Tension-free vaginal mesh (TVM) surgery is a common and minimally invasive procedure for pelvic organ prolapses. Since commercial kits are not readily available in Japan, we have planned tailor-made mesh by informatio...Tension-free vaginal mesh (TVM) surgery is a common and minimally invasive procedure for pelvic organ prolapses. Since commercial kits are not readily available in Japan, we have planned tailor-made mesh by information of each patient before every TVM surgery. The aim of this report is to inform methods to design mesh for individual patients with pelvic organ prolapses. We also investigated the correlations among mesh size and height, weight, and body mass index (BMI). Before the operation, we obtained a KUB (abdominal X-ray). Three factors were measured from this X-ray: the first was the distance between the bilateral ischial spine, the second was the distance between the obturator foramen, and the third was the length of the arcus tendineus fascia pelvis (ATFP). These three factors always should be considered for designing of mesh. The correlations among the bilateral ischial spine distance, obturator foramen distance, ATFP length, height, weight, and BMI were assessed using the Pearson correlation coefficient. Although these three factors described above are necessary to design a mesh for individual patients, the bilateral ischial spine and obturator foramen distance correlated with the height of the patient. On the other hand, since the length of ATFP differs in each patient and is not correlated with height, we should consider this length when we design the mesh. Well-designed, tailor-made mesh will probably fit each pelvic organ prolapsed patient very well.展开更多
In this editorial,we comment on an article by Wang et al.Recent literature shows an increase in research on pelvic organ prolapse(POP).Although the true incidence of POP remains uncertain,its impact on quality of life...In this editorial,we comment on an article by Wang et al.Recent literature shows an increase in research on pelvic organ prolapse(POP).Although the true incidence of POP remains uncertain,its impact on quality of life is substantial.Anatomical studies report high incidence rates,surpassing those observed in symptom-based surveys.Weakness of the endopelvic fascia is a primary anatomical risk factor for POP.Additionally,gestational diabetes mellitus(GDM)has emerged as a growing concern,as poor glycemic control increases complications for both mother and fetus.GDM and POP are interconnected,with factors like maternal obesity,macrosomia,and hormonal changes exacerbating pelvic floor dysfunction.Modifiable risk factors,such as obesity and chronic hyperglycemia,along with multiparity,instrumental deliveries,and obstetric trauma,further increase susceptibility.For patients with GDM,gynecological exams,Pelvic Organ Prolapse Quantification staging,and pelvic floor ultrasonography are valuable diagnostics,with proctological exams and magnetic resonance defecography aiding in multi-compartment prolapse diagnoses.Imaging,though uncomfortable during pregnancy,is safe in the early postpartum period.This editorial emphasizes the need for further research on the pathophysiology of GDM-related POP and offers recommendations for improving diagnosis and clinical management of patients with GDM.展开更多
BACKGROUND Among patients referred for colonoscopy to evaluate bowel bleeding,many present with hemorrhoidal disease-associated bleeding and prolapse.AIM To compare endoscopic band ligation(EBL)with rigid proctoscope ...BACKGROUND Among patients referred for colonoscopy to evaluate bowel bleeding,many present with hemorrhoidal disease-associated bleeding and prolapse.AIM To compare endoscopic band ligation(EBL)with rigid proctoscope band ligation(RPBL)in patients referred for colonoscopy due to internal hemorrhoids.METHODS This retrospective cohort study included 171 patients with previous anal bleeding and hemorrhoidal prolapse complaints who underwent routine colonoscopy who were referred for band ligation treatment.Seventy-five patients underwent EBL,and 96 underwent RPBL.Control of bleeding,prolapse recurrence,pain,tenesmus,overall satisfaction,and cost were analyzed.A log-binomial regression model was used to analyze and compare binary outcomes between the ligation types,which allowed for the direct estimation of relative risks.RESULTS EBL achieved hemorrhoid symptom control in 92%of patients after a single session,compared with 63.5%for RPBL,which typically required three to four sessions(P<0.01).Short-term prolapse was significantly lower with EBL(13.3%)than with RPBL(55.2%,P<0.01),and long-term prolapse recurrence remained lower(8% vs 36.5%,P<0.01).Short-term bleeding was also reduced with EBL(4% vs 19%,P<0.01),while long-term bleeding control was comparable between groups(97.3% vs 92.7%).RPBL patients were more likely to report pain(relative risk=1.29;95%confidence interval:1.08-1.54;P<0.01).Overall satisfaction was markedly higher in the EBL group(86.7%“very satisfied”)than in the RPBL group(24%,P<0.01).CONCLUSION EBL demonstrated superior control of hemorrhoidal symptoms,lower prolapse recurrence,and better short-term bleeding outcomes compared with RPBL.Long-term bleeding control and tenesmus rates were comparable;however,numerical trends favored EBL.Despite a higher per-session cost,the reduced number of sessions made overall expenses similar.EBL appears to be a more effective,efficient,and well-tolerated minimally invasive option for treating symptomatic internal hemorrhoids.展开更多
Objectives:Recently,pre-/post-operative Local Estrogen Therapy(LET)has shown effectiveness in alleviating Pelvic Organ Prolapse(POP)symptoms in clinical therapy.However,there is a lack of scientific evidence to suppor...Objectives:Recently,pre-/post-operative Local Estrogen Therapy(LET)has shown effectiveness in alleviating Pelvic Organ Prolapse(POP)symptoms in clinical therapy.However,there is a lack of scientific evidence to support these claims.Therefore,we aimed to explore the anti-senescence effects and mechanisms of 17β-estradiol(E2)on POP-derived fibroblasts.Methods:The primary fibroblast cells were isolated and cultured fromthe surgical samples of postmenopausal women clinically diagnosed with pelvic organ prolapse(POP)at stages III-IV(quantified using the POP-Q system)and without any other treatment within 6 months.(n=12,age 50–75).Colorimetric Cell Counting Kit(CCK-8)assay and Senescence-Associated-β-Galactosidase(SA-β-Gal)staining were used to test the cell proliferative capacity and the senescence rate.Western blotting(WB)was used to detect the expression of Collagen Type I(COL-I),Collagen Type III(COL-III),Cyclin-dependent kinase 4 inhibitor A(p16INK4a),Cyclin-dependent kinase inhibitor 1A(p21),Tumor Protein 53(p53),Sirtuin 1(SIRT-1)and Microtubule-associated protein 1A/1B-light chain 3-I/II(LC3-I/II)protein.A transmission ElectronMicroscope(TEM)was used to observe the ultrastructure of fibroblasts.Results:The results showed that E2 significantly promoted the proliferation of fibroblasts derived from POP and reduced the staining rate of SA-β-Gal.It markedly enhanced the extracellular matrix proteins COL-I and COL-III,accompanied by inhibition of the senescent maker p16INK4a.Additionally,our results improved the cells’autophagy and metabolic activity.Additionally,our results indicate the anti-senescence mechanism of E2 through the mediated SIRT-1/p53/p21 axis pathway.Conclusion:We provide preliminary evidence for the anti-aging effects and mechanisms of E2 on POP,hoping to provide a theoretical basis for estrogen against POP senescence and guide the clinical application and local administration of estrogen in POP treatment.展开更多
