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Objective:To discusse the value of pituitin in laparoscopic ovarian cyst removal.Methods:From October 2015 to June 2018 in Dalian Medical University Affiliated Dalian Maternity Hospital, useing prospective research methods, 90 patients with unilateral ovarian cyst (except endometriomas) were randomly divided in 3 groups of pituitrin group,control group 1 and control group 2. The pituitrin group: laparoscopic cystectomy with the injection of diluted pituitrin 6 U, the total amount of diluted pituitrin 10 - 20 ml, ovarian hemostasis was achieved by sutura. The control group 1: ordinary laparoscopic cystectomy without injection suture hemostasis. The control group 2: laparoscopic cystectomy with the injection of normal saline 10 - 20 ml, ovarian hemostasis was same to pituitrin group. The operation time and the amount of bleeding were compared among the three groups. The ovarian reserve was compared between before and 3 months after operation by estradiol (E 2), follicle-stimulating hormone (FSH), luteinizing hormone (LH). Results:The amount of bleeding in the pituitrin group was less than that in the control group1: (14.00 ± 5.48) ml vs. (18.33 ± 6.99) ml, P<0.05. The operation time in the pituitrin group and control group 2 was less than that in the control group1: (43.50 ± 7.21) min, (45.00 ± 10.29) min vs. (50.17 ± 8.95) min, P<0.05. The level of FSH after operatiaon in the pituitrin group and control group 2 was less than that in the control group1: (7.20 ± 1.55) U/L, (7.43 ± 1.52) U/L vs. (8.31 ± 0.97) U/L, P<0.05. The level of E 2 3 months after operation in the pituitrin group was higher than that in the control group 1 and control group 2: (54.20 ± 10.90) ng/L vs. (46.63 ± 10.76) ng/L, (43.90 ± 18.23) ng/L, P<0.05. There was no significant difference of LH 3 months after operation among the three groups ( P>0.05). Conclusions:This study shows that diluted pituitrin decreases operation time and the amount of bleeding during operation, at the same time,the pituitrin injection is valued of ovarian reserve.
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Objective:To study the effect of different hemostasis methods on postoperative pain and sex hormone levels in patients undergoing laparoscopic ovarian cystectomy.Methods:A total of 118 patients with ovarian cysts admitted to our hospital from Jun. 2018.6 to Aug. 2020 were collected and grouped by digital table method into electrocoagulation hemostasis group (59 cases, electrocoagulation hemostasis) and suture hemostasis group (59 cases, suture hemostasis). Pain at time points, serum inflammatory factors and sex hormone levels in the two groups were measured, and the incidence of complications was counted 12 weeks after surgery.Results:The VAS scores of suture hemostasis group at 6, 12 and 24 h after operation (3.33±0.93, 3.63±1.02, 3.01±0.94) were significantly lower than those of the electrocoagulation hemostasis group (4.16±1.05, 4.61±1.17, 3.72±1.05) ; there was no significant difference in serum interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) levels between the preoperative suture hemostasis group and the electrocoagulation hemostasis group. The serum levels of IL-6 and TNF-α in the group (37.64±4.82ng/L, 39.67±4.71ng/L) were lower than those in the electrocoagulation hemostasis group (45.96±5.25ng/L, 48.96±5.14ng/L) ( P<0.05) .) ; there was no significant difference in serum follicle-stimulating hormone (FSH), estradiol (E 2) or luteinizing hormone (LH) levels between preoperative electrocoagulation hemostasis group and suture hemostasis group ( P>0.05) ; There was no significant difference in the three indexes in the suture hemostasis group 3 months after operation compared with those before treatment ( P>0.05). The serum FSH and LH [ (6.59±0.91) mIU/ml, (5.24±0.77) mIU/ml] in the suture hemostasis group were lower than those in the electrocoagulation hemostasis group [ (7.39±1.02) mIU/m, (5.97±0.89) mIU/m], E 2 in suture hemostasis group [ (51.08±6.09) pg/ml] was higher than that in electrocoagulation hemostasis group [ (46.88±5.59) pg/ml] ( P<0.05). In terms of the complication rate at 3 months after operation, the suture hemostasis group (32.20%) was significantly lower than electrocoagulation hemostasis (13.56%) ( P<0.05). After 1 year of follow-up, the pregnancy success rate of the suture hemostasis group (72.88%) was significantly higher than that of the electrocoagulation hemostasis group (52.54%) ( P<0.05). There was no significant difference in pregnancy outcomes ( P>0.05) . Conclusions:Suture hemostasis in patients undergoing laparoscopic ovarian cystectomy is beneficial to relieve postoperative pain, improve postoperative inflammatory response, protect their ovarian function, avoid complications such as abnormal ovulation and excessive menstrual flow, and improve the success rate of pregnancy. The overall application effect is better than electrocoagulation hemostasis.
