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Objective To study the reproductive outcome of infertile women suffered from hydrosalpinx treated by laparoscopic salpingostomy or salpingectomy.Methods There were 77 infertile women diagnosed hydrosalpinx by HSG or B ultrasonography and excepted for other infertile factors. Unilateral or bilateral salpingostomy or salpingectomy was performed after hydrosalpinx conifrmed by laparoscopy. Seventy seven patients were followed up for 1 ~ 4 years postoperatively.Results Among 77 cases 39 cases (50.65%) got pregnancy. Thirteen cases (16.88%) conceived spontaneously and 26 cases (33.77%) conceived by IVF-ETin. Thirty ifve cases delivered health babies and 3 cases of pregnancy, 1 cases of early abortion.Conclusion Both laparoscopic surgeries were effective treatment of hydrosalpinx results in infertility. After operation the pregnant rate of those conceived by IVF-ET is higher than spontaneously.
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Objective To observe the efficacy of Foley balloon combining with uterine adhesions to prevent the recurrence of intrauterine adhesions after resection of intrauterine adhesions.Methods Patients underwent resection of intrauterine adhesions were randomized into two groups. 30 patients in control group underwent the therapy of uterine adhesions to prevent the relapse intrauterine. On the other hand, the study group with 30 patients were placed Foley balloon for 5 ~ 7 days and combined with the therapy of uterine adhesions to intervention for 1 ~ 2 weeks. All patients were followed-up for 1 ~ 2 months, and the result of the intrauterine adhesion were assessed by hysteroscopy.Results The rate of the relapse in control group was 3.33%; the study group had the same result (the rate was 3.33%). There was no difference between these two groups.Conclusions The rate of recurrent intrauterine adhesions is no different between the control group of only use therapy of uterine adhesions and replacement of Foley balloon combining with therapy of uterine adhesions as intervention.
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ObJective To investigate the efficacy of different treatments applied to infertility patients with u-terine septa undergoing transcervical resection of septa to prevent the post-operation adhesion. Methods 55 infertili-ty patients with uterine septa underwent laparoscopy guidance transcervical resecition of septa(TCRS), different treatments were given to the patients post-operation, including placement of IUD in uterus cavity or not, artificial cy-cle treatment, GnRH-a medication using post-operation, hysteroscopy examination was performed for the first and third month post surgery and IUD was taken out in the third month post surgery. Results Total 54 eases completed hysteroscopy examination follow-up visits,of which 40 cases completed total two times of hysteroscopy in the first and third month, and 14 eases completed only once hysteroscopy examination. Whether or not placement of IUD hadno effect on uterus cavity shape(P > 0.05). Compared to eases without using artificial cycle treatment post-opera-tion, the endometrium was thicker in the cases with it post-operation. Both cases using and not using artificial cycle treatment were found to have endometrium covered in fundus under hysteroscopy in the third month post-operation.The satisfactory cavity shape was achieved on patient receiving GnRH-a medication. Conclusion Placement of IUD is not helpful in preventing the occurrence of post-operation adhesions. Individualized post-operation artificial cycle treatments should be applied to different patients and using GnRH-a medication should be in right direction. The hysteroscopy examination post-surgery should be given in time to prevent the new occurrence of adhesion in fundus post-operation.
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Objective To evaluate clinical effects of combined use of hysteroscopy and laparoscopy in the diagnosis and treatment of infertility with uterine septum,and to analyze the relationship between infertility and uterine septum. Methods Surgery using hysteroscopy combined with laparoscopy was performed in 110 patients with infertility accompanying uterine septum,including primary infertility in 78 patients and secondary infertility in 32 patients.The relative infertility factors and post-operative pregnancy prognoses were analyzed. Results Unexplained infertility accounted for 40% of patients(44/110).As of March 2006,a total of 82 patients were successfully followed.The total post-operative pregnancy rate was 45.1%(37/82),consisting of 46.6% in patients with primary infertility(27/58) and 41.7% in patients with secondary infertility(10/24),without significant difference between the two groups(?~2=0.164,P=0.686).The post-operative pregnancy rates in patients with unexplained infertility and etiologically-clarified infertility were 51.2%(22/43) and 38.5%(15/39),respectively,without significant difference(?~2=1.332,P=0.248).In patients with unexplained infertility,the post-operative pregnancy rate for primary infertility was 56.7%(17/30) and for secondary infertility,38.5%(5/13). Conclusions Combined use of hysteroscopy and laparoscopy for infertility with uterine septum can improve the post-operative pregnancy rate.The presence of uterine septum bears some relationship to the incidence of infertility.
