Construction and evaluation of a nomogram prediction model for the intrauterine adhesions risk factor after hysteroscopic surgery for subumcosal myoma of uterus / 中国医师进修杂志

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.

The preoperative and postoperative effects of preoperative misoprostol and carboprost methylate placement of methyl methacrylate on patients with submucous myoma of uterus undergoing hysteroscopy / 中国生化药物杂志

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.

Accuracy of Transvaginal Ultrasonography, Hysteroscopy and Uterine Curettage in Evaluating Endometrial Pathologies / Acurácia da ultrassonografia transvaginal, histeroscopia e curetagem uterina na avaliação de patologias endometriais

Abstract Objective To evaluate the accuracy of transvaginal ultrasonography, hysteroscopy and uterine curettage in the diagnosis of endometrial polyp, submucous myoma and endometrial hyperplasia, using as gold standard the histopathological analysis of biopsy samples obtained during hysteroscopy or uterine curettage. Methods Cross-sectional study performed at the Hospital Universitário de Brasília (HUB). Data were obtained from the charts of patients submitted to hysteroscopy or uterine curettage in the period from July 2007 to July 2012. Results One-hundred and ninety-one patients were evaluated, 134 of whom underwent hysteroscopy, and 57, uterine curettage. Hysteroscopy revealed a diagnostic accuracy higher than 90% for all the diseases evaluated, while transvaginal ultrasonography showed an accuracy of 65.9% for polyps, 78.1% for myoma and 63.2% for endometrial hyperplasia. Within the 57 patients submitted to uterine curettage, there was an accuracy of 56% for polyps and 54.6% for endometrial hyperplasia. Conclusion Ideally, after initial investigation with transvaginal ultrasonography, guided biopsy of the lesion should be performed by hysteroscopy, whenever necessary, in order to improve the diagnostic accuracy and subsequent clinical management.

Resumo Objetivo avaliar a acurácia da ultrassonografia transvaginal, da histeroscopia e da curetagem uterina no diagnóstico de pólipo endometrial, mioma submucoso e hiperplasia de endométrio, utilizando como padrão-ouro a análise histopatológica de amostras obtidas por biópsia realizada durante a histeroscopia ou a curetagem. Métodos estudo transversal realizado no Hospital Universitário de Brasília (HUB), cujas informações foram obtidas nos prontuários das pacientes que foram submetidas à histeroscopia ou curetagem uterina no período de julho de 2007 a julho de 2012. Resultados Foram avaliadas 191 pacientes, sendo que 134 foram submetidas à histeroscopia e 57 à curetagem uterina. Observou-se acurácia diagnóstica maior que 90% para todas as patologias avaliadas por histeroscopia, enquanto que por ultrassonografia transvaginal observou-se acurácia de 65,9% para pólipo, 78,1% para mioma e 63,2% para hiperplasia endometrial. Nas 57 pacientes submetidas a curetagem uterina, observou-se acurácia de 56% para pólipo e de 54,6% para hiperplasia endometrial. Conclusão Idealmente, após a investigação inicial com ultrassonografia transvaginal, deveria, sempre que necessário, ser realizada histeroscopia com biópsia guiada da lesão, o que melhoraria a acurácia diagnóstica e posterior conduta clínica.

Hysteroscopic Resection for Submucous Myoma of Uterus in 4 Patients Without Sexual Experience / 中国微创外科杂志

[Summary] Four women with uterus submucosal myoma without sexual experience were treated with hysteroscopic surgery from January 2008 to January 2015.There were 2 cases of 0 type myoma, 1 case of Ⅱtype myoma, and 1 case of multiple myomas with 0 type,Ⅰtype, andⅡtype, respectively.The operation was performed by using the plasma bipolar hysteroscopic resectoscope (sheath diameter , 8 mm) .All the operations were successfully completed with myoma resected in one time .The hymens were undamaged .The patients were followed up for 6, 4, 3, and 1 year, finding no recurrence .One patient naturally conceived after 6 years postoperatively and gave birth to a healthy baby .

