Objective To investigate the clinical diagnosis, treatment, and prevention of fallopian tube prolapse (FTP) after hysterectomy.Methods A total of 7949 patients received hysterectomy from January 1983 to August 2005 in...Objective To investigate the clinical diagnosis, treatment, and prevention of fallopian tube prolapse (FTP) after hysterectomy.Methods A total of 7949 patients received hysterectomy from January 1983 to August 2005 in Peking Union Medical College Hospital, and 9 cases (including 1 case from other hospital) of FTP after hysterectomy were involved during this period.All of them were diagnosed according to pathological results and were followed up.The symptoms, diagnosis, and treatment of the FTP patients were analyzed retrospectively.Results The incidence of FTP after hysterectomy was 0.1% (8/7949), with the incidence of FTP after trans- abdominal hysterectomy being 0.06% (4/6229), after trans-vaginal hysterectomy being 0.5% (4/780), after laparoscopic assistant vaginal hysterectomy being 0 (0/940).There was no symptom in 3 cases.The pelvic examination revealed the typical prolapsed fimbrial end of a fallopian tube in 3 cases and the other 6 cases revealed red granulation tissue.All of them were excised vaginally and cauterized.The results were proved by pathological examination.No recurrence was reported during follow-up.Conclusions FTP is a rare complication after hysterectomy.The prognosis is well after proper diagnosis and treatment.Fixation of accessories onto the pelvic wall and complete peritonealization at the time of hysterectomy are the most important methods to prevent FTP after hysterectomy.展开更多
BACKGROUND Retroperitoneal lipomas are extremely rare tumors and tend to be large in size(>10 cm)when diagnosed,causing various clinical manifestations.Preoperative diagnosis of retroperitoneal lipomas is difficult...BACKGROUND Retroperitoneal lipomas are extremely rare tumors and tend to be large in size(>10 cm)when diagnosed,causing various clinical manifestations.Preoperative diagnosis of retroperitoneal lipomas is difficult.There is a lack of relevant information about the management and prognosis of these benign tumors due to limited reports.CASE SUMMARY A 53-year-old woman who complained about progressive abdominal distention and aggravating satiety was referred to the gynecological outpatient department of Peking Union Medical College Hospital.Computerized tomography(CT)revealed an immense mass with fat density,measuring 28.6 cm×16.6 cm in size.Adjacent organs,including the intestinal tract and uterus,were squeezed to the right side of the abdomen.An exploratory laparotomy was performed with suspicion of liposarcoma.Intraoperatively,a giant yellowish lobulated mass was found occupying the retroperitoneum and it was removed by tumor debulking.Postoperative histopathological results confirmed the diagnosis of retroperitoneal lipoma.CONCLUSION Retroperitoneal lipoma is a very rare condition and is difficult to differentiate from well-differentiated liposarcoma.Radiographic investigations,especially CT and magnetic resonance imaging,are important for preoperative diagnosis.Surgical resection is the fundamental treatment,which is difficult due to its size and relation to neighboring structures.展开更多
Background： When considering the issue of recurrence, perimenopausal women may have more dilemma during management comparing with young women, for example, whether to retain the uterus and ovary during surgery, wheth...Background： When considering the issue of recurrence, perimenopausal women may have more dilemma during management comparing with young women, for example, whether to retain the uterus and ovary during surgery, whether it is necessary to add adjuvant medicine treatment after operation, and there is no evidence for reference about using ofgonadotropin-releasing hormone agonist. This study aimed to study the risk factors for the recurrence of ovarian endometriosis （EM） in patients aged 45 and over. Methods： This is a retrospective nested case-control study. We reviewed the medical records of patients aged over 45 years who underwent surgical treatments for ovarian EM from 1994 to 2014, in Peking Union Medical College Hospital of Chinese Academy of Medical Sciences. By following