Complete rectal prolapse,characterized by the protrusion of the rectal wall layers through the anal canal,poses significant treatment challenges,particularly due to controversies surrounding surgical approaches and th...Complete rectal prolapse,characterized by the protrusion of the rectal wall layers through the anal canal,poses significant treatment challenges,particularly due to controversies surrounding surgical approaches and the absence of a standardized assessment system.This study comprehensively reviews the main surgical tech-niques for complete rectal prolapse,categorized as transabdominal and transpe-rineal/transanal procedures.Despite various techniques,challenges persist,inclu-ding high recurrence rates and potential complications.Factors influencing the choice of the surgical approach include patient characteristics,symptomatology,and surgical expertise.With advances in medical technology,laparoscopic and robotic surgeries offer promising avenues,albeit with considerations of cost and accessibility.Ultimately,treatment plans tailored to the individual needs of the patient and surgical expertise are essential.Although controversies remain,the continued refinement of surgical techniques holds promise for improving out-comes in complete rectal prolapse surgery.展开更多
Introduction: Urethral prolapse, a rare benign lesion of the female urethra, is considered unusual in children, but it is far from exceptional in girls aged 18 to 24. African origin. The diagnosis is clinical but can ...Introduction: Urethral prolapse, a rare benign lesion of the female urethra, is considered unusual in children, but it is far from exceptional in girls aged 18 to 24. African origin. The diagnosis is clinical but can be overlooked or confused with other pathologies. Treatment remains controversial. The aim of this work is to study the epidemiological, clinical and therapeutic data of urethral mucosal prolapse in young girls in our department. Materials and methods: Retrospective and descriptive study on urethral mucosal prolapse in little girls identified from the hospitalization records of the Sino-Guinean Friendship Hospital in Conakry. The study period was 5 years. Patients were selected randomly. Outcome assessment focused on the occurrence of recurrences and urinary incontinence. The mean follow-up duration was 24 months. The parameters studied were: Age, clinical and histological findings, therapeutic data and patient outcomes. Results: The incidence of urethral mucosal prolapse in girls in the urology department was 2.2 cases/year. The mean age of the patients was 6.7 years (with extremes of 5 months and 10 years). The age group of 7 to 10 years was the most represented, observed in 63.63% of patients. The most frequent reason for consultation was vulvar bleeding in 7 patients, or 63.63%. Malpighian hyperplasia with a congested chorion was the most observed histological type, in 4 patients. Surgical treatment consisting of complete excision of the prolapsed part had given excellent results. Conclusion: Urethral prolapse is a rare pathology, observed mainly in young black girls. Its diagnosis is based mainly on clinical examination. Surgical treatment gives satisfactory results, both clinically and aesthetically.展开更多
BACKGROUND Stapled hemorrhoidopexy(SH)is one of the most commonly used surgical techniques for hemorrhoidal disease,being particularly effective for grade III and IV hemorrhoids.The procedure is associated with better...BACKGROUND Stapled hemorrhoidopexy(SH)is one of the most commonly used surgical techniques for hemorrhoidal disease,being particularly effective for grade III and IV hemorrhoids.The procedure is associated with better short-term outcomes,including less postoperative pain,shorter operative time,faster return to work,and higher patient satisfaction.However,there is a risk-benefit debate surrounding SH due to significant complications from the procedure,such as anal stenosis,rectovaginal fistula,fecal incontinence,and recurrence.AIM To evaluate recurrence rates and factors influencing surgical outcomes following SH in patients with grade III and IV hemorrhoids.METHODS This retrospective,single-center study enrolled a total of 77 patients with grade III/IV hemorrhoids for analysis.Early(less than 7 days after SH)and late(7 or more days after SH)complications were analyzed.Recurrence rates were calculated as well.RESULTS Patients were categorized by hemorrhoid grade and showed no differences in demographic data between the two groups.Recurrence was observed in 4 patients(23.6%)with grade IV hemorrhoids,and no recurrence was noted in patients with grade III hemorrhoids.Postoperative bleeding,incomplete defecation,urgent defecation,incontinence,skin tags,and anal fissure were complications reported by both groups.CONCLUSION Due to the high recurrence rate,SH is not an appropriate treatment option for patients with grade IV hemorrhoids.Open surgery may be a more suitable option for these patients.展开更多
We present a case report of laparoscopic herniorrhaphy in an infant with ovarian prolapse. Using this case study, we demonstrate the role of the ovarian ligamentous apparatus. A structure appearing like the male guber...We present a case report of laparoscopic herniorrhaphy in an infant with ovarian prolapse. Using this case study, we demonstrate the role of the ovarian ligamentous apparatus. A structure appearing like the male gubernaculum was identified. The anatomical and functional role of this “gubernaculum” will be the subject of discussion. Further detailed laparoscopic examinations are indicated to better understand the ligamentous anatomy of ovarian prolapse.展开更多
Introduction: Genital prolapse is a health problem that gynaecologists are increasingly facing due to patients’ legitimate demands for care and the improvement in life expectancy without associated disabilities. The ...Introduction: Genital prolapse is a health problem that gynaecologists are increasingly facing due to patients’ legitimate demands for care and the improvement in life expectancy without associated disabilities. The objective of this work was to evaluate the clinical aspects and functional disorders of patients with genital prolapse in Butembo in Democratic Republic of the Congo (DRC). Material and Methods: A descriptive study with analytical aims was conducted from January 1 to September 30, 2024 in Butembo/DRC. It involved 112 patients with symptomatic genital prolapse in whom an interview on functional disorders as well as clinical assessment according to the Baden and Walker classification were carried out. The data were entered into Microsoft Office LTSC 2021 Excel software and analysed using R software version 4.4.0. Results: Patients aged over 50 years were exposed to developing genital prolapse especially the mixed type (81.1%) compared to those aged under 50 years (p-value 0.014). Multi and large multiparous women had developed all types of prolapse especially the mixed type (100%) compared to primiparous and pauciparous women (p-value 0.027). Associated pathologies were more observed in case of mixed prolapse (51.4%) including vesicovaginal fistula (37.8%) (p-value Conclusion: Genital prolapse is common and functional urinary, sexual and anorectal signs are frequently observed in patients in Butembo/DRC.展开更多
