【摘要】 宫颈锥形切除术是宫颈上皮内病变诊断和治疗的重要方法，已广泛应用于临床，而部分患者锥切术后因特殊原因如宫颈浸润癌等需进一步切除子宫。研究显示，宫颈锥切术后可导致残留宫颈组织在短时间内出现炎症病变，从而导致周围组织粘连，进而增加后续子宫切除手术的操作难度及术后并发症，然而时间间隔过长可能病变进一步发展。关于子宫切除手术时机的选择，目前仍存在争议，本文就宫颈锥形切除术后行子宫切除术的时机作一综述。

【摘要】 子宫内膜透明细胞癌（endometrial clear cell carcinoma， ECCC）具体发病的分子机制不明。依据癌症基因组图谱（The Cancer Genome Atlas, TCGA）子宫内膜癌分子分型检测流程结果显示，ECCC中TP53突变率远低于浆液性癌，微卫星不稳定性和POLE基因突变的检出率罕见。p53蛋白异常表达可能作为ECCC临床管理和预后评估的重要参考指标，而POLE突变和MSI状态可能为具有透明细胞特征或透明细胞癌成分的混合性子宫内膜癌提供克隆性起源、分化方向和治疗预测的分子依据。

慢性子宫内膜炎（chronic endometritis, CE） 属于盆腔炎性疾病的一种， 是子宫内膜的局部炎症，
慢性子宫内膜炎的间质部常常有大量浆细胞及淋巴细胞， 因为症状的非特异性在临床工作中常常被忽视。 近年
来， 许多研究发现， 慢性子宫内膜炎与不孕症、 许多产科和新生儿并发症有关， 故而逐渐引起临床医生重视。 现
就慢性子宫内膜炎的发病原因及相关预防措施作一综述。

Objective To detect the values of serum tumor markers including CA₁₂₅,CA199,AFP and CEA and to assess their value in the diagnosis of mature cystic teratoma (MCT). Methods Data of 512 patients with cystic teratoma of ovary diagnosed by postoperative pathology who treated in our hospital were analyzed retrospectively. Results 492 cases were tested for serum CA₁₂₅. Among these 492 patients, 44 had elevated CA₁₂₅ levels (>35U/ml). If we excluded the 24 cases who suffered from other diseases which could cause increased CA₁₂₅ levels, the positive rate was 4.27%. 101 patients were tested for serum CA199 and the mean level was 47.10 U/ml. 41 had the CA199 levels above 37 U/ml with the positive rate of 40.59%.149 patiens were detected AFP and no abnormal AFP was found. 93 cases were tested for CEA.Only one was abnormal and the positive rate was 1.08%. The mean diameter of the CA199 positive group ((8.32±3.19)cm) was bigger than that of the negative group ((6.43±3.12)cm,P< 0.05)).But the elevated level of CA199 had no correlation with tumor location, age,and nerve tissue in the tumor. Conclusions CA199 is the only tumor marker which has clinical significance and the highest positive rate for MCT. The diameter of the tumor with positive CA199 may be bigger than those with negative CA199.

Objective To investigate the expression of E-cadherin, Snail and N-cadherin and their relationship in cervical carcinoma. Methods The expression of E-cadherin, Snail and N-cadherin in tissues from 42 patients with chronic cervicitis, 29 cervical intraepithelial neoplasia(CIN group)and 44 cervical carcinoma (CA group) were detected by immunohistochemistry (SP method). Results Compared with chronic cervicitis, the expression of E-cadherin was significant decreased, the Snail and N-cadherin were significant increased in CIN and CA group (P<0.05). The expression of N-adherin was correlated positively with Snail (r=0.671,P<0.01); there was a significant negative correlation between expression of E-cadherin and N-adherin (r= -0.643,P<0.01),as well as between expression of E-cadherin and Snail (r=-0.492,P<0.01). Conclusions The lower E-adherin expression and higher level of Snail and N-cadherin may be play some role on the pathogenesis of cervical cancer.

