Combined estrogen-progestin pill is a safe and effective option for endometrial hyperplasia without atypia: a three-year single center experience / 부인종양

OBJECTIVE: To evaluate the effectiveness of oral contraceptive pill (OCP) as therapy for endometrial hyperplasia (EH) without atypia in reproductive-aged women compared with oral progestin. METHODS: A retrospective cohort study was carried out in our reproductive center. Consecutive patients diagnosed with infertility and non-atypical EH identified through electronic database who met inclusion criteria (n=309). Patients were assigned to two treatment groups: OCP (n=216) and oral progestin (n=93); clinical and reproductive outcomes were recorded. RESULTS: Reversal of EH to normal endometrium, clinical pregnancy, live birth and miscarriage rate. Women in OCP group were younger, had higher prevalence of Polycystic Ovary Syndrome and other uterine pathology and longer duration of infertility than women in progestin group. Reversal of EH was observed in 93.52% women on OCP and in 86.02% women on progestin (p=0.032; adjusted odds ratio [aOR]= 2.35; 95% confidence interval [CI]=1.06-5.21) after the initial course of treatment for 2 to 6 months. Cyclic OCP (n=184) resulted in better response to treatment compared to continuous OCP (n=32) (95.11% vs. 84.38%; p=0.039; aOR =3.60; 95% CI =1.12-11.55). Clinical pregnancy rate in OCP group was marginally higher than progestin group (87/208, 41.83% vs. 27/90, 30.00%; p=0.054). Miscarriage (25.29% vs. 29.63%; p=0.654) and live birth rate (31.25% vs. 21.11%; p=0.074) were comparable between the groups. CONCLUSION: For the first time we demonstrate that OCP is an effective therapy for non-atypical EH and is associated with higher remission rate compared with oral progestin. Reproductive outcomes are reassuring and comparable between the two groups.

Application of CBL combined with LBL in the training of refresher doctors in reproductive medicine / 中华医学教育探索杂志

Objective@#The aim of this study was to evaluate the value for CBL and LBL teaching method in the training of refresher doctors in reproductive medicine.@*Methods@#A questionnaire survey was conducted among 186 refresher doctors who had studied in the reproductive medicine center at Peking University Third Hospital from January 2016 and December 2017 one year after their graduation. We tested 33 refresher doctors in observe group and 33 refresher doctors in the CBL+LBL group who graduated at the same period.@*Results@#Ninety-two refresher doctors responded to the investigation. The questionnaire survey showed that 84.78% of the refresher doctors thought that CBL and LBL teaching method could improve their learning abilities, clinical problem analysis and solving skills, and surgical techniques, which was conducive to promoting their assisted reproductive technology. Besides, 63.04% of refresher doctors believed this method improved their research abilities. In CBL+LBL group, examination scores of theoretical knowledge were significantly higher than the observe group (P<0.05).@*Conclusion@#The combination of CBL and LBL is effective and feasible in the training of refresher doctors in reproductive medicine.

Application of CBL combined with LBL in the training of refresher doctors in reproductive medicine / 中华医学教育探索杂志

Objective The aim of this study was to evaluate the value for CBL and LBL teaching method in the training of refresher doctors in reproductive medicine.Methods A questionnaire survey was conducted among 186 refresher doctors who had studied in the reproductive medicine center at Peking University Third Hospital from January 2016 and December 2017 one year after their graduation.We tested 33 refresher doctors in observe group and 33 refresher doctors in the CBL+LBL group who graduated at the same period.Results Ninety-two refresher doctors responded to the investigation.The questionnaire survey showed that 84.78％ of the refresher doctors thought that CBL and LBL teaching method could improve their learning abilities,clinical problem analysis and solving skills,and surgical techniques,which was conducive to promoting their assisted reproductive technology.Besides,63.04％ of refresher doctors believed this method improved their research abilities.In CBL+LBL group,examination scores of theoretical knowledge were significantly higher than the observe group (P＜0.05).Conclusion The combination of CBL and LBL is effective and feasible in the training of refresher doctors in reproductive medicine.

