Journal of International Obstetrics and Gynecology

Pathogenesis of Endometriosis Complicated with Chronic Endometritis and Its Impact on Reproduction

SHAO Meng-yu, MA Sai-hua, GONG Zheng, ZHAO Xiao-li, ZHAO Zhi-mei

2025, 52 (3): 241-245. doi: 10.12280/gjfckx.20241166

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Endometriosis (EMs) is a common benign gynecological disease among women of childbearing age. An increasing number of clinical studies have found that the risk of chronic endometritis (CE) is elevated in patients with EMs. The negative impacts of both conditions on female reproductive capacity have also drawn extensive attention. The potential pathogenesis of EMs complicated with CE may be related to immune-inflammatory state, steroid hormones, microbial pathogens, and microRNAs. As an inflammatory disease, the immune-inflammatory changes caused during the pathogenesis of EMs directly promote the development of CE. Abnormal concentrations of estrogen and progestogen in steroid hormones, especially elevated estrogen levels, contribute to the co-occurrence of EMs and CE. The imbalance of intra- and extra- uterine flora accelerates the co-pathogenesis of EMs and CE through local immune abnormalities and inflammatory responses. As regulators of gene expression, microRNAs also play a role in the co-morbidity process by influencing the expression of proteins in various pathways. The co-occurrence of EMs and CE further impairs endometrial receptivity and affects female reproductive capacity. This review summarizes the pathogenesis of EMs complicated with CE and its impact on reproduction, aiming to provide new ideas and evidence for the treatment of EMs.

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Research Progress on the Treatment of Adenomyosis-Related Pain with Dienogest

YAN Ying, YANG Yang, ZHONG Hua, LIANG Yan-chun

2025, 52 (3): 246-251. doi: 10.12280/gjfckx.20250166

Abstract ( 88 )

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Dysmenorrhea is one of the main symptoms of adenomyosis (AM). The pathogenesis of AM-related pain involves multiple mechanisms. Dienogest, as one of the key drugs for the treatment of AM-related pain, plays an important role in the long-term management of AM. Basic research shows that dienogest can achieve the goals of reducing inflammation, decreasing pain hypersensitivity, and controlling the progression of AM through multiple mechanisms of action, such as inhibiting the proliferation and inflammatory response of ectopic endometrial stromal cells, promoting apoptosis, regulating the expression of nerve growth factors and the immune microenvironment, and inhibiting angiogenesis. Clinical research evidence further clarifies that dienogest is more effective than other drugs in relieving AM-related pain, improving uterine bleeding, and controlling uterine volume. It can be used as a long-term treatment drug for AM-related pain, providing a scientific basis for further in-depth research on the mechanism of action and clinical application of dienogest.

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Research Progress on the Pathogenesis and Combination Treatment of Pelvic Inflammatory Disease

ZENG Lu-lu, ZENG Qiao-qiao, ZHANG Wan-qing, PAN Ying-shan, YUAN Zi-xin, LIU Hui-ling, OUYANG Mei-jin

2025, 52 (3): 252-256. doi: 10.12280/gjfckx.20250088

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Pelvic inflammatory disease (PID) is an infectious disease of the upper reproductive tract caused by the synergistic action of multiple pathogens such as Chlamydia trachomatis, Neisseria gonorrhoeae, and anaerobic bacteria. Its pathological features include chronic inflammatory response and fallopian tube fibrosis, which can lead to serious complications such as infertility and ectopic pregnancy. In terms of pathogenesis, sexually transmitted pathogens mediate the initial infection through immune escape, and anaerobic bacteria exacerbate secondary infection through biofilm formation and toxins secretion. The excessive inflammatory response of the host and the activation of the transforming growth factor-β1 (TGF-β1)/Smad signaling pathway are the key driving factors for tissue fibrosis. In terms of therapeutic strategies, the combination of antibiotics can significantly improve the cure rate compared with single-drug therapy. The combination of Chinese patent medicines and antibiotics can reduce the recurrence rate and the levels of inflammatory factors. Physical therapy and the multi-disciplinary treatment model can improve the pain score and quality of life of patients with chronic pelvic pain. Many studies have confirmed that combination therapy achieves synergistic effects by covering multiple pathogens, inhibiting the inflammatory cascade reaction, and promoting tissue repair. However, the etiological diagnostic techniques in the acute phase and the anaerobic bacteria detection system need to be further optimized. In the future, whole-genome sequencing and genetic testing technologies should be combined to construct individualized stratified treatment strategies. The long-term efficacy of the triple combination of antibiotics, traditional Chinese medicine, and physical therapy for chronic PID should be explored, with the aim of providing more precise diagnosis and treatment paths for clinical practice.