Objective To understand the role of single-time colposcopy and HPV-DNA genotyping test in the diagnosis of HSIL patients. Methods 551 patients whose cervical cytology test results were HSIL underwent immediate colposcopy detection from January 2005 to December 2007,multiple punch biopsy was taken for 519 patients who had abnormal findings under colposcopy, for those unsatisfied colposcopy test, cervical curettage were added . Results Among the 551 cases of HSIL patients,there were 58 (10.5%) cases of CIN 1, 334 (62.4%) cases of CIN 2 and CIN 3, 11 (2%) cases of cervical cancer diagnosed by multi-point biopsy under single-time colpscopy. The occurrence in different age groups had significant difference (P=0.034). Meanwhile 376 HSIL patients received HPV-DNA genotyping test, the positive rate of high-risk HPV was 87.5%, and the most common subtype was HPV 16 ( 45.7%). In HR -HPV positive group, especially HPV 16 subtype positive group, the detection rate of CIN2 was significant higher than that in the HR-HPV negative group (P=0.000). Conclusions Only 62.4% patients of CIN2 and more advanced lesion were diagnosed under single-time colposcopy. HPV-DNA genotyping test may help increasing the detection rate of CIN and cervical cancer.We should pay more attention to HSIL patients whose colposcopy test has no abnormal findings.

Objective To assess the relationship between increment of nuchalskinfold thickness and chromosomally abnormal fetuses by ultrasonography. Methods Nuchalkinfold thickness(NT) of pregnant women(10~22 weeks) collected by prenatal ultrasonic B in in the People's Hospital Peking University from Feb.2007 to Dec. 2009.Those with increment of NT were suggestted to perform amniocentesis and cordocentesis chromosomal karyotypes analysis and were under followed-up. Results There were totally 78 cases with increment of NT,3 cases were chromosomally abnormal and all of the 3 cases were Down syndrome. The incidence of Down syndrome was 3.85% these were tatally.There were 6 cases with bad pregnant results,incluing 5 cases with abnomal fetuses which included right hydrencephaly and liquorrhea,polycystic kidney,teratic heart,rubella virus infection and hydrosarca. Conclusions Increment of NT measured by ultrasound may play an important guiding role in diagnosising Down syndrome.It is one of the main markers at early and middle stage pregnancy.

Objective To investigate the clinical application value of surface plasmon resonance( SPR) in detecting human papillomavirus subtype in patients with cervical lesions. Methods 109 patients who underwent screening for cervical lesions in Peking University People's Hospital and had not received any cervical treatment before were enrolled. Cytology was performed for everyone by liquid- based Thin- prep test. Colposcopy and biopsy were performed on patients who had a cytology result of ASCUS or greater. Testing for high- risk human papillomavirus (HPV) DNA were performed using HC2 method and HPV subtypes were detected using SPR method. These results were compared with the cloning and sequencing results. TERC gene expression were detected by FISH. Results (1) Regarding cloning and sequencing results as gold standard, the specificity of HPV-SPR in detecting high- risk HPV was significantly higher than HC2 (P<0.05), and there was no significant difference in sensitivity between them (P>0.05). (2) In term of the pathology results, the sensitivity and NPV of SPR in identificating CIN 2 and above lesions were significantly lower than that of HC2 method in distinguishing the CIN 2 and above lesions ( P<0.05). There was no significant difference in specificity and PPV between the two methods (all P>0.05). The specificity of TERC detecting in distinguishing the CIN 2 and above lesions was significantly higher than that of HC2 method (P<0.01). There was no significant difference in sensitivity, PPV and NPV between this two methods (P>0.05). Conclusions The specificity of SPR method in detecting high- risk HPV was higher than that of HC2 method. The sensitivity of the two methods in detecting high- risk HPV was comparative. Utilizing SPR method in high lesions can improve the specificity of liquid- based cytology and HC2 test and could avoid unnecessary colposcopy and treatment.

