To the Editor: The septate uterus is the most common uterine anomaly and is associated with an increased risk of adverse reproductive outcomes. Transcervical resection of septum (TCRS) is widely performed in patients with adverse reproductive outcomes. The incidence of de novo intrauterine adhesions (IUAs) after TCRS is approximately 5% to 25%. [1] Various anti-adhesion methods are widely used in the clinical management of patients with septate uteri, including intrauterine devices, Foley balloons, estrogen, antibiotics, and hyaluronic acid gel. However, insufficient evidence supports or opposes any of these methods (Level C),[2] lacking high-grade evidence. We designed this multicenter, open-label, randomized controlled trial to investigate the efficacy of the intrauterine balloon stent and estrogen on preventing the development of IUAs after TCRS (ChiCTR2000032061; ChiCTR.org.cn). The primary outcome is the occurrence of de novo IUAs confirmed by second-look hysteroscopy. The secondary outcomes include live birth rate (>28 weeks), pregnancy rate, ongoing pregnancy rate, pregnancy loss rate, operation-related complications, and other adverse events. This protocol and other relevant materials were approved by the Ethics Committee of Peking Union Medical College Hospital (PUMCH; No. JS-2268). This study is compliant with the clinical guidelines and regulations for the management of septate uterus. We will recruit patients from 10 grade A tertiary hospitals (Supplementary Materials, https://links.lww.com/CM9/B170) treating >50% of Chinese patients with septate uteri, and all the surgeons are experienced in hysteroscopic surgery. The inclusion criteria are women who are (1) ≤35 years; (2) nulliparous; (3) diagnosed with septate uterus according to the European Society of Human Reproduction and Embryology/European Society for Gynaecological Endoscopy (ESHRE/ESGE)-2016 classification criteria[3] and agree to receive TCRS monitored by concomitant laparoscopy; and (4) have regular menstrual cycles. The exclusion criteria are women with (1) double cervix and/or vaginal septum; (2) IUAs; (3) a history of metroplasty; (4) severe endometriosis and adenomyosis; and (5) breast cancer. Recruitment began in May 2020 and is expected to finish by April 2022. Due to the COVID-19 pandemic, recruitment could be prolonged. Informed consent will be obtained from eligible patients by senior doctors at each center. This trial was designed as a superiority study. The incidence of postoperative IUAs ranges from 0 to 37.5%, as reported previously.[1,4–6] We selected 24%, 5%, and 5% as the estimated incidence of postoperative uterine adhesion for the control group and two intervention groups, respectively. The required sample size for 80% power using a two-tailed test at α = 0.05 was 81 in each group, with an expected dropout rate of 10% (http://powerandsamplesize.com). Therefore, we aim to recruit 243 patients. Each center will be distributed a target number of participants to recruit. On the day of surgery, the participants will be assigned 1:1:1 to one of the three groups by a central unblocked randomization system on an online platform (http://www.medresman.org). The surgery-only group (Group A) will be the control group without any adjuvant therapy. The participants in the balloon group (Group B) will have an intrauterine balloon stent placed during the operation. The participants in the estrogen group (Group C) will take estradiol valerate (2 mg, bid) for 2 months after surgery. After randomization, the investigators and the participants will know the specific assignment, while the outcome assessors and data analysts will be blinded. Before surgery, baseline characteristics will be recorded, including age, gravida, para, menstrual history, body mass index, and some other information. Three-dimensional ultrasound will be carried out to assess the uterine cavity in the coronal position and measure the septum's size [Supplementary Table 1, https://links.lww.com/CM9/B170]. The participants will undergo surgery within 1 week after menstrual bleeding. All the participants will receive a single dose of prophylactic antibiotics, commonly second-generation cephalosporins, within 30 min before surgery. Other antibiotics will be used as appropriate when an allergy to cephalosporin is considered. The polyps found by hysteroscopy will be resected simultaneously. Bipolar energy instruments (electrical needles or electrical rings) will be used. For the participants in the balloon stent group (Group B), the COOK balloon stent (5 mL) will be inserted into the uterine cavity at the end of the operation and removed in an outpatient setting 1 week later. Only the barrier function of the balloon will be used without water injection into the balloon to avoid pressure on the endometrial blood supply. Using bipolar energy instruments requires cervical dilatation to Hegar 9.5–10, which ensures the balloon's placement. No extra antibiotics will be given during the week because short-term balloon indwelling does not increase the infection risk, according to previous experience. The participants in the estrogen group (Group C) will start to take oral estradiol valerate (2 mg, bid) from the day after surgery. If menstruation-like bleeding occurs, the medication should be stopped for 5 days before resumption. The management of bleeding during medication use depends on the specific situation. Progesterone can be added temporarily for bleeding management when there is no sign of ovulation. The investigator will follow each patient's medication use. Based on our clinical experience, the dosage of estrogen and the COOK balloon stent used in this trial is safe and is probably associated with only slight adverse effects. Anaphylaxis rarely occurs. The researchers will answer the participants’ questions within 24 hours over the phone and give guidance. If a participant insists on withdrawing from the study for any reason, her choice will be respected. The participants will undergo a hysteroscopic re-examination at 2 months after TCRS, before which they will be advised of strict barrier contraception. The duration of 2 months was chosen considering the recuperation of the endometrium after surgery, which takes at least 1 month, thus avoiding the preventive effect of hysteroscopic procedures on the formation of IUAs. Adhesion lysis will be performed after the detection of IUAs, and the type and location of the adhesion will be recorded. If a residual fundal notch is found, it will be measured and recorded. Further septal incision will be performed only if the residual fundal notch is >0.5 cm, considering its possible influence on reproductive outcomes. A COOK balloon stent or estrogen is not allowed to