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Reproductive Prognosis after Minimally Invasive Surgery for Herlyn-Werner-Wunderlich Syndrome

LIU Lin-lin, HUANG Xiao-wu, XIA En-lan

2025, 52 (3): 257-261. doi: 10.12280/gjfckx.20250261

Abstract ( 85 )

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Objective: To investigate the reproductive prognosis of patients with Herlyn-Werner-Wunderlich syndrome (HWWS) after minimally invasive surgery and analyze the pregnancy outcomes and influencing factors. Methods: A retrospective analysis was conducted on the clinical data of 25 HWWS patients with fertility requirements who underwent minimally invasive surgery at the Hysteroscopy Diagnosis and Treatment Center of Fuxing Hospital Affiliated to Capital Medical University from April 2008 to December 2023. All patients underwent hysteroscopy or combined hysteroscopy and laparoscopy, and their pregnancy outcomes were followed up. Results: The postoperative pregnancy rate(80% vs. 8%) and live birth rate (69.2% vs. 0%) of the 25 patients were significantly improved compared with those before surgery, and the differences were statistical significant(P<0.05). The incidence of preterm birth rate was 23.1%(6/26). 20 patients achieved successful pregnancy after surgery, among which 17 were spontaneous pregnancies and 3 patients were conceived through in vitro fertilization-embryo transfer. Adverse pregnancy outcomes included preterm birth, miscarriage, and induced abortion due to fetal malformation. There were differences in pregnancy outcomes among patients with uterus didelphys, septate uterus and bicornuate uterus. In patients with uterus didelphys, pregnancy mostly occurred on the side of the oblique vaginal septum, while patients with septate uterus had a higher postoperative fertility rate. All parturient patients underwent cesarean section. Conclusions: The pregnancy and live birth rates of HWWS patients are significantly improved after minimally invasive surgery, but adverse pregnancy outcomes such as preterm birth and miscarriage need attention. Factors such as the type of uterine malformation, pregnancy location, and surgical approach affect pregnancy outcomes. Close postoperative monitoring and management are crucial for improving reproductive prognosis.

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Exploration of the Genetic Etiology of Complete Androgen Insensitivity Syndrome Using Whole Exome Sequencing Technology

ZHOU Jing, QIAO Feng-chang, ZHANG Cui-ping, LIU An, LI Li, JI Xiu-qing, XU Zheng-feng

2025, 52 (3): 262-266. doi: 10.12280/gjfckx.20250087

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Complete androgen insensitivity syndrome (CAIS) is a disorder of sex development. Patients with CAIS have male-characteristic genetic materials, hormone levels, and gonads. However, due to abnormalities in the androgen receptors (AR), androgens cannot exert their biological effects, ultimately leading to a female phenotype in patients. Whole exome sequencing (WES) technology was used to analyze the genetic etiology of 4 patients highly suspected of having CAIS. The results indicated that all of them had mutations in the AR (NM_000044.6) gene. In case 1, there was a c.2401del:p.T801Pfs*8 variant in the AR gene. In case 2, a c.2494C>T p.Arg832* stop_gained variant. In case 3, a c.1581G>A p.Trp527* stop_gained variant, and in case 4, a c.57C>A p.Tyr19* stop _gained variant. All of these variants were evaluated as pathogenic and were the main causes of CAIS. Among them, the AR gene mutations in cases 1, case 3 and case 4 had not been previously reported, and the AR gene mutation in case 2 had only been reported in one case. Using WES technology to detect the genetic etiology of CAIS can quickly, efficiently and accurately identify the pathogenic cause, thereby enabling a definite diagnosis and targeted treatment.

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A Case of Sudden Air Embolism during Hysteroscopy

ZHOU Yuan, WANG Zhen-zhen, CAO Meng-dong, SHEN Xue

2025, 52 (3): 267-270. doi: 10.12280/gjfckx.20241162

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Hysteroscopy is a commonly used diagnosis and therapeutic method for gynecological diseases. Air embolism is a rare but extremely serious complication during hysteroscopy. If it is not diagnosed and treated in time, it may lead to irreversible and severe consequences. This paper reports a case of a 24-year-old patient. After 40 days of normal vaginal delivery, the patient was hospitalized for hysteroscopy due to intermittent vaginal bleeding and abnormal echoe in the uterine cavity indicated by ultrasound. During the operation, the patient suddenly became irritable, and her blood pressure, blood oxygen saturation, and partial pressure of end-tidal carbon dioxide (PetCO₂) dropped sharply. After emergency rescue, the patient′s vital signs were temporarily stable and she was transferred to the intensive care unit (ICU) for further treatment. However, due to the recurrence of the condition, the family members finally chose to give up treatment. This case suggests that if symptoms such as irritability, decreased blood pressure, and decreased blood oxygen saturation occur during hysteroscopy, the possibility of air embolism should be highly suspected. Especially when the PetCO₂ is accompanied by a decrease in blood pressure and cannot be explained by hypovolemia, it may be an early warning signal of air embolism. Therefore, early prevention and timely diagnosis are crucial for improving the prognosis.