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Background:Laparoscopy is a widely used procedure in gynecological cases both for diagnostic and operative procedures. It is recommended due to lesser hospital stay, less post operative pain and better panoramic vision. Aim of the study is to assess the effectiveness of laparoscopic intervention of adnexal masses with benign pathology in recent series of consecutive patient. The focus is on pathology findings, length of stay, operating time, complications and laparotomy conversion rate. Material And Methods: This was a prospective observational study conducted at tertiary care hospital in Department of Obstetrics & Gynaecology during period of 1stAugust 2018 to 31st July 2020.This study consists of 70 patients, who presented with symptoms like pain in abdomen, bleeding per vaginum, irregular menses, excessive white discharge, distension of abdomen, infertility visiting outdoor patient department either diagnosed clinically(sign and symptoms) or by ultrasonography of adnexal masses. Result:Maximumpatients in this study were in age group 21-30 years. Maximum patients(21.42%)were having simple cyst. Among laparoscopic procedure most common procedure was left ovarian cystectomy(38.57%). Mean operative duration was 40.78 min and average duration of hospital stay was 3 days. There were minimal peri-operative complications; commonest being postoperative fever. Conclusion:Ade quatesurgical skill, case selection, multi disciplinary team approach and expert laproscopic surgical team are imperative for good patient outcome. This study gives an overview of experience in favour of laproscopic management of benign adnexal mass
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Objective@#To study the clinical effect of laparoscopic excision of ovarian cyst in the treatment of patients with ovarian cyst.@*Methods@#From August 2016 to August 2018, 106 patients with ovarian cyst were selected in the Second People's Hospital of Yuyao.According to the different operation methods, 106 patients were divided into two groups, with 53 cases in each group.The control group was treated with open excision of ovarian cyst.The observation group was treated by laparoscopic excision of ovarian cyst.The clinical effect was observed and compared between the two groups.@*Results@#In the observation group, the time of operation, the amount of blood lost during operation, the time of anal exhaust, the time of getting out of bed and the time of hospitalization were (38.95±3.64)min, (45.12±4.48)mL, (1.01±0.08)d, (30.58±3.07)h, (4.97±0.46)d, respectively, which in the control group were (59.72±5.33)min, (86.62±8.52)mL, (2.07±0.20)d, (44.20±4.28)h, (7.14±0.72)d, respectively, the differences between the two groups were statistically significant(t=23.242, 31.386, 35.825, 18.825, 18.490, all P<0.05). The pregnancy rate in the observation group was 79.25%(42/53), which in the control group was 49.06%(26/53), the difference was statistically significant(χ2=10.502, P<0.01).@*Conclusion@#Laparoscopic excision of ovarian cyst can shorten the operation time, anal exhaust time, the time of getting out of bed after operation, hospital stay, reduce the amount of bleeding and improve the pregnancy rate of the patients.
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Objective To study the clinical effect of laparoscopic excision of ovarian cyst in the treatment of patients with ovarian cyst.Methods From August 2016 to August 2018,106 patients with ovarian cyst were selected in the Second People's Hospital of Yuyao .According to the different operation methods ,106 patients were divided into two groups,with 53 cases in each group.The control group was treated with open excision of ovarian cyst .The observation group was treated by laparoscopic excision of ovarian cyst .The clinical effect was observed and compared between the two groups.Results In the observation group,the time of operation,the amount of blood lost during operation,the time of anal exhaust,the time of getting out of bed and the time of hospitalization were (38.95 ±3.64)min,(45.12 ± 4.48)mL,(1.01 ±0.08) d,(30.58 ±3.07) h,(4.97 ±0.46) d,respectively,which in the control group were (59.72 ±5.33)min,(86.62 ±8.52) mL,(2.07 ±0.20) d,(44.20 ±4.28) h,(7.14 ±0.72) d,respectively,the differences between the two groups were statistically significant (t=23.242,31.386,35.825,18.825,18.490,all P<0.05).The pregnancy rate in the observation group was 79.25％(42/53),which in the control group was 49.06％(26/53),the difference was statistically significant(χ2 =10.502,P<0.01).Conclusion Laparoscopic excision of ovarian cyst can shorten the operation time ,anal exhaust time,the time of getting out of bed after operation ,hospital stay,reduce the amount of bleeding and improve the pregnancy rate of the patients .