Study on the differences of nerve conduction of lower limbs in general population with different nationalities in Xining region / 临床神经病学杂志

Objective To explore the differences of nerve conduction of lower limbs in general population with different nationalities in Xining region.Methods Physical examination and healthy volunteers in No.1 People's Hospital of Xining were collected.Two hundred and forty Hui people of them was Hui group.Two hundred and forty people with other ethnic minorities including Tibetan,Tu and Mongolian of them was mixed group.Two hundred and forty Han people of them was Han group.The nerve conduction of lower limbs in all the people were detected.And the differences were compared.Results The differences of nerve conduction of posterior tibial nerve among all the groups were not statistical significant (all P>0.05).The latent period of common peroneal nerve in Hui group was significantly longer than mixed group and Han group,the motor conduction velocity of which was significantly slower,the motor nerve action potential of which was significantly reduced (all P0.05).The differences of nerve conduction of each group among different age periods were statistical significant(all P<0.05).Conclusions The nerve conduction of lower limbs in general Hui people in Xining region must be different with other general people.It must be noticed in clinical examination.

The electromyography and ultrasound examination for lumbosacral nerve root lesions and peripheral neurop-athy in lower extremity / 中国基层医药

Objective To observe and analyze the clinical values of ultrasonic and electromyography exami-nation in lumbosacral nerve root lesions and peripheral neuropathy of lower extremity.Methods The prospective clinical study was performed.A total of 32 cases of suspected lumbosacral nerve root disease were recruited.All patients underwent ultrasound and electromyography examination to eliminate peripheral neuropathy;a total of 15 cases of suspected peripheral neuropathy patients were recruited to eliminate lumbosacral nerve root lesions.Results Among 32 cases of lumbosacral nerve root lesions,neuromuscular electrical diagram screening found 4 cases of periph-eral neuropathy(12.5%),and ultrasound screening found 5 cases of peripheral neuropathy(15.6%).There was no significant difference between the two groups(P >0.05).Among 15 cases of peripheral neuropathy,neuromuscular electrical diagram screening found 3 cases of lumbosacral nerve root lesions(20.0%),and ultrasound screening found 0 case of lumbosacral nerve root lesions.There was no significant difference between the two groups(χ2 =6.47,P <0.05).Conclusion Neuromuscular electrical diagram inspection and ultrasonic inspection in the lumbosacral nerve root lesions in the differential diagnosis of lower limb peripheral neuropathy has certain clinical values.Detection rate regarding lower limb peripheral neuropathy has no significant difference between the two methods.

Differential expression of microRNA in eutopic endometrium tissue during implantation window for patients with endometriosis related infertility / 中华妇产科杂志