be used during or after the second-look hysteroscopy. If a patient inevitably fails to receive a second-look hysteroscopy on schedule, for example, due to quarantining for COVID-19, the re-examination can be postponed, and the reason should be recorded clearly. All participants will be followed up for >1 year after the second-look hysteroscopy to collect information on their fertility status and reproductive outcome. During the time, the researchers will provide free consultation on common obstetrical and gynecological symptoms and make a diagnosis when necessary. The management-related medical costs will be at the participant's own expense. The participants will be contacted every 3 months in the following year, which will be informed at discharge. If a participant fails to respond at the 3-month contact, the staff will make every effort to regain contact with the attempts documented via telephone, e-mail, or a letter to their last known mailing address. Should the participant continue to be unreachable, she will be considered lost to follow-up. These participants will not be withdrawn from the study, and existing data will be analyzed. Any incidents of withdrawal and the reason for it will be documented. We created a unified case report form (CRF) and a web-based data entry system to facilitate the data collection and track the enrollment status regularly. We cooperated with a third-party data management company to customize a mobile application for data input. The participants’ information, added by each center, will be fed back to the organizer regularly by the data platform as needed. The adverse events (AEs) will be recorded in the CRF weekly. The investigator at each center is required to report serious AEs in a timely manner by filling in the Serious Adverse Event Report Form within 24 h of discovery and deciding whether they necessitate a participant's withdrawal from the study. In addition, we will establish a platform for patients’ self-reporting. The information collected during the follow-up will be specified by the research team before the study. Patients' records will be anonymized for privacy. The management of patients’ medical records will comply with related regulations. Participant case report forms and source documents will be stored securely at PUMCH. Data will be entered electronically from original study materials into a password-protected file for analysis. The electronically transmitted data will be protected with a password. A dedicated staff member will be responsible for the paper and electronic materials involved in this study, and access to the system will be limited to protect the confidentiality of the information. The chi-square test will be used to compare the rates of three independent samples. P values <0.05 will be considered to indicate statistical significance. All statistical analyses will be performed using Stata software, version 17.0. The interim analyses will be performed after one-third or half of the participants undergo second-look hysteroscopy. To avoid bias caused by the interim results in the following research, specialized statisticians free of clinical work will perform the interim analyses. The interventions we will use in this research are widely applied in clinical practice. Therefore, the possibility of pretermination is slight. The trial will be performed under the guidance and monitoring of the steering committee. It will be overseen by the protocol committee and data coordination committee, consisting of investigators from different centers. The principal investigator will report the trial's progress to the Institutional Review Board of PUMCH once a year. Training and monitoring will be essential in the implementation of this trial to improve the data quality. The interim quality-control conference will be held every 6 months to monitor the research progress of each center without data disclosure. The registration forms of screened cases and enrolled participants must be submitted monthly. The electronic information form must be completed within one week after the operation. Each center will intermittently perform spot checks of the electronic medical records and conduct on-site supervision when necessary. The investigators will allow study-related monitoring, including institutional ethics committee review and regulatory inspection(s), and provide access to relevant data or documents. Any protocol modifications, including changes to the eligibility criteria, outcomes, and analyses, will be reported to the ethical committees in a timely manner and the investigators at each center will be informed by telephone, email, or WeChat groups. If the amendment concerns the participants, the investigators at each center will communicate with the participants enrolled there. The results of this study will be published in international peer-reviewed journals and presented at relevant research conferences. TCRS is performed in many patients with septate uteri, and some will develop IUAs after surgery. However, there is a lack of high-grade evidence on the efficacy of intra- or postoperative anti-adhesion interventions. This trial aims to examine the efficacy of intrauterine balloon stents and estrogen on the occurrence of IUAs after TCRS. This study is rigorously designed. The large population in China provides a large pool of potential patients. The results of this trial will provide high-quality evidence to guide clinical practice on the primary prevention of IUAs after TCRS. However, recruitment is challenging due to the low prevalence of septate uterus, infrequent screening among women without reproductive problems, and stringent screening criteria. The possible confounders include (1) the effects of a previous uterine operation on the uterine cavity, such as induced abortion, (2) the morphology of the septum, and (3) the compliance of the patients in the estrogen group. Another limitation is that this study will only test the efficacy of one specific balloon stent (COOK) and one specific dosage of estrogen (4 mg/day), without comparison with other appliances or dosages. Acknowledgements We would like to thank the person to contact at each center (Jinghua Li, Haiyan Wang, Xiangdong Hua, Ruonan Xu, Yousheng Zhang, Yun Yang, Li Chen, Shasha Rao, Qiuhong Liu, Yaling Sun) for their contribution in implementation of this trial. We would like to thank Weijie Tian for his help in registering and applying working account. We would like to thank Haiqing Zhan and Jing Dong for their work in development and maintenance of the data input platform. Funding This study was supported by a grant from the Non-profit Central Research Institute Fund of Chinese Academy of Medical Sciences (NO. 2020-PT320-003).