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A Case of Severe Anemia Caused by Massive Hemorrhage during the Treatment of Adenomyosis with LNG-IUS Fixation

LI Fei-yan, ZHU Cong-xin, LI Yong, SUN Li, LIU Yu

2025, 52 (3): 271-274. doi: 10.12280/gjfckx.20250063

Abstract ( 71 )

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The levonorgestrel-releasing intrauterine system (LNG-IUS) is an effective method for treating adenomyosis, but it has a relatively high expulsion rate. Hysteroscopic suture fixation is a new minimally invasive technique that can improve the stability of LNG-IUS. This paper reports a case of a 37-year-old patient with adenomyosis. The patient received LNG-IUS fixation due to a history of LNG-IUS expulsion. The short- term efficacy after the operation was remarkable. However, persistent and massive vaginal bleeding occurred 11 months after the operation. Eventually, laparoscopic surgery to temporarily block the uterine artery and remove the adenomyosis lesions was performed. This case suggests that LNG-IUS fixation has good short-term efficacy, but long-term complications should be vigilant. The patient′s condition should be fully evaluated before surgery, and follow-up management should be strengthened after surgery to reduce the occurrence of severe adverse events.

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The Role of Thrombospondin-1 in the Pathogenesis of Preeclampsia

REN Sheng, WANG Yong-hong

2025, 52 (3): 275-279. doi: 10.12280/gjfckx.20250051

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Preeclampsia (PE) is a pregnancy-specific disorder and one of the leading causes of maternal mortality and neonatal morbidity. To date, the etiology and pathogenesis of PE remain incompletely elucidated. Insufficient trophoblast invasion leading to impaired uterine spiral artery remodeling, aberrant placental development, and vascular endothelial dysfunction are key factors contributing to the pathogenesis of PE. Thrombospondin-1 (TSP-1), a multi-domain and multi-functional extracellular matrix glycoprotein secreted by various human cells, interacts with multiple cell surface receptors and plays a role in regulating diverse physiological and pathological processes, including angiogenesis, inflammatory responses, platelet activation, cellular invasion, and immune responses, and the occurrence and development of hypertension and hyperlipidemia. Recent studies have demonstrated elevated expression levels of TSP-1 in both the placenta and maternal serum of patients with PE. Consequently, TSP-1 may be one of the contributing factors to the pathogenesis of PE. This review aims to summarize the role of TSP-1 in the pathophysiology of PE, providing new ideas for its diagnosis and treatment.

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Research Progress on Non-Pharmacological and Pharmacological Prevention of Preeclampsia

QIN Xiao-pei, ZHOU Qi

2025, 52 (3): 280-285. doi: 10.12280/gjfckx.20250094

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Preeclampsia is a common high-risk complication during pregnancy, mainly manifested as hypertension, edema and massive proteinuria. In severe cases, it can lead to a series of serious complications such as maternal and neonatal mortality. The prevention of preeclampsia mainly includes non-pharmacological and pharmacological preventions. Non-pharmacological prevention of preeclampsia mainly focus on lifestyle optimization and systematic pregnancy management, including a balanced diet, regular exercise, and stratified weight management based on pre-pregnancy body mass index. At the same time, clinicians should accurately identify high-risk groups for preeclampsia in the early stage of pregnancy by combining the patient′s medical history, physical examination, and relevant laboratory test results, and carry out personalized prevention to improve the long-term prognosis of maternal and fetal outcomes. In terms of pharmacological prevention, low-dose aspirin (60-150 mg/d), as the most evidence-based intervention, is recommended by many national guidelines for early prevention in high-risk pregnant women. Calcium supplements (≥1 g/d) can also reduce the risk of preeclampsia, especially for people with low calcium intake. Vitamin D (600-2 000 IU/d) demonstrates its potential value in preventing preeclampsia through immunomodulatory and antioxidant effects. Additionally, statins, metformin, and esomeprazole, etc. are still in the stage of clinical research. Although preliminary evidence supports their efficacy, their safety still needs to be verified by large-scale samples.