BACKGROUND Pelvic organ prolapse(POP)can lead to urinary incontinence,fecal incontinence,and other symptoms,affecting the quality of life,which results in anxiety and depression and other negative emotions in many pat...BACKGROUND Pelvic organ prolapse(POP)can lead to urinary incontinence,fecal incontinence,and other symptoms,affecting the quality of life,which results in anxiety and depression and other negative emotions in many patients.Trans-vaginal sacrospinous ligament suspension(VSSLS)involves securing the apex of the prolapsed vagina to the sacrospinous ligament to maintain the physiological axis of the vagina,help in repairing pelvic floor defects,and maintain the normal function of the pelvic floor,thereby alleviating patients’anxiety and depression.AIM To explore the effect of VSSLS in the treatment of POP and its influence on anxiety and depression among patients.METHODS Sixty patients with moderate to severe POP who underwent surgical treatment between January 2023 and June 2024 in Suzhou Ninth Hospital Affiliated to Soochow University were retrospectively enrolled in the study.According to treatment methods,they were divided into the control group(n=30,treated with vaginal hysterectomy alone)and observation group(n=30,treated with VSSLS combined with vaginal hysterectomy).The two groups were compared by baseline data,perioperative indicators,and postoperative pain intensity,prolapse distance before and after surgery,sexual function,pelvic function,anxiety,and depression.RESULTS No significant differences in baseline data,preoperative POP Quantification measurement value,Pelvic Floor Dysfunction Inventory 20(PFDI-20),Pelvic Floor Impact Questionnaire 7(PFIQ-7),Self-Rating Anxiety Scale(SAS),and Self-Rating Depression Scale(SDS)scores were found between the two groups.The obser vation group had longer operation time and more intraoperative blood loss than the control group,the Visual Analog Scale score on postoperative day 1 was slightly higher in than in the control group.On the reexamination 3 months postoperatively,the POP Quantification measurement values in the observation group were lower than those in the control group(P<0.05).Evaluation 6 months after surgery,the FSFI score was higher in the observation group than in the control group,the PFDI-20,PFIQ-7,SAS and SDS score scored were lower in than in the control group(P<0.05).The PFDI-20,PFIQ-7 scores positively correlated with the SAS and SDS scores.CONCLUSION VSSLS demonstrated a significant effect on the treatment of moderate and severe POP,as it can reduce the prolapse distance and PFDI-20 and PFIQ-7 scores and improve anxiety and depression among patients.展开更多
Objective This is a self-controlled multicenter retrospective study based on the clinical efficacy and complications of physiological reconstruction in the treatment of moderate and severe pelvic organ prolapse.Method...Objective This is a self-controlled multicenter retrospective study based on the clinical efficacy and complications of physiological reconstruction in the treatment of moderate and severe pelvic organ prolapse.Methods From December 2014 to August 2021,517 women were included and registered for physiological reconstruction at four Chinese urogynecology institutions.We enrolled 364 women with POP-Q stage≥3.The degree of POP was quantified via a POP-Q system.The surgical purpose of physiological reconstruction is to repair the vagina,levator ani muscle,perineum,and urogenital hiatus and adopt a repair method in accordance with the axial direction of physiology.All 330 evaluable participants were followed for 2 years.The evaluation indices included the PFDI-20,PGI-I,PFIQ-7,PISQ-12,PGI-I,and PGI-S.All complications were coded according to the category-time-site system proposed by the International Urogynecological Association(IUGA)and International Continence Society(ICS).Results Compared with the preoperative POP-Q scores,statistically significant improvements were observed at the 6-month,1-year and 2-year time points(P<0.001).Statistically significant improvements in quality of life were observed across all time points.Conclusions Physiologic reconstructive surgical techniques combined with modified anterior pelvic floor mesh implantation could help restore the physiologic axis and vaginal shape,which may be the most important factors in maintaining the functional position of pelvic floor organs and is the most effective method for repairing the pelvic fascia tendon arch.This surgical method is safe,feasible,and effective in patients with severe prolapse.展开更多
BACKGROUND Circumferential prolapsed hemorrhoids(CPHs)necessitate surgical intervention.While Milligan-Morgan hemorrhoidectomy(MMH)remains widely used,it compromises functional preservation and associates with signifi...BACKGROUND Circumferential prolapsed hemorrhoids(CPHs)necessitate surgical intervention.While Milligan-Morgan hemorrhoidectomy(MMH)remains widely used,it compromises functional preservation and associates with significant post-operative pain,edema,and delayed healing in severe CPH cases.To address these limitations,our research team innovatively proposed the transverse incision with longitudinal ligation procedure(TILL).This novel technique utilizes targeted transverse incisions and longitudinal pedicle ligation to optimize complete resection while preserving anal anatomy and function.METHODS A total of 180 patients were retrospectively reviewed in China.The patients were divided into two groups of 90 based on the surgical methods.The treatment group underwent the TILL procedure,while the control group underwent MMH.The main observation index was the evaluation of clinical efficacy after wound healing.Secondary outcomes included the recurrence rate and wound healing time.Safety measurements were also evaluated.RESULTS The TILL group showed a significant difference compared to the MMH group(P=0.022),indicating better overall treatment effects.The time for wound healing in the TILL group was shorter than that in the MMH group(P=0.001).Compared to those who underwent MMH,those who underwent TILL experienced significantly reduced postoperative pain,with lower average scores for anal edema and anal stenosis(both P<0.05).CONCLUSION TILL demonstrates superior efficacy to MMH for advanced CPH,reducing recovery times and postoperative pain,edema,and stenosis while preserving anal function.展开更多
