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Objective:To investigate the protective effect of laparoscopic water separation and removal combined with suture hemostasis on ovarian reserve function after bilateral ovarian endometriotic cyst (OEC) stripping.Methods:From January 2016 to January 2018, 60 patients with bilateral ovarian endometriosis cystectomy underwent laparoscopic surgery in the Department of Obstetrics and Gynecology, Jiading Hospital of traditional Chinese medicine.According to the random number table method, they were divided into study group (water separation and stripping combined suture hemostasis group) and the control group (direct stripping combined with electrocoagulation hemostasis group), 30 cases in each group.The changes of operation time, hemoglobin level before and after operation and the levels of follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2) and anti Mullerian hormone (AMH) were compared between the two groups.Results:There was no significant difference in operation time (47.52 ±10.11) min, hemoglobin decrease (0.55 ±0.26) g/L, hospital stay (6.1 ±0.3) d, control group (48.01 ±10.24) min, hemoglobin decrease (0.56 ±0.25) g/L and hospitalization time (6.2 ±0.4) d before and after operation ( t=0.056, 0.964, 0.863, all P>0.05). The levels of FSH, E2, LH and AMH in the study group before operation were (6.15 ±2.31) U/L, (152.41 ±41.40) nmol/L, (5.44 ±1.52) U/L and (2.21 ±0.13) μg/L, respectively.One month after operation, they were(6.21±2.24) U/L, (150.63±40.33) nmol/L, (5.13±1.58) U/L, (2.18±0.16) μg/L, respectively.Three months after operation, they were (6.52±2.41) U/L, (149.57±42.37) nmol/L, (5.30±1.45) U/L, (2.17± 0.15) μg/L, respectively.Six months after operation, they were (6.53±2.44) U/L, (151.36±41.54) nmol/L, (4.98±1.61) U/L, (2.20±0.08) μg/L, respectively.The levels of FSH, E2, LH and AMH in the control group before operation were (6.14±2.21) U/L, (153.31±40.39) nmol/L, (5.51±1.46) U/L, (2.23±0.13) μg/L, respectively.One month after operation, they were (8.11±2.44) U/L, (131.43±41.23) nmol/L, (5.92±1.64) U/L, (1.58±0.14) μg/L, respectively.Three months after operation, they were (8.42±2.35) U/L, (135.67±40.38) nmol/L, (6.12±1.51) U/L, (1.54±0.16) μg/L, respectively.Six months after operation, they were (9.17±2.64) U/L, (133.66±40.44) nmol/L, (6.28±1.74) U/L, (1.51±0.13) μg/L, respectively.There was no significant difference in the levels of FSH, E2, LH and AMH between the two groups (all P>0.05). There was significant difference between the preoperative FSH level and the postoperative 1, 3, 6 months in the control group (all P<0.05); there was significant difference between the preoperative E2 level and the postoperative 1 month in the control group ( P<0.05); there was statistical significance between the preoperative AMH level and the postoperative 1, 3 months in the control group (all P<0.05). The levels of FSH, LH, E2 and AMH in the study group were significantly higher than those in the control group (all P<0.05). Conclusion:Laparoscopic hydrodissection combined with suture hemostasis does not increase the operation time and the amount of bleeding, and does not affect the ovarian reserve function after operation.
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Objective@#To investigate the protective effect of laparoscopic water separation and removal combined with suture hemostasis on ovarian reserve function after bilateral ovarian endometriotic cyst (OEC) stripping.@*Methods@#From January 2016 to January 2018, 60 patients with bilateral ovarian endometriosis cystectomy underwent laparoscopic surgery in the Department of Obstetrics and Gynecology, Jiading Hospital of traditional Chinese medicine.According to the random number table method, they were divided into study group (water separation and stripping combined suture hemostasis group) and the control group (direct stripping combined with electrocoagulation hemostasis group), 30 cases in each group.The changes of operation time, hemoglobin level before and after operation and the levels of follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2) and anti Mullerian hormone (AMH) were compared between the two groups.@*Results@#There was no significant difference in operation time (47.52 ±10.11) min, hemoglobin decrease (0.55 ±0.26) g/L, hospital stay (6.1 ±0.3) d, control group (48.01 ±10.24) min, hemoglobin decrease (0.56 ±0.25) g/L and hospitalization time (6.2 ±0.4) d before and after operation (t=0.056, 0.964, 0.863, all P>0.05). The levels of FSH, E2, LH and AMH in the study group before operation were (6.15 ±2.31) U/L, (152.41 ±41.40) nmol/L, (5.44 ±1.52) U/L and (2.21 ±0.13) μg/L, respectively.One month after operation, they were(6.21±2.24) U/L, (150.63±40.33) nmol/L, (5.13±1.58) U/L, (2.18±0.16) μg/L, respectively.Three months after operation, they were (6.52±2.41) U/L, (149.57±42.37) nmol/L, (5.30±1.45) U/L, (2.17± 0.15) μg/L, respectively.Six months after operation, they were (6.53±2.44) U/L, (151.36±41.54) nmol/L, (4.98±1.61) U/L, (2.20±0.08) μg/L, respectively.The levels of FSH, E2, LH and AMH in the control group before operation were (6.14±2.21) U/L, (153.31±40.39) nmol/L, (5.51±1.46) U/L, (2.23±0.13) μg/L, respectively.One month after operation, they were (8.11±2.44) U/L, (131.43±41.23) nmol/L, (5.92±1.64) U/L, (1.58±0.14) μg/L, respectively.Three months after operation, they were (8.42±2.35) U/L, (135.67±40.38) nmol/L, (6.12±1.51) U/L, (1.54±0.16) μg/L, respectively.Six months after operation, they were (9.17±2.64) U/L, (133.66±40.44) nmol/L, (6.28±1.74) U/L, (1.51±0.13) μg/L, respectively.There was no significant difference in the levels of FSH, E2, LH and AMH between the two groups (all P>0.05). There was significant difference between the preoperative FSH level and the postoperative 1, 3, 6 months in the control group (all P<0.05); there was significant difference between the preoperative E2 level and the postoperative 1 month in the control group (P<0.05); there was statistical significance between the preoperative AMH level and the postoperative 1, 3 months in the control group (all P<0.05). The levels of FSH, LH, E2 and AMH in the study group were significantly higher than those in the control group (all P<0.05).@*Conclusion@#Laparoscopic hydrodissection combined with suture hemostasis does not increase the operation time and the amount of bleeding, and does not affect the ovarian reserve function after operation.