Objective To predict the genes that affect endometrial receptivity through the differential expression of microRNA (miRNA) in eutopic endometrial tissues during implantation window in patients with endometriosis infertility. Methods Among infertile patients that received treatments at the Center for Reproductive Medicine,Peking University Third Hospital between May and December 2013, patients with endometriosis infertility were selected as endometriosis group (among the selected 17 cases, there were 6 cases with follicular phase endometrium and 11 cases with implantation window phase endometrium), and patients with tubal factor infertility were selected as control group (among the selected 19 cases, there were 7 cases with follicular phase endometrium and 12 cases with implantation window phase endometrium). (1)Implantation window phase endometrium was selected from 3 cases in each group. Using miRNA and mRNA joint gene sequencing and database for forecast results, as well as using the negative regulatory relationship between miRNA and mRNA, the intersection of target gene that negatively correlates with miRNA expression were obtained. The co-expression network of miRNA-mRNA wae constructed. Combined with the genes associated with endometrial receptivity found through bioinformatics method, the miRNA with core regulatory functionwas found. (2) Expand sample size to 14 cases for endometriosis group and 16 cases for control group.Reverse transcription (RT)-PCR technique was utilized to detect the expression of miR-142-5p, miR-146a-5p and miR-543 in endometrial tissues, and verify miRNA microarray results. Results (1) miRNA and mRNA microarray screening results showed that, among the endometrial tissues of patients with endometriosis infertility and with implantation window phase, 6 differentially expressed miRNA were indentified, among which miR-142-5p, miR-146a-5p, miR-1281, miR-940, miR-4634 showed significantly enhanced expression and miR-543 showed significantly inhibited expression. Sixty-three differentially expressed mRNA were indentified, among which 58 mRNA such as CADM1, IL-10RA, ITGAL and LPAR5 had significantly enhanced expression. Five mRNA such as HLA-DRB1,3,4,5 and SOHLH2 showed significantly inhibited expression. Thirty-six taget genes were found in consideration of negatively correlated miRNA expression with the genes, miRNA-mRNA co-expression network were constructed. The miR-543 was found at the core of the network. Targetscan and other database predicted that miR-142-5p, miR-146a-5p and miR-543 could act on various types of endometrial receptivity molecular corresponding marker genes such as HOX10, ITGAV, ITGB3, OPN, LIF, ESR, PGR, CDH1 and MMP. (2) RT-PCR test showed that the average levels of expression of miR-142-5p and miR-146a-5p in implantation window phase endometrium in endometriosis group were 8.3 ± 10.6 and 1.9 ± 0.8 respectively;the average levels of that in control group were 1.1±0.6 and 0.9±0.4, respectively. The difference was statistically significant (P=0.027, P=0.015), and was consistent with results from miRNA microarray test. The expression of miR-543 in tissues of follicular phase endometrium in endometriosis group (2.3±1.0) was significantly higher than that in control group (1.0 ± 0.4), and the difference was statistically significant (P=0.008). However, when comparing the expression of miR-543 implantation window phase endometrium in endometriosis group (1.2±0.6) with that in control group (1.5 ± 1.0), the difference was not statistical significant (P=0.890). Conclusions There are multiple differential expressions of miRNA in the implantation window phase endometrium tissues of endometriosis infertility patients, among which miR-142-5p and miR-146a-5p show significantly enhanced expression and may affect embryo implantation by acting on a variety of endometrial receptivity marker molecules. The expression of miR-543 in implantation window phase endometrium of endometriosis infertility patients is lower than that in the follicular phase, forewarned changes in the pattern of cyclic variation of miR-543, and may be the reason for affecting endometrial receptivity.

Combined incisional ropivacaine infiltration and pulmonary recruitment manoeuvre for postoperative pain relief after diagnostic hysteroscopy and laparoscopy / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Preoperative incisional local anaesthesia with ropivacaine is a common method of providing post-laparoscopy pain relief. The pulmonary recruitment manoeuvre also provides pain relief, but the combined effect of these two methods on pain following laparoscopic procedures has not been reported. We investigated the efficacy of combining local anaesthetic infiltration of ropivacaine with pulmonary recruitment manoeuvre on postoperative pain following diagnostic hysteroscopy and laparoscopy.</p><p><b>METHODS</b>This prospective, randomized, controlled study involved 60 patients divided into two groups (n = 30, each). Group 1 received 20 ml of 0.5% ropivacaine injected peri-incisionally preoperatively, with intra-abdominal carbon dioxide removed by passive deflation. Group 2 received 20 ml of 0.5% ropivacaine injected peri-incisionally with five manual inflations of the lungs with a positive-pressure ventilation of 40 cmH2O at the end of surgery. The last inflation was held for 5 seconds. The intensity of postoperative incisional and shoulder pain was evaluated using a numerical rating scale at 0, 2, 4, 8, 12, 24 and 48 hours postoperatively by an independent blinded anaesthesiologist. Tramadol was given postoperatively for analgesia.</p><p><b>RESULTS</b>Compared with group 1, incisional ropivacaine infiltration combined with pulmonary recruitment manoeuvre significantly reduced dynamic pain at 0 hour, 4 hours, and 24 hours postoperatively (4.1 ± 2.2 vs. 2.1 ± 1.9, P = 0.002; 2.7 ± 2.7 vs. 1.2 ± 1.3, P = 0.035; and 3.5 ± 2.1 vs. 2.1 ± 1.8, P = 0.03, respectively). Static incisional pain was significantly relieved at 0 hour, 2 hours, and 24 hours postoperatively (3.1 ± 1.7 vs. 1.6 ± 1.3, P = 0.001; 1.4 ± 1.3 vs. 0.5 ± 0.8, P = 0.012; and 2.3 ± 1.9 vs. 1.0 ± 1.5, P = 0.038, respectively). Group 2 had more patients without shoulder pain (P < 0.05) and fewer requiring tramadol (P < 0.05).</p><p><b>CONCLUSION</b>Ropivacaine with pulmonary recruitment manoeuvre provided simple and effective pain relief after diagnostic hysteroscopy and laparoscopy.</p>