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Objective To investigate the expression of anti mullerian hormone(AMH)in the serum of patients with ovarian endometriosis cyst and its clinical significance.Methods Fifty-one cases of ovarian endometriosis cyst from March 2014 to June 2016 in Maternal and Child Health Hospital Affiliated to Southern Medical University(observation group)and thirty-five cases of normal women who were diagnosed through physical examination(control group)were selected as the research objects.The observation group patients received laparoscopic ovarian endometriosis cystectomy treatment,enzyme-linked immunosorbent assay(ELISA) was applied to detect and analyze serum AMH in the control group at physical examination and in the observation group before surgery and at 1 month,3 months after surgery.Results (1)The preoperative serum AMH level of the observation group was significantly lower than that of the control group,the difference was statistically significant((2.45±0.68)μg/L vs.(3.75±0.80)μg/L,t=7.8604,P=0.0000).(2)Serum AMH level in the groups where the ages were above 35years was significantly lower than that of the age less than 35 group( (1.76±0.57)μg/L vs.(3.61±0.88)μg/L,t=9.1249,P=0.0000); the preoperative serum AMH level in the group where disease course was more than 12 months was significantly lower than that of the disease course less than 12 months group((2.03 ± 0.64)μg/L vs.(3.98 ± 0.91)μg/L,t=8.1408,P=0.0000); the preoperative serum AMH level in patients with dysmenorrhea was significantly lower than that of patients without dysmenorrhea((1.65±0.53)μg/L vs.(3.91±0.84)μg/L,t=11.7861,P=0.0000),the preoperative serum AMH level in the bilateral lesion group was significantly lower than that of the unilateral lesion((2.01±0.68) μg/L vs.(2.84±0.72)μg/L,t=4.2174,P=0.0001); there was no significant difference in the preoperative serum AMH level between patients with<5.0 cm diameter cyst and patients with smaller cyst((2.52 + 0.81)μg/L vs.(2.39 + 0.50)μg/L,t=0.8411,P=0.4029).The serum AMH level in the observation group at 3 months after surgery was significantly lower than that before surgery((2.45±0.68)μg/L vs.(1.81± 0.55) μg/L,t=24.3657,P=0.0000).Conclusion The expression of serum AMH level in patients with ovarian endometriosis is low,and it is closely related to the age,course of disease,history of dysmenorrhea and the location of the lesion.Laparoscopic ovarian cystectomy may reduce ovarian reserve capacity in patients with ovarian endometriosis.
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Objective To compare the clinical efficacy between the vaginal ovarian cystectomy and the laparoscopic ovarian cystectomy. Methods A total of 104 patients with ovarian cyst hospitalized in our hospital during June 2013-June 2016 were selected and divided into observation group (vaginal ovarian cystectomy, n=55) and control group (laparoscopic ovarian cystectomy, n=49). There were no significant differences in mean age, body mass index (BMI), abdominal surgical history, cyst diameter and cyst type between the two groups. The operation time, blood loss in operation, hospitalization expenses and average hospital stay were observed in the two groups. The ovarian reserve function before and after the operation was also observed. Results The operation time [(46.9±18.4 min)], hospitalization cost [(8165.3±951.8) yuan] and the average length of hospital stay (4.5 ± 1.9 days) were significantly less in the observation group than those of the control group [(62.3 ± 26.5) min], [(12543.9 ± 1464.4) yuan] and [(6.8 ± 2.3) days], (P<0.05). Before the operation, there were no significant differences in estradiol (E2), follicle stimulating hormone (FSH)/luteinizing (LH), FSH and antral follicle count (AFC) between the two groups. After the operation, the values of FSH/LH (1.4±0.4 vs. 1.8±0.6) and FSH [(9.2±2.9) U/L vs. (13.6±4.3) U/L] were significantly decreased in the observation group than those of the control group. The AFC (7.2±1.6 vs. 6.0±1.3) was significantly more in the observation group than that of the control group (P<0.05). Conclusion The vaginal ovarian cystectomy is of little damage to ovarian reserve function, which is suitable for women of child-bearing age and conforms to the requirement of"value medicine".
