IntroductionDespite rapid advances in molecular biology, personalized molecular therapy remains a clinical challenge for endometrial cancer due to its complex and heterogeneous tumor microenvironment.Based on clinical findings, AIB1 is a marker molecule for poor prognosis in endometrial cancer and may serve as a potential therapeutic target. Moreover, it is well known that aerobic glycolysis plays an important role in tumour energy metabolism. It has been previously reported in various hormone-related tumour studies that AIB1 affects glycolysis and promotes tumour development. However, the link between AIB1 and aerobic glycolysis in estrogen-dependent endometrial cancer remains unclear.MethodsWe used two endometrial cancer cell lines to validate the high expression of target genes and the effect on the proliferative and invasive capacity of the tumours and verified the pattern of interactions and epigenetic modifications by CHIP and CO-IP techniques. Finally, the conclusions were validated on homozygous miceResultsIn this study, we investigated the transcriptional co-activation functions of AIB1, including its acetylation by PCAF, binding to the c-myc transcription factor, and recruitment of glycolysis-related gene promoters.DiscussionOur findings provide new clues that perturbation of normal homeostatic levels of AIB1 is linked with endometrial cancer. These findings suggest that targeting AIB1-mediated regulation of aerobic glycolysis may offer a novel therapeutic approach for endometrial cancer with high AIB1 expression, opening new avenues for personalized diagnostics and treatment strategies in this disease.

特殊病理类型子宫内膜癌(special type endometrial carcinoma,STEC)是一类病死率较高的妇科恶性肿瘤,相较常见的子宫内膜样腺癌,STEC进展快、复发率高,且具有显著组织异型性,传统病理分型无法满足临床需要.近年来提出的TCGA等分子分型对STEC的诊治具有重要意义,本文就分子分型在浆液性癌、透明细胞癌、癌肉瘤、去/未分化癌和高级别不明确子宫内膜癌五类STEC中的研究进展进行综述,包括分子分型在STEC诊断和鉴别、靶向药物研发、疗效预测及预后中的应用,以期为临床合理应用分子分型提供参考.

背景 高危型人乳头瘤病毒(high risk human papillomavirus,HR-HPV)感染并不一定会导致癌前病变或宫颈癌,阴道微生物多样性的改变可能是造成HPV持续感染继而发生宫颈病变的伴随因素.目的 探讨阴道微生态改变与HR-HPV感染的相关性,为宫颈癌的防治提供参考.方法 选取 2021年 10月-2022年 3月就诊于解放军总医院第一医学中心妇产科门诊,同时行阴道分泌物微生态检测及人乳头瘤病毒基因分型检测的 324例患者(年龄 21～72岁)为研究对象,分析阴道微生态异常与HR-HPV感染的相关性.结果 324例患者中HR-HPV阳性 71例,阳性率 21.91％(71/324);阴道微生态正常的178例中HR-HPV阳性43例,阳性率24.16％(43/178);阴道微生态异常的146例中HR-HPV阳性28例,阳性率19.18％(28/146).阴道微生态异常结果中细菌性阴道病(bacterial vaginosis,BV)及BV中间型37例,HR-HPV阳性率40.54％(15/37);菌群抑制 32例,HR-HPV阳性率 18.75％(6/32);阴道菌群正常存在炎症反应 77例,HR-HPV阳性率 9.09％(7/77).阴道微生态正常组与菌群抑制组HPV阳性率差异无统计学意义(P＞0.05);与BV及BV中间型组、阴道菌群正常存在炎症反应组的HPV阳性率差异均有统计学意义(P＜0.05).Logistic回归分析显示,BV及BV中间型发生HR-HPV感染的概率更高(OR= 2.240,P=0.030)、阴道菌群正常存在炎症反应者HR-HPV感染的概率更低(OR=0.329,P=0.009).结论 BV及单纯白细胞增多引起的阴道微生态改变与HR-HPV感染密切相关.

