Objective To investigate the safety and feasibility of hysteroscopic treatment for retained products of conception (RPOC) combined with enhanced myometrial vascularity (EMV) in ambulatory surgery mode. Methods A retrospective analysis was conducted on the clinical data of patients who underwent hysteroscopic treatment for RPOC combined with EMV in ambulatory surgery mode at West China Second University Hospital between May 2021 and May 2024, including their basic information and surgical related conditions. Results A total of 54 patients were included, with an average age of (33.37±4.54) years and an average number of pregnancies of 3.14±1.56. The preoperative blood level of human chorionic gonadotropin was 11.45 (5.00, 82.96) mU/mL. Color Doppler ultrasound showed an average size of pregnancy residue (2.47±0.77) cm. The average peak systolic velocity was (55.13±18.55) cm/s. The intraoperative blood loss was 17.63 (1.00, 300.00) mL. The average surgical time was (30.07±20.64) minutes. The hospital stay was 0.69 (0.50, 1.00) days. There was 1 case of postoperative complications (incidence rate 1.9%), which had the second hysteroscopy to remove retained pregnancy tissue one month after the first surgery due to RPOC. There were 6 cases of postoperative re pregnancy. Conclusion Hysteroscopic treatment for RPOC combined with EMV in ambulatory surgery mode is safe and feasible, and is worth promoting.
摘要：目的：探讨晚期产后大出血的发生原因，提出防治措施。方法：对我院1992年1月至2000年1月收治的晚期产后大出血36例病例进行回顾性分析。结果：晚期产后出血的原因依次为胎盘残留、子宫复旧不全、切口裂开。结论：重视第三产程的处理，特别是对产时出血米索前列醇的应用，可有效预防大出血的发生。采用宫缩素及抗感染、清宫术等对症治疗可获得满意的治疗效果，对严重急性出血者可行子宫切除术。
目的:研究子宫腺肌病局部病灶切除术的可行性,方法及手术疗效的评价。方法:对2002年3月至2006年3月97例子宫腺肌病保留子宫仅作局部病灶切除术的患者进行随访观察。结果:97例子宫腺肌病手术后痛经治愈率:轻度,100%,中度37.8%,重度36%,痛经缓解率,中度及重度分别为62.2%及64%。月经过多治愈率为100%。妊娠分娩率原发不孕57.6%,继发不孕52.9%。结论:子宫腺肌病局部病灶切除术既治愈和改善了患者的临床症状又保留生殖器官的完整性及生理生殖功能可且有助于妊娠率的提高,是值得使用的方法。
Objective To investigate the effectiveness of laparoscopic Y-shaped polypropylene mesh in the treatment of uterine and vaginal vault prolapse. Methods Between June 2010 and December 2012, 24 patients with uterine and vaginal vault prolapse were treated by laparoscopic pelvic reconstruction (vagina and uterus-sacral fixation) with Y-shaped polypropylene mesh. The age of patients was 35-60 years (mean, 48.6 years). The disease duration was 2-8 years (mean, 5 years). According to the pelvic organ prolapse quatitative (POP-Q) classification by International Continence Society (ICS), 16 cases were classified as uterine prolapsed degree II and 8 cases as degree III; 15 cases were classified as vaginal prolapse degree I, 7 cases as degree II, and 2 cases as degree III. All patients received postoperative follow-up regularly. Subjective evaluation was done based on prolapse quality of life questionnaire (P-QOL), and objective evaluation based on POP-Q classification. Results All the patients were operated successfully. The operation time was 22-68 minutes (mean, 33 minutes); the blood loss was 30-80 mL (mean, 51 mL); the indwelling urethral catheter remain was 3-7 days (mean, 4 days); and the hospitalization days were 4-9 days (mean, 6.8 days). Twenty-four patients were followed up 3-12 months (mean, 9 months), of whom, 2 were followed up less than 6 months. All patients had normal urination after withdrawal of urethral catheter, and the residual urine volume was in normal range. No patients had mesh erosion and discomfort during sex, vaginal and anal bearing down. The P-QOL scores at 3, 6, and 12 months after operation were significantly improved when compared with the preoperative value (P lt; 0.05); but there was no significant difference among 3, 6, and 12 months after operation (P gt; 0.05). The postoperative POP-Q classification was degree 0 in 19 cases and degree I in 3 cases, and the objective cure rate was 91.7%. No recurrence was found during follow-up. Conclusion Laparoscopic Y-shaped polypropylene mesh for treatment of uterine and vaginal vault prolapse is a safe and effective method, especially applicable to preserve the uterus, and higher requirements of sexual life of patients.