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Objective To compare the clinical efficacy between the vaginal ovarian cystectomy and the laparoscopic ovarian cystectomy. Methods A total of 104 patients with ovarian cyst hospitalized in our hospital during June 2013-June 2016 were selected and divided into observation group (vaginal ovarian cystectomy, n=55) and control group (laparoscopic ovarian cystectomy, n=49). There were no significant differences in mean age, body mass index (BMI), abdominal surgical history, cyst diameter and cyst type between the two groups. The operation time, blood loss in operation, hospitalization expenses and average hospital stay were observed in the two groups. The ovarian reserve function before and after the operation was also observed. Results The operation time [(46.9±18.4 min)], hospitalization cost [(8165.3±951.8) yuan] and the average length of hospital stay (4.5 ± 1.9 days) were significantly less in the observation group than those of the control group [(62.3 ± 26.5) min], [(12543.9 ± 1464.4) yuan] and [(6.8 ± 2.3) days], (P<0.05). Before the operation, there were no significant differences in estradiol (E2), follicle stimulating hormone (FSH)/luteinizing (LH), FSH and antral follicle count (AFC) between the two groups. After the operation, the values of FSH/LH (1.4±0.4 vs. 1.8±0.6) and FSH [(9.2±2.9) U/L vs. (13.6±4.3) U/L] were significantly decreased in the observation group than those of the control group. The AFC (7.2±1.6 vs. 6.0±1.3) was significantly more in the observation group than that of the control group (P<0.05). Conclusion The vaginal ovarian cystectomy is of little damage to ovarian reserve function, which is suitable for women of child-bearing age and conforms to the requirement of"value medicine".
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OBJECTIVE: To compare the in vitro fertilization (IVF) outcomes between women with diminished ovarian reserve (DOR) after endometrioma operation and women with DOR without ovarian surgery. METHODS: This retrospective case-control study included 124 women aged under 40 and had DOR (serum anti-Müllerian hormone level <1.1 ng/mL or antral follicle count ≤6). They participated in fresh first and/or second IVF cycles between March in 2010 and December in 2015. Basal characteristics and IVF outcomes were compared between 47 cycles (32 women) with surgery-induced DOR and 119 cycles (92 women) with DOR without ovarian surgery. RESULTS: Basal characteristics were similar in both groups except that the median ages were lower in the surgery-induced DOR group compared to the DOR group without ovarian surgery. The data regarding the controlled ovarian stimulation and IVF cycle outcomes showed similar result in both groups. Also, clinical pregnancy and live birth rate were not different significantly between two groups. CONCLUSION: In the same condition of DOR, clinical pregnancy and live birth rate were not different significantly between two groups regarding etiology of DOR.
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Female , Humans , Pregnancy , Case-Control Studies , Endometriosis , Fertilization in Vitro , In Vitro Techniques , Infertility , Live Birth , Ovarian Reserve , Ovulation Induction , Retrospective StudiesABSTRACT
Objective To investigate the effects of preoperative anxiety on the recovery of anesthesia and postoperative analgesia in patients undergoing elective laparoscopic ovarian cystectomy.Methods A total of 87 patients were enrolled who were undergoing elective laparoscopic ovarian cystectomy during July 2015 to June 2016.State-Trait Anxiety Inventory-1 was administered to the patients:patients with anxiety were included in the high-anxiety group (Group H) and patients witouth anxiety were included in the low-anxiety group (Group L) We observed the recovery of anesthesia and postoperative analgesia of the patients in two groups.Results In group H,the extubation time,the time for the Aldrete score to reach 9,were significantly longer;more agitation were found;and more fentanyl and parecoxib were needed.The difference was statistically significant (P＜0.05).The age,BMI,operation time,anesthesia time of the patients in the two groups had no statistically significant differences (P＞0.05).Conclusion High anxiety has a negative effect on recovery from anesthesia and on postoperative pain control in patients undergoing elective laparoscopic ovarian cystectomy.