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Research Progress on Maternal and Infant Risk Assessment and Management of Pregnancy Complicated with Heart Disease

MAO Xiao, QU Dong-ying

2025, 52 (3): 286-292. doi: 10.12280/gjfckx.20250190

Abstract ( 70 )

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Pregnancy complicated with heart disease, as a common obstetric complication, has become the leading cause of non-obstetric maternal mortality in China. Physiological changes such as hemodynamics alterations during pregnancy can significantly increase the cardiac load, induce the clinical manifestations of latent cardiac diseases or promote the progression of pre-existing cardiac disease, leading to severe cardiovascular events such as heart failure. Meanwhile, it significantly increases the risk of neonatal events such as preterm birth and small for gestational age infant. An ideal clinical management strategy should be based on a comprehensive preconception assessment, and an individualized treatment plan should be formulated through multidisciplinary collaboration to balance maternal therapeutic needs and fetal safety. In recent years, although there have been continuous advancements in the maternal cardiac risk assessment system, the research on predicting neonatal outcomes is still insufficient. In addition, how to balance maternal and infant safety in clinical decision-making during pregnancy management (e.g., drug or surgical treatment, timing and mode of pregnancy termination) has become a critical issue to be urgently addressed. Combining the latest clinical evidence and international guidelines and consensuses, this article systematically elaborates on the progress of maternal and infant risk assessment and pregnancy management strategies for pregnancy with heart disease, aiming to provide evidence-based medical basis for clinical practice.

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The Impact of Liver Cirrhosis in Pregnancy on Adverse Maternal and Infant Outcomes: A Meta-Analysis

PAN Zhi-xiu, GAO Shuang, SHI Ke, ZHANG Xiu-ping, WANG Fu-ling

2025, 52 (3): 293-301. doi: 10.12280/gjfckx.20241098

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Objective: To explore the adverse outcomes and their impacts on both mothers and fetuses resulting from pregnancy complicated by liver cirrhosis. Methods: Computerized searches of CNKI, WanFang Data, VIP, SinoMed, PubMed, Web of Science, and the Cochrane Library were conducted to collect relevant studies on liver cirrhosis in conjunction with pregnancy from the time of establishment until June 2024. A statistical meta-analysis was performed using RevMan 5.4 and Stata 16.0 software. Results: A total of 21 studies were included in the literature review, encompassing 8 958 patients with cirrhosis during pregnancy across six countries. The meta-analysis revealed that women with cirrhosis faced a significantly higher risk of adverse maternal and infant outcomes. These outcomes included cesarean section (OR=2.57, 95%CI:2.07-3.18), post-partum hemorrhage (OR=4.29, 95%CI: 3.41-5.40), hypertensive disorders in pregnancy (OR=4.12, 95%CI: 1.95-8.71), gestational diabetes mellitus (OR=2.08, 95%CI: 1.56-2.79), fetal death (OR=2.87, 95%CI: 2.04-4.04), and preterm labor (OR=5.19, 95%CI: 3.51-7.69). Conclusions: Cirrhosis during pregnancy may elevate the risk of adverse maternal and fetal outcomes. However, further research is necessary to more accurately identify the risk factors associated with these negative outcomes.

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Application of Chromosomal Microarray Analysis in Prenatal Diagnosis of Fetuses with Increased Nuhal Translucency

LIANG Yi-xuan, ZHOU Ran, MENG Lu-lu, LIU Ting-ting, HUO Hai-qin, ZHANG Qin-xin, HU Ping, XU Zheng-feng, WANG Yan