The transverse incision with longitudinal ligation(TILL)procedure is a new method for treating circumferential prolapsed hemorrhoids.A study by Song et al found TILL to be better than the traditional Milligan-Morgan h...The transverse incision with longitudinal ligation(TILL)procedure is a new method for treating circumferential prolapsed hemorrhoids.A study by Song et al found TILL to be better than the traditional Milligan-Morgan hemorrhoidectomy for short-term results,showing less pain,quicker healing,and lower risk of anal stenosis.TILL reduces tissue tension and controls blood supply,allowing effective removal of diseased tissue while maintaining anal function and structure.However,the study's limitations,including its retrospective,single-center design,small sample size,and short follow-up,restrict the findings'generalizability and ability to assess long-term outcomes like recurrence.Larger,multicenter trials are needed for a thorough evaluation and wider clinical adoption of TILL.展开更多
BACKGROUND In the field of anesthesia for procedure for prolapse and hemorrhoids(PPH)surgery,combined spinal-epidural(CSE)anesthesia has been a common approach.However,exploring new combinations to optimize patient ou...BACKGROUND In the field of anesthesia for procedure for prolapse and hemorrhoids(PPH)surgery,combined spinal-epidural(CSE)anesthesia has been a common approach.However,exploring new combinations to optimize patient outcomes remains crucial.Remimazolam,a short-acting benzodiazepine,shows potential for improving sedation and reducing patient anxiety.The effects of combining remimazolam with CSE anesthesia,compared to traditional CSE anesthesia alone,on patient anxiety,sedation depth,and hemodynamics during PPH surgery have not been fully elucidated.AIM To compare remimazolam-CSE vs CSE alone on State-Trait Anxiety Inventory-State scale(STAI-S)scores,sedation,and hemodynamics in PPH surgery.METHODS This study is a single-center,prospective,randomized controlled trial.Between November 23,2022,and August 6,2024,60 eligible patients were randomly assigned to the CSE anesthesia group or the remimazolam-combined CSE anesthesia group(30 patients each).STAI-S scores,Ramsay sedation scores,and hemodynamic parameters(systolic blood pressure,diastolic blood pressure,heart rate)were measured at multiple time points.Two-way mixed-effects ANOVA and posthoc analyses were performed.RESULTS The Combined group demonstrated significantly lower STAI-S scores before leaving the operating room[mean:28.80 vs 54.03,mean difference(95%CI):25.23(21.24-29.23),P<0.001]and 24 hours post-operation[mean:45.07 vs 54.53,mean difference(95%CI):9.47(6.29-12.64),P<0.001]than the CSE group.Moreover,the Combined group achieved a deeper sedation level during intraoperative maintenance[median:5.00(IQR:5.00-5.00)vs 2.00(IQR:2.00-2.00);median difference(95%CI):3.00(3.00-3.00),P<0.001].Regarding hemodynamics,a significant intergroup difference in systolic blood pressure was observed at the start of the surgery[mean:128.8 vs 114.7 for the Combined and CSE groups,mean difference(95%CI):14.17(0.77-27.57),adjusted P=0.033].CONCLUSION Remimazolam-combined anesthesia outperformed CSE anesthesia in reducing STAI-S scores,enhancing intraoperative sedation,and stabilizing systolic blood pressure at a critical stage,indicating its superiority in perioperative management.展开更多
AIM:To analyze the clinical and pathological features of 89 patients presenting as lacrimal gland prolapse(LGP).METHODS:This retrospective study included 89 patients presenting as LGP.Magnetic resonance imaging(MRI)sc...AIM:To analyze the clinical and pathological features of 89 patients presenting as lacrimal gland prolapse(LGP).METHODS:This retrospective study included 89 patients presenting as LGP.Magnetic resonance imaging(MRI)scan was performed for all patients.Pathology and immunohistochemical staining of prolapsed tissue were performed during the surgery.The histopathological subtype was obtained,and the related clinical manifestations of different subtype were marked.RESULTS:Among the 89 patients involved,the histopathological subtype includes dacryoadenitis(43%;n=38),focal lymphocytes infiltration(20%;n=18),immunoglobulin G4(IgG4)-related lacrimal gland inflammatory disease(15%;n=13),lacrimal gland(13%;n=12),and extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue(9%;n=8).As for manifestations of different subtypes,eyelid swelling was found the most frequent of lymphocytes infiltration(44%,n=8),and palpable lacrimal gland mass of dacryoadenitis(55%,n=21).All the IgG4-related lacrimal gland inflammatory disease(100%,n=13)and most dacryoadenitis(97%,n=37)presented as bilateral.CONCLUSION:LGP has the histopathological subtype most commonly as inflammation,followed by structural and lymphoproliferative changes.Most of patients present as eyelid swelling.Clinical manifestations can be significant to differentiate the diagnosis.展开更多
盆腔器官脱垂（pelvic organ prolapse,POP）是指因盆底支持力量的减弱引起的盆腔器官位置的下降,主要表现为阴道前、后壁,子宫、膀胱及直肠等的脱垂或膨出。虽然POP并不对患者的生命构成危险,但该病及其一系列并发症严重影响着患者的...盆腔器官脱垂（pelvic organ prolapse,POP）是指因盆底支持力量的减弱引起的盆腔器官位置的下降,主要表现为阴道前、后壁,子宫、膀胱及直肠等的脱垂或膨出。虽然POP并不对患者的生命构成危险,但该病及其一系列并发症严重影响着患者的生存质量。展开更多
吻合器痔上黏膜环切术（procedure for prolapse and hemorrhoids,PPH）用于治疗环状脱垂的Ⅲ、Ⅳ度内痔,反复出血的Ⅱ度内痔（[1]）。我科2007年10月—2015年8月行PPH术356例,总结报道如下。1资料与方法1.1一般资料356例患者中,男228例...吻合器痔上黏膜环切术（procedure for prolapse and hemorrhoids,PPH）用于治疗环状脱垂的Ⅲ、Ⅳ度内痔,反复出血的Ⅱ度内痔（[1]）。我科2007年10月—2015年8月行PPH术356例,总结报道如下。1资料与方法1.1一般资料356例患者中,男228例,女128例;年龄40～80岁,中位年龄58岁;均有间歇性大便带血和肛门肿物脱出。展开更多
妇女一生中有11%~19%的风险行盆底修复手术,而盆腔器官脱垂（pelvic organ prolapse,POP）传统修复手术是在已经薄弱和缺陷的筋膜、结缔组织及韧带上进行悬吊和修补,再次手术的风险高。近年来使用移植物尤其是合成网片的盆底重建手术降...妇女一生中有11%~19%的风险行盆底修复手术,而盆腔器官脱垂（pelvic organ prolapse,POP）传统修复手术是在已经薄弱和缺陷的筋膜、结缔组织及韧带上进行悬吊和修补,再次手术的风险高。近年来使用移植物尤其是合成网片的盆底重建手术降低了传统修复手术的复发率,改善了压力性尿失禁（stress urinary incontinence,SUI）和POP患者的生活质量。展开更多
Tension-free vaginal mesh (TVM) surgery is a common and minimally invasive procedure for female pelvic organ prolapse. In 2004, this procedure was developed by a French group, and standardized surgical kits are now co...Tension-free vaginal mesh (TVM) surgery is a common and minimally invasive procedure for female pelvic organ prolapse. In 2004, this procedure was developed by a French group, and standardized surgical kits are now commercially available in many countries. Although it is less invasive, one of the shortcomings of this procedure is that it involves a single surgeon groping around with their fingers without any intraoperative monitoring. Therefore, using Intraoperative fluoroscopic monitoring during TVM surgery makes it safer, even for beginners. In this case, we performed TVM for the anterior vaginal wall. First, we used the c-arm of a fluoroscope to insert bilateral ureteral stents. A urethral catheter was then used for both urine drainage and contrast medium injection. In all procedures, we were able use fluoroscopic imaging whenever necessary. We were able to easily confirm the positions of the prolapsed bladder and the bilateral ureteral stents with fluoroscopic imaging, and the ischial spine was easy to locate before the procedure. We were also able to confirm the position of the top of the needle with fluoroscopic imaging whenever necessary. If a surgeon is worried about the risk of bladder injury during TVM surgery, they should inject contrast medium into the bladder at the start of the procedure. Intraoperative fluoroscopic monitoring during TVM surgery is easy and makes the procedure safer, even for beginners. Moreover, fluoroscopic imaging also allows intraoperative training. To avoid exposing the body to excess radiation, we must minimize the total length of the fluoroscopic examination.展开更多