宫腔粘连术后目前临床常用雌激素等药物来促进子宫内膜生长、改善子宫血流;用羊膜、透明质酸等生物屏障或材料、宫内节育器或球囊等物理屏障来预防再粘连,一定程度上减少了粘连复发,改善了生殖预后,但对重度宫腔粘连的治疗效果有限;一些促进子宫内膜损伤修复的新型治疗方法如干细胞、外泌体结合生物材料、组织工程和物理治疗等尚在研究阶段,其常规应用于临床尚需深入研究以明确其效果和安全性.

Intrauterine adhesion (IUA) is a common clinical endometrial disease, which can severely damage the fertility and quality of life in women. This study aims to find the differentially expressed endogenous peptides and their possible roles in IUA. Liquid chromatography-mass spectrometry was used to identify the peptidomic profiling of IUA tissues, and the differentially expressed peptides were screened out. Using real-time quantitative PCR, Western blotting, and immunocytochemistry staining, the function of six endogenous peptides was verified in vitro. It was found that peptide 6 (T6) (peptide sequence: TFGGAPGFPLGSPLSSVFPR) could inhibit the expression of TGF-β1-induced cell fibrosis in human endometrial stromal cell line and primary human endometrial stromal cell at a concentration of 50 μmol/L. This study provides new targets for further clarifying the formation and prevention of IUA.

