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Objective:To analyze the risk factors of intrauterine adhesions in patients after hysteroscopic surgery for subumcosal myoma of uterus, and to construct and evaluate a nomogram prediction model.Methods:The clinical data of 322 patients underwent hysteroscopic surgery for subumcosal myoma of uterus in Dongguan Maternal and Child Health Hospital from January 2017 to December 2020 were collected. The univariate analysis and multivariate Logistic regression were used to analyze the factors affecting the occurrence of intrauterine adhesions, according to the analysis results, R software was used to construct a nomogram prediction model that affected the occurrence of intrauterine adhesions after hysteroscopic surgery for subumcosal myoma of uterus, and the H-L fit curve and the area under the curve were used to evaluate the effectiveness and discrimination of the model.Results:Through a 1-year follow-up, it was found that 47 patients had intrauterine adhesions (adhesions group), accounting for 14.60%; another 275 patients was enrolled in non-adhesions group. The results of univariate analysis showed that combined pelvic inflammatory disease, pregnancy times, history of curettage, combined uterine fibroids, and serumtransforming growth factor (TGF)-β1 level were risk factors that affected the occurrence of intrauterine adhesions ( P<0.05). The results of multivariate Logistic regression analysis showed that serum TGF-β1 level, pelvic inflammatory disease, history of curettage and uterine fibroids were independent risk factors that affected the occurrence of intrauterine adhesions ( P<0.05). The nomogram prediction model was established with the results of multivariate Logistic regression analysis, and the discrimination of the nomogram model was evaluated, the results showed that the area under the curve was 0.854, and the sensitivity and specificity were 91.50% and 70.50%, respectively. The validity of the model (H-L fit curve) was evaluated and the results showed that χ2 = 7.12, P = 0.413. Conclusions:Serum TGF-β1 level, combined with pelvic inflammatory disease, history of curettage, combined with uterine fibroids are independent risk factors that affect the occurrence of uterine adhesions after hysteroscopic surgery for subumcosal myoma of uterus. The constructed nomogram prediction model has relatively good effectiveness and discrimination. It can be used as an effective predictive tool for early clinical intervention.
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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 efficacy of Chaichuan Tongren Mixture supplemented with hysteroscopic recanalization in the treatment of tubal obstructive infertility of liver depression and qi stagnation type.Methods:A total of 60 patients with tubal obstructive infertility of liver depression and qi stagnation type who met the inclusion criteria were selected, between August 2018 and June 2020, and they were divided into the observation group with 31 cases and the control group with 29 cases, according to the random number table method. The control group was treated with hysteroscopic recanalization, while the observation group was given Chaichuan Tongren Mixture on the basis of the control group. Both groups were treated for 4 months and followed up for 12 months. TCM syndromes were scored before and after treatment, and prostaglandin E 2 (PGE 2) was detected by fully automatic biochemical analyzer and levels of TNF-α, CRP and IL-6 were measured by ELISA. The tubal patency of patients after treatment was observed, the pregnancy status was recorded after the end of follow-up and the clinical efficacy was evaluated. Results:The total effective rate was 96.77% in the observation group and that in the control group was 75.86% ( χ2=4.01, P<0.01). The scores of breast distending pain, irregular menstruation, dark purple menstrual flow and lumbosacral pain in the observation group after treatment were significantly lower than those in the control group ( t values were 17.69, 21.67, 20.89, 14.67, 18.20, respectively, all Ps<0.001). After treatment, the levels of serum PGE 2, TNF-α, CRP, and IL-6 were significantly lower in the observation group than those in the control group [(65.31±6.73) ng/L vs. (87.10±8.85) ng/L, t=10.78; (6.90±0.71) ng/L vs. (11.35±1.23) ng/L, t=17.30; (2.47±0.25) mg/L vs. (5.10±0.52) mg/L, t=25.23; (12.38±1.26) ng/L vs. (30.16±3.15) ng/L, t=29.05] ( P<0.01). After treatment, there was statistical significance in the total effective rate of tubal patency of 96.8% (30/31) in the observation group compared to 79.3% (23/29) in the control group ( χ2=4.43, P<0.01). At the end of follow-up, the pregnancy rate was 71.0% (22/31) in the observation group and 44.8% (13/29) in the control group, and the difference was statistically significant ( χ2=4.21, P<0.01). Conclusion:The Chaichuan Tongren Mixture supplemented with hysteroscopic recanalization can reduce the levels of inflammatory mediators and increase the pregnancy rate of patients with tubal obstructive infertility of liver depression and qi stagnation type.