up to January 2016, 45 patients were found to have relapses and regarded as the recurrence group. The patients with no recurrence during the same follow-up period were randomly selected by the ratio of 1：4 as the nonrecurrence group （ 180 patients in total）. Stratified Cox regression was used to analyze the risk factors of the recurrence. Results： Univariate analysis showed that there was a significant difference in the postoperative treatment （the percentage of patients who received postoperative treatment in non-recurrence group and recurrence group, 23.9% vs. 40.0%, x2=4.729, P = 0.030） and ovarian preservation （the percentage of patients who received surgery of ovarian preservation in non-recurrence group and recurrence group. 25.0 % vs. 44.4%, x2 = 19.462, P 〈 0.001 ） between the nonrecurrence group and the recurrence group. There was no correlation between recurrence and the following factors including patient＇s age, menarche age, gravidity, parity, CA125 level, ovarian lesions, menopausal status, combined benign gynecological conditions （such as myoma and adenomyoma） and endometrial abnormalities, and surgical approach or surgical staging （all P 〉 0.05）. Multivariate analysis indicated that whether to retain the ovary was the only independent risk factor of recurrence for patients aged 45 years and over with ovarian EM （odds ratio： 5.594, 95% confidence interval： 1.919-16.310, P= 0.002）. Conclusion： Ovarian preservation might be the only independent risk factor of recurrence for patients aged 45 years and over with ovarian EM.展开更多
To the Editor:Endometriosis refers to the endometrial tissue (interstitial substance and gland) with growth function occurring in the uterine lining of uterine cavity and the places outside myometrium.It often leads t...To the Editor:Endometriosis refers to the endometrial tissue (interstitial substance and gland) with growth function occurring in the uterine lining of uterine cavity and the places outside myometrium.It often leads to pain,infertility,nodules or masses and other symptoms and signs,and thus,brings a heavy burden on individuals and society.Traditional blood reflux theory,immune theory,inflammatory theory,hormone theory,etc.,cannot fully elucidate the pathogenesis of endometriosis.展开更多
To the Editor： Uterine adenomyosis （AM） is caused by the ectopic growth of endometrial glands and stroma in the myometrium of the uterus, accompanied by hyperplasia and hypertrophy of the surrounding smooth muscle ...To the Editor： Uterine adenomyosis （AM） is caused by the ectopic growth of endometrial glands and stroma in the myometrium of the uterus, accompanied by hyperplasia and hypertrophy of the surrounding smooth muscle cells, leading to a diffuse enlargement of the uterus.展开更多
文摘Objective To investigate the clinical diagnosis, treatment, and prevention of fallopian tube prolapse (FTP) after hysterectomy.Methods A total of 7949 patients received hysterectomy from January 1983 to August 2005 in Peking Union Medical College Hospital, and 9 cases (including 1 case from other hospital) of FTP after hysterectomy were involved during this period.All of them were diagnosed according to pathological results and were followed up.The symptoms, diagnosis, and treatment of the FTP patients were analyzed retrospectively.Results The incidence of FTP after hysterectomy was 0.1% (8/7949), with the incidence of FTP after trans- abdominal hysterectomy being 0.06% (4/6229), after trans-vaginal hysterectomy being 0.5% (4/780), after laparoscopic assistant vaginal hysterectomy being 0 (0/940).There was no symptom in 3 cases.The pelvic examination revealed the typical prolapsed fimbrial end of a fallopian tube in 3 cases and the other 6 cases revealed red granulation tissue.All of them were excised vaginally and cauterized.The results were proved by pathological examination.No recurrence was reported during follow-up.Conclusions FTP is a rare complication after hysterectomy.The prognosis is well after proper diagnosis and treatment.Fixation of accessories onto the pelvic wall and complete peritonealization at the time of hysterectomy are the most important methods to prevent FTP after hysterectomy.
基金Supported by the National Key Research and Development Program,No.2018YFC1002105.