• BackgroundThe septate uterus is the most common uterine malformation. The uterus septum increases the possibility of adverse pregnancy outcomes which can be improved by hysteroscopic metroplasty (trans-cervical resection of septate, TCRS). Various methods are used to prevent postoperative intrauterine adhesion in clinical practice. However, there is insufficient evidence to support or oppose the use of any of them. This study will be a multi-center, open labeled, prospective, randomized, controlled study. We will examine whether it is necessary to use the anti-adhesion barrier or a certain dose estrogen to prevent intrauterine adhesion after TCRS and further improve the fertility outcome.• MethodsA total of 243 patients with septate uterus who meet the inclusion criteria will be randomly assigned into three groups with 1:1:1 allocation ratio. Group A will be the control group without any application of anti-adhesion method after TCRS; the participants in group B will be inserted an intrauterine balloon stent after TCRS for one week; the participants in group C will take estradiol valerate (2mg, bid) for 2 months after the surgery. A second-look hysteroscopy will be carried out after two menstrual cycles after the surgery to evaluate the intrauterine condition. Pregnancy outcomes, particularly the live birth rate, will be followed for at least one year.• DiscussionThis study will be the first well-powered clinical trial to assess the effectiveness of the anti-adhesion barrier or a certain dose of estrogen to prevent intrauterine adhesion after TCRS and further improve the fertility outcome. Our findings will guide the clinical care of patients after TCRS.Trial registration: ChiCTR, ChiCTR2000032061. Registered on Apr 19, 2020, http://www.chictr.org.cn/showproj.aspx?proj=52499

目的 探讨宫腔镜在宫角妊娠物残留诊治中的应用价值.方法 选取22例宫角妊娠物残留患者的临床资料,分析宫角妊娠物残留的临床特点、围术期及术后随访情况.结果 22例患者均通过盆腔三维彩超或MRI检查及宫腔镜来明确诊断,宫角残留妊娠物直径为(1.91±1.02)cm;残留物距浆膜最近距离为(0.39±0.10)cm.术中发现宫腔粘连者11例,占50％,手术时间(20.05±10.03)min,手术出血(14.55±6.38)ml.术中无严重手术并发症发生.16例患者在术后2～3个月进行了宫腔镜二探,1例患者(1/16,6.25％)出现了宫腔粘连,余15例均无残留妊娠物及粘连形成;术后3个月宫角形态基本恢复正常.11例术中无宫腔粘连患者在术后均未出现月经量的减少.术后妊娠无严重产科并发症发生.结论 宫腔镜治疗宫角妊娠物残留安全有效,值得临床推广.

目的:分析腹腔镜监护宫腔镜下子宫纵隔电切术治疗93例子宫完全纵隔患者的生殖预后情况及其影响因素.方法:回顾性分析2008年3月至2017年6月南京医科大学附属妇产医院收治的具有完整随访资料的93例子宫完全纵隔患者的临床资料,进行电话追踪及门诊随访妊娠情况,统计分析妊娠情况及影响术后妊娠的相关因素.结果:对93例患者的术后生育情况进行跟踪记录,随访12 ～24个月,随访中位数20个月.①术后76例(81.72％)获得妊娠,累计妊娠次数83次,其中流产累计24人次,活产累计59例;59例活产中,47例(79.66％)剖宫产,12例(20.34％)顺产.与手术前比,手术后妊娠人次和活产人次增加,人均妊娠次数和流产人次减少,差异有统计学意义(P＜0.05).②宫腔镜二次探查后1个月妊娠13例(17.11％),2个月妊娠14例(18.42％),半年内共计妊娠46例(60.53％),术后1年共计妊娠61例(80.26％).③妊娠患者的年龄、阴道纵隔、宫腔粘连与未妊娠患者比较,差异无统计学意义(P＞0.05);而无盆腔粘连、有流产史和输卵管通畅的患者妊娠率更高,差异有统计学意义(P＜0.05).Logistic回归进行多因素分析,盆腔粘连(OR 8.802,95％ CI 6.035 ～ 10.635)、流产史(OR5.053,95％CI 3.256 ～ 12.369)为术后妊娠的危险因素,输卵管畅通(OR0.051,95％ CI 0.016 ～0.436)为术后妊娠的保护因素.结论:腹腔镜监护宫腔镜下子宫纵隔切除术可以显著降低子宫完全纵隔患者的自然流产率,提高妊娠率和活产率,改善妊娠结局.盆腔粘连、流产史、输卵管是否畅通是影响子宫纵隔切除术后患者妊娠的独立危险因素.

一、病例摘要 患者30岁,因“剖宫产术后2年未复经”于2017年8月28日入住南京医科大学附属苏州医院.该患者平素月经规则,5～7/28 d,量中,无痛经.既往有2次人工流产术史.2015年9月16日因“胎儿宫内窘迫”外院行子宫下段剖宫产+胎盘人工剥离+子宫B-lynch缝合捆绑术,共计出血约1 500ml,因“胎盘植入、产后出血”遂行子宫动脉栓塞术(uterine artery embolization,UAE),胎盘病理示:胎盘部分梗死、钙化,小灶区胎盘植入.

