Cervical stenosis is a clinical condition involving partial or complete obstruction of the endocervical canal.In 1996,Bauldauf proposed that the definition of cervical stenosis is a cervical canal into which a 2.5# He...Cervical stenosis is a clinical condition involving partial or complete obstruction of the endocervical canal.In 1996,Bauldauf proposed that the definition of cervical stenosis is a cervical canal into which a 2.5# Hegar dilator cannot be inserted.1 Acquired cervical stenosis can be a complication of surgical procedures such as conization,trachelectomy,and curettage.It is a serious complication because of the clinical repercussions,which can include amenorrhea,hematometra,dysmenorrhea,infertility,infection,and endometriosis.Various surgical techniques are used in dilation and cervix reconstruction.However,in some cases,unsuccessful dilation with refractory recurrent stenosis may lead to hysterectomy.A successful case in which a self-expanding nitinol vascular stent was used to treat cervical stenosis was described by Grund et al.2 Here we report two additional cases in which vascular stents were used to treat patients with recurrent cervical stenosis after cervical surgeries.展开更多
Uterus didelphys occurs in~0.4%of females and is found in~11%-20%of all uterus defects.It is a risk factor for cervical insufficiency,consequently contributing to late miscarriage or preterm birth.Thus far,only two pr...Uterus didelphys occurs in~0.4%of females and is found in~11%-20%of all uterus defects.It is a risk factor for cervical insufficiency,consequently contributing to late miscarriage or preterm birth.Thus far,only two prior cases of uterus didelphys accompanied by cervical insufficiency treated through laparoscopic cervical cerclage have been reported;however,livebirth only occurred in one hemiuterus.Herein,we report a case of uterus didelphys in a patient diagnosed with cervical insufficiency.Following the placement of a modified laparoscopic cervical cerclage,the patient had two successful livebirths through both hemiuteruses,respectively,with longer gestation age(ie,>36 weeks).The aim of this case report was to provide useful information for clinical practitioners to make better decisions on the management of cervical insufficiency in patients with uterus didelphys,and identify obstetric complications that clinicians should pay attention to during pregnancy.展开更多
To editor:Cervical insufficiency,or cervical incompetence,is characterized by painless cervix dilatation during the second trimester without contractions.1 It is found in 0.1%–1%of all pregnancies and in up to 8.0%of...To editor:Cervical insufficiency,or cervical incompetence,is characterized by painless cervix dilatation during the second trimester without contractions.1 It is found in 0.1%–1%of all pregnancies and in up to 8.0%of women with recurrent second-trimester miscarriages.2–4 Cervical insufficiency is associated with premature birth,which is a leading cause of neonatal and perinatal mortality and morbidity.展开更多
1.Background For the past several decades,minimally invasive surgery(MIS)has been advantageous for the treatment of cervical cancer compared to open surgery.MIS is favored due to reduced blood loss,decreased postopera...1.Background For the past several decades,minimally invasive surgery(MIS)has been advantageous for the treatment of cervical cancer compared to open surgery.MIS is favored due to reduced blood loss,decreased postoperative complications,rapid recovery,and shorter hospitalization time.In 2018,results from the Laparoscopic Approach to Cervical Cancer(LACC)trial,an international multicenter randomized phase III trial of women with early-stage cervical cancer comparing the survival outcomes among different surgical approaches1 and a real-world study published in the New England Journal of Medicine.展开更多