Comparison of GnRH antagonist fixed protocol and GnRH agonists long protocol in infertile patients with normal ovarian reserve function in their first in vitro fertilization-embryo transfer cycle / 中华妇产科杂志

Objective To compare the clinical outcomes of gonadotropin-releasing hormone (GnRH) antagonist (GnRH-ant) fixed protocol with GnRH agonist (GnRH-a) long protocol in infertile patients with normal ovarian reserve function in their first in vitro fertilization-embryo transfer (IVF-ET) cycle,and to explore the feasibility and advantage of GnRH antagonist protocol performed in normal responders.MethodsFrom January 2011 to June 2011,771 infertile women with normal ovarian reserve function underwent their first IVF or intracytoplasmic sperm injection (ICSI) cycles in Peking University Third Hospital,which were divided into 245 cycles in GnRH-ant fixed protocol group ( GnRH-ant group) and 526 cycles in GnRH-a long protocol group ( GnRH-a group).The data of general demographic,treatment and clinical outcome were compared between two groups.ResultsAge,infertile duration,body mass index (BMI),baseline serum follicle-stimulating hormone (FSH) and estradiol levels between two groups did not reached statistical difference (P ＞ 0.05 ).The level of estradiol was (12 289 ± 6856) pmol/L in GnRH-ant group and (14934±8007)pmol/L in GnRH-a group at day of hCG injection.The mean length of stimulation was ( 10.3 ± 1.2) days in GnRH-ant group and ( 12.8 ± 1.6) days in GnRH-a group.The dose of gonadotropin was (2013 ± 607 ) U in GnRH-ant group and (2646 ± 913 ) U in GnRH-a group.The number of ovum was 15 ± 7 in GnRH-ant group and 17 ± 8 in GnRh-a group.Those clinical parameter all reached statistical difference (P ＜0.05 ).The number of embryo was 7 ±4 in GnRH-ant group and 8 ± 5 in GnRH-a group,the rate of clinical pregnancy was 40.9％ (94/230) in GnRH-ant group and 45.6％ (216/474)in GnRH-a group,the rate of implantation was 26.1％ (128/490)in GnRH-ant group and 30.9％ (307/994) in GnRH-a group,the rate of continuing pregnancy was 38.7％ ( 89/230 ) in GnRH-ant group and 42.6％ (202/474) in GnRH-a group,those parameter did not reach statistical difference (P ＞ 0.05).The rate of moderate or severe ovarian hyperstimulation syndrome was 2.4％ ( 6/245 ) in GnRH-ant group and 4.2％ (22/526) in GnRH-a group,which did not show significant difference ( P ＞ 0.05 ).ConclusionIn the first IVF or ICSI cycle of the patients with normal ovarian reserve function,the fixed GnRH-ant protocol could get the same satisfied clinical outcome,and it is more economic,convenient and safer compared with low dose depot GnRH-a long protocol.

Clinical analysis of 12 491 cycles treated in embryo transfer program / 中华妇产科杂志

Objective To analyze the clinical outcomes of patients treated with in vitro fertilization and embryo transfer (IVF-ET) and influence factors of pregnancy rate. Methods We retrospectively analyzed the clinical data of 12 491 cycles, including 6832 fresh IVF/intracytoplast single sperm injection (ICSI) cycles and 5659 frozen embryo transfer (FET) cycles from 2005 to 2007. Results The clinical pregnancy rate per cycle was 32. 99% (2254/6832)in fresh embryo transfer program, and the live birth rate was 25.75% (1394/5413); the early pregnant loss rate was 9. 36% (211/2254), and the prenatal defect rate was 1.45% (25/1722). Through analysis of these patients' basic data, we found that the patients' age, causes for infertility, egg retrieval and cycle number affected the pregnancy rate. Using logistic regression method, we found that patients′ age was the most important factor affecting pregnancy outcome. In FET cycles, the clinical pregnancy rate was 38.08% (2155/5659), significantly higher than fresh embryo transfer cycles. Conclusions IVF-ET treatment is a safe and effective method for infertility couples. However, the female age and poor ovarian response are the main factors affecting pregnancy rate. Thawed embryo transfer can increase the accumulated pregnancy rate effectively.