目的:探讨经阴道手术治疗剖宫产瘢痕憩室(CSD)的疗效及其预后影响因素.方法:回顾性分析2016年9月至2018年4月在南京医科大学附属妇产医院经阴道手术治疗的55例CSD患者的临床资料,随访术后恢复情况并比较影响手术疗效的因素.结果:①术后3个月B超检测憩室完全消失率为74.55％ (41/55),术后6个月78.18％(43/55)的患者月经期缩短至10天以内.②子宫前位或中位的患者术后愈合良好(术后经期≤10天)率(87.88％)高于子宫后位的患者(63.64％)(x2=4.548,P =0.033);愈合良好组的术前憩室深度(8.28±1.42 mm)小于愈合不良组患者的术前憩室深度(9.58±2.61 mm),差异有统计学意义(t=-2.302,P=0.025);愈合良好组的残余肌层厚度(3.31±1.22 mm)大于愈合不良组(2.42 ±0.85 mm),差异有统计学意义(=2.384,P=0.021).③多因素分析结果示子宫位置、术前憩室深度和残余肌层厚度是影响手术疗效的独立因素(P＜0.05).结论:经阴道手术治疗CSD能够改善患者症状,子宫后位、憩室深度及残余肌层厚度是手术修复效果的独立影响因素.

目的 探讨宫腔镜下子宫纵隔切开术(TCIS)后妊娠结局.方法 不全子宫纵隔患者193例行TCIS,分析术后妊娠结局.结果 193例患者无一例发生水中毒、穿孔、大出血或感染等并发症.其中,188例均行宫腔镜二次探查,未发现宫腔粘连及纵隔残余.193例患者术后随访时间12～60个月.154例患者术后1年内妊娠.176例患者妊娠184次,自然流产30次,其中早期自然流产24次,晚期自然流产6次;异位妊娠5次;无死胎死产.17例未孕患者中,原发不孕7例,继发不孕10例.176例患者分娩145次,其中早产19次,足月产126次.孕周26～42周,共有活产儿150个,新生儿体重(3263.33±669.51)g.结论 TCIS能够改善不全子宫纵隔患者的妊娠结局,建议术后应尽快妊娠,并加强患者孕期管理及产程监护.

诊断纵隔子宫的金标准仍然是宫腔镜联合腹腔镜手术.文章阐述宫腔镜子宫纵隔切开术的手术技巧,回顾分析190例纵隔子宫患者术后的妊娠结局.宫腔镜下子宫纵隔切开术可减少流产率,提高活产率.宫腔镜下子宫纵隔矫形手术安全,并发症少,可明显改善纵隔子宫合并不良孕产史患者的妊娠结局.

目的 探讨宫腔镜子宫肌瘤切除术治疗子宫黏膜下肌瘤的临床疗效.方法 回顾性分析89例子宫黏膜下肌瘤患者的临床资料,依据国际妇产科联盟推荐的子宫肌瘤分类标准将患者分为A组(0型,27例)、B组(1型,39例)和C组(2型,23例).分析宫腔镜子宫肌瘤切除术治疗子宫黏膜下肌瘤的临床疗效和手术安全性.结果 89例患者均在超声监护下完成宫腔镜子宫黏膜下肌瘤切除术,无中转腹腔镜或开腹手术.三组术中均无子宫穿孔的并发症发生,C组1例患者术中出现经尿道前列腺电切综合征.三组手术时间 、术中出血量及术后住院时间比较差异均有统计学意义(P<0.05).术后2个月复查宫腔镜检查,三组患者均未发现残余黏膜下肌瘤.结论 宫腔镜子宫肌瘤切除术治疗子宫黏膜下肌瘤临床疗效确切.

子痫前期(Pre-eclampsia,PE)是妊娠期特有的疾病,全球发病率3％ ～5％,可引发孕产妇子痫抽搐、胎儿生长受限、多脏器功能损害等,是导致孕产妇和围产儿病死率最高的疾病之一.子痫前期时存在着血脂异常,尤其是高甘油三酯血症.高甘油三酯血症可引起血管内皮细胞损伤,是动脉粥样硬化时内皮细胞功能紊乱的重要标志.而血管内皮细胞损伤是子痫前期发病的中心环节,是子痫前期病理变化从胎盘局部向全身脏器扩展的载体,是母体血流动力学和各器官功能发生异常的直接原因.因此本文将对血脂异常与子痫前期的相关性研究作一综述.