In this study, we explored the risk factors for lymph node metastasis in patients with type II endometrial carcinoma (EC). Patients diagnosed with type II EC who underwent staged surgery and lymph node dissection were included. Univariate analysis was performed using a chi-square test for factors such as age, body mass index (BMI), menopausal status, histologic type, histologic grade, myometrial invasion, lymphatic vascular invasion (LVSI), tumor volume index, and para-aortic lymph node (PALN) or pelvic lymph node (PLN) metastasis. An analysis of multivariate factors was performed on the factors that were statistically significant in the univariate analysis. Pelvic lymph node metastasis was identified in 38 of the 184 patients with type II EC. Univariate analyses revealed that age >= 55 years, menopause, more than one-half myometrial invasion, and LVSI were risk factors for pelvic lymph node metastasis. Multivariate analysis indicated that myometrial invasion of more than one-half (hazard ratio (HR): 4.259) and LVSI (HR: 3.317) were independent risk factors for pelvic lymph node metastasis. Para-aortic lymph node metastasis was identified in 13 of the 184 patients with type II EC. Univariate analysis indicated that para-aortic lymph node metastasis was significantly associated with LVSI and pelvic lymph node metastases. Multivariate analysis suggested that pelvic lymph node metastasis (HR: 5.887) was an independent risk factor for para-aortic lymph node metastasis. LVSI and myometrial invasion depth >1/2 were significant predictors of pelvic lymph node metastasis in patients with type II EC. Patients with type II EC who have pelvic lymph node metastasis may be at risk of para-aortic lymph node metastasis.

Ovarian teratoma is a common benign ovarian tumor in gynecology, the preferred treatment of which is minimally invasive surgery. A patient with left ovarian teratoma was admitted to the First Medical Center of PLA General Hospital on 2 March 2022, and underwent domestic single-port robot-assisted laparoscopic surgery for the removal of ovarian teratoma, which is the first clinical trial in China. The surgery was successfully completed with satisfactory postoperative effect,rapid postoperative recovery and beautiful abdominal incision.The successful completion of this clinical trial preliminarily proves that the domestic single-port robot is safe and feasible.

子宫切除术是妇科常见的治疗手段,从开腹到微创的手术入路变革已经大大改善了患者的手术并发症和预后.作为微创手术的一种,机器人手术系统自2005年开始在妇科领域展开[1],因其较传统腹腔镜有缩短住院时间、减少围手术期并发症、改善患者疼痛等优势[2],在临床推广迅速.da Vinci SP手术系统是单孔机器人手术系统,2018年在美国推出.我科于2022年1月完成1例da Vinci SP机器人下子宫、双附件切除术,报道如下.

Objective:To compare the efficacy of robotic, laparoscopic surgery and laparotomy in the treatment of primary cytoreductive surgery for FIGO stage Ⅱ-Ⅲ ovarian cancer.Methods:A total of 130 patients who received primary cytoreductive surgery for ovarian cancer in Department of Gynecology and Obstetrics, The First Medical Center of Chinese PLA General Hospital from Jan. 2016 to Dec. 2020 were collected. According to different surgical methods, they were divided into three groups, including laparotomy group (n= 87), laparoscopy group (n= 23) and robotic group (n= 20). Perioperative parameters (operation time, intraoperative blood loss, intraoperative blood transfusion rate, total number of dissected lymph nodes, intraoperative complications, postoperative fever and other postoperative complications, postoperative exhaust time, postoperative pathological types) were compared among the three groups, as well as disease recurrence during postoperative follow-up until Dec. 2021.Results:There was no significant difference in age, BMI, medical complications and previous abdominal surgery among the three groups (P> 0.05). No significant difference was found in operating time among the three groups (P= 0.328); The intraoperative blood loss in robotic group and laparoscopic group was significantly lower than that in the laparotomy group [(231.00 ± 320.20)ml and (241.30 ± 118.37)ml vs (823.68 ± 685.73)ml] (P<0.001); and the intraoperative blood transfusion rate in robotic group and laparoscopic group was significantly less than that in laparotomy group (5.00% and 0.00% vs 48.28%, P< 0.001); There was no significant differencein the total number of dissected lymph nodes, postoperative fever and postoperative complications among the three groups (P>0.05); The intraoperative complication rate in robotic group and laparoscopic group was significantly lower than that in laparotomy group (5.00% and 0.00% vs 17.24%, P= 0.046); And the postoperative exhaust time in robotic group and laparoscopic group was earlier than that in laparotomy group [(2.15 ± 0.81) d and (1.87 ± 0.97) d vs (3.06 ± 1.09) d](P< 0.001). The follow-up was lasted to Dec. 2021, and there was no significant difference in postoperative progression-free survival among the three groups (P= 0.601).Conclusions:Robotic and laparoscopic surgery in primary cytoreductive surgery are safe and reliable for selected patients with FIGO stage Ⅱ-Ⅲ ovarian cancer.