文摘BACKGROUND Retroperitoneal lipomas are extremely rare tumors and tend to be large in size(>10 cm)when diagnosed,causing various clinical manifestations.Preoperative diagnosis of retroperitoneal lipomas is difficult.There is a lack of relevant information about the management and prognosis of these benign tumors due to limited reports.CASE SUMMARY A 53-year-old woman who complained about progressive abdominal distention and aggravating satiety was referred to the gynecological outpatient department of Peking Union Medical College Hospital.Computerized tomography(CT)revealed an immense mass with fat density,measuring 28.6 cm×16.6 cm in size.Adjacent organs,including the intestinal tract and uterus,were squeezed to the right side of the abdomen.An exploratory laparotomy was performed with suspicion of liposarcoma.Intraoperatively,a giant yellowish lobulated mass was found occupying the retroperitoneum and it was removed by tumor debulking.Postoperative histopathological results confirmed the diagnosis of retroperitoneal lipoma.CONCLUSION Retroperitoneal lipoma is a very rare condition and is difficult to differentiate from well-differentiated liposarcoma.Radiographic investigations,especially CT and magnetic resonance imaging,are important for preoperative diagnosis.Surgical resection is the fundamental treatment,which is difficult due to its size and relation to neighboring structures.
基金This work was supported by grants from the National Key R＆D Program of China （No. SQ2017YFSF080001） and National Natural Science Foundation of China （No. 81501236）.
文摘Background： When considering the issue of recurrence, perimenopausal women may have more dilemma during management comparing with young women, for example, whether to retain the uterus and ovary during surgery, whether it is necessary to add adjuvant medicine treatment after operation, and there is no evidence for reference about using ofgonadotropin-releasing hormone agonist. This study aimed to study the risk factors for the recurrence of ovarian endometriosis （EM） in patients aged 45 and over. Methods： This is a retrospective nested case-control study. We reviewed the medical records of patients aged over 45 years who underwent surgical treatments for ovarian EM from 1994 to 2014, in Peking Union Medical College Hospital of Chinese Academy of Medical Sciences. By following up to January 2016, 45 patients were found to have relapses and regarded as the recurrence group. The patients with no recurrence during the same follow-up period were randomly selected by the ratio of 1：4 as the nonrecurrence group （ 180 patients in total）. Stratified Cox regression was used to analyze the risk factors of the recurrence. Results： Univariate analysis showed that there was a significant difference in the postoperative treatment （the percentage of patients who received postoperative treatment in non-recurrence group and recurrence group, 23.9% vs. 40.0%, x2=4.729, P = 0.030） and ovarian preservation （the percentage of patients who received surgery of ovarian preservation in non-recurrence group and recurrence group. 25.0 % vs. 44.4%, x2 = 19.462, P 〈 0.001 ） between the nonrecurrence group and the recurrence group. There was no correlation between recurrence and the following factors including patient＇s age, menarche age, gravidity, parity, CA125 level, ovarian lesions, menopausal status, combined benign gynecological conditions （such as myoma and adenomyoma） and endometrial abnormalities, and surgical approach or surgical staging （all P 〉 0.05）. Multivariate analysis indicated that whether to retain the ovary was the only independent risk factor of recurrence for patients aged 45 years and over with ovarian EM （odds ratio： 5.594, 95% confidence interval： 1.919-16.310, P= 0.002）. Conclusion： Ovarian preservation might be the only independent risk factor of recurrence for patients aged 45 years and over with ovarian EM.
文摘To the Editor:Endometriosis refers to the endometrial tissue (interstitial substance and gland) with growth function occurring in the uterine lining of uterine cavity and the places outside myometrium.It often leads to pain,infertility,nodules or masses and other symptoms and signs,and thus,brings a heavy burden on individuals and society.Traditional blood reflux theory,immune theory,inflammatory theory,hormone theory,etc.,cannot fully elucidate the pathogenesis of endometriosis.
基金This work was supported by grants from the CAMS Innovation Fund for Medical Sciences （No. 2016-12M-1-002） and National Natural Science Foundation of China （No. 81501236）.
文摘To the Editor： Uterine adenomyosis （AM） is caused by the ectopic growth of endometrial glands and stroma in the myometrium of the uterus, accompanied by hyperplasia and hypertrophy of the surrounding smooth muscle cells, leading to a diffuse enlargement of the uterus.
