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Objective:To observe the efficacy and safety of single-port laparoscopy for giant ovariotubal cysts.Methods:38 patients with giant ovarian and fallopian tube cysts in Ruijin Hospital Affiliated to Shanghai Jiaotong University Hospital from January 2018 to June 2019 were retrospectively analyzed. They were divided into transumbilical single-port laparoscopy group (18 cases) and traditional laparoscopy group (20 cases). The perioperative related indexes such as operation time, intraoperative bleeding and the number of analgesic cases were compared between the two groups.Results:All 38 patients successfully completed the operation without conversion to laparotomy, and no auxiliary hole was added in the single-port laparoscopy group; There were no postoperative complications and no cystic fluid leakage. In the single-port laparoscopy group, 18 patients were satisfied with the concealment of umbilical scar. There was no statistically significant difference in operation time [(51.67±13.72)min vs (55.50±14.59)min], intraoperative blood loss [(52.22±24.38)ml vs (61.50±28.88)ml] and first postoperative anal exhaust time [(25.77±8.59)h vs (27.60±6.67)h] between single-port laparoscopy group and traditional laparoscopy group (all P>0.05); The number of cases requiring postoperative analgesia in the single-port laparoscopy group (2 cases vs 12 cases) was less than that in the traditional laparoscopy group ( P<0.05); The out of bed activity time [(20.95±3.65)h vs (26.95±5.43)h] and postoperative discharge time [(3.11±0.68)h vs (4.30±1.21)h] were shorter than those in the traditional laparoscopy group (all P<0.05). All 38 patients were followed up in the gynecological clinic for 6-24 months. The incision healed well without recurrence. Conclusions:Transumbilical single-port laparoscopic surgery for giant ovarian and fallopian tube cysts is reliable and safe when the possibility of malignant ovarian and fallopian tube tumors was excluded before operation.
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Objective:To study the clinical manifestations, diagnosis and treatment of primary hyperparathyroidism (PHPT) in pregnancy.Methods:This study involved six pregnant patients with PHPT who were admitted to Ruijin Hospital of Shanghai Jiao Tong University from August 2014 to November 2019. Their clinical manifestations, treatment strategies (multidisciplinary consultation with departments including Obstetrics, Endocrinology, Neonatology, General Surgery, Anesthesiology and Intensive Care Unit), maternal complications and maternal and infant outcomes were described and retrospectively analyzed.Results:(1) The median age of the six patients was 34(23-38) years old. PHPT was diagnosed in one case before pregnancy, four in the second or third trimester and one after delivery. The main clinical manifestations of four cases were nausea, vomiting, anorexia and other non-specific symptoms. Anemia was the most common maternal complication (five cases). Other complications included hypercalcemia crisis with renal failure (one case), multiple bone destruction and osteoporosis (one case). The median levels of serum calcium, parathyroid hormone and 25-hydroxyvitamin D were 3.08 (2.84-4.21) mmol/L, 216.7(93.1-2 603.6) ng/L and 29.66 (13.50-90.24) nmol/L, respectively. Results of parathyroid ultrasonography showed all patients had hypoechoic focus. Four cases underwent routine parathyroid radionuclide imaging showing abnormal radioactive concentration areas. (2) Obstetricians initiated the multidisciplinary team (MDT) for all patients to determine the treatment plans after communication with the patients and their families. One case received surgical treatment five months after delivery. Three cases received surgical treatment in the second trimester and among them, one terminated the pregnancy in the second trimester and the other two continued and achieved good pregnancy outcomes. Two cases underwent surgical treatment after giving up pregnancy and induced abortion. Postoperative pathology revealed that five cases were isolated parathyroid adenoma and one was parathyroid carcinoma. All of the patients were followed up and no abnormal serum calcium was reported. (3) One newborn had hypocalcemic convulsions one month after birth and was recovered by intravenous calcium supplementation. The newborn was followed up and the serum calcium level was normal so far. The other two neonates had normal serum calcium during follow-ups, but one of them was diagnosed with autism at the age of four and is now undergoing rehabilitation treatment.Conclusions:Pregnancy complicated by PHPT may lead to serious maternal and infant complications. MDT consultation ensures timely diagnosis, comprehensive treatment for the patients and better pregnancy outcomes.
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Objective To investigate the factors correlated to the pregnancy rate of the patients with endometriosis after laparoscopy.Methods A total of 80 patients with endometriosis related infertile who received laparoscopic surgery in our hospital from January 2010 to January 2017 were enrolled in this study.The postoperative pregnancy of the patients and related factors were analyzed by logistic regression.Results The postoperative pregnancy rate was 37.5％ (30/80).Among the pregnancies,22 cases were ≤ 12 months,8 cases ＞ 12 months.Logistic regression analysis revealed that postoperative combined medication [gonadotropin-releasing hormone-agonist (GnRH-a)] (OR =19.222,95％ CI:3.528-104.731,P ＜ 0.05) and artificial proconceptive (OR =13.581,95％ CI:1.913-96.397,P ＜0.05) are correlated with pregnancy rate after laparoscopic surgery.Conclusions Postoperative combined medication and artificial proconceptive are influencing factors of pregnancy rate after laparoscopy in endometriosis patients with infertile.
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Objective To investigate the suitable mode of induced termination of pregnancy at second trimester for women with scarred uterus.Methods A retrospective study was performed in 120 cases of second trimester pregnant women with scarred uterus,who requested termination of pregnancy in Department of Obstetrics,Ruijin Hospital of Shanghai Jiaotong University from January 2010 to July 2016.The indications of termination of pregnancy were fetal anomaly,serious pregnant complication,intrauterine fetal deaths and personal factors.The interval time of previous operation to this pregnancy were recorded.It was ＜ 2 years in 35 cases and ≥2 years in 85 cases.The patients with normal hepatic function began to take mifepristone combined with ethacridine lactate (group A,62 cases).The method of mifepristone combined with misoprostol was used in the patients who failed to amniotomy to inject ethacridine lactatebecause of oligohydramnios or small gestational age (group B,58 cases).The detail information of every patient was recorded,including age,gestational weeks,gravidity,parity,the mode of previous operation,previous operation time and indication,the mode of induced labor inthis pregnancy,the interval time from administration to uterine contraction,delivery or not and the interval time from induction to delivery,postpartum hemorrhage,the successful rate of induce labor,and placental retention ratio.Results (1) It had no significant difference between groups A and B in age,gravidity,parity and the interval time of previous operation to this pregnancy (P ＞ 0.05).There was significant difference between two groups in gestational weeks of induction (P ＜0.01).(2) It had no significant difference between two groups in successful rate of induction and postpartum hemorrhage (P ＞ 0.05),but the time from induction to regular uterine contractionand delivery in group B was significant shorter than that of group A (P ＜ 0.01).The rate of delivery with 24 hours in group B was 89.66％.It was significant higher than that of group A (22.58％,P ＜0.01).(3) The rate of retained placenta in group A (19.23％,10/52) was significant lower than group B (4g.7g％,20/41),but the ratio of residual of placenta and membranes in group A (75％,39/52) was significant higher than that of group B (48.78％,20/41).It was no significant difference between the over 2 years group and the less 2 years group in the incidence rate of complications including placental retention,residual of placenta and membranes and postpartum hemorrhage.It had no significant difference between two groups in incidence of severe pain (P ＞ 0.05).Conclusions Both of methods of mifepristone combined with misoprostol and the mifepristone combined with ethacridine lactate are feasible to induce second trimester termination of pregnancy for women with scarred uterus.