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Objective To investigate the effects of Shengxuening tablets combined with ethinylestradiol and cycloproterone acetate on endometrial thickness and hemoglobin level in patients with endometrial polyps for transcervical resection of polyp. Methods A total of 150 patients with hysteroscopic endometrial polypectomy were randomly divided into three groups, 50 in each group. The control group was treated with hysteroscopy endometrial polyp electrotomy, while the western medicine group was treated with ethinylestradiol and cycloprogesterone acetate tablets on the basis of the control group, and the combined group was treated with Shengxuening tablets on the basis of the western medicine group. The menstrual volume, endometrial thickness and hemoglobin levels were observed before treatment, at 3 month, 6 month and 12 month after treatment, and the clinical efficacy and recurrence during follow-up were evaluated. Results The total effective rate was 98.0％(49/50) in the combined group, 96.0％ (48/50) in the western medicine group, 86.0％ (43/50) in the control group. The total effective rate in the combined group and the western medicine group was significantly higher than that in the control group (χ2=6.643, P=0.036). The menstrual volume (F=28.096, 49.096, 33.303), endometrial thickness (F=11.214, 20.265, 63.947) in the three groups were significantly different after treatment (P<0.01), and which in the combined group were significantly lower than those in the western medicine group, menstrual volume at 36,12 after treatment (t value were 4.747, 2.244, 4.489, P<0.01); endometrial thickness at 3, 6, 12 month after treatment (t value were 3.293, 3.356, 5.293, P<0.01); there were significant differences in hemoglobin levels in the three groups (F=11.002, 8.662, 8.958, P<0.01), and which in the combined group was significantly higher than that in the western medicine group at 3,6,12 month after treatment (t value were 2.722, 2.074, 2.028, P<0.05). During the follow-up period, 2 cases (4.1％) recurred in the combined group, 3 cases (6.3％) recurred in the western medicine group and 9 cases (20.9％) recurred in the control group. The recurrence rate in the combined group or the western medicine group was significantly lower than that in the control group (χ2=6.775, P=0.034). There was no significant difference in the recurrence rate in the combined group and the western medicine group (χ2=0.211, P=0.646). Conclusions The Ethynestradiol and Cyproterone acetate combined with Shengxuening tablets could improve the curative effect, reduce menstrual volume and endometrial thickness, increase hemoglobin level and reduce recurrence rate in patients with endometrial polyps for transcervical resection of polyp.
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Objective@#To investigate the clinical value of ultrasonography-guided hysteroscopy in the treatment of uterine fibroids.@*Methods@#From October 2015 to June 2016, 96 patients with uterine fibroids in Laiyang Central Hospital were selected as study objects, and they were randomly divided into two groups, with 48 cases in each group.The control group underwent conventional hysteroscopic myomectomy.The observation group was guided by ultrasonography to guide the hysteroscopic myoma stripping under the control group.The operation time, intraoperative blood loss and postoperative hospitalization were observed.The postoperative recurrence and postoperative success rate of pregnancy were compared between the two groups.@*Results@#The operation time in the observation group was (40.6±3.8)min, which was shorter than (59.8±8.5)min in the control group (t=10.566, P<0.05). The intraoperative blood loss in the observation group was (100.5±2.9)mL, which was less than (156.8±5.9)mL in the control group (t=59.332, P<0.05). The hospitalization time of the observation group was (4.2±0.2)d, which was shorter than (6.5±0.3)d in the control group (t=44.195, P<0.05). The recurrence rate of the observation group (4.17%) was lower than that of the control group (31.25%) (χ2=10.293, P<0.05). The postoperative pregnancy rate of the observation group (68.75%) was higher than that of the control group (22.92%) (χ2=18.374, P<0.05).@*Conclusion@#Ultrasound-guided hysteroscopy is effective in the treatment of intrauterine uterine fibroids with less trauma and faster postoperative recovery.It can significantly reduce the probability of recurrence and improve the pregnancy rate.