目的 探讨两种不同手术方式治疗剖宫产子宫切口憩室的疗效.方法 回顾性分析2015年1月至2017年1月南京医科大学附属妇产医院收治的32例剖宫产术后子宫切口憩室患者,其中7例选择宫腹腔镜联合手术(腔镜组),25例选择阴道手术(阴式组),比较两种术中及术后月经的改变及疤痕憩室修复状况.结果 两组均顺利完成手术,腹腔组无术中中转开腹手术病例.腹腔组的手术时间较阴式组延长,术中出血量和住院费用增加(P<0.05);两组肛门排气时间和住院时间相当(P>0.05);两组月经改善情况、术后憩室修复情况差异无统计学意义(P>0.05).结论 对于剖宫产子宫切口憩室患者,给予宫腹腔镜手术与阴式手术治疗均有效,各有优缺点,临床医生在选择手术方式时,可结合患者实际情况选择.

Objective:To study the effect of different adhesion preventing methods on reproductive outcomes after transcervical resection for moderate intrauterine adhesion.Methods:Totally 193 patients with moderate intrauterine adhesion after transcervical resection all used hormone cycles treatment.Patients were divided into three groups:balloon and ring group (79 cases),single balloon group (60 cases) and single gel group (54 cases) according to postoperative adhesion prevention methods.The pregnancy rate,live birth rate,repeated cutting rate,pregnancy outcomes and intrapartum complication were investigated.Results:There were 184 cases having fertility requirement and a total of 126 cases had pregnancy(pregnancy rate=68.48％).The pregnancy rates of three groups were 72.37％,75.86％ and 54.00％ with the statistical difference among three groups(P=0.032).Live birth rates of three groups were 46.05％,50.00％ and 30.00％ with no significant difference among three groups(P=0.086).There was no significant statistical difference in miscarriage rate,premature birth rate,full term yield rate,complications incidence of postpartum hemorrhage,placenta conglutination,placenta previa and placenta increta among three groups.Conclusion:There is no statistical difference in reproductive outcomes of patients with moderate intrauterine adhesion after transcervical resection using different preventing methods.But the postoperative pregnancy rate and live birth rate of balloon and ring group and single balloon groups may be superior to single gel group.

Objective To investigate the safety and efficacy of hysteroscopic excision of submucous myoma.MethodsClinical data of 300 patients with submucous myoma admitted between January 2010 and June 2016 in our hospital were retrospectively analyzed.All patients were treated by hysteroscopic excision of submucous myoma, with 99 cases with type 0, 134 cases with type I and 67 cases with type II.The effect of intraoperative and postoperative treatments were compared.ResultsPreoperative evaluation revealed 205 cases (68.3%) with abnormal uterine bleeding (AUB), 77 (25.7%) cases with anemia, 74 cases (24.7%) with spontaneous abortion, and 99 cases (33.0%) with infertility.The operation duration was (22.2±7.0) min and intraoperative hemorrhage was (12.9±4.3) ml.All patients with type 0 and type I submucous myoma were successfully excised, but 4 cases with type II needed a second hysteroscopic excision.No complications were encountered.In the 1-2 years of postoperative follow-up, 152 cases were followed up successfully.Of the 111 cases with preoperative AUB, postoperative menstruation improved in 91 cases (82.0%).Of 92 cases with infertility, postoperative pregnancy were successful in 47 cases (63.0%).ConclusionHysteroscopic excision of submucous myoma was safe and reliable for patients and improved menstruation and reproductive outcomes.Strict surgical indications could enhance the quality of surgery.It is a preferred and recommended surgical method for the treatment of submucosal myoma.