Objective To study the efficacy of Levonorgestrel-releasing intrauterine system (LNG-IUS Band name: Mirena) on the treatment of adenomyosis. Methods 65 patients with adenomyosis who received LNG-IUS placement recruited in this study. The visual analogue seale (VAS) scores, menstrual blood volume and uterine volume were compared before and after 6 and 12 months LNG-IUS placement. Results Compared with before treatment,dysmenorrhea was completely relieved or significantly alleviated in all patients after 6 month treatment of LNG-IUS. The mean VAS scores dropped from 81.3±9.4 to 16.8±12.1(P<0.01), the menstrual blood volume reduced significantly [100% vs (25.3±12.2)%, P<0.01]. After 12 months, hemoglobin recovered to normal in 30 patients with anemia (P<0.01). Uterine volume reduced and had significantly difference compared to before treatment (P<0.05). Conclusions LNG-IUS is an efficient method to treat adenomyosis, it can alleviate dysmenorrheal, decrease menstrual blood volume and reduce uterus volume.

Objective To discuss the role of age and HR-HPV in evaluation of cervical lesions with negative Liquid-Based Cytology. Methods 906 women with positive HPV DNA and negative cytology results were included. The sampling methods were standardized. All cases underwent colposcopic indicated biopsy and pathological diagnosis. Analysis were based on the final results. Results The average age was (36.69±9.06 )years old. Pathological results showed 3 invasive cancer (2 micro-invasive cancer included), 1 adenocarcinoma, 29 cases of CIN3, 50 of CIN2, 155 of CIN1,2 of VAIN1 and 666 of normal. The odds ratio of ≥CIN3 between 30~49 years and <30 years was 3.4(1.02~11.40) while HR-HPV DNA load between ≥100 and <10 was 12.44 (2.89~53.5). Prevalence rate of ≥CIN3 in low, median, high HR-HPV load group 30~49 age group was 1.0%,4.0%,8.8%(χ² =14.978,P=0.001) while the prevalence rate of ≥CIN2 was 4.3%,7.5% and 19.1%(χ² =27.270,P=0.000)respectively. The average HR-HPV load of non-CIN patients in <30 years group and ≥30 years group were 244.04±547.20 and 149.59±328.39 (P<0.050). Conclusions Increased HR-HPV load are generally associated with an increasing risk of high-grade CIN. Women who are in the high risk age group should be assessed by HR-HPV load and be performed colposcopy to minimize the missed diagnostic cases of high grade lesions.

Objective To construct cDNA of laminin receptor and study it's protein expression. Methods The cDNA of laminin receptor was amplified from total RNA of HeLa cells and was ligated into pGEM-T Easy plasmid. Recombinant LRP was expressed by using pET 22b(+).coli expression system. Results Restriction endonucleases mapping analysis and DNA sequencing demonstrated that the constructed plasmid was the recombinant pET-LRP. A new band of protein was found in SDS-PAGE. Conclusions The construction of pET-LRP is succeed . This will be a basis of further study on the structure and biological function of LRP.

Objective To analysis the diagnosis, treatment and outcome of malignant tumor in pregnancy, in order to improve the outcome of mother and fetal. Methods Data of 9 pregnant patients with malignant tumor who were treated in Shanghai Jiaotong University No. 6 People's Hospital from 2007 to 2010 were reviewed. The patients include 2 lung cancer, 2 gastric carcinoma, 1 hepatocellular carcinoma,1 Nasopharyngeal carcinoma,1 brain neurogliocytoma,1 breast adenocarcinoma and 1 ovarian cancer. Results Of the 9 patients, only 4 had regular prenatal examination; 2 patients were diagnosed before pregnancy,the other 7 were diagnosed during pregnancy;7 patients were diagnosed by pathology and 2 patients were diagnosed by clinical imageology. 7 patients were in advanced stage, the other 2 were in early stage.Pregnant outcomes included 1 early induced abortion, 2 middle induced abortion, 2 vaginal delievery and 4 cesarean section delievery. As for the fetus outcome, there were 5 preterm infant and 2 term infant;6 newborn infants had good outcome,1 preterm fetal dead in uterus; 5 patients received treatment after delivery, other 4 didn't received any treatment after delivery;6 patients died during the first year's follow-up. Conclusions The deficient of the recognition of malignant tumor, lack of full-scale perinatal monitoring, short of perfect analyses of history, symptoms and sign of malignant disease and the delayed treatment for malignant tumor being considering the adverse effect on fetal were the main causes of the delay diagnosis and treatment of malignant disease in pregnancy. The pregnancy with malignant tumor was associated with poor maternal outcome but no unnormal fetal development was found.