BACKGROUND Laparoscopic myomectomy is increasingly used for resecting gynecological tumors.Leiomyomas require morcellation for retrieval from the peritoneal cavity.However,morcellated fragments may implant on the peri...BACKGROUND Laparoscopic myomectomy is increasingly used for resecting gynecological tumors.Leiomyomas require morcellation for retrieval from the peritoneal cavity.However,morcellated fragments may implant on the peritoneal cavity during retrieval.These fragments may receive a new blood supply from an adjacent structure and develop into parasitic leiomyomas.Parasitic leiomyomas can occur spontaneously or iatrogenically;however,trocar-site implantation is an iatrogenic complication of laparoscopic uterine surgery.We describe a parasitic leiomyoma in the trocar-site after laparoscopic myomectomy with power morcellation.CASE SUMMARY A 50-year-old woman presented with a palpable abdominal mass without significant medical history.The patient had no related symptoms,such as abdominal pain.Computed tomography findings revealed a well-defined contrast-enhancing mass measuring 2.2 cm,and located on the trocar site of the left abdominal wall.She had undergone laparoscopic removal of uterine fibroids with power morcellation six years ago.The differential diagnosis included endometriosis and neurogenic tumors,such as neurofibroma.The radiologic diagnosis was a desmoid tumor,and surgical excision of the mass on the abdominal wall was successfully performed.The patient recovered from the surgery without complications.Histopathological examination revealed that the specimen resected from the trocar site was a uterine leiomyoma.CONCLUSION Clinicians should consider the risks and benefits of laparoscopic vs laparotomic myomectomy for gynecological tumors.Considerable caution must be exercised for morcellation to avoid excessive tissue fragmentation.展开更多
目的探讨腹腔镜下子宫深静脉入路C型宫颈癌根治术治疗宫颈癌的疗效。方法2021年1月~2022年12月我院采用腹腔镜下子宫深静脉入路C型宫颈癌根治术+盆腔淋巴结清扫术±腹主动脉旁淋巴结切除术治疗58例宫颈癌。建立通道后,在阔韧带后叶...目的探讨腹腔镜下子宫深静脉入路C型宫颈癌根治术治疗宫颈癌的疗效。方法2021年1月~2022年12月我院采用腹腔镜下子宫深静脉入路C型宫颈癌根治术+盆腔淋巴结清扫术±腹主动脉旁淋巴结切除术治疗58例宫颈癌。建立通道后,在阔韧带后叶定位输尿管,分离输尿管后暴露子宫动脉,沿子宫动静脉背侧分离结缔组织,逐渐暴露子宫深静脉。将包绕子宫深静脉周围的宫旁淋巴结切除,单独送病理检查。继续向膀胱方向追踪子宫深静脉,游离其属支,血管夹双重夹闭。结果手术时间(307.2±54.1)min,出血量中位数50(20,100)ml,淋巴结清扫(26.3±6.9)枚,留置导尿管时间(20.6±4.7)d,拔除腹腔引流管时间(9.4±4.1)d,肛门排气时间(36.7±4.1)h,抗生素使用时间(9.2±4.2)d,住院时间(13.4±2.6)d。术后并发症发生率3.4%(2/58)。术后病理分期升级率为22.4%(13/58)。术后欧洲癌症研究治疗组织(European Organization of Research and Treatment of Cancer,EORTC)生活质量核心30问卷(Quality of Life Questionnaire-Core 30,QLQ-C30)评分较术前显著升高[(78.6±10.7)分vs.(47.1±7.6)分,t=17.177,P=0.000]。58例随访4~25个月,(13.5±6.2)月,无复发。结论腹腔镜下子宫深静脉入路C型宫颈癌根治术疗效确切、安全可靠。展开更多
文摘Cervical stenosis is a clinical condition involving partial or complete obstruction of the endocervical canal.In 1996,Bauldauf proposed that the definition of cervical stenosis is a cervical canal into which a 2.5# Hegar dilator cannot be inserted.1 Acquired cervical stenosis can be a complication of surgical procedures such as conization,trachelectomy,and curettage.It is a serious complication because of the clinical repercussions,which can include amenorrhea,hematometra,dysmenorrhea,infertility,infection,and endometriosis.Various surgical techniques are used in dilation and cervix reconstruction.However,in some cases,unsuccessful dilation with refractory recurrent stenosis may lead to hysterectomy.A successful case in which a self-expanding nitinol vascular stent was used to treat cervical stenosis was described by Grund et al.2 Here we report two additional cases in which vascular stents were used to treat patients with recurrent cervical stenosis after cervical surgeries.
文摘Uterus didelphys occurs in~0.4%of females and is found in~11%-20%of all uterus defects.It is a risk factor for cervical insufficiency,consequently contributing to late miscarriage or preterm birth.Thus far,only two prior cases of uterus didelphys accompanied by cervical insufficiency treated through laparoscopic cervical cerclage have been reported;however,livebirth only occurred in one hemiuterus.Herein,we report a case of uterus didelphys in a patient diagnosed with cervical insufficiency.Following the placement of a modified laparoscopic cervical cerclage,the patient had two successful livebirths through both hemiuteruses,respectively,with longer gestation age(ie,>36 weeks).The aim of this case report was to provide useful information for clinical practitioners to make better decisions on the management of cervical insufficiency in patients with uterus didelphys,and identify obstetric complications that clinicians should pay attention to during pregnancy.
