose of this review is to summarize drug selection for peri-menopausal symptoms caused by gonadotropin releasing-hormone agonist (GnRH-a) in the treatment of endometriosis. Mechanism: GnRH-a treatment often leads to low estrogen levels, resulting in peri-menopausal symptoms and osteoporosis. Add-back therapy relieves clinical symptoms by supplementing low-dose estrogen. The idea of “combined regulation” is to improve symptoms by adding plant preparations or proprietary Chinese medicines. Studies have shown that they may play a role by regulating serotonin activity. Findings in Brief: For patients treated with GnRH-a for less than 3 months, the combined-regulation regimen can be considered, whereas for patients who have had more than 3 courses of GnRH-a, add-back therapy with sex hormones must be used because the patients will have begun to have obvious bone-mass loss and even bone pain; this bone-mass loss is often irreversible. Conclusions: In the early treatment of endometriosis with GnRH-a, non-hormone combined-regulation therapy is a relatively safe and feasible choice, but hormone add-back therapy should be selected for patients who have had more than 3 courses of GnRH-a.

手术采用气管插管全麻下取膀胱截石位,消毒铺单后置入导尿管.切开阴道前壁黏膜并向两侧分离至坐骨支,扩大间隙,清晰触诊双侧坐骨棘及骶棘韧带,使用穿刺器沿尿道口两侧切口穿入,经闭孔、坐骨棘上方自阴道旁间隙穿出.放置网片于膀胱下,将网片上下端采用不可吸收丝线缝合两侧子宫主韧带附着处及膀胱颈周围筋膜.距阴道黏膜切缘 1 cm处予以可吸收线缝合阴道黏膜,修补阴道前后壁.向外牵拉网片丝线,平皮肤剪除丝线,完成改良简易式前盆底重建.

Background: Diffuse uterine leiomyomatosis is a benign disease with a low incidence rate, mainly manifested as menorrhagia and infertility. Due to its clinical manifestations similar to multiple uterine myomas or adenomyosis, it is often misdiagnosed in clinical practice. Research has found that they can be distinguished through histopathological examination. According to existing reported cases, Diffuse uterine leiomyomatosis mainly occurs during the child-bearing period and has a significant impact on fertility. Hysterectomy is recognized as a radical cure, but uterine-sparing treatment methods need to be continuously explored. Case: A 41-year-old woman presented with recurrent menorrhagia 5 years after myomectomy. B-ultrasound examination indicated that the uterus was enlarged and the myometrium was full of hypoechoic, Considering the patient's desire to preserve the uterus, we performed laparotomy myomectomy again. Result: Hysteroscopic myomectomy has been shown to have a certain therapeutic effect on infertile patients in the early stage of DUL. Laparotomy myomectomy can remove a wider range of lesions and can be combined with gonadotropin releasing hormone agonists or antagonists for pretreatment. Uterine artery embolization is also a commonly administered therapy. High-intensity focused ultrasound ablation has been used with significant success in reducing uterine volume but requires further evaluation for its impact on fertility. Conclusion: A DUL patient underwent extensive myomectomy. This atudy further discussed uterine-sparing treatments, and reviewed existing research reports.

子宫内膜异位症(EMs)是导致女性不孕的较为常见疾病之一.对于卵巢型EMs,腹腔镜手术可提高患者术后自然妊娠率.但EMs具有复发性高的特点,因此术后需药物长期管理,尤其对于有生育要求的女性患者,应选择既能抑制病灶复发,又不影响卵巢排卵的药物.目前研究表明,地屈孕酮是治疗剂量可减少EMs术后复发且不抑制排卵的唯一药物.本文报道两例卵巢型EMs患者在行腹腔镜卵巢子宫内膜异位囊肿剥除术后予地屈孕酮20 mg/d长周期(月经周期第5～25天)管理,均自然妊娠,且一名患者顺利分娩一名健康男婴,另一名患者仍继续妊娠中,未见患者及胎儿异常.随访结果提示地屈孕酮在管理EMs的同时不影响自然妊娠,可能是作为近期有生育计划的育龄期EMs患者术后长期管理的优选药物.

宫颈机能不全(cervical insufficiency, CI)通常是指由于先天性发育异常或者后天损伤导致孕妇在妊娠中晚期时宫颈无痛性扩张,最终导致妊娠中晚期流产或早产.

本手术方式对反复复发盆腔器官脱垂患者采取膀胱截石位,气管插管全身麻醉,常规消毒铺单后采用腹腔镜手术方式,举宫杯顶起阴道残端,用超声刀逐渐分离膀胱阴道间隙、直肠阴道间隙;打开直肠右侧旁间隙,确定骶骨岬位置,暴露骶前间隙.将自制的Y型网片头端平铺固定于阴道前后壁,网片尾端沿直肠侧间隙平铺,固定于骶骨岬.稀释的美兰溶液充盈膀胱确认无损伤后,连续缝合关闭腹膜.排空气体,常规缝合穿刺孔,完成腹腔镜阴道残端骶骨固定术.该手术方式通过Y型网片通过缝合阴道前后壁和固定骶骨前韧带,使盆腔脏器脱垂恢复正常结构,对反复复发脱垂有着很好的治疗效果.

Abstract Objectives To investigate the safety and feasibility of laparoendoscopic single-site surgery (LESS) for the treatment of giant uterine myoma (diameter ≥ 8.0cm). Methods A retrospective analysis was made on 60 cases of uterine myoma (diameter ≥ 8.0 cm) who underwent laparoscopic myomectomy in Changzhou Second People's Hospital of Nanjing Medical University between April 2020 and April 2022. The patients were divided into a single-site laparoscopic group (LESS group) and a traditional multi-port laparoscopic surgery (MPLS group), with 20 patients in the study group (LESS group) and 40 patients in the control group (MPLS group). Observation and comparison were made between the two groups on demographic, perioperative, and follow-up data. Results All 60 surgeries were successfully completed without conversion. There was no statistically significant difference in estimated blood loss, and the first exhaust time after surgery between the two groups (P > 0.05); the operative time was longer in the LESS group than in the control group (P < 0.05); the length of hospital stay was shorter in the LESS group than in the control group (P < 0.05); The 24-hour visual analogue score (VAS) and body image score (BIS) were lower in the LESS group than in the control group (P < 0.05); the cosmetic score (CS) of the LESS was higher than that of the control group (P < 0.05). Conclusions Laparoendoscopic single-site myomectomy may be safe, feasible, and effective for the treatment of giant myoma (diameter ≥ 8.0cm). Compared with conventional multi-port laparoscopy, Laparoendoscopic single-site takes relatively longer to perform, but the hospital stay is relatively shorter, the postoperative pain is less, and the advantages of the aesthetic incision are outstanding, which meet the aesthetic needs of women and deserve a further clinical promotion.