Objective:To analyze the reproductive outcomes of moderate and severe intrauterine adhesions after transcervical resection of adhesions(TCRA).Methods:A retrospective analysis was carried out to explore the clinical data of 506 patients with moderate or severe intrauterine adhesions who were hospitalized in Nanjing Maternity and Child Care Center from January 2011 to December 2014.And they all underwent the TCRA surgery successfully for the first time.The pregnancy and live birth rates,the ratio of term birth,abortion,and premature birth,and the intrapartum complications of patients with two different adhesions degrees were separately calculated.Results:①This study contained 506 patients of IUA,274 moderate cases and 232 severe cases;90.51％ of all cases had experienced hypomenorrhea even amenorrhea.The incidence of hypomenorrhea and secondary infertility in severe group was significantly higher than that of moderate group(P=0.000).②A total of 433 cases were followed up and the follow-up rate was 85.57％.406 of them had fertility requirements(93.76％);the total pregnancy rate was 57.64％(234/406),and the total live birth rate was 34.98％ (142/406).The pregnancy rate of 67.11％(151/225) in moderate group was significantly higher than that of 45.86％(83/181) in severe group (P=0.000).The live birth rate of 25.97％ (47/181) in severe group was significantly lower than that of 42.22％ (95/ 225) in moderate group(P=0.01).③Among all the pregnant patients,the constituent ratio of full-term birth and abortion was 46.58％ and 32.05％,respectively.In severe group,the constituent ratio of full-term birth was lower than that in the moderate group,and the abortion constitution ratio was higher than that in the moderate group,but there was no statistically significant difference(P=0.466,P=0.198).There were 178 cases of postpartum hemorrhage,placenta adhesion,placenta praevia and placenta implantation.The placenta implantation was significantly higher in severe group than in moderate group,the difference was statistically significant(P=0.045).Conclusion:The reproductive outcome of moderate IUA is better than that of severe intrauterine adhesions.

Objective To explore the expression of Toll like receptor?9( TLR?9) and its correlation with microvessel density ( MVD) and vascular endothelial growth factor( VEGF) in cervical squamous cell carcinoma. Methods The expression of TLR?9 was detected by immunohistochemical SP method in 48 cases of cervical squamous cell carcinoma and 20 cases of normal cervical epitheli?um. The tissues were labeled with CD34 monoclonal antibody to calculate MVD, and the level of VEGF was measured by enzyme linked immunosorbent assay. The effectiveness of TLR?9 expression in the diagnosis of cervical squamous cell carcinoma was evaluated by re?ceiver operating characteristic curve. Results In the tissues from cervical squamous cell carcinoma, the positive expression rate of TLR?9 was 83?3%(40/48), and the MVD and level of VEGF were 36?8±7?25 and(25?58±3?49)ng/mg, all higher than those of normal cervical epithelial tissues( P<0?05) . The high expression of TLR?9 was related to the clinical stage and the expression of matrix metalloproteinase 9, but unrelated with histological grade and lymph node metastasis. The levels of VEGF and MVD in tissues with TLR?9 positive expression were significantly higher than those in the negative group( P<0?05) . The diagnostic efficiency of TLR?9 in cervical squamous cell carcinoma was good, and its AUC, sensitivity and specificity were 0?830, 76?1% and 82?7%, respectively. Conclusion The carcinogenesis and metastasis with high expression of TLR?9 may be involved in cervical squamous cell carcinoma, and angiogenesis is closely related with cervical squamous cell carcinoma.

根据肌瘤与子宫肌层的关系可将子宫黏膜下肌瘤分为3种类型。宫腔镜子宫黏膜下肌瘤电切术( transcervical resection of myoma,TCRM)是治疗子宫黏膜下肌瘤的首选手术方法。本文结合我们在临床中的经验和体会,总结了各型子宫黏膜下肌瘤的宫腔镜电切术的操作方法、技巧以及手术并发症预防。

The Mayer-Rokitansky-Kuster-Hauser( MRKH) syndrome is characterized by vaginal agenesis and typically accompanied by uterine agenesis. Neovaginal creation to restoring functional anatomy and satisfactory quality of sexual life for the couple is the most ideal approach of the management of MRKH patients. Neovaginal reconstruction using amniotic membranes was practiced widely,and results in satisfying anatomic and functional outcome. The amnion vaginoplasty is simple and safe technique with less chance of the injury ofbladder,urethral and rectal and fewer operation complications. So the neovaginal reconstruction using amniotic membranes is an effective and preferred surgical technique for treatment of congenital absence of vagina.