Objective To observe the clinical efficacy of auricular subcutaneous penetration needling combining with row acupuncture at meridian sinew on prolapse of lumbar intervertebral disc. Methods One hundred and three patie...Objective To observe the clinical efficacy of auricular subcutaneous penetration needling combining with row acupuncture at meridian sinew on prolapse of lumbar intervertebral disc. Methods One hundred and three patients with prolapse of lumbar intervertebral disc were treated with a combined treatment of auricular subcutaneous penetration needling and row acupuncture at meridian sinew. Results Of 103 patients, 46 cases were cured, 33 were markedly effective, 21 effective and 3 ineffective. The total effective rate was 97.1% （100/103）. Conclusion The combined treatment of auricular subcutaneous penetration needling and row acupuncture at meridian sinew has a significant efficacy for the treatment of prolapse of lumbar intervertebral disc.展开更多
文摘Tension-free vaginal mesh (TVM) surgery is a common and minimally invasive procedure for pelvic organ prolapses. Since commercial kits are not readily available in Japan, we have planned tailor-made mesh by information of each patient before every TVM surgery. The aim of this report is to inform methods to design mesh for individual patients with pelvic organ prolapses. We also investigated the correlations among mesh size and height, weight, and body mass index (BMI). Before the operation, we obtained a KUB (abdominal X-ray). Three factors were measured from this X-ray: the first was the distance between the bilateral ischial spine, the second was the distance between the obturator foramen, and the third was the length of the arcus tendineus fascia pelvis (ATFP). These three factors always should be considered for designing of mesh. The correlations among the bilateral ischial spine distance, obturator foramen distance, ATFP length, height, weight, and BMI were assessed using the Pearson correlation coefficient. Although these three factors described above are necessary to design a mesh for individual patients, the bilateral ischial spine and obturator foramen distance correlated with the height of the patient. On the other hand, since the length of ATFP differs in each patient and is not correlated with height, we should consider this length when we design the mesh. Well-designed, tailor-made mesh will probably fit each pelvic organ prolapsed patient very well.
文摘In this editorial,we comment on an article by Wang et al.Recent literature shows an increase in research on pelvic organ prolapse(POP).Although the true incidence of POP remains uncertain,its impact on quality of life is substantial.Anatomical studies report high incidence rates,surpassing those observed in symptom-based surveys.Weakness of the endopelvic fascia is a primary anatomical risk factor for POP.Additionally,gestational diabetes mellitus(GDM)has emerged as a growing concern,as poor glycemic control increases complications for both mother and fetus.GDM and POP are interconnected,with factors like maternal obesity,macrosomia,and hormonal changes exacerbating pelvic floor dysfunction.Modifiable risk factors,such as obesity and chronic hyperglycemia,along with multiparity,instrumental deliveries,and obstetric trauma,further increase susceptibility.For patients with GDM,gynecological exams,Pelvic Organ Prolapse Quantification staging,and pelvic floor ultrasonography are valuable diagnostics,with proctological exams and magnetic resonance defecography aiding in multi-compartment prolapse diagnoses.Imaging,though uncomfortable during pregnancy,is safe in the early postpartum period.This editorial emphasizes the need for further research on the pathophysiology of GDM-related POP and offers recommendations for improving diagnosis and clinical management of patients with GDM.
文摘BACKGROUND Among patients referred for colonoscopy to evaluate bowel bleeding,many present with hemorrhoidal disease-associated bleeding and prolapse.AIM To compare endoscopic band ligation(EBL)with rigid proctoscope band ligation(RPBL)in patients referred for colonoscopy due to internal hemorrhoids.METHODS This retrospective cohort study included 171 patients with previous anal bleeding and hemorrhoidal prolapse complaints who underwent routine colonoscopy who were referred for band ligation treatment.Seventy-five patients underwent EBL,and 96 underwent RPBL.Control of bleeding,prolapse recurrence,pain,tenesmus,overall satisfaction,and cost were analyzed.A log-binomial regression model was used to analyze and compare binary outcomes between the ligation types,which allowed for the direct estimation of relative risks.RESULTS EBL achieved hemorrhoid symptom control in 92%of patients after a single session,compared with 63.5%for RPBL,which typically required three to four sessions(P<0.01).Short-term prolapse was significantly lower with EBL(13.3%)than with RPBL(55.2%,P<0.01),and long-term prolapse recurrence remained lower(8% vs 36.5%,P<0.01).Short-term bleeding was also reduced with EBL(4% vs 19%,P<0.01),while long-term bleeding control was comparable between groups(97.3% vs 92.7%).RPBL patients were more likely to report pain(relative risk=1.29;95%confidence interval:1.08-1.54;P<0.01).Overall satisfaction was markedly higher in the EBL group(86.7%“very satisfied”)than in the RPBL group(24%,P<0.01).CONCLUSION EBL demonstrated superior control of hemorrhoidal symptoms,lower prolapse recurrence,and better short-term bleeding outcomes compared with RPBL.Long-term bleeding control and tenesmus rates were comparable;however,numerical trends favored EBL.Despite a higher per-session cost,the reduced number of sessions made overall expenses similar.EBL appears to be a more effective,efficient,and well-tolerated minimally invasive option for treating symptomatic internal hemorrhoids.
基金supported by 1.3.5 project for disciplines of excellence,West China Hospital,Sichuan University(ZYJC21048)Foundation of Sichuan Provincial Science and Technology Program(2022JDR0091,2023NSFSC0004,2023NSFSC0639,2023NSFSC1742)+5 种基金Cooperation Project for Academician&Expert Workstation(HXYS20001)Sichuan University Education Foundation(0040206107011)National Natural Science Foundation of China(Nos.82371883,82402191)China Postdoctoral Science Foundation(2023M732456)Postdoctor Research Fund of West China Hospital(2024HXBH142)Sichuan University“From 0 to 1”Innovation Research Project(2023SCUH0056).