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Objective In order to evaluate the clinical curative effect of Guizhi-Fuling pill combined with conventional therapy for the patients with oviduct obstructive infertility.Methods In this study,102 patients with oviduct obstructive infertility (OO1) that accorded with the inclusion criteria were randomly divided into two groups according to the order of treatment.During the study,a total of 5 patients were lost in the two groups,and so 49 in the treatment group and 48 in the control group completed the protocol.The control group was given fallopian tube recanalization under the hysteroscopy,and the treatment group was given oral Guizhi-Fuling pill at day 2 after surgery on the basis of the control group treatment.Both groups were observed for 6 months.Before and after treatment,TCM symptom score was conducted,and IL-6 level was determined by radioimmunoassay;the uterine fallopian tube was examined after the 6th month of treatment,and pregnancy rate was observed and recorded.Results After treatment,abdominal pain degree (0.6 ± 0.1 vs.1.3 ± 0.1,t=3.612),the low back pain (0.9 ± 0.2 vs.1.6 ± 0.2,t=2.553),abdominal distension (0.5 ± 0.0 vs.1.0 ± 0.8,t=2.364),menstrual blood clots (0.5 ± 0.1 vs.1.0 ± 0.1,t=2.331) in the treatment group were significantly lower than those in the control group (Ps＜0.05).After treatment,the rate of oviduct patency was 75.5％ (37/49) in thetreatment group,50.0％ (24/48) in the control group,and the comparison difference between the two groups was statistically significant (x2=8.075,P=0.044).After 6 months of treatment,the pregnancy rate of the treatment group was 63.3％ (31/49),and that of the control group was 37.5％ (18/48),the difference of pregnancy rate between the two groups was statistically significant (x2=6.724,P=0.035).After treatment,serum IL-6 (31.04 ± 2.47 ng/ml vs.42.71 ± 2.52 ng/ml,t=7.593) in the treatment group was signicantly lower than the control group (P＜0.05).Conelusions Guizhi-Fuling pill combined with conventional therapy can reduce IL-6 level,promote fallopian tube recanalization,improve the intrauterine pregnancy rate,and improve the clinical symptoms of OOI patients.
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Objective To investigate the clinical value of transvaginal color doppler ultrasonography and hysteroscopy uteroscope in the diagnosis of endometrial lesions in postmenopausal women.Methods A total of 135 postmenopausal women with endometrial lesions were selected in this research.The patients were divided into observation group(67 patients)and control group(68 patients)according to random number table.The observation group adopted transvaginal color doppler ultrasonography and hysteroscopy uteroscope,the control group adopted transvaginal color doppler ultrasonography.The patients' treatment effect in the two groups were collected and analyzed.Results Of 67 patients in the observation group,there were 4 cases of endometrial polyp,23 cases of endometrial cyst,25 cases of adenomyomatous endometrial polyp and 15 cases of endometrial cancer,the diagnostic accuracy was significantly higher than that of the control group,the differences were statistically significant(x2=9.129,9.131,9.128,9.132,all P<0.05).In the observation group,the diagnostic accuracy of the obvious characteristics of internal granular internal echo,sparse punctate flow endometrial and uterine wall line than before obviously pathological lesions were better than those in the control group,the differences were statistically significant(x2=8.964,9.045,8.980,9.024,all P<0.05).Conclusion Transvaginal color doppler ultrasonography and hysteroscopy uteroscope has better effect in diagnosis of endometrial lesions in postmenopausal women,which is worthy of promotion.