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<p><b>OBJECTIVE</b>To evaluate transcervical removal of foreign bodies (TCRF) and to estimate the effectiveness of its monitoring methods.</p><p><b>METHODS</b>One hundred and thirteen women were identified as having residual intrauterine devices (IUD), residual pregnancy products, unabsorbed strings and broken hooks, which were not removed during routine curettage or IUD removal. All patients were monitored using B ultrasonography while TCRF was performed. Four cases were monitored by laparoscopy simultaneously. One case was monitored by laparoscopic ultrasonography.</p><p><b>RESULTS</b>Foreign bodies of one hundred and nine patients were taken out by TCRF. Uterine bleeding, amenorrhoea, discharge, abdominal pain, micturition and hematuria disappeared postoperatively. Fetal bones embedded into intramural uterin in four cases were not removed completely. Of these four, one became pregnant 4 months later after TCRF and term delivered. One case encountered uterine perforation that was sutured by laparoscopy.</p><p><b>CONCLUSIONS</b>TCRF is safe and efficient. Sufficient cervical canal distension, selection of equipment and methods to be used is important for successful TCRF. As a non-invasive and effective monitoring method, B ultrasonography is the first choice to monitor for TCRF. For patients with high risk factors for uterine perforation, laparoscopic monitoring should be done simultaneously. Laparoscopic ultrasonography monitoring has both the advantages of B ultrasonography and laparoscopy monitoring, but is invasive and expensive.</p>
Subject(s)
Adult , Aged , Female , Humans , Middle Aged , Pregnancy , Foreign Bodies , Diagnostic Imaging , General Surgery , Hysteroscopy , Methods , Intrauterine Devices , Laparoscopy , UltrasonographyABSTRACT
Objective To compare the clinical effects between hysteroscopic electroresection and open hysterectomy in the treatment of intrauterine benign diseases. Methods A total of 58 women with intrauterine benign received hysteroscopic electroresection (hysteroscopic group) and 60 women underwent open total hysterectomy (control group). The operating time, hospital stay, postoperative recovery and cure rates were compared between the two groups, respectively. Results The operating time was 68.4?20.6 min in control group and 55.2?19.7 min in hysteroscopic group ( t=-3.555, P =0.000). The postoperative hospital stay was 7.2?1.8 d and 4.5?1.5 d in control and hysteroscopic group, respectively ( t=-8.836, P =0.000). The time to resume regular work was 64.4?25.3 d in control group and 37.2?7.8 d in hysteroscopic group ( t=-7.835, P =0.000). The cure rates in control and hysteroscopic group were 100% (60/60) and 94.7% (54/57), respectively ( ? 2 =1.477, P =0.224). Conclusions Hysteroscopic electroresection gives good short-term therapeutic effects and quick postoperative recovery. It may replace hysterectomy in part of patients with intrauterine benign diseases.
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Objective To discuss the safety and efficacy of hysteroscopy in the diagnosis and treatment of intrauterine adhesions (IUA). Methods Clinical data of 108 patients who had been treated by transcervical resection of adhesions (TCRA) under B-ultrasound and/or laparoscopic monitoring from January 1998 to August 2002 in this center were reviewed. Results Intraoperative B-ultrasound monitoring was used in 59 cases and B-ultrasound combined with laparoscopic monitoring was used in 49 cases. Complications occurred in 7 cases (3 cases of hemorrhage and 4 cases of uterine perforation) and were cured after proper treatment. Follow-up checkups in 84 cases showed a total effective rate of 82.1% (69/84). The effective rate in patients with a menorrhea, hypomenorrhea and irregular menstruation was 87.0% (40/46), in patients with infertility and habitual abortion was 42.9% (6/14), and in patients with abdominal pain and failing to remove IUD was 95.8% (23/24). Conclusions Diagnosis and treatment of IUA by hysteroscopy is microtraumatic and effective. B-ultrasound and/or laparoscopic monitoring is the key to the operation safety and success.