基金This work was supported by the National Key Research and Development Program of China(no.2021YFC2700700).
文摘To editor:Cervical insufficiency,or cervical incompetence,is characterized by painless cervix dilatation during the second trimester without contractions.1 It is found in 0.1%–1%of all pregnancies and in up to 8.0%of women with recurrent second-trimester miscarriages.2–4 Cervical insufficiency is associated with premature birth,which is a leading cause of neonatal and perinatal mortality and morbidity.
文摘1.Background For the past several decades,minimally invasive surgery(MIS)has been advantageous for the treatment of cervical cancer compared to open surgery.MIS is favored due to reduced blood loss,decreased postoperative complications,rapid recovery,and shorter hospitalization time.In 2018,results from the Laparoscopic Approach to Cervical Cancer(LACC)trial,an international multicenter randomized phase III trial of women with early-stage cervical cancer comparing the survival outcomes among different surgical approaches1 and a real-world study published in the New England Journal of Medicine.
文摘BACKGROUND Laparoscopic myomectomy is increasingly used for resecting gynecological tumors.Leiomyomas require morcellation for retrieval from the peritoneal cavity.However,morcellated fragments may implant on the peritoneal cavity during retrieval.These fragments may receive a new blood supply from an adjacent structure and develop into parasitic leiomyomas.Parasitic leiomyomas can occur spontaneously or iatrogenically;however,trocar-site implantation is an iatrogenic complication of laparoscopic uterine surgery.We describe a parasitic leiomyoma in the trocar-site after laparoscopic myomectomy with power morcellation.CASE SUMMARY A 50-year-old woman presented with a palpable abdominal mass without significant medical history.The patient had no related symptoms,such as abdominal pain.Computed tomography findings revealed a well-defined contrast-enhancing mass measuring 2.2 cm,and located on the trocar site of the left abdominal wall.She had undergone laparoscopic removal of uterine fibroids with power morcellation six years ago.The differential diagnosis included endometriosis and neurogenic tumors,such as neurofibroma.The radiologic diagnosis was a desmoid tumor,and surgical excision of the mass on the abdominal wall was successfully performed.The patient recovered from the surgery without complications.Histopathological examination revealed that the specimen resected from the trocar site was a uterine leiomyoma.CONCLUSION Clinicians should consider the risks and benefits of laparoscopic vs laparotomic myomectomy for gynecological tumors.Considerable caution must be exercised for morcellation to avoid excessive tissue fragmentation.
文摘目的探讨腹腔镜下子宫深静脉入路C型宫颈癌根治术治疗宫颈癌的疗效。方法2021年1月~2022年12月我院采用腹腔镜下子宫深静脉入路C型宫颈癌根治术+盆腔淋巴结清扫术±腹主动脉旁淋巴结切除术治疗58例宫颈癌。建立通道后,在阔韧带后叶定位输尿管,分离输尿管后暴露子宫动脉,沿子宫动静脉背侧分离结缔组织,逐渐暴露子宫深静脉。将包绕子宫深静脉周围的宫旁淋巴结切除,单独送病理检查。继续向膀胱方向追踪子宫深静脉,游离其属支,血管夹双重夹闭。结果手术时间(307.2±54.1)min,出血量中位数50(20,100)ml,淋巴结清扫(26.3±6.9)枚,留置导尿管时间(20.6±4.7)d,拔除腹腔引流管时间(9.4±4.1)d,肛门排气时间(36.7±4.1)h,抗生素使用时间(9.2±4.2)d,住院时间(13.4±2.6)d。术后并发症发生率3.4%(2/58)。术后病理分期升级率为22.4%(13/58)。术后欧洲癌症研究治疗组织(European Organization of Research and Treatment of Cancer,EORTC)生活质量核心30问卷(Quality of Life Questionnaire-Core 30,QLQ-C30)评分较术前显著升高[(78.6±10.7)分vs.(47.1±7.6)分,t=17.177,P=0.000]。58例随访4~25个月,(13.5±6.2)月,无复发。结论腹腔镜下子宫深静脉入路C型宫颈癌根治术疗效确切、安全可靠。
