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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 influence of misoprostol and carboprost methylate for preoperative vaginal placement on the clinical index, the cervical dilatation degree and adverse reactions of patients with submucous myoma of uterus by hysteroscopic surgery.Methods150 patients with submucous myoma of uterus by hysteroscopic surgery were chosen in the period from August 2013 to August 2016 in Yiwu Maternal and Child Health Care Family Planning Service Center and divided into two groups including group A (75 patients) with misoprostol and group B (75 patients) with carboprost methylate for preoperative vaginal placement;and the operation time, the intraoperative blood loss, the recovery time of gastrointestinal function, the effects of cervical dilatation, the width of cervical dilatation and the adverse reactions incidence of both groups were compared.ResultsThe operation time and the intraoperative blood loss of B group were significantly better than A group(P<0.05).There was no significant difference in the recovery time of gastrointestinal function between the two groups.The effects of cervical dilatation in group B were significantly better than that in group A(P<0.05).The width of cervical dilatation in group B were significantly larger than that in group A(P<0.05).There was no significant difference in the adverse effects incidence between the two groups.ConclusionCompared with misoprostol, carboprost methylate for preoperative vaginal placement in the treatment of patients with submucous myoma of uterus by hysteroscopic surgery can efficiently shorten the operation time, reduce the operation bleeding, improve the effect of cervical dilatation and not increase the adverse reactions risk.
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Objective:To investigate the analysis of features and differential diagnosis of ultrasonic image for patient with endometrial lesions.Methods: The imaging data of 80 patients with endometrial lesions were selected as random number table. The relevant ultrasound manifestations and sonographic features of patients were further analyzed, and then these data were compared with the pathological diagnosis by using operation.Results: In the 80 patients with endometrial lesions, 43 cases were endometrial polyps, and in the 43 cases, there were 41 cases were consistent with the pathological diagnosis and the diagnostic accordance rate was 95.35%, while there were 2 cases were not consistent between the two methods. 33 cases of the 80 patients were submucous myoma of uterus, and there were 29 cases of them were consistent with the pathological diagnosis and the diagnostic accordance rate was 87.88%, while there were 4 cases were not inconformity. And 4 cases of the 80 patients were endometrial carcinoma, the result was completely consistent with the pathological diagnosis and the diagnostic accordance rate was 100%. In the 6 misdiagnose cases, the ratios of atypical cases and (or) typical cases were 1:16, 5:36 and 1:8, respectively. All of these endometrial lesions has the distinctive manifestations on the ultrasonoscopy of color Doppler.Conclusion: For the detection of endometrial lesions, transvaginal colar Doppler ultrasonic detection has unique feature of ultrasonogram compared with other detection methods. In the contrast, there is a regular congruent relationship between the ultrasonogram of typical disease and section of pathological specimen by using operation in a certain degree, and the ultrasonogram of typical disease has definite diagnosis value.
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Objective To compare the clinical efficacy of radiofrequency ablation operation with small inci -sion operation and traditional operation in the treatment of uterine fibroids .Methods 120 patients with myoma of uterus were randomly divided into the control group ,small incision group and radiofrequency ablation operation group , each group had 40 patients.Radiofrequency ablation operation group were given radiofrequency ablation operation , small incision group were treated with abdominal small incision operation (the legth of incision 0.05).Conclusion The use of radio frequency ablation operation can be safe and effective in the treatment of uterine fibroids ,shorten the operation time and hospitalization time ,reduce the incidence of postoperative complications ,but the recurrence rate is worthy of attention.