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Objective To investigate the causations, management and prevention methods on the complications of hysteroscopic procedures. Methods Retrospective analysis of 36 cases with hysteroscopic complication, focusing on their characteristics and clinical management as well as prevention methods during the ten years from 1993 to 2004. Results Among 36 cases, 11 cases with uterine perforation and incomplete perforation, which happened during the complicated procedures, were treated by both laparoscopy and laparotomy. Five cases with heavy bleeding were encountered because of the deeply injury to the uterine wall and Foley catheter was inserted into uterine cavity and it stopped the bleeding successfully except in one case done by hysterectomy. Three cases with fluid overload syndrome were cured by using diuretic agent and saline infusion. There is no serious consequence in one case with air embolism due to prompt diagnosis and treatment. Four cases with postablation-sterilization syndrome were treated effectively by performing hysterectomy plus single or bilateral salpingectomy, dilating cervical canal as well as resecting adhesions. Twelve cases with adhesion inside uterine cavity followed hysteroscopy were also treated by dilating cervical canal, underwent adhesionlysis and hysterectomy. Conclusions The potential factors causing complications of hysteroscopy include complicated procedures inside uterine cavity, higher pressure of irrigation, deep injury of endometrium as well as incomplete removal of endometrium during hysteroscopic operations. It is the necessary measures to reduce the complications by performing laparoscopy or B ultrasound monitoring simultaneously, standardizing the procedure and strengthening postoperation management.
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Objective To investigate the clinical characteristics, treatment and prevention methods of severe complications during hysteroscopic procedures Methods From January 1995 to January 2001, seventeen cases with uterine perforation, heavy bleeding and fluid overload respectively were encountered during hysteroscopic procedures This analysis focuses on their diagnosis and clinical management as well as prevention methods Results Three cases with uterine perforation and seven with uncomplete perforation followed transcerivcal resection of myoma (TCRM), transcerivcal resection of adhension, transcerivcal resection of septum and transcerivcal removal of foreign body respectively, which were diagnosied by both B ultrasonography and laparoscopy and treated laparoscopically Four cases with heavey bleeding were encountered during TCRM Foley catheter was inserted into uterine cavity to stop the bleeding successfully Three cases with fluid overload were cured by diuretic agent and saline infusion There were no serious consequence happened Conclusions It is a potential high risk factor of resulting in complications that performing complicated procedures inside uterine cavity during hysteroscopic operations Pre treatment with gonadotropin releasing a and guiding with B ultrasound/ laparoscopy as well as controlling irrigation pessure are necessary for proventing above complications
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Objective To study the relationship between the polymorphism of estrogen receptor ? gene (ER?)and unknown aetiological hypomenorrhea in the women from Southwestern China. Methods Totally 100 hypomenorrhea and 100 eumenorrhea women from Southwestern China served respectively as case group and control group. Restriction fragment length polymorphism (RFLP) was used to analyze the first intron incision enzyme PvuⅡ and XbaⅠin ER? gene. Short tandem repeat (STR) in hypervariable region of the gene was depurated, cloned and sequenced. The distribution of the gene genotype was studied in case group and control group. Results P genotypic frequency was 47.5% in case group, and 30.5% in control group (OR 1.810, 95%CI 1.113-2.765,P=0.012). While X genotypic frequency was 20.5% in case group and 32.0% in control group (OR 0.641, 95%CI 0.361-0.898, P=0.036). PvuⅡ and XbaⅠ restriction fragments were distributed in polymorphism in the 2 groups. The TA13 allele frequency was higher in case group than in control group (P