The value of diffusion weighted imaging in differential diagnosis of endometrial carcinoma staged Ⅰa / 实用放射学杂志

Objective To evaluate the value of diffusion weighted imaging in differential diagnosis of endometrial carcinoma stagedⅠa.Methods A retrospective analysis of 18 patients with endometrial carcinoma staged Ⅰ a which was confirmed by pathology. Other 22 patients with benign endometrial diseases were also enrolled in the study including endometrial hyperplasia in 9,endometrial polyp in 8 and degenerative submucous myoma in 5.DWI with b value of 0 s/mm2 and 1 000 s/mm2 was performed with single shot sequence of EPI,and the ADC values were measured.Results The mean ADC values of endometrial carcinoma staged Ⅰa,endome-trial hyperplasia,endometrial polyp and degenerative submucous myoma were (0.89±0.21)×10 -3 mm2/s,(1.45±0.19)×10 -3 mm2/s, (1.29±0.32)×10 -3 mm2/s and (1.32 ±0.29)× 10 -3 mm2/s,respectively.There were statistical significant differences between them (F =48.021,P =0.00).Furthermore,statistically significant differences also existed between endometrial carcinoma and other groups (P <0.05).Conclusion ADC value shows a good value in differential diagnosis of endometrial carcinoma staged Ⅰa.

Submucosal myoma resection by guidance of esophageal endoscopic ultrasound / 局解手术学杂志

Objective To investigate the effects of submucosal resection by guidance under esophageal endoscopic ultrasound. Methods 79 cases ofsuspected upper gastrointestinal submucosal tumors were found by endoscopic ultrasonography,transesophageal endoscopic ultra-sound showed lesions under muscularis mucosa,after informed consent,they were underwent endoscopic mucosal resection. Pathological diag-nose of the lesions were found out after resection. Results Compared with pathological results showed that endoscopic ultrasound accurately determine tumor location in the hierarchy;through endoscopic mucosal resection to remove all lesions,5 patients were found bleeding postop-erative,6 patients were found esophageal stricture,the prognosis was good after treatment. Conclusion Endoscopic ultrasonography can accu-rately determine submucosal myoma,it can be used to guide resection of submucosal myoma.

Hysteroscopic Resection with Dipolar Electrodes for Uterine Submucous Myoma:Report of 456 Cases / 中国微创外科杂志

Objective To determine the efficacy and safety of hysteroscopic resection with dipolar electrodes for submucous myoma of the uterus. Methods By hysteroscopy combined with B-ultrasonography,totally 456 cases of submucous myoma of the uterus were confirmed in our hospital from January 1998 to December 2007. Among the patients,241 cases showed type 0,138 patients were type Ⅰ,and 77 cases were type Ⅱ. In 341 of the cases,the myoma sized 1.0 to 2.0 in diameter,86 cases from 2.1 to 4.0 in diameter,and the other 29 cases had the myoma ranged from 4.1 to 6.0 cm in diameter. Hysteroscopic resection with dipolar electrodes were performed on all the cases,among which microelectrode was used in 341 patients,and ring electrode was employed in 115 cases. Results The operation time ranged from 9 to 55 min with a mean of (32.9?16.7) min. The removed tissues weighed (30.2?8.2) g in average (ranged from 5 to 55 g). During the operation,the patients had 5 to 100 ml blood loss [mean,(48.1?12.7) ml]. No complications occurred during and after the operation. The patients were followed up for three months,during which 431 (94.5%) showed reduced menstruation and decreased menstrual blood loss,only 5 patients (1.1%,all were type Ⅱ) had residual myoma. In this series,totally 42 patients wished pregnancy,15 of them became pregnant in 24 months postoperation. After the treatment,anemia was corrected in 206 patients with the level of Hb increased to a normal range;before the operation,81 patients had menstrual pain,42 of them were relieved and 19 were improved by the operation,while the other 20 showed no changes in the symptoms. Conclusion Hysteroscopic resection with dipolar electrodes is safe and effective for uterine submucous myoma.

