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Endometrial cancer is a common malignancy of the female reproductive system. Despite improvement in living standards, the incidence of endometrial cancer is increasing due to the lack of effective screening. Early detection of endometrial cancer and precancerous lesions can significantly improve prognosis and survival. At present, China lacks a method for screening endometrial lesions comparable to that for cervical cancer screening. A recently introduced endometrial sampler has the advantages of simple operation, low cost, and minimal trauma, and is gradually being accepted for clinical screening of endometrial cancer and precancerous lesions in other countries.This study aims to explore current screening methods for endometrial cancer and precancerous lesions and the clinical application of an endometrial sampler for screening.
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Objective To determine the efficiency and safety of Phloroglucinol and Misoprostol for cervix pretreat-ment before diagnostic hysteroscopy. Methods Trials were located through electronic searches of the PubMed, MED-LINE, Springer, CNKI, VIP, CBM, WanFang Data (from the date of establishment of the databases to June 2015). Bibliographies of the retrieved articles were also checked. Result A total of 18 trials involving 2 341 patients were included. The Meta-analysis showed: application of Phloroglucinol lenovo better open and dilate the cervix [O? =2.95, 95 % CI (1.96, 4.45), = 0.000]; To better clarity of the operative field [ O? = 9.50, 95 % CI (6.46, 13.98), = 0.000]; To better shorten the operation time [O? =-4.12, 95 % CI (-5.75,-2.49), =0.000];To bet-ter able to reduce the amount of intraoperative leakage [ O? =0.22, 95%CI (0.10, 0.49), = 0.0002]; and postop-erative adverse reactions should be significantly lower than Misoprostol [ O? = 0.01, 95 % CI (0.00, 0.04), =0.000]. The difference was statistically significant. Conclusions Phloroglucinol is more effective and safer than Miso-prostol in inducing proper cervical priming and may be the optimal choice for cervical pretreatment before diagnostic hysteroscopy.
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Objective To explore the curative effect and safety of uterine artery embolization combined with hysteroscope in treating cesarean scar pregnancy. Methods 36 cesarean scar pregnancy patients (CSP diameter under six cm by ultrasound) from June 2014 to June 2015 were selected and studied. All patients received the UAE and arterial injection of Methotrexate (MTX), and while the blood beta-HCG fell to around 1 000 u/L and the lesions thickness to serous membrane were over 0.2 cm by ultrasound, pregnancy lesions were resected by hysteroscopy surgery. Results The UAE and arterial injection of Methotrexate about (20.12 ± 3.85) min. Blood beta-HCG level and lesion diameter both fell or decreased, each with [(17 902.74±11 818.23) u/L vs (12 842.73 ± 8 525.73) u/L and (3.65 ± 1.02) cm vs (3.12 ± 0.97) cm] (t = 8.58, P < 0.01, t = 2.26, P < 0.05). Hysteroscopy surgery cost about (19.13 ± 2.67) min, the amount of bleeding were (17.43 ± 7.28) ml. Postoperative blood beta-HCG decreased to (113.45 ± 36.14) u/L within 2~4 days, the patients were discharged. Conclusion Hysteroscopy surgery with pretreatment of UAE combined with MTX injection could gain satisfactory outcome for patients with CSP. It has high success rate, low blood loss, fewer adverse reactions satisfactory outcome.
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Objective To observe the effects of hysteroscopic transcervical resection of endometrium combined with levonorgestrel-relea-sing intrauterine system in the treatment of adenomyosis. Methods Clinical data of 62 cases with adenomyosis from January 2009 to January 2011 were randomly divided into 2 groups with 31 cases each. The observation group was given hysteroscopic transcervical resection of endo-metrium ( TCRE) combined with levonorgestrel-releasing intrauterine system( LNG-IUS) ,the control group was given LNG-IUS. All patients were followed up in 0,1,3,6,12 months after treatmenting with LNG-IUS. The menstrual blood volume,score of VAS,volume of uterus, CA125 and the levels of serum reproductive hormone were analyzed before treatment and after treatment. Results After the therapy,the cur-ative effects of controlling menorrhea were improved and the the observation group was significantly better than the control group(P0. 05). Conclusion It is exact effect to treat adenomyosis by TCRE combined with LNG-IUS,which can prevent dripping bleeding induced by application of LNG-IUS effectively.
