Résumé
OBJECTIVE: To investigate the effect of different uterine volume on the therapeutic effect of GnRH-a combined with levonorgestrel-releasing intrauterine system(LNG-IUS)in the treatment of adenomyosis.METHODS: From July 2014 to December 2017 in Center of Minimally Invasive Gynecology,Beijing Obstetrics and Gynecology Hospital,160 patients with adenomyosis were divided into experimental group and control group according to the volume of uterine cavity before inserting LNG-IUS.The experimental group(n=80)was inserted LNG-IUS when the uterine volume ≥100 cm~3.The control group(n=80)was inserted LNG-IUS when the uterine volume0.05).(3)The fall-off rate and LNG-IUS drop rate in the experimental group were higher than those in the control group(The fall-off rate was 15.0% and 5.0% in the two groups,P=0.035.The LNG-IUS drop rate was 25.0% and 12.5% in the two groups,P=0.043).(4)The uterine volume,the depth of uterine cavity and the amount of menstruation before insertion were risk factors which affected the fall-off/drop rate of LNG-IUS.When the uterine volume was greater than 97.33 cm~3,the prediction sensitivity was 96.0% and the specificity was 58.3%.When the depth of uterine cavity was greater than 8.75 cm,the prediction sensitivity was 92.0% and the specificity was 53.3%.CONCLUSION: Excessive uterine volume affects the efficacy of LNG-IUS in the treatment of adenomyosis.When the uterine volume is greater than 97.33 cm~3,or the depth of uterine cavity is greater than 8.75 cm before placement of LNG-IUS,the fall-off/drop rate is significantly increased.
Résumé
Objective To discuss the causes and clinical significance of conversion to laparotomy during laparoscopic surgery.Method Three thousand two hundred and three cases who underwent laparoscopic surgery during the past five years were analyzed retrospectively.Results Three thousand one hundred and eighty cases underwent laparoscopic surgery,in which 23 cases were converted to laparotomy due to factors including severe pelvic adhesions(6 cases),complex disease with difficulties in laparoscopy (7 cases),massive haemorrhage(3 cases),bladder trauma(1 case),gastric trauma(1 case),intestinal trauma(1 case),as well as unexpected malignant genitalia neoplasm(4 cases).Conclusion The major causes for the conversion to laparotomy during gynecology laparoscopic surgery are severe pelvic adhesion and complex disease with difficulties in laparoscopy.Careful evaluation before surgery and conversion to laparotomy at the right moment can decrease the complication.