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Objective To investigate the clinical value of hysteroscopy in helping identify the etiology of intrauterine fluid collection in postmenopausal women.Methods One hundred and thirtyfour postmenopausal women with intrauterine fluid collection,detected via transvaginal sonography,were admitted in the department of gynecology and obstetrics at Beijing ChaoYang Hospital from May 2014 to October 2016.All clinical data were retrospectively analyzed.All patients underwent hysteroscopy and biopsy of the endometrium.The results of hysteroscopy were analyzed against biopsy results.Results Hysteroscopy revealed that 116 of the 134 cases had uterine fluid(86.6％).Based on hysteroscopy results,44 (37.9 ％) had endometritis,10 (8.6 ％) had atrophic endometritis,5 (4.3 ％) had endometrial carcinoma,and 7(6.0 ％)had endometrial polyps,but the case numbers and rates for these conditions from microscopic examination were39 (33.6％),15 (12.9％),6 (5.2％),and 7 (6.0 ％),respectively.When microscopic examination was used as the gold standard,the sensitivities and specificities of hysteroscopy in the diagnosis of endometritis,atrophic endometritis,endometrial cancer and endometrial polyps were 82.0 ％ and 85.7 ％,66.7 ％ and 97.1％,80.0 ％ and 98.2 ％,and 100.0％ and 97.3％,respectively.The diagnostic coincidence rates were 84.6％,93.2％,94.4％ and 97.4％,respectively.Conclusions Postmenopausal women with intrauterine fluid collection shown on transvaginal sonography should receive hysteroscopy for early detection of endometrial lesions.
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Objective To analyze the diagnostic value of transvaginal three-dimensional ultrasound in intrauterine adhesion.Methods The data in 75 patients with intrauterine adhesion confirmed by hysteroscopy surgery and conducting transvaginal twodimensional and three-dimensional ultrasound examination in this hospital from November 2014 to November 2016 were retrospectively analyzed.Results The diagnostic accuracy rate of the three-dimensional transvaginal ultrasound for diagnosing intrauterine adhesion reached 87.7 ％,which of two-dimensional ultrasound reached 69.2 ％;the accuracy rates of transvaginal two-dimensional ultrasound for detecting mild,middle and severe intrauterine adhesion were 56.7％,76.9％ and 88.9％ respectively,while which of transvaginal three-dimensional ultrasound were 76.7 ％,96.2 ％ and 100.0 ％ respectively;the accuracy rates of transvaginal two-dimensional ultrasound for detecting peripheral,central and mixed intrauterine adhesion were 66.7％,76.7％ and 54.5％ respectively,while which of transvaginal three-dimensional ultrasound were 83.3％,88.7％ and 100.0％ respectively;the accuracy rate of three-dimensional transvaginal ultrasound was significantly superior to that of transvaginal two-dimensional ultrasound,the difference was statistically significant (P＜0.05).Conclusion Compared with transvaginal two-dimensional ultrasound,transvaginal three-dimensional ultrasound is more accuracy in diagnosing intrauterine adhesion and can provide more information for clinical doctors.
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Objective To investigate the clinical practice value of transvaginal ultrasound (TVU) combined with hysterosalpinography (HSG) in diagnosis of previous cesarean scar defect (PCSD).Methods Forty-two patients with colporrhagia,algomenorrhea or infertility after cesarean section were examined by TVU,HSG and hysteroscope.The results were compared among TVU,HSG and TVU combined with HSG.Results Among the 42 patients,21 patients were diagnosed PCSD by hysteroscope.The sensitivity of TVU was 66.7％ (14/21),specificity was 95.2％ (20/21),positive predictive value was 14/15,negative predictive value was 74.1％ (20/27).The sensitivity of HSG was 95.2％ (20/21),specificity was 100.0％ (21/21),positive predictive value was 100.0％(20/20),negative predictive value was 95.5％(21/22).The sensitivity of TVU combined with HSG was 95.2％(20/21),the sensitivity of TVU combined with HSG was significantly higher than TVU,there was statistical difference (P ＜0.05).Conclusions Compared with TVU,the sensitivity of TVU combined with HSG is increased markedly.TVU combined with HSG is a feasible clinical diagnostic method.