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Objective To compare the clinical effect about hysteroscope and laparotomy in patients with submucous uterine myoma. Methods Eighty-four patients with submucous uterine myoma were randomly divided into control group(n=42)and observation group(n=42). The patients in the control group were given laparotomy treatment,while in the observation group were given hysteroscope treatment. The intraoperative and postoperative conditions between the two groups were recorded and compared. Results The operation time, intraoperatve blood volume,postoperative anal exhaust time,postoperative pain intensity( judged by VAS)and hospital stays periods in observation group were(52. 5 ± 9. 6)min,(84. 6 ± 16. 7)ml,(21. 5 ± 3. 6)h,(3. 6 ± 1. 4)scores and(5. 4 ± 1. 8)d,significant lower than those in control group((72. 6 ± 13. 4)min,(116. 8 ± 28. 4)ml,(29. 8 ± 5. 4)h,(1. 8 ± 0. 5)scores,(9. 6 ± 2. 4)d),and the differences were significant( t=5. 468,4. 263,4. 438,6. 283;P =0. 006,0. 018,0. 024,0. 001,0. 002 ). While the hospitalization costs in observation group was(7394. 9 ± 1164. 8)yuan,higher than that of the control group((5 428. 9 ± 824. 5) yuan;t=4. 647,P=0. 036). There were no statistical significant in terms of recurrence rate between the two groups( 20. 5% vs. 19. 6%;χ2 = 0. 236,P = 0. 637 ). Conclusion Treatment of hysteroscope surgery on submucosal myoma of uterus has the advantages of small trauma and quick recovery and it is an ideal surgical method for uterine myoma.
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Eighty cases of intrauterine adhesions who received adhesion separation technique were divided into two groups equally. The control group was placed intrauterine device and ballon catheter in intrauterine,and received o-ral female estrogen cycle treatment. The test group with the same treatment was added growth hormone treatment. Three months later,all of the patients were checked the hysteroscopy and intrauterine device was took out, also the uterine cavity form,and follow-up recovery of endometrial and menses were evaluated. Then it showed:①Endome-trial thickness increased by an average of (1.73±0.83) mm in the test group,while the control group average in-creased by (1.10±0.66) mm. The difference was statistically significant (t=3.73,P<0.01).② The re-adhe-sion rate was 45.0% in the control group,while it was 32.5% in the test group,respectively. The difference was not statistically significant. ③ The difference of mensual recovery between both groups was not statistical significant. Therefore growth hormone can promote the growth of endometrium of intrauterine adhesions after resection of adhe-sions.
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Objective To investigate the value of hysteroscopy in the diagnosis of postmenopausal uterine bleeding.Methods 106 cases of outpatient of postmenopausal bleeding were analyzed.Hysteroscopic diagnosis and the biopsy result were compared in all patients.Results Histological diagnosis was 73 cases of uterine cavity abnormality,33 cases of normal were diagnosed in hysteroscopy.78 cases of pathological abnormalities,and 28 cases of normal were diagnosed.Comparing to histology, sensitivity was 95.89% ,specificity 84.85% , positive predictive value 93.33% , negative predictive value of 90.32%.Conclusion Hysteroscopy combined pathology was the best method to diagnose postmenopausal uterus bleeding.
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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 discuss the value of hysteroseope in the diagnosis and treatment of infertility.Methods Retrospectively 60 cases of hysteroscope examimtiom on infertility patients.Results Uterine lesions had been found in 70%(42/60)cases.The most common type was endometrial polyps followed by endometrisitis.Conclusion Hysteroscope isone of the most effective examinations for diseases of uterine cavity.It has great value in the infertility diagnosis.