文摘Objectives:Recently,pre-/post-operative Local Estrogen Therapy(LET)has shown effectiveness in alleviating Pelvic Organ Prolapse(POP)symptoms in clinical therapy.However,there is a lack of scientific evidence to support these claims.Therefore,we aimed to explore the anti-senescence effects and mechanisms of 17β-estradiol(E2)on POP-derived fibroblasts.Methods:The primary fibroblast cells were isolated and cultured fromthe surgical samples of postmenopausal women clinically diagnosed with pelvic organ prolapse(POP)at stages III-IV(quantified using the POP-Q system)and without any other treatment within 6 months.(n=12,age 50–75).Colorimetric Cell Counting Kit(CCK-8)assay and Senescence-Associated-β-Galactosidase(SA-β-Gal)staining were used to test the cell proliferative capacity and the senescence rate.Western blotting(WB)was used to detect the expression of Collagen Type I(COL-I),Collagen Type III(COL-III),Cyclin-dependent kinase 4 inhibitor A(p16INK4a),Cyclin-dependent kinase inhibitor 1A(p21),Tumor Protein 53(p53),Sirtuin 1(SIRT-1)and Microtubule-associated protein 1A/1B-light chain 3-I/II(LC3-I/II)protein.A transmission ElectronMicroscope(TEM)was used to observe the ultrastructure of fibroblasts.Results:The results showed that E2 significantly promoted the proliferation of fibroblasts derived from POP and reduced the staining rate of SA-β-Gal.It markedly enhanced the extracellular matrix proteins COL-I and COL-III,accompanied by inhibition of the senescent maker p16INK4a.Additionally,our results improved the cells’autophagy and metabolic activity.Additionally,our results indicate the anti-senescence mechanism of E2 through the mediated SIRT-1/p53/p21 axis pathway.Conclusion:We provide preliminary evidence for the anti-aging effects and mechanisms of E2 on POP,hoping to provide a theoretical basis for estrogen against POP senescence and guide the clinical application and local administration of estrogen in POP treatment.
基金Supported by Science and Technology Fund Project of Guizhou Health Commission,No.gzwkj2023-042 and No.gzwkj2024-010National Natural Science Foundation of China,No.82060440+2 种基金Guizhou Provincial Science and Technology Projects,No.QKHJC ZK[2024]-210Cultivation Program for General Projects of the National Natural Science Foundation of China,No.gyfynsfc[2023]-01Cultivation Program for Regional Projects of the National Natural Science Foundation of China,No.gyfynsfc[2024]-19.
文摘Complete rectal prolapse,characterized by the protrusion of the rectal wall layers through the anal canal,poses significant treatment challenges,particularly due to controversies surrounding surgical approaches and the absence of a standardized assessment system.This study comprehensively reviews the main surgical tech-niques for complete rectal prolapse,categorized as transabdominal and transpe-rineal/transanal procedures.Despite various techniques,challenges persist,inclu-ding high recurrence rates and potential complications.Factors influencing the choice of the surgical approach include patient characteristics,symptomatology,and surgical expertise.With advances in medical technology,laparoscopic and robotic surgeries offer promising avenues,albeit with considerations of cost and accessibility.Ultimately,treatment plans tailored to the individual needs of the patient and surgical expertise are essential.Although controversies remain,the continued refinement of surgical techniques holds promise for improving out-comes in complete rectal prolapse surgery.
文摘Introduction: Urethral prolapse, a rare benign lesion of the female urethra, is considered unusual in children, but it is far from exceptional in girls aged 18 to 24. African origin. The diagnosis is clinical but can be overlooked or confused with other pathologies. Treatment remains controversial. The aim of this work is to study the epidemiological, clinical and therapeutic data of urethral mucosal prolapse in young girls in our department. Materials and methods: Retrospective and descriptive study on urethral mucosal prolapse in little girls identified from the hospitalization records of the Sino-Guinean Friendship Hospital in Conakry. The study period was 5 years. Patients were selected randomly. Outcome assessment focused on the occurrence of recurrences and urinary incontinence. The mean follow-up duration was 24 months. The parameters studied were: Age, clinical and histological findings, therapeutic data and patient outcomes. Results: The incidence of urethral mucosal prolapse in girls in the urology department was 2.2 cases/year. The mean age of the patients was 6.7 years (with extremes of 5 months and 10 years). The age group of 7 to 10 years was the most represented, observed in 63.63% of patients. The most frequent reason for consultation was vulvar bleeding in 7 patients, or 63.63%. Malpighian hyperplasia with a congested chorion was the most observed histological type, in 4 patients. Surgical treatment consisting of complete excision of the prolapsed part had given excellent results. Conclusion: Urethral prolapse is a rare pathology, observed mainly in young black girls. Its diagnosis is based mainly on clinical examination. Surgical treatment gives satisfactory results, both clinically and aesthetically.
文摘BACKGROUND Stapled hemorrhoidopexy(SH)is one of the most commonly used surgical techniques for hemorrhoidal disease,being particularly effective for grade III and IV hemorrhoids.The procedure is associated with better short-term outcomes,including less postoperative pain,shorter operative time,faster return to work,and higher patient satisfaction.However,there is a risk-benefit debate surrounding SH due to significant complications from the procedure,such as anal stenosis,rectovaginal fistula,fecal incontinence,and recurrence.AIM To evaluate recurrence rates and factors influencing surgical outcomes following SH in patients with grade III and IV hemorrhoids.METHODS This retrospective,single-center study enrolled a total of 77 patients with grade III/IV hemorrhoids for analysis.Early(less than 7 days after SH)and late(7 or more days after SH)complications were analyzed.Recurrence rates were calculated as well.RESULTS Patients were categorized by hemorrhoid grade and showed no differences in demographic data between the two groups.Recurrence was observed in 4 patients(23.6%)with grade IV hemorrhoids,and no recurrence was noted in patients with grade III hemorrhoids.Postoperative bleeding,incomplete defecation,urgent defecation,incontinence,skin tags,and anal fissure were complications reported by both groups.CONCLUSION Due to the high recurrence rate,SH is not an appropriate treatment option for patients with grade IV hemorrhoids.Open surgery may be a more suitable option for these patients.
文摘We present a case report of laparoscopic herniorrhaphy in an infant with ovarian prolapse. Using this case study, we demonstrate the role of the ovarian ligamentous apparatus. A structure appearing like the male gubernaculum was identified. The anatomical and functional role of this “gubernaculum” will be the subject of discussion. Further detailed laparoscopic examinations are indicated to better understand the ligamentous anatomy of ovarian prolapse.
文摘Introduction: Genital prolapse is a health problem that gynaecologists are increasingly facing due to patients’ legitimate demands for care and the improvement in life expectancy without associated disabilities. The objective of this work was to evaluate the clinical aspects and functional disorders of patients with genital prolapse in Butembo in Democratic Republic of the Congo (DRC). Material and Methods: A descriptive study with analytical aims was conducted from January 1 to September 30, 2024 in Butembo/DRC. It involved 112 patients with symptomatic genital prolapse in whom an interview on functional disorders as well as clinical assessment according to the Baden and Walker classification were carried out. The data were entered into Microsoft Office LTSC 2021 Excel software and analysed using R software version 4.4.0. Results: Patients aged over 50 years were exposed to developing genital prolapse especially the mixed type (81.1%) compared to those aged under 50 years (p-value 0.014). Multi and large multiparous women had developed all types of prolapse especially the mixed type (100%) compared to primiparous and pauciparous women (p-value 0.027). Associated pathologies were more observed in case of mixed prolapse (51.4%) including vesicovaginal fistula (37.8%) (p-value Conclusion: Genital prolapse is common and functional urinary, sexual and anorectal signs are frequently observed in patients in Butembo/DRC.