2025, 52 (3): 302-308. doi: 10.12280/gjfckx.20250061

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Objective: To investigate the application value of chromosomal microarray analysis (CMA) in the prenatal diagnosis of fetuses with increased nuchal translucency (NT). Methods: A total of 1 033 pregnant women with increased NT (≥3.0 mm) detected by ultrasound and who underwent CMA testing at the Women′s Hospital of Nanjing Medical University from June 2017 to June 2024 were selected. According to the presence of other ultrasonographic soft markers, they were divided into a simple increased NT group (918 cases) and increased NT combined with other ultrasonographic soft markers group (115 cases). The simple increased NT group was further divided into an advanced-age group (≥35 years old, 135 cases) and a non-advanced-age group (<35 years old, 783 cases) according to the pregnant women′s age; and divided into a 3.0-3.4 mm group (506 cases), a 3.5-4.4 mm group (288 cases), a 4.5-5.4 mm group (80 cases) and a ≥5.5 mm group (44 cases) according to the NT thickness. Results: Among the 1 033 fetuses with increased NT, 170 cases (16.5%) of chromosomal abnormalities were detected, including 122 cases (11.8%) of chromosomal aneuploidy, 10 cases (1.0%) of large-scale structural abnormalities [(copy number variations，CNV) ≥10 Mb] and 38 cases (3.7%) of pathogenic microdeletion and microduplication (CNV<10 Mb). The detection rate of chromosomal abnormalities in the increased NT combined with other ultrasonographic soft markers group was significantly higher than in the simple increased NT group (39.1% vs. 13.6%, χ²=48.388, P<0.001). In the simple increased NT group, the detection rate of chromosomal abnormalities in the advanced-age group was significantly higher than that in the non-advanced-age group (25.9% vs. 11.5%, χ²=20.389, P<0.001). In both the advanced-age and non-advanced-age group, the detection rate of chromosomal abnormalities significantly increased with the increased NT thickness(all P<0.05). When NT values were between 3.5-4.4 mm and 4.5-5.4 mm, the detection rate of chromosomal abnormalities in the advanced-age group was significantly higher than that in the non-advanced-age group (45.0% vs. 10.9%, P<0.001; 42.9% vs. 16.7%, P=0.040). Conclusions: In addition to aneuploidy, chromosomal microdeletion and microduplication are closely related to increased NT. CMA can effectively improve the detection rate of chromosomal abnormalities in fetuses with increased NT. The detection rate of chromosomal abnormalities shows an upward trend with the increase of NT thickness. Increased NT combined with advanced maternal age or other ultrasonographic soft markers will increase the risk of fetal chromosomal abnormalities.

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A Case Report of Rectal Buttonhole Tear by Vaginal Delivery

LIU Chi-wen, WEI Jing

2025, 52 (3): 309-311. doi: 10.12280/gjfckx.20241002

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Perineal laceration is a common complication of vaginal delivery. Clinically, first- and second-degree perineal lacerations are more common, while the incidence of third- and fourth-degree perineal lacerations is low. Rectal buttonhole tear is a special and rare complication of vaginal delivery. This paper reports a case of rectal buttonhole tear complicated with vaginal delivery admitted to Taizhou People′s Hospital affiliated to Nanjing Medical University. During the patient′s delivery, the fetus′ arm penetrated the perineal body. After delivery, vaginal laceration repair and rectal repair were performed. Postoperatively, antibiotics were given to prevent infection, the diet structure was adjusted, and sufficient tube drainage was set for the wound. Complications such as rectovaginal fistula and wound dehiscence did not occur, and the patient was cured and discharged. The diagnosis and treatment process of this patient was retrospectively analyzed, and relevant literature was reviewed to summarize the clinical experience in the diagnosis and treatment of rectal buttonhole tear.

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Genetic Analysis of A Family with CTNNB1 Gene Variation

HUANG Fen-fang, ZHANG Lan-lan, HUANG Yan-hua, LIANG Pei

2025, 52 (3): 312-314. doi: 10.12280/gjfckx.20250055

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This study aimed to detect the pathogenic gene variation sites in a rare disease family with neurodevelopmental disorder accompanied by spastic bilateral paralysis and visual deficiency and conduct genetic analysis. The proband presented at Qinzhou Maternal and Child Health Hospital due to severe intellectual disability, language disorder, spastic diplegia, strabismus and special facial features. Clinical data of the proband and family members were collected. The proband’s mother had the same phenotype as the proband and was 23 weeks pregnant, while other family members had no abnormal phenotypes. Peripheral blood samples of family members and amniotic fluid from the proband’s mother were collected, and whole-exome sequencing technology was applied for gene detection. The gene detection results of the proband and his mother indicated a heterozygous mutation c.1759C>T (p.R587*) in exon 11 of the CTNNB1 gene. The proband inherited this variation from his mother with intellectual disability. This variation replaced the cytosine (C) at nucleotide 1759 of the CTNNB1 gene with thymine (T), resulting in the 587th amino acid being changed to a stop codon. Analysis by the SWISS-MODEL software suggested that the mutation site led to a change in the protein structure, resulting in a truncated protein. According to the Standards and Guidelines for the Interpretation of Sequence Variants of the American College of Medical Genetics and Genomics, c.1759C>T (p.R587*) was rated as a pathogenic variation (PVS1+PS2+PM2-Supporting). The mutation was not detected in the proband’s maternal grandparents and father. The amniotic fluid test showed that the fetus did not carry this mutation, and no abnormalities have been found since birth. The heterozygous variation of the CTNNB1 gene in the proband and his mother is considered to be the pathogenic cause of neurodevelopmental disorder accompanied by spastic bilateral paralysis and visual deficiency. Gene detection technology can assist clinicians in disease diagnosis.