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Objective To investigate the influence of wound treatment methods on residual ovarian reserve function after laparoscopic ovarian cystectomy.Methods A total of 120 patients with ovarian cyst who underwent laparoscopic ovarian cystec‐tomy in the hospital were randomly divided into three groups in terms of different wound treatment methods:electric coagulation group ,ultrasound group and suture group ,with 40 cases in each group.The levels of follicle stimulating hormone(FSH) ,luteini‐zing hormone(LH) ,and estradiol(E2 ) were detected in the blood before and immediately after the operation ,2 days after men‐struation at postoperative 3 and 6 months ,and the number of ovarian reserve follicles determined by transvaginal ultra‐sound.The changes of menstruation and clinical manifestations of the patients were recorded at the same time.Results The lev‐els of LH ,E2 and FSH were dramatically changed in electric coagulation group ,which was followed by the ultrasonic group.Patients in the suture group had the smallest changes of these indices and recovered quickly(P<0.05).In the electric co‐agulation group relative to the other two groups ,the number of ovarian reserve follicles was significantly decreased and the inci‐dence of adverse reactions was profoundly increased.Conclusion Electric coagulation greatly adversely affects the residual ovar‐ian reserve function after laparoscopic ovarian cystectomy ,and ultrasonic and suture hemostasis techniques can help to protect o‐varian function.
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0.05).The pregnancy rate was 41.5%(17/41) in the(Non-cystectomy) Group,33.3%(23/69) in the Laparoscopic Group,and 25.5%(14/55) in the Open Group,respectively,without significant differences(?~2=2.754,P=0.252).A total of 86 patients(90 cycles) were given a unilateral cystectomy,including 37 cycles in the Open Group and 53 cycles in the Laparoscopic Group.In the 37 cycles of the Open Group,the number of dominant follicles was less in affected ovary(4.41?4.02) than in contralateral one(6.14?4.37)(t=-2.364,P=0.024),whereas in the 53 cycles of the Laparoscopic Group,the number of dominant follicles was significantly less in affected ovary(3.33?3.50) than in contralateral ovary(6.40?3.61)(t=-5.358,P=0.000).Conclusions Both laparoscopic and open cystectomy of ovarian endometrioma may cause damage to ovarian response of COH.
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OBJECTIVE: To analyse the clinical aspects of vaginal approach for gynecologic pelvic surgery, we evaluated age distribution, parity, indications for hysterectomy, postoperative pathology, operating time, bleeding amount, weight of uterus, postoperative complications. resected uterus weight, operating time and bleeding amount based on operative procedure type. METHODS: We reviewed the medical records of the 136 patients who underwent vaginal approach for gynecologic pelvic surgery for the indications other than uterine prolapse from Jan. 1998 to April. 1998, and from July. 1999 to Sep. 2001 at Chosun University Hospital. RESULTS: We performed 136 cases of vaginal approach for gynecologic pelvic surgery. We performed 132 cases of total vaginal hysterectomy, 4 cases of transvaginal ovarian cystectomy, a high increased rate of vaginal approach for gynecologic pelvic surgery significantly. The most common indication for vaginal approach for gynecologic pelvic surgery was uterine leiomyoma (63.2%), followed by HSIL, adenomyosis, MIC of the cervix, and ovarian cyst. The operating time was within 90 min in almost cases (47.1%). The most common postoperaive pathologic finding was uterine leiomyoma (47.1%), followed by adenomyosis, uterine leiomyoma with adenomyosis, MIC of the cervix, HSIL, LSIL, ovarian serouscys- tadenoma, and endometrioma. There were 4 cases (2.9%) of cuff cellulitis, 2 cases of pelvic cellulitis (1.5%), 3 cases of hematoma formation (2.2%), 1 case of laparatomy (0.7%) as postoperative complications. etc. CONCLUSION: Vaginal approach for hysterectomy and ovarian cystectomy is a safe method for removing uterus even in the absence of prolapse. Recently it's indication is widened to the patient who has larger uterus and history of previous pelvic surgery. Because of it's advantage, Vaginal approach for hysterectomy and ovarian cystectomy would be the preferred method of gynecologic pelvic surgery in the future.