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Objective To investigate the prevention of re-adhesion after high dose estradiol valerate and hysteroscopy regular inspection after separation of severe intrauterine adhesions.Methods A total of 97 severe intrauterine adhesions patients after transcervical resection of adhesions were divided into group A,B,C:group A placed intrauterine device and oral intook progynova 1 mg/d after 2 days of surgery,3 times/d,for 3 months; group B placed intrauterine device and oral intook progynova 3 mg/d after 2 days of surgery,3 times/d,for 3 months; group C with the same treatment as group B with further hystemscopy regular inspection every month.Regular follow-up data were collected in the following 3 months to compare endometrial thickness,re-adhesion occurrence and treatment effect in different groups.Results After 3 months of treatment,endometrial thickness of group B and group C was higher than that in group A [(0.83 ± 0.23),(0.99 ± 0.28) cm vs.(0.54 ± 0.18) cm],group C was higher than group B,and there were significant differences (P＜ 0.05).The effective rate in group B and group C was higher than that in group A [75.00％(24/32),90.32％(28/31) vs.61.76％(21/34)],group C was higher than group B,and there were significant differences (P＜ 0.05).The occurrence rate of re-adhesion in group B and group C was lower than that in group A [21.88％(7/32),9.68％(3/31)vs.38.23％(13/34)],group C was higher than group B,and there were significant differences (P ＜ 0.05).Conclusion The prevention of re-adhesion after high dose estradiol valerate and hysteroscopy regular inspection is effective and superior.
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Objective To explore the clinical effectiveness of transcervical resection of polyps (TCRP) under hysteroscopes and dilatation and curettage in treatment for endometrial polyps infertility.Methods Ninety patients with endometrial polyps infertility from October 2010 to August 2012 were enrolled in this study.In them,45 patients were treated with TCRP under hysteroscopes (TCRP group),45 patients were treated with dilatation and curettage (dilatation and curettage group).Patients were followed up for 1 year,menstrual blood volume and endometrial thickness in ovulatory before operation and after operation for 3,6 and 12 months were recorded and compared between two groups.While the recurrence rate after operation for 6,12 months and 1-year pregnancy rate were also recorded and compared between two groups.Results The menstrual blood volume and endometrial thickness in ovulatory before operation between two groups had no significant difference (P ＞ 0.05).The menstrual blood volume after operation for 3,6 and 12 months in TCRP group was (125.2 ±56.4),(154.0 ±72.3) and (189.8 ±96.6) ml,respectively.While in dilatation and curettage group was (215.3 ± 87.8),(267.5 ± 98.4) and (297.5 ± 125.6) ml.There were significant differences (P ＜ 0.05 or ＜ 0.01).The endometrial thickness in ovulatory after operation for 3,6 and 12 months in TCRP group was significantly lower than that in dilatation and curettage group (P ＜ 0.05 or ＜ 0.01).The recurrence rate after operation for 6,12 months and 1-year pregnancy rate in TCRP group was 4.4％ (2/45),8.9％ (4/45)and 20.0％ (9/45) ; in dilatation and curettage group was 8.9％ (4/45),35.6％(16/45) and 26.7％ (12/45).The recurrence rate after operation for 12 months in TCRP group was significantly higher than that in dilatation and curettage group (P ＜0.01).Conclusions The prospective efficacy of TCRP under hysteroscopes in treatment of endometrial polyps infertility is better than dilatation and curettage.It is one of better methods and worthy to spread.
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Objective To investigate the clinical efficacy and safety of hysteroscopy surgery combined with methotrexate (MTX) for treating the patients with cesarean scar pregnancy(CSP).Methods The clinical data of 64 patients with CSP were retrospectively analyzed.The patients were divided into observation group (46 cases) and control group (18 cases) according to treatment methods,the control group was given the therapy of local pregnancy intracapsular MTX combined with uterine curettage,and the observation group was given the therapy of local pregnancy intracapsular MTX combined with lesions removed surgery by hysteroscopy.The intraoperative blood Ioss,epistrophy time of β-human chorionic gonadotrophin (hCG),hospitalization time,clinical efficacy of the two groups were observed.Follow-up for 6 months the menstruation of the two groups was observed.Results The total effective rate in observation group was significantly higher than that in control group [100.0％ (46/46) vs.66.7％ (12/18),x2 =16.920,P ＜ 0.01].The intraoperative blood loss,epistrophy time of β-hCG and hospitalization time in observation group were significantly lower than those in control group [(35.46 ± 11.63) ml vs.(176.78 ± 57.96) ml,(21.04 ± 6.79)d vs.(39.65 ± 12.79) d,(13.89 ±4.63) d vs.(26.82 ±8.94) d,P＜0.01].The observation group had a successful surgery and no complications.In the control group,4 cases occurred uterine curettage intraoperative bleeding,2 cases underwent open lesion resection and then were forced to line hysterectomy.The rate of menstruation in observation group after operation 30-39 d was significantly higher than that in control group [84.8％ (39/46) vs.25.0％ (4/16),P ＜ 0.01].Conclusions Hysteroscopy surgery combined with MTX for treating the patients with CSP has exact clinical effect.It is safe and reliable,and is worthy of promotion and application.