基金Supported by 2023 Academy Level Research Start-up Fund,No.YK2023332024 Academy Level Research Start-up Fund,No.YK202430+1 种基金Wujiang District,Suzhou City,“Promoting Health through Science and Education”Project,No.WWK202201Xuzhou Medical University Affiliated Hospital Development Fund Support Project,No.XYFY202423.
文摘BACKGROUND Pelvic organ prolapse(POP)can lead to urinary incontinence,fecal incontinence,and other symptoms,affecting the quality of life,which results in anxiety and depression and other negative emotions in many patients.Trans-vaginal sacrospinous ligament suspension(VSSLS)involves securing the apex of the prolapsed vagina to the sacrospinous ligament to maintain the physiological axis of the vagina,help in repairing pelvic floor defects,and maintain the normal function of the pelvic floor,thereby alleviating patients’anxiety and depression.AIM To explore the effect of VSSLS in the treatment of POP and its influence on anxiety and depression among patients.METHODS Sixty patients with moderate to severe POP who underwent surgical treatment between January 2023 and June 2024 in Suzhou Ninth Hospital Affiliated to Soochow University were retrospectively enrolled in the study.According to treatment methods,they were divided into the control group(n=30,treated with vaginal hysterectomy alone)and observation group(n=30,treated with VSSLS combined with vaginal hysterectomy).The two groups were compared by baseline data,perioperative indicators,and postoperative pain intensity,prolapse distance before and after surgery,sexual function,pelvic function,anxiety,and depression.RESULTS No significant differences in baseline data,preoperative POP Quantification measurement value,Pelvic Floor Dysfunction Inventory 20(PFDI-20),Pelvic Floor Impact Questionnaire 7(PFIQ-7),Self-Rating Anxiety Scale(SAS),and Self-Rating Depression Scale(SDS)scores were found between the two groups.The obser vation group had longer operation time and more intraoperative blood loss than the control group,the Visual Analog Scale score on postoperative day 1 was slightly higher in than in the control group.On the reexamination 3 months postoperatively,the POP Quantification measurement values in the observation group were lower than those in the control group(P<0.05).Evaluation 6 months after surgery,the FSFI score was higher in the observation group than in the control group,the PFDI-20,PFIQ-7,SAS and SDS score scored were lower in than in the control group(P<0.05).The PFDI-20,PFIQ-7 scores positively correlated with the SAS and SDS scores.CONCLUSION VSSLS demonstrated a significant effect on the treatment of moderate and severe POP,as it can reduce the prolapse distance and PFDI-20 and PFIQ-7 scores and improve anxiety and depression among patients.
基金supported by the National Natural Science Foundation of China(No.82260297)Yunnan Province Clinical Research Center for Chronic Kidney Disease(No.202102AA100060).
文摘Objective This is a self-controlled multicenter retrospective study based on the clinical efficacy and complications of physiological reconstruction in the treatment of moderate and severe pelvic organ prolapse.Methods From December 2014 to August 2021,517 women were included and registered for physiological reconstruction at four Chinese urogynecology institutions.We enrolled 364 women with POP-Q stage≥3.The degree of POP was quantified via a POP-Q system.The surgical purpose of physiological reconstruction is to repair the vagina,levator ani muscle,perineum,and urogenital hiatus and adopt a repair method in accordance with the axial direction of physiology.All 330 evaluable participants were followed for 2 years.The evaluation indices included the PFDI-20,PGI-I,PFIQ-7,PISQ-12,PGI-I,and PGI-S.All complications were coded according to the category-time-site system proposed by the International Urogynecological Association(IUGA)and International Continence Society(ICS).Results Compared with the preoperative POP-Q scores,statistically significant improvements were observed at the 6-month,1-year and 2-year time points(P<0.001).Statistically significant improvements in quality of life were observed across all time points.Conclusions Physiologic reconstructive surgical techniques combined with modified anterior pelvic floor mesh implantation could help restore the physiologic axis and vaginal shape,which may be the most important factors in maintaining the functional position of pelvic floor organs and is the most effective method for repairing the pelvic fascia tendon arch.This surgical method is safe,feasible,and effective in patients with severe prolapse.
基金Supported by Scientific Research Fund of China-Japan Friendship Hospital,No.2019-1-QN-53.
文摘BACKGROUND Circumferential prolapsed hemorrhoids(CPHs)necessitate surgical intervention.While Milligan-Morgan hemorrhoidectomy(MMH)remains widely used,it compromises functional preservation and associates with significant post-operative pain,edema,and delayed healing in severe CPH cases.To address these limitations,our research team innovatively proposed the transverse incision with longitudinal ligation procedure(TILL).This novel technique utilizes targeted transverse incisions and longitudinal pedicle ligation to optimize complete resection while preserving anal anatomy and function.METHODS A total of 180 patients were retrospectively reviewed in China.The patients were divided into two groups of 90 based on the surgical methods.The treatment group underwent the TILL procedure,while the control group underwent MMH.The main observation index was the evaluation of clinical efficacy after wound healing.Secondary outcomes included the recurrence rate and wound healing time.Safety measurements were also evaluated.RESULTS The TILL group showed a significant difference compared to the MMH group(P=0.022),indicating better overall treatment effects.The time for wound healing in the TILL group was shorter than that in the MMH group(P=0.001).Compared to those who underwent MMH,those who underwent TILL experienced significantly reduced postoperative pain,with lower average scores for anal edema and anal stenosis(both P<0.05).CONCLUSION TILL demonstrates superior efficacy to MMH for advanced CPH,reducing recovery times and postoperative pain,edema,and stenosis while preserving anal function.
文摘The transverse incision with longitudinal ligation(TILL)procedure is a new method for treating circumferential prolapsed hemorrhoids.A study by Song et al found TILL to be better than the traditional Milligan-Morgan hemorrhoidectomy for short-term results,showing less pain,quicker healing,and lower risk of anal stenosis.TILL reduces tissue tension and controls blood supply,allowing effective removal of diseased tissue while maintaining anal function and structure.However,the study's limitations,including its retrospective,single-center design,small sample size,and short follow-up,restrict the findings'generalizability and ability to assess long-term outcomes like recurrence.Larger,multicenter trials are needed for a thorough evaluation and wider clinical adoption of TILL.