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Objective To study the clinical value of body mass index (BMI), fasting blood glucose (FPG)and glycosylated hemoglobin (HbA1c) combined tests for prediction of gestational diabetes mellitus (GDM) in first trimester. Methods 138 cases diagnosed as GDM and 133 cases of normal pregnant women were divided into study group and control group. The parameters of BMI , FPG and HbA1c were measured and compared. Results (1) BMI, FPG and HbA1c from study group were significantly higher than those from control group (P 23.25, FPG > 4.25 L, HbA1c > 4.95% as screening method, AUC was 0.773. This method showed a diagnostic sensitivity of 73.3% and specificity of 82.4%. Conclusion BMI, FPG and HbA1c combined method in first trimester is valuable in predicting GDM.
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Objective To selectively resect the lymph nodes in the endometrial cancer by risk factors evaluation pre-and intra-operation.Methods Three hundred and seventy-four cases who in the Obstetric and Gynecology Hospital Affiliated to Fudan University from Oct.2010 and Dec.2012 were clinically diagnosed as stage Ⅰ pre-and intra-operation,grouped as one (staged Ⅰ A,294 cases) and two (staged Ⅰ B,80 cases),and the situation of lymph nodes metastasis and the related risk factors were analyzed.Results (1) Lymph nodes metastasis were positive in 6 cases in group one (2.0％) and 12 cases in group two(15.0％),and the difference was significant between two groups (x2 =23.054,P =0.000).(2) University analyses showed that pathologic type,grade,myometrial invasion,lymphovascular invasion and cervical gland invastion were the risk factors contributed to the lymphatic metastasis in early staged endometrial cancer (P＜ 0.05).Multivariate analysis showed that myometrial invasion was independent risk factor affecting early metastasis of lymph node in endometrial carcinoma (regression coefficient =2.339,standard error =0.585,OR =10.897,95％ CI 3.273 ～ 32.367,P =0.000).(3)Based on the gynecology oncology group test and risk factors that recent used in different countries and clinical centers,superficial myometrial layer invasion,G2,age＞ 60 years,tumor ≥ 2 cm in diameter as the medium risk factors,and deep myometrial layer invasion,G3,lower portion of the uterus or cervical gland invasion as high risk factors,and patients with two or more medium risk factor (106 cases) and with one or more high risk factors(138 cases) were inclined to develop lymph node metastasis((5.66％ (6/ 106),0(0/130),P =0.04;8.70％ (12/138),2.54％ (6/236),P =0.007).(4) Two hundred and thirteen patients were found with superficial layer invasion by frozen section,and 11 of them were upgraded to Ⅰ B by postoperative pathologic examination.Interestingly,all of the 11 cases were accompanied by two medium or one of high risk factor.Conclusion Low incidence of lymph nodes involvement is found in stage Ⅰ endometrial cancer,especial stage Ⅰ A.Myometrial invasion is closely linked to lymph node metastasis,thus,lymphadenectomy should routinely be carried out in endmetrial cancer diagnosed as Ⅰ B whether pre-or intraoperation.As in stage Ⅰ A,unless two medium and one high risk factors are found.
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Objective To investigate the clinical characteristics of endometrial carcinoma in young women,especially the normal weight women.Methods Seventy and five cases of endometrial carcinoma aged ≤ 40 years were treated in Obstetrics and Gynecology Hospital affiliated to Fudan University from January 2008 to December 2011.Among them,there are 68 cases of normal weight and obesity,who were divided into normal weight group (group A,32 cases) and obesity group(group B,36 cases) for comparisons and analysis.Results About 81.2％ of the patients were menstrual disorders in group A and 83.3％ in group B(P =0.822);The merge infertility accounted for 31.2％ and 19.4％ (P =0.279) respectively,and the oligomenorrhea accounted for 21.9％ and 30.6％ (P =0.418) respectively,the patients combined diabetes,high blood pressure or PCOS were 6.2％ and 44.4％ (P =0.001) respectively.According to International Federation of Gynecology and Ostetrics(FIGO) surgery-pathologic stage,two groups of stage Ⅰ were 68.8％ and 83.3％ (P =0.157),respectively.Stage Ⅱ-Ⅳ were 31.2％ and 16.7％ (P =0.157),respectively.Pathological type:8 (25.0％) cases were high-risk of pathology classification in group A,and Five cases (13.8％) in group B,others were endometrial adenocarcinoma.Operations were the main treatments.Five cases were progestogen therapied.After treatments,2 cases were full term pregnant,1 case is now pregnant.Conclusion The clinical manifestations of endometrial carcinoma in young women were mainly menstrual disorders.There were higher percentage infertilities and lower percentage diabetes,high blood pressure and PCOS in normal body weight patients.In normal body weight patients,pathology classification for middle-late of high-risk pattern was increasing.For patients in early stage,if have birth requirement,could be treated with the trial progesterone conservative.