Comparison between Vaginal and Abdominal Myomectomy / 中国微创外科杂志

Objective To investigate the clinical value of vaginal myomectomy. Methods From March 2005 to May 2008,78 women with abnormal uterine bleeding were diagnosed with submucous myoma by hysteroscopy combined with ultrasonography. All the myomas were located in the lower uterine segment,and the diameter of the tumor ranged from 30 mm to 63 mm. The patients were divided into two groups to underwent vaginal myomectomy (vaginal group,36 cases) or abdominal electrotomy (open group,42 cases). The operation time,intraoperative blood loss,postoperative hospital stay and recovery of the two groups were compared. Results The vaginal operation was accomplished in all of the 36 cases. Compared with the open group,the vaginal group had significantly shorter operation time [(64.7?10.4) min vs (71.1?11.3) min,t=-2.599,P=0.011],less intraoperative blood loss [(200.0?38.4) ml vs (253.6?47.6) ml,t=-5.412,P=0.000],quicker recovery of bowel movement [(18.5?4.3) h vs (30.9?4.7) h,t=-12.078,P=0.000],and shorter postoperative hospital stay [(4.9?1.2) d vs (7.0?1.3) d,t=-7.368,P=0.000]. Follow-up was available in all of the 78 cases for 3 to 40 months (mean,28 months),during which no relapse occurred,and no statistical differences in pregnancy rate between the two groups was revealed [2.8% (1/36) vs 4.8% (2/42),?2=0.000,P=1.000]. The operation satisfaction rates in both of the two groups were up to 100%. Conclusions Vaginal myomectomy has advantages in less hemorrhage,fast recovery,short postoperative hospital stay,and low complication rate. For the tumors located in the lower uterine segment or those larger than 30 mm in diameter,vaginal myomectomy is an alternative to hysteroscopic electrotomy.

Simplified Submucosal Myomectomy by Operating Hysteroscopy on OPD Basis / 대한산부인과학회잡지

OBJECTIVE: To evaluate possibility of simplified hysteroscopic operation instead of resectoscopic operation on OPD basis for sumucosal myoma with small pedicle. MATERIALS AND METHODS: On twenty five patients, who diagnosed submucosal myoma with small pedicle by sonohysterogram and diagnostic hysteroscopy, simplified hyteroscopic operations were performed on OPD. Used expanding media was normal saline. At first, pedicle was incised by hysteroscopic scissors and myoma mass was dissected by pushing of scope. After dissection of myoma mass, remained pedicle was cut by hysteroscopic scissors. The bleeding from cut pedicle site was controlled by bipolar coagulation. Cut myoma mass was removed to outside of uterus by ring forceps. However if removal of myoma mass is failed, let it in uterine cavity and it is removed at second-look hysteroscopy 1 month later after degeneration. RESULTS: On 1 of 25 patients, cutting of pedicle was failed due to fundal invisible pedicle on hysteroscopic view. On 20 of 24 patients, pedicles were completely cut. On 12 of these 20 patients, myoma masses were completely removed to outside of uterus by grasping forceps. However on remained 8 of 20 patients, myoma mass was removed easily on second-look hysteroscopy 1 month later due to shrinkage of mass. On 4 of 24 patients, pedicles were not cut completely due to large submucosal myoma. They were removed also easily on second-look hysteroscopy. Postoperative bleeding from cutting pedicle was surprisingly minimal in most cases and moderate bleeding was only in 3 cases. Severe bleeding case was not observed. Preoperative GnRH agonist therapy had not so big benefit due to these minimal to moderate postoperative bleeding. CONCLUSION: Therefore simplified hysteroscopic operation on OPD basis for submucosal myoma with small pedicle should be considered before resectoscopic operation, because this simplified hysteroscopic operation has many benefit economically and psychologically to patients on submucosal myoma with small pedicle. It is better that resectoscopic operation is performed in failed case of this simplified operation.

Vaginal Removal of the Pedunculated Submucous Myoma: Twisting-off Method / 대한산부인과학회잡지

OBJECTIVE: To evaluate the efficacy of the twisting-off method in transvaginal removal of the pedunculated submucous myoma. METHODS: After paracervical block and vaginal dressing with Povidone iodine, the myoma was grasped at its widest diameter and twisted to avulse it from its attatchment. Several kinds of grasping instruments, ie. kelley clamp, tenaculum, ring forcep, was used. If there was bleeding from its detachment site, vaginal gauze or tampon was inserted for bleeding control. RESULTS: The procedure was perfomed successfully on all 33 patients (100%). In most patients, bleeding was scanty in amount. But in one patient, emergency hysterectomy was performed because of massive uterine bleeding. The myoma varied greatly in size. Largest volume was 62.24 cm3, and mean volume was 13.79 cm3. Pathology revealed classic leiomyomas in most cases. Some showed endocervical polyp or endometrial polyp. Follow up examination was done, and its mean interval was eighteen weeks and no patient was recurred. CONCLUSION: The transvaginal removal of pedunculated submucous myoma utilizing grasping instruments may be an effective and safe procedure and the complication is minimal. Twisting-off method was may be a safe alternative to abdominal myomectomy and hysterectomy. Reproductive capacity can be preserved, also.