Objective To evaluate the clinical effect and safety of nerve sparing radical hysterectomy(NSRH) for cervical cancer compared with radical hysterectomy (RH). Methods We searched the Cochrane Library (Issue 2, 2010), MEDLINE (1960 to March, 2010), EMbase (1960 to March, 2010), CBM (1960 to March, 2010), VIP (1960 to March, 2010) and CNKI (1960 to March, 2010), and hand searched related literatures. With a defined search strategy, both randomized controlled trials and controlled clinical trials of comparing NSRH with RH for cervical cancer were identified. Data were extracted and evaluated by two reviewers independently. The quality of the included trials was evaluated by Cochrane’s evaluation criterion. Meta-analysis was conducted with the Cochrane collaboration’s RevMan 4.2.2 software. Results Nine controlled clinical trials involving 742 patients were identified. The meta-analysis showed that: a) There was statistical significance in postoperative recovery of bladder function between two groups; compared with RH, NSRH was much better in aspects of the recovery time of post void residual urine volume (PVR) (WMD= – 5.80, 95%CI – 6.22 to – 5.37), the bladder dysfunction morbidity (RR=0.43, 95%CI (0.26 to 0.75), and the urodynamic study; b) The operation time of NSRH was longer than that of RH with a significant difference (WMD=37.23, 95%CI 12.84 to 61.61); c) There was no significant difference between two groups in bleeding amount (WMD=19.66, 95%CI – 51.57 to 90.90); d) There was no significant difference between two groups in both survival rate and recurrent rate (RR=0.79, 95%CI 0.17 to 3.58); e) There was no significant difference between two groups in resection extension and pathologic outcome, such as, infiltration around uterus and vessels; f) One trail showed a significant difference between two groups that NSRH seldom led to anorectal and sexual dysfunction. Conclusions Compared with RH, NSRH can quickly improve the postoperative recovery of bladder, anorectal and sexual functions, but haven’t larger quantity of operative bleeding, larger resection extension, lower survival rates and higher recurrence rates except longer operation time. NSRH can improve the quality of postoperative life and is safe. However, the trails available for this systematic review were limited, as well as non-randomized controlled trails. Some outcomes were only included by one trail. So there is no confirmed conclusion about these. The prospective randomized controlled trials are required for further investigation.
目的：探讨腹腔镜下卵巢子宫内膜异位囊肿保守手术的疗效。方法:2005年1月至2006年7月间采用腹腔镜保守手术治疗卵巢子宫内膜异位囊肿患者106例。患者平均年龄（32.5±6.4）岁，平均病程2.1年。合并不孕症21例，痛经54例，性交痛38例，慢性盆腔痛76例。无明显自觉症状仅以普查发现附件肿物者23例。结果：106例患者中行囊肿剔除术100例（94.3％），其中单侧卵巢内膜异位囊肿剔除61例，双侧卵巢内膜异位囊肿剔除39例（其中双侧囊肿剔除术34例，一侧囊肿剔除而另一侧附件切除5例），单侧附件切除6例。所有患者平均手术时间(38±11)分钟，平均出血量（35.6±12.5）mL。首次排气时间平均在术后（22.3±4.2）小时。平均住院天数（4.2±1.3）天。随访3～18个月，除21例不孕患者均于术后服用内美通或孕三烯酮2.5 mg 2次/周共3～6个月。106例患者中治疗性交痛总有效率92.2％，治疗慢性盆腔痛总有效率92.1％，治疗痛经总有效率90.7％。21例不孕患者中总妊娠率61.9％，7例(53.8％)半年内妊娠，6例（46.2％）1年内妊娠。术后复发9例（8.5％）。结论:对保留生育功能的卵巢子宫内膜异位囊肿患者，腹腔镜下保守手术是目前公认的安全、有效的手术方法。
Objective To evaluate the clinical effectiveness, safety and cost-effectiveness of postoperative radiotherapy on endometrial carcinoma. Methods We searched The Cochrane Library, The Cochrane Central Register of Controlled Trials (CENTRAL), The National Research Register, Health Technology Assessment Database (HTA), MEDLINE, EMbase, CancerLit, CBMdisc, VIP, WANFANG DATABASE and CNKI to March 2007. Relevant journals were also hand searched. Study selection and assessment, data collection and analyses were undertaken by two reviewers independently according to the Cochrane Handbook for Systematic Reviews of Interventions. Meta-analyses were performed. Results Three RCTs involving 1126 patients were included. Each of the 3 RCTs compared adjuvant radiotherapy (external beam radiotherapy, EBRT) versus chemotherapy. Two trials (730 patients) compared adjuvant radiotherapy versus CAP chemotherapy (carboplatin + adriamycin + cisplatin). The other trial (396 patients) compared adjuvant radiotherapy versus AP chemotherapy (adriamycin + cisplatin). The meta-analyses showed that for patients with endometrial cancer at stage Ic, II or III, there were no significant differences between adjuvant radiotherapy and CAP in 5-year overall survival (OS), 5-year progress-free survival (PFS) and 5-year recurrence (local, distant, total). For patients with endometrial cancer at stage III or IV, adjuvant radiotherapy was superior to AP regimen on 5-year OS and 5-year PFS. The incidence of grade 3/4 toxicities of digestive system and urogenital system was similar between the two groups of patients. The chemotherapy group showed a higher incidence of grade 3/4 toxicities of hematology than the radiotherapy group. Conclusion The effect of adjuvant pelvic radiotherapy for endometrial carcinoma at stage Ic, II or III is similar to that of adjuvant chemotherapy. However, for endometrial carcinoma at stage III or IV, the effect of radiotherapy is superior to that of chemotherapy. Radiotherapy has a lower role of myelosuppression than chemotherapy. No significant difference was observed between the radiotherapy and chemotherapy in grade 3/4 toxicities of the digestive system and the urogenital system.