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The Interpretation of 2024 SMFM Consult Series: Management of Short Cervix in Individuals without A History of Spontaneous Preterm Birth

LENG Qin, ZHONG Xiao-ling, YU Wei-wei

2025, 52 (3): 315-318. doi: 10.12280/gjfckx.20250165

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The rate of preterm birth has been increasing in recent years, most deliveries before 34 weeks of gestation occur in individuals with no previous history of preterm birth. Since short cervix is associated with preterm birth, cervical length assessment and targeted preventive measures can reduce the incidence of preterm birth. Midtrimester cervical length assessment using transvaginal ultrasound is one of the best clinical predictors of spontaneous preterm birth. In 2024, the Society for Maternal-Fetal Medicine (SMFM) issued the Consult Series No.70: Management of short cervix in individuals without a history of spontaneous preterm birth, covering cervix length assessment, definition of short cervix and its prevention and therapy. The recommendation provides guidance for the diagnosis and management of pregnant women with short cervix without a history of preterm birth.

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Research Progress on E3 Ubiquitin Ligases in the Cervical Cancer

LIAN Si-han, HAN Meng-fei, WANG Yu-jue, ZHAO Lin-yan, HU Yan

2025, 52 (3): 319-325. doi: 10.12280/gjfckx.20250173

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Cervical cancer is the common gynecological malignancy with a relatively high incidence and mortality rate, and it shows a trend of younger onset, seriously endangering women′s health. Persistent infection with high-risk human papilloma virus (HPV) is the key and initiating factor for the occurrence and development of cervical cancer. Although surgery, radiotherapy, and chemotherapy have greatly improved the prognosis of cervical cancer patients, the survival rate of advanced cervical cancer remains unsatisfactory. Therefore, finding targeted therapeutic targets can provide new methods for clinical diagnosis and treatment. As a key enzyme in the ubiquitination cascade reaction, E3 ubiquitin ligases is responsible for tagging ubiquitin molecules onto target proteins, thereby regulating their biological function. E3 ubiquitin ligases can be mainly divided into three major categories: RING-type, HECT-type, and RBR-type. They can block the persistent HPV infection state and inhibit the progression of cervical cancer through mechanisms such as regulating the proliferation of cervical cancer cells, participating in cell migration and invasion, affecting the cell cycle, regulating the sensitivity to radiotherapy and chemotherapy, and mediating immune evasion. In terms of application, using proteasome inhibitors or directly targeting E3 ubiquitin ligases can delay the progression of the disease. In recent years, newly developed proteolysis, targeting chimeras and molecular glues also show broad prospects in the field of treatment.

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Application of Microfluidic Technology in the Diagnosis and Treatment of Ovarian Cancer

XU Ruo-lan, YANG Jiang, ZHOU Jin-ting

2025, 52 (3): 326-330. doi: 10.12280/gjfckx.20250185

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Ovarian cancer poses a significant threat to women′s health worldwide due to its high mortality rate, which is mainly attributed to the difficulties in early diagnosis and chemotherapy resistance. As an emerging technology, microfluidic technology shows certain potential in ovarian cancer diagnosis and treatment, thanks to its advantages such as high sensitivity, low sample/reagents consumption, rapid response, and cost-effectiveness. In the field of diagnosis, microfluidic technology breaks through the limitations of single-biomarker detection by jointly detecting multiple biomarkers, enabling high-sensitivity and rapid screening. Moreover, it significantly improves the reliability of early diagnosis of ovarian cancer through liquid biopsy, such as screening exosome biomarkers and efficiently identifying circulating tumor cells. In terms of treatment, microfluidic technology reveals drug-resistance mechanisms by simulating the tumor microenvironment, develops targeted delivery systems to enhance drug sensitivity, and precisely constructs controllable-release nanocarriers to optimize drug efficacy and safety. With the continuous advancement of microfluidic technology, it is expected to bring more precise and effective diagnostic and treatment options for patients.

