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简介：AbstractObjective:To evaluate the efficacy and safety of a modified cesarean hysterectomy (MCH) procedure in controlling hemorrhage in patients with placenta previa complicated with placenta percreta.Methods:A retrospective analysis was conducted on 23 patients with placenta previa complicated with placenta percreta from January 2016 to December 2018 in the Union Hospital. The patients’ age ranged from 24 to 41 years, and had gestational durations of 32-38 weeks. Nine of them underwent MCH and 14 underwent conventional cesarean hysterectomy (CCH). In the MCH group, the bladder was not mobilized, deliberately. The uterus was excised horizontally above the tourniquet level. Placental tissue around the cervical os was cleaned thoroughly, and hemostatic suturing was performed under direct vision. In the CCH group, the uterus was removed gradually after programmed hemostasis and dissection of adhesions of the vesicouterine peritoneal fold and mobilization of the bladder.Results:There were no significant differences in general conditions between the two groups. The blood loss was significantly less in the MCH group (P < 0.05). The operation time was also decreased dramatically and hospital stay (in days) was shorter than in the CCH group (P < 0.05). There were no bladder or ureter injuries in the MCH group, compared with three cases in the CCH group. There were no statistically significant differences in neonatal birth weight, Apgar score, or intensive care unit admittance rates between the two groups (P > 0.05).Conclusion:This MCH procedure reduced blood loss, avoided bladder injury, and had no long-term complications. It is a safe, rapid, and effective way to control fatal hemorrhage during surgery for women with placenta previa complicated with placenta percreta.

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简介：AbstractBackground:After radical hysterectomy for cervical cancer, the most common complication is lower urinary tract symptoms. Post-operatively, bladder capacity can alter bladder function for a prolonged period. This study aimed to identify factors affecting bladder storage function.Methods:A multicenter, retrospective cohort study was conducted. Information of patients with stages IA2 to IIB cervical cancer with urodynamic study results were retrospectively collected from nine hospitals between June 2013 and June 2018 according to the inclusion criteria. Demographic, surgical, and oncological data were collected. The univariate and multivariate logistic regression was used to identify clinical factors associated with bladder storage function.Results:Two hundred and three patients with cervical cancer had urodynamic testing post-operatively. Ninety-five (46.8%) patients were diagnosed with stress urinary incontinence (SUI). The incidence of low bladder compliance (LBC) was 23.2%. Twenty-seven (13.3%) patients showed detrusor overactivity (DO). Fifty-seven patients (28.1%) presented with a decreased maximum cystometric capacity (DMCC). The probability of composite bladder storage dysfunction was 68.0%. Multivariate analysis confirmed that laparoscopy represents a protective factor for SUI with an odds ratio of 0.498 (P = 0.034). Patients who underwent a nerve-sparing procedure were less odds to experience SUI (P = 0.014). A significant positive correlation between LBC and DO was observed (P < 0.001). A greater length of the resected vagina and chemoradiotherapy were common risk factors for LBC and DO, while radiotherapy exerted a stronger effect than chemotherapy. Additionally, patients who received chemoradiotherapy frequently developed a DMCC. The follow-up time was not correlated with bladder storage function.Conclusion:A nerve-sparing procedure without longer resected vagina is recommended for protecting the bladder storage function.

简介：Objective:Theaimofthisstudywastoinvestigatethefeasibilityofusingultrasonicscalpelcombinedwithvascularclipinparametrialmanagement,calledlimitedenergyparametrialresection/dissection(LEPRD),inlaparoscopicnerveplane-sparingradicalhysterectomy(NPSRH),amodifiednerve-sparingradicalhysterectomy(NSRH);andtoevaluateitseffectivenessinpelvicautonomicnervepreservation.Methods:FromJuly2012toJanuary2016,257consecutivepatientswithstageIB1toIIA2cervicalcancerwhounderwentNPSRHwereincludedinthisstudy.Patientsweredividedintothreecohortsaccordingtothedifferentparametrialresectionmodality.Theclinical,pathologicalandsurgery-relatedparameterswerecomparedbetweenthethreegroups.Short-andlong-termpostoperativebladderfunctionswereevaluated.Results:LEPRDwasattemptedin94patients,andwassuccessfulin65(69.1%)patients(LEPRDgroup).Theremaining29(30.9%)patientsrequiredbipolarcoagulationafterfailureofvascularclipping(combinedmodalitygroup).Routinebipolarcauterywasusedintheother163patientsduringtheparametrialresection(bipolargroup).ThebloodlossintheLEPRDgroupwassignificantlylowerthanthoseintheothertwogroups(P<0.001).TherateofsuccessfulFoleyremovalonpostoperativeday7wassignificantlyhigherintheLEPRDgroupthaninthebipolargroup(P=0.022).TheincidenceofchronicvoidingdysfunctionwassignificantlylowerintheLEPRDgroupthaninthebipolargroup(P=0.019).Conclusions:ItisfeasibletoperformLEPRDinNPSRHforcervicalcancers.Thiskindoflimitedenergysurgicaltechniqueisassociatedwithlessbloodloss,andleadstoimprovedpostoperativebladderfunction.