背景 子宫内膜癌是最常见的女性生殖系统恶性肿瘤之一,与高血压、糖尿病、肥胖症等内分泌代谢紊乱紧密相关.尽管大量文献报道达芬奇机器人手术具有手术时间短、出血量少、生存预后优于传统手术的特点,但目前缺乏大样本量达芬奇机器人系统治疗子宫内膜癌(endometrial carcinoma,EC)患者的围术期结果和长期生存预后分析.目的 分析达芬奇机器人手术系统治疗子宫内膜癌患者的围术期结果、临床病理特征及预后,探讨达芬奇机器人手术治疗子宫内膜癌的特点和应用优势,为临床应用提供参考.方法 回顾性分析解放军总医院第一医学中心妇科2012年2月-2020年6月收治的333例采用机器人手术初治的子宫内膜癌患者临床资料,分析患者年龄、体质量指数(body mass index,BMI)、绝经年龄、婚育情况、代谢合并症情况、手术时间、术中出血量、淋巴结切除数目、术后肛门排气时间、住院时间、术后并发症情况、肿瘤病理特征及生存预后数据.结果 子宫内膜癌患者平均发病年龄(53.03±9.05)岁;平均体质量指数(26.04±4.00)kg/m2,肥胖患者(BMI>28 kg/m2)占27.63％;未生育患者占9％;绝经后患者占63％;合并代谢综合征患者占43.84％.机器人手术平均手术时间(184.91±49.78)min,平均术中出血量(135.29±62.68)mL,平均淋巴结清扫数量(28.00±11.47)枚.手术并发症38例(11.41％),包括淋巴漏23例、感染7例、下肢静脉血栓4例、肠梗阻2例、腹腔内出血1例、输尿管阴道瘘1例,经积极治疗均治愈.平均术后排气时间(1.90±0.63)d,平均术后住院时间(9.59±4.04)d.Ⅰ型子宫内膜癌占92.19％,Ⅱ型子宫内膜癌占7.81％;高分化内膜癌占41.19％,中低分化占58.81％;子宫内膜癌Ⅰ期患者占78.08％,Ⅱ期占10.51％,Ⅲ期占10.81％,Ⅳ期占0.60％;肥胖(BMI>28 kg/m2)和年龄(年龄>53岁)对子宫内膜癌患者接受达芬奇机器人系统治疗的围术期影响差异无统计学意义(P<0.05).333例达芬奇机器人手术治疗子宫内膜癌患者的3年累积生存率96.5％,5年累积生存率95.8％.结论 达芬奇机器人手术系统治疗子宫内膜癌稳定性强、精确度高,手术效果不受患者高龄、肥胖、复杂合并症等多元化临床特征影响.

子宫内膜癌(EC)是女性生殖系统常见的恶性肿瘤,在全球范围内其发病率逐年升高.多数EC患者经手术治疗后预后较好,但对于晚期或复发、转移性EC来说,传统的治疗手段效果有限,患者预后较差.1983年Bokhman根据流行病学、内分泌及预后特点将EC分为I型(雌激素依赖型)和II型(非雌激素依赖型),然而在临床应用中该分型手段具有一定局限性.随着分子生物学及基因测序技术的发展,EC的研究深入分子水平.2013年美国TCGA第一次归纳提出EC的4种分子分型,由于其费用高昂、技术复杂,临床不易获得.2015年Talhouk等提出简易替代分型并在后续的研究中将其命名为ProMisE分子风险分型,包括:POLE突变型、MSI高突变型、p53野生型、p53突变型.EC分子分型的研究具有重要的临床指导意义.本文就EC传统分型到分子分型的转变做一回顾,并对分子分型与临床相关的研究做一总结与分析.EC分子分型的不断完善有助于实现临床诊疗中的精准化、规范化、个体化,在精准医学背景下有重要价值.

Objective:To review the clinical data of a large sample from a single center, describe and analyze the perioperative indicators of robotic system therapy for elderly patient suffered from gynecological malignant tumor, so as to provide reference for the selection of clinical surgical procedures.Methods:A retrospective analysis in Feb. 2012-Jun. 2020 were conducted. 221 the elderly cases treated with minimally invasive surgery in the department of gynecology in Chinese PLA General Hospital were collected. Compared operation time(installed time included), blood loss, lymph node resection, postoperative hospital stay, exhaust time, surgical complications, etc.Results:In the study, 221 elderly patient (age over 60) were included and 37 senile patient(age over 70) accounted for 16.74%.Compared with elderly patient treated with traditional laparoscopic, the blood loss of that treated by robotic system was [(134.75±151.33)ml vs (200.56±253.06)ml, P=0.024]; lymph node resection[(22.53±12.14)vs (12.64±15.56), P<0.001]; operation time[(203.51±66.95)min vs (161.55±83.70)min, P<0.001)]; exhaust time[(1.93±0.81)d vs (1.72±0.84)d, P=0.061)]; surgical complication rate (5.79% vs 9.00%, P=0.438).Conclusions:Da Vinci robotic system applied in elderly gynecological malignant tumor patient can reduce intraoperative blood loss and increase the number of lymph nodes resection significantly with prolonged operation time, without more surgical complication and affecting postoperative recovery. Da Vinci robotic system applied in elderly gynecological malignant tumor patient is safe and efficient.It provide a selection for elderly patient suffered from gynecological malignant tumor.