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Objective To observe the safety and feasibility of low-dose dexmedetomidine combined with target controlled infusion propofol in hysteroscope electric resection of submucous myoma.Methods Eighty ASA Ⅰ-Ⅱ patients undergoing hysteroscope electric resection of submucous myoma were divided into four groups with 20 cases each by table of random digit:group A was 0.9％ sodium chloride combined with propofol,group B was dexmedetomidine 0.25 μ g/kg combined with propofol,group C was dexmedetomidine 0.50 μ g/kg combined with propofol and group D was dexmedetomidine 1.00 μ g/kg combined with propofol.The perioperative hemedynamic changes,total dose of propofol,recovery time,rate of adverse reaction and postoperative uterine contraction pain were observed and compared among the four groups.Results When expanding the palace and electric cutting,systolic blood pressure (SBP) and heart rate (HR) in group B,C and D were significantly lower than those in group A [(107.3 ± 8.8),(108.6 ± 9.3) and (105.7 ± 8.9)mm Hg (1 mm Hg =0.133 kPa) vs.(115.1 ± 8.2) mm Hg,(109.9 ±9.6),(109.2 ± 9.5) and (106.7 ±9.1)mm Hg vs.(121.3 ± 9.9) mm Hg,(83.9 ± 6.6),(81.2 ± 7.1) and (78.7 ± 6.9) times/min vs.(91.3 ± 6.5)times/min,(84.2 ± 7.6),(83.6 ± 7.3) and (80.7 ± 6.8) times/min vs.(97.3 ± 7.2) times/min,P ＜ 0.05].The recovery time in group D was significantly longer than that in group A [(13.2 ± 3.0) min vs.(11.2 ±3.3)min,P＜ 0.05].The total dose of propofol in group C and D were significantly lower than that in group A [(289.6 ± 57.7) and (278.5 ± 56.9) mg vs.(324.6 ± 67.9) mg,P ＜ 0.05],and analgesic effect were better than group A (P ＜ 0.05).The rates of respiratory depression and recovery period restlessness in group C and D were significantly lower than those in group A [10％(2/20) and 10％(2/20) vs.20％(4/20),15％(3/20)and 20％ (4/20) vs.65％ (13/20),P ＜ 0.05],while,the rate of drowsiness after operation in group D was significantly higher than that in group A [45％(9/20) vs.10％(2/20),P＜ 0.05].Conclusions Low-dose dexmedetomidine combined with target controlled infusion propofol can be safely applied in hysteroscope electric resection of submucous myoma,and has a good analgesic effect,less adverse reaction,postoperative analgesia perfect advantages.
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Objective To study the correlative risk factors of uterine cavity adhesion (UCA),and observe the clinical efficacy of hysteroscope operation treatment of UCA.Methods According to whether the occurrence of UCA,120 patients with spontaneous abortion were divided into two groups.The correlative risk factors of UCA were analyzed by multiple factors regression analysis.The patients with UCA were treated with hysteroscope operation treatment,and the clinical efficacy were observed.Results In 120 patients with spontaneous abortion,46 patients (38.3％) had UCA.Single factor analysis result showed:UCA was correlated with pelvic inflammation,gravidity,uterine cavity suction negative pressure,uterine cavity suction time (P ＜ 0.05),but UCA was not correlated with age,years of education,occupation,gestational weeks,menarche age (P＞ 0.05).Multiple factors analysis result showed:UCA was correlated with pelvic inflammation,uterine cavity suction negative pressure,uterine cavity suction time (P ＜ 0.05).The total effective rates of hysteroscope operation treatment of mild,moderate and severe UCA were 100.0％ (18/18),93.8％ (15/16)and 83.3％ (10/12) respectively,there was no significant difference among them (P ＞ 0.05).Conclusions Along with the increasing of uterine cavity suction negative pressure and extension of uterine cavity suction time,the risk of UCA is also increasing,pelvic inflammation is also an independent risk factor of UCA.Hysteroscope operation treatment of UCA has better curative effect,especially for mild UCA,it is worth clinical application.
