ABSTRACT
Objective:To compare the clinical effects of three laparoscopic conservative surgical procedures for tubal pregnancy.Methods:From January 2016 to June 2017, 296 patients with tubal pregnancy who underwent laparoscopic fallopian tube window embryo retrieval in our hospital were included in the study. Ninety six patients received meshmental suture combined with tubal incision and suture (group A), 102 patients receive mesentery suture (group B) and 98 patients received conventional surgery (group C). All patients in the three groups were given methotrexate 25 mg injected to the mesentery of the fallopian tube after surgery. The general conditions, treatment effects and postoperative conditions of the three groups were compared. Statistical analysis was performed using analysis of variance or χ 2 test. Results:There was no significant difference in general conditions among the three groups ( P>0.05). The surgical success rate of groups A and B were significantly higher than that of the group C [99.0%(95/96),99.0%(101/102),93.9%(92/98);χ 2=6.52, P=0.04]; the intraoperative blood loss of groups A and B was significantly lower than that in the group C [(30.6±10.9)ml, (30.9±11.6)ml, (63.5±21.8)ml; F=144.18, P<0.01]. At three months after operation, the tubal patency (patency, tortuous, obstruction) of the affected side of the group A was significantly better than that of the groups B and C [group A:81.1%(77/95),13.7%(13/95),5.3%(5/95); group B: 62.4%(63/101),21.8%(22/101),15.8%(16/101);group C:55.4%(51/92),26.1%(24/92),18.5%(17/92); χ 2=15.64, P<0.01]. Eighteen months after surgery, the fallopian pregnancy rate and secondary infertility rate of the affected side of the tubal in group A were significantly lower than those in groups B and C [group A:7.3%(7/96) and 12.5%(12/96),group B: 17.6%(18/102) and 21.6%(22/102), group C: 19.4%(19/98) and 28.6%(28/98); χ 2=6.56, P=0.04; χ 2=7.60, P=0.02]. The intrauterine pregnancy rate of tree groups was similar [45.8%(44/96),35.3%(36/102),33.7%(33/98); χ 2=3.59, P=0.17]; none of the patients in the three groups had persistent ectopic pregnancy, and no serious adverse reactions occurred during treatment. Conclusions:Laparoscopic salpingotomy and tubal incision and laparoscopic suture combined with tubal incision suture are easy to be performed with less bleeding, high surgical success rate and high recanalization rate of fallopian tubes, which deserves clinical promotion.
ABSTRACT
Objective To evaluate the impact of the intrauterine device (IUD) insertion on the mental state of women.Methods From Jan.2009 to Jun.2010,a multi-center clinical observational study was performed.Totally 641 women were selected in the six provinces' 18 family planning service stations and hospitals for IUD insertion surgery study.Analysis of the change of women's mental state which was evaluated by symptom checklist-90 (SCL-90) scale before and after IUD insertion surgery.Results Before and after IUD insertion surgery,10 factors' scores in SCL-90 of the observed objects were between 1.1 to 1.2,total scores were 107 ± 27 and 105 ± 25,respectively.Before and after surgery,total average score both were 1.2,the average score of positive items both were 2.1.The difference of the above results were not statistically significance (all P ＞0.05).Preoperative and postoperative,the rate of positive items was 9.2％-19.6％ and 7.7％-17.6％,respectively.In addition to anxiety and fear,the rate of other factors' positive items postoperative was significantly lower than those in the preoperative (all P ＜ 0.05).The incidence of the observed objects postoperative of each factor score,deteriorated was in the range of 4.9％ to 23.0％,improved was in the range of 26.3％-50.1％.The incidence of total scores,deterioration was 28.8％ (166/575),improved was 45.6％ (262/575).The incidence of the average score of positive items,deterioration was 3.7％ (21/575),improved was 52.3％ (301/575).Logistic analysis showed that,in addition to unit level,there were no other significant influencing factors for women' mental state of postoperative (all P ＞ 0.05).Conclusion IUD insertion surgery has no adverse effect on women's mental state.