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.

宫颈癌是最常见的妇科恶性肿瘤,严重威胁女性健康,其发生与人乳头瘤病毒(HPV)的持续感染密切相关.随着分子生物学与免疫学研究的进展,HPV疫苗已在宫颈癌预防方面取得卓越成效,免疫治疗成为宫颈癌尤其是晚期及复发癌治疗的新模式.针对手术及放化疗治疗不理想的进展期或复发性宫颈癌,目前许多研究均在探索免疫治疗的安全性、效应性,主要研究方向包括标准治疗同期加用免疫治疗、单独使用免疫治疗、联合抗血管治疗或多种免疫治疗药物联用,以及新型HPV预防性疫苗的研究.本文对疫苗免疫治疗、过继细胞免疫治疗、树突状细胞免疫治疗和免疫检查点抑制剂等宫颈癌免疫治疗的进展进行综述.

1 病例简介 女,32 岁.主诉:月经量大伴严重痛经 4 个月.现病史:2016 年因月经不调于当地医院诊断为子宫腺肌症;后自然受孕并于 2017 年 6 月行剖宫产术,术后3 个月月经复潮,月经量及颜色正常,轻微痛经;2018 年4 月出现月经量大伴严重痛经,视觉模拟评分(visual analogue scale,VAS)9 分,持续 17 d,于当地医院放置曼月乐环,2 个月后曼月乐环脱落.既往病史:孕2 产 2,2 次剖宫产史.影像学检查:超声提示子宫前壁厚 2.0 cm,后壁厚 2.4 cm,后壁回声粗强不均,诊断为子宫腺肌症.MRI 提示子宫体底部前后肌壁间见大小约 65 mm×73 mm×67 mm、边界模糊呈等和短 T1、短和长 T2 的异常信号,诊断为子宫腺肌症,增强扫描 T2WI 见图 1A.

Background The objective of this study was to compare the diagnostic value of integrated PET/MRI with PET/CT for assessment of regional lymph node metastasis and deep myometrial invasion detection of endometrial cancer. Methods Eighty-one patients with biopsy-proven endometrial cancer underwent preoperative PET/CT ( n = 37) and integrated PET/MRI ( n = 44) for initial staging. The diagnostic performance of PET/CT and integrated PET/MRI for assessing the extent of the primary tumor and metastasis to the regional lymph nodes was evaluated by two experienced readers. Histopathological and follow-up imaging results were used as the gold standard. McNemar’s test was employed for statistical analysis. Results Integrated PET/MRI and PET/CT both detected 100% of the primary tumors. Integrated PET/MRI proved significantly more sensitivity and specificity than PET/CT in regional lymph node metastasis detection ( P = 0.015 and P < 0.001, respectively). The overall accuracy of myometrial invasion detection for PET/CT and Integrated PET/MRI was 45.9% and 81.8%, respectively. Integrated PET/MRI proved significantly more accurate than PET/CT ( P < 0.001). Conclusion Integrated PET/MRI, which complements the individual advantages of MRI and PET, is a valuable technique for the assessment of the lymph node metastasis and myometrial invasion in patients with endometrial cancer.

近年来,能量器械在使用过程中带来的损伤甚至因此导致死亡的病例并未引起足够重视,据美国FDA统计,1994～2013年手术患者中由于能量器械使用造成的损伤多达3553例,致死178例[1]. 假性动脉瘤多见于血管损伤后期,瘤壁为纤维性组织,并不包含正常血管壁的3 层组织(内膜、中膜及外膜) [2]. 髂外动脉等深部动脉的假性血管瘤多由医源性原因造成. 我院2018年7月收治1例机器人宫颈癌根治术后并发左髂外动脉假性血管瘤,本文探讨其发生原因及防治对策,旨在提高广大临床医师对手术中使用能量器械造成损伤的防范意识.