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The Application of Ataxia Telangiectasia Mutated and Rad3-Related Protein in the Pathogenesis, Development and Treatment of Ovarian Cancer

FENG Xiao-yu, YAN Li-jun

2025, 52 (3): 331-336. doi: 10.12280/gjfckx.20250141

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Ovarian cancer is a common gynecological malignant tumor, and its treatment faces the dual challenge of platinum resistance and poly (ADP-ribose) polymerase inhibitor (PARPi) resistance. Therefore, how to overcome its drug resistance has become a research hotspot. The drug resistance of ovarian cancer is closely related to the reverse mutation of key genes in the DNA damage response. Ataxia telangiectasia mutated and Rad3-related protein (ATR) is an important intracellular protein kinase in cells, plays a crucial role in multiple physiological processes such as cell cycle regulation and DNA damage repair. Studies have found that high expression of ATR promotes the survival of ovarian cancer cells and increases their tolerance to chemotherapeutic drugs. This article reviews the classic biological functions of ATR, explores the role of ATR in the occurrence and development of ovarian cancer, and introduces the therapeutic strategies for ovarian cancer targeting ATR, aiming to provide guidance for the individualized treatment of ovarian cancer and further improve the prognosis of ovarian cancer patients.

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Exploration of Surgical Techniques for Transumbilical Laparoendoscopic Single-Site Surgery for Resection of Benign Ovarian Tumors

ZHANG Wei-feng, ZHANG Yi

2025, 52 (3): 337-341. doi: 10.12280/gjfckx.20241135

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Objective: To investigate the surgical techniques for transumbilical laparoendoscopic single-site surgery (TU-LESS) for resection of benign ovarian tumors using conventional instruments. Methods: A retrospective analysis was conducted on the clinical data of patients who underwent TU-LESS for benign ovarian tumors at the Women and Children′s Hospital of Ningbo University from June 2023 to June 2024. The data included the patients′ age, tumor maximal diameter, tumor type, intraoperative blood loss and operation time. The surgical videos of these cases were reviewed to summarize the relevant surgical techniques, and the relationship between the surgical techniques and the surgical outcomes was further analyzed. Results: A total of 24 patients underwent TU-LESS, and all operations were successfully completed. Among them, 3 cases required an additional auxiliary port. No organ injury, conversion to open surgery, postoperative incision infection, bleeding or umbilical hernia occurred in all patients. The average age of the patients was (26.6±7.2) years, the average operation time was (81.5±13.7) minutes, and the average intraoperative blood loss was (46.6±15.1) mL. The 24 patients were divided into two groups according to the chronological order of the operations. The operation time of the latter 12 patients was significantly shorter than that of the former 12 patients [(87.9±14.1) minutes vs. (75.2±10.3) minutes, t=2.527, P=0.019]. However, there were no statistically significant differences in intraoperative blood loss, postoperative exhaust time, and hospital stay between the two groups (all P>0.05). Video analysis indicated that establishing an effective operating triangle was the most crucial step in single-port laparoscopic surgery, which could be achieved by forming a small operating triangle, a cross-triangle, or adding an auxiliary port. Conclusions: TU-LESS for resection of benign ovarian tumors has the advantages of minimal trauma and high aesthetic degree, and can be performed using conventional laparoscopic instruments. However, surgeons need to learn and master the relevant techniques, especially the method of establishing an effective operating triangle under the laparoscope, to shorten the learning curve and reduce the occurrence of complications.

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Construction of A Nomogram Prognosis Prediction Model for the Prognosis of Ovarian Yolk Sac Tumors Based on SEER Database

CHU Ying, WANG Yi-xuan, HUA Zhen-dan, ZHENG Jia-hui, WANG Zan-hong

2025, 52 (3): 342-349. doi: 10.12280/gjfckx.20240966

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Objective: To analyze the relevant influencing factors of tumor-specific survival in patients with ovarian yolk sac tumor (OYST) and construct a nomogram prediction model for the tumor-specific survival rate of OYST patients. Methods: A total of 358 patients diagnosed with OYST from January 2000 to December 2020 were screened from the SEER database. They were randomly divided into a training set (266 cases) and a validation set (92 cases) at a ratio of 3:1. Univariate and multivariate competing risk analyses were used to identify the independent influencing factors of tumor-specific survival. A nomogram prediction models for the 1-year, 3-year, and 5-year tumor-specific survival rates was constructed. The discrimination, accuracy, and practicality of the model were evaluated by the concordance index (C-index), area under the curve (AUC) of the receiver operating characteristic curve, calibration curves, Hosmer-Lemeshow goodness-of-fit test, and decision curve analysis. A risk stratification system was established to divide the patients into high- and low-risk groups, and the Kaplan-Meier curve was used to analyze the survival differences between the two groups. Results: Multivariate competing risk analysis showed that age, surgery, and regional lymph node dissection were independent influencing factors for tumor-specific survival in OYST patients. Based on this, a nomogram prediction model was constructed. The C-indices of the training set and validation set were 0.829 (95%CI: 0.825-0.833) and 0.808 (95%CI: 0.804-0.812), respectively. The AUCs for predicting the 1-year, 3-year, and 5-year tumor-specific survival rates were 0.927, 0.833, 0.815 and 0.982, 0.880, 0.745, respectively. The Calibration curve and Hosmer-Lemeshow goodness-of-fit test showed good consistency between the predicted and actual tumor-specific survival rates of OYST patients. The clinical decision analysis indicated that the model had certain clinical practicality. The Kaplan-Meier curve showed that the tumor-specific survival rate of the high-risk group was significantly lower than that of the low-risk group (P<0.000 1). Conclusions: The constructed nomogram prediction model for the tumor-specific survival rate of OYST patients has good discrimination and accuracy, which can help clinicians evaluate the prognosis of patients and develop individualized treatment plans to improve the prognosis of patients.