A comparison among three ultrasound-guided transvaginal embryo reduction techniques in multifetal pregnancy / 中国微创外科杂志

Objective To compare clinical effects among three techniques of multifetal pregnancy reduction(MFPR) guided by transvaginal ultrasonography through vaginal approach.Methods Under the guidance of transvaginal B-ultrasonography,99 cases of multiple pregnancy following assisted reproductive technique underwent three different methods of embryo reduction: drug injection directly to the pregnancy sac(Drug Group),simple embryonic bud aspiration(Aspiration Group),and combined use of drug and aspiration(Combination Group).Results The gestational age at the procedure ranged 41~88 days(mean,58.9?8.7 days).The success rate of the procedure on one session was 100%(99/99).Short-term outcomes included 3 cases of abortion(3.0%).On continuing follow-up observations in 73 cases,the incidences of abortion and premature delivery were 11%(8/73) and 12%((9/73)),respectively.No statistical differences were seen among the three groups in rates of abortion,premature delivery,and full-term delivery(?~2=1.131,P=0.889).In the Aspiration Group,however,the exposure time to B-ultrasound and the operative time were significantly shorter than those in the other two groups.The gestational age at the procedure was 61.7?8.2 days in the Drug Group,48.8?2.7 days in the Aspiration Group,and 56.7?7.2 days in the Combination Group,respectively,with significant differences between the Aspiration Group and other two groups(F=19.36,P=0.000).The number of embryos reduced was associated with pregnancy outcomes: the abortion rate was remarkably higher in patients receiving the reduction of more than two embryos than only one embryo(?~2=6.415,P=0.040).Conclusions Ultrasound-guided multifetal pregnancy reduction is a safe,effective and microinvasive procedure.It is recommended that simple embryonic bud aspiration be used for multifetal pregnancy before 7 gestational weeks,combined use of drug injection and aspiration for multifetal pregnancy at 7~9 gestational weeks,and drug injection to the pregnancy sac for multifetal pregnancy after 9 weeks.

Effects of laparoscopic cystectomy for ovarian endometrioma on ovarian response of controlled ovarian hyperstimulation / 中国微创外科杂志

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.

Effects of laparoscopic management of hydrosalpinx on outcomes of in vitro fertilization and embryo transfer / 中国微创外科杂志

Objective To investigate the effects of laparoscopic management of hydrosalpinx on outcomes of in vitro fertilization and embryo transfer(IVF-ET).Methods A total of 53 patients with hydrosalpinx undergoing IVF-ET from 2002 to 2005 were divided into three groups: ①Untreated Group included 17 patients who were given no interventions for hydrosalpinx prior to IVF-ET;②Preoperative Group included 17 patients undergoing laparoscopic treatment of hydrosalpinx prior to IVF-ET;③Postoperative Group had 19 patients who had experienced a history of unsuccessful IVF-ET treatment cycles and received laparoscopic management of hydrosalpinx prior to subsequent IVF-ET cycles.Results The pregnancy rates in fresh IVF cycles,the pregnancy rates in frozen cycles,the mean pregnancy rates per transfer,and the accumulative rate of live fetuses were 15.8%(3/19),10.5%(2/19),13.2%(5/38),and 17.6%(3/17) in the Untreated Group,36.8%(7/19),23.1%(3/13),30.3%(10/32),and 41.7%(8/17) in the Preoperative Group,and 16.7%(2/12),58.3%(14/24),44.4%(16/36),and 73.7%(14/19) in the Postoperative Group,respectively.The pregnancy rates in frozen cycles,the mean pregnancy rates per transfer,and the accumulative rate of live fetuses were all significantly higher in the Postoperative Group than in the Untreated Group(?~2=10.374,P=0.001;?~2=8.903,P=0.003;?~2=11.305,P=0.001,respectively).The mean pregnancy rates per transfer and the accumulative rate of live fetuses in the Preoperative Group tended to higher than those in the Untreated Group(?~2=3.377,P=0.066;?~2=3.360,P=0.067).Conclusions Hydrosalpinx is associated with poor IVF-ET outcomes.Laparoscopic management for hydrosalpinx prior to IVF-ET improves the pregnancy rate of IVF-ET.