Objective To study the relevance between the polymorphisms of CYP1A1 and SULT1A1 gene and uterine leiomyoma in Han women in the Northern of QiLu area. Methods MspI genotypes of CYP1A1 and Arg213His genotypes of SULT1A1 gene in 123 patients with uterine leiomyoma and 123 healthy women (control group) were detected by PCR-RFLP .Multivariate logistic regression analysis was used to analyze the risk of uterine leiomyoma and gene polymorphisms. Results There was no significant difference between CYP1A1 gene of MspI polymorphism in uterine leiomyoma group and in control group (P=0.927), but the SULT1A1 polymorphisms in the two groups had significant difference (P=0.011). The interaction between CYP1A1 gene of MspI polymorphism and SULT1A1 gene of Arg213His polymorphism in the two groups were significant different (P=0.024). Conclusions The results show that CYP1A1 polymorphism of MspI has no relationship with uterine leiomyoma, but SULT1A1 polymorphism of Arg213His may be associated with the occurrence of uterine leiomyoma in Han women in the Northern QiLu. The synergistic action of the polymorphism CYP1A1 gene and SULT1A1 gene may play a role in the etiology of uterine leiomyoma.

Objective To investigate the effect of different factors on post-delivery C-reactive protein (CRP). Methods Altogether 296 maternal who delivered in Peking University 1st Hospital during June to August,2008 were involved. Blood regular test and high sensitivity C-reactive protein of these patients were detected forty eight hours after delivery. Results A control group comprised 112 maternal who had no complication, 58 of them underwent vaginal delivery whereas 54 urderwent cesarean section. The serum white blood cell count 48 hours after delivery was (10.0±2.2)×10⁹/L in vaginal delivery group and (12.0±8.1)×10⁹/L in cesarean section group. Both were higher than the reference value of non-pregnant woman. Besides, CRP of vaginal delivery group and cesarean section group were (29.2±15.7) mg/L and (75.5±35.8) mg/L, both were much higher than that of non- pregnant women(3.0 mg/L). CRP of vaginal delivery group was significantly lower than that of cesarean section group (P<0.05). Correlation analysis showed that the type of d elivery was strongly correlated with CRP(r=0.6 32, P<0.001).184 maternal developed some complications.Complications like gestational impaired glucose tolerance, gestational hypertension, preterm labor and premature rupture of membranes had no effect on CRP while intrauterine infection during labor, neonatal infection and post-delivery upper respiratory tract infection, which were detected 48 hours after delivery,could elevated CRP level. Conclusions CRP elevated significantly 48 hours after delivery than the normal range in non-pregnant woman. Delivery type is the main factor that influences CRP lerel. Doctors using CRP to monitor post-delivery infectious diseases should consider the effect of delivery type. Dynamic observation is of much significance.

Objective To explore the effect of tolterodine combined with vaginal estrogen cream on overactive bladder(OAB) of menopause-female. Methods 88 cases of OAB menopausal patients who treated in the first People's Hospital of Xuchang from January 2008 to June 2009 were randomly divided into two groups, the tolterodine group were treated with tolterodine alone, and the united-treatment-group were given viginal estrogen cream twice a week beside tolterodine. Effect was compared after 6 weeks. Results After treatment, the urination frequency decreased from (7.55±0.80)to(5.74±0.76) times in the day time and from (3.76±0.63)to (3.13±0.62) times at night in tolterodine group, the efficient rate was 86.84%. In united-treatment-group, in daytime the urination frequency decreased from (7.46±0.79)to(4.85±0.71) times and at night it decreased from (3.85±0.63)to (1.97±0.67) times, the efficient rate was 92.31%.The efficient rates in the two groups had significant difference (P<0.01). Conclusions Tolterodine united with vaginal estrogen cream has better effect than tolterodine alone on the treatment of OAB menopausal patients.