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Objective To evaluate advantages and safety of bipolar electrodes for the treatment of submucosal myoma of uterus.Methods Three hundred patients with submucous myoma of uterus were performed with bipolar electrodes under hysteroscope,including 212 cases of type 0 submucous myoma,54 cases of type ?,and 34 cases of type Ⅱ.Results Total volumes of uterine distention fluid used during operation were 500-2000 ml(mean,626 ml);operation time was 20-50 min(mean,25 min);intraoperative blood loss was 10-20 ml.Cardio-cerebral syndrome occurred in one case and was relieved by timely treatment.There was no operation discontinuation as a consequence of pain.The diameters of resected myomas were 3-5 cm,with an average of 3.8 cm.The postoperative diagnosis showed leiomyosarcoma in 1 case and was performed by radical hysterectomy resection combined with a pelvic lymphadenectomy at 10 day postoperatively.During the follow-up period of 1-24 months in 277 cases,40 cases(type I in 12 cases;type II in 28 cases) needed hysteroscope operation again.Conclusions Hysteroscopic resection for submucosal myoma of uterus with dipolar electrodes has advantages of safety,minimal invasion,quicker recovery,higher efficiency,so it is worthy of being recommended.
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Objective To investigate the clinical value of wire-guided tubal recanalization under hysteroscope combined with laparoscope for the treatment of occluded oviduct infertility.Methods A total of 63 cases of infertility were diagnosed by hysterosalpingography(HSG) as having bilateral oviduct obstruction,of which at least one side of oviduct was proximally occluded.After laparoscopic exploration and hysteroscopic hydrotubation were performed for clarifying the diagnosis and managing related pelvic lesions,wire-guided tubal recanalization was conducted under hysteroscope combined with laparoscope for the treatment of proximal oviduct obstruction.Results Out of the 63 cases,a total of 118 oviducts were involved(eight oviducts had been previously resected).Of the 118 oviducts,59 were proximally occluded,45 were distally occluded or blinded,and 14 were proximally and distally occluded.After the surgery 99 oviducts were unobstructed.Intrauterine pregnancy was obtained within 1 year in 23 cases(36.6%).There were 25 cases of unpregnancy within 1 year,which were re-examined with HSG,presenting a re-obstruction in 7 cases.Conclusions Wire-guided tubal recanalization under hysteroscope combined with laparoscope is an ideal option for the treatment of occluded oviduct infertility.
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0.05).The medical expenses of the Hysteroscopic Group was significantly lower than that of the Laparoscopic Group(t=-85.584,P=0.000).Conclusions As compared with laparoscopic conservative operation,hysteroscopic tubal catheterization with MTX injection is another simple,cost-effective,and minimally invasive alternative for early tubal pregnancy.
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Objective To investigate the value of hysteroscopy combined with B-ultrasonography in the diagnosis and treatmeant of early cornual pregnancy (within 7 weeks of pregnancy). Methods A total of 28 cases of early cornual pregnancy diagnosed and treated by hysteroscopy combined with B-ultrasonography from January 1999 to December 2004 were analyzed retrospectively. Results The operation were carried out successfully on one session in 27 cases, while placental remnants were found after the second curettage in 1 case, in which after an injection of methotrexate was given under hysteroscope, the serum ?-HCG decreased to a normal level 2 week later. No intra- or post-operative complications were recorded. Follow-up observations for 4~36 months (mean, 20 months) in the 28 cases found 6 cases of pregnancy out of 11 patients with childbearing demand. Conclusions Hysteroscopy combined with B-ultrasonography in the diagnosis and treatment of early cornual pregnancy is a preferable method with advantages of highly efficacy, safety and mini-invasion.
