ABSTRACT
Objective:To investigate the clinical effect of focused ultrasound ablation surgery (FUAS) combined with suction curettage for mass-type cesarean scar pregnancy (CSP) and to analyze the influencing factors of vaginal bleeding and readmission.Methods:From January 2014 to December 2020, 88 patients with mass-type CSP were treated by FUAS combined with suction curettage in the Third Xiangya Hospital of Central South University. The clinical results and the influencing factors of bleeding and readmission for mass-type CSP were analyzed.Results:All the patients underwent one time FUAS treatment successfully. Immediately after FUAS treatment, color Doppler ultrasound showed obvious necrosis and no perfusion area in all lesions, and the blood flow in the mass-type CSP tissue significantly decreased. The median volume of blood loss in the procedure was 20 ml (range: 5-950 ml). Thirteen patients (15%, 13/88) had vaginal bleeding≥200 ml, and 15 patients (17%, 15/88) were hospitalized again. The average time for menstruation recovery was (28±8) days (range: 18-66 days). The average time needed for serum human chorionic gonadotropin-beta subunit to return to normal levels was (22±6) days (range: 7-59 days). The risk of large vaginal bleeding of patients were related to the blood supply of the mass ( OR=5.280, 95% CI: 1.335-20.858, P=0.018) and the largest diameter of the mass ( OR=1.060, 95% CI: 1.010-1.120, P=0.030). The risk of readmission were related to the largest diameter of the mass ( OR=1.055, 95% CI: 1.005-1.108, P=0.030) and the depth of the uterus cavity ( OR=1.583, 95% CI: 1.015-2.471, P=0.043). No serious complications such as intestinal and nerve injury occurred during and after FUAS treatment. Conclusions:FUAS combined with suction curettage is safe and effective in treating patients with mass-type CSP through this preliminary study. The volume of vaginal bleeding are associated with the blood supply of the mass and the largest diameter of the mass, the risk of readmission are related to the largest diameter of the mass and the depth of the uterus cavity.
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Objective:To evaluate the sedative effect of remimazolam for induction of general anesthesia in elderly patients.Methods:One hundred patients of both sexes, aged 65-75 yr, with American Society of Anesthesiologists physical status Ⅱ or Ⅲ, undergoing elective general anesthesia requiring tracheal intubation, were divided into 4 groups ( n=25 each) using a random number table method: propofol group (group P) and three different doses of remimazolam groups (group R1, group R2 and group R3). In group P, general anesthesia was induced with propofol 1.5 mg/kg intravenously injected over 30 s, cisatracurium 0.2 mg/kg and fentanyl 4 μg/kg were intravenously injected when bispectral index (BIS) value ≤ 60, and endotracheal intubation was performed.In R1, R2 and R3 groups, general anesthesia was induced with 0.2, 0.3 and 0.4 mg/kg of remimazolam intravenously injected over 30 s, respectively, cisatracurium 0.2 mg/kg and fentanyl 4 μg/kg were intravenously injected when BIS value ≤ 60, and endotracheal intubation was performed.When the BIS value was > 60 during the induction of anesthesia, propofol 0.5 mg/kg was intravenously injected per time for rescue sedation in group P, and remimazolam 0.05 mg/kg was intravenously injected per time for rescue sedation until the BIS value ≤ 60, with the interval between the two injections > 1 min in R1, R2, and R3 groups.The onset time of propofol or remazolam was recorded.The occurrence of hypertension, hypotension, bradycardia, hypoxemia, injection pain and rescue sedation during the induction of anesthesia was recorded.The occurrence of intraoperative awareness was recorded during follow-up at 1 day after surgery. Results:Compared with group P, the rate of rescue sedation was significantly increased in group R1, the incidence of hypoxemia was significantly reduced in R1 and R2 groups, the onset time was significantly prolonged, and the incidence of hypotension, bradycardia and injection pain was decreased in R1, R2 and R3 groups ( P<0.05). Compared with group R1, the rate of rescue sedation was significantly decreased in R2 and R3 groups ( P<0.05). Compared with R1 and R2 groups, the incidence of hypoxemia was significantly increased in group R3 ( P<0.05). There was no significant difference in the incidence of hypotension, hypoxemia and injection pain among R1 group, R2 group and R3 group ( P>0.05). No hypertension and intraoperative awareness was found in the four groups. Conclusion:Remimazolam can be safely and effectively used for sedation during induction of general anesthesia in elderly patients, and the optimal dose is 0.3 mg/kg.
ABSTRACT
Objective To investigate the clinical effect of dysmenorrhea in patients with adenomyosis treated by high intensity focused ultrasound (HIFU) ablation combined with gonadotropin-releasing hormone agonist (GnRH-a) and levonorgestrel-releasing intrauterine system (LNG-IUS). Methods From April 2012 to December 2015, 477 cases of adenomyosis patients with dysmenorrhea were treated by HIFU in the Third Xiangya Hospital. Among them, some patients were treated with HIFU alone, some of them were treated with HIFU combined with GnRH-a and (or) LNG-IUS, thus were classified as H group, H+G group, H+M group and H+G+M group. The improvements of clinical results were compared among the four groups and the influencing factors of HIFU treatment for adenomyosis were also analyzed. Results During the follow-up period, the overall effective rates of the treatment decreased with time, 3 months 89.4% (345/386), 12 months 84.0%(221/263), 24 months 74.2%(98/132), and the overall recurrence rate was 12.9%(39/303). The significant difference in the curative at 3 months [H group 83.7%(170/203), H+M group 95.0%(95/100), H+G group 100.0%(43/43), H+G+M group 96.8%(30/31)], 12 months [H group 79.4%(123/155), H+M group 93.2%(69/74), H+G group 11/12, H+G+M group 15/17], and 24 months [H group 68.0%(51/75), H+M group 96.4% (27/28), H+G group 6/12, H+G+M group 15/15] after HIFU treatment and recurrence rate [H group 19.0%(29/153), H+M group 3.3%(3/90), H+G group 19.4%(6/31), H+G+M group 4.5%(1/22)] were observed among the four groups (P<0.05). Pairwise comparison further showed that, in 3 months after the treatment, the effect of H group was significantly lower than those of H+M group and H+G group (P=0.003, P=0.005);in 12 months after the treatment, the effect of H group was significantly lower than that of H+M group (P=0.006);while in 24 months after treatment, the effect of H group was significantly lower than that of H+G+M group (P=0.005), and the effect of H+G group was lower than that of H+G+M group (P=0.001); and the recurrence rate of H group was significantly higher than that of H+M group (P<0.008). In patients of group H, the effect of HIFU was related to uterine size, the effect of patients with large uterine volume was significantly higher than that of small volume of uterine of patients (P=0.017, OR=2.739, 95%CI:1.200-6.251); with increasing of age, the improvement of dysmenorrhea had a increasing trend (P<0.05). Conclusions HIFU combined with GnRH-a and (or) LNG-IUS could improve the treatment effect in relief of dysmenorrhea. Based on our results, individual treatment protocol should be selected for different patients.