Objective To investigate the serum AMH level in domestic healthy reproductive age women, and to discuss the clinical application for AMH . Methods A total of 100 healthy reproductive age women participated in this study. All the subjects were grouped by menstrual cycle and age. Serum AMH concentration were measured by ELISA. Results AMH levels in follicular phase and luteal phase had no statistically differences. The average AMH level was (2.85 ± 1.66) ng / ml in reproductive age women. AMH level was negatively correlated to age(r=-0.667,P<0.001).It was (4.25±1.23)ng/ml in 18 to 25 year-old female, then declined with age increasing, and dropped significantly in 41 to 47 years old with the average level of (1.12±0.98) ng/ml. Conclusions Serum AMH level has no significantly difference in the follicular phase and luteal phase of the menstrual cycle. AMH detection is not limited to the follicular phase. Age is an important factor affecting the level of AMH, the clinical application of AMH should combine with age and need comprehensive judgment.

【Abstract】 Objective To compare the pregnancy outcomes of luteal support protocols by methods of endometrium preparation in frozen-thawed embryo transfer cycles. Methods The retrospective study included the frozen-thawed embryo transfer cycles using vaginal micronized progesterone for luteal support in Sun Yat-sen Memorial Hospital of Sun Yat-sen University from January 2017 to December 2017, including 437 patients in the natural cycle group and 416 patients in the hormone replacement cycle group. According to different luteal support programs, they were divided into four groups: ① Group A: Progesterone soft capsule 400 mg/d; ② Group B: Progesterone soft capsule 400 mg/d+dydrogesterone 20 mg/d; ③ Group C: Progesterone soft capsule 600 mg/d; ④ Group D: Progesterone soft capsule 600 mg/ D+dydrogesterone 20 mg/ D. Different endometrial preparation regimens, luteal support dosages and pregnancy outcomes were compared. Results ①There was no significant difference in the clinical pregnancy rate, abortion rate and live birth rate among different luteal support schemes in the natural cycle group (P>0.05).② The clinical pregnancy rate in group C was lower than that in group D (35.50%, 51.30%, P=0.008). ③ In group C of hormone replacement cycle, the miscarriage rate of patients <35 years old was lower than those ≥35 years old (7.14%, 36.80%, P=0.004). In group C, the clinical pregnancy rate of patients <35 years of age in the hormone replacement cycle group was lower than that in the natural cycle group (38.90%, 68.30%, P=0.002). Conclusion Enhancing luteal support in artificial cycles would improve the pregnancy outcomes of frozen-thawed cycles.

慢性子宫内膜炎（chronic endometritis, CE） 临床特点多样， 无特异性诊断方法， 在临床实践中易
被漏诊。 近年来的研究表明， CE 与不明原因不孕、 反复种植失败和复发性流产等不良生殖疾病密切相关。 CE 主
要由各种病原体感染引起的子宫内膜炎症， 因此， 明确易于导致子宫内膜感染的微生物及其致病性， 将有助于改
善 CE 的诊治现状， 而微生物组学为此提供了更大的可能性。 本文将对近年来子宫内膜微生物组学及微生物组学
在 CE 诊治中的应用研究进展进行综述。

Objective To explore the effect of mucosal flap suspension of the anterior vaginal wall in treating pelvic organ prolapse (POP)characterized by anterior vaginal prolapse (AVP). Methods Data of 52 POP patients characterized by AVP accepted mucosal flap suspension of the anterior vaginal wall in The Second Affiliated Hospital of Zhengzhou University from Jan 2005 to Jan 2010 were analyzed retrospectively. The comitant surgical approach included hysterectomy, oophorectomy, vaginal wall repair, sacral spine ligament suspension surgery, repair of old perineal laceration and mid-urethral suspension surgery. Results The average operative time was (43.47±5.18)min and the estimated blood loss was (50.7±2.5) ml. No hematoma, urethra, bladder or rectum damage occurred. There were 4 postoperative urinary retention and returned to normal by appropriate treatment. Patients were followed up for 12 to 60 months. The objective cure rate was 90.4% and the subjective cure rate was 100% on 28.4 months fellow-up . Conclusions Mucosal flap suspension of the anterior vaginal wall combined with other defection repair surgery is a less trauma, low cost operation with high cure rate, and low recurrence rate for AVP patients, it is worth to be applied in clinic.