【摘要】 目的 探讨子宫颈巨大平滑肌瘤在其诊断及治疗上的特殊性。 方法 对2007年10月-2010年3月收治的11例子宫颈巨大平滑肌瘤患者的临床资料进行分析，对其发病率，诊断和手术治疗进行评价。 结果 11例子宫颈巨大平滑肌瘤中黏膜下2例，腹膜后9例。术前9例出现误诊，其中误诊为盆腔包块5例，子宫体肌瘤3例，子宫肉瘤1例。6例行经腹子宫全切加双附件切除，2例行经腹子宫切除术，1例行经腹肌瘤挖除术，1例行经阴道肌瘤摘除术，1例行经腹肌瘤挖出加宫颈残端切除术。 结论 子宫颈巨大平滑肌瘤由于其位置的特殊性，尤其是凸向腹膜后的肌瘤，由于盆腔器官被挤压，使盆腔解剖结构发生改变，术前易被误诊。且手术过程中易出现损伤及出血，因此术前估计充分，术中仔细认清各器官解剖关系，可有效地减少术中损伤和控制出血。【Abstract】 Objective To investigate the particularity of diagnosis and treatment for giant uterine cervical leiomyoma. Methods We analyzed the clinical data of 11 patients with giant uterine cervical leiomyoma who were admitted in our hospital from October 2007 to March 2010. The incidence, diagnosis and surgical treatment of the disease were evaluated. Results Of the 11 cases, nine were retroperitoneal leiomyoma and two were submucous leiomyoma. There were nine misdiagnosed cases before operation, including five diagnosed as pelvic mass, one as uterine sarcoma and three as uterine corpus leiomyoma. Six patients underwent abdominal hysterectomy and bilateral salpingo-oophorectomy; two underwent abdominal hysterectomy; one underwent abdominal myomectomy; one underwent transvaginal myomectomy; and one underwent abdominal myomectomy with excision of cervical stump. Conclusion The giant uterine cervical leiomyoma is easily misdiagnosed preoperatively due to its special anatomic site. A good example is the retroperitoneal leiomyoma in which the pelvic anatomic structure is changed because of the extrusion of the tumor on other pelvic organs. Furthermore, injuries and bleeding often happen during the operation. Consequently, sufficient preoperative assessment and clearly identifying regional anatomical relations can effectively reduce the damage and bleeding during the operation.
Age is the main cause of neurodegenerative changes in the central nervous system (CNS), and the loss of neurons would increase with the migration of the disease. The current treatment is also mainly used to relieve symptoms, while the function of CNS is very difficult to recover. The emergence of endogenous stem cells has brought new hope for the treatment of CNS diseases. However, this nerve regeneration is only in some specific areas, and the recovery of neural function remains unknown. More and more experts in the field of neuroscience have carried out various in vivo or in vitro experiments, in order to increase nerve regeneration and nerve function recovery through mechanism research, in the expectation that the results would be applied to the treatment of CNS diseases. This article reviews the recent progress of endogenous neural stem cells in degenerative diseases of CNS.
Objective To assess the efficacy and toxicity of the maintenance radiotherapy for epithelial ovarian cancer. Methods We searched MEDLINE (1950 to 2009), EMbase (1966 to 2009), The Cochrane Library (Issue 1, 2009), CBMdisc (1978 to 2009), CNKI (1979 to 2009), VIP (1989 to 2009) and relevant internet websites to identify randomized controlled trials (RCTs) of maintenance radiotherapy for epithelial ovarian cancer. The quality of the included trials was assessed by Cochrane Systematic Review Handbook. Meta-analyses were conducted by RevMan 5.0 and SPSS 10.0 software. Results A total of 5 RCTs involving 529 patients were identified. The result of meta-analyses showed that the whole-abdominal radiation increased the 5-year progression-free survival (PFS) at RR1.76 and 95%CI 1.13 to 2.73, while it showed no effect on the 5-year overall survival (OS) at RR1.30 and 95%CI 0.96 to 1.76. The main adverse reactions of maintenance radiotherapy for epithelial ovarian cancer included diarrhea and abdominal pains, whose severity was related to radiation dose. Conclusion The whole-abdominal radiation can increase the 5-year PFS while its effect on the 5-year OS needs to be further studied.
目的 探讨宫颈癌漏诊的原因及特点，提高首诊诊断率。 方法 回顾性分析2009年1月－2011年3月收治的外院漏诊的65例宫颈癌患者临床资料。 结果 漏诊的65例中有51例误诊为宫颈糜烂，其中仅13例首诊曾行细胞学筛查，16例行阴道镜检查及活检，总平均年龄仅39岁，农村居民54例。 结论 各地区应加强宫颈癌筛查意识，采取相应措施及适合的筛查方式提高宫颈癌筛查率，减少漏诊。
ObjectiveTo report a case of port-site metastasis (PSM) after laparoscopic treatment for borderline ovarian tumor (BOT), and to discuss the safety and efficacy of laparoscopic treatment for BOT as well as whether chemotherapy is beneficial for BOT patients. MethodsWe retrospectively studied a case of PSM after laparoscopic treatment of a micropapillary borderline ovarian tumor in August 2013, and reviewed the related literatures in PubMed and Cochrane databases from 1929 to 2014 using "port-site metastasis", "borderline ovarian tumor" , "laparoscopy" , "chemotherapy" as the subject words. ResultsAfter conservative operation and chemotherapy of "carboplatin and taxol" for 8 times, the subcutaneous nodes didn't shrink and the level of CA125 didn't reduce. Though some studies supported that laparoscopy was safe and effective for early-stage ovarian cancer and BOT, there was no high-quality evidence to help quantify the risks and benefits of laparoscopy for the management of early-stage ovarian cancer as routine clinical practice. While early researches suggested adjunctive chemotherapy benefited BOT patients, the subsequent studies indicated opposite results. Therefore, it was still controversial and a lack of high quality evidence existed. However, chemotherapy was recommended for those with high risks. ConclusionLaparotomy is still the standard treatment for ovarian tumor. For patients with low risks and requiring minimally invasive therapy, laparoscopy is an alternative choice, but it should be staged completely. For those with high risks or laparoscopy is difficult to perform, it should be converted to laparotomy as soon as possible. All these procedures should be completed by experienced and skillful gynecologic oncologists. For those with high risks, it is recommended that they should receive chemotherapy and be followed up for a long time.