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Objective To inquire clinical effects of hysteroscopic electroresection in the treatment of submucous hysteromyoma. Methods A retrospective analysis regarding curative effects of hysteroscopic electroresection in 72 cases of submucous hysteromyoma was carried out. Results The resected myoma was 1.5~7 cm in diameter, and the number of resected myoma was 1~3. The operation time was 10~90 min (mean, 30 min). The operation was accomplished on one session in all the 72 cases. No uterine perforation, bleeding and bowel injuries took place. Postoperative follow-up for 4~20 months in the 72 cases reported a satisfaction rate of 97 2% (70/72). Out of 6 patients who had pregnancy desire, 2 were pregnant with child and 1 of them had a delivery. Conclusions Hysteroscopic electroresection in the treatment of submucous hysteromyoma is safe and effective. It can markedly improve the menstruation and elevate the pregnancy rate.
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Objective To investigate the diagnosis under hysteroscopy for uterine malformation,especially in maiden. Methods Hysteroscopy combined with ultrasonography was used to determine the types of uterine malformation in 24 cases. Results Definitive diagnosis indicated 8 cases of uterus bicornis,10 cases of uterus septus with single uterine neck,2 cases of uterus septus with double uterine neck and single uterine body,and 4 cases of puberal rudimentary horn of uterus. Conclusions Combined use of hysteroscopy and ultrasonography in the diagnosis of uterine malformation is accurate and applicable to maiden.
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Objective To investigate the clinical effect of hysteroscope combined with B-ultrasound in the treatment of uterin cavity adhesion. Methods Hegar dilatior or electric knife of hysteroscope was used to cut adhesion, which was monitored by B-ultrasound. Antibotics, artificial hormonal cycle treatment and IUD in uterin cavity were used after operation. Results 55 cases of uterin cavity adhesion were separated completely and had no complication. Amenorrhvea or rare menstrual flow occurred in 48 cases,and menstrual flow recovered in 43 cases (89 6%) . 24 cases of dysmenorrhvea relieved. 21 of 36 patients who hoped for pregnancy became pregnant(58.3%).The pregnant rate of patients with light uterin cavity adhesion was highest, followed by moderate uterin cavity adhesion, and there was no pregnancy in the cases of serious uterin cavity adhesion(? 2=6 826, P =0 033). Conclusions Hysteroscope combined with B-ultrasound to treat uterin cavity adhesion is a preferable method. Pregnancy after operation was closely related to degree of uterin cavity adhesion.
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Objective To assess the value of intraoperative ultrasonography during the uterus septum resection under a hysteroscope.MethodsThe uterus septum resection was performed under the guidance of transabdominal ultrasonography by using a hysteroscope in 30 patients.The operative procedure and the position of the hysteroscope were monitored,and the depth of the dissection and thickness of the myometrium in the fundus uteri were measured with transabdominal ultrasound during the operation.ResultsThe thickness between the incisal surface and serosal layer in the fundus uteri was within the normal limits in 28 cases.In 2 cases,the tissue was over-ectomized.The position of the urethral catheter balloon was correct in all of the 30 cases.Three months after the procedure,reexamination by transvaginal ultrasonography showed that the uterine cavity was normal in the patients.ConclusionsIntraoperative ultrasonography is quick,safe and precise for monitoring uterus septum resection.It is valuable for establishing surgical strategy and reducing operative complications.
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AIM : To observe the effects of misoprostol used for intenerating cervical and ease pain in hysteroscopy. METHODS : 63 of 107 cases were randomly chosen as the group of misoprostol, and 200 ?g misoprostol was taken orally 1h before hysteroscopy. Another 44 cases were taken as the group of antitheses, and no medication was taken before hysteroscopy. RESULTS : The diameter of cervical, hemorrhage, the rate of PAAS and bellyache in the group of misoprostol were lower than that in the group of antitheses. CONCLUSION : 200 ?g misoprotol orally 1h before hysteroscopy is an advantageous and ideal method with alleviating pain from wound, reducing manipulation, decreasing hemorrhage, reducing PAAS happening in intenerating cervical.