基金Supported by the Health Commission of Hunan Province,No.202204115263the Fundamental Research Funds for the Central Universities of Central South University,No.2024XQLH027.
文摘BACKGROUND In the field of anesthesia for procedure for prolapse and hemorrhoids(PPH)surgery,combined spinal-epidural(CSE)anesthesia has been a common approach.However,exploring new combinations to optimize patient outcomes remains crucial.Remimazolam,a short-acting benzodiazepine,shows potential for improving sedation and reducing patient anxiety.The effects of combining remimazolam with CSE anesthesia,compared to traditional CSE anesthesia alone,on patient anxiety,sedation depth,and hemodynamics during PPH surgery have not been fully elucidated.AIM To compare remimazolam-CSE vs CSE alone on State-Trait Anxiety Inventory-State scale(STAI-S)scores,sedation,and hemodynamics in PPH surgery.METHODS This study is a single-center,prospective,randomized controlled trial.Between November 23,2022,and August 6,2024,60 eligible patients were randomly assigned to the CSE anesthesia group or the remimazolam-combined CSE anesthesia group(30 patients each).STAI-S scores,Ramsay sedation scores,and hemodynamic parameters(systolic blood pressure,diastolic blood pressure,heart rate)were measured at multiple time points.Two-way mixed-effects ANOVA and posthoc analyses were performed.RESULTS The Combined group demonstrated significantly lower STAI-S scores before leaving the operating room[mean:28.80 vs 54.03,mean difference(95%CI):25.23(21.24-29.23),P<0.001]and 24 hours post-operation[mean:45.07 vs 54.53,mean difference(95%CI):9.47(6.29-12.64),P<0.001]than the CSE group.Moreover,the Combined group achieved a deeper sedation level during intraoperative maintenance[median:5.00(IQR:5.00-5.00)vs 2.00(IQR:2.00-2.00);median difference(95%CI):3.00(3.00-3.00),P<0.001].Regarding hemodynamics,a significant intergroup difference in systolic blood pressure was observed at the start of the surgery[mean:128.8 vs 114.7 for the Combined and CSE groups,mean difference(95%CI):14.17(0.77-27.57),adjusted P=0.033].CONCLUSION Remimazolam-combined anesthesia outperformed CSE anesthesia in reducing STAI-S scores,enhancing intraoperative sedation,and stabilizing systolic blood pressure at a critical stage,indicating its superiority in perioperative management.
基金Supported by National Natural Science Foundation of China(No.82201214,No.82201221)Ophthalmic New Technology Incubation Fund Project of China Primary Health Care Foundation(No.2022 No.005)Shaanxi Key Research and Development Program(No.2021SF-156).
文摘AIM:To analyze the clinical and pathological features of 89 patients presenting as lacrimal gland prolapse(LGP).METHODS:This retrospective study included 89 patients presenting as LGP.Magnetic resonance imaging(MRI)scan was performed for all patients.Pathology and immunohistochemical staining of prolapsed tissue were performed during the surgery.The histopathological subtype was obtained,and the related clinical manifestations of different subtype were marked.RESULTS:Among the 89 patients involved,the histopathological subtype includes dacryoadenitis(43%;n=38),focal lymphocytes infiltration(20%;n=18),immunoglobulin G4(IgG4)-related lacrimal gland inflammatory disease(15%;n=13),lacrimal gland(13%;n=12),and extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue(9%;n=8).As for manifestations of different subtypes,eyelid swelling was found the most frequent of lymphocytes infiltration(44%,n=8),and palpable lacrimal gland mass of dacryoadenitis(55%,n=21).All the IgG4-related lacrimal gland inflammatory disease(100%,n=13)and most dacryoadenitis(97%,n=37)presented as bilateral.CONCLUSION:LGP has the histopathological subtype most commonly as inflammation,followed by structural and lymphoproliferative changes.Most of patients present as eyelid swelling.Clinical manifestations can be significant to differentiate the diagnosis.
文摘吻合器痔上黏膜环切术（procedure for prolapse and hemorrhoids,PPH）用于治疗环状脱垂的Ⅲ、Ⅳ度内痔,反复出血的Ⅱ度内痔（[1]）。我科2007年10月—2015年8月行PPH术356例,总结报道如下。1资料与方法1.1一般资料356例患者中,男228例,女128例;年龄40～80岁,中位年龄58岁;均有间歇性大便带血和肛门肿物脱出。
文摘妇女一生中有11%~19%的风险行盆底修复手术,而盆腔器官脱垂（pelvic organ prolapse,POP）传统修复手术是在已经薄弱和缺陷的筋膜、结缔组织及韧带上进行悬吊和修补,再次手术的风险高。近年来使用移植物尤其是合成网片的盆底重建手术降低了传统修复手术的复发率,改善了压力性尿失禁（stress urinary incontinence,SUI）和POP患者的生活质量。
文摘Tension-free vaginal mesh (TVM) surgery is a common and minimally invasive procedure for female pelvic organ prolapse. In 2004, this procedure was developed by a French group, and standardized surgical kits are now commercially available in many countries. Although it is less invasive, one of the shortcomings of this procedure is that it involves a single surgeon groping around with their fingers without any intraoperative monitoring. Therefore, using Intraoperative fluoroscopic monitoring during TVM surgery makes it safer, even for beginners. In this case, we performed TVM for the anterior vaginal wall. First, we used the c-arm of a fluoroscope to insert bilateral ureteral stents. A urethral catheter was then used for both urine drainage and contrast medium injection. In all procedures, we were able use fluoroscopic imaging whenever necessary. We were able to easily confirm the positions of the prolapsed bladder and the bilateral ureteral stents with fluoroscopic imaging, and the ischial spine was easy to locate before the procedure. We were also able to confirm the position of the top of the needle with fluoroscopic imaging whenever necessary. If a surgeon is worried about the risk of bladder injury during TVM surgery, they should inject contrast medium into the bladder at the start of the procedure. Intraoperative fluoroscopic monitoring during TVM surgery is easy and makes the procedure safer, even for beginners. Moreover, fluoroscopic imaging also allows intraoperative training. To avoid exposing the body to excess radiation, we must minimize the total length of the fluoroscopic examination.
文摘Objective To observe the clinical efficacy of auricular subcutaneous penetration needling combining with row acupuncture at meridian sinew on prolapse of lumbar intervertebral disc. Methods One hundred and three patients with prolapse of lumbar intervertebral disc were treated with a combined treatment of auricular subcutaneous penetration needling and row acupuncture at meridian sinew. Results Of 103 patients, 46 cases were cured, 33 were markedly effective, 21 effective and 3 ineffective. The total effective rate was 97.1% （100/103）. Conclusion The combined treatment of auricular subcutaneous penetration needling and row acupuncture at meridian sinew has a significant efficacy for the treatment of prolapse of lumbar intervertebral disc.