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Objective To explore the clinical effect of cassia twig tuckahoe capsule combined with mifepris-tone in the treatment of myoma of uterus,and to observe and analyze its influence on the quality of life,thus to provide basis for clinical treatment of uterine fibroids.Methods 138 patients with myoma of uterus were selected randomly. They were randomly divided into the control group and the observation group,69 cases in each group.The control group received mifepristone treatment,and the observation group received cassia twig tuckahoe capsule combined with mifepristone.The treatment effect of the two groups,tumor volume change were observed,follicle generate hormone (FSH),estradiol (E2 )and luteinizing hormone (LH)generated levels before and after treatment were detected,the quality of life and adverse reaction were assessed.Results The total effective rate of the observation group was 92.75% (64 /69),which was higher than the control group [82.61% (57 /69)],the difference was statistically significant (χ2 =10.16,P <0.05 ).The tumors volume of the observation group after treatment was (13.35 ± 1.17)cm3 ,which was lower than the control group after treatment (15.64 ±1.33)cm3 ,the difference was statistically significant (t =9.04,P <0.05).FSH and LH levels of the observation group after treatment were (30.55 ±6.14)U /L and (32.02 ±7.12)U /L,which were lower than the control group after treatment[(38.27 ±6.75)U /L and (36.91 ± 5.38)U /L],the differences were statistically significant (t =9.07,7.98,all P <0.05).E2 of the observation group after treatment was (53.41 ±5.13)pmol/L,which was higher than the control group after treatment[(47.82 ± 5.19)pmol/L],the difference was statistically significant (t =8.76,P <0.05).The period and menstrual volume of the observation group after treatment were (4.62 ±0.81)d and (52.36 ±6.21)mL,which were less than the control group after treatment[(6.71 ±0.86)d and (60.75 ±6.86)d],the differences were statistically significant (t =8.61,9.29,all P <0.05).The overall quality of life,physical function,emotional function and social function of the observation group after treatment were higher than the control group,the differences were statistically significant (t =10.26,9.69,10.13,10.27,all P <0.05).Conclusion Cassia twig tuckahoe capsule in combination with mifepris-tone in the treatment of myoma of uterus has better clinical curative effect,which can significantly improve sex hormone levels and menstrual status,and improve the quality of life.It has high security.
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Objective To investigate the hysteroscopy application on uterine cavitary benign and its safety.Methods Two hundred and ten patients with benign lesions in the uterine cavity from Jan 2010 to Jan 2013 were selected as our subjects.They were underwent hysteroscopy and electric section,including 72 cases with uterine polyps resection,70 cases with uterine fibroids resection,and 68 cases with pregnancy tissue residue removal surgery.The follow up periods were 4 months to 2 years and the therapy effects were recorded.Results Two hundred and ten patients were got one successful operation.Operation period was ranged from 11 to 39 minutes and average was 15 minutes.The intraoperation bleeding volumes was ranged from 5 to 70 ml and no intraoperation complications occurred.During the follow-up periods,94.1％ (191/203) patients were recovered to regular menstruation and dysmenorrhea improvement rate was 87.70％ (178/203) at 1 month after operation.At 6 months after operation,96.1％ (195/203) and 91.6％ (186/203) patient were with the regular menstruation and dysmenorrhea improvement.Two cases with uterine cavitypolyp were reoccurred after operation and cured by electron section.Conclusion Hysteroscopy in treatment of benign uterine lesions is showed the satisfactory curative effect in terms of keep uterus integrity with little injury,slight pain.It is proved to be as the prefer methods to treatment for benign uterine cavity lesions.
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Objective To explore the clinical effect of hysteroscopic resection in the treatment of submucous myoma.Methods The clinical data of 78 submucosal myoma patients with hysteroscopic resection which were diagnosed by B ultrasound and hysteroscopy were retrospectively analyzed,including 35 cases of type O,23 cases of type Ⅰ,20 cases of type Ⅱ.Results Application of hysteroscopic resection in the treatment of type O and type Ⅰ submucosal myoma,the rate of postoperative satisfaction was 100.0％.There were 3 cases of multiple myoma in 20 cases of type Ⅱ,which were not one time of resection,and were taken the second times of resection 4 months after operation.In all operation,there was on complications,and the rate of postoperative satisfaction was 96.2％.Conclusion Hysteroscopic resection in the treatment of submucous myoma for the preservation of reproductive function and not affecting ovarian function has the advantage of less bleeding,short operation time,rapid postoperative recovery,shorter hospitalization time,and greatly improve the quality of life of patients,and has good clinical application value,it provides the effective treatment for clinical,and is worthy of clinical popularization.
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Objective To evaluate the advantages and disadvantages between transabdominal myomectomy(TAM)and laparoscopic myomectomy(LM).Methods We were trospectively reviewed the clinical data of 35 cases of TAM and 30 cases of LM,analyzed adaptation,complication,bleeding quantity and recover time.Results Every patients operated successful.The operation time of LM group was longer than TAM group.The bleeding quantity,recovery time and post-operation in-hospital days of LM group were all shorter than TAM group.Conclusions Laparoscopic myomectomy have advantages of micro invasion,rapidrecovery,less in-hospital days and less complication.
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0.05). After operation about 50% cases (11/22) improved the menstrual dysfunction, and most cases avoid doing operation again in short period. Conclusion While cases chosen properly and adequate operative preparation, it is feasible and valuable to carry out cesarean section and myomectomy at the same time.
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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.