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A Case of Giant Ovarian Leiomyoma in A Young Woman

JIANG Wen-jing, DING Yong-li, LYU Qun, XIE Hui-xia, LI Ruo-peng, ZHOU Min

2025, 52 (3): 350-353. doi: 10.12280/gjfckx.20241085

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Ovarian leiomyoma is a relatively rare benign ovarian tumor, typically presenting unilaterally, with a usual small tumor diameter, is prone to misdiagnosis before surgery. Surgical treatment is the key method for definite diagnosis and treatment of the disease, and postoperative pathological examination can confirm the diagnosis. This paper reports a rare case of ovarian leiomyoma. The patient presented with abdominal pain, nausea and vomiting. Imaging examinations indicated the presence of a giant pelvic mass. The patient was misdiagnosed as having an ovarian malignant tumor before surgery, so a laparotomy was performed. Bilateral ovarian masses were removed during the operation. Postoperative pathology and immunohistochemistry examinations confirmed the diagnosis of ovarian leiomyoma. The patient′s symptoms were relieved after surgery, and she was cured and discharged from the hospital. There was no recurrence during a 6-month follow-up. By summarizing and analyzing the clinical manifestations, imaging features, diagnosis and treatment process of this case, the aim is to improve the understanding of the disease among clinicians.

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Ovarian Steroid Cell Tumor, Not Otherwise Specified: A Case Report

HUANG Yin-bo, WANG Ying, LI Cui-hong, CHE Li-fan

2025, 52 (3): 354-357. doi: 10.12280/gjfckx.20241005

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Ovarian steroid cell tumor, not otherwise specified (SCT-NOS) is a relatively rare ovarian tumor in clinical practice and has certain malignant potential. Patients usually present with virilization signs and are accompanied by abnormally elevated androgen levels. The imaging examination of ovarian SCT-NOS is non-specific, so the preoperative diagnosis is quite difficult. This paper reports a case of ovarian SCT-NOS. The patient was admitted to the hospital due to a 7-day discovery of an abdominal mass and 1-day lower abdominal pain. Gynecological color ultrasound showed an abnormal cystic pelvic mass in the pelvis, torsion was not excluded, and the initially diagnosis was an abdominal cyst. Laparoscopic resection of the left ovarian tumor was performed, and the postoperative pathological diagnosis was left ovarian SCT-NOS. The patient was lost to follow-up after discharge.

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A Case of Advanced Ovarian Serous Carcinoma with Inguinal Lymph Node Metastasis

CHEN Jia-yu, SHAO Ya-wen, PENG Hao-chen, WU Zhen-zhen

2025, 52 (3): 357-360. doi: 10.12280/gjfckx.20250035

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A case of advanced ovarian cancer with inguinal lymph node metastasis was reported. The patient presented with abdominal distension for 3 months and self-palpated abdominal mass for 2 months. Imaging examinations revealed a large pelvic masses and pelvic effusion, as well as multiple enlarged lymph nodes in the left inguinal region, which were highly suspected to be metastasis. Subsequently, cytoreductive surgery for ovarian malignant was performed. Postoperative pathological biopsy indicated high-grade serous carcinoma of left ovary, stage ⅣB, with left inguinal lymph node metastasis. Intravenous chemotherapy was performed after surgery. In the first cycle, paclitaxel and carboplatin were used for chemotherapy. In the second cycle, bevacizumab was added to the original chemotherapy regimen for targeted therapy. After 6 cycles of chemotherapy and 17 cycles of targeted therapy, maintenance therapy with niraparib has been continued to date. There have been no obvious adverse reactions, and no tumor recurrence or metastasis has been observed.

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