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Objective To investigate the clinical effect of uterine arterial embolization combined with hysteroscopes in the treatment of cesarean scar pregnancy(CSP).Methods Seventy CSP patients were divided by willingness of patients and their familiality into treatment group and control group with 35 cases each.The treatment group was treated with uterine arterial embolization combined with hysteroscopes,while the control group was treated with uterine curettage after crug therapy.The intraoperative and postoperative situations of two groups were observed.Results The intraoperative blood loss,erythrocyte suspension transfusion,plasma transfusion,preparation time before curettage,hospital stay and pestoperative serum β- human chorionic gonadotropin in treatment group were all obviously lower than those in control group [(420.7 ± 18.9) ml vs.(1893.9 +39.8) ml,(2.1 + 1.3) U vs.(11.1 ±1.4) U,(400.2 ±23.6) ml vs.(1700.3 ± 31.4) ml,(3.9 ± 2.3) d vs.( 18.8 ± 6.7) d,( 14.32 ± 3.89) d vs.(37.83 ± 8.98) d,(312 ± 54) U/L vs.(532 ± 85) U/L,P＜ 0.01].There was 1 case with massive hemorhage in treatment group,while 3 cases in control group.Conclusions Uterine artery embolization combined with hysteroscopes is a safe and effective treatment with less trauma for CSP.It is worthy of clinical promotion and application.
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Objective To discuss the effect of treating tubal obstruction infertility through hydrotubation by hysteroscopy combined with Chinese traditional medicine. Methods Chose 308 patients with tubal obstruction infertility from October 2001 to December 2008 and used the hysteroseopy under which making tubal cannulation, then injected methylene blue and clear liquid to record cases of tubal patency.After the operation the patients would be given Chinese traditional medicine and followed up the case of pregnancy. Result The recanalization rate in 308 patients was 90.9% (280/308), and the rate ofre-pregnancy was 55.5%(161/290). Conclusion The effect of treatment through hysteroscopy to make tubal cannulation and have patients take medicine after operation is very satisfactory and it is worth promoting.
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Objective To investigate the clinical value of the combination of hysterescope and laparoecope in the treatment of tubal obstruction infertility.Methods Two hundred and sixty-slx infertile women managed by the combination of hysteroscope and laparoecope from August 2003 to December 2006 were enrolled.The postoperation tubal recapalization extent and pregnancy rate were analyzed.Results The recanalization rate of the umbrella and ampulla portion was higher (86.9%) than that of other sites (interstitial portion was 33.8%,isthmic portion was 35.5% ),and the pregnancy rote of patients with one tubal recavalization was signifieenfly higher than that of patients with bilateral tubal obstruction.The pregnancy rate was 48.0% in 12 months,little higher than 41.0% in 6 months after operation.Conclusion The combination of hysterecope and laparescope in treatment of tubal obstruction infertility has ideal effect and clinical application value.
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Objective To explore the clinical value of hysteroscopy combined with laparoscopy in the diagnosis and treatment of congenital uterine malformation. Method The clinical data of 53 cases with congenital uterine malformation being diagnosed and treated by hysteroscopy combined with laparoscopy were analyzed retrospectively. Results The 53 diagnosed cases included 25 with incomplete uterus septum, 14 with complete uterus septum, 4 with rudimentary horn of uterus, 3 with unicomuate uterus, 2 with bicornuate uterus, 3 with double-uterus, 2 with bicorbate uterus. Hysteroscopy combined with laparoscopy could diagnose the lesions in the uterine and the abdominal cavity, also could rectify the uterine malformation simultaneously. Ultrasound, hysterosalpingography, hysteroscopy all could not diagnose the uterine malformation completely correct, but hysteroscopy combined with laparoscopy could do. Conclusion Hysteroscopy combined with iaparoscopy is safe and effective, which can be the first-line selection for the diagnosis and treatment of congenital uterine malformation.