Laparoscopy Combined with Hysteroscopy for the Diagnosis and Treatment of Female Infertility:Report of 145 Cases / 中国微创外科杂志

Objective To study the clinical application of laparoscopy combined with hysteroscopy to female infertility.Methods From January 2007 to March 2008,145 cases of female infertility were examined and treated by laparoscopy combined with hysteroscopy in our hospital.We analyzed the clinical records of the patients to determine the value of the method.Results By using laparoscopy combined with hysteroscopy,136 cases of pelvic disease(93.8%,136/145) were detected in this series.The most common causes of infertility were pelvic inflammation(58.6%,85/145) and endometriosis(29.0%,42/145).The incidence rate of pelvic inflammation in secondary infertility patients was significantly higher than in those with primary infertility(P

Expression of matrix metalloproteinase-2 and tissue inhibitor of metalloproteinase-2 in endometriosis / 第三军医大学学报

Objective To investigate the role of matrix metalloproteinase-2 (MMP-2) and tissue inhibitor of metalloproteinase-2 (TIMP-2) in the pathogenesis of endometriosis. Methods Immunohistochemical S-P method was employed to detect the expression of MMP-2 and TIMP-2 in the ectopic tissues and eutopic endometrium of 22 patients with endometriosis and 20 normal controls. Results The expression of MMP-2 in glandular cells was significantly higher than those of uterine endometrium from women with and without endometriosis (P0.05). The expressions of MMP-2 and TIMP-2 were not related to the degree of endometriosis. Conclusion The increased expression of MMP-2 and the decreased expression of TIMP-2 in the ectopic endometriotic tissues result in the higher ratio of MMP-2/TIMP-2 that can make ectopic endometrial tissues have a greater capacity to invade and play an important role in the pathogenesis of endometriosis.

Cost analysis of laparoscopy vs.laparotomy in the treatment of ovarian cysts / 中国微创外科杂志

Objective To compare the costs of laparoscopy and laparotomy in the operative treatment of ovarian cysts. Methods Patients with ovarian cysts who were operated on by laparoscopy (83) or by laparotomy (65) in the Peking University Third Hospital from June 2000 to August 2001 were retrospectively analyed.Patients' hospital stay,time taken for the patients to return to work,hospital charges,costs because of inability to work and total costs (including the direct medical costs,direct non-medical costs and indirect costs) were compared between the two groups. Results The mean hospital stay and the mean time taken for the patients to return to work were statistically shorter in the laparoscopy group than those in the laparotomy group.The mean hospital charges were significantly higher and the mean costs of without work were significantly lower in the laparoscopy group.The total costs in the two groups were similar (no significant difference). Conclusions According to the mean income of the people in Beijing,the costs of laparoscopy in the operative of the ovarian cysts are not higher than that of lapatomy.

Laparoscopic management of ectopic pregnancy / 中国微创外科杂志

Objective To study the value of laparoscopic operation in the management of ectopic pregnancy. Methods The management of 509 cases of ectopic pregnancy reviewed retrospectively in our hospital from January 1999 to December 2001.Selected 60 cases treated by laparoscopy in 2001 were compared with 58 cases treated by laparotomy without hypovolemia shock.Operating time, postoperative hospital stay, time returning to normal temperature,total cost were compared. Results Laparoscopic surgery was performed in three cases in 1999,twenty three cases in 2000 and sixty cases in 2001. Comparison between laparoscopic and laparotomy group showed the operating time (66.3?25.3) min vs (75.9?22.0)min( t =-2.02, P =0.03);postoperative hospital stay (3.3?1.9)days vs (5.1?1.7)days( t =-5.42, P =0.00); total cost (7318.4?1440.1) RMB vs (5567.8?1567.8) RMB ( t =6.32, P =0.00). Conclutions Laparoscopic surgery is superior to laparotomy in the management of ectopic pregnancy.

Transvaginal Hydrolaparoscopic Ovarian Drilling in the Treatment of Polycystic Ovarian Syndrome / 中国微创外科杂志

Objective To evaluate the efficacy and safety of transvaginal hydrolaparoscopic ovarian drilling for treatment of the polycystic ovary syndrome(PCOS)in clomiphene citrate-resistant infertile women.Methods Between February 2008 and November 2008,11 clomiphene citrate-resistant anovulatory women with PCOS mean age:(29.3?3.7)years,mean body mass index:(24.3?8.3)kg/m2] were enrolled in this study.Transvaginal hydrolaparoscopy using a F5 bipolar needle was performed on the patients to create 5-15 holes with a free length of 0.8 cm and a diameter of 0.2 mm in each ovary(electrocoagulation time 10-15 sec).Results A mean of(17?6)holes were made in both the ovaries in the patients.No surgical complications occurred.The levels of LH,FSH,and androstenedione dropped from(14.7?4.5)IU/L,(7.1?6.4)IU/L,and(12.2?4.4)nmol/L to(10.5?3.7)IU/L,(6.4?1.7)IU/L,and(8.9?3.0)nmol/L(t=2.389,P=0.027;t=1.007,P=0.326;and t=2.104,P=0.048)respectively after the operation.The patients were followed up for 2 to 9 months,during the period 6(54.5%)patients recovered spontaneous menstruation,among which 3 recovered ovulatory cycles(27.3%)and 2(18.2%)had spontaneous pregnancy.In the other 8 patients who didn't recover spontaneous menstruation,5 cases received CC or FSH(one of them was pregnant after the treatment);1 case was not pregnant though received IVF;and 2 are still in follow-up.Conclusions Transvaginal hydrolaparoscopic ovarian drilling is safe and effective for clomiphene citrate-resistant infertile women.

Clinical outcomes of laparoscopic treatment of tubal adhesion and tubal distal occlusion / 中国微创外科杂志

Objective To investigate the clinical pregnancy outcomes of laparoscopic treatment for different degrees of tubal adhesion and tubal distal occlusion.Methods Clinical information of 41 infertile patients from April 2001 to December 2005 was reviewed.According to the extent of tubal and pelvic lesion,the patients were classified as stage Ⅰ in 10 patients,stage Ⅱ in 10,stage Ⅲ in 17,and stage Ⅳ in 6.After a diagnosis was made by hysterosalpinggography(HSG),all the patients received a salpingostomy and adhesionlysis under laparoscope.Results No abnormal findings were detected by hysteroscopy and bilateral tubes were patent after operation in all the 41 patients.The 10 patients at stage Ⅰ were followed up for 12~21 months.Four of them got pregnant in six months and 1 got pregnant in 1 year because of intermittent separation,all the 5 patients being intrauterine pregnancy.The 8 patients at stage Ⅱ were followed up for 12~26 months.Three patients got pregnant,including intrauterine pregnancy in 1 and ectopic pregnancy in 2.The pregnancy occurred at 15,16,and 26 months after operation,respectively.The 17 patients at stage Ⅲ were followed up for 3~48 months.Four had pregnancy,at 3,4,12,and 14 months after operation,respectively,including intrauterine pregnancy in 1 and ectopic pregnancy in 3.The 6 patients at stage Ⅳ were followed up for 12~36 months and no pregnancy was observed.Among the 12 patients with pregnancy,8 got pregnant within 12 months and 3 at 13~18 months after operation,the pregnancy rate within 18 months being 91.7%(11/12). Conclusions Clinical pregnancy outcomes are related with the degree of tubal lesion and adnexal adhesion.Patients at stage Ⅰ~Ⅱ have better pregnancy outcomes